source: WorldVistAEHR/trunk/r/ENROLLMENT_APPLICATION_SYSTEM-EAS/EASEZP64.m@ 1150

Last change on this file since 1150 was 613, checked in by George Lilly, 15 years ago

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1EASEZP64 ; ALB/AMA - Print 1010EZ, Version 6 or greater, Cont. ; 10/25/2000
2 ;;1.0;ENROLLMENT APPLICATION SYSTEM;**60,57**;Mar 15, 2001
3 ;
4 ;This routine carved from EASEZPF3; if the version # of the 1010EZ
5 ;application is 6.0 or greater, then this routine will be executed.
6 ;
7EN(EALNE,EAINFO) ; Entry point to print Page 3, called from EN^EASEZP6F
8 N EASIGN,EASD
9 ;
10 I $$GET1^DIQ(712,EAINFO("EASAPP")_",",4)]"" D
11 . S EASIGN=$$GET1^DIQ(712,EAINFO("EASAPP")_",",4.1)
12 S EASIGN=$G(EASIGN)
13 ;
14 D HDR^EASEZP6F(.EALNE,.EAINFO)
15 S EASD=$NA(^TMP("EASEZ",$J,2))
16 ;
17 D NET
18 D CON
19 D AOB
20 D FT^EASEZP6F(.EALNE,.EAINFO)
21 ;
22 Q
23 ;
24NET ; Print SECTION X - PREVIOUS CALENDAR YEAR NET WORTH
25 ;
26 W !!?18,"SECTION X - PREVIOUS CALENDAR YEAR NET WORTH (Use a separate sheet for additional dependents)"
27 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
28 ;
29 W !?78,"|",?84,"VETERAN",?96,"|",?102,"SPOUSE",?114,"|",?120,"CHILD 1"
30 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
31 ;
32 W !,"1. CASH, AMOUNT IN BANK ACCOUNTS (e.g., checking and savings accounts,",?78,"| $ ",$P(@EASD@("2E1"),U),?96,"| $ ",$P(@EASD@("2E1"),U,2),?114,"| $ ",$P(@EASD@("2E1"),U,3)
33 W !,"certificates of deposit, individual retirement accounts, stocks and bonds)",?78,"|",?96,"|",?114,"|"
34 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
35 ;
36 W !,"2. MARKET VALUE OF LAND AND BUILDINGS MINUS MORTGAGES AND LIENS (e.g., second",?78,"| $ ",$P(@EASD@("2E2"),U),?96,"| $ ",$P(@EASD@("2E2"),U,2),?114,"| $ ",$P(@EASD@("2E2"),U,3)
37 W !,"homes and non-income-producing property. Do not count your primary home.)",?78,"|",?96,"|",?114,"|"
38 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
39 ;
40 W !,"3. VALUE OF OTHER PROPERTY OR ASSETS (e.g., art, rare coins, collectibles)",?78,"| $ ",$P(@EASD@("2E3"),U),?96,"| $ ",$P(@EASD@("2E3"),U,2),?114,"| $ ",$P(@EASD@("2E3"),U,3)
41 W !,"MINUS THE AMOUNT YOU OWE ON THESE ITEMS. INCLUDE VALUE OF FARM, RANCH, OR",?78,"|",?96,"|",?114,"|"
42 W !,"BUSINESS ASSETS. Exclude household effects and family vehicles.",?78,"|",?96,"|",?114,"|"
43 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
44 Q
45 ;
46CON ; Print SECTION XI - CONSENT TO COPAYMENTS
47 ;
48 W !!?49,"SECTION XI - CONSENT TO COPAYMENTS"
49 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
50 ;
51 W !,"If you are a 0% service-connected veteran and do not receive VA monetary benefits or a nonservice-connected veteran (and you are"
52 W !,"not an Ex-POW, Purple Heart Recipient, WWI veteran or VA pensioner) and your household income (or combined income and net worth)"
53 W !,"exceeds the established threshold, this application will be considered for enrollment, but only if you agree to pay VA copayments"
54 W !,"for treatment of your nonservice-connected conditions. If you are such a veteran, by signing this application you are agreeing"
55 W !,"to pay the applicable VA copayment as required by law.",!
56 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
57 Q
58 ;
59AOB ; Print SECTION XII - ASSIGNMENT OF BENEFITS
60 ;
61 W !!?48,"SECTION XII - ASSIGNMENT OF BENEFITS"
62 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
63 ;
64 W !,"I understand that pursuant to 38 U.S.C. section 1729, VA is authorized to recover or collect from my health plan (HP) for the"
65 W !,"reasonable charges of nonservice-connected VA medical care or services furnished or provided to me. I hereby authorize payment"
66 W !,"directly to VA from any HP under which I am covered (including coverage provided under my spouse's HP) that is responsible for"
67 W !,"payment of the charges for my medical care, including benefits otherwise payable to me or my spouse.",!
68 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
69 ;
70 W !!?6,"ALL APPLICANTS MUST SIGN AND DATE THIS FORM. REFER TO INSTRUCTIONS WHICH DEFINE WHO CAN SIGN ON BEHALF OF THE VETERAN.",!
71 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
72 ;
73 W !,"SIGNATURE OF APPLICANT",?90,"| DATE"
74 I $G(EASIGN)]"" W !,"SIGNATURE OF APPLICANT OR APPLICANT'S REPRESENTATIVE HAS BEEN VERIFIED",?90,"| ",EASIGN,!?90,"|"
75 E W !?90,"|",!?90,"|"
76 W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
77 Q
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