source: internationalization/trunk/TranslationSpreadsheets/WV-DIALOG-0025.txt@ 1039

English French  Notes   Complete/Exclude
WARNING:  You are about to access a means test for which a hardship has                 
          been authorized.  If you proceed, the hardship will be removed                        
          and the means test category will be recalculated!  To avoid                   
          this problem, enter NO at the next prompt and use the 'View                   
          a Past Means Test' option should you need to see details of                   
          this means test.                      
Enter NO to stop editing this means test.  Enter YES to continue                        
Do you want to continue editing this means test?                        
Last means test is not PENDING ADJUDICATION.                    
Patient pending adjudication for                        
Last means test is not REQUIRED.                        
No means test to change.                        
MEANS TEST DATE:                        
SOURCE OF TEST:                         
CATEGORY A                      
DG MEANS TEST EVENTS                    
HARDSHIP?                       
CURRENT STATUS                  
TEST DATE                       
CTGRY CHNGD BY                  
DT/TM CTGRY CHNGD                       
TEST STATUS                     
A Hardship has been granted for                         
Only the site granting the Hardship may edit it.                        
Please, contact                         
 to edit the record.                    
Enter <RETURN> to continue.                     
DGMTH HARDSHIP                  
Hardship                        
Current Means Test Status:                      
Income Year:                    
Means Test Date:                        
Agreed To Pay Deductible:                       
Hardship?:                      
Hardship Effective Date:                        
Site Granting Hardship:                         
Approved By:                    
Hardship Reason:                        
Date Category Last Changed:                     
Category Last Changed By:                       
COMMENTS:                       
YOUR DUZ IS NOT DEFINED!                        
PATIENT NOT CURRENTLY RESPONSIBLE FOR COPAYMENT CHARGES!                        
AN ERROR OCCURRED -                     
Pr^408.32:EMZ                   
Means Test Status                       
Hardship Effective Date                 
Hardship Review Date                    
Enter a future date if you wish to conduct a review.                    
Hardship Reason                 
Are you sure that the hardship should be deleted                        
Means Test Menu Options^1N^                     
   Future dates are not allowed.                        
Select    Ending Date:                  
Beginning Date must be prior to Ending Date                     
Agreed to Pay Deductible Listing                        
NO ACTIVE PATIENTS WHO HAVE NOT AGREED TO PAY DEDUCTIBLE                        
Pend Adj                        
Cat. C                  
Active Patients Who Have Not Agreed To Pay Deductible                   
ACTIVE= Sched. Admissions, Dispositions, Pt. Movements, or Clinic Appts.                        
INHOUSE = Current Inpatient                     
PAST    =                       
FUTURE  = After                         
Future Appt. w/ Means Test                      
VAUTC(                  
VAUTD(                  
Do you want to generate letters                 
Enter 'Y'es to generate letters from the listing or                     
Enter 'N'o to produce the listing, but not the letters.                 
THERE ARE NO PATIENTS THAT WILL NEED A                  
 TEST AT THEIR NEXT APPOINTMENT FOR THIS DATE RANGE                     
PEND. ADJ.                      
Patients Requiring Means Test At Next Appointment                       
Copay Exemptions That Will Need Updating At Next Appointment                    
PATIENT ID                      
APPT DATE/TIME                  
No review dates found between selected date range.                      
Hardship Review Date(s)                 
 Patient ID                     
Review Date                     
Hardship Review Output                  
Previous Year Threshold Output                  
Means Test Using Previous Years Threshold                       
Date of Test                    
NO MEANS TEST WITH PREVIOUS YEARS THRESHOLD                     
 TEST STATUS NAME:                      
DGCAT#^DGBEG^DGEND^DGMTYPT                      
 TEST STATUS Report                     
STATUS:                         
No patients found with                  
 test status of                         
No patients found for requested date range.                     
Date of                 
Pend. Adj.                      
Source                  
Test                    
Date of Test:                   
Completion Date/time:                   
By:                     
VA FORM 10-10F                  
DEPARTMENT OF VETERANS AFFAIRS                  
FINANCIAL WORKSHEET                     
THE LAW PROVIDES SEVERE PENALTIES FOR WILLFUL SUBMISSION OF FALSE INFORMATION                   
SEE PAGE 3 FOR PRIVACY ACT AND PAPERWORK REDUCTION ACT INFORMATION                      
Applicant's Name:                       
| Social Security Number:                       
A. Marital Status                       
1. Were you married last calendar year.                 
| 2. Did you live with your spouse                      
| 3. If you did not live with your spouse, show the                     
, go to Section B).                     
| last calendar year. (If                       
| amount you contributed to your spouse's support                       
| to Section B).                        
| last calendar year                            
B. Dependent Children                   
During last calendar year, did you have any UNMARRIED children or stepchildren who are under the age of 18 or between the ages                  
of 18 and 23 and attending school?  OR did you have any unmarried children over the age of 17 who became permanently incapable                  
of self-support before reaching the age of 18?                          
, go to Section C)                      
Child's Name                    
| Did the child                 
| Did you contribute                    
| Did the                       
| Was the child's                       
| incapable of                  
| live with you                 
| to the child's                        
| child have                    
| income available                      
| any income?                   
| to you?                       
C. Previous Calendar Year Gross Income for                      
  (including amounts deducted for taxes, insurance, Medicare, etc.)                     
Type of Income                  
1. Social Security (Not SSI)                    
2. U.S. Civil Service                   
3. U.S. Railroad Retirement                     
4. Military Retirement                  
5. Unemployment Compensation                    
6. Other Retirement (Company, state, local, etc.)                       
7. Total Income from Employment                 
8. Interest, Dividend, or Annuity Income                        
9. Workers Compensation or Black Lung Benefits                  
10. All Other Income                    
11. Total Income                        
E. Previous Calendar Year Net Worth                     
Type of Asset                   
1. Cash, Amounts in Bank Accounts (Include IRA's)                       
2. Stocks and Bonds                     
3. Real Property (Not including your primary residence)                 
(market value of property minus incumbrances)                   
4. Other Property or Assets not Shown Elsewhere                 
5. Debts (Include any debts that will reduce the value                  
of property listed in E4)(Cannot exceed E4)                     
6. Net Worth (Line E1 + E2 + E3 + E4 minus line E5)                     
7. TOTAL (Add items D(11) and E(6))                     
D. Deductible Expenses                  
1. List medical expenses ACTUALLY paid by you during the previous calendar year                 
(include Medicare and other health insurance expenses).                         
2. List amounts paid by you during the previous calendar year for funeral and burial expenses                   
of a deceased spouse or child.                          
3. List amounts paid by you during the previous calendar year for YOUR educational expenses.                    
(Do NOT show spouse's or children's payments)                           
4. Was employment income reported for a child in item C7                        
|     FOR VA USE ONLY                   
| 5. Enter child's income exclusion                     
6. List each child for whom employment income was reported in item C7.                  
| Exclusion from                        
| income from                   
| employment income                     
| and enter                     
| education expenses                    
TO BE COMPLETED BY VA (VETERANS AFFAIRS)                        
7. Child's Reported Employment Income (Item D6(B) above)                        
8. Child's Countable Employment Income (Item D6(F) above)                       
9. Child's Employment Income Exclusion (Subtract Item D8 from Item D7))                 
10. Total Deductible Expenses (Add Items D1, D2, D3 and D9)                     
11. Attributable Income (Subtract Item D10 from C11)                    
Completion of this form with signature of veteran is certification                      
that the veteran has received a copy of the privacy act statement.                      
THE ABOVE INFORMATION IS CORRECT                        
| Signature of Veteran or Designee                      
TO THE BEST OF MY KNOWLEDGE.                    
F.  TO BE COMPLETED BY DISCRETIONARY VETERANS WHO                       
ARE REQUIRED TO MAKE COPAYMENTS                 
Eligibility Category                    
| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare                   
| Deductible plus a per diem for Hospital and Nursing Home care.  A per Visit                   
| Deductible is required for Category C Veterans to receive Outpatient care.                    
| The Billing Period and Rates are specified in 38 U.S.C.                       
I AGREE TO PAY THE VA THE APPLICABLE                    
DEDUCTIBLE FOR MY MEDICAL CARE.                 
HAS NOT AGREED                  
Special Note(s):                        
This means test was administered by the                         
Patient's means test is Pending Adjudication.                   
Patient's means test is No Longer Required.                     
Patient has declined to provide income information.                     
Previous years thresholds were used to determine the patient's eligibility for care.                    
The means test must be re-applied once the correct thresholds are available.                    
Patient's annual income does not match the income associated with the means test.                       
Please edit and complete the means test again.                  
Copay Exemption Test Status is:                         
NON-EXEMPT                      
NO LONGER APPLICABLE                    
PENDING ADJUDICATION                    
MEANS TEST REQUIRED                     
CURRENT MEANS TEST STATUS IS                    
MEANS TEST NO LONGER REQUIRED                   
MEANS TEST EVENT DRIVER                 
Entry with an IEN OF                    
 missing from                   
the ELIGIBILITY CODE file (#8)                  
ELIGIBILITY CODE file (#8) entry with an IEN OF                         
have a valid pointer to the MAS ELIGIBILITY CODE file (#8.1)                    
This Rx Copay Test was automatically created based on a completed means test                    
which was changed to NO LONGER REQUIRED. All data including income                      
screening was copied from the test on                   
LTC copay exemption test. All data including income screening                   
was copied from the test on                     
COMMENTS(                       
Patient                         
 has an invalid secondary eligibility                   
PIMS PACKAGE                    
On                      
has an invalid secondary eligibility                    
XMY(                    
MAILMAN MSG FOR INVALID ELIGIBILITY CODE FILE ENTRIES                   
     Means Test Required                        
DGBUL(                  
Action was taken on the following appointment out and the patient 'REQUIRES' a means test.                      
 Patient ID:                    
Appointment:                    
 Entered By:                    
 Entered On:                    
Patient Relation cannot be setup for patient.                   
Individual Annual Income cannot be setup for patient.                   
Means Test Thresholds are not defined.                  
Please contact your site manager.                       
Do you wish to edit the                         
copay exemption                 
Veteran                 
Spouse                  
Children                        
Social Security (Not SSI)                       
U.S. Civil Service                      
U.S. Railroad Retirement                        
Military Retirement                     
Unemployment Compensation                       
Other Retirement                        
Total Employment Income                 
Interest,Dividend,Annuity                       
Workers Comp or Black Lung                      
All Other Income                        
Total -->                       
Medical Expenses:                       
Funeral and Burial Expenses:                    
Veteran's Educational Expenses:                         
 Child's Education Expenses:                    
Enter:  R to REDISPLAY information on dependent children                        
 to edit information for the child listed after that number                     
Enter CHOICE:                   
Post-secondary education expenses are not applicable for this child.                    
Child's                 
Employment                      
Post-secondary                  
First Name                      
Income                  
Education Expenses                      
Income Thresholds:                      
MT Threshold:                   
GMT Threshold:                  
*Previous Years Thresholds*                     
Cash, Amts in Bank Accts                        
Stocks and Bonds                        
Real Property                   
Other Property or Assets                        
Debts                   
Declines to give income information makes a MT COPAY REQUIRED status.                   
Source of Test is IVM                   
Income of                       
with property of                        
MT COPAY REQUIRED status.                       
 requires property information.                 
Requires property information.                  
 test cannot be completed.                      
...means test status is                         
...copay test status is                         
Do you wish to complete the                     
NOTE: If you do not complete the LTC copay exemption test, the incomplete test                  
will be deleted.                        
Do you wish to complete the copay exemption test                        
DECLINES TO GIVE INCOME INFORMATION                     
Marital section must be completed.                      
Married is 'YES'.  An active spouse for this means test does not exist.                 
An active spouse exists for this means test. Married should be 'YES'.                   
Dependent Children section must be completed.                   
Dependent Children is 'YES'.  No active children exist.                 
A status of                     
####################    ####################    ####################    
####################    ####################    ####################    
####################    ####################    ####################    
####################    ####################    ####################    
####################    ####################    ####################