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Routine: EASEC101

Package: Enrollment Application System

Routine: EASEC101


Information

EASEC101 ;ALB/BRM,LBD - Print 1010EC LTC Enrollment Form ; 9/6/01 9:46am

Source Information

Source file <EASEC101.m>

Entry Points

Name Comments DBIA/ICR reference
PAGE1(EALNE,EAINFO,EASDFN) ;Print page 1
SEC1 ;print section 1 - General Information
SEC2 ;print section 2 - Insurance Information
SEC3 ;print section 3 - Spouse/Dependent Information
DISCLAIM ;

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !,"1. Veteran's Name",?100,"|2. Social Security Number"
  • Line Location: SEC1+3
Function Call: WRITE
  • Prompt: !?3,@EAS1@(1),?100,"|",?104,@EAS1@(2),?131,$C(13)
  • Line Location: SEC1+4
Function Call: WRITE
  • Prompt: !?26,"Answer Yes or No where applicable (Otherwise provide the requested information)",?131,$C(13)
  • Line Location: SEC1+6
Function Call: WRITE
  • Prompt: !,"3. Are You Eligible for Medicaid?"
  • Line Location: SEC1+8
Function Call: WRITE
  • Prompt: ?36,"|3A. Are You Enrolled in Medicare Part A (Hospital Insurance)"
  • Line Location: SEC1+9
Function Call: WRITE
  • Prompt: ?100,"|3B. Effective Date (If ""Yes"")"
  • Line Location: SEC1+10
Function Call: WRITE
  • Prompt: !?3,@EAS1@(3),?36,"|",?41,@EAS1@(4),?100,"|",?105,@EAS1@(5),?131,$C(13)
  • Line Location: SEC1+11
Function Call: WRITE
  • Prompt: !,"4. Are You Enrolled in Medicare Part B (Medical Insurance)"
  • Line Location: SEC1+13
Function Call: WRITE
  • Prompt: ?63,"|4A. Effective Date (If ""Yes"")"
  • Line Location: SEC1+14
Function Call: WRITE
  • Prompt: ?97,"|4B. Medicare Claim Number"
  • Line Location: SEC1+15
Function Call: WRITE
  • Prompt: !?3,@EAS1@(6),?63,"|",?68,@EAS1@(7),?97,"|",?102,@EAS1@(8),?131,$C(13)
  • Line Location: SEC1+16
Function Call: WRITE
  • Prompt: !?48,"SECTION II - INSURANCE INFORMATION",!,EALNE("D")
  • Line Location: SEC2+4
Function Call: WRITE
  • Prompt: !,"5. Are You Covered By Health Insurance (including coverage through a spouse)? (If ""Yes"", provide the following information for"
  • Line Location: SEC2+6
Function Call: WRITE
  • Prompt: !?3,"all insurance company(s) providing coverage to you.)"
  • Line Location: SEC2+7
Function Call: WRITE
  • Prompt: !?3,@EAS2@(1),?131,$C(13)
  • Line Location: SEC2+8
Function Call: WRITE
  • Prompt: !?44,"SECTION III - SPOUSE/DEPENDENT INFORMATION",!,EALNE("D")
  • Line Location: SEC3+5
Function Call: WRITE
  • Prompt: !,"We need to collect information regarding income, assets, and "
  • Line Location: DISCLAIM+1
Function Call: WRITE
  • Prompt: "expenses for you and your spouse. If you do not wish to provide this"
  • Line Location: DISCLAIM+2
Function Call: WRITE
  • Prompt: !,"information you must sign agreeing to make copayments and will "
  • Line Location: DISCLAIM+3
Function Call: WRITE
  • Prompt: "be charged the maximum copayment amount for all services. See the"
  • Line Location: DISCLAIM+4
Function Call: WRITE
  • Prompt: !,"top of page 2, read, sign, and date."
  • Line Location: DISCLAIM+5
Info |  Source |  Entry Points |  Interaction Calls