[604] | 1 | English French Notes Complete/Exclude
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| 2 | Weapons Total # :
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| 3 | Firearms :
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| 4 | Knives/Hatchets/Clubs :
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| 5 | Explosives :
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| 6 | Other :
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| 7 | DISTURBANCES Total # :
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| 8 | Demonstrations :
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| 9 | Employee Threat :
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| 10 | Smoking Violation :
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| 11 | Unauthorized Photograph :
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| 12 | MANSLAUGHTER/MURDER Total # :
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| 13 | Manslaughter/Murder/Negligent :
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| 14 | Manslaughter/Murder/Non-Neg. :
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| 15 | NON-CRIMINAL INVESTIGATIONS Total # :
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| 16 | Government Veh. Accident :
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| 17 | Assist Law Officer :
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| 18 | Alarm Response :
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| 19 | Information Only :
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| 20 | OTHER OFFENSES Total # :
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| 21 | Arson :
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| 22 | Arson $ Damage :
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| 23 | Possession of Stolen Property :
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| 24 | Receive/Sell Stolen Property :
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| 25 | Suicide :
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| 26 | Suicide Attempt :
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| 27 | RAPES Total # :
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| 28 | Attempted Rape :
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| 29 | Forcible Rape :
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| 30 | ROBBERY Total # :
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| 31 | STOPS & ARRESTS Total # :
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| 32 | Stops for Questioning :
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| 33 | Package Stops :
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| 34 | Non-Package Stops :
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| 35 | THEFTS Total # :
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| 36 | Coin-Operated Machines :
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| 37 | Total $ Loss :
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| 38 | Total $ Recovery :
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| 39 | Actual Drug Thefts :
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| 40 | Controlled Substance :
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| 41 | Non-Controlled Substance :
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| 42 | Attempted Drug Thefts :
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| 43 | Total Drug Thefts :
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| 44 | Total $ Recovered :
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| 45 | Government Property :
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| 46 | Personal Property :
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| 47 | Motor Vehicles :
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| 48 | Government Motor Vehicle :
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| 49 | Gov't Vehicles Recovered :
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| 50 | Private Motor Vehicle :
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| 51 | Private Veh's Recovered :
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| 52 | VICE SOLICITING Total # :
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| 53 | Forgery :
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| 54 | Gambling :
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| 55 | Sexual Misconduct :
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| 56 | VIOLATION CHARGES Total # :
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| 57 | USDC Notice Total # :
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| 58 | The report will be forwarded to the national database. You may now enter
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| 59 | any additional people you would like to forward this report to.
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| 60 | XXX@Q-VAP.VA.GOV
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| 61 | ...Forwarded to National Database.
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| 62 | VICE SOLICITING Total # :
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| 63 | Is this a courtesy or USDC violation
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| 64 | Enter C for COURTESY or V for USDC violation
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| 65 | The program is now exiting!
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| 66 | Do you want to add a new violation
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| 67 | DATE/TIME OF OFFENSE
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| 68 | Enter the date and time of the offense. Future dates not allowed.
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| 69 | Court Date must be after the Date/Time of Offense!
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| 70 | NO EXISTING VIOLATIONS FOR
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| 71 | EXISTING VIOLATIONS FOR
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| 72 | OFFENSE CHARGED
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| 73 | Data Validation in progress
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| 74 | No Date/Time Received.
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| 75 | No Date/Time of Offense.
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| 76 | No Investigating Officer.
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| 77 | No Classification Code.
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| 78 | No Type for this Classification Code.
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| 79 | No Sub-Type for this Type.
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| 80 | This report must have the above before it can be completed.
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| 81 | Report Completed.
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| 82 | Select Vehicle Registration:
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| 83 | VIOLATION #:
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| 84 | PRINT USDC VIOLATION NOTICE
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| 85 | OFFENSE CHARGED:
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| 86 | OFFENSE DESCRIPTION:
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| 87 | OFFENDER:
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| 88 | RECORD DOESN'T EXIST.
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| 89 | DRIVER'S LICENSE #:
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| 90 | TAG # & STATE:
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| 91 | VEHICLE COLOR:
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| 92 | YEAR:
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| 93 | COURT DATE:
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| 94 | * * * VIOLATION NOTICE * * *
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| 95 | * * * COURTESY VIOLATION NOTICE * * *
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| 96 | Enter the Decal # (ex. 9999)
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| 97 | NO MATCH FOUND.
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| 98 | Do you want to add this decal #
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| 99 | DECAL COLOR:
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| 100 | VEHICLE MAKE:
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| 101 | ASSIGNED PARKING SPACE:
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| 102 | CAR POOL MEMBER:
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| 103 | READY TO UPDATE
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| 104 | Another user is editing this record!
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| 105 | This decal # is already in the Police Registration Log.
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| 106 | Do you want to edit this registration
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| 107 | Select OFFICER
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| 108 | This officer is not a current police officer.
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| 109 | WORKLOAD REPORT
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| 110 | ALL OFFICERS
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| 111 | Checking SOUNDEX for matches.
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| 112 | No matches found.
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| 113 | Do you still want to add this entry: NO//
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| 114 | NnYy^?
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| 115 | Answer NO to stop the addition of
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| 116 | as a new master name index person.
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| 117 | Answer YES to add, a '^' will be taken as a NO.
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| 118 | Print 7079's for:
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| 119 | There are no 7079's to be printed!
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| 120 | Want only those that have not yet been printed
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| 121 | ID Card Number:
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| 122 | (1) Veterans Name
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| 123 | |(2) ID Number | Period of Validity
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| 124 | |DATE OF ISSUE
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| 125 | | CONDITIONS FOR WHICH SERVICES ARE REQUESTED (DESCRIPTION OF DISABILITY)
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| 126 | Name and Address of Fee Participant
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| 127 | AUTHORIZATION #:
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| 128 | AUTHORIZATION REMARKS
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| 129 | (5) STATE CODE | (6) COUNTY CODE | (7) TYPE OF | (8) YEAR OF BIRTH | (9) WAR | (10) PURPOSE |
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| 130 | STATION OF JURISDICTION
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| 131 | Veterans Administration
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| 132 | SHORT TERM - 1
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| 133 | HOME NURSING - 2
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| 134 | ID CARD STATUS - 3
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| 135 | | APPROVED BY (Name and Title)
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| 136 | TELEPHONE:
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| 137 | Information On Veterans Administration Program
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| 138 | Acceptance of this request to render the prescribed services will constitute an agreement which is subject
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| 139 | to the following:
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| 140 | I. SERVICES. If services are not initiated, please return this document to the Station of Jurisdiction with a brief
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| 141 | explanation. Unless approved by the VA, services are limited in type and extent to those shown.
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| 142 | II. PERIOD OF VALIDITY. Service must be performed within the period of validity indicated.
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| 143 | If a longer time is needed, please request an extension.
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| 144 | III. REPORTS. Clinical reports are required when an examination only has been requested. Please
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| 145 | submit reports promptly to the Station Of Jurisdiction.
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| 146 | IV. STATEMENT OF ACCOUNTS. Submit a Statement of Account in your usual manner. Your statement must
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| 147 | include: (1) Patient's Name; (2) Identification NO.; (3) Treatment (CPT) and Dates Rendered; and (4) Fees.
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| 148 | V. FEES. Fees claimed may not exceed those made to the general public for like services.
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| 149 | VI. PAYMENT. Payment by the VA for services rendered and approved is payment in full.
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| 150 | VII. HOSPITALIZATION. When a need for hospital care is indicated, please call the Station of Jurisdiction
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| 151 | for assistance in admitting the veteran to a VA hospital.
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| 152 | VIII. INQUIRIES. Additional information when required may be obtained by contacting the Station Of Jurisdiction.
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| 153 | VA Form 10-7079
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| 154 | ELIGIBILITY HAS NOT BEEN DETERMINED NOR PENDING, CANNOT ENTER AN AUTHORIZATION.
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| 155 | VETERAN HAS A DISHONORABLE DISCHARGE,
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| 156 | ONLY ELIGIBLE FOR AGENT ORANGE EXAM.
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| 157 | NOT ELIGIBLE FOR BENEFITS.
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| 158 | Want to Print 7079 for this patient now
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| 159 | Is this vendor information correct
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| 160 | FBAA ESTABLISH VENDOR
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| 161 | You must contact a vendorizing clerk or supervisor to update this record!
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| 162 | Vendor flagged for updating!
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| 163 | Are you sure you want to update this Vendor in the FMS and Central Fee vendor files
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| 164 | Will NOT be Updated
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| 165 | This option should only be used to update the FMS and Central
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| 166 | Fee vendor files in Austin with the appropriate information.
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| 167 | (NOTE: The vendor may not exist in the FMS vendor file,
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| 168 | or may exist, but the information in the FMS vendor
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| 169 | file does not reflect accurate information.)
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| 170 | Use of this option should update the FMS system to reflect
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| 171 | what is currently in the DHCP system. Information at all
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| 172 | other VA Medical Centers using this vendor will also be updated.
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| 173 | Sure you want to DELETE this batch
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| 174 | Batch Deleted.
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| 175 | Obligation Number:
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| 176 | Do you want to change the Obligation Number
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| 177 | Select Obligation Number:
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| 178 | DUZ and DUZ(0) must be defined as a valid user to run the batch purge.
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| 179 | You must have programmer access (DUZ(0)='@') before running the batch purge.
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| 180 | There are no batches finalized !!
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| 181 | This option is used to purge Fee Basis batch numbers for a time frame in the past. Do you want to continue
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| 182 | if you wish to proceed with Fee Basis batch number purging!
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| 183 | Purge batch #'s PRIOR to date :
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| 184 | *** BEGIN FEE BASIS BATCH NUMBER PURGE ***
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| 185 | There are no batch numbers to purge for this time frame !!
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| 186 | This option has purged
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| 187 | batch numbers
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| 188 | finalized prior to
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| 189 | *** FEE BASIS BATCH NUMBER PURGE FINISHED ***
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| 190 | Unknown User
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| 191 | FBAA BATCH PURGE
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| 192 | Do you want to print ALL Fee Basis Batch Status':
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| 193 | CLERK CLOSED
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| 194 | SUPERVISOR CLOSED
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| 195 | FORWARDED TO PRICER
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| 196 | ASSIGNED PRICE
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| 197 | REVIEWED AFTER PRICER
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| 198 | Select STATUS to print
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| 199 | Do you want to select another STATUS:
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| 200 | FBSTAT(
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| 201 | MEDICAL & STAT PAYMENTS
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| 202 | HOMETOWN PHARMACY PAYMENTS
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| 203 | TRAVEL PAYMENTS
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| 204 | CH/CNH
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| 205 | STATUS OF BATCHES
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| 206 | BATCH #
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| 207 | BATCH TYPE
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| 208 | DATE OPENED
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| 209 | No payments in Batch yet!
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| 210 | No Payments in Batch yet!
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| 211 | Want to review batch
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| 212 | If you want a detail list of each payment line, answer
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| 213 | otherwise press Return key
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| 214 | Do you still want to close Batch
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| 215 | Batch Closed
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| 216 | ('*' Reimbursement to Patient '+' Cancellation Activity)
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| 217 | ('#' Voided Payment)
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| 218 | Batch #
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| 219 | Voucher Date
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| 220 | Vendor Name
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| 221 | Vendor ID
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| 222 | Invoice #
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| 223 | Date Rec'd.
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| 224 | SVC DATE
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| 225 | CPT-MOD
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| 226 | SERVICE PROVIDED
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| 227 | FPPS CLAIM
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| 228 | FPPS LINE
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| 229 | ADJ CODE
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| 230 | ADJ AMOUNT
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| 231 | RX DATE
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| 232 | RX #
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| 233 | '+' Represents Cancellation Activity
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| 234 | Travel Amount
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| 235 | Invoice #:
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| 236 | FPPS Claim ID:
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| 237 | FPPS Line:
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| 238 | ('*' Reimbursement to Veteran '+' Cancellation Activity)
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| 239 | Batch Number
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| 240 | Dt Inv Rec'd
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| 241 | FR DATE
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| 242 | TO DATE CLAIMED PAID
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| 243 | Dx:
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| 244 | Proc:
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| 245 | Date Paid:
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| 246 | >>>Amount paid altered to $
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| 247 | on the Fee Payment Voucher document.<<<
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| 248 | >>>Check cancelled on:
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| 249 | Check WILL be replaced.
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| 250 | Check WILL be re-issued.
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| 251 | Check WILL NOT be replaced.
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| 252 | Patient has never been assigned ID Card!
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| 253 | Current ID Card:
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| 254 | Date Issued:
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| 255 | No previous ID Cards!
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| 256 | Does not currently have ID Card!
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| 257 | Date/Time Changed
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| 258 | Old Card #
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| 259 | Person Who Changed
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| 260 | Reason For Change
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| 261 | There are no Invoices Pending completion!
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| 262 | Fee Site Parameters must be Initialized!
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| 263 | Invoice is Complete
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| 264 | Totals: $
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| 265 | Vendor:
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| 266 | Vendor ID:
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| 267 | Patient ID:
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| 268 | FPPS Line Item:
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| 269 | Drug Name
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| 270 | Amt Claimed
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| 271 | Generic Drug Substituted:
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| 272 | Pharmacy Remarks:
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| 273 | Hit Return to accept default dispensing fee or enter a dollar amount between .01 and 20
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| 274 | **Payment is for emergency treatment under 38 U.S.C. 1725.
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| 275 | Amount Paid cannot be greater than the Amount Claimed
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| 276 | This option is restricted to holders of the 'FBAASUPERVISOR' security key.
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| 277 | The last user to enter/edit this Authorization was
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| 278 | FPPS CLAIM ID:
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| 279 | Invoice:
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| 280 | Service selected for that date already in system.
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| 281 | Do you want to add another service for the SAME DATE
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| 282 | You must use the 'EDIT PAYMENT' option to edit the service previously
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| 283 | entered for that date.
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| 284 | Want to edit it
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| 285 | Warning, you can only enter
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| 286 | more line(s)!
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| 287 | This Batch already has the maximum number of Payments!
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| 288 | Will any line items in this invoice be for contracted services
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| 289 | Answering no indicates interest will not be paid for any line items.
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| 290 | Patient:
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| 291 | No Address information for this patient!
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| 292 | Patient's Permanent address:
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| 293 | Address Line
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| 294 | Zip:
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| 295 | County
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| 296 | Want to edit Permanent Address data
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| 297 | Payment is for a contracted service so fee schedule does not apply.
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| 298 | However, f
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| 299 | ee schedule amount is $
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| 300 | from the
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| 301 | Unable to determine a FEE schedule amount.
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| 302 | Therefore, fee schedule amount reduced to $
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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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