| [613] | 1 | DGMTP4 ;ALB/RMO,CAW,LD - Print Means Test 10-10F Cont. ;16 APR 1992 2:35 pm
|
|---|
| 2 | ;;5.3;Registration;**33,182,300**;Aug 13, 1993
|
|---|
| 3 | ;
|
|---|
| 4 | EN ;Entry point to print signature block and special notes
|
|---|
| 5 | ; Set category, status and type of care variables from means test file.
|
|---|
| 6 | ; These are initially set in DGMTP with the call to SET^DGMTSCU2, but
|
|---|
| 7 | ; are calculated by the data available. For this portion of the
|
|---|
| 8 | ; printout they should be set to the means test file entry.
|
|---|
| 9 | N DGCAT,DGMTS,DGTYC,X
|
|---|
| 10 | S DGMTS=$P(DGMT0,"^",3),DGCAT=$P($$MTS^DGMTU(DFN,$S(DGMTS=2:6,1:DGMTS)),"^",2),DGTYC=$P($G(^DG(408.32,DGMTS,0)),"^",3)
|
|---|
| 11 | D SIG,NOTE
|
|---|
| 12 | Q Q
|
|---|
| 13 | ;
|
|---|
| 14 | SIG ;Print signature block
|
|---|
| 15 | W $$UL^DGMTSCU1(DGUL,DGLNE1),!?30,"Completion of this form with signature of veteran is certification",!?30,"that the veteran has received a copy of the privacy act statement."
|
|---|
| 16 | W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"THE ABOVE INFORMATION IS CORRECT",?63,"| Signature of Veteran or Designee",?109,"| Date",!?1,"TO THE BEST OF MY KNOWLEDGE.",?63,"|",?109,"|"
|
|---|
| 17 | W $$UL^DGMTSCU1(DGUL,DGLNE1),!,?37,"F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO",!,?41,"ARE REQUIRED TO MAKE COPAYMENTS"
|
|---|
| 18 | W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"Eligibility Category",?30,"| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare"
|
|---|
| 19 | W !?30,"| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit",!
|
|---|
| 20 | W:DGMTYPT=1 ?11,DGCAT
|
|---|
| 21 | W ?30,"| Deductible is required for Category C Veterans to receive Outpatient care."
|
|---|
| 22 | W !?30,"| The Billing Period and Rates are specified in 38 U.S.C."
|
|---|
| 23 | W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"I AGREE TO PAY THE VA THE APPLICABLE",?63,"| Signature of Veteran or Designee",?109,"| Date"
|
|---|
| 24 | W !?1,"DEDUCTIBLE FOR MY MEDICAL CARE.",?63,"| ",$S(DGTYC'="D":"NOT APPLICABLE",'$P(DGMT0,"^",11):"HAS NOT AGREED",1:""),?109,"|"
|
|---|
| 25 | Q
|
|---|
| 26 | ;
|
|---|
| 27 | NOTE ;Print any special notes
|
|---|
| 28 | W !,DGLNE,!?1,"Special Note(s):"
|
|---|
| 29 | S X=+$P(DGMT0,"^",23) I (X>1) W ?30,"This means test was administered by the ",$S(X<4:"IVM",1:$$SR^DGMTAUD1(DGMT0,DGMTI)_" Medical")," Center.",!
|
|---|
| 30 | I DGMTS=2 W ?30,"Patient's means test is Pending Adjudication.",!
|
|---|
| 31 | I DGMTS=3 W ?30,"Patient's means test is No Longer Required.",!
|
|---|
| 32 | I $P(DGMT0,"^",14),DGMTS=6 W ?30,"Patient has declined to provide income information.",!
|
|---|
| 33 | I $P(DGMT0,"^",16) W ?30,"Previous years thresholds were used to determine the patient's eligibility for care.",!?30,"The means test must be re-applied once the correct thresholds are available.",!
|
|---|
| 34 | I $P(DGMT0,"^",4)'=DGINT W ?30,"Patient's annual income does not match the income associated with the means test." W:DGTYC'="N" !?30,"Please edit and complete the means test again.",!
|
|---|
| 35 | I $P(DGMT0,"^",19)=2 W ?30,"Copay Exemption Test Status is: "_$S($P(DGMT0,U,3)=7:"EXEMPT",$P(DGMT0,U,3)=8:"NON-EXEMPT",$P(DGMT0,U,3)=9:"INCOMPLETE",$P(DGMT0,U,3)=10:"NO LONGER APPLICABLE",$P(DGMT0,U,3)=11:"PENDING ADJUDICATION",1:"")
|
|---|
| 36 | W ! S DGPGE=2 D FT^DGMTP ;end of second page of form
|
|---|
| 37 | Q
|
|---|
