source: internationalization/trunk/TranslationSpreadsheets/WV-DIALOG-0025.txt@ 604

Last change on this file since 604 was 604, checked in by George Lilly, 15 years ago

Internationalization

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1English French Notes Complete/Exclude
2WARNING: You are about to access a means test for which a hardship has
3 been authorized. If you proceed, the hardship will be removed
4 and the means test category will be recalculated! To avoid
5 this problem, enter NO at the next prompt and use the 'View
6 a Past Means Test' option should you need to see details of
7 this means test.
8Enter NO to stop editing this means test. Enter YES to continue
9Do you want to continue editing this means test?
10Last means test is not PENDING ADJUDICATION.
11Patient pending adjudication for
12Last means test is not REQUIRED.
13No means test to change.
14MEANS TEST DATE:
15SOURCE OF TEST:
16CATEGORY A
17DG MEANS TEST EVENTS
18HARDSHIP?
19CURRENT STATUS
20TEST DATE
21CTGRY CHNGD BY
22DT/TM CTGRY CHNGD
23TEST STATUS
24A Hardship has been granted for
25Only the site granting the Hardship may edit it.
26Please, contact
27 to edit the record.
28Enter <RETURN> to continue.
29DGMTH HARDSHIP
30Hardship
31Current Means Test Status:
32Income Year:
33Means Test Date:
34Agreed To Pay Deductible:
35Hardship?:
36Hardship Effective Date:
37Site Granting Hardship:
38Approved By:
39Hardship Reason:
40Date Category Last Changed:
41Category Last Changed By:
42COMMENTS:
43YOUR DUZ IS NOT DEFINED!
44PATIENT NOT CURRENTLY RESPONSIBLE FOR COPAYMENT CHARGES!
45AN ERROR OCCURRED -
46Pr^408.32:EMZ
47Means Test Status
48Hardship Effective Date
49Hardship Review Date
50Enter a future date if you wish to conduct a review.
51Hardship Reason
52Are you sure that the hardship should be deleted
53Means Test Menu Options^1N^
54 Future dates are not allowed.
55Select Ending Date:
56Beginning Date must be prior to Ending Date
57Agreed to Pay Deductible Listing
58NO ACTIVE PATIENTS WHO HAVE NOT AGREED TO PAY DEDUCTIBLE
59Pend Adj
60Cat. C
61Active Patients Who Have Not Agreed To Pay Deductible
62ACTIVE= Sched. Admissions, Dispositions, Pt. Movements, or Clinic Appts.
63INHOUSE = Current Inpatient
64PAST =
65FUTURE = After
66Future Appt. w/ Means Test
67VAUTC(
68VAUTD(
69Do you want to generate letters
70Enter 'Y'es to generate letters from the listing or
71Enter 'N'o to produce the listing, but not the letters.
72THERE ARE NO PATIENTS THAT WILL NEED A
73 TEST AT THEIR NEXT APPOINTMENT FOR THIS DATE RANGE
74PEND. ADJ.
75Patients Requiring Means Test At Next Appointment
76Copay Exemptions That Will Need Updating At Next Appointment
77PATIENT ID
78APPT DATE/TIME
79No review dates found between selected date range.
80Hardship Review Date(s)
81 Patient ID
82Review Date
83Hardship Review Output
84Previous Year Threshold Output
85Means Test Using Previous Years Threshold
86Date of Test
87NO MEANS TEST WITH PREVIOUS YEARS THRESHOLD
88 TEST STATUS NAME:
89DGCAT#^DGBEG^DGEND^DGMTYPT
90 TEST STATUS Report
91STATUS:
92No patients found with
93 test status of
94No patients found for requested date range.
95Date of
96Pend. Adj.
97Source
98Test
99Date of Test:
100Completion Date/time:
101By:
102VA FORM 10-10F
103DEPARTMENT OF VETERANS AFFAIRS
104FINANCIAL WORKSHEET
105THE LAW PROVIDES SEVERE PENALTIES FOR WILLFUL SUBMISSION OF FALSE INFORMATION
106SEE PAGE 3 FOR PRIVACY ACT AND PAPERWORK REDUCTION ACT INFORMATION
107Applicant's Name:
108| Social Security Number:
109A. Marital Status
1101. Were you married last calendar year.
111| 2. Did you live with your spouse
112| 3. If you did not live with your spouse, show the
113, go to Section B).
114| last calendar year. (If
115| amount you contributed to your spouse's support
116| to Section B).
117| last calendar year
118B. Dependent Children
119During last calendar year, did you have any UNMARRIED children or stepchildren who are under the age of 18 or between the ages
120of 18 and 23 and attending school? OR did you have any unmarried children over the age of 17 who became permanently incapable
121of self-support before reaching the age of 18?
122, go to Section C)
123Child's Name
124| Did the child
125| Did you contribute
126| Did the
127| Was the child's
128| incapable of
129| live with you
130| to the child's
131| child have
132| income available
133| any income?
134| to you?
135C. Previous Calendar Year Gross Income for
136 (including amounts deducted for taxes, insurance, Medicare, etc.)
137Type of Income
1381. Social Security (Not SSI)
1392. U.S. Civil Service
1403. U.S. Railroad Retirement
1414. Military Retirement
1425. Unemployment Compensation
1436. Other Retirement (Company, state, local, etc.)
1447. Total Income from Employment
1458. Interest, Dividend, or Annuity Income
1469. Workers Compensation or Black Lung Benefits
14710. All Other Income
14811. Total Income
149E. Previous Calendar Year Net Worth
150Type of Asset
1511. Cash, Amounts in Bank Accounts (Include IRA's)
1522. Stocks and Bonds
1533. Real Property (Not including your primary residence)
154(market value of property minus incumbrances)
1554. Other Property or Assets not Shown Elsewhere
1565. Debts (Include any debts that will reduce the value
157of property listed in E4)(Cannot exceed E4)
1586. Net Worth (Line E1 + E2 + E3 + E4 minus line E5)
1597. TOTAL (Add items D(11) and E(6))
160D. Deductible Expenses
1611. List medical expenses ACTUALLY paid by you during the previous calendar year
162(include Medicare and other health insurance expenses).
1632. List amounts paid by you during the previous calendar year for funeral and burial expenses
164of a deceased spouse or child.
1653. List amounts paid by you during the previous calendar year for YOUR educational expenses.
166(Do NOT show spouse's or children's payments)
1674. Was employment income reported for a child in item C7
168| FOR VA USE ONLY
169| 5. Enter child's income exclusion
1706. List each child for whom employment income was reported in item C7.
171| Exclusion from
172| income from
173| employment income
174| and enter
175| education expenses
176TO BE COMPLETED BY VA (VETERANS AFFAIRS)
1777. Child's Reported Employment Income (Item D6(B) above)
1788. Child's Countable Employment Income (Item D6(F) above)
1799. Child's Employment Income Exclusion (Subtract Item D8 from Item D7))
18010. Total Deductible Expenses (Add Items D1, D2, D3 and D9)
18111. Attributable Income (Subtract Item D10 from C11)
182Completion of this form with signature of veteran is certification
183that the veteran has received a copy of the privacy act statement.
184THE ABOVE INFORMATION IS CORRECT
185| Signature of Veteran or Designee
186TO THE BEST OF MY KNOWLEDGE.
187F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO
188ARE REQUIRED TO MAKE COPAYMENTS
189Eligibility Category
190| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare
191| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit
192| Deductible is required for Category C Veterans to receive Outpatient care.
193| The Billing Period and Rates are specified in 38 U.S.C.
194I AGREE TO PAY THE VA THE APPLICABLE
195DEDUCTIBLE FOR MY MEDICAL CARE.
196HAS NOT AGREED
197Special Note(s):
198This means test was administered by the
199Patient's means test is Pending Adjudication.
200Patient's means test is No Longer Required.
201Patient has declined to provide income information.
202Previous years thresholds were used to determine the patient's eligibility for care.
203The means test must be re-applied once the correct thresholds are available.
204Patient's annual income does not match the income associated with the means test.
205Please edit and complete the means test again.
206Copay Exemption Test Status is:
207NON-EXEMPT
208NO LONGER APPLICABLE
209PENDING ADJUDICATION
210MEANS TEST REQUIRED
211CURRENT MEANS TEST STATUS IS
212MEANS TEST NO LONGER REQUIRED
213MEANS TEST EVENT DRIVER
214Entry with an IEN OF
215 missing from
216the ELIGIBILITY CODE file (#8)
217ELIGIBILITY CODE file (#8) entry with an IEN OF
218have a valid pointer to the MAS ELIGIBILITY CODE file (#8.1)
219This Rx Copay Test was automatically created based on a completed means test
220which was changed to NO LONGER REQUIRED. All data including income
221screening was copied from the test on
222LTC copay exemption test. All data including income screening
223was copied from the test on
224COMMENTS(
225Patient
226 has an invalid secondary eligibility
227PIMS PACKAGE
228On
229has an invalid secondary eligibility
230XMY(
231MAILMAN MSG FOR INVALID ELIGIBILITY CODE FILE ENTRIES
232 Means Test Required
233DGBUL(
234Action was taken on the following appointment out and the patient 'REQUIRES' a means test.
235 Patient ID:
236Appointment:
237 Entered By:
238 Entered On:
239Patient Relation cannot be setup for patient.
240Individual Annual Income cannot be setup for patient.
241Means Test Thresholds are not defined.
242Please contact your site manager.
243Do you wish to edit the
244copay exemption
245Veteran
246Spouse
247Children
248Social Security (Not SSI)
249U.S. Civil Service
250U.S. Railroad Retirement
251Military Retirement
252Unemployment Compensation
253Other Retirement
254Total Employment Income
255Interest,Dividend,Annuity
256Workers Comp or Black Lung
257All Other Income
258Total -->
259Medical Expenses:
260Funeral and Burial Expenses:
261Veteran's Educational Expenses:
262 Child's Education Expenses:
263Enter: R to REDISPLAY information on dependent children
264 to edit information for the child listed after that number
265Enter CHOICE:
266Post-secondary education expenses are not applicable for this child.
267Child's
268Employment
269Post-secondary
270First Name
271Income
272Education Expenses
273Income Thresholds:
274MT Threshold:
275GMT Threshold:
276*Previous Years Thresholds*
277Cash, Amts in Bank Accts
278Stocks and Bonds
279Real Property
280Other Property or Assets
281Debts
282Declines to give income information makes a MT COPAY REQUIRED status.
283Source of Test is IVM
284Income of
285with property of
286MT COPAY REQUIRED status.
287 requires property information.
288Requires property information.
289 test cannot be completed.
290...means test status is
291...copay test status is
292Do you wish to complete the
293NOTE: If you do not complete the LTC copay exemption test, the incomplete test
294will be deleted.
295Do you wish to complete the copay exemption test
296DECLINES TO GIVE INCOME INFORMATION
297Marital section must be completed.
298Married is 'YES'. An active spouse for this means test does not exist.
299An active spouse exists for this means test. Married should be 'YES'.
300Dependent Children section must be completed.
301Dependent Children is 'YES'. No active children exist.
302A status of
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