OOPSWCE1 ;WIOFO/LLH-Worker's Comp Edit CA1 ;3/23/2000
 ;;2.0;ASISTS;;Jun 03, 2002
 ;;
CA1 ; CA1 FORM
 N CONT,ITEM,DTINJ,DT110,VWIT
 S (AIEN,AGN,ADD,CITY,STATE,ZIP)=""
 S (PNAME,PADD,PCITY,PSTATE,PZIP,PTITLE,STAT,SIEN)=""
 S WCPDO=""
 W !!," Federal Employee's Notice of Traumatic Injury and Claim"
 W !," for Continuation of Pay/Compensation (Form CA-1)"
 W !!,"     Witness"
 W !,"     -------"
 S DR=""
 ; Patch 8 - DOL project.  Added collection of multiple witnesses
 ; note: if Witness Statement entry ever allowed, max length = 528
 S DR(2,2260.0125)=".01:5"
 S DR(2,2260.0125,6)="6////SIGNED WITNESS STATEMENT TO FOLLOW."
 S DR(1,2260,1)="125"         ; call to witness multiple
 S DR(1,2260,2)="S VWIT=$$WIT^OOPSUTL3"
 S DR(1,2260,3)="I +VWIT=0!($P(VWIT,U,2)=0) S Y=125"
 S DR(1,2260,5)="W !!,""     Worker's Comp Edit of Supervisor's Report"""
 S DR(1,2260,6)="W !,""       -------------------------------------"""
 ; Patch 8 - added OWCP District Office
 S WCPDO=$$GET1^DIQ(2262,"1,","2:.01","E")
 S DR(1,2260,8)="73      OWCP DISTRICT OFFICE......//^S X=WCPDO"
 ; Patch 11 - default chargeback code from site parameter file
 S DR(1,2260,9)="70      OWCP CHARGEBACK CODE......//^S X=OWCP"
 S DR(1,2260,10)="62      OWCP NOI CODE............."
 ; Patch 8 - if CA1 NOI code must begin with T
 S DR(1,2260,12)="I X,($E($$GET1^DIQ(2263.3,X,1))'=""T"") W !?3,""NOI Code must begin with a T for a CA1."" S Y=62"
 ; Remove will generate Occ Code from PAID file
 ; S DR(1,2260,13)="122 14a. OCCUPATION CODE..........."
 S DR(1,2260,15)="123 14b. TYPE CODE................."
 S DR(1,2260,20)="124 14c. SOURCE CODE..............."
 D AGNINFO^OOPSUTL2
 S DR(1,2260,25)="130 17.  AGENCY NAME...............//^S X=AGN;I X="""" S Y=""@5"""
 S DR(1,2260,26)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=130"
 S DR(1,2260,30)="131      STREET ADDRESS............//^S X=ADD"
 S DR(1,2260,31)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=131"
 S DR(1,2260,35)="132      CITY......................//^S X=CITY"
 S DR(1,2260,36)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=132"
 S DR(1,2260,40)="133      STATE.....................//^S X=STATE"
 S DR(1,2260,45)="134      ZIP CODE..................//^S X=ZIP"
 S DR(1,2260,50)="S Y=176"
 S DR(1,2260,60)="@5"
 S DR(1,2260,65)="131////@"
 S DR(1,2260,70)="132////@"
 S DR(1,2260,75)="133////@"
 S DR(1,2260,80)="134////@"
 S DR(1,2260,85)="176 18.  EMPLOYEE'S DUTY STATION..."
 S DR(1,2260,86)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=176"
 S DR(1,2260,90)="177      STREET ADDRESS............"
 S DR(1,2260,91)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=177"
 S DR(1,2260,95)="178      CITY......................"
 S DR(1,2260,96)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=178"
 S DR(1,2260,100)="179      STATE....................."
 S DR(1,2260,105)="180      ZIP CODE.................."
 S DR(1,2260,110)="60 19.  EMPLOYEE'S RETIREMENT.....//^S X=RET;I X<3 S Y=""@6"""
 S DR(1,2260,115)="61      OTHER RETIREMENT.........."
 S DR(1,2260,116)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=61"
 S DR(1,2260,117)="S Y=""@7"""
 S DR(1,2260,120)="@6"
 S DR(1,2260,121)="61////@"
 S DR(1,2260,122)="@7"
 S DR(1,2260,125)="W !,"" 20.  REGULAR WORK HOURS:"""
 S DR(1,2260,130)="138      FROM......................"
 S DR(1,2260,135)="139      TO........................"
 S DR(1,2260,140)="S ITEM=21 W !,"" 21.  REGULAR WORK SCHEDULE.....: ""_$$GET1^DIQ(2260,D0,140,""E"")"
 S DR(1,2260,145)="K DIR S DIR(""A"")=""                                 "",DIR(""B"")=$$GET1^DIQ(2260,D0,140,""I"") D RWS^OOPSUTL2 S:$D(DIRUT) Y=""@2"""
 ;
 ; Default from 2162, require time entry but allow edit
 S DTINJ=$$GET1^DIQ(2260,IEN,4,"E")
 S DR(1,2260,150)="4 22.  DATE/TIME INJURY OCCURRED.......//^S X=DTINJ"
 S DR(1,2260,155)="I $P(X,""."",2)="""" W !,""Time is REQUIRED in this response."" S Y=4"
 ; Patch 8 - default from Date of This Notice
 S DR(1,2260,159)="S DT110=$$GET1^DIQ(2260,IEN,110,""E"")"
 S DR(1,2260,160)="175 23.  DATE OF NOTICE RECEIVED...//^S X=DT110"
 S DR(1,2260,165)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=175"
 S DR(1,2260,170)="142 24.  DATE/TIME STOPPED WORK...."
 S DR(1,2260,175)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=142"
 S DR(1,2260,180)="143 25.  DATE PAY STOPPED.........."
 S DR(1,2260,185)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=143"
 S DR(1,2260,190)="144 26.  DATE 45 DAY PERIOD BEGAN.."
 S DR(1,2260,195)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=144"
 S DR(1,2260,200)="145 27.  DATE/TIME RETURNED TO WORK"
 S DR(1,2260,205)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=145"
 S DR(1,2260,210)="146 28.  WAS EMPLOYEE INJURED IN PERFORMANCE OF DUTY;I X=""Y"" S Y=148;"
 S DR(1,2260,215)="147      EXPLANATION"
 S DR(1,2260,216)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=147"
 S DR(1,2260,220)="148 29.  WAS INJURY CAUSED BY EMPLOYEE'S WILLFUL MISCONDUCT, INTOXICATION, OR            INTENT TO INJURE SELF OR ANOTHER;I X=""N"" S Y=150;"
 S DR(1,2260,225)="149      EXPLANATION"
 S DR(1,2260,226)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=149"
 S DR(1,2260,230)="150 30.  WAS INJURY CAUSED BY 3RD PARTY;I X=""N"" S Y=""@1"""
 S DR(1,2260,235)="W !,"" 31.  NAME AND ADDRESS OF THIRD PARTY:"""
 S DR(1,2260,240)="151      NAME OF THIRD PARTY.......;I X="""" S Y=""@1"""
 S DR(1,2260,241)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=151"
 S DR(1,2260,245)="152      STREET ADDRESS............"
 S DR(1,2260,246)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=152"
 S DR(1,2260,250)="153      CITY......................"
 S DR(1,2260,251)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=153"
 S DR(1,2260,255)="154      STATE....................."
 S DR(1,2260,256)="155      ZIP CODE.................."
 S DR(1,2260,257)="S Y=""@8"""
 S DR(1,2260,258)="@1"
 S DR(1,2260,259)="151////@"
 S DR(1,2260,260)="152////@"
 S DR(1,2260,261)="153////@"
 S DR(1,2260,262)="154////@"
 S DR(1,2260,263)="155////@"
 S DR(1,2260,266)="@8"
 S DR(1,2260,270)="W !,"" 32.  NAME AND ADDRESS OF PHYSICIAN FIRST PROVIDING MEDICAL CARE:"""
 D PHINFO^OOPSUTL2
 S DR(1,2260,275)="156      NAME OF PHYSICIAN.........//^S X=PNAME;I X="""" S Y=""@4"""
 S DR(1,2260,276)="I X'="""",'$$NMCHK^OOPSUTL3(X) D NMERR^OOPSUTL3 K X S Y=156"
 S DR(1,2260,280)="157      STREET ADDRESS............//^S X=PADD"
 S DR(1,2260,281)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=157"
 S DR(1,2260,285)="158      CITY......................//^S X=PCITY"
 S DR(1,2260,286)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=158"
 S DR(1,2260,290)="159      STATE.....................//^S X=PSTATE"
 S DR(1,2260,295)="160      ZIP CODE..................//^S X=PZIP"
 S DR(1,2260,296)="182      TITLE.....................//^S X=PTITLE"
 S DR(1,2260,300)="S Y=161"
 S DR(1,2260,305)="@4"
 S DR(1,2260,310)="157////@"
 S DR(1,2260,315)="158////@"
 S DR(1,2260,320)="159////@"
 S DR(1,2260,325)="160////@"
 S DR(1,2260,326)="182////@"
 S DR(1,2260,330)="161 33.  1ST DATE MEDICAL CARE RECEIVED"
 S DR(1,2260,335)="I X'="""",'$$FUT^OOPSUTL4(X) S Y=161"
 S DR(1,2260,340)="162 34.  DO MEDICAL REPORTS SHOW EMPLOYEE IS DISABLED FOR WORK"
 S DR(1,2260,345)="163 35.  DOES YOUR KNOWLEDGE OF THE FACTS AGREE WITH STATEMENTS OF THE EMPLOYEE;I X=""Y"" S Y=165.1"
 S DR(1,2260,350)="164      EXPLANATION~"
 S DR(1,2260,351)="S MAX=$$WP^OOPSUTL4(164)"
 S DR(1,2260,352)="I '$P(MAX,U,2) D VCHAR^OOPSUTL2 S Y=164"
 S DR(1,2260,353)="I +MAX>MAX1 W !!,""Max length for field is "",MAX1,"" characters, you have entered "",+MAX,"".  Please Edit."",! S Y=164"
 S DR(1,2260,355)="W !"
 ; Patch 8 - added by TAG
 S DR(1,2260,356)="165.1 36a.  DOES THE AGENCY CONTROVERT THIS CLAIM;S CONT=X"
 S DR(1,2260,357)="165.2 36b.  DOES THE AGENCY DISPUTE THIS CLAIM..."
 S DR(1,2260,358)="I X'=""Y""&(CONT'=""Y"") S Y=""@9"""
 S DR(1,2260,360)="165 36.  IF THE EMPLOYING AGENCY CONTROVERTS CONTINUATION OF PAY, STATE THE REASON       IN DETAIL~"
 S DR(1,2260,361)="S MAX=$$WP^OOPSUTL4(165)"
 S DR(1,2260,362)="I '$P(MAX,U,2) D VCHAR^OOPSUTL2 S Y=165"
 S DR(1,2260,363)="I +MAX>MAX1 W !!,""Max length for field is "",MAX1,"" characters, you have entered "",+MAX,"".  Please Edit."",! S Y=165"
 S DR(1,2260,364)="@9"
 S DR(1,2260,365)="W !!,"" 37.  PAY RATE WHEN EMPLOYEE STOPPED WORK:"""
 S DR(1,2260,370)="166      $.........................//^S X=SAL"
 S DR(1,2260,375)="167      PER.......................//^S X=PAY"
 S DR(1,2260,380)="174 39.  FILING INSTRUCTIONS"
 S DR(1,2260,385)="@2"
EXIT ;
 K I,ITEM
 Q