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WV-DIALOG-0016.txt@ 1099

Last change on this file since 1099 was 604, checked in by George Lilly, 15 years ago
Internationalization
File size: 9.2 KB

Line
1	English French Notes Complete/Exclude
2	Do you wish to return to Screen #9 to enter missing Income Data?
3	A means test for this encounter date was not found and may be required!
4	Further investigation will be needed.
5	Press ENTER to continue
6	Patient Requires a means Test
7	Primary Means Test Required from '
8	SCENI MEANS TEST EDIT
9	You do not have the appropriate IEMM Security Key. Contact your supervisor.
10	Do you wish to proceed with the means test at this time
11	No registrations to print from.
12	Registration date/time:
13	Enter the date and time, Entry #, or 'L' for the last registration,
14	to select the registration you wish to print a 10/10 for.
15	This output requires 132 column output to a PRINTER.
16	Output to SCREEN will be unreadable.
17	FACILITY NOT IDENTIFIED
18	APPLICATION FOR MEDICAL BENEFITS
19	PRINT
20	ENTER 'Y'ES TO PRINT A
21	. OTHERWISE ENTER 'N'O.
22	NOT APPLICABLE
23	SEE ATTACHMENT FOR PAPERWORK REDUCTION INFORMATION AND PRIVACY ACT INFORMATION
24	PART I - PATIENT DATA
25	1. Type of benefit applied for:
26	HOSPITAL/OUTPATIENT TREATMENT^DOMICILIARY CARE^HOSPITAL/OUTPATIENT TREATMENT^OUTPATIENT DENTAL^NURSING HOME CARE
27	3. Other names used (Alias)
28	4. Social Security Number
29	5. Claim Number
30	\| 6. LOCATION OF CLAIMS FOLDER
31	\| 7. DATE OF BIRTH
32	\| 8. PLACE OF BIRTH
33	9. PERMANENT ADDRESS
34	10. TEMPORARY ADDRESS
35	9A. STREET ADDRESS:
36	10A. STREET ADDRESS:
37	9D. ZIP CODE:
38	10D. ZIP CODE:
39	9F. HOME TELEPHONE NUMBER:
40	10F. HOME TELEPHONE NUMBER:
41	11. CONFIDENTIAL ADDRESS
42	Not Applicable
43	11A. STREET ADDRESS:
44	11D. ZIP CODE:
45	\| 11F. START DATE:
46	\| STOP DATE:
47	11G. Active Confidential Address Categories
48	13. MOTHER'S MAIDEN NAME
49	16. RELIGIOUS PREFERENCE
50	17. DATE OF PREVIOUS CARE
51	18. LOCATION OF PREVIOUS CARE
52	19. SPINAL CORD INJURY
53	PARAPLEGIA-TRAUMATIC
54	QUADRIPLEGIA-TRAUMATIC
55	PARAPLEGIA-NONTRAUMATIC
56	QUADRIPLEGIA-NONTRAUMATIC
57	PART II - EMERGENCY CONTACT DATA
58	1A. FIRST NEXT OF KIN
59	2A. SECOND NEXT OF KIN
60	3A. FIRST CONTACT IN AN EMERGENCY
61	4A. SECOND CONTACT IN AN EMERGENCY
62	C. HOME TELEPHONE NUMBER
63	D. WORK TELEPHONE NUMBER
64	E. ADDRESS (Number, Street, City, State, ZIP Code)
65	Reg Date/Time:
66	PRINTED:
67	Clerk:
68	AUTOMATED VA FORM 10-10
69	PART III - APPLICANT/SPOUSE DATA
70	1. APPLICANT'S EMPLOYMENT STATUS:
71	2. SPOUSE'S EMPLOYMENT STATUS:
72	3. APPLICANT INFORMATION
73	3B. EMPLOYER (Name, Street Address, City, State, Zip)
74	4B. EMPLOYER (Name, Street Address, City, State, Zip)
75	3C. WORK TELEPHONE NUMBER:
76	4C. WORK TELEPHONE NUMBER:
77	NOT ANSWERED
78	PART IV - MILITARY SERVICE DATA
79	1A. LAST BRANCH OF SERVICE
80	1B. LAST SERVICE NUMBER
81	1C. LAST DATE OF ENTRY
82	1D. LAST DISCHARGE DATE
83	1E. DISCHARGE TYPE
84	2A. PRIOR BRANCH OF SERVICE
85	2B. PRIOR SERVICE NUMBER
86	2C. PRIOR DATE OF ENTRY
87	2D. PRIOR DISCHARGE DATE
88	2E. DISCHARGE TYPE
89	3A. PRIOR BRANCH OF SERVICE
90	3B. PRIOR SERVICE NUMBER
91	3C. PRIOR DATE OF ENTRY
92	3D. PRIOR DISCHARGE DATE
93	3E. DISCHARGE TYPE
94	PART V - ELIGIBILITY STATUS DATA
95	1. PATIENT TYPE:
96	2. IS NEED FOR MEDICAL CARE RELATED TO AN
97	3. IS THE NEED FOR MEDICAL CARE RELATED
98	4. IS PATIENT ELIGIBLE FOR MEDICAID:
99	ON THE JOB INJURY:
100	TO AN ACCIDENT:
101	5A. DOES PATIENT HAVE HEALTH INSURANCE
102	5B. IF YES, COVERAGE PROVIDED BY:
103	COVERAGE:
104	PATIENT'S INSURANCE
105	SPOUSE'S INSURANCE
106	NO ACTIVE (UNEXPIRED) INSURANCE ON FILE FOR THIS APPLICANT
107	6. DOES VETERAN HAVE GI
108	7. PRIMARY ELIGIBILITY CODE
109	8. OTHER ELIGIBILITY CODE
110	9. PERIOD OF SERVICE
111	INSURANCE:
112	10. SERVICE CONNECTED CONDITIONS AS STATED BY APPLICANT:
113	10. RATED SERVICE CONNECTED CONDITIONS:
114	NO RATED SERVICE-CONNECTED CONDITIONS
115	10. SERVICE CONNECTED CONDITIONS:
116	NOT APPLICABLE: NOT A SERVICE-CONNECTED APPLICANT
117	PART VI - INCOME SCREENING DATA OR ANNUAL INCOME
118	1A. CURRENT MARITAL STATUS:
119	1B. DATE OF MARRIAGE:
120	2A. WAS PATIENT MARRIED OR SEPARATED AT THE END OF LAST CALENDAR YEAR?:
121	2B. NAME OF SPOUSE
122	2C. SEX OF SPOUSE
123	2D. SPOUSE'S SOCIAL SECURITY NO
124	2E. SPOUSE'S DATE OF BIRTH
125	B. SOCIAL SECURITY NO
126	D. DATE OF BIRTH
127	F. DEPENDENT AS
128	NONE INDICATED
129	4. PREVIOUS CALENDAR YEAR (
130	) INCOME INFORMATION
131	CHECK ALL APPLICABLE BOXES
132	11. TOTAL INCOME
133	PART VII - INELIGIBLE/MISSING DATA
134	1. INELIGIBLE DATE
135	2. TWX SOURCE
136	3. TWX CITY
137	4. TWX STATE
138	6. VACO DECISION:
139	7. MISSING DATE
140	8. TWX SOURCE
141	9. TWX CITY
142	10. TWX STATE
143	1. ELIGIBILITY STATUS
144	2. STATUS DATE
145	3. STATUS ENTERED BY
146	PENDING VERIFICATION
147	RE-VERIFY
148	4. VERIFICATION METHOD
149	5. SERVICE VERIFICATION DATE
150	6. RATED DISABILITIES
151	SIGNATURE OF APPLICANT OR APPLICANT'S REPRESENTATIVE
152	FOR VA USE ONLY
153	VA FACILITY NUMBER
154	ADMISSION DATE
155	AUTHORITY FOR ADMISSION OR TREATMENT
156	SUPPLEMENTAL DATA SHEET
157	HEALTH SUMMARY
158	DRUG PROFILE
159	ENCOUNTER FORMS
160	No Type Selected. HS will not print
161	Select type of Drug Profile
162	11. OTHER ELIGIBILITY DATA
163	L. SERVICE IN PERSIAN GULF THEATER
164	B. PRISONER OF WAR STATUS
165	M. DENTAL INJ. \|
166	TEETH EXTRACTED
167	C. EXPOSURE TO AGENT ORANGE
168	N. SERVICE CONNECTED
169	D. EXPOSURE TO RADIATION
170	O. RECEIVING AID & ATTENDANCE
171	E. COMBAT SERVICE
172	P. RECEIVING HOUSEBOUND
173	F. MILITARY DISABILITY
174	Q. RECEIVING VA PENSION
175	G. VIETNAM SERVICE
176	R. RECEIVING VA DISABILITY
177	H. LEBANON SERVICE
178	S. SERVICE IN SOMALIA
179	I. GRENADA SERVICE
180	T. SERVICE IN YUGOSLAVIA
181	J. PANAMA SERVICE
182	U. PURPLE HEART RECIPIENT
183	K. PERSIAN GULF SERVICE
184	V. VA MONETARY AMOUNT:
185	3. Other Name(s):
186	NO ALIAS' ON FILE
187	NO REMARKS CURRENTLY ENTERED FOR THIS APPLICANT
188	5. Fathers Name:
189	NOT SPECIFIED
190	Mothers Name:
191	Mothers Maiden Name:
192	6a. Enrollment Clinic(s):
193	NOT ACTIVELY ENROLLED IN ANY CLINICS AT THIS TIME
194	6b. Future Appointments:
195	NO PENDING APPOINTMENTS ON FILE
196	7a. Last Admission:
197	NO PREVIOUS ADMISSIONS TO THIS FACILITY ON FILE
198	LAST ADMISSION PTF DATA NO LONGER STORED
199	7b. Discharge Diagnosis(es):
200	NO DIAGNOSES ON FILE FOR THIS ADMISSION PERIOD YET
201	7c. Admit Diagnosis:
202	7d. Diagnosis Responsible for Greatest Length of Stay:
203	8. Eligibility Status:
204	PENDING RE-VERIFICATION
205	UNKNOWN OR NONE
206	\| Status Date:
207	Verification Method:
208	ELIGIBLE APPLICANT -- NOT APPLICABLE
209	Ineligible Date:
210	CITY UNKNOWN
211	STATE UNKNOWN
212	VARO DECISION UNKNOWN
213	\| TWX Source:
214	TWX City:
215	\| TWX State:
216	VARO Decision:
217	9. Vietnam Service:
218	From:
219	To :
220	Agent Orange:
221	Reg :
222	Exam :
223	Reg #:
224	Loc:
225	ION Radiation:
226	Method:
227	Prisoner of War:
228	Where:
229	Combat:
230	Purple Heart:
231	Status:
232	Remarks:
233	10. Next of Kin, Address and Zip Code:
234	Name:
235	KOREAN DMZ
236	NAGASAKI/HIROSHIMA
237	NUCLEAR TESTING
238	NUCLEAR TESTING & NAGASAKI/HIROSHIMA
239	STREET ADDRESS UNKNOWN
240	CITY STATE UNKNOWN
241	GLOBAL SUBSCRIPT LOCATION
242	Unknown/Invalid pointer, DD(
243	GLOBAL NAME
244	Cannot convert the
245	in the
246	File 11 and 13 Conversion Problem list
247	MARITAL STATUS (#11) File Conversion Problems:
248	RELIGION (#13) File Converion Problems:
249	No problems
250	Pointer File/Subfile^Field^Problem Description
251	DG5.3172
252	DGY(
253	File 11 and 13 Conversion Problems
254	* Conversion is not necessary! *
255	Uninstalling patch...
256	* Not all non-standard entries have been mapped...see DG172 options *
257	* Job appears to already be running! *
258	Are you sure you want to start the conversion process
259	Marital/Religion File Conversion
260	Are you sure you want to stop the background conversion process
261	* Job will stop soon *
262	* Conversion process is NOT running! *
263	RGPR PRE-IMP MENU
264	DG172
265	RELIGION/MARITAL STATUS REINDEX
266	Reindex Religion and Marital Status file xrefs ...
267	Setting up files that need to be converted...
268	Setting up standard/non-standard mapping file...
269	You can not re-start this process!
270	* No mapping necessary! *
271	Select Non-Standard
272	Marital Status:
273	Religion:
274	Religion/Marital Status Conversion
275	Conversion Finished
276	DG172(1,
277	Conversion NOT Finished
278	The conversion process appears to have been stopped.
279	To finish the conversion process, restart by using
280	the 'Begin Religion/Marital Status Conversion' option
281	on the CIRN Pre-Implementation Menu.
282	Marital Status
283	Religion
284	File Non-Standard Entries:
285	All non-standard entries listed above have been removed
286	from their respective files.
287	Entry:
288	repointed to:
289	Starting post-install process...
290	Post-install process has completed.
291	total records have been identified and corrected.
292	Report cancelled!
293	Means Test Update Report
294	Updated Means Test Listing
295	Run Date:
296	Veteran Name
297	Veteran SSN
298	Year
299	Old Status
300	New Status
301	Income Year
302	Old Means Test Status
303	#################### #################### ####################
304	#################### #################### ####################
305	#################### #################### ####################
306	#################### #################### ####################
307	#################### #################### ####################

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