source: WorldVistAEHR/trunk/g/ANRV.zwr@ 1582

Last change on this file since 1582 was 613, checked in by George Lilly, 15 years ago

initial load of WorldVistAEHR
File size: 18.3 KB
RevLine 
[613]1FirstRelease WVEHR VER VOE1.0
2Cache 31-Jan-2008 23:07:04 ZWR
3^ANRV(2040,0)="VIST ROSTER^2040IP^^"
4^ANRV(2041,0)="VIST PARAMETERS^2041P^1^1"
5^ANRV(2041,1,0)="1^^^^VHACO117AMIS@MED.VA.GOV"
6^ANRV(2041,"B",1,1)=""
7^ANRV(2041.5,0)="VIST EYE DIAGNOSIS^2041.5^14^14"
8^ANRV(2041.5,1,0)="CATARACT"
9^ANRV(2041.5,2,0)="CORNEAL DISEASE"
10^ANRV(2041.5,3,0)="DIABETIC RETINOPATHY"
11^ANRV(2041.5,4,0)="CHORIOID/RETINAL"
12^ANRV(2041.5,5,0)="GLAUCOMA"
13^ANRV(2041.5,6,0)="MACULAR DISEASE"
14^ANRV(2041.5,7,0)="RETINITIS PIGMENTOSA"
15^ANRV(2041.5,8,0)="OPTIC NERVE"
16^ANRV(2041.5,9,0)="RETINAL DETACHMENT"
17^ANRV(2041.5,10,0)="HISTOPLASMOSIS"
18^ANRV(2041.5,11,0)="OPTIC ATROPHY"
19^ANRV(2041.5,12,0)="OTHER"
20^ANRV(2041.5,13,0)="TRAUMA"
21^ANRV(2041.5,14,0)="APHAKIA"
22^ANRV(2041.5,"B","APHAKIA",14)=""
23^ANRV(2041.5,"B","CATARACT",1)=""
24^ANRV(2041.5,"B","CHORIOID/RETINAL",4)=""
25^ANRV(2041.5,"B","CORNEAL DISEASE",2)=""
26^ANRV(2041.5,"B","DIABETIC RETINOPATHY",3)=""
27^ANRV(2041.5,"B","GLAUCOMA",5)=""
28^ANRV(2041.5,"B","HISTOPLASMOSIS",10)=""
29^ANRV(2041.5,"B","MACULAR DISEASE",6)=""
30^ANRV(2041.5,"B","OPTIC ATROPHY",11)=""
31^ANRV(2041.5,"B","OPTIC NERVE",8)=""
32^ANRV(2041.5,"B","OTHER",12)=""
33^ANRV(2041.5,"B","RETINAL DETACHMENT",9)=""
34^ANRV(2041.5,"B","RETINITIS PIGMENTOSA",7)=""
35^ANRV(2041.5,"B","TRAUMA",13)=""
36^ANRV(2041.6,0)="VIST CHECKLIST OPTIONS^2041.6^5^5"
37^ANRV(2041.6,1,0)="YES"
38^ANRV(2041.6,2,0)="DECLINED"
39^ANRV(2041.6,3,0)="NOT ELIGIBLE"
40^ANRV(2041.6,4,0)="NOT AVAILABLE"
41^ANRV(2041.6,5,0)="PENDING"
42^ANRV(2041.6,"B","DECLINED",2)=""
43^ANRV(2041.6,"B","NOT AVAILABLE",4)=""
44^ANRV(2041.6,"B","NOT ELIGIBLE",3)=""
45^ANRV(2041.6,"B","PENDING",5)=""
46^ANRV(2041.6,"B","YES",1)=""
47^ANRV(2041.7,0)="VIST BENEFITS AND SERVICES CHECKLIST^2041.7P^^"
48^ANRV(2042,0)="VIST REFERRAL FACILITY^2042^17^15"
49^ANRV(2042,1,0)="AMERICAN LAKE (CENTER FOR SPECIAL NEEDS)"
50^ANRV(2042,2,0)="BIRMINGHAM (CENTER)"
51^ANRV(2042,3,0)="HINES (CENTER)"
52^ANRV(2042,4,0)="PALO ALTO (CENTER)"
53^ANRV(2042,5,0)="SAN JUAN (CENTER)"
54^ANRV(2042,6,0)="WACO (CENTER FOR SPECIAL NEEDS)"
55^ANRV(2042,7,0)="WEST HAVEN (CENTER)"
56^ANRV(2042,8,0)="WEST HAVEN (CENTER FOR SPECIAL NEEDS)"
57^ANRV(2042,9,0)="VICTORS (LOW VISION)"
58^ANRV(2042,10,0)="VISUAL SERVICES (STATE)"
59^ANRV(2042,11,0)="COMMUNITY AGENCY"
60^ANRV(2042,12,0)="GUIDE DOG SCHOOL"
61^ANRV(2042,13,0)="OTHER"
62^ANRV(2042,16,0)="TUCSON (CENTER)"
63^ANRV(2042,17,0)="AUGUSTA (CENTER)"
64^ANRV(2042,"B","AMERICAN LAKE (CENTER FOR SPEC",1)=""
65^ANRV(2042,"B","AUGUSTA (CENTER)",17)=""
66^ANRV(2042,"B","BIRMINGHAM (CENTER)",2)=""
67^ANRV(2042,"B","COMMUNITY AGENCY",11)=""
68^ANRV(2042,"B","GUIDE DOG SCHOOL",12)=""
69^ANRV(2042,"B","HINES (CENTER)",3)=""
70^ANRV(2042,"B","OTHER",13)=""
71^ANRV(2042,"B","PALO ALTO (CENTER)",4)=""
72^ANRV(2042,"B","SAN JUAN (CENTER)",5)=""
73^ANRV(2042,"B","TUCSON (CENTER)",16)=""
74^ANRV(2042,"B","VICTORS (LOW VISION)",9)=""
75^ANRV(2042,"B","VISUAL SERVICES (STATE)",10)=""
76^ANRV(2042,"B","WACO (CENTER FOR SPECIAL NEEDS",6)=""
77^ANRV(2042,"B","WEST HAVEN (CENTER FOR SPECIAL",8)=""
78^ANRV(2042,"B","WEST HAVEN (CENTER)",7)=""
79^ANRV(2042.5,0)="VIST REFERRAL ROSTER^2042.5P^^"
80^ANRV(2043,0)="VIST LETTER^2043^5^5"
81^ANRV(2043,1,0)="BRC APPLICATION LETTER^1"
82^ANRV(2043,1,1,0)="^^48^48^2980609^^^^"
83^ANRV(2043,1,1,1,0)=" "
84^ANRV(2043,1,1,2,0)=" "
85^ANRV(2043,1,1,3,0)="|NOWRAP|"
86^ANRV(2043,1,1,4,0)="|TODAY|"
87^ANRV(2043,1,1,5,0)=" "
88^ANRV(2043,1,1,6,0)=" "
89^ANRV(2043,1,1,7,0)="<Enter Name of Chief (Routing Symbol)>"
90^ANRV(2043,1,1,8,0)="|BLANK(0)|"
91^ANRV(2043,1,1,9,0)="Chief"
92^ANRV(2043,1,1,10,0)="|BLANK(0)|"
93^ANRV(2043,1,1,11,0)="Central Blind Rehabilitation Center"
94^ANRV(2043,1,1,12,0)="|BLANK(0)|"
95^ANRV(2043,1,1,13,0)="<Enter Your VA Medical Center>"
96^ANRV(2043,1,1,14,0)="|BLANK(0)|"
97^ANRV(2043,1,1,15,0)="<Enter Street Address>"
98^ANRV(2043,1,1,16,0)="|BLANK(0)|"
99^ANRV(2043,1,1,17,0)="<Enter City, State ZIP>"
100^ANRV(2043,1,1,18,0)="|BLANK(2)|"
101^ANRV(2043,1,1,19,0)=" "
102^ANRV(2043,1,1,20,0)="SUBJ: Application for Admission to a VA Blind Rehabilitation Program"
103^ANRV(2043,1,1,21,0)=" "
104^ANRV(2043,1,1,22,0)="1. VETERAN: |NAME|"
105^ANRV(2043,1,1,23,0)=" |NAME:SSN|"
106^ANRV(2043,1,1,24,0)=" "
107^ANRV(2043,1,1,25,0)="2. VIST BRC PROGRAM RECOMMENDATION: CENTER"
108^ANRV(2043,1,1,26,0)=" "
109^ANRV(2043,1,1,27,0)="3. PREVIOUS VA BLIND REHABILITATION: <Enter Year and Place>"
110^ANRV(2043,1,1,28,0)=" "
111^ANRV(2043,1,1,29,0)="4. Enclosed with this cover letter is the following BRC application"
112^ANRV(2043,1,1,30,0)="information:"
113^ANRV(2043,1,1,31,0)=" "
114^ANRV(2043,1,1,32,0)=" * VAF 10-10 (signed)"
115^ANRV(2043,1,1,33,0)=" * VIS Team Assessment"
116^ANRV(2043,1,1,34,0)=" * Eye Examination"
117^ANRV(2043,1,1,35,0)=" * History and Physical Examination"
118^ANRV(2043,1,1,36,0)=" * Relevant Lab, EKG and X-ray Reports"
119^ANRV(2043,1,1,37,0)=" * Audiology Examination"
120^ANRV(2043,1,1,38,0)=" * Required VA Forms"
121^ANRV(2043,1,1,39,0)=" "
122^ANRV(2043,1,1,40,0)="5. If you have any questions or concerns regarding this application,"
123^ANRV(2043,1,1,41,0)="please don't hesitate to contact me at FTS:<Enter Your Facility's Phone"
124^ANRV(2043,1,1,42,0)="Number>."
125^ANRV(2043,1,1,43,0)=" "
126^ANRV(2043,1,1,44,0)=" "
127^ANRV(2043,1,1,45,0)=" "
128^ANRV(2043,1,1,46,0)=" "
129^ANRV(2043,1,1,47,0)=" "
130^ANRV(2043,1,1,48,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
131^ANRV(2043,2,0)="CLAIM LETTER^1"
132^ANRV(2043,2,1,0)="^^41^41^2980611^^^^"
133^ANRV(2043,2,1,1,0)="|NOWRAP|"
134^ANRV(2043,2,1,2,0)="|BLANK(0)|"
135^ANRV(2043,2,1,3,0)="|CENTER(""Department of Veterans Affairs"")|"
136^ANRV(2043,2,1,4,0)="|BLANK(0)|"
137^ANRV(2043,2,1,5,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
138^ANRV(2043,2,1,6,0)="|BLANK(0)|"
139^ANRV(2043,2,1,7,0)="|CENTER(""<Enter Street Address>"")|"
140^ANRV(2043,2,1,8,0)="|BLANK(0)|"
141^ANRV(2043,2,1,9,0)="|CENTER(""<Enter City, State ZIP>"")|"
142^ANRV(2043,2,1,10,0)="|BLANK(2)|"
143^ANRV(2043,2,1,11,0)=" "
144^ANRV(2043,2,1,12,0)="|TODAY|"
145^ANRV(2043,2,1,13,0)=" "
146^ANRV(2043,2,1,14,0)=" "
147^ANRV(2043,2,1,15,0)="SUBJ: Re-evaluation of SC Condition"
148^ANRV(2043,2,1,16,0)=" "
149^ANRV(2043,2,1,17,0)=" "
150^ANRV(2043,2,1,18,0)="1. Identifying Information: Veteran: |NAME|"
151^ANRV(2043,2,1,19,0)=" Claim #: c-|NAME:CLAIM NUMBER|"
152^ANRV(2043,2,1,20,0)=" SS #: |NAME:SSN|"
153^ANRV(2043,2,1,21,0)=" "
154^ANRV(2043,2,1,22,0)=" "
155^ANRV(2043,2,1,23,0)="|WRAP|"
156^ANRV(2043,2,1,24,0)="2. |LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))| was seen by the VIS Team"
157^ANRV(2043,2,1,25,0)="on <Enter Date Veteran was seen by VIS Team>."
158^ANRV(2043,2,1,26,0)="|$S((NAME:SEX[""F""):""She"",1:""He"")| reports having decreased vision in both"
159^ANRV(2043,2,1,27,0)="eyes and is requesting a re-evaluation of |$S((NAME:SEX[""F""):""her"",1:""his"")|"
160^ANRV(2043,2,1,28,0)="current VA rating for vision loss. The veteran is currently rated"
161^ANRV(2043,2,1,29,0)="<Enter SC Percentage> SC for vision loss. Our eye clinic found the veteran's"
162^ANRV(2043,2,1,30,0)="best corrected central acuity to be <Enter Best Corrected Central Acuity> in"
163^ANRV(2043,2,1,31,0)="both eyes. Enclosed with this letter is a copy of the VIST eye exam."
164^ANRV(2043,2,1,32,0)=" "
165^ANRV(2043,2,1,33,0)="3. If you have any questions or concerns regarding this request please"
166^ANRV(2043,2,1,34,0)="don't hesitate to contact me at FTS: <Enter Your Facility's Phone Number>."
167^ANRV(2043,2,1,35,0)="Please send me a copy of your rating decision."
168^ANRV(2043,2,1,36,0)=" "
169^ANRV(2043,2,1,37,0)=" "
170^ANRV(2043,2,1,38,0)=" "
171^ANRV(2043,2,1,39,0)=" "
172^ANRV(2043,2,1,40,0)=" "
173^ANRV(2043,2,1,41,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
174^ANRV(2043,3,0)="IRS EXEMPTION^1"
175^ANRV(2043,3,1,0)="^^35^35^2980609^^^^"
176^ANRV(2043,3,1,1,0)="|NOWRAP|"
177^ANRV(2043,3,1,2,0)="|BLANK(0)|"
178^ANRV(2043,3,1,3,0)="|CENTER(""Department of Veterans Affairs"")|"
179^ANRV(2043,3,1,4,0)="|BLANK(0)|"
180^ANRV(2043,3,1,5,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
181^ANRV(2043,3,1,6,0)="|BLANK(0)|"
182^ANRV(2043,3,1,7,0)="|CENTER(""<Enter Street Address>"")|"
183^ANRV(2043,3,1,8,0)="|BLANK(0)|"
184^ANRV(2043,3,1,9,0)="|CENTER(""<Enter City, State ZIP>"")|"
185^ANRV(2043,3,1,10,0)=" "
186^ANRV(2043,3,1,11,0)=" "
187^ANRV(2043,3,1,12,0)="|TODAY|"
188^ANRV(2043,3,1,13,0)="|NOWRAP||BLANK(2)|"
189^ANRV(2043,3,1,14,0)="|LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))|"
190^ANRV(2043,3,1,15,0)="|LOWERCASE(NAME:STREET ADDRESS [LINE 1])|"
191^ANRV(2043,3,1,16,0)="|WRAP|"
192^ANRV(2043,3,1,17,0)="|LOWERCASE(NAME:CITY)_"", ""|"
193^ANRV(2043,3,1,18,0)="|NAME:STATE:ABBREVIATION_"" ""_ZIP CODE|"
194^ANRV(2043,3,1,19,0)="|NOWRAP|"
195^ANRV(2043,3,1,20,0)="|BLANK(2)|"
196^ANRV(2043,3,1,21,0)="To Whom It May Concern:"
197^ANRV(2043,3,1,22,0)=" "
198^ANRV(2043,3,1,23,0)=" "
199^ANRV(2043,3,1,24,0)="This is to advise that the veteran mentioned above is legally blind"
200^ANRV(2043,3,1,25,0)="according to records of this Medical Center. If there are any questions"
201^ANRV(2043,3,1,26,0)="with regard to the veteran's visual acuities or visual fields, you may"
202^ANRV(2043,3,1,27,0)="contact (Release of Information) at this Medical Center <Enter Your"
203^ANRV(2043,3,1,28,0)="Facility's Phone Number>. The veteran's legal blindness is permanent and"
204^ANRV(2043,3,1,29,0)="irreversible."
205^ANRV(2043,3,1,30,0)=" "
206^ANRV(2043,3,1,31,0)=" "
207^ANRV(2043,3,1,32,0)=" "
208^ANRV(2043,3,1,33,0)=" "
209^ANRV(2043,3,1,34,0)=" "
210^ANRV(2043,3,1,35,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
211^ANRV(2043,4,0)="INVITATION FOR VIST REVIEW^1"
212^ANRV(2043,4,1,0)="^^69^69^2980609^^^^"
213^ANRV(2043,4,1,1,0)=" "
214^ANRV(2043,4,1,2,0)=" "
215^ANRV(2043,4,1,3,0)="|NOWRAP|"
216^ANRV(2043,4,1,4,0)="|BLANK(0)|"
217^ANRV(2043,4,1,5,0)="|CENTER(""Department of Veterans Affairs"")|"
218^ANRV(2043,4,1,6,0)="|BLANK(0)|"
219^ANRV(2043,4,1,7,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
220^ANRV(2043,4,1,8,0)="|BLANK(0)|"
221^ANRV(2043,4,1,9,0)="|CENTER(""<Enter Street Address>"")|"
222^ANRV(2043,4,1,10,0)="|BLANK(0)|"
223^ANRV(2043,4,1,11,0)="|CENTER(""<Enter City, State ZIP>"")|"
224^ANRV(2043,4,1,12,0)=" "
225^ANRV(2043,4,1,13,0)=" "
226^ANRV(2043,4,1,14,0)="|TODAY|"
227^ANRV(2043,4,1,15,0)="|NOWRAP||BLANK(2)|"
228^ANRV(2043,4,1,16,0)="|LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))|"
229^ANRV(2043,4,1,17,0)="|LOWERCASE(NAME:STREET ADDRESS [LINE 1])|"
230^ANRV(2043,4,1,18,0)="|WRAP|"
231^ANRV(2043,4,1,19,0)="|LOWERCASE(NAME:CITY)_"", ""|"
232^ANRV(2043,4,1,20,0)="|NAME:STATE:ABBREVIATION_"" ""_ZIP CODE|"
233^ANRV(2043,4,1,21,0)="|NOWRAP|"
234^ANRV(2043,4,1,22,0)="|BLANK(2)|"
235^ANRV(2043,4,1,23,0)="|$S((NAME:SEX[""F""):""Dear Ms. ""_LOWERCASE($P(NAME,"","",1))_"":"",1:""Dear Mr. ""_LOWERCASE($P(NAME,"","",1))_"":"")|"
236^ANRV(2043,4,1,24,0)=" "
237^ANRV(2043,4,1,25,0)=" "
238^ANRV(2043,4,1,26,0)="The Visual Impairment Services Team (VIS Team), <Enter Your VAMC> is"
239^ANRV(2043,4,1,27,0)="pleased to offer your annual appointment to evaluate your overall health"
240^ANRV(2043,4,1,28,0)="status and to make certain you are receiving the specialized benefits"
241^ANRV(2043,4,1,29,0)="available through the Department of Veterans Affairs. This appointment"
242^ANRV(2043,4,1,30,0)="includes the following: (1) A complete physical examination; (2) An eye"
243^ANRV(2043,4,1,31,0)="examination; (3) A hearing evaluation; (4) A review of your prosthetic"
244^ANRV(2043,4,1,32,0)="needs as they relate to your blindness; and (5) An interview with the VIST"
245^ANRV(2043,4,1,33,0)="Coordinator who may be able to assist you with specific problems as they"
246^ANRV(2043,4,1,34,0)="relate to your sight loss."
247^ANRV(2043,4,1,35,0)=" "
248^ANRV(2043,4,1,36,0)="This annual review is entirely VOLUNTARY ON YOUR PART. IT DOES NOT IN ANY"
249^ANRV(2043,4,1,37,0)="WAY affect your status with the VA if you choose not to participate."
250^ANRV(2043,4,1,38,0)="However, we sincerely encourage you to take advantage of this opportunity."
251^ANRV(2043,4,1,39,0)=" "
252^ANRV(2043,4,1,40,0)="Please complete the form at the bottom of this letter and return it in the"
253^ANRV(2043,4,1,41,0)="enclosed prepaid envelope. Even if you choose not to request an"
254^ANRV(2043,4,1,42,0)="appointment, it would be appreciated if you would complete and return the"
255^ANRV(2043,4,1,43,0)="form."
256^ANRV(2043,4,1,44,0)=" "
257^ANRV(2043,4,1,45,0)="I personally look forward to an opportunity to meet with you if I have not"
258^ANRV(2043,4,1,46,0)="already done so."
259^ANRV(2043,4,1,47,0)=" "
260^ANRV(2043,4,1,48,0)="Sincerely,"
261^ANRV(2043,4,1,49,0)=" "
262^ANRV(2043,4,1,50,0)=" "
263^ANRV(2043,4,1,51,0)=" "
264^ANRV(2043,4,1,52,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
265^ANRV(2043,4,1,53,0)=" "
266^ANRV(2043,4,1,54,0)="***************************************************************************"
267^ANRV(2043,4,1,55,0)="IF YOU HAVE QUESTIONS, PLEASE CALL <Enter VIST Coordinator's Name>, VIST"
268^ANRV(2043,4,1,56,0)="COORDINATOR:"
269^ANRV(2043,4,1,57,0)="TELEPHONE <Enter Your Facility's Phone Number>"
270^ANRV(2043,4,1,58,0)="NAME:_____________________________________________________________________"
271^ANRV(2043,4,1,59,0)="ADDRESS:__________________________________________________________________"
272^ANRV(2043,4,1,60,0)="__________________________________________________________________________"
273^ANRV(2043,4,1,61,0)="HOME OR CONTACT TELEPHONE #:___________________ BIRTHDATE:________________"
274^ANRV(2043,4,1,62,0)="|WRAP|"
275^ANRV(2043,4,1,63,0)="SCHEDULE ME FOR"
276^ANRV(2043,4,1,64,0)="|YEAR(TODAY)|"
277^ANRV(2043,4,1,65,0)=": YES:___ NO:___ I PREFER THE MONTH OF:______________"
278^ANRV(2043,4,1,66,0)="|NOWRAP|"
279^ANRV(2043,4,1,67,0)="I AM NOT INTERESTED IN A VIST REVIEW BECAUSE:_____________________________"
280^ANRV(2043,4,1,68,0)="__________________________________________________________________________"
281^ANRV(2043,4,1,69,0)="SIGNATURE:____________________________________ DATE:______________________"
282^ANRV(2043,5,0)="BRC FOLLOW-UP LETTER^1"
283^ANRV(2043,5,1,0)="^^63^63^2980609^^^^"
284^ANRV(2043,5,1,1,0)=" "
285^ANRV(2043,5,1,2,0)=" "
286^ANRV(2043,5,1,3,0)="|NOWRAP|"
287^ANRV(2043,5,1,4,0)="|BLANK(0)|"
288^ANRV(2043,5,1,5,0)="|CENTER(""Department of Veterans Affairs"")|"
289^ANRV(2043,5,1,6,0)="|BLANK(0)|"
290^ANRV(2043,5,1,7,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
291^ANRV(2043,5,1,8,0)="|BLANK(0)|"
292^ANRV(2043,5,1,9,0)="|CENTER(""<Enter Street Address>"")|"
293^ANRV(2043,5,1,10,0)="|BLANK(0)|"
294^ANRV(2043,5,1,11,0)="|CENTER(""<Enter City, State ZIP>"")|"
295^ANRV(2043,5,1,12,0)=" "
296^ANRV(2043,5,1,13,0)=" "
297^ANRV(2043,5,1,14,0)="|TODAY|"
298^ANRV(2043,5,1,15,0)="|NOWRAP||BLANK(2)|"
299^ANRV(2043,5,1,16,0)="|LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))|"
300^ANRV(2043,5,1,17,0)="|LOWERCASE(NAME:STREET ADDRESS [LINE 1])|"
301^ANRV(2043,5,1,18,0)="|WRAP|"
302^ANRV(2043,5,1,19,0)="|LOWERCASE(NAME:CITY)_"", ""|"
303^ANRV(2043,5,1,20,0)="|NAME:STATE:ABBREVIATION_"" ""_ZIP CODE|"
304^ANRV(2043,5,1,21,0)="|NOWRAP|"
305^ANRV(2043,5,1,22,0)=" "
306^ANRV(2043,5,1,23,0)=" "
307^ANRV(2043,5,1,24,0)="|$S((NAME:SEX[""F""):""Dear Ms. ""_LOWERCASE($P(NAME,"","",1))_"":"",1:""Dear Mr. ""_LOWERCASE($P(NAME,"","",1))_"":"")|"
308^ANRV(2043,5,1,25,0)=" "
309^ANRV(2043,5,1,26,0)=" "
310^ANRV(2043,5,1,27,0)="We hope you enjoyed your recent blind rehabilitation training and were"
311^ANRV(2043,5,1,28,0)="able to take some new found knowledge home with you that will make living"
312^ANRV(2043,5,1,29,0)="with your visual loss easier. For the benefit of the VIST Coordinator as"
313^ANRV(2043,5,1,30,0)="well as the Blind Rehabilitation Center or Clinic, we would appreciate your"
314^ANRV(2043,5,1,31,0)="assistance with answering the following questions as they relate to your"
315^ANRV(2043,5,1,32,0)="return from Blind Rehabilitation:"
316^ANRV(2043,5,1,33,0)=" "
317^ANRV(2043,5,1,34,0)="l. Has there been a change in your vision or medical condition?"
318^ANRV(2043,5,1,35,0)="______________________________________________________________________"
319^ANRV(2043,5,1,36,0)=" "
320^ANRV(2043,5,1,37,0)="2. Has there been a change in your financial situation?"
321^ANRV(2043,5,1,38,0)="______________________________________________________________________"
322^ANRV(2043,5,1,39,0)=" "
323^ANRV(2043,5,1,40,0)="3. How are you using the skills learned at the Blind Rehabilitation Center"
324^ANRV(2043,5,1,41,0)="or Clinic?____________________________________________________________"
325^ANRV(2043,5,1,42,0)="______________________________________________________________________"
326^ANRV(2043,5,1,43,0)=" "
327^ANRV(2043,5,1,44,0)="4. What did your spouse or family member think of the family program at"
328^ANRV(2043,5,1,45,0)="the Blind Center or Clinic?____________________________________________"
329^ANRV(2043,5,1,46,0)=" "
330^ANRV(2043,5,1,47,0)="5. Are you using the low vision aids issued to you? If so how?"
331^ANRV(2043,5,1,48,0)="______________________________________________________________________"
332^ANRV(2043,5,1,49,0)=" "
333^ANRV(2043,5,1,50,0)="6. Are you continuing to have major problems coping with your vision loss?"
334^ANRV(2043,5,1,51,0)="______________________________________________________________________"
335^ANRV(2043,5,1,52,0)=" "
336^ANRV(2043,5,1,53,0)="7. What are your goals and future plans?______________________________"
337^ANRV(2043,5,1,54,0)="______________________________________________________________________"
338^ANRV(2043,5,1,55,0)=" "
339^ANRV(2043,5,1,56,0)="Thank you for your assistance. Please return this completed letter in the"
340^ANRV(2043,5,1,57,0)="enclosed envelope."
341^ANRV(2043,5,1,58,0)=" "
342^ANRV(2043,5,1,59,0)="Sincerely Yours,"
343^ANRV(2043,5,1,60,0)=" "
344^ANRV(2043,5,1,61,0)=" "
345^ANRV(2043,5,1,62,0)=" "
346^ANRV(2043,5,1,63,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
347^ANRV(2043,"B","BRC APPLICATION LETTER",1)=""
348^ANRV(2043,"B","BRC FOLLOW-UP LETTER",5)=""
349^ANRV(2043,"B","CLAIM LETTER",2)=""
350^ANRV(2043,"B","INVITATION FOR VIST REVIEW",4)=""
351^ANRV(2043,"B","IRS EXEMPTION",3)=""
352^ANRV(2043.5,0)="VARO CLAIMS^2043.5P^^"
353^ANRV(2044,0)="VIST LOCAL BENEFITS AND SERVICES^2044^5^5"
354^ANRV(2044,1,0)="STATE SERVICES FOR THE BLIND"
355^ANRV(2044,2,0)="LOCAL AGENCY FOR THE BLIND"
356^ANRV(2044,3,0)="PROPERTY TAX EXEMPTION"
357^ANRV(2044,4,0)="HUNTING/FISHING LICENSE"
358^ANRV(2044,5,0)="TRANSIT PASS"
359^ANRV(2044,"B","HUNTING/FISHING LICENSE",4)=""
360^ANRV(2044,"B","LOCAL AGENCY FOR THE BLIND",2)=""
361^ANRV(2044,"B","PROPERTY TAX EXEMPTION",3)=""
362^ANRV(2044,"B","STATE SERVICES FOR THE BLIND",1)=""
363^ANRV(2044,"B","TRANSIT PASS",5)=""
364^ANRV(2048,0)="ANRV PATIENT REVIEW^2048P^^"
365^ANRV(2048.1,0)="ANRV PATIENT REVIEW SECTIONS^2048.1^6^6"
366^ANRV(2048.1,1,0)="1^SECTION 1"
367^ANRV(2048.1,1,2)="1"
368^ANRV(2048.1,2,0)="2^SECTION 2"
369^ANRV(2048.1,2,2)="1"
370^ANRV(2048.1,3,0)="3^SECTION 3"
371^ANRV(2048.1,3,2)="1"
372^ANRV(2048.1,4,0)="4^SECTION 4"
373^ANRV(2048.1,4,2)="1"
374^ANRV(2048.1,5,0)="5^SECTION 5"
375^ANRV(2048.1,5,2)="1"
376^ANRV(2048.1,6,0)="6^SECTION 6"
377^ANRV(2048.1,6,2)="1"
378^ANRV(2048.1,"B",1,1)=""
379^ANRV(2048.1,"B",2,2)=""
380^ANRV(2048.1,"B",3,3)=""
381^ANRV(2048.1,"B",4,4)=""
382^ANRV(2048.1,"B",5,5)=""
383^ANRV(2048.1,"B",6,6)=""
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