| 1 | English French Notes Complete/Exclude
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| 2 | PSC Category:
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| 3 | Item:
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| 4 | Unit Cost :
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| 5 | Actual Unit Cost:
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| 6 | Serial #:
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| 7 | Patient Category:
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| 8 | Type of Transaction:
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| 9 | Special Category:
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| 10 | Appliance/Repair:
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| 11 | Item Remarks:
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| 12 | Brief Description:
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| 13 | Extended Description:
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| 14 | (Example, PO number), or Bank Authorization Number (6 digit number).
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| 15 | ERROR** This transaction was not posted to 2319, please contact your IRM..
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| 16 | Ready to Reconcile and Close-Out Transaction
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| 17 | You may now Close-out and Post this Transaction. Please answer Yes or No.
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| 18 | Transaction NOT Closed-Out!
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| 19 | ** No Item selected..
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| 20 | 2R~UNIT COST;
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| 21 | 4R~UNIT OF ISSUE;7;11////C
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| 22 | DO YOU WANT TO ADD A DUPLICATE ITEM?
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| 23 | ***** NOT CLOSED-OUT !!!!
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| 24 | **** NOT CLOSED-OUT!! ****
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| 25 | **** TRANSACTION NOT CLOSED-OUT!! ****
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| 26 | Enter Next Transaction to Close-out, or <RETURN> to continue.
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| 27 | INCOMPLETE RECORD..file 664..entry..
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| 28 | ...PLEASE CONTACT YOUR IRM or CANCEL THIS ENTRY!!!
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| 29 | UNKNOWN 2319 RECORD TO UPDATE, 2319 NOT UPDATED!
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| 30 | This Transaction has already been CLOSED!
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| 31 | This Transaction has been CANCELED!
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| 32 | Updated
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| 33 | 10-2319 record for this Veteran
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| 34 | Would You like to Edit another Entry (Y/N)
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| 35 | NOT DELIVERED/ACCEPTED
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| 36 | RMPR FCP MANAGER
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| 37 | SUB TOTAL:
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| 38 | NO ITEMS ON FILE
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| 39 | AMIS:
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| 40 | NO CODE FOR THIS ITEM
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| 41 | PSAS HCPCS CODE:
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| 42 | UNIT COST:
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| 43 | ITEM COST:
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| 44 | SPEC/LEG
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| 45 | Enter '^' to Quit Display, <Return> to Continue :
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| 46 | This report lists Open Purchase Card Transactions created in the
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| 47 | Prosthetics Package.
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| 48 | This report is sorted by Transaction Date and Initiator.
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| 49 | The PC # column is the abbreviated Purchase Card Transaction Number,
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| 50 | Example: 644-PC546, would display as 546.
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| 51 | OPEN 2421PC TRANSACTIONS
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| 52 | Item Cost
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| 53 | Open 2421PC Transactions
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| 54 | ...now posting to file 660...
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| 55 | **** POSTING TO 2319 FOR ITEM..
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| 56 | PLEASE RUN CLOSE-OUT OPTION AGAIN...
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| 57 | Select Transaction or Patient Name:
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| 58 | <REQUEST QUEUED>
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| 59 | <REQUEST NOT QUEUED>
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| 60 | OMB Number 2900-0188
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| 61 | Estimated Burden: 4 minutes
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| 62 | ***ORIGINAL COPY AND COMMERCIAL INVOICE MUST BE SUBMITTED***
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| 63 | TO THE VAMC PROSTHETIC ACTIVITY LISTED BELOW
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| 64 | Prosthetic Authorization for Items or Services
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| 65 | 1. Name and Address of Vendor
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| 66 | 2. Name and Address of VA Facility
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| 67 | NO STATE ON FILE
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| 68 | 3. Veterans Name (Last, First, MI)
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| 69 | 4. Date of Authorization
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| 70 | 5. Veterans Address
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| 71 | 6. Date Required
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| 72 | 9. Authority For Issuance CFR 17.115
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| 73 | CHARGE MEDICAL APPROPRIATION
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| 74 | 7. Claim Number
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| 75 | 10. Statistical Data
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| 76 | 11. FOB Point
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| 77 | 13. Delivery Time
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| 78 | 14. Delivery To:
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| 79 | 15. DESCRIPTION OF ITEMS OR SERVICES AUTHORIZED
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| 80 | ITEM NUMBER
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| 81 | DESCRIPTION/NOMENCLATURE
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| 82 | ***SEE ATTACHED CONTINUATION SHEET FOR ITEM DESCRIPTION(S)***
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| 83 | CONTINUATION OF PURCHASE CARD
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| 84 | 16. Contract Number:
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| 85 | Discount $
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| 86 | Shipping:
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| 87 | 17. Signature of
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| 88 | 19. Signature and Title of
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| 89 | Requesting Official
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| 90 | Contracting/Accountable Officer
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| 91 | Order and Receipt Action
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| 92 | 21. Order Number
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| 93 | 22. Date of Order
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| 94 | 23. Date Item Received
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| 95 | 24. Date Delivered
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| 96 | 25. The articles or services listed herein have been received, or rendered
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| 97 | ordered in the quantity and quality specified orginally or as shown by
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| 98 | authenticated changes, except as noted.
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| 99 | Signature of Veteran or VA Official
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| 100 | VOUCHER AUDIT BLOCK (For use by VA Facility only)
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| 101 | Bank Authorization Number:
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| 102 | Acct. Symbol
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| 103 | ADP Form 10-2421PC APR 1991
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| 104 | 52.224-2 PRIVACY ACT (APR 1984)
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| 105 | (a) The Contractor agrees to---
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| 106 | (1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and
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| 107 | regulations issued under the Act in the design, development, or operation
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| 108 | of any system of records on individuals to accomplish an agency function when
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| 109 | the contract specifically identifies---
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| 110 | (i) The systems of records: and
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| 111 | (ii) The design, development, or operation work that the contractor is to
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| 112 | (2) Include the Privacy Act notification contained in this contract in every
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| 113 | solicitation and resulting subcontract and in every subcontract awarded without
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| 114 | a solicitation, when the work statement in the proposed subcontract required the
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| 115 | redesign, development, or operation of a system of records on individuals that
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| 116 | is subject to the Act; and
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| 117 | (3) Include this clause, including this subparagraph (3), in all subcontracts
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| 118 | awarded under this contract which requires the design, development, or opera-
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| 119 | tion of such a system of records.
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| 120 | (b) In the event of violations of the Act, a civil action may be brought ag-
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| 121 | ainst the agency involved when the violation concerns the design, development or
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| 122 | operation of a system of records on individuals to accomplish an agency function,
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| 123 | and criminal penalties may be imposed upon the officers or employees of the ag-
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| 124 | ency when the violation concerns the operation of a system of records on indivi-
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| 125 | duals to accomplish an agency function. For purposes of the Act, when the con-
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| 126 | tract is for the operation of a system of records on individuals to accomplish
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| 127 | an agency function, the Contractor is considered to be an employee of the agen-
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| 128 | Operation of a system of records,
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| 129 | as used in this clause, means per-
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| 130 | formance of any of the activities associated with maintaining the system of re-
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| 131 | cords, including the collection, use, and dissemination of records.
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| 132 | Record,
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| 133 | as used in this clause, means any item, collection, or grouping
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| 134 | of information about an individual that is maintained by an agency, including,
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| 135 | but not limited to, education, financial transactions, medical history, and
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| 136 | criminal or employment history and that contains the person's name, or the iden-
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| 137 | tifying number, symbol, or other identifying particular assigned to the indivi-
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| 138 | dual, such as a fingerprint or voiceprint or a photograph.
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| 139 | System of records on individuals
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| 140 | as used in this clause, means a
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| 141 | group of any records under the control of any agency from which information is
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| 142 | retrieved by the name of the individual or by some identifying number, symbol,
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| 143 | or other identifying particular assigned to the individual.
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| 144 | MR.
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| 145 | MS.
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| 146 | In reply refer to:
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| 147 | Accounting Symbol
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| 148 | This is to notify you that the items listed below were ordered
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| 149 | for you on
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| 150 | . Delivery of this equipment is expected
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| 151 | on or about
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| 152 | in 30 days from the order date.
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| 153 | If you do not receive it within 5 days of the expected date,
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| 154 | please contact
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| 155 | , of my staff, at
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| 156 | 17;16;8////^S X=$G(RMTYPE);9////^S X=$G(RMCAT);10////^S X=$G(RMSPE);1R~BRIEF DESCRIPTION OF ITEM (for Vendor);
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| 157 | 17;8TYPE OF TRANSACTION;9PATIENT CATEGORY;S RMPRDIS=+$P(^RMPR(664,DA(1),1,DA,0),U,10);S Y=$S(RMPRDIS=4:
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| 158 | );@2;3QTY;2;4UNIT OF ISSUE;11////C;
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| 159 | ;@1;10SPECIAL CATEGORY;S Y=
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| 160 | Enter the IFCAP Site used with the Purchase Card Module
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| 161 | The following site you select will be used on all your
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| 162 | Purchase Card Transactions in IFCAP only.
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| 163 | Prosthetics PIP Extract
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| 164 | G.RMPR SERVER
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| 165 | The Prosthetics PIP Inventory Data was transmitted to PSAS HQ today.
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| 166 | The dates used for Days On-Hand, and Days Average Usage Rate calculations
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| 167 | The server was activated by
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| 168 | No HQ mail address is defined in your PROSTHETICS SITE
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| 169 | PARAMETERS file for the PIP report. The PIP report
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| 170 | will not be run. Please contact your system administrator
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| 171 | or enter a NOIS in Forum for the NVS Team.
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| 172 | VHACOPSASPIPReport@med.va.gov
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| 173 | No Records to Print !!
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| 174 | GRAND TOTAL $ VALUE ISSUED (Used) =
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| 175 | GRAND TOTAL $ VALUE ON-HAND (Used) =
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| 176 | GRAND TOTAL $ VALUE ISSUED (New) =
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| 177 | GRAND TOTAL $ VALUE ON-HAND (New) =
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| 178 | PROSTHETIC INVENTORY ITEM DETAIL REPORT
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| 179 | calendar days ]
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| 180 | HCPCS PSAS/ITEM
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| 181 | HCPCS DESCRIPTION
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| 182 | NPPD LINE
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| 183 | NPPD GROUP
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| 184 | V.A.(Used) Total| COM. (New) Total| Total |Days Ave | Stock On-Hand| Days |Total $ Value On-Hand
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| 185 | Issue $ Value| Issue $ Value| Issue |Usage Rate| Used New | On-Hand| Used New
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| 186 | INVENTORY REPORT
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| 187 | RMPRSEL(
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| 188 | Select inventory report level of detail
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| 189 | Ending date should not precede start date
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| 190 | Select NPPD line(s) within the above group
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| 191 | NPPD Lines for Group:
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| 192 | Choose HCPCS selection option
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| 193 | Select HCPCS
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| 194 | You need at least 132 columns for this report.
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| 195 | Please use a device capable of this requirement.
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| 196 | 100:WHEELCHAIRS AND ACCESSORIES
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| 197 | 200:ARTIFICIAL LEGS
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| 198 | 300:ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 199 | 400:BRACES AND ORTHOTICS
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| 200 | 600:NEUROSENSORY AIDS
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| 201 | 800:OXYGEN AND RESPIRATORY
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| 202 | 900:MEDICAL EQUIPMENT
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| 203 | 910:ALL OTHER SUPPLIES AND EQUIPMENT
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| 204 | 920:HOME DIALYSIS PROGRAM
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| 205 | 930:ADAPTIVE EQUIPMENT
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| 206 | 960:SURGICAL IMPLANTS
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| 207 | Processing report.......
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| 208 | NPPD_GROUP
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| 209 | NPPD_LINE
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| 210 | HCPC_CODE
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| 211 | HCPC_ITEM
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| 212 | ISSUE COST
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| 213 | INVENTORY_IEN
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| 214 | HCPC_IEN
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| 215 | PIP DETAIL ITEM REPORT
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| 216 | PIP HCPCS SUMMARY REPORT
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| 217 | PIP NPPD LINE SUMMARY REPORT
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| 218 | PIP NPPD GROUP SUMMARY REPORT
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| 219 | GRAND TOTAL $ VALUE ISSUED (Used) = $
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| 220 | GRAND TOTAL $ VALUE ON-HAND (Used) = $
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| 221 | GRAND TOTAL $ VALUE ISSUED (New) = $
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| 222 | GRAND TOTAL $ VALUE ON-HAND (New) = $
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| 223 | HCPCS DESCRIPTION
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| 224 | NPPD LINE
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| 225 | NPPD GROUP
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| 226 | V.A.(Used) Total| COM. (New) Total| Total |Days Ave | Stock On-Hand| Days |Total $ Value On-Hand
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| 227 | PROSTHETIC INVENTORY HCPCS SUMMARY REPORT
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| 228 | PROSTHETIC INVENTORY NPPD GROUP/LINE REPORT
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| 229 | GRAND TOTAL $ VALUE ON-HAND =
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| 230 | PROSTHETIC INVENTORY NPPD GROUP REPORT
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| 231 | ENTIRE SUMMARY
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| 232 | ..Duplicate HCPCS
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| 233 | STOCK ITEM REPORT
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| 234 | RMPRI(
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| 235 | Processing report......
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| 236 | *** ISSUE and STOCK CONTROL RECORD - PROSTHETICS STOCK ITEMS ***
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| 237 | *** Dollar Value of HCPCS Issued
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| 238 | *** Dollar Value of Item Issued
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| 239 | No Item Statistics for HCPCS:
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| 240 | ...for this date range !!!
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| 241 | NO DATA AT THIS DATE RANGE!!!!
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| 242 | Enter 'ALL' for all Locations or 'RETURN' to select individual Locations:
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| 243 | Select Location
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| 244 | ..Duplicate Location
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| 245 | PROSTHETIC INVENTORY LOCATION SUMMARY
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| 246 | Processing report.....
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| 247 | *** PROSTHETICS INVENTORY BALANCE BY LOCATION ***
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| 248 | NO DATA !!!!
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| 249 | Enter 'ALL' for all HCPCS or 'RETURN' to select individual HCPCS:
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| 250 | *** PROSTHETICS INVENTORY BALANCE BY HCPCS ***
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| 251 | NO DATA !!!!!
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| 252 | Enter 'ALL' for all Lab Employees or 'RETURN' to select individual names:
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| 253 | Select EMPLOYEE
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| 254 | ..Duplicate employee name
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| 255 | PROS LAB ITEM SUMMARY
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| 256 | PROSTHETICS LAB ITEM SUMMARY BY EMPLOYEE
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| 257 | TIME SPENT(hr)
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| 258 | No Lab data for Employee:
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| 259 | ....for this date range !!!
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| 260 | NO DATA FOR THIS DATE RANGE!!!
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| 261 | Adding Item to a Location.....
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| 262 | Enter Pros Location:
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| 263 | Record in use. Try again later...
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| 264 | Select HCPCS to ADD
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| 265 | ** No HCPCS Selected or Unable to Select Inactive HCPCS...
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| 266 | Enter Item to Add:
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| 267 | 22R;23R~TOTAL COST OF QUANTITY;24;25R;26;27
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| 268 | Added/Updated by
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| 269 | Delete an Inventory Location.....
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| 270 | This option now requires the electronic signatures of 2 users
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| 271 | holding the RMPRMANAGER key to be entered before a location
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| 272 | Are you sure you want to DELETE this LOCATION (Y/N)
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| 273 | Nothing Deleted..
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| 274 | Location is deleted!!!!
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| 275 | Pease ask another user with the RMPRMANAGER key to
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| 276 | enter their user name and electronic signature.
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| 277 | Enter user name of 2nd manager:
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| 278 | The 2nd manager must be different to the manager logged on.
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| 279 | The 2nd manager does not have the correct security key set up.
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| 280 | The above location contains
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| 281 | types of items
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| 282 | with a total quantity of
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| 283 | and cost of $
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| 284 | Editing an Inventory Item in a Location.....
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| 285 | Location has been edited from '
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| 286 | Select HCPCS to EDIT:
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| 287 | ** No HCPCS selected...
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| 288 | Enter PSAS Item to Edit:
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| 289 | 29;22R;23R~TOTAL COST OF QUANTITY;24;25R;26;27
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| 290 | This will DELETE all HCPCS and ITEMS under this LOCATION...
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| 291 | Ordering ITEM from Supply or Vendor....
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| 292 | Select HCPCS to ORDER:
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| 293 | Enter Item to ORDER:
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| 294 | Quantity to Order
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| 295 | *** Item was not ordered....
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| 296 | Enter quantity 1 to 99999..
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| 297 | Order from supply or vendor
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| 298 | was ordered....
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| 299 | *** Receiving Item from Supply, Vendor or Veteran...
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| 300 | Enter Receiving Location:
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| 301 | Select HCPCS to RECEIVE:
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| 302 | Enter Item to RECEIVE:
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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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