source: FOIAVistA/tag/r/ASISTS-OOPS/OOPSWCE1.m@ 1267

Last change on this file since 1267 was 628, checked in by George Lilly, 15 years ago

initial load of FOIAVistA 6/30/08 version
File size: 8.3 KB
Line 
1OOPSWCE1 ;WIOFO/LLH-Worker's Comp Edit CA1 ;3/23/2000
2 ;;2.0;ASISTS;;Jun 03, 2002
3 ;;
4CA1 ; CA1 FORM
5 N CONT,ITEM,DTINJ,DT110,VWIT
6 S (AIEN,AGN,ADD,CITY,STATE,ZIP)=""
7 S (PNAME,PADD,PCITY,PSTATE,PZIP,PTITLE,STAT,SIEN)=""
8 S WCPDO=""
9 W !!," Federal Employee's Notice of Traumatic Injury and Claim"
10 W !," for Continuation of Pay/Compensation (Form CA-1)"
11 W !!," Witness"
12 W !," -------"
13 S DR=""
14 ; Patch 8 - DOL project. Added collection of multiple witnesses
15 ; note: if Witness Statement entry ever allowed, max length = 528
16 S DR(2,2260.0125)=".01:5"
17 S DR(2,2260.0125,6)="6////SIGNED WITNESS STATEMENT TO FOLLOW."
18 S DR(1,2260,1)="125" ; call to witness multiple
19 S DR(1,2260,2)="S VWIT=$$WIT^OOPSUTL3"
20 S DR(1,2260,3)="I +VWIT=0!($P(VWIT,U,2)=0) S Y=125"
21 S DR(1,2260,5)="W !!,"" Worker's Comp Edit of Supervisor's Report"""
22 S DR(1,2260,6)="W !,"" -------------------------------------"""
23 ; Patch 8 - added OWCP District Office
24 S WCPDO=$$GET1^DIQ(2262,"1,","2:.01","E")
25 S DR(1,2260,8)="73 OWCP DISTRICT OFFICE......//^S X=WCPDO"
26 ; Patch 11 - default chargeback code from site parameter file
27 S DR(1,2260,9)="70 OWCP CHARGEBACK CODE......//^S X=OWCP"
28 S DR(1,2260,10)="62 OWCP NOI CODE............."
29 ; Patch 8 - if CA1 NOI code must begin with T
30 S DR(1,2260,12)="I X,($E($$GET1^DIQ(2263.3,X,1))'=""T"") W !?3,""NOI Code must begin with a T for a CA1."" S Y=62"
31 ; Remove will generate Occ Code from PAID file
32 ; S DR(1,2260,13)="122 14a. OCCUPATION CODE..........."
33 S DR(1,2260,15)="123 14b. TYPE CODE................."
34 S DR(1,2260,20)="124 14c. SOURCE CODE..............."
35 D AGNINFO^OOPSUTL2
36 S DR(1,2260,25)="130 17. AGENCY NAME...............//^S X=AGN;I X="""" S Y=""@5"""
37 S DR(1,2260,26)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=130"
38 S DR(1,2260,30)="131 STREET ADDRESS............//^S X=ADD"
39 S DR(1,2260,31)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=131"
40 S DR(1,2260,35)="132 CITY......................//^S X=CITY"
41 S DR(1,2260,36)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=132"
42 S DR(1,2260,40)="133 STATE.....................//^S X=STATE"
43 S DR(1,2260,45)="134 ZIP CODE..................//^S X=ZIP"
44 S DR(1,2260,50)="S Y=176"
45 S DR(1,2260,60)="@5"
46 S DR(1,2260,65)="131////@"
47 S DR(1,2260,70)="132////@"
48 S DR(1,2260,75)="133////@"
49 S DR(1,2260,80)="134////@"
50 S DR(1,2260,85)="176 18. EMPLOYEE'S DUTY STATION..."
51 S DR(1,2260,86)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=176"
52 S DR(1,2260,90)="177 STREET ADDRESS............"
53 S DR(1,2260,91)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=177"
54 S DR(1,2260,95)="178 CITY......................"
55 S DR(1,2260,96)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=178"
56 S DR(1,2260,100)="179 STATE....................."
57 S DR(1,2260,105)="180 ZIP CODE.................."
58 S DR(1,2260,110)="60 19. EMPLOYEE'S RETIREMENT.....//^S X=RET;I X<3 S Y=""@6"""
59 S DR(1,2260,115)="61 OTHER RETIREMENT.........."
60 S DR(1,2260,116)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=61"
61 S DR(1,2260,117)="S Y=""@7"""
62 S DR(1,2260,120)="@6"
63 S DR(1,2260,121)="61////@"
64 S DR(1,2260,122)="@7"
65 S DR(1,2260,125)="W !,"" 20. REGULAR WORK HOURS:"""
66 S DR(1,2260,130)="138 FROM......................"
67 S DR(1,2260,135)="139 TO........................"
68 S DR(1,2260,140)="S ITEM=21 W !,"" 21. REGULAR WORK SCHEDULE.....: ""_$$GET1^DIQ(2260,D0,140,""E"")"
69 S DR(1,2260,145)="K DIR S DIR(""A"")="" "",DIR(""B"")=$$GET1^DIQ(2260,D0,140,""I"") D RWS^OOPSUTL2 S:$D(DIRUT) Y=""@2"""
70 ;
71 ; Default from 2162, require time entry but allow edit
72 S DTINJ=$$GET1^DIQ(2260,IEN,4,"E")
73 S DR(1,2260,150)="4 22. DATE/TIME INJURY OCCURRED.......//^S X=DTINJ"
74 S DR(1,2260,155)="I $P(X,""."",2)="""" W !,""Time is REQUIRED in this response."" S Y=4"
75 ; Patch 8 - default from Date of This Notice
76 S DR(1,2260,159)="S DT110=$$GET1^DIQ(2260,IEN,110,""E"")"
77 S DR(1,2260,160)="175 23. DATE OF NOTICE RECEIVED...//^S X=DT110"
78 S DR(1,2260,165)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=175"
79 S DR(1,2260,170)="142 24. DATE/TIME STOPPED WORK...."
80 S DR(1,2260,175)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=142"
81 S DR(1,2260,180)="143 25. DATE PAY STOPPED.........."
82 S DR(1,2260,185)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=143"
83 S DR(1,2260,190)="144 26. DATE 45 DAY PERIOD BEGAN.."
84 S DR(1,2260,195)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=144"
85 S DR(1,2260,200)="145 27. DATE/TIME RETURNED TO WORK"
86 S DR(1,2260,205)="I X'="""",'$$FUT^OOPSUTL4($P(X,""."")) S Y=145"
87 S DR(1,2260,210)="146 28. WAS EMPLOYEE INJURED IN PERFORMANCE OF DUTY;I X=""Y"" S Y=148;"
88 S DR(1,2260,215)="147 EXPLANATION"
89 S DR(1,2260,216)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=147"
90 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;"
91 S DR(1,2260,225)="149 EXPLANATION"
92 S DR(1,2260,226)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=149"
93 S DR(1,2260,230)="150 30. WAS INJURY CAUSED BY 3RD PARTY;I X=""N"" S Y=""@1"""
94 S DR(1,2260,235)="W !,"" 31. NAME AND ADDRESS OF THIRD PARTY:"""
95 S DR(1,2260,240)="151 NAME OF THIRD PARTY.......;I X="""" S Y=""@1"""
96 S DR(1,2260,241)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=151"
97 S DR(1,2260,245)="152 STREET ADDRESS............"
98 S DR(1,2260,246)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=152"
99 S DR(1,2260,250)="153 CITY......................"
100 S DR(1,2260,251)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=153"
101 S DR(1,2260,255)="154 STATE....................."
102 S DR(1,2260,256)="155 ZIP CODE.................."
103 S DR(1,2260,257)="S Y=""@8"""
104 S DR(1,2260,258)="@1"
105 S DR(1,2260,259)="151////@"
106 S DR(1,2260,260)="152////@"
107 S DR(1,2260,261)="153////@"
108 S DR(1,2260,262)="154////@"
109 S DR(1,2260,263)="155////@"
110 S DR(1,2260,266)="@8"
111 S DR(1,2260,270)="W !,"" 32. NAME AND ADDRESS OF PHYSICIAN FIRST PROVIDING MEDICAL CARE:"""
112 D PHINFO^OOPSUTL2
113 S DR(1,2260,275)="156 NAME OF PHYSICIAN.........//^S X=PNAME;I X="""" S Y=""@4"""
114 S DR(1,2260,276)="I X'="""",'$$NMCHK^OOPSUTL3(X) D NMERR^OOPSUTL3 K X S Y=156"
115 S DR(1,2260,280)="157 STREET ADDRESS............//^S X=PADD"
116 S DR(1,2260,281)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=157"
117 S DR(1,2260,285)="158 CITY......................//^S X=PCITY"
118 S DR(1,2260,286)="I X'="""",'$$VCHAR^OOPSUTL4(X) D VCHAR^OOPSUTL2 S Y=158"
119 S DR(1,2260,290)="159 STATE.....................//^S X=PSTATE"
120 S DR(1,2260,295)="160 ZIP CODE..................//^S X=PZIP"
121 S DR(1,2260,296)="182 TITLE.....................//^S X=PTITLE"
122 S DR(1,2260,300)="S Y=161"
123 S DR(1,2260,305)="@4"
124 S DR(1,2260,310)="157////@"
125 S DR(1,2260,315)="158////@"
126 S DR(1,2260,320)="159////@"
127 S DR(1,2260,325)="160////@"
128 S DR(1,2260,326)="182////@"
129 S DR(1,2260,330)="161 33. 1ST DATE MEDICAL CARE RECEIVED"
130 S DR(1,2260,335)="I X'="""",'$$FUT^OOPSUTL4(X) S Y=161"
131 S DR(1,2260,340)="162 34. DO MEDICAL REPORTS SHOW EMPLOYEE IS DISABLED FOR WORK"
132 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"
133 S DR(1,2260,350)="164 EXPLANATION~"
134 S DR(1,2260,351)="S MAX=$$WP^OOPSUTL4(164)"
135 S DR(1,2260,352)="I '$P(MAX,U,2) D VCHAR^OOPSUTL2 S Y=164"
136 S DR(1,2260,353)="I +MAX>MAX1 W !!,""Max length for field is "",MAX1,"" characters, you have entered "",+MAX,"". Please Edit."",! S Y=164"
137 S DR(1,2260,355)="W !"
138 ; Patch 8 - added by TAG
139 S DR(1,2260,356)="165.1 36a. DOES THE AGENCY CONTROVERT THIS CLAIM;S CONT=X"
140 S DR(1,2260,357)="165.2 36b. DOES THE AGENCY DISPUTE THIS CLAIM..."
141 S DR(1,2260,358)="I X'=""Y""&(CONT'=""Y"") S Y=""@9"""
142 S DR(1,2260,360)="165 36. IF THE EMPLOYING AGENCY CONTROVERTS CONTINUATION OF PAY, STATE THE REASON IN DETAIL~"
143 S DR(1,2260,361)="S MAX=$$WP^OOPSUTL4(165)"
144 S DR(1,2260,362)="I '$P(MAX,U,2) D VCHAR^OOPSUTL2 S Y=165"
145 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"
146 S DR(1,2260,364)="@9"
147 S DR(1,2260,365)="W !!,"" 37. PAY RATE WHEN EMPLOYEE STOPPED WORK:"""
148 S DR(1,2260,370)="166 $.........................//^S X=SAL"
149 S DR(1,2260,375)="167 PER.......................//^S X=PAY"
150 S DR(1,2260,380)="174 39. FILING INSTRUCTIONS"
151 S DR(1,2260,385)="@2"
152EXIT ;
153 K I,ITEM
154 Q
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