| 1 | English French Notes Complete/Exclude
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| 2 | Select FRAME SIZE/TEMPLE LENGTH:
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| 3 | ENTER THE NAME OF THE FRAMES MANUFACTURER ; 3 TO 30 CHARACTERS ALLOWED
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| 4 | MAS Disability Code(s):
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| 5 | Disability%
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| 6 | Service Connected?
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| 7 | Is a non-existent code ; Check the MAS disability codes on this patient.
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| 8 | Enter `^`to exit, or `return` to continue:
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| 9 | Enter `return` to continue
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| 10 | YOU MUST ENTER `RETURN` TO FINISH VIEWING MAS DISABILITY CODES
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| 11 | MAS Disability Codes continued:
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| 12 | Press `RETURN` to continue.
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| 13 | Last Movement Actions
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| 14 | No Movements Recorded for this Patient
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| 15 | Trans. Type:
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| 16 | Type of Movement:
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| 17 | Clinic Enrollments
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| 18 | No Clinic Enrollments for this Patient
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| 19 | OPT or AC
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| 20 | Pending Appointments
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| 21 | No Pending Appointments for this Patient
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| 22 | Appt. Date
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| 23 | Suspense Processing
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| 24 | INITIAL ACTION DATE
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| 25 | Chronological list of notes posted to the request...
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| 26 | No notes have been posted to this request
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| 27 | Initial Action Note
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| 28 | Completion Note
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| 29 | Other Action Note
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| 30 | posted by
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| 31 | RMPREO LINK 2319
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| 32 | Old suspense record, no completion note available.
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| 33 | VENDOR PHONE:
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| 34 | Can Not Edit This Suspense Record!
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| 35 | STOCK ISSUE
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| 36 | Initial Action Note Already Posted!
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| 37 | nothing noted
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| 38 | Can Not Forward.
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| 39 | Completion Note Already Posted!
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| 40 | Select Service To Forward Consult:
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| 41 | Not Forwarded! No Service Selected .
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| 42 | Must Have Note to Forward. Consult Not Forwarded.
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| 43 | See Completion Note, this was forwarded to another service.
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| 44 | not noted
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| 45 | ERROR, DID NOT FORWARD!
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| 46 | Consult Forwarded.
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| 47 | See Completion Note for Initial Action Taken.
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| 48 | No Initial Action Taken...
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| 49 | This has already been completed, cannot cancel!
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| 50 | This will CANCEL/DELETE this Suspense Request.
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| 51 | Are you sure you want to CANCEL/DELETE this Suspense Request? (Y/N)
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| 52 | Suspense Not Cancelled!
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| 53 | DELETED/CANCELLED!
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| 54 | Someone else is editing this record
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| 55 | Only CPRS Suspense Can Be Cloned!
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| 56 | Could NOT CLONE DUE TO BAD DATA!
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| 57 | Done... Please select a device to print the new SUSPENSE Record.
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| 58 | Nothing to Display, Manual Suspense.
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| 59 | RMPR DETAILED DISPLAY
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| 60 | Select PROSTHETICS SITE PARAMETER SITE NAME
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| 61 | PIP ROLL-UP
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| 62 | PIP REPORT
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| 63 | Prosthetics Data Extract
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| 64 | The National Data Server has been activated today by Prosthetics HQ.
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| 65 | Data has been collected for the date range
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| 66 | Disability Code information will be transmitted.
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| 67 | PSAS National Extract From
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| 68 | RMPRXMZ(
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| 69 | Total Number of Unique SSN's for this site:
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| 70 | PSAS Summary National Extract From
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| 71 | Extract From
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| 72 | Prosthetics National Data Extract
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| 73 | Message Numbers Created
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| 74 | Summary
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| 75 | RMPRM(
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| 76 | Prosthetics Data Extract Open Obligations
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| 77 | Data has been collected for all open obligations.
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| 78 | Select FORM LETTER TYPE:
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| 79 | Would you like a header on this letter
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| 80 | Answer `YES` for a header, `NO` for no header
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| 81 | Enter `return` to continue:
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| 82 | You may only enter `return` here..
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| 83 | PRINT PROSTHETICS FL 10-90
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| 84 | REQUEST FOR QUOTATION
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| 85 | FROM: Prosthetics Service
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| 86 | Prosthetics Service
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| 87 | Vendor Phone #:
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| 88 | SSN:
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| 89 | Your firm is being considered for the following:
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| 90 | An estimate on the above-listed item(s) is requested.
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| 91 | YOUR QUOTATION
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| 92 | DOES NOT CONSTITUTE A PURCHASE ORDER.
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| 93 | Upon completion of the esti-
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| 94 | mate, return the original to the Veterans Affairs facility indicated
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| 95 | above and retain a copy for your files.
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| 96 | If approved, a purchase order will be prepared and forwarded to you.
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| 97 | VENDOR'S ESTIMATE
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| 98 | (To be completed by Vendor)
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| 99 | Article or Service
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| 100 | |Quantity| Unit |Unit Cost|Total Cost|
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| 101 | Contract number (if applicable) |
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| 102 | Signature & Title of Company Official|
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| 103 | | Note:List Terms/Discounts if Applicable
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| 104 | FL 10-90 ADP
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| 105 | Push return to continue
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| 106 | CONTINUATION OF REQUEST FOR QUOTATION
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| 107 | SSN:
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| 108 | CONTINUATION OF ITEM LIST:
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| 109 | PROSTHETICS GENERIC CODE SHEETS
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| 110 | AMIS is Already Running!
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| 111 | PROSTHETICS ORTHOTIC/RESTORATION GENERIC CODE SHEETS
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| 112 | Would you like to Delete this Transaction
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| 113 | Would you like to Edit this Transaction
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| 114 | 1R;12R;4R;7R;2R;62R;63;14R~UNIT COST;5R;10;9;21
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| 115 | Do you wish to POST this entry
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| 116 | Do you wish to Delete this entry
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| 117 | Enter HOME/LIAISON VISIT DATE OPENED
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| 118 | VISIT HAS NOT BEEN CLOSED OUT
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| 119 | Select HOME/LIAISON VISIT DATE OPENED:
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| 120 | MSH|^~\&|PROSTHETICS|
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| 121 | unable to file order
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| 122 | Request Failed to Suspense
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| 123 | RMPR SUSP
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| 124 | RMPR LOAN DEL
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| 125 | RMPR LOAN CREATE
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| 126 | RMPR LOAN RET
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| 127 | RMPR LOAN DISP
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| 128 | RMPR LOAN FOLLOW-UP
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| 129 | RMPR LOAN PRINT ALL
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| 130 | RMPR LOAN EDIT
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| 131 | RMPR LOAN STAT
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| 132 | RMPR LOAN MENU
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| 133 | ENTRIES FOR
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| 134 | NO. - DESCRIPTION
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| 135 | NO OUTSTANDING 2237 ENTRIES.
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| 136 | ELIG/REF
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| 137 | Select Item to Edit
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| 138 | Deliver To information is Missing!! 2421 is incomplete
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| 139 | REQUIRED ITEM INFORMATION IS MISSING
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| 140 | Do you want to delete the 2421 Request
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| 141 | Do You want to delete the 2421 Request
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| 142 | This report lists open purchasing transactions created in the
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| 143 | Prosthetic Package. It will not include manual transactions done
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| 144 | in the IFCAP 1358 module.
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| 145 | OPEN 1358 TRANSACTIONS
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| 146 | ITEM COST
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| 147 | This Transaction has been Closed!
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| 148 | This Transaction has already been Canceled!
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| 149 | An X in the Item column is an error and must be reported to your Application Coordinator!
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| 150 | Enter 'W' for WHEELCHAIR, 'O' for BRACE, 'B' for BLIND AIDS, 'A' for ART. LIMBS
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| 151 | Select PSC ITEM CATEGORY:
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| 152 | You will not be able to exceed an item repair cost of more than $
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| 153 | BLIND AID
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| 154 | ARTIFICIAL LIMB
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| 155 | Transaction NOT Closed-out, IFCAP Failed to Post for the Following Reason.
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| 156 | Enter Date to Start NPPD Calculations From:
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| 157 | DETAIL & NEW SUMMARY
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| 158 | Prosthetic NPPD
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| 159 | NO UPDATE!
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| 160 | NEW TO REPAIR
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| 161 | REPAIR TO NEW
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| 162 | Line is null, something wrong with file 661.1 :
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| 163 | HCPCS DES
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| 164 | PICKUP/DEL
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| 165 | Ave Com
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| 166 | SP LEG
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| 167 | ELG REF
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| 168 | $ELG REF
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| 169 | STATION SUMMARY (REPAIR ACTIVITIES)
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| 170 | Elg Ref $
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| 171 | SPEC LEG
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| 172 | Total Disability:
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| 173 | HEARING AID, LOCAL REPAIRS
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| 174 | WHEELCHAIRS AND ACCESSORIES
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| 175 | ARTIFICIAL LEGS
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| 176 | ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 177 | BRACES AND ORTHOTICS
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| 178 | NEUROSENSORY AIDS
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| 179 | HOME DIALYSIS EQUIPMENT
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| 180 | MEDICAL EQUIPMENT
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| 181 | ALL OTHER
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| 182 | AUTO & VAN EQUIP
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| 183 | WHEELCHAIRS AND ACCESSORIES
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| 184 | ARTIFICIAL LEGS
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| 185 | ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 186 | BRACES AND ORTHOTICS
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| 187 | SHOES/ORTHOTICS
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| 188 | NEUROSENSORY AIDS
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| 189 | HOME DIALYSIS EQUIPMENT
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| 190 | MEDICAL EQUIPMENT
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| 191 | OXYGEN & RESPIRATORY
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| 192 | AUTO & VAN EQUIP
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| 193 | ERROR, STOPPING!
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| 194 | STATION SUMMARY (NEW ACTIVITIES)
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| 195 | Unique SSN:
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| 196 | OXYGEN AND RESPIRATORY
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| 197 | ALL OTHER SUPPLIES AND EQUIPMENT
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| 198 | HOME DIALYSIS PROGRAM
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| 199 | ADAPTIVE EQUIPMENT
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| 200 | SURGICAL IMPLANTS
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| 201 | OXYGEN AND RESPIRATORY
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| 202 | ALL OTHER SUPPLIES AND EQUIPMENT
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| 203 | HOME DIALYSIS PROGRAM
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| 204 | ADAPTIVE EQUIPMENT
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| 205 | SURGICAL IMPLANTS
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| 206 | Sort Options
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| 207 | 2 or 5 = USED INVENTORY ONLY (NEW REPORT)
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| 208 | 1 or 4 = NEW ITEM COSTS, USED INVENTORY (VA) COST AS ZERO,
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| 209 | (PREVIOUS BRIEF/DETAILED NPPD REPORT)
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| 210 | 3 or 6 = NEW AND USED COST, BOTH DOLLAR AMOUNTS TOTALED (NEW REPORT)
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| 211 | USED INVENTORY ONLY
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| 212 | NEW ITEM COSTS, USED INVENTORY (VA) COST AS ZERO
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| 213 | NEW AND USED COST, BOTH DOLLAR AMOUNTS TOTALED
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| 214 | 2. ARTIFICIAL LEGS
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| 215 | 3. ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 216 | 8. OXYGEN AND RESPIRATORY
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| 217 | 9. MEDICAL EQUIPMENT
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| 218 | 10. ALL OTHER SUPPLIES AND EQUIPMENT
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| 219 | 11. HOME DIALYSIS PROGRAM
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| 220 | 12. ADAPTIVE EQUIPMENT
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| 221 | 14. SURGICAL IMPLANTS
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| 222 | REPAIR TO NEW
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| 223 | Create Date Patient HCPCS Item Vendor PA
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| 224 | Changed From Line
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| 225 | To NPPD Line:
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| 226 | Local Record #:
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| 227 | Nothing Changed, Someone Was Editing Record. Local Record #:
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| 228 | Prosthetics Auto-Fix
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| 229 | Prosthetic 2529-3 NPPD
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| 230 | REPORT OF 2529-3 REPAIR PROSTHETICS ACTIVITIES
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| 231 | STATION SUMMARY (2529-3 REPAIR ACTIVITIES)
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| 232 | 2529-3 WHEELCHAIRS AND ACCESSORIES
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| 233 | 2529-3 ARTIFICIAL LEGS
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| 234 | 2529-3 ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 235 | 2529-3 BRACES AND ORTHOTICS
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| 236 | 2529-3 NEUROSENSORY AIDS
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| 237 | 2529-3 HOME DIALYSIS EQUIPMENT
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| 238 | 2529-3 MEDICAL EQUIPMENT
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| 239 | 2529-3 ALL OTHER
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| 240 | 2529-3 AUTO & VAN EQUIP
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| 241 | REPORT OF 2529-3 NEW PROSTHETICS ACTIVITIES
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| 242 | STATION SUMMARY (2529-3 NEW ACTIVITIES)
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| 243 | 2529-3 WHEELCHAIRS AND ACCESSORIES
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| 244 | 2529-3 ARTIFICIAL LEGS
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| 245 | 2529-3 ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 246 | 2529-3 BRACES AND ORTHOTICS
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| 247 | 2529-3 NEUROSENSORY AIDS
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| 248 | 2529-3 OXYGEN AND RESPIRATORY
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| 249 | 2529-3 MEDICAL EQUIPMENT
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| 250 | 2529-3 ALL OTHER SUPPLIES AND EQUIPMENT
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| 251 | 2529-3 HOME DIALYSIS PROGRAM
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| 252 | 2529-3 ADAPTIVE EQUIPMENT
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| 253 | 2529-3 SURGICAL IMPLANTS
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| 254 | 2529-3 OXYGEN AND RESPIRATORY
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| 255 | 2529-3 ALL OTHER SUPPLIES AND EQUIPMENT
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| 256 | 2529-3 HOME DIALYSIS PROGRAM
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| 257 | 2529-3 ADAPTIVE EQUIPMENT
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| 258 | 2529-3 SURGICAL IMPLANTS
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| 259 | 2529-3 Form Type Only
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| 260 | This Represents Prosthetic Lab Transactions
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| 261 | 2529-3 LAB DETAIL
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| 262 | 2529-3 LAB BRIEF
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| 263 | 1. 2529-3 WHEELCHAIRS AND ACCESSORIES
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| 264 | 2. 2529-3 ARTIFICIAL LEGS
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| 265 | 3. 2529-3 ARTIFICIAL ARMS AND TERMINAL DEVICES
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| 266 | 4. 2529-3 BRACES AND ORTHOTICS
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| 267 | 6. 2529-3 NEUROSENSORY AIDS
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| 268 | 8. 2529-3 OXYGEN AND RESPIRATORY
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| 269 | 9. 2529-3 MEDICAL EQUIPMENT
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| 270 | 10. 2529-3 ALL OTHER SUPPLIES AND EQUIPMENT
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| 271 | 11. 2529-3 HOME DIALYSIS PROGRAM
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| 272 | 12. 2529-3 ADAPTIVE EQUIPMENT
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| 273 | 14. 2529-3 SURGICAL IMPLANTS
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| 274 | Select 2529-3 NPPD Group
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| 275 | Select 2529-3 NPPD Line
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| 276 | Please Enter the 2319 Date or the Patient's Name:
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| 277 | Would You like to Delete this 2319 Entry (Y/N)
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| 278 | OPEN STOCK ISSUES
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| 279 | Would you like Approve Multiple Purchases
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| 280 | Would you like to Approve this Request
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| 281 | Request not Approved
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| 282 | ***WORKING COPY***
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| 283 | CONTINUATION OF 2421
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| 284 | 17. Signature and Title of
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| 285 | Approved For
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| 286 | Voucher Auditor
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| 287 | Acct. Symbol
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| 288 | ADP Form 10-2421 APR 1991
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| 289 | ****DUPLICATE COPY****
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| 290 | In Reply Refer to:
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| 291 | With reference to your request of
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| 292 | , authority is granted to repair
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| 293 | the appliance described below for the above-named veteran.
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| 294 | DESCRIPTION OF APPLIANCE OR REPAIR
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| 295 | The total cost, not including mailing cost, will not exceed
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| 296 | When repairs are completed, please attach the original of this letter to
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| 297 | the original copy of your invoice covering repair charges. Your invoice,
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| 298 | in original and one copy should then be forwarded to this office for
|
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| 299 | Please retain the duplicate copy of this letter for your files.
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| 300 | ADP FORM 10-55
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|---|
| 301 | PROSTHETICS PRINT OF 10-55
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| 302 | <REQUEST DID NOT QUEUE!>
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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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