1 | IBCF1TP ;ALB/MJB - UB-82 TEST PATTERN PRINT ;23 SEP 88 13:42
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2 | ;;Version 2.0 ; INTEGRATED BILLING ;; 21-MAR-94
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3 | ;;Per VHA Directive 10-93-142, this routine should not be modified.
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4 | ;
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5 | ;MAP TO DGCRTP
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6 | ;
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7 | ZIS ;
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8 | ;***
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9 | ;S XRTL=$ZU(0),XRTN="IBCF1TP-1" D T0^%ZOSV ;start rt clock
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10 | ;
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11 | S %ZIS="QM" D ^%ZIS G:POP Q
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12 | I $D(IO("Q")) K IO("Q") S ZTRTN="ENP^IBCF1TP",ZTDESC="IB - TEST UB-82 PRINT" D ^%ZTLOAD K ZTSK D HOME^%ZIS G Q
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13 | U IO
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14 | ;***
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15 | ;I $D(XRT0) S:'$D(XRTN) XRTN="IBCF1TP" D T1^%ZOSV ;stop rt clock
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16 | ;
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17 | D ENP
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18 | Q I $D(ZTQUEUED) S ZTREQ="@"
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19 | K DGPGM,DGVAR,POP
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20 | ;***
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21 | ;I $D(XRT0) S:'$D(XRTN) XRTN="IBCF1TP" D T1^%ZOSV ;stop rt clock
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22 | Q
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23 | ENP ;
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24 | ;***
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25 | ;S XRTL=$ZU(0),XRTN="IBCF1TP-2" D T0^%ZOSV ;start rt clock
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26 | ;
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27 | W @IOF,?24,"*** UB-82 TEST PATTERN ***",!,"AGENT CASHIER",!,"AGENT CASHIER STREET",?24," F. L. 2",?57,"BILL NUMBER",?74,"XXX"
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28 | W !,"CITY STATE ZIP",!,"PHONE #",?24,"BC/BS #",?38,"FED TAX #",?71,"F. L. 9"
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29 | W !!,"PATIENT NAME",?33,"PATIENT ADDRESS",!!,"PT DOB",?8,"X",?10,"X",?14,"ADM DT",?21,"HR",?25,"X",?28,"X",?30,"AH",?33,"DH",?36,"XX",?40,"FROM",?48,"TO",?70,"F. L. 27",!!
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30 | W "OC",?3,"DATE" W ?11,"OC",?14,"DATE" W ?22,"OC",?25,"DATE",?35,"OC",?38,"DATE",?46,"OC",?49,"DATE"
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31 | W !,"MAILING ADDRESS NAME",!,"STREET ADDRESS 1",?30,"CC",?33,"CC",?36,"CC",?39,"CC",?42,"CC",?61,"F. L. 45"
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32 | W !,"STREET ADDRESS 2",!,"STREET ADDRESS 3"
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33 | W !,"CITY",?$X+2,"STATE",?$X+2,"ZIP"
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34 | 8 W !!!!,"000 DAYS MEDICAL CARE",!
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35 | F I=1:1:3 W !,"REV CODE ",I,?24,"000.00",?31,"000",?35,"00",?39," 0000.00"
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36 | W !!,"SUBTOTAL",?39," 00000.00"
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37 | F I=1:1 Q:$Y=30 W !
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38 | W !!,"TOTAL",?39," 00000.00"
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39 | F I=1:1 Q:$Y=40 W !
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40 | F I=1:1:3 W !,"PAYER ",I,?24,"X",?27,"X"
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41 | F I=1:1 Q:$Y=45 W !
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42 | F I=1:1:3 W !,"INSURED NAME ",I,?23,"X",?26,"XX",?29,"POLICY # ",I,?46,"GROUP NAME ",I,?61,"GROUP # ",I
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43 | F I=1:1 Q:$Y=50 W !
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44 | W "X",?2,"X",?4,"EMPLOYER NAME",?42,"CITY STATE ZIP"
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45 | F I=1:1 Q:$Y=53 W !
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46 | W "PRINCIPAL DIAGNOSIS",?44,"CODE" F I=51,58,65,72 W ?I,"CODE"
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47 | W !!,"X",?3,"PRINCIPAL PROCEDURE",?44,"CODE",?51,"DATE",?57,"CODE",?63,"DATE",?68,"CODE",?74,"DATE"
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48 | F I=1:1 Q:$Y=56 W !
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49 | W !?22,"TX. AUTH.",?33,"Dept. Veterans Affairs",?56,"F. L. 93"
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50 | W !!,"Patient ID: ","XXXXXXXXX",!,"Bill Type: ","XXXX XXXXXXX",!,"UB-82 TEST PATTERN",!,"**TEST PATTERN**"
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51 | 16 F I=1:1 Q:$Y=62 W !
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52 | W ?46,"UB-82 SIGNER NAME",!,?46,"UB-82 SIGNER TITLE",?69,"DATE"
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53 | K I
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54 | I $D(ZTQUEUED) S ZTREQ="@" Q
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55 | D ^%ZISC
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56 | ;***
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57 | ;I $D(XRT0) S:'$D(XRTN) XRTN="IBCF1TP" D T1^%ZOSV ;stop rt clock
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58 | Q
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59 | ;IBCF1TP
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