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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