English French Notes Complete/Exclude PSC Category: Item: Unit Cost : Actual Unit Cost: Serial #: Patient Category: Type of Transaction: Special Category: Appliance/Repair: Item Remarks: Brief Description: Extended Description: (Example, PO number), or Bank Authorization Number (6 digit number). ERROR** This transaction was not posted to 2319, please contact your IRM.. Ready to Reconcile and Close-Out Transaction You may now Close-out and Post this Transaction. Please answer Yes or No. Transaction NOT Closed-Out! ** No Item selected.. 2R~UNIT COST; 4R~UNIT OF ISSUE;7;11////C DO YOU WANT TO ADD A DUPLICATE ITEM? ***** NOT CLOSED-OUT !!!! **** NOT CLOSED-OUT!! **** **** TRANSACTION NOT CLOSED-OUT!! **** Enter Next Transaction to Close-out, or to continue. INCOMPLETE RECORD..file 664..entry.. ...PLEASE CONTACT YOUR IRM or CANCEL THIS ENTRY!!! UNKNOWN 2319 RECORD TO UPDATE, 2319 NOT UPDATED! This Transaction has already been CLOSED! This Transaction has been CANCELED! Updated 10-2319 record for this Veteran Would You like to Edit another Entry (Y/N) NOT DELIVERED/ACCEPTED RMPR FCP MANAGER SUB TOTAL: NO ITEMS ON FILE AMIS: NO CODE FOR THIS ITEM PSAS HCPCS CODE: UNIT COST: ITEM COST: SPEC/LEG Enter '^' to Quit Display, to Continue : This report lists Open Purchase Card Transactions created in the Prosthetics Package. This report is sorted by Transaction Date and Initiator. The PC # column is the abbreviated Purchase Card Transaction Number, Example: 644-PC546, would display as 546. OPEN 2421PC TRANSACTIONS Item Cost Open 2421PC Transactions ...now posting to file 660... **** POSTING TO 2319 FOR ITEM.. PLEASE RUN CLOSE-OUT OPTION AGAIN... Select Transaction or Patient Name: OMB Number 2900-0188 Estimated Burden: 4 minutes ***ORIGINAL COPY AND COMMERCIAL INVOICE MUST BE SUBMITTED*** TO THE VAMC PROSTHETIC ACTIVITY LISTED BELOW Prosthetic Authorization for Items or Services 1. Name and Address of Vendor 2. Name and Address of VA Facility NO STATE ON FILE 3. Veterans Name (Last, First, MI) 4. Date of Authorization 5. Veterans Address 6. Date Required 9. Authority For Issuance CFR 17.115 CHARGE MEDICAL APPROPRIATION 7. Claim Number 10. Statistical Data 11. FOB Point 13. Delivery Time 14. Delivery To: 15. DESCRIPTION OF ITEMS OR SERVICES AUTHORIZED ITEM NUMBER DESCRIPTION/NOMENCLATURE ***SEE ATTACHED CONTINUATION SHEET FOR ITEM DESCRIPTION(S)*** CONTINUATION OF PURCHASE CARD 16. Contract Number: Discount $ Shipping: 17. Signature of 19. Signature and Title of Requesting Official Contracting/Accountable Officer Order and Receipt Action 21. Order Number 22. Date of Order 23. Date Item Received 24. Date Delivered 25. The articles or services listed herein have been received, or rendered ordered in the quantity and quality specified orginally or as shown by authenticated changes, except as noted. Signature of Veteran or VA Official VOUCHER AUDIT BLOCK (For use by VA Facility only) Bank Authorization Number: Acct. Symbol ADP Form 10-2421PC APR 1991 52.224-2 PRIVACY ACT (APR 1984) (a) The Contractor agrees to--- (1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies--- (i) The systems of records: and (ii) The design, development, or operation work that the contractor is to (2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract required the redesign, development, or operation of a system of records on individuals that is subject to the Act; and (3) Include this clause, including this subparagraph (3), in all subcontracts awarded under this contract which requires the design, development, or opera- tion of such a system of records. (b) In the event of violations of the Act, a civil action may be brought ag- ainst the agency involved when the violation concerns the design, development or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the ag- ency when the violation concerns the operation of a system of records on indivi- duals to accomplish an agency function. For purposes of the Act, when the con- tract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agen- Operation of a system of records, as used in this clause, means per- formance of any of the activities associated with maintaining the system of re- cords, including the collection, use, and dissemination of records. Record, as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person's name, or the iden- tifying number, symbol, or other identifying particular assigned to the indivi- dual, such as a fingerprint or voiceprint or a photograph. System of records on individuals as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. MR. MS. In reply refer to: Accounting Symbol This is to notify you that the items listed below were ordered for you on . Delivery of this equipment is expected on or about in 30 days from the order date. If you do not receive it within 5 days of the expected date, please contact , of my staff, at 17;16;8////^S X=$G(RMTYPE);9////^S X=$G(RMCAT);10////^S X=$G(RMSPE);1R~BRIEF DESCRIPTION OF ITEM (for Vendor); 17;8TYPE OF TRANSACTION;9PATIENT CATEGORY;S RMPRDIS=+$P(^RMPR(664,DA(1),1,DA,0),U,10);S Y=$S(RMPRDIS=4: );@2;3QTY;2;4UNIT OF ISSUE;11////C; ;@1;10SPECIAL CATEGORY;S Y= Enter the IFCAP Site used with the Purchase Card Module The following site you select will be used on all your Purchase Card Transactions in IFCAP only. Prosthetics PIP Extract G.RMPR SERVER The Prosthetics PIP Inventory Data was transmitted to PSAS HQ today. The dates used for Days On-Hand, and Days Average Usage Rate calculations The server was activated by No HQ mail address is defined in your PROSTHETICS SITE PARAMETERS file for the PIP report. The PIP report will not be run. Please contact your system administrator or enter a NOIS in Forum for the NVS Team. VHACOPSASPIPReport@med.va.gov No Records to Print !! GRAND TOTAL $ VALUE ISSUED (Used) = GRAND TOTAL $ VALUE ON-HAND (Used) = GRAND TOTAL $ VALUE ISSUED (New) = GRAND TOTAL $ VALUE ON-HAND (New) = PROSTHETIC INVENTORY ITEM DETAIL REPORT calendar days ] HCPCS PSAS/ITEM HCPCS DESCRIPTION NPPD LINE NPPD GROUP V.A.(Used) Total| COM. (New) Total| Total |Days Ave | Stock On-Hand| Days |Total $ Value On-Hand Issue $ Value| Issue $ Value| Issue |Usage Rate| Used New | On-Hand| Used New INVENTORY REPORT RMPRSEL( Select inventory report level of detail Ending date should not precede start date Select NPPD line(s) within the above group NPPD Lines for Group: Choose HCPCS selection option Select HCPCS You need at least 132 columns for this report. Please use a device capable of this requirement. 100:WHEELCHAIRS AND ACCESSORIES 200:ARTIFICIAL LEGS 300:ARTIFICIAL ARMS AND TERMINAL DEVICES 400:BRACES AND ORTHOTICS 600:NEUROSENSORY AIDS 800:OXYGEN AND RESPIRATORY 900:MEDICAL EQUIPMENT 910:ALL OTHER SUPPLIES AND EQUIPMENT 920:HOME DIALYSIS PROGRAM 930:ADAPTIVE EQUIPMENT 960:SURGICAL IMPLANTS Processing report....... NPPD_GROUP NPPD_LINE HCPC_CODE HCPC_ITEM ISSUE COST INVENTORY_IEN HCPC_IEN PIP DETAIL ITEM REPORT PIP HCPCS SUMMARY REPORT PIP NPPD LINE SUMMARY REPORT PIP NPPD GROUP SUMMARY REPORT GRAND TOTAL $ VALUE ISSUED (Used) = $ GRAND TOTAL $ VALUE ON-HAND (Used) = $ GRAND TOTAL $ VALUE ISSUED (New) = $ GRAND TOTAL $ VALUE ON-HAND (New) = $ HCPCS DESCRIPTION NPPD LINE NPPD GROUP V.A.(Used) Total| COM. (New) Total| Total |Days Ave | Stock On-Hand| Days |Total $ Value On-Hand PROSTHETIC INVENTORY HCPCS SUMMARY REPORT PROSTHETIC INVENTORY NPPD GROUP/LINE REPORT GRAND TOTAL $ VALUE ON-HAND = PROSTHETIC INVENTORY NPPD GROUP REPORT ENTIRE SUMMARY ..Duplicate HCPCS STOCK ITEM REPORT RMPRI( Processing report...... *** ISSUE and STOCK CONTROL RECORD - PROSTHETICS STOCK ITEMS *** *** Dollar Value of HCPCS Issued *** Dollar Value of Item Issued No Item Statistics for HCPCS: ...for this date range !!! NO DATA AT THIS DATE RANGE!!!! Enter 'ALL' for all Locations or 'RETURN' to select individual Locations: Select Location ..Duplicate Location PROSTHETIC INVENTORY LOCATION SUMMARY Processing report..... *** PROSTHETICS INVENTORY BALANCE BY LOCATION *** NO DATA !!!! Enter 'ALL' for all HCPCS or 'RETURN' to select individual HCPCS: *** PROSTHETICS INVENTORY BALANCE BY HCPCS *** NO DATA !!!!! Enter 'ALL' for all Lab Employees or 'RETURN' to select individual names: Select EMPLOYEE ..Duplicate employee name PROS LAB ITEM SUMMARY PROSTHETICS LAB ITEM SUMMARY BY EMPLOYEE TIME SPENT(hr) No Lab data for Employee: ....for this date range !!! NO DATA FOR THIS DATE RANGE!!! Adding Item to a Location..... Enter Pros Location: Record in use. Try again later... Select HCPCS to ADD ** No HCPCS Selected or Unable to Select Inactive HCPCS... Enter Item to Add: 22R;23R~TOTAL COST OF QUANTITY;24;25R;26;27 Added/Updated by Delete an Inventory Location..... This option now requires the electronic signatures of 2 users holding the RMPRMANAGER key to be entered before a location Are you sure you want to DELETE this LOCATION (Y/N) Nothing Deleted.. Location is deleted!!!! Pease ask another user with the RMPRMANAGER key to enter their user name and electronic signature. Enter user name of 2nd manager: The 2nd manager must be different to the manager logged on. The 2nd manager does not have the correct security key set up. The above location contains types of items with a total quantity of and cost of $ Editing an Inventory Item in a Location..... Location has been edited from ' Select HCPCS to EDIT: ** No HCPCS selected... Enter PSAS Item to Edit: 29;22R;23R~TOTAL COST OF QUANTITY;24;25R;26;27 This will DELETE all HCPCS and ITEMS under this LOCATION... Ordering ITEM from Supply or Vendor.... Select HCPCS to ORDER: Enter Item to ORDER: Quantity to Order *** Item was not ordered.... Enter quantity 1 to 99999.. Order from supply or vendor was ordered.... *** Receiving Item from Supply, Vendor or Veteran... Enter Receiving Location: Select HCPCS to RECEIVE: Enter Item to RECEIVE: #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################