IBDEI00Y ; ; 18-MAR-1994
;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94
Q:'DIFQR(358.5) F I=1:2 S X=$T(Q+I) Q:X="" S Y=$E($T(Q+I+1),4,999),X=$E(X,4,999) S:$A(Y)=126 I=I+1,Y=$E(Y,2,999)_$E($T(Q+I+1),5,99) S:$A(Y)=61 Y=$E(Y,2,999) X NO E S @X=Y
Q Q
;;^UTILITY(U,$J,358.5,47,0)
;;=ADDRESS LINE 1^11^9^0^1
;;^UTILITY(U,$J,358.5,47,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,47,2,1,0)
;;=LINE1^^I^^^0^39^45^1
;;^UTILITY(U,$J,358.5,48,0)
;;=ADDRESS LINE 2^11^9^0^2
;;^UTILITY(U,$J,358.5,48,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,48,2,1,0)
;;=LINE2^^I^^^1^39^45^1
;;^UTILITY(U,$J,358.5,49,0)
;;=DATE^11^10
;;^UTILITY(U,$J,358.5,49,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,49,2,1,0)
;;=Date Printed:^^^90^1^1^104^12^1
;;^UTILITY(U,$J,358.5,50,0)
;;=CHECK IF SC^11^3
;;^UTILITY(U,$J,358.5,50,2,0)
;;=^357.52I^2^2
;;^UTILITY(U,$J,358.5,50,2,1,0)
;;=*** NOTE: IF THE PATIENT'S TREATMENT WAS FOR ANY CONDITION RELATED TO THE FOLLOWING SERVICE-CONNECTED^^^7^4
;;^UTILITY(U,$J,358.5,50,2,2,0)
;;=DISABILITIES, CHECK BELOW TO THE LEFT OF THE LISTED CONDITON(S). ***^^^11^5
;;^UTILITY(U,$J,358.5,51,0)
;;=SC DISABILITY 1^11^11^0^1
;;^UTILITY(U,$J,358.5,51,2,0)
;;=^357.52I^3^3
;;^UTILITY(U,$J,358.5,51,2,1,0)
;;=Disabilities:^^^8^7
;;^UTILITY(U,$J,358.5,51,2,2,0)
;;=(__)^^^0^8^8^5^45^1
;;^UTILITY(U,$J,358.5,51,2,3,0)
;;=% - SERVICE CONNECTED^^I^^^8^51^24^5
;;^UTILITY(U,$J,358.5,52,0)
;;=SC DISABILITY 2^11^11^0^2
;;^UTILITY(U,$J,358.5,52,2,0)
;;=^357.52I^2^2
;;^UTILITY(U,$J,358.5,52,2,1,0)
;;=(__)^^^0^9^9^5^45^1
;;^UTILITY(U,$J,358.5,52,2,2,0)
;;=% - SERVICE CONNECTED^^I^^^9^51^24^5
;;^UTILITY(U,$J,358.5,53,0)
;;=SC DISABILITY 3^11^11^1^3
;;^UTILITY(U,$J,358.5,53,2,0)
;;=^357.52I^2^2
;;^UTILITY(U,$J,358.5,53,2,1,0)
;;=(__)^^^0^10^10^5^45^1
;;^UTILITY(U,$J,358.5,53,2,2,0)
;;=% - SERVICE CONNECTED^^I^^^10^51^24^5
;;^UTILITY(U,$J,358.5,54,0)
;;=INSURED?^11^12
;;^UTILITY(U,$J,358.5,54,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,54,2,1,0)
;;=Health Insurance:^^^3^12^12^21^7^1
;;^UTILITY(U,$J,358.5,55,0)
;;=INSURANCE 1^11^13^0^1
;;^UTILITY(U,$J,358.5,55,2,0)
;;=^357.52I^4^4
;;^UTILITY(U,$J,358.5,55,2,1,0)
;;=Insurance^^U^3^13^14^3^30^1
;;^UTILITY(U,$J,358.5,55,2,2,0)
;;=Policy #^^U^35^13^14^35^20^3
;;^UTILITY(U,$J,358.5,55,2,3,0)
;;=Group #^^U^58^13^14^58^17^4
;;^UTILITY(U,$J,358.5,55,2,4,0)
;;=Holder^^U^77^13^14^77^9^7
;;^UTILITY(U,$J,358.5,56,0)
;;=INSURANCE 2^11^13^0^2
;;^UTILITY(U,$J,358.5,56,2,0)
;;=^357.52I^4^4
;;^UTILITY(U,$J,358.5,56,2,1,0)
;;=COMPANY^^I^^^15^3^30^1
;;^UTILITY(U,$J,358.5,56,2,2,0)
;;=POLICY #^^I^^^15^35^20^3
;;^UTILITY(U,$J,358.5,56,2,3,0)
;;=GROUP #^^I^^^15^58^17^4
;;^UTILITY(U,$J,358.5,56,2,4,0)
;;=HOLDER^^I^^^15^77^9^7
;;^UTILITY(U,$J,358.5,57,0)
;;=INSURANCE 3^11^13^1^3
;;^UTILITY(U,$J,358.5,57,2,0)
;;=^357.52I^4^4
;;^UTILITY(U,$J,358.5,57,2,1,0)
;;=COMPANY^^I^^^16^3^30^1
;;^UTILITY(U,$J,358.5,57,2,2,0)
;;=POLICY #^^I^^^16^35^20^3
;;^UTILITY(U,$J,358.5,57,2,3,0)
;;=GROUP #^^I^^^16^58^17^4
;;^UTILITY(U,$J,358.5,57,2,4,0)
;;=HOLDER^^I^^^16^77^9^7
;;^UTILITY(U,$J,358.5,58,0)
;;=FACILITY^11^14
;;^UTILITY(U,$J,358.5,58,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,58,2,1,0)
;;=FACILITY:^^^90^0^0^100^30^1
;;^UTILITY(U,$J,358.5,59,0)
;;=ADDRESS LINE 3^11^9^1^3
;;^UTILITY(U,$J,358.5,59,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,59,2,1,0)
;;=LINE 3^^I^^^2^39^45^1
;;^UTILITY(U,$J,358.5,60,0)
;;=CLINIC^12^5
;;^UTILITY(U,$J,358.5,60,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,60,2,1,0)
;;=Clinic:^^^0^0^0^8^30^1
;;^UTILITY(U,$J,358.5,61,0)
;;=APPT. DT/TIME^12^4
;;^UTILITY(U,$J,358.5,61,2,0)
;;=^357.52I^1^1
;;^UTILITY(U,$J,358.5,61,2,1,0)
;;=Appt. DT/Time:^^^0^2^2^15^23^1
;;^UTILITY(U,$J,358.5,62,0)
;;=OTHER ALLERGIES^13^3
;;^UTILITY(U,$J,358.5,62,2,0)
;;=^357.52I^1^1
IBDEI00Y ; ; 18-MAR-1994
+1 ;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94
+2 IF 'DIFQR(358.5)
QUIT
FOR I=1:2
SET X=$TEXT(Q+I)
IF X=""
QUIT
SET Y=$EXTRACT($TEXT(Q+I+1),4,999)
SET X=$EXTRACT(X,4,999)
IF $ASCII(Y)=126
SET I=I+1
SET Y=$EXTRACT(Y,2,999)_$EXTRACT($TEXT(Q+I+1),5,99)
IF $ASCII(Y)=61
SET Y=$EXTRACT(Y,2,999)
XECUTE NO
IF '$TEST
SET @X=Y
Q QUIT
+1 ;;^UTILITY(U,$J,358.5,47,0)
+2 ;;=ADDRESS LINE 1^11^9^0^1
+3 ;;^UTILITY(U,$J,358.5,47,2,0)
+4 ;;=^357.52I^1^1
+5 ;;^UTILITY(U,$J,358.5,47,2,1,0)
+6 ;;=LINE1^^I^^^0^39^45^1
+7 ;;^UTILITY(U,$J,358.5,48,0)
+8 ;;=ADDRESS LINE 2^11^9^0^2
+9 ;;^UTILITY(U,$J,358.5,48,2,0)
+10 ;;=^357.52I^1^1
+11 ;;^UTILITY(U,$J,358.5,48,2,1,0)
+12 ;;=LINE2^^I^^^1^39^45^1
+13 ;;^UTILITY(U,$J,358.5,49,0)
+14 ;;=DATE^11^10
+15 ;;^UTILITY(U,$J,358.5,49,2,0)
+16 ;;=^357.52I^1^1
+17 ;;^UTILITY(U,$J,358.5,49,2,1,0)
+18 ;;=Date Printed:^^^90^1^1^104^12^1
+19 ;;^UTILITY(U,$J,358.5,50,0)
+20 ;;=CHECK IF SC^11^3
+21 ;;^UTILITY(U,$J,358.5,50,2,0)
+22 ;;=^357.52I^2^2
+23 ;;^UTILITY(U,$J,358.5,50,2,1,0)
+24 ;;=*** NOTE: IF THE PATIENT'S TREATMENT WAS FOR ANY CONDITION RELATED TO THE FOLLOWING SERVICE-CONNECTED^^^7^4
+25 ;;^UTILITY(U,$J,358.5,50,2,2,0)
+26 ;;=DISABILITIES, CHECK BELOW TO THE LEFT OF THE LISTED CONDITON(S). ***^^^11^5
+27 ;;^UTILITY(U,$J,358.5,51,0)
+28 ;;=SC DISABILITY 1^11^11^0^1
+29 ;;^UTILITY(U,$J,358.5,51,2,0)
+30 ;;=^357.52I^3^3
+31 ;;^UTILITY(U,$J,358.5,51,2,1,0)
+32 ;;=Disabilities:^^^8^7
+33 ;;^UTILITY(U,$J,358.5,51,2,2,0)
+34 ;;=(__)^^^0^8^8^5^45^1
+35 ;;^UTILITY(U,$J,358.5,51,2,3,0)
+36 ;;=% - SERVICE CONNECTED^^I^^^8^51^24^5
+37 ;;^UTILITY(U,$J,358.5,52,0)
+38 ;;=SC DISABILITY 2^11^11^0^2
+39 ;;^UTILITY(U,$J,358.5,52,2,0)
+40 ;;=^357.52I^2^2
+41 ;;^UTILITY(U,$J,358.5,52,2,1,0)
+42 ;;=(__)^^^0^9^9^5^45^1
+43 ;;^UTILITY(U,$J,358.5,52,2,2,0)
+44 ;;=% - SERVICE CONNECTED^^I^^^9^51^24^5
+45 ;;^UTILITY(U,$J,358.5,53,0)
+46 ;;=SC DISABILITY 3^11^11^1^3
+47 ;;^UTILITY(U,$J,358.5,53,2,0)
+48 ;;=^357.52I^2^2
+49 ;;^UTILITY(U,$J,358.5,53,2,1,0)
+50 ;;=(__)^^^0^10^10^5^45^1
+51 ;;^UTILITY(U,$J,358.5,53,2,2,0)
+52 ;;=% - SERVICE CONNECTED^^I^^^10^51^24^5
+53 ;;^UTILITY(U,$J,358.5,54,0)
+54 ;;=INSURED?^11^12
+55 ;;^UTILITY(U,$J,358.5,54,2,0)
+56 ;;=^357.52I^1^1
+57 ;;^UTILITY(U,$J,358.5,54,2,1,0)
+58 ;;=Health Insurance:^^^3^12^12^21^7^1
+59 ;;^UTILITY(U,$J,358.5,55,0)
+60 ;;=INSURANCE 1^11^13^0^1
+61 ;;^UTILITY(U,$J,358.5,55,2,0)
+62 ;;=^357.52I^4^4
+63 ;;^UTILITY(U,$J,358.5,55,2,1,0)
+64 ;;=Insurance^^U^3^13^14^3^30^1
+65 ;;^UTILITY(U,$J,358.5,55,2,2,0)
+66 ;;=Policy #^^U^35^13^14^35^20^3
+67 ;;^UTILITY(U,$J,358.5,55,2,3,0)
+68 ;;=Group #^^U^58^13^14^58^17^4
+69 ;;^UTILITY(U,$J,358.5,55,2,4,0)
+70 ;;=Holder^^U^77^13^14^77^9^7
+71 ;;^UTILITY(U,$J,358.5,56,0)
+72 ;;=INSURANCE 2^11^13^0^2
+73 ;;^UTILITY(U,$J,358.5,56,2,0)
+74 ;;=^357.52I^4^4
+75 ;;^UTILITY(U,$J,358.5,56,2,1,0)
+76 ;;=COMPANY^^I^^^15^3^30^1
+77 ;;^UTILITY(U,$J,358.5,56,2,2,0)
+78 ;;=POLICY #^^I^^^15^35^20^3
+79 ;;^UTILITY(U,$J,358.5,56,2,3,0)
+80 ;;=GROUP #^^I^^^15^58^17^4
+81 ;;^UTILITY(U,$J,358.5,56,2,4,0)
+82 ;;=HOLDER^^I^^^15^77^9^7
+83 ;;^UTILITY(U,$J,358.5,57,0)
+84 ;;=INSURANCE 3^11^13^1^3
+85 ;;^UTILITY(U,$J,358.5,57,2,0)
+86 ;;=^357.52I^4^4
+87 ;;^UTILITY(U,$J,358.5,57,2,1,0)
+88 ;;=COMPANY^^I^^^16^3^30^1
+89 ;;^UTILITY(U,$J,358.5,57,2,2,0)
+90 ;;=POLICY #^^I^^^16^35^20^3
+91 ;;^UTILITY(U,$J,358.5,57,2,3,0)
+92 ;;=GROUP #^^I^^^16^58^17^4
+93 ;;^UTILITY(U,$J,358.5,57,2,4,0)
+94 ;;=HOLDER^^I^^^16^77^9^7
+95 ;;^UTILITY(U,$J,358.5,58,0)
+96 ;;=FACILITY^11^14
+97 ;;^UTILITY(U,$J,358.5,58,2,0)
+98 ;;=^357.52I^1^1
+99 ;;^UTILITY(U,$J,358.5,58,2,1,0)
+100 ;;=FACILITY:^^^90^0^0^100^30^1
+101 ;;^UTILITY(U,$J,358.5,59,0)
+102 ;;=ADDRESS LINE 3^11^9^1^3
+103 ;;^UTILITY(U,$J,358.5,59,2,0)
+104 ;;=^357.52I^1^1
+105 ;;^UTILITY(U,$J,358.5,59,2,1,0)
+106 ;;=LINE 3^^I^^^2^39^45^1
+107 ;;^UTILITY(U,$J,358.5,60,0)
+108 ;;=CLINIC^12^5
+109 ;;^UTILITY(U,$J,358.5,60,2,0)
+110 ;;=^357.52I^1^1
+111 ;;^UTILITY(U,$J,358.5,60,2,1,0)
+112 ;;=Clinic:^^^0^0^0^8^30^1
+113 ;;^UTILITY(U,$J,358.5,61,0)
+114 ;;=APPT. DT/TIME^12^4
+115 ;;^UTILITY(U,$J,358.5,61,2,0)
+116 ;;=^357.52I^1^1
+117 ;;^UTILITY(U,$J,358.5,61,2,1,0)
+118 ;;=Appt. DT/Time:^^^0^2^2^15^23^1
+119 ;;^UTILITY(U,$J,358.5,62,0)
+120 ;;=OTHER ALLERGIES^13^3
+121 ;;^UTILITY(U,$J,358.5,62,2,0)
+122 ;;=^357.52I^1^1
