[604] | 1 | English French Notes Complete/Exclude
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| 2 | TRANSMIT OVERDUE ABSENCE BULLETIN
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| 3 | Y - To search for inpatients overdue from AA, UA and PASS and transmit
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| 4 | bulletin to select mailgroup.
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| 5 | N - If you don't wish to search for overdue absences.
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| 6 | OVERDUE ABSENCES AS OF
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| 7 | ...BACKGROUND SEARCH QUEUED!!
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| 8 | Select AMIS 334-341 MONTH/YEAR:
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| 9 | Results already exist for this month. Do you wish to recalculate
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| 10 | Enter 'YES' to recalculate monthly totals, or 'NO' to print.
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| 11 | Beginning
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| 12 | End
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| 13 | of month statistics are missing for ward
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| 14 | Ward not included in AMIS
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| 15 | AMIS
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| 16 | INTERMEDIATE MEDICINE
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| 17 | REHABILITATION MED
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| 18 | BLIND REHABILITATION
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| 19 | SPINAL CORD INJURY
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| 20 | FOR THIS SEGMENT FIELDS SHOULD BALANCE AS FOLLOWS:
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| 21 | Fields 009 and 010 prior period plus 001,002,003 current period
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| 22 | less fields 004 thru 008 current period must equal fields
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| 23 | 009 and 010 current period.
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| 24 | *** This segment
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| 25 | has Not been Balanced
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| 26 | is Out of Balance
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| 27 | Press RETURN to continue or '^' to stop
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| 28 | Select AMIS 345-346 MONTH/YEAR:
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| 29 | NURSING HOME
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| 30 | less fields 005 thru 008 current period must equal fields
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| 31 | No admissions on file, will check scheduled admissions
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| 32 | Since an admission was not chosen, scheduled admissions for this patient will be checked
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| 33 | No scheduled admissions on file
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| 34 | This report requires 132 column output
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| 35 | NO ADDRESS ON FILE
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| 36 | PRINT THIRD PARTY REVIEW
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| 37 | YES - If you wish to print Third Party Review Sheet
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| 38 | NO - If you don't want to print Third Party Review Sheet
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| 39 | Beneficiary Travel Claim Information <Screen 1>
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| 40 | Claim Date:
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| 41 | PT ID:
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| 42 | Address:
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| 43 | SC%:
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| 44 | Other Elig.:
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| 45 | Disabilities:
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| 46 | Income:
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| 47 | Source of Income:
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| 48 | MEANS TEST
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| 49 | COPAY TEST
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| 50 | INCOME SCREENING
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| 51 | VA CHECK
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| 52 | No. of Dependents:
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| 53 | MT Status:
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| 54 | NOT APPLICABLE
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| 55 | MEANS TEST
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| 56 | BT Income:
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| 57 | NOT RECORDED
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| 58 | Certified Eligible:
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| 59 | Date Certified:
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| 60 | * * * NOTE * * PATIENT HAS BEEN CERTIFIED INELIGIBLE BASED ON INCOME
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| 61 | * * * * Discrepancy exists in incomes reported, please verify * * * *
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| 62 | VERSION 1.0 OF BENEFICIARY TRAVEL HAS NOT BEEN LOADED.
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| 63 | >> Environment check complete and okay.
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| 64 | Updating PACKAGE File...
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| 65 | No PACKAGE entry defined - Cannot update!
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| 66 | Updating PACKAGE file complete.
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| 67 | Re-indexing 'BB' cross-reference.
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| 68 | Beneficiary Travel
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| 69 | SHORT DESCRIPTION field complete.
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| 70 | DESCRIPTION field complete.
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| 71 | FILE field complete.
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| 72 | FIELD field complete.
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| 73 | VERSION 5.3 OF REGISTRATION HAS NOT BEEN LOADED.
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| 74 | BENEFICIARY TRAVEL
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| 75 | REGISTRATION PACKAGE HAS NOT BEEN FOUND
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| 76 | CONTACT - PIMS National VISTA Support Team for assistance!
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| 77 | Visits For:
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| 78 | * * * * ADMITTED ON THIS DATE * * * *
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| 79 | * * * * DISCHARGED ON THIS DATE * * * *
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| 80 | * * * * CURRENTLY AN INPATIENT * * * *
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| 81 | * * * INPATIENT STATUS * * *
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| 82 | Admitted On:
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| 83 | Ward Location:
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| 84 | Discharge Date:
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| 85 | Appointments:
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| 86 | NONE RECORDED FOR THIS DATE
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| 87 | PATIENT/DATE
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| 88 | Elig for Visit:
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| 89 | Appt Type:
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| 90 | Clinic Stop:
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| 91 | NO-SHOW
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| 92 | Past Claims: NONE RECORDED
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| 93 | Date/Time
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| 94 | Account
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| 95 | Deductible
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| 96 | Amt. Paid
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| 97 | Past Claims:
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| 98 | >> WARNING! No ACCOUNT TYPE for this claim, Please correct through Claim Enter/Edit!
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| 99 | Beneficiary Travel Claim Information <Display>
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| 100 | Depart From:
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| 101 | To:
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| 102 | Cert. Date:
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| 103 | Account:
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| 104 | REVIEW VISIT
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| 105 | Most Econ. Cost:
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| 106 | Attend/Payee:
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| 107 | Meals & Lodging:
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| 108 | One Way/
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| 109 | CoreFLS
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| 110 | Carrier
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| 111 | CoreFLS Carrier:
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| 112 | Carrier:
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| 113 | Ferry, Bridges, Etc.:
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| 114 | Round Trip:
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| 115 | ONE WAY
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| 116 | ROUND TRIP
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| 117 | Auth. Person:
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| 118 | Total Mileage Amount:
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| 119 | Mileage/
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| 120 | Applied Deductible:
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| 121 | One Way:
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| 122 | Amount Payable:
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| 123 | Remarks:
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| 124 | MILEAGE REMARKS:
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| 125 | ;@9;9;S DGBTDE=X S:DGBTDE>DGBTTC DGBTDE=DGBTTC,DGBTFLAG=2 S:DGBTDE>DGBTDRM DGBTDE=DGBTDRM,DGBTFLAG=1
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| 126 | DEDUCTIBLE AMOUNT HAS BEEN CHANGED
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| 127 | DEDUCTIBLE AMOUNT CAN NOT EXCEED THE TOTAL COSTS FOR THIS CLAIM
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| 128 | DEDUCTIBLE FOR THIS CLAIM CAN NOT EXCEED THE AMOUNT REMAINING FOR THIS MONTH
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| 129 | This needs to be printed at 132 columns
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| 130 | , DESIGNEE OF CERTIFYING OFFICIAL
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| 131 | VA FORM 70-3542d
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| 132 | TASK #
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| 133 | | VOUCHER FOR CASH REIMBURSEMENT OF BENEFICIARY TRAVEL EXPENSES |
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| 134 | | 2. Name and Address of Issuing Health Care Facility
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| 135 | 1. Patient Data Card Information
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| 136 | | 3. Fiscal Symbols
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| 137 | | 4. From (Place of Departure)
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| 138 | | 6. Miles Traveled
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| 139 | | 7. Authorized Mileage Rate:
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| 140 | | 8. Mileage Allowance (Item 6 X Item 7)
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| 141 | per mile
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| 142 | | 9. Meals & Lodging Costs |
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| 143 | | 11. Total (Sum of 8, 9, and 10)
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| 144 | | 12. Most Economical
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| 145 | | 13. Total (Sum of 9 and 12)
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| 146 | | 14. AMOUNT CLAIMED AND PAYABLE *
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| 147 | | Public Trans. Costs
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| 148 | APPLIED DEDUCTIBLE
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| 149 | | * The amount payable will be the amount entered in Item 11 or Item 13, whichever is less. Exception: If public transportation
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| 150 | | is not reasonably accessible or would be medically inadvisable, the amount payable will be the amount entered in item 11.
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| 151 | | I CERTIFY THAT THE CLAIMANT REPORTED FOR AN AUTHORIZED SERVICE ON THE DATE SHOWN. (Authority VA Regulation 6100 & PL 100-322)
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| 152 | | 15. Date/Time of Claim
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| 153 | | 16. Signature of Certifying Official
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| 154 | | I have neither obtained transportation at Government expense nor through the use of Government request, tickets, or tokens;
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| 155 | | and have not used any Government-owned conveyance or incurred any expenses which may be presented as charges against the
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| 156 | | Dept. of Veterans Affairs for transportation, meals, or lodging in connection with my authorized travel that is not herein
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| 157 | | claimed. I hereby claim the amount entered in Item 14 above. I certify that the claim is correct and just and that payment
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| 158 | | has not been received.
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| 159 | | I hereby acknowledge receipt, in cash or check to be mailed, of the amount in Item 14 above, in full payment of this claim.
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| 160 | | 17. Signature of Payee
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| 161 | REMARKS:
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| 162 | ACCOUNT:
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| 163 | REVIEW VISIT
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| 164 | AUDIT BLOCK
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| 165 | AMOUNT PAID FOUND CORRECT
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| 166 | Auditor's Initials
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| 167 | VA Form 70-3542d
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| 168 | DO YOU WANT TO QUERY CoreFLS FOR A VENDOR
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| 169 | SITE_CODE
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| 170 | ** COMMUNICATIONS SERVICE LIBRARY (CSL) PACKAGE NOT INSTALLED **
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| 171 | ** CoreFLS national database query **
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| 172 | ** LOCAL VENDOR (#392.31) File updated. **
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| 173 | Unsuccessful Query!
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| 174 | ** CoreFLS Query **
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| 175 | **COREFLS Vendor interface is not active.
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| 176 | No Problems were found in the Distance Data.
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| 177 | Enter Departure City
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| 178 | Enter the name for the departure city
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| 179 | Name must be free text, 1-30 characters in length
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| 180 | FILE IN USE, PLEASE TRY AGAIN LATER
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| 181 | Enter another division for this departure city
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| 182 | Enter a 'Y'es to add or enter another division, or 'N'o to exit to the Departure City prompt
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| 183 | CITY OR TOWN
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| 184 | THE MILEAGE FOR THE SELECTED DIVISION WILL BE USED AS THE
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| 185 | DEFAULT MILEAGE FOR THIS DEPARTURE CITY.
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| 186 | Enter the CITY as the point of origin. The MILEAGE/ONE-WAY
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| 187 | is the distance from the CITY to the Medical Center Division.
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| 188 | INCOMPLETE INFORMATION WAS ENTERED, BOTH THE STATE AND ZIP CODE
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| 189 | ARE REQUIRED, RECORD DELETED
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| 190 | You can either correct these problems, or add a new departure city.
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| 191 | CORRECT PROBLEMS
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| 192 | ***WARNING...MEDICAL CENTER DIVISION FILE IS NOT SET UP
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| 193 | >> ONE OR MORE ADDITIONAL INFORMATION FIELDS NEED TO BE COMPLETED
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| 194 | >> ONE OR MORE ZIP CODES ARE MISSING
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| 195 | >> ONE OR MORE DEFAULT MILEAGES ARE MISSING OR SET TO ZERO
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| 196 | WARNING...MEDICAL CENTER DIVISION FILE IS NOT SET UP
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| 197 | USE THE ADT PARAMETER OPTION FILE TO SET UP DIVISION
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| 198 | Select DIVISION:
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| 199 | ***WARNING...BENE TRAVEL PARAMETERS HAVE NOT BEEN SET UP
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| 200 | USE THE BENEFICIARY TRAVEL PARAMETER RATES ENTER/EDIT OPTION TO PROPERLY INITIALIZE
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| 201 | Eligibility is missing from registration and is required to continue.
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| 202 | Continue processing claim
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| 203 | Sorry, enter 'Y'es or RETURN to continue procesing claim, 'N'o to exit
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| 204 | Complete claim for
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| 205 | SORRY, '^' NOT ALLOWED
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| 206 | ENTER 'Y'ES OR 'N'O
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| 207 | INSTITUTION HAS NOT BEEN DEFINED FOR
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| 208 | USE THE ADT PARAMETER OPTION TO UPDATE
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| 209 | INSTITUTION ADDRESS NOT ENTERED. PLEASE UPDATE USING THE INSTITUTION FILE ENTER/EDIT
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| 210 | Enter a 'P' to display Past CLAIM dates for editing.
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| 211 | Time is required when adding a new CLAIM.
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| 212 | Select TRAVEL CLAIM DATE/TIME
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| 213 | There are other claims on this date.
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| 214 | Select by number to edit or <RETURN> to add a new CLAIM.
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| 215 | Select 1
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| 216 | , or <RETURN> to add a new claim:
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| 217 | Select, by number, one of the displayed claim dates:
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| 218 | Are you sure you want to add a new claim
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| 219 | Enter 'YES' to add a new claim, or 'NO' not to add the claim.
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| 220 | There are no entries on file for this patient
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| 221 | Select CLAIM
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| 222 | Type '^' to exit date list, or <RETURN> to display more dates
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| 223 | Entering a '^' will exit the Past CLAIM list, entering <RETURN> will continue to scroll through past dates.
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| 224 | Select a Past CLAIM date by number, or enter 'N' for NOW.
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| 225 | INVALID ENTRY!
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| 226 | Time is required when adding a new CLAIM date.
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| 227 | If there is more than one claim per date, select by number to edit.
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| 228 | Please wait, Checking Mileage ...
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| 229 | DEFAULT MILEAGE USED
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| 230 | Module has not been properly initialized - to continue you should first complete
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| 231 | the parameters
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| 232 | Beneficiary Travel Claim Information <Enter/Edit>
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| 233 | Another user is editing this entry.
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| 234 | Select ELIGIBILITY
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| 235 | SORRY, '^' NOT ALLOWED!!
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| 236 | ELIGIBILITY REQUIRED.
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| 237 | Choose by NUMBER the primary eligibility or other entitled eligibilities
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| 238 | Choose 1-
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| 239 | Enter choice from those displayed
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| 240 | Select ELIGIBILITY:
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| 241 | Select ACCOUNT:
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| 242 | ACCOUNT IS REQUIRED!!
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| 243 | ;9;S DGBTDE=X S:DGBTDE>DGBTTC DGBTDE=DGBTTC,DGBTFlAG=2 S:DGBTDE>DGBTDRM DGBTDE=DGBTDRM,DGBTFLAG=1
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| 244 | Primary and other entitled eligibilities for patient:
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| 245 | Last Certification:
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| 246 | Eligible:
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| 247 | Amount Certified:
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| 248 | 'A'DD A NEW DATE, 'E'DIT EXISTING OR 'Q'UIT:
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| 249 | ENTER A - to 'A'dd a new certification date
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| 250 | E - to 'E'dit an existing entry for this patient
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| 251 | Select CERTIFICATION DATE:
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| 252 | There is already a certification for
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| 253 | Only one certification per date is necessary.
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| 254 | REPORTED MEANS TEST INCOME:
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| 255 | There are no computer entries on file for this patient.
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| 256 | Enter the date of annual certification.
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| 257 | Time is required when adding a new certification date.
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| 258 | Future dates are not allowed.
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| 259 | New travel rates are determined each fiscal year. The rates should be
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| 260 | entered each year with the effective date of Oct 1.
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| 261 | Changing values for the current or past fiscal years could result in changes
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| 262 | to the claims already entered.
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| 263 | Select EFFECTIVE DATE
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| 264 | ACCOUNT TYPES are determined by Fiscal Service and have a direct impact
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| 265 | on the type of questions asked in the Beneficiary Travel CLAIM ENTER/EDIT
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| 266 | DO NOT add to this file unless so instructed by Fiscal Service.
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| 267 | Select ACCOUNT
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| 268 | You are about to enter/edit Bene Travel account types. Although
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| 269 | this process is now decentralized, changes and additions should be
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| 270 | made with extreme care.
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| 271 | Would you like to Enter/Edit another ACCOUNT
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| 272 | ENTER DEDUCTIBLE AMOUNT/
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| 273 | Type a dollar amount between 0 and
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| 274 | with up to 2 decimal places.
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| 275 | -- Deductible exceeds limit.
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| 276 | The effective date must start on the fiscal year, Oct 1.
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| 277 | <I>nformation, <D>isplay claim, <E>dit claim,
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| 278 | <P>rint form,
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| 279 | Quit
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| 280 | Do you want to delete this claim
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| 281 | This claim is incomplete and is now being deleted.....
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| 282 | You may choose from the following:
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| 283 | <I>nformation - to view the two informational screens
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| 284 | <D>isplay - to view this claim
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| 285 | <E>d it - to change this claim
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| 286 | <P>rint - to print form 70-3542d (132 columns)
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| 287 | <Q>uit - to exit from this option
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| 288 | ADD:
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| 289 | PH:
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| 290 | NO:
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| 291 | FAX:
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| 292 | ****THIS VENDOR IS INACTIVE
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| 293 | INTERN'L
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| 294 | Enter beginning date:
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| 295 | Enter ending date:
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| 296 | The ending date cannot be before the beginning date
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| 297 | Future dates are not allowed
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| 298 | Sort output by:
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| 299 | Select one from the above list
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| 300 | Sort Bene Travel claims by one of the following:
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| 301 | A for Account
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| 302 | C for Carrier
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| 303 | #################### #################### ####################
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| 304 | #################### #################### ####################
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| 305 | #################### #################### ####################
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| 306 | #################### #################### ####################
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| 307 | #################### #################### ####################
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