English	French	Notes	Complete/Exclude
Y - If you want to purge data.			
N - If you don't wish to purge data.			
Purge patients not seen since:  			
SELECT A DATE IN THE PAST PLEASE!!			
I'm going to purge all patients from the INCONSISTENT DATA file who haven't been			
admitted or registered since 			
Is this correct			
Y - To start the purge process.			
N - To QUIT.			
Generate a listing of inconsistent data elements by:			
CHOOSE OUTPUT METHOD OR ENTER '^' TO QUIT:  			
The available choices are:			
     Go To 			
List by (N)ame or (T)erminal Digit:  			
N - To generate listing in Alphabetical Order			
T - To generate listing in Terminal Digit Order.			
THIS OUTPUT REQUIRES 132 COLUMN OUTPUT			
INCONSISTENT ELEMENTS FOR PATIENTS WITH A			
Missing			
Last Day			
Home Phone #			
Soc Sec #			
ID'ed			
Edited by			
Inconsistent/Missing Data Elements			
TABLE OF INCONSISTENT/MISSING DATA ELEMENTS			
UNIDENTIFIED PATIENT #			
Do you want to delete the existing entries and rebuild the file			
Y - If you want to remove all existing entries from the INCONSISTENT DATA			
file and rebuild from scratch.			
N - If you just want to add newly identified inconsistencies to the			
existing file.			
Rebuild for patients seen since what date:  			
I'm going to check all patients who were admitted or registered on or after 			
 [Within the Past 			
DELETE all existing entries prior to rebuilding			
add any new inconsistent data elements to the existing file			
Y - If this is what you want to do.			
N - If you wish to STOP processing and reconsider this action.			
INCONSISTENT DATA^38.5P^^0			
' OPTION RUNNING FROM 			
UNABLE TO RUN THIS OPTION AT CURRENT TIME!!			
Do you really want to update existing inconsistent entries			
Y - If you want me to run through all the entries currently filed in			
the INCONSISTENT DATA file and verify they're still inconsistent.			
N - If you wish to QUIT and rethink this action.			
This check can not be edited.  It is automatically turned 			
Temporary: 			
POS: 			
Claim #: 			
Relig: 			
Ethnicity: 			
Primary Eligibility: 			
PENDING REVERIFICATION			
Other Eligibilities: 			
Confidential Address:  			
From/To: NOT APPLICABLE			
From/To:  			
COORDINATING MASTER OF RECORD: 			
Scheduled Admit			
 for treating specialty 			
Currently enrolled in 			
Future Appointments: 			
See Scheduling options for additional appointments.			
 * NO ACTION TAKEN *			
Press RETURN to CONTINUE: 			
Catastrophically Disabled Review Date: 			
 Primary Elig. Code: 			
Other Elig. Code(s): 			
  Service Connected: NO			
         SC Percent: 			
NOT A VETERAN			
    Health Insurance: 			
Medicaid Elig: 			
  Means Test Status:  NOT IN MEANS TEST FILE			
  Invalid pseudo SSN.			
Type 'P' for the valid one			
Pseudo SSN adjusted to match edited name value ==> 			
VERIFY FIELDS			
  Already used by patient '			
  The SSN must not begin with 9.			
   First three digits cannot be zeros.			
      Note: This is a RR Retirement SSN.			
      Note: This is a Test Patient SSN.			
 Collateral of 			
Must have same SSN to be collateral			
Has collateral 			
 be sure to change SSN			
The date of birth is too early for the selected category of beneficiary			
Make another selection or correct the date of birth.			
The date of birth is too late for the selected category of beneficiary.			
The patient's age is too young for the selected category of beneficiary.			
This service entry date would make the patient too young for service.			
DOB 			
Previous service entry date is not on file			
This service entry date must be before than the first service entry date 			
This service entry date must be less than the second service entry date 			
The service separation date must be after the entry date 			
This service separation date must be before the next service entry date 			
The service separation date must be before the next service entry date 			
**NOTE-Change(s) made in this session deleted the veteran's Combat Vet status!			
But I need a Start Date for this Temporary Address.			
But I need at least one line of a Temporary address.			
But I need a Start Date.			
But I need at least one active category.			
I need at least one line of Address.			
But I need to know where you were treated most recently.			
Patient is not a veteran.  Can't enter rated disabilities			
SPOUSE'S 			
DEPENDENT'S 			
CHILD'S 			
Incomplete Entry...Deleted			
No dependents to inactivate!			
Enter a number 1-			
 to indicate the dependent you wish to inactivate: 			
 indicating the number of the dependent you wish to inactivate			
RELATIONSHIP: 			
Entry incomplete...deleted			
Dependent has been inactivated as of 			
Date 			
 no longer a dependent			
Enter the date this person was no longer a dependent of the veteran.			
This could include a date of death or the date a child turned 18 for			
children.  For a spouse, this would be the date of divorce or date 			
of death of the spouse.  Date must be after the person became a			
dependent, but prior to 12/31/			
A person should only be inactivated if the individual was not a			
dependent at any time during the prior calendar year.			
A spouse should be inactivated if the spouse and veteran were not			
married as of 12/31/			
Warning: Data will be used if dependent was active at least one day in a			
year.  Data will not be used if inactivation is prior to 1/1/			
 or it			
is equal to the activation date.			
Do you wish to inactivate this dependent on the selected date?			
    [Must edit through means test!!]			
EFFECTIVE DATE			
Please return to screen 8 and check the veteran's effective date.			
The effective date was created based on the veteran's date of birth.			
You might also want to check the date of birth for this veteran.			
This dependent is 18 years or older.  To list this person as a dependent			
they have to be:			
     1.  An UNMARRIED child who is under the age of 18.			
     2.  Between the ages of 18 and 23 and attending school.			
     3.  An unmarried child over the age of 17 who became permanently			
         incapable of self support before the age of 18.			
Use 'Expand Dependent' option to change effective date.			
Enter the date this person first became a dependent of the veteran.			
In the case of a spouse, this would be the date of marriage.  For			
a parent or other dependent, this would be the date the dependent			
moved in.  For a child, this would be the date of birth or date of			
Date must be before DEC 31, 			
 as dependents are collected for the			
prior calendar year only.			
Enter '^' to stop the display 			
and edit 			
of data, '^N' to jump to screen #N (see			
listing below), <RET> to continue on to the next available screen			
 or enter			
the field group number(s) you wish to edit using commas and dashes as			
delimiters.  Those groups enclosed in brackets 			
 are editable while those			
enclosed in arrows 			
 are not.			
  Enter 'ALL' to edit all editable data			
elements on the screen.			
You may precede your selection with 'V' to denote veteran.			
DATA GROUPS ON SCREEN 			
Press RETURN key			
 to EXIT Screen 			
TO EXIT			
Name, SSN, DOB^Alias Name & SSN (if applicable)^Remarks concerning this patient^Home Address, Phone & Work Phone^Temporary Address, Dates, Phone			
Confidential Address,Dates and Types			
Sex, POB, Parents, etc.^Dates/Locations of Previous Care^Race and Ethnicity			
Primary Next-of-Kin^Secondary Next-of-Kin^Primary Emergency Contact^Secondary Emergency Contact^Designee to receive personal effects			
Applicant Employer, Address^Spouses Employer, Address			
Unexpired Insurance Policies^Eligibile for Medicaid			
Service History^Prisoner of War^Combat^Vietnam Service^Agent Orange Exposure^IONizing Radiation Exposure^			
Lebanon Service^Grenada Service^Panama Service^Persian Gulf Service^Somalia Service^Environmental Contaminants Exposure^Military Retirement/Disability^Dental History^Yugoslavia Service^Purple Heart Recipient^			
Nose/Throat Radium Treatment			
Patient Type, SC Data, Claim Info^VA Monetary Benefits^POS, Eligibility Code(s)^SC Conditions relayed by applicant			
Spouse's Demographic Info^Dependents' Demographic Info			
Social Security^U.S. Civil Service^U.S. Railroad Retirement^Military Retirement^Unemployment^Other Retirement^Total Employment Income^Interest,Dividend,Annuity^Workers Comp or Black Lung^Other Income			
Ineligible Patient Information^Missing Patient Information			
Eligibility Verification^Monetary Benefits Verification^Service Record Verification^Rated Disabilities (VA)			
Four most recent admission episodes on file for this applicant are displayed			
in inverse order.			
Four most recent applications for care (registrations) are displayed in			
inverse order.			
Clinics in which actively enrolled^Pending (future) appointments			
Sponsor information is displayed for patients.			
Demographic^Confidential Address^Patient^Contact^Employment^Insurance^Service Record^Eligibility^Family Demographic^Income Screening^Missing/Ineligible^Eligibility Verification^			
Admission Info^Application Info^Appointment Info^Sponsor Demograhics			
Enter your division: 			
Unable to update Purple Heart Data.			
Unable to update Purple Heart History.			
=ENTER new 			
 to EDIT, 			
 for screen N or 			
 to QUIT			
  COPYING will move Family Demographic and Income Data into the next year...			
   YOU HAVE ALREADY MODIFIED CURRENT YEAR DEPENDENT INFORMATION			
     COPYING will OVERWRITE this modified dependent information			
     with LAST year's data -  ** Please review dependent data **			
   ...FAMILY DEMOGRAPHIC DATA COPIED			
   ...............INCOME DATA COPIED			
===> Record has been classified as sensitive.			
Your MAS PARAMETER file is not properly set up!			
LOCAL REGISTRATION QUESTIONS			
INVALID SCREEN NUMBER...VALID SCREENS ARE 			
(To edit only veteran income, precede selection with 'V' [ex. 'V1-3']			
precede with 'S' to edit spouse			
precede with 'D' to edit dependents			
>>> Patient cannot be registered while there is still an open disposition.			
Patient: Eligibility, Demographic			
   Emergency Contact and Military Service			
Marital			
Another user is editing, try later...			
Insurance			
HINQ Inquiry			
Consistency Checker			
At this time you may Register the patient if he or she is present and			
seeking care.  Answer 'No' if this was a mail-in application.			
Would you like to Register the patient			
Exit Interview			
PRINT 10/10T			
DGRPT 10-10T REGISTRATION			
Patient Demographics			
Permanent Address:			
Emergency Contact			
NOK: 			
Military Service			
Service Branch [Last]: 			
Number [Last]: 			
Purple Heart: 			
Eligibility			
Patient Type: 			
Primary Elig Code: 			
Marital/Spouse			
Spouse's Name: 			
Last Year's Estimated 			
Covered by Health Insurance: 			
Insurance Co.      Subscriber ID     Group       Holder  Effective Expires			
PRINT 10-10T			
 - FROM REGISTRATION			
Reg Date/Time: 			
AUTOMATED VA FORM 10-10T			
VA FORM 10-10T			
|2. Social Security Number			
|3. Date of Birth			
4A. Applicant's Mailing Street Address			
|4D. Zip Code			
|6. Home Telephone Number			
|7. Work Telephone Number			
8A. Emergency Contact			
|8C. Home Telephone Number			
|8D. Work Telephone Number			
8E. Mailing Address of Emergency Contact			
|9. Is Emergency Contact			
|Also Next of Kin			
10. Benefit Applying For:   			
HOSPITAL/OUTPATIENT TREATMENT			
11. Applicant Status: 			
A. Service Connected			
|B. Prisoner of War			
|C. Aid and Attendance			
|D. Military Disability Retired			
E. VA Pension			
|F. Primary Eligibility Code			
|G. Other Eligibility Code			
|H. Purple Heart Recipient			
12. Exposure To: 			
|A. Agent Orange			
|C. Environmental Contaminants			
13. Medical Care Related To: 			
14A. Do You Have Health Coverage			
|14B. Name of Health Insurance Carrier			
15. Branch of Service			
|16. Latest Service Number			
|17. Marital Status			
|18B. Spouse's Social Security Number			
18C. Year of Marriage			
|18D. Number of Dependents			
|19. Last Year's Estimated 			
 Taxable Income			
Consent To Release Information: I hereby authorize the Department of Veterans Affairs to disclose any such history, diagnostic and			
treatment information from my medical records (including information relating to the diagnosis, treatment or other therapy for the			
conditions of drug abuse, alcoholism or alcohol abuse, sickle cell anemia, or testing for or infection with the human			
immunodeficiency virus) to the carrier or contractor of any health plan contract under which I am apparently entitled to medical			
care or payment of the expense of care that is identified above, as considered necessary by VA representatives for the discharge			
of the legal or contractual obligations of the insurer or other party against whom liability is asserted.  I understand that I			
may revoke this authorization at any time, except to the extent that action has already been taken in reliance on it.  Without my			
express revocation, this consent will automatically expire when all action arising from VA's claim for reimbursement for my			
medical care has been completed.			
Co-payment Notice: If your household income exceeds the established threshold, you will be considered 			
Discretionary			
Such veterans must pay a co-payment not to exceed the Medicare deductible, plus a per diem for hospital and nursing care.			
By signing this application, you are agreeing to pay the VA the applicable co-payment if you are determined to be a			
Signature of Applicant			
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for			
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the			
####################	####################	####################	
####################	####################	####################	
####################	####################	####################	
####################	####################	####################	
####################	####################	####################	
