[604] | 1 | English French Notes Complete/Exclude
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| 2 | Y - If you want to purge data.
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| 3 | N - If you don't wish to purge data.
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| 4 | Purge patients not seen since:
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| 5 | SELECT A DATE IN THE PAST PLEASE!!
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| 6 | I'm going to purge all patients from the INCONSISTENT DATA file who haven't been
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| 7 | admitted or registered since
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| 8 | Is this correct
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| 9 | Y - To start the purge process.
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| 10 | N - To QUIT.
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| 11 | Generate a listing of inconsistent data elements by:
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| 12 | CHOOSE OUTPUT METHOD OR ENTER '^' TO QUIT:
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| 13 | The available choices are:
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| 14 | Go To
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| 15 | List by (N)ame or (T)erminal Digit:
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| 16 | N - To generate listing in Alphabetical Order
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| 17 | T - To generate listing in Terminal Digit Order.
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| 18 | THIS OUTPUT REQUIRES 132 COLUMN OUTPUT
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| 19 | INCONSISTENT ELEMENTS FOR PATIENTS WITH A
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| 20 | Missing
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| 21 | Last Day
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| 22 | Home Phone #
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| 23 | Soc Sec #
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| 24 | ID'ed
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| 25 | Edited by
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| 26 | Inconsistent/Missing Data Elements
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| 27 | TABLE OF INCONSISTENT/MISSING DATA ELEMENTS
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| 28 | UNIDENTIFIED PATIENT #
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| 29 | Do you want to delete the existing entries and rebuild the file
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| 30 | Y - If you want to remove all existing entries from the INCONSISTENT DATA
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| 31 | file and rebuild from scratch.
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| 32 | N - If you just want to add newly identified inconsistencies to the
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| 33 | existing file.
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| 34 | Rebuild for patients seen since what date:
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| 35 | I'm going to check all patients who were admitted or registered on or after
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| 36 | [Within the Past
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| 37 | DELETE all existing entries prior to rebuilding
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| 38 | add any new inconsistent data elements to the existing file
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| 39 | Y - If this is what you want to do.
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| 40 | N - If you wish to STOP processing and reconsider this action.
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| 41 | INCONSISTENT DATA^38.5P^^0
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| 42 | ' OPTION RUNNING FROM
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| 43 | UNABLE TO RUN THIS OPTION AT CURRENT TIME!!
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| 44 | Do you really want to update existing inconsistent entries
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| 45 | Y - If you want me to run through all the entries currently filed in
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| 46 | the INCONSISTENT DATA file and verify they're still inconsistent.
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| 47 | N - If you wish to QUIT and rethink this action.
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| 48 | This check can not be edited. It is automatically turned
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| 49 | Temporary:
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| 50 | POS:
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| 51 | Claim #:
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| 52 | Relig:
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| 53 | Ethnicity:
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| 54 | Primary Eligibility:
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| 55 | PENDING REVERIFICATION
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| 56 | Other Eligibilities:
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| 57 | Confidential Address:
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| 58 | From/To: NOT APPLICABLE
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| 59 | From/To:
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| 60 | COORDINATING MASTER OF RECORD:
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| 61 | Scheduled Admit
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| 62 | for treating specialty
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| 63 | Currently enrolled in
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| 64 | Future Appointments:
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| 65 | See Scheduling options for additional appointments.
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| 66 | * NO ACTION TAKEN *
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| 67 | Press RETURN to CONTINUE:
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| 68 | Catastrophically Disabled Review Date:
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| 69 | Primary Elig. Code:
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| 70 | Other Elig. Code(s):
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| 71 | Service Connected: NO
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| 72 | SC Percent:
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| 73 | NOT A VETERAN
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| 74 | Health Insurance:
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| 75 | Medicaid Elig:
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| 76 | Means Test Status: NOT IN MEANS TEST FILE
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| 77 | Invalid pseudo SSN.
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| 78 | Type 'P' for the valid one
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| 79 | Pseudo SSN adjusted to match edited name value ==>
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| 80 | VERIFY FIELDS
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| 81 | Already used by patient '
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| 82 | The SSN must not begin with 9.
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| 83 | First three digits cannot be zeros.
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| 84 | Note: This is a RR Retirement SSN.
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| 85 | Note: This is a Test Patient SSN.
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| 86 | Collateral of
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| 87 | Must have same SSN to be collateral
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| 88 | Has collateral
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| 89 | be sure to change SSN
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| 90 | The date of birth is too early for the selected category of beneficiary
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| 91 | Make another selection or correct the date of birth.
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| 92 | The date of birth is too late for the selected category of beneficiary.
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| 93 | The patient's age is too young for the selected category of beneficiary.
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| 94 | This service entry date would make the patient too young for service.
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| 95 | DOB
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| 96 | Previous service entry date is not on file
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| 97 | This service entry date must be before than the first service entry date
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| 98 | This service entry date must be less than the second service entry date
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| 99 | The service separation date must be after the entry date
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| 100 | This service separation date must be before the next service entry date
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| 101 | The service separation date must be before the next service entry date
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| 102 | **NOTE-Change(s) made in this session deleted the veteran's Combat Vet status!
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| 103 | But I need a Start Date for this Temporary Address.
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| 104 | But I need at least one line of a Temporary address.
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| 105 | But I need a Start Date.
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| 106 | But I need at least one active category.
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| 107 | I need at least one line of Address.
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| 108 | But I need to know where you were treated most recently.
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| 109 | Patient is not a veteran. Can't enter rated disabilities
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| 110 | SPOUSE'S
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| 111 | DEPENDENT'S
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| 112 | CHILD'S
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| 113 | Incomplete Entry...Deleted
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| 114 | No dependents to inactivate!
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| 115 | Enter a number 1-
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| 116 | to indicate the dependent you wish to inactivate:
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| 117 | indicating the number of the dependent you wish to inactivate
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| 118 | RELATIONSHIP:
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| 119 | Entry incomplete...deleted
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| 120 | Dependent has been inactivated as of
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| 121 | Date
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| 122 | no longer a dependent
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| 123 | Enter the date this person was no longer a dependent of the veteran.
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| 124 | This could include a date of death or the date a child turned 18 for
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| 125 | children. For a spouse, this would be the date of divorce or date
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| 126 | of death of the spouse. Date must be after the person became a
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| 127 | dependent, but prior to 12/31/
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| 128 | A person should only be inactivated if the individual was not a
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| 129 | dependent at any time during the prior calendar year.
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| 130 | A spouse should be inactivated if the spouse and veteran were not
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| 131 | married as of 12/31/
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| 132 | Warning: Data will be used if dependent was active at least one day in a
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| 133 | year. Data will not be used if inactivation is prior to 1/1/
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| 134 | or it
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| 135 | is equal to the activation date.
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| 136 | Do you wish to inactivate this dependent on the selected date?
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| 137 | [Must edit through means test!!]
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| 138 | EFFECTIVE DATE
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| 139 | Please return to screen 8 and check the veteran's effective date.
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| 140 | The effective date was created based on the veteran's date of birth.
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| 141 | You might also want to check the date of birth for this veteran.
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| 142 | This dependent is 18 years or older. To list this person as a dependent
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| 143 | they have to be:
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| 144 | 1. An UNMARRIED child who is under the age of 18.
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| 145 | 2. Between the ages of 18 and 23 and attending school.
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| 146 | 3. An unmarried child over the age of 17 who became permanently
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| 147 | incapable of self support before the age of 18.
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| 148 | Use 'Expand Dependent' option to change effective date.
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| 149 | Enter the date this person first became a dependent of the veteran.
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| 150 | In the case of a spouse, this would be the date of marriage. For
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| 151 | a parent or other dependent, this would be the date the dependent
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| 152 | moved in. For a child, this would be the date of birth or date of
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| 153 | Date must be before DEC 31,
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| 154 | as dependents are collected for the
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| 155 | prior calendar year only.
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| 156 | Enter '^' to stop the display
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| 157 | and edit
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| 158 | of data, '^N' to jump to screen #N (see
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| 159 | listing below), <RET> to continue on to the next available screen
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| 160 | or enter
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| 161 | the field group number(s) you wish to edit using commas and dashes as
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| 162 | delimiters. Those groups enclosed in brackets
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| 163 | are editable while those
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| 164 | enclosed in arrows
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| 165 | are not.
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| 166 | Enter 'ALL' to edit all editable data
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| 167 | elements on the screen.
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| 168 | You may precede your selection with 'V' to denote veteran.
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| 169 | DATA GROUPS ON SCREEN
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| 170 | Press RETURN key
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| 171 | to EXIT Screen
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| 172 | TO EXIT
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| 173 | Name, SSN, DOB^Alias Name & SSN (if applicable)^Remarks concerning this patient^Home Address, Phone & Work Phone^Temporary Address, Dates, Phone
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| 174 | Confidential Address,Dates and Types
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| 175 | Sex, POB, Parents, etc.^Dates/Locations of Previous Care^Race and Ethnicity
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| 176 | Primary Next-of-Kin^Secondary Next-of-Kin^Primary Emergency Contact^Secondary Emergency Contact^Designee to receive personal effects
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| 177 | Applicant Employer, Address^Spouses Employer, Address
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| 178 | Unexpired Insurance Policies^Eligibile for Medicaid
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| 179 | Service History^Prisoner of War^Combat^Vietnam Service^Agent Orange Exposure^IONizing Radiation Exposure^
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| 180 | Lebanon Service^Grenada Service^Panama Service^Persian Gulf Service^Somalia Service^Environmental Contaminants Exposure^Military Retirement/Disability^Dental History^Yugoslavia Service^Purple Heart Recipient^
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| 181 | Nose/Throat Radium Treatment
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| 182 | Patient Type, SC Data, Claim Info^VA Monetary Benefits^POS, Eligibility Code(s)^SC Conditions relayed by applicant
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| 183 | Spouse's Demographic Info^Dependents' Demographic Info
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| 184 | Social Security^U.S. Civil Service^U.S. Railroad Retirement^Military Retirement^Unemployment^Other Retirement^Total Employment Income^Interest,Dividend,Annuity^Workers Comp or Black Lung^Other Income
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| 185 | Ineligible Patient Information^Missing Patient Information
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| 186 | Eligibility Verification^Monetary Benefits Verification^Service Record Verification^Rated Disabilities (VA)
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| 187 | Four most recent admission episodes on file for this applicant are displayed
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| 188 | in inverse order.
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| 189 | Four most recent applications for care (registrations) are displayed in
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| 190 | inverse order.
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| 191 | Clinics in which actively enrolled^Pending (future) appointments
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| 192 | Sponsor information is displayed for patients.
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| 193 | Demographic^Confidential Address^Patient^Contact^Employment^Insurance^Service Record^Eligibility^Family Demographic^Income Screening^Missing/Ineligible^Eligibility Verification^
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| 194 | Admission Info^Application Info^Appointment Info^Sponsor Demograhics
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| 195 | Enter your division:
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| 196 | Unable to update Purple Heart Data.
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| 197 | Unable to update Purple Heart History.
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| 198 | =ENTER new
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| 199 | to EDIT,
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| 200 | for screen N or
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| 201 | to QUIT
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| 202 | COPYING will move Family Demographic and Income Data into the next year...
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| 203 | YOU HAVE ALREADY MODIFIED CURRENT YEAR DEPENDENT INFORMATION
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| 204 | COPYING will OVERWRITE this modified dependent information
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| 205 | with LAST year's data - ** Please review dependent data **
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| 206 | ...FAMILY DEMOGRAPHIC DATA COPIED
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| 207 | ...............INCOME DATA COPIED
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| 208 | ===> Record has been classified as sensitive.
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| 209 | Your MAS PARAMETER file is not properly set up!
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| 210 | LOCAL REGISTRATION QUESTIONS
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| 211 | INVALID SCREEN NUMBER...VALID SCREENS ARE
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| 212 | (To edit only veteran income, precede selection with 'V' [ex. 'V1-3']
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| 213 | precede with 'S' to edit spouse
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| 214 | precede with 'D' to edit dependents
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| 215 | >>> Patient cannot be registered while there is still an open disposition.
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| 216 | Patient: Eligibility, Demographic
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| 217 | Emergency Contact and Military Service
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| 218 | Marital
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| 219 | Another user is editing, try later...
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| 220 | Insurance
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| 221 | HINQ Inquiry
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| 222 | Consistency Checker
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| 223 | At this time you may Register the patient if he or she is present and
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| 224 | seeking care. Answer 'No' if this was a mail-in application.
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| 225 | Would you like to Register the patient
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| 226 | Exit Interview
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| 227 | PRINT 10/10T
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| 228 | DGRPT 10-10T REGISTRATION
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| 229 | Patient Demographics
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| 230 | Permanent Address:
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| 231 | Emergency Contact
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| 232 | NOK:
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| 233 | Military Service
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| 234 | Service Branch [Last]:
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| 235 | Number [Last]:
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| 236 | Purple Heart:
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| 237 | Eligibility
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| 238 | Patient Type:
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| 239 | Primary Elig Code:
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| 240 | Marital/Spouse
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| 241 | Spouse's Name:
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| 242 | Last Year's Estimated
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| 243 | Covered by Health Insurance:
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| 244 | Insurance Co. Subscriber ID Group Holder Effective Expires
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| 245 | PRINT 10-10T
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| 246 | - FROM REGISTRATION
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| 247 | Reg Date/Time:
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| 248 | AUTOMATED VA FORM 10-10T
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| 249 | VA FORM 10-10T
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| 250 | |2. Social Security Number
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| 251 | |3. Date of Birth
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| 252 | 4A. Applicant's Mailing Street Address
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| 253 | |4D. Zip Code
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| 254 | |6. Home Telephone Number
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| 255 | |7. Work Telephone Number
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| 256 | 8A. Emergency Contact
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| 257 | |8C. Home Telephone Number
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| 258 | |8D. Work Telephone Number
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| 259 | 8E. Mailing Address of Emergency Contact
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| 260 | |9. Is Emergency Contact
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| 261 | |Also Next of Kin
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| 262 | 10. Benefit Applying For:
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| 263 | HOSPITAL/OUTPATIENT TREATMENT
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| 264 | 11. Applicant Status:
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| 265 | A. Service Connected
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| 266 | |B. Prisoner of War
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| 267 | |C. Aid and Attendance
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| 268 | |D. Military Disability Retired
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| 269 | E. VA Pension
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| 270 | |F. Primary Eligibility Code
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| 271 | |G. Other Eligibility Code
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| 272 | |H. Purple Heart Recipient
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| 273 | 12. Exposure To:
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| 274 | |A. Agent Orange
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| 275 | |C. Environmental Contaminants
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| 276 | 13. Medical Care Related To:
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| 277 | 14A. Do You Have Health Coverage
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| 278 | |14B. Name of Health Insurance Carrier
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| 279 | 15. Branch of Service
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| 280 | |16. Latest Service Number
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| 281 | |17. Marital Status
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| 282 | |18B. Spouse's Social Security Number
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| 283 | 18C. Year of Marriage
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| 284 | |18D. Number of Dependents
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| 285 | |19. Last Year's Estimated
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| 286 | Taxable Income
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| 287 | Consent To Release Information: I hereby authorize the Department of Veterans Affairs to disclose any such history, diagnostic and
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| 288 | treatment information from my medical records (including information relating to the diagnosis, treatment or other therapy for the
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| 289 | conditions of drug abuse, alcoholism or alcohol abuse, sickle cell anemia, or testing for or infection with the human
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| 290 | immunodeficiency virus) to the carrier or contractor of any health plan contract under which I am apparently entitled to medical
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| 291 | care or payment of the expense of care that is identified above, as considered necessary by VA representatives for the discharge
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| 292 | of the legal or contractual obligations of the insurer or other party against whom liability is asserted. I understand that I
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| 293 | may revoke this authorization at any time, except to the extent that action has already been taken in reliance on it. Without my
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| 294 | express revocation, this consent will automatically expire when all action arising from VA's claim for reimbursement for my
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| 295 | medical care has been completed.
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| 296 | Co-payment Notice: If your household income exceeds the established threshold, you will be considered
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| 297 | Discretionary
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| 298 | Such veterans must pay a co-payment not to exceed the Medicare deductible, plus a per diem for hospital and nursing care.
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| 299 | By signing this application, you are agreeing to pay the VA the applicable co-payment if you are determined to be a
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| 300 | Signature of Applicant
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| 301 | Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for
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| 302 | reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
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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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