English French Notes Complete/Exclude Select FRAME SIZE/TEMPLE LENGTH: ENTER THE NAME OF THE FRAMES MANUFACTURER ; 3 TO 30 CHARACTERS ALLOWED MAS Disability Code(s): Disability% Service Connected? Is a non-existent code ; Check the MAS disability codes on this patient. Enter `^`to exit, or `return` to continue: Enter `return` to continue YOU MUST ENTER `RETURN` TO FINISH VIEWING MAS DISABILITY CODES MAS Disability Codes continued: Press `RETURN` to continue. Last Movement Actions No Movements Recorded for this Patient Trans. Type: Type of Movement: Clinic Enrollments No Clinic Enrollments for this Patient OPT or AC Pending Appointments No Pending Appointments for this Patient Appt. Date Suspense Processing INITIAL ACTION DATE Chronological list of notes posted to the request... No notes have been posted to this request Initial Action Note Completion Note Other Action Note posted by RMPREO LINK 2319 Old suspense record, no completion note available. VENDOR PHONE: Can Not Edit This Suspense Record! STOCK ISSUE Initial Action Note Already Posted! nothing noted Can Not Forward. Completion Note Already Posted! Select Service To Forward Consult: Not Forwarded! No Service Selected . Must Have Note to Forward. Consult Not Forwarded. See Completion Note, this was forwarded to another service. not noted ERROR, DID NOT FORWARD! Consult Forwarded. See Completion Note for Initial Action Taken. No Initial Action Taken... This has already been completed, cannot cancel! This will CANCEL/DELETE this Suspense Request. Are you sure you want to CANCEL/DELETE this Suspense Request? (Y/N) Suspense Not Cancelled! DELETED/CANCELLED! Someone else is editing this record Only CPRS Suspense Can Be Cloned! Could NOT CLONE DUE TO BAD DATA! Done... Please select a device to print the new SUSPENSE Record. Nothing to Display, Manual Suspense. RMPR DETAILED DISPLAY Select PROSTHETICS SITE PARAMETER SITE NAME PIP ROLL-UP PIP REPORT Prosthetics Data Extract The National Data Server has been activated today by Prosthetics HQ. Data has been collected for the date range Disability Code information will be transmitted. PSAS National Extract From RMPRXMZ( Total Number of Unique SSN's for this site: PSAS Summary National Extract From Extract From Prosthetics National Data Extract Message Numbers Created Summary RMPRM( Prosthetics Data Extract Open Obligations Data has been collected for all open obligations. Select FORM LETTER TYPE: Would you like a header on this letter Answer `YES` for a header, `NO` for no header Enter `return` to continue: You may only enter `return` here.. PRINT PROSTHETICS FL 10-90 REQUEST FOR QUOTATION FROM: Prosthetics Service Prosthetics Service Vendor Phone #: SSN: Your firm is being considered for the following: An estimate on the above-listed item(s) is requested. YOUR QUOTATION DOES NOT CONSTITUTE A PURCHASE ORDER. Upon completion of the esti- mate, return the original to the Veterans Affairs facility indicated above and retain a copy for your files. If approved, a purchase order will be prepared and forwarded to you. VENDOR'S ESTIMATE (To be completed by Vendor) Article or Service |Quantity| Unit |Unit Cost|Total Cost| Contract number (if applicable) | Signature & Title of Company Official| | Note:List Terms/Discounts if Applicable FL 10-90 ADP Push return to continue CONTINUATION OF REQUEST FOR QUOTATION SSN: CONTINUATION OF ITEM LIST: PROSTHETICS GENERIC CODE SHEETS AMIS is Already Running! PROSTHETICS ORTHOTIC/RESTORATION GENERIC CODE SHEETS Would you like to Delete this Transaction Would you like to Edit this Transaction 1R;12R;4R;7R;2R;62R;63;14R~UNIT COST;5R;10;9;21 Do you wish to POST this entry Do you wish to Delete this entry Enter HOME/LIAISON VISIT DATE OPENED VISIT HAS NOT BEEN CLOSED OUT Select HOME/LIAISON VISIT DATE OPENED: MSH|^~\&|PROSTHETICS| unable to file order Request Failed to Suspense RMPR SUSP RMPR LOAN DEL RMPR LOAN CREATE RMPR LOAN RET RMPR LOAN DISP RMPR LOAN FOLLOW-UP RMPR LOAN PRINT ALL RMPR LOAN EDIT RMPR LOAN STAT RMPR LOAN MENU ENTRIES FOR NO. - DESCRIPTION NO OUTSTANDING 2237 ENTRIES. ELIG/REF Select Item to Edit Deliver To information is Missing!! 2421 is incomplete REQUIRED ITEM INFORMATION IS MISSING Do you want to delete the 2421 Request Do You want to delete the 2421 Request This report lists open purchasing transactions created in the Prosthetic Package. It will not include manual transactions done in the IFCAP 1358 module. OPEN 1358 TRANSACTIONS ITEM COST This Transaction has been Closed! This Transaction has already been Canceled! An X in the Item column is an error and must be reported to your Application Coordinator! Enter 'W' for WHEELCHAIR, 'O' for BRACE, 'B' for BLIND AIDS, 'A' for ART. LIMBS Select PSC ITEM CATEGORY: You will not be able to exceed an item repair cost of more than $ BLIND AID ARTIFICIAL LIMB Transaction NOT Closed-out, IFCAP Failed to Post for the Following Reason. Enter Date to Start NPPD Calculations From: DETAIL & NEW SUMMARY Prosthetic NPPD NO UPDATE! NEW TO REPAIR REPAIR TO NEW Line is null, something wrong with file 661.1 : HCPCS DES PICKUP/DEL Ave Com SP LEG ELG REF $ELG REF STATION SUMMARY (REPAIR ACTIVITIES) Elg Ref $ SPEC LEG Total Disability: HEARING AID, LOCAL REPAIRS WHEELCHAIRS AND ACCESSORIES ARTIFICIAL LEGS ARTIFICIAL ARMS AND TERMINAL DEVICES BRACES AND ORTHOTICS NEUROSENSORY AIDS HOME DIALYSIS EQUIPMENT MEDICAL EQUIPMENT ALL OTHER AUTO & VAN EQUIP WHEELCHAIRS AND ACCESSORIES ARTIFICIAL LEGS ARTIFICIAL ARMS AND TERMINAL DEVICES BRACES AND ORTHOTICS SHOES/ORTHOTICS NEUROSENSORY AIDS HOME DIALYSIS EQUIPMENT MEDICAL EQUIPMENT OXYGEN & RESPIRATORY AUTO & VAN EQUIP ERROR, STOPPING! STATION SUMMARY (NEW ACTIVITIES) Unique SSN: OXYGEN AND RESPIRATORY ALL OTHER SUPPLIES AND EQUIPMENT HOME DIALYSIS PROGRAM ADAPTIVE EQUIPMENT SURGICAL IMPLANTS OXYGEN AND RESPIRATORY ALL OTHER SUPPLIES AND EQUIPMENT HOME DIALYSIS PROGRAM ADAPTIVE EQUIPMENT SURGICAL IMPLANTS Sort Options 2 or 5 = USED INVENTORY ONLY (NEW REPORT) 1 or 4 = NEW ITEM COSTS, USED INVENTORY (VA) COST AS ZERO, (PREVIOUS BRIEF/DETAILED NPPD REPORT) 3 or 6 = NEW AND USED COST, BOTH DOLLAR AMOUNTS TOTALED (NEW REPORT) USED INVENTORY ONLY NEW ITEM COSTS, USED INVENTORY (VA) COST AS ZERO NEW AND USED COST, BOTH DOLLAR AMOUNTS TOTALED 2. ARTIFICIAL LEGS 3. ARTIFICIAL ARMS AND TERMINAL DEVICES 8. OXYGEN AND RESPIRATORY 9. MEDICAL EQUIPMENT 10. ALL OTHER SUPPLIES AND EQUIPMENT 11. HOME DIALYSIS PROGRAM 12. ADAPTIVE EQUIPMENT 14. SURGICAL IMPLANTS REPAIR TO NEW Create Date Patient HCPCS Item Vendor PA Changed From Line To NPPD Line: Local Record #: Nothing Changed, Someone Was Editing Record. Local Record #: Prosthetics Auto-Fix Prosthetic 2529-3 NPPD REPORT OF 2529-3 REPAIR PROSTHETICS ACTIVITIES STATION SUMMARY (2529-3 REPAIR ACTIVITIES) 2529-3 WHEELCHAIRS AND ACCESSORIES 2529-3 ARTIFICIAL LEGS 2529-3 ARTIFICIAL ARMS AND TERMINAL DEVICES 2529-3 BRACES AND ORTHOTICS 2529-3 NEUROSENSORY AIDS 2529-3 HOME DIALYSIS EQUIPMENT 2529-3 MEDICAL EQUIPMENT 2529-3 ALL OTHER 2529-3 AUTO & VAN EQUIP REPORT OF 2529-3 NEW PROSTHETICS ACTIVITIES STATION SUMMARY (2529-3 NEW ACTIVITIES) 2529-3 WHEELCHAIRS AND ACCESSORIES 2529-3 ARTIFICIAL LEGS 2529-3 ARTIFICIAL ARMS AND TERMINAL DEVICES 2529-3 BRACES AND ORTHOTICS 2529-3 NEUROSENSORY AIDS 2529-3 OXYGEN AND RESPIRATORY 2529-3 MEDICAL EQUIPMENT 2529-3 ALL OTHER SUPPLIES AND EQUIPMENT 2529-3 HOME DIALYSIS PROGRAM 2529-3 ADAPTIVE EQUIPMENT 2529-3 SURGICAL IMPLANTS 2529-3 OXYGEN AND RESPIRATORY 2529-3 ALL OTHER SUPPLIES AND EQUIPMENT 2529-3 HOME DIALYSIS PROGRAM 2529-3 ADAPTIVE EQUIPMENT 2529-3 SURGICAL IMPLANTS 2529-3 Form Type Only This Represents Prosthetic Lab Transactions 2529-3 LAB DETAIL 2529-3 LAB BRIEF 1. 2529-3 WHEELCHAIRS AND ACCESSORIES 2. 2529-3 ARTIFICIAL LEGS 3. 2529-3 ARTIFICIAL ARMS AND TERMINAL DEVICES 4. 2529-3 BRACES AND ORTHOTICS 6. 2529-3 NEUROSENSORY AIDS 8. 2529-3 OXYGEN AND RESPIRATORY 9. 2529-3 MEDICAL EQUIPMENT 10. 2529-3 ALL OTHER SUPPLIES AND EQUIPMENT 11. 2529-3 HOME DIALYSIS PROGRAM 12. 2529-3 ADAPTIVE EQUIPMENT 14. 2529-3 SURGICAL IMPLANTS Select 2529-3 NPPD Group Select 2529-3 NPPD Line Please Enter the 2319 Date or the Patient's Name: Would You like to Delete this 2319 Entry (Y/N) OPEN STOCK ISSUES Would you like Approve Multiple Purchases Would you like to Approve this Request Request not Approved ***WORKING COPY*** CONTINUATION OF 2421 17. Signature and Title of Approved For Voucher Auditor Acct. Symbol ADP Form 10-2421 APR 1991 ****DUPLICATE COPY**** In Reply Refer to: With reference to your request of , authority is granted to repair the appliance described below for the above-named veteran. DESCRIPTION OF APPLIANCE OR REPAIR The total cost, not including mailing cost, will not exceed When repairs are completed, please attach the original of this letter to the original copy of your invoice covering repair charges. Your invoice, in original and one copy should then be forwarded to this office for Please retain the duplicate copy of this letter for your files. ADP FORM 10-55 PROSTHETICS PRINT OF 10-55 #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################