DGMTP4 ;ALB/RMO,CAW,LD - Print Means Test 10-10F Cont. ;16 APR 1992 2:35 pm
;;5.3;Registration;**33,182,300**;Aug 13, 1993
;
EN ;Entry point to print signature block and special notes
; Set category, status and type of care variables from means test file.
; These are initially set in DGMTP with the call to SET^DGMTSCU2, but
; are calculated by the data available. For this portion of the
; printout they should be set to the means test file entry.
N DGCAT,DGMTS,DGTYC,X
S DGMTS=$P(DGMT0,"^",3),DGCAT=$P($$MTS^DGMTU(DFN,$S(DGMTS=2:6,1:DGMTS)),"^",2),DGTYC=$P($G(^DG(408.32,DGMTS,0)),"^",3)
D SIG,NOTE
Q Q
;
SIG ;Print signature block
W $$UL^DGMTSCU1(DGUL,DGLNE1),!?30,"Completion of this form with signature of veteran is certification",!?30,"that the veteran has received a copy of the privacy act statement."
W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"THE ABOVE INFORMATION IS CORRECT",?63,"| Signature of Veteran or Designee",?109,"| Date",!?1,"TO THE BEST OF MY KNOWLEDGE.",?63,"|",?109,"|"
W $$UL^DGMTSCU1(DGUL,DGLNE1),!,?37,"F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO",!,?41,"ARE REQUIRED TO MAKE COPAYMENTS"
W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"Eligibility Category",?30,"| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare"
W !?30,"| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit",!
W:DGMTYPT=1 ?11,DGCAT
W ?30,"| Deductible is required for Category C Veterans to receive Outpatient care."
W !?30,"| The Billing Period and Rates are specified in 38 U.S.C."
W $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"I AGREE TO PAY THE VA THE APPLICABLE",?63,"| Signature of Veteran or Designee",?109,"| Date"
W !?1,"DEDUCTIBLE FOR MY MEDICAL CARE.",?63,"| ",$S(DGTYC'="D":"NOT APPLICABLE",'$P(DGMT0,"^",11):"HAS NOT AGREED",1:""),?109,"|"
Q
;
NOTE ;Print any special notes
W !,DGLNE,!?1,"Special Note(s):"
S X=+$P(DGMT0,"^",23) I (X>1) W ?30,"This means test was administered by the ",$S(X<4:"IVM",1:$$SR^DGMTAUD1(DGMT0,DGMTI)_" Medical")," Center.",!
I DGMTS=2 W ?30,"Patient's means test is Pending Adjudication.",!
I DGMTS=3 W ?30,"Patient's means test is No Longer Required.",!
I $P(DGMT0,"^",14),DGMTS=6 W ?30,"Patient has declined to provide income information.",!
I $P(DGMT0,"^",16) W ?30,"Previous years thresholds were used to determine the patient's eligibility for care.",!?30,"The means test must be re-applied once the correct thresholds are available.",!
I $P(DGMT0,"^",4)'=DGINT W ?30,"Patient's annual income does not match the income associated with the means test." W:DGTYC'="N" !?30,"Please edit and complete the means test again.",!
I $P(DGMT0,"^",19)=2 W ?30,"Copay Exemption Test Status is: "_$S($P(DGMT0,U,3)=7:"EXEMPT",$P(DGMT0,U,3)=8:"NON-EXEMPT",$P(DGMT0,U,3)=9:"INCOMPLETE",$P(DGMT0,U,3)=10:"NO LONGER APPLICABLE",$P(DGMT0,U,3)=11:"PENDING ADJUDICATION",1:"")
W ! S DGPGE=2 D FT^DGMTP ;end of second page of form
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDGMTP4 2962 printed Oct 16, 2024@18:45:49 Page 2
DGMTP4 ;ALB/RMO,CAW,LD - Print Means Test 10-10F Cont. ;16 APR 1992 2:35 pm
+1 ;;5.3;Registration;**33,182,300**;Aug 13, 1993
+2 ;
EN ;Entry point to print signature block and special notes
+1 ; Set category, status and type of care variables from means test file.
+2 ; These are initially set in DGMTP with the call to SET^DGMTSCU2, but
+3 ; are calculated by the data available. For this portion of the
+4 ; printout they should be set to the means test file entry.
+5 NEW DGCAT,DGMTS,DGTYC,X
+6 SET DGMTS=$PIECE(DGMT0,"^",3)
SET DGCAT=$PIECE($$MTS^DGMTU(DFN,$SELECT(DGMTS=2:6,1:DGMTS)),"^",2)
SET DGTYC=$PIECE($GET(^DG(408.32,DGMTS,0)),"^",3)
+7 DO SIG
DO NOTE
Q QUIT
+1 ;
SIG ;Print signature block
+1 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?30,"Completion of this form with signature of veteran is certification",!?30,"that the veteran has received a copy of the privacy act statement."
+2 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"THE ABOVE INFORMATION IS CORRECT",?63,"| Signature of Veteran or Designee",?109,"| Date",!?1,"TO THE BEST OF MY KNOWLEDGE.",?63,"|",?109,"|"
+3 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!,?37,"F. TO BE COMPLETED BY DISCRETIONARY VETERANS WHO",!,?41,"ARE REQUIRED TO MAKE COPAYMENTS"
+4 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"Eligibility Category",?30,"| Veterans in Category C must agree to pay VA a Deductible not to exceed the Medicare"
+5 WRITE !?30,"| Deductible plus a per diem for Hospital and Nursing Home care. A per Visit",!
+6 if DGMTYPT=1
WRITE ?11,DGCAT
+7 WRITE ?30,"| Deductible is required for Category C Veterans to receive Outpatient care."
+8 WRITE !?30,"| The Billing Period and Rates are specified in 38 U.S.C."
+9 WRITE $$UL^DGMTSCU1(DGUL,DGLNE1),!?1,"I AGREE TO PAY THE VA THE APPLICABLE",?63,"| Signature of Veteran or Designee",?109,"| Date"
+10 WRITE !?1,"DEDUCTIBLE FOR MY MEDICAL CARE.",?63,"| ",$SELECT(DGTYC'="D":"NOT APPLICABLE",'$PIECE(DGMT0,"^",11):"HAS NOT AGREED",1:""),?109,"|"
+11 QUIT
+12 ;
NOTE ;Print any special notes
+1 WRITE !,DGLNE,!?1,"Special Note(s):"
+2 SET X=+$PIECE(DGMT0,"^",23)
IF (X>1)
WRITE ?30,"This means test was administered by the ",$SELECT(X<4:"IVM",1:$$SR^DGMTAUD1(DGMT0,DGMTI)_" Medical")," Center.",!
+3 IF DGMTS=2
WRITE ?30,"Patient's means test is Pending Adjudication.",!
+4 IF DGMTS=3
WRITE ?30,"Patient's means test is No Longer Required.",!
+5 IF $PIECE(DGMT0,"^",14)
IF DGMTS=6
WRITE ?30,"Patient has declined to provide income information.",!
+6 IF $PIECE(DGMT0,"^",16)
WRITE ?30,"Previous years thresholds were used to determine the patient's eligibility for care.",!?30,"The means test must be re-applied once the correct thresholds are available.",!
+7 IF $PIECE(DGMT0,"^",4)'=DGINT
WRITE ?30,"Patient's annual income does not match the income associated with the means test."
if DGTYC'="N"
WRITE !?30,"Please edit and complete the means test again.",!
+8 IF $PIECE(DGMT0,"^",19)=2
WRITE ?30,"Copay Exemption Test Status is: "_$SELECT($PIECE(DGMT0,U,3)=7:"EXEMPT",$PIECE(DGMT0,U,3)=8:"NON-EXEMPT",$PIECE(DGMT0,U,3)=9:"INCOMPLETE",$PIECE(DGMT0,U,3)=10:"NO LONGER APPLICABLE",$PIECE(DGMT0,U,3)=11:"PENDING ADJUDICATION",1:""
)
+9 ;end of second page of form
WRITE !
SET DGPGE=2
DO FT^DGMTP
+10 QUIT
