English French Notes Complete/Exclude Patient is in an 'EXEMPT' status and requires property information. Patient's deductible expenses cannot exceed income. Patient has more than one spouse for this means test. Since assets exceed the threshold, the test can be sent to adjudication. If the test is not adjudicated, the patient will be placed in GMT Copay Required MT Copay Required Non-exempt Do you wish to send this case to adjudication PRINT 10-10F THIS OUTPUT REQUIRES 132 COLUMN OUTPUT TO THE PRINTER. CANNOT QUEUE TO HOME DEVICE! Print 10-10F to CONTINUE, to EDIT, for screen N, or to EXIT: Enter to continue to the next available screen. Enter an available item number from to edit. The items should be separated by commas or a range of numbers separated by a dash, or a combination of commas and dashes. To edit a specific column, enter 'V' in front of the selected items. Enter 'ALL' to edit all available items on the screen. Enter '^N' to jump to a select screen. Enter '^' to exit. AVAILABLE SCREENS IOINHI;IOINLOW ANNUAL INCOME FOR Means Test Signed?: Patient Requires a Means Test Patient's Means Test is Pending Adjudication for Means Test Not Required Patient's status is based on primary means test Has agreed to pay the deductible Primary Means Test Required from Last Applied (NO LONGER REQUIRED: proceed with the means test at this time *** Patient Requires a Means Test *** Primary Means Test Required from Patient's Test dated The test date is greater than 365 days old. Please update. Cannot copy information. Either there is no prior year income or there is income already on file for this year. Previous year data contains a negative amount. Data cannot be copied. Patient: Date of Test: Total Dependents: Type Of Test: Status: Date/Time Completed: Primary Test For Year: Source Of Test: Income: Completed By: Net Worth: Date/Time Category Changed: Deductible Expenses: Category Changed By: Agreed to Pay Deduct.: Adjudicated Date/Time: Declines Income Info: No Longer Required Date: No Longer Applicable Date: MT Threshold: Hardship Review Date: GMT Threshold: Date Vet Signed Test: Income Data Purged: Means Test Signed?: Refused to Sign: Date IVM MT Completed: Hardship Approved By: OTHER VAMC Hardship Review Site: Hardship Reason: COMMENT(S): Date Range Selection Past dates are not allowed. Division Selection Clinic Selection LOCAL INCOME TEST TEST INCOME INFORMATION IS NOT AVAILABLE ** ** MEANS TEST IS NO LONGER REQUIRED INCOME INFORMATION MAY NOT BE ACCURATE ** ** COPAY TEST IS NO LONGER APPLICABLE INCOME INFORMATION MAY NOT BE ACCURATE ** DETAILED MEANS TEST INCOME INFORMATION COULD NOT BE CONVERTED FOR THE FOLLOWING RELATIONS ASSOCIATED WITH THIS MEANS TEST: NET WORTH TO COLLECT THE NEW DETAILED DEPENDENT DEMOGRAPHIC AND INCOME INFORMATION THE MEANS TEST WOULD HAVE TO BE EDITED. Variables DGCAT, DGINT, DGNWT, DGTHA, DGTYC and DGMTS must be defined! Variables DFN, DGND, DGDET and DGMTDT must be defined! DECLINES TO GIVE INCOME INFO DG(408.32, NJ13,2 DEDUCTIBLE EXPENSES NJ2,0 TOTAL DEPENDENTS COMPLETED BY DATE/TIME COMPLETED SITE CONDUCTING TEST AGREED TO PAY DEDUCTIBLE NJ8,2 THRESHOLD A THRESHOLD B GMT THRESHOLD PREVIOUS YEARS THRESHOLD HARDSHIP REVIEW DATE APPROVED BY HARDSHIP EFFECTIVE DATE SITE GRANTING HARDSHIP HARDSHIP REASON PERMANENTLY INCAPABLE OF SELF-SUPPORT DID THE CHILD LIVE WITH YOU DID YOU CONTRIBUTE TO THE CHILD'S SUPPORT DID CHILD HAVE ANY INCOME WAS THE CHILD'S INCOME AVAILABLE TO YOU Variables DGDR and DGVIR0 must be defined! NJ8,2X MEDICAL EXPENSES FUNERAL AND BURIAL EXPENSES VETERAN'S EDUCATIONAL EXPENSES Variable DGDR and DGPRTY must be defined! NJ10,2X SOCIAL SECURITY (NOT SSI) U.S. CIVIL SERVICE U.S. RAILROAD RETIREMENT MILITARY RETIREMENT UNEMPLOYMENT COMPENSATION OTHER RETIREMENT NJ9,2X TOTAL INCOME FROM EMPLOYMENT INTEREST, DIVIDEND, OR ANNUITY WORKERS COMP. OR BLACK LUNG ALL OTHER INCOME Variables DFN and DGDR must be defined! WAS YOUR MARITAL STATUS EITHER MARRIED OR SEPARATED ON DEC 31ST LAST YEAR DID YOU LIVE WITH YOUR SPOUSE LAST YEAR NJ8,2XR IF YOU DID NOT LIVE WITH SPOUSE, AMOUNT CONTRIBUTED TO SPOUSE LAST YEAR DID YOU HAVE ANY DEPENDENT CHILDREN CASH, AMOUNTS IN BANK ACCOUNTS STOCKS AND BONDS REAL PROPERTY OTHER PROPERTY OR ASSETS DA))'>0 DA) TE VALUE ` BULLETIN WILL NOT BE TRIGGERED) -1^MISSING DFN -1^Missing DFN UNABLE TO GENERATE RELEASE NOTES!! GENERATING FOR VERSION MAS VERSION RELEASE NOTES NOT VALID Did you receive Nose or Throat Radium Treatments in the military? Did you serve as an aviator in the military before Jan 31, 1955? Did you have submarine training in the military before Jan 1, 1965? DGNT VERIFY Do you want to verify now? Nose and throat radium treatment verified by: Has the veteran been diagnosed with Cancer of the Head and/or Neck? Enter the sort type Current N/T Radium Treatment Pending Verification report. **** No records to report. **** Total Patients Pending Documentation REPORT STOPPED AT USER REQUEST Total Patients Pending Verification: N/T RADIUM TREATMENT PENDING VERIFICATION REPORT Avi Sub Date/Time Entered YES,PENDING BOTH DOCUMENTATION AND DIAGNOSIS YES,PENDING DOCUMENTATION YES,PENDING DIAGNOSIS YES,VERIFIED Enter date of ASIH: You have entered a future date...to prevent the printing of a negative report, remember to task this request for the appropriate date. ASIH LIST FOR *** THERE ARE NO PATIENTS OUT ON ASIH FOR Enter to continue or ^ to Quit DISCRETIONARY WORKLOAD OPTIONS ARE NO LONGER AVAILABLE! Do you wish (I)npatient,(O)utpatient,or (B)oth reports: BOTH// DGODOP1,^DGODNP1 Enter I,O,B, or ^ to QUIT Purge single (M)onth or (A)ll or (^ to quit): MONTH// MONTH/YR RUN DATE Nothing purged, all your data is current Select MONTH/YEAR to PURGE: SELECT ENTRY FROM LIST IN MONTH/YEAR FORMAT. IF JANUARY 1988 WAS LISTED YOU WOULD ENTER 01/88 ARE YOU SURE YOU WISH TO PURGE YOUR FILE INPATIENT DISCHARGES BY MEANS TEST CATEGORY REPORT REQUIRES 132 COLUMN OUTPUT QUEUE ON DEVICE: CANNOT QUEUE TO YOUR OWN DEVICE CONTINUE DIRECTLY TO YOUR I/O DEVICE// If you say YES execution will begin immediately and your default i/o device will hang during compilation, NO or ^ will end Requested Start Time: DISCRETIONARY WORK REPORT- From DATE: To DATE: TO DATE IS LESS THAN FROM DATE, TRY AGAIN SC 50-100%^A&A/HB/WW1/POW/MEX^SC<50%^NSC/PEN^NSC^DOM^ Elapsed time for this run: INPATIENT DISCHARGES REPORT DATE RANGE: FROM MEANS TEST CLASSIFICATION FACILITY: TOTAL DISCHARGES: Patients remaining on VETERAN ELIGIBILITY NON-VETERAN ELIGIBILITY Hit RETURN to continue SUBTOTAL % Inpatient Workload Summary TOTAL % TOTAL VISITS: Outpatient Workload Summary Admitted on Died while an inpatient on Died on Unscheduled visit on Inpatient List SORT BY START WITH WARD LOCATION Enter all or part of a ward name. If the FROM and TO wards are pure numbers (no alphas), no wards with an alpha suffix will appear on the sort. GO TO End must be after beginning PRINT WITH WARD BREAKOUT PRINT WITH DRG BREAKOUT INPATIENT LIST Patient name Admit/Tran Ward LOS AA Pass UA ASIH Avg Int- Affil Days to Trim Nat/Loc WARD LOCATION: DIVISION(S): '+' Before the Patient name indicates patient is currently ASIH, '!' Indicates patient chose not to be in Facility Directory LEGEND: '####' - Stay exceeds high trim, '**' - Stay exceeds 69% of high trim, '@' Stay exceeds 49% of high trim Press '^' to QUIT or Return to Continue BAD 'CN' CROSS REFERENCE FOR WARD , PATIENT NUMBER No DRG can be calculated Rm: Spec: Sort this report by (W)ard or (P)rovider? WARD// Enter W to sort this report of inpatients by WARD or P to sort the report by PROVIDER. Which provider? (P)rimary Care, (A)ttending, or (E)ITHER? EITHER// Enter P to sort this report of inpatients by PRIMARY CARE PHYSICIAN A to sort the report by ATTENDING PHYSICIAN, or E to print the report where the provider was EITHER Attending or Primary Care Sub-sort by (N)ame of Patient or (R)oom NAME// SECONDARY SORT ORDER: Enter N to sort this report of inpatients by NAME or R to sort the report by ROOM NUMBER. Note: ROOM NUMBER = First set of numbers that appear in ROOM-BED WOULD YOU LIKE THE INPATIENT ROSTER DOUBLE SPACED Enter 'Y'es to double space this report, 'N'o to single space HOW MANY COPIES OF THE INPATIENT ROSTER WOULD YOU LIKE? 1// Enter a number from 1 to 10 indicating the number of copies you want printed. THIS REPORT REQUIRES 132 COLUMN OUTPUT VAUTD#^VAUTW#^DGPVAR^DGHOW^DGCPYS^DGDS^DGSUBS INPATIENT ROSTER ROOM-BED '!' Before the Patient name indicates the patient chose not to be listed in the Facility Directory Display report for (D)ATE RANGE or (C)URRENT DATE: CURRENT// You may display report for : Include Service Connected Inpatients VAUTD#^DGBEG^DGBEG1^DGEND^DGEND1^DGL^DGSC Enter the beginning date: The ending date can not be before the beginning date C for CURRENT DATE - Report will display only those patients that are inpatients in hospital today. D for DATE RANGE - to display all patients that were admitted to the hospital during that period. Choose (Y)es or (N)o: #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### #################### ####################