| 1 | RMPFQP2 ;DDC/KAW-PRINT VA FORM 10-2477a; [ 06/16/95   3:06 PM ]
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| 2 |  ;;2.0;REMOTE ORDER/ENTRY SYSTEM;;JUN 16, 1995
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| 3 | RMPFSET I '$D(RMPFMENU) D MENU^RMPFUTL I '$D(RMPFMENU) W !!,$C(7),"*** A MENU SELECTION MUST BE MADE ***" Q  ;;RMPFMENU must be defined
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| 4 |  I '$D(RMPFSTAN)!'$D(RMPFDAT)!'$D(RMPFSYS) D ^RMPFUTL Q:'$D(RMPFSTAN)!'$D(RMPFDAT)!'$D(RMPFSYS)
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| 5 |  ;; input: None
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| 6 |  ;;output: None
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| 7 |  F KX=1:1:RMPFCNT D PRINT
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| 8 |  G END
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| 9 | PRINT D ^RMPFQP1
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| 10 |  W:$Y>0 @IOF W !?25,"DEPARTMENT OF VETERANS AFFAIRS"
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| 11 |  W !?21,"AUDIOLOGICAL SERVICES ACKNOWLEDGEMENT"
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| 12 |  D LINE
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| 13 |  W !,"1. Extended Audiology Clinic",?38,"|   2. Issuing Audiology Clinic"
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| 14 |  W !?3,"Station No. ",RMPFRSTA,?38,"|",?45,"Station No. ",RMPFSTAP
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| 15 |  W !?38,"|"
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| 16 |  F I=1:1:4 W ! W:$D(RMPFR(I)) ?3,$E(RMPFR(I),1,32) W ?38,"|" W:$D(RMPFS(I)) ?45,$E(RMPFS(I),1,36)
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| 17 |  D LINE
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| 18 | NAM W !,"3. Veteran's Name and Address ",?38,"|  4. Eligibility Status(es) "
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| 19 |  W !,?38,"|"
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| 20 |  W ! W ?38,"|  __ SC for Hearing",?61,"__ IN PAT"
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| 21 |  W ! W ?38,"|  __ 50-100% SC",?61,"__ NHCU"
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| 22 |  W ! W ?38,"|  __ POW",?61,"__ DOM"
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| 23 |  W ! W ?38,"|  __ WWI",?61,"__ OPT-NSC"
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| 24 |  W ! W ?38,"|  __ MBW",?61,"__ ADJ"
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| 25 |  W !?38,"|  __ A&A",?54,"__ ALLIED (Authority Req.)"
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| 26 |  W !?38,"|  __ HB",?54,"__ OTHER  (Specify)"
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| 27 |  D LINE
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| 28 |  D CONT G END:$D(RMPFOUT) D LINE:IOST?1"C-".E
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| 29 |  W !,"5. Soc. Security No.",?16,"| 6. VA Claim No.",?38,"| 7. Date of Birth",?59,"| 8. Disability Code"
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| 30 |  W !?20,"|",?38,"|",?59,"|"
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| 31 |  W !,"       -    -",?20,"|      -    -",?38,"|",?59,"| __DEAF/U  __DEAF/B"
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| 32 |  D LINE
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| 33 | AUTH W !,"9. Currently Authorized Hearing Aid(s)"
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| 34 |  D LINE
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| 35 |  W !?2,"Manfacturer",?16,"|",?22,"Model",?32,"|",?34,"Serial Number",?48,"|",?50,"Furnished By",?64,"|",?67,"Date Issued"
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| 36 |  D LINE
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| 37 |  F I=1:1:4 W !,?16,"|",?32,"|",?48,"|",?64,"|" D LINE
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| 38 | CLINIC W !,"10. Clinic Action Taken    __  VETERAN DOES NOT REQUIRE NEW HEARING AID"
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| 39 |  W !?27,"__  VETERAN DOES NOT REQUIRE HEARING AID"
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| 40 |  W !?27,"__  ITEM(S) LISTED BELOW WERE ISSUED TO VETERAN"
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| 41 |  D LINE
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| 42 |  D CONT G END:$D(RMPFOUT) D LINE:IOST?1"C-".E
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| 43 |  W !,?16,"|",?27,"|",?44,"|",?57,"| Battery",?67,"| Serial No."
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| 44 |  W !,"Natl. Stock No.",?16,"|",?20,"Make",?33,"Model"
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| 45 |  W ?44,"| Serial No.",?57,"|  Type",?67,"| Replaced"
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| 46 |  D LINE
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| 47 |  F I=1:1:2 W !,"6515-01-",?16,"|",?27,"|",?44,"|",?57,"|",?67,"|" D LINE
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| 48 |  D CONT G END:$D(RMPFOUT) D LINE:IOST?1"C-".E
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| 49 |  W !,"11. Type of Fitting",?24,"__ MONAURAL",?38,"__  BINAURAL",?56,"__  CROS",?69,"__  BICROS"
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| 50 |  D LINE
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| 51 |  W !,"12. Authorized Usage of Aids",?38,"__  MONAURAL",?56,"__  BINAURAL"
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| 52 |  D LINE
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| 53 |  W !,"13. Issued aids to be replaced to clinic stock by DDC:",?58,"__  YES",?66,"__  NO",?73,"__ N/A"
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| 54 |  D LINE
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| 55 |  W !,"14. Signature of Issuing Audiologist",?38,"|",?44,"Name and Title",?65,"|15. Order Date"
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| 56 |  W !?38,"|",?65,"|",!?38,"|",?65,"|"
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| 57 |  D LINE
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| 58 |  I IOST?1"P-".E,$Y>58 W @IOF
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| 59 |  W !,"16. I certify that I have",?37,"Signature of Veteran",?65,"|17. Date"
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| 60 |  W !?4,"received the item(s)",?65,"|"
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| 61 |  W !?4,"listed under 10 above ->",?65,"|"
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| 62 |  D LINE
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| 63 |  W !,"VA Form 10-2477a"
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| 64 |  W !,"SEP 1991"
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| 65 |  D CONT G END:$D(RMPFOUT) W:IOST?1"P-".E @IOF
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| 66 |  D:$D(IO("S")) ^%ZISC
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| 67 | END K RMPFRSTA,RMPFR,RMPFS,RMPFRSTA,RMPFS,RMPFR,%DT,I,IN,Y,RMPFOUT,RMPFQUT,RMPFCNT Q
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| 68 | READ K RMPFOUT,RMPFQUT
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| 69 |  R Y:DTIME I '$T W $C(7) R Y:5 G READ:Y="." S:'$T Y=U
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| 70 |  I Y?1"^".E S (RMPFOUT,Y)="" Q
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| 71 |  S:Y?1"?".E (RMPFQUT,Y)=""
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| 72 |  Q
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| 73 | LINE W !,"--------------------------------------------------------------------------------"
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| 74 |  Q
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| 75 | CONT Q:IOST'["C-"  F I=1:1 Q:$Y>21  W !
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| 76 |  W !,"Enter <RETURN> to continue:" D READ Q:$D(RMPFOUT)
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| 77 |  I $D(RMPFQUT) W !!,"Enter <RETURN> to continue or <^> to exit." G CONT
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| 78 |  W @IOF Q
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