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Routine: EASEZPF1

Package: Enrollment Application System

Routine: EASEZPF1


Information

EASEZPF1 ;ALB/SCK - Print 1010EZ Cont. ; 10/19/2000

Source Information

Source file <EASEZPF1.m>

Entry Points

Name Comments DBIA/ICR reference
EN(EALNE,EAINFO) ; Main entry point for VA 10-10EZ page 1
DEM ; Print VA 10-10 Section I, Demographic information
EXP ; Print VA 10-10EZ Section I, Questions
;
EMP ;
INS ;
NOK ;

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !,"1A. Type of Benefits Applied For: ",@EASD@("1A")
  • Line Location: DEM+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+3
Function Call: WRITE
  • Prompt: !,"1B. If Applying For Health Services, Which VA Medical Center or Outpatient Clinic Do You Prefer "
  • Line Location: DEM+5
Function Call: WRITE
  • Prompt: !?5,@EASD@("1B")
  • Line Location: DEM+6
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+7
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+7
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+7
Function Call: WRITE
  • Prompt: !,"2. Veteran's Name",?60,"|3. Other Names Used",?110,"|4. Gender"
  • Line Location: DEM+9
Function Call: WRITE
  • Prompt: !?3,@EASD@(2),?60,"| ",@EASD@(3),?110,"| ",@EASD@(4)
  • Line Location: DEM+10
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+11
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+11
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+11
Function Call: WRITE
  • Prompt: !,"5. Social Security Number",?30,"|6. Claim Number",?60,"|7. Date of Birth",?95,"|8. Religion"
  • Line Location: DEM+13
Function Call: WRITE
  • Prompt: !?4,@EASD@(5),?30,"| ",@EASD@(6),?60,"| ",@EASD@(7),?95,"| ",@EASD@(8)
  • Line Location: DEM+14
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+15
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+15
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+15
Function Call: WRITE
  • Prompt: !,"9A. Current Mailing Address",?60,"|9B. City",?95,"|9C. State",?110,"|9D. Zip"
  • Line Location: DEM+17
Function Call: WRITE
  • Prompt: !?4,@EASD@("9A"),?60,"| ",@EASD@("9B"),?95,"| ",@EASD@("9C"),?110,"| ",@EASD@("9D")
  • Line Location: DEM+18
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+19
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+19
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+19
Function Call: WRITE
  • Prompt: !,"9E. County ",?40,"|10. Home Telephone Number ",?85,"|11. Work Telephone Number "
  • Line Location: DEM+21
Function Call: WRITE
  • Prompt: !?4,@EASD@("9E"),?40,"| ",@EASD@(10),?85,"| ",@EASD@(11)
  • Line Location: DEM+22
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+23
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+23
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+23
Function Call: WRITE
  • Prompt: !,"12. Current Marital Status: ",@EASD@(12)
  • Line Location: DEM+25
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: DEM+26
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: DEM+26
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: DEM+26
Function Call: WRITE
  • Prompt: !,"13A. Last Branch of Service",?28,"|13B. Last Entry Date",?52,"|13C.Last Discharge Date",?78,"|13D. Discharge Type",?100,"|13E. Military Service Number"
  • Line Location: DEM+28
Function Call: WRITE
  • Prompt: !?4,@EASD@("13A"),?28,"| ",@EASD@("13B"),?52,"| ",@EASD@("13C"),?78,"| ",@EASD@("13D"),?100,"| ",@EASD@("13E")
  • Line Location: DEM+29
Function Call: WRITE
  • Prompt: !,EALNE("D"),!?2,"14. Answer Yes or No for the Following Questions"
  • Line Location: EXP+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+3
Function Call: WRITE
  • Prompt: !?2,"A1.",?6,"Are You a Purple Heart Award Recipient ",?58,@EASD@("14A1"),?65,"|"
  • Line Location: EXP+5
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+6
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+6
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+6
Function Call: WRITE
  • Prompt: !?2,"A2.",?6,"Are You a Former Prisoner of War ",?58,@EASD@("14A2"),?65,"|H.",?70,"Do You Have a Military Dental Injury",?126,@EASD@("14H")
  • Line Location: EXP+8
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+9
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+9
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+9
Function Call: WRITE
  • Prompt: !?2,"B.",?6,"Do You Have a VA Service Connected Rating ",?58,@EASD@("14B"),?65,"|I.",?70,"Do You Have a Spinal Cord Injury ",?126,@EASD@("14I")
  • Line Location: EXP+11
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+12
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+12
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+12
Function Call: WRITE
  • Prompt: !?2,"B1.",?6,"If Yes, What is Your Rated Percentage ",?58,@EASD@("14B1"),?63,"% |J.",?70,"Are You Eligible for MEDICAID",?126,@EASD@("14J")
  • Line Location: EXP+14
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+15
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+15
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+15
Function Call: WRITE
  • Prompt: !?2,"C.",?6,"Are You Receiving a VA Pension: ",?58,@EASD@("14C"),?65,"|K.",?70,"Are You Enrolled in MEDICARE Hospital Insurance Part A",?126,@EASD@("14K")
  • Line Location: EXP+17
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+18
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+18
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+18
Function Call: WRITE
  • Prompt: !?2,"D.",?6,"Are You Retired From The Military: ",?58,@EASD@("14D"),?65,"|K1.",?70,"Effective Date",?110,@EASD@("14K1")
  • Line Location: EXP+20
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+21
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+21
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+21
Function Call: WRITE
  • Prompt: !?2,"D1.",?6,"Was Your Retirement The Result Of a Disability: ",?58,@EASD@("14D1"),?65,"|L.",?70,"Are You Enrolled in MEDICARE Hospital Insurance Part B",?126,@EASD@("14L")
  • Line Location: EXP+23
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+24
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+24
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+24
Function Call: WRITE
  • Prompt: !?2,"D2.",?6,"Were You Regularly Retired (20+yrs.)",?58,@EASD@("14D2"),?65,"|L1.",?70,"Effective Date",?110,@EASD@("14L1")
  • Line Location: EXP+26
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+27
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+27
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+27
Function Call: WRITE
  • Prompt: !?2,"E.",?6,"Were You Exposed To Toxins In The Gulf War",?58,@EASD@("14E"),?65,"|M.",?70,"MEDICARE Claim Number",?110,@EASD@("14M")
  • Line Location: EXP+29
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+30
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+30
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EXP+30
Function Call: WRITE
  • Prompt: !?2,"F.",?6,"Were You Exposed To Agent Orange",?58,@EASD@("14F"),?65,"|N.",?70,"Name Exactly As It Appears On Your MEDICARE Card"
  • Line Location: EXP+32
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EXP+33
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EXP+33
Function Call: WRITE
  • Prompt: $E(EALNE("UL"),1,65)
  • Line Location: EXP+33
Function Call: WRITE
  • Prompt: !?2,"G.",?6,"Were You Exposed to Radiation",?58,@EASD@("14G"),?65,"| ",@EASD@("14N")
  • Line Location: EXP+35
Function Call: WRITE
  • Prompt: !,EALNE("D")
  • Line Location: EMP+1
Function Call: WRITE
  • Prompt: !,"15A. Veteran's Employment Status ",$P(@EASD@("15A"),U),?58,"| 15B. Company Name, Address, Telephone"
  • Line Location: EMP+2
Function Call: WRITE
  • Prompt: !?5,"Date of Retirement: ",$P(@EASD@("15A"),U,2),?58,"| ",$P(@EASD@("15B"),U)," ",$P(@EASD@("15B"),U,3)
  • Line Location: EMP+3
Function Call: WRITE
  • Prompt: !?7,"(If employed or retired, complete 15B)",?58,"| ",$P(@EASD@("15B"),U,2)
  • Line Location: EMP+4
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EMP+5
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EMP+5
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EMP+5
Function Call: WRITE
  • Prompt: !,"16A. Spouse's Employment Status ",$P(@EASD@("16A"),U),?58,"| 16B. Company Name, Address, Telephone"
  • Line Location: EMP+7
Function Call: WRITE
  • Prompt: !?5,"Date of Retirement: ",$P(@EASD@("16A"),U,2),?58,"| ",$P(@EASD@("16B"),U)," ",$P(@EASD@("16B"),U,3)
  • Line Location: EMP+8
Function Call: WRITE
  • Prompt: !?7,"(If employed or retired, complete 16B)",?58,"| ",$P(@EASD@("16B"),U,2)
  • Line Location: EMP+9
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: EMP+10
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: EMP+10
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: EMP+10
Function Call: WRITE
  • Prompt: !,"17. Does The Veteran Have Health Insurance",?65,"|18. Does The Spouse Have Health Insurance"
  • Line Location: INS+1
Function Call: WRITE
  • Prompt: !," (Other Than Medicare) ",@EASD@(17),?65,"| (Other Than Medicare) ",@EASD@(18)
  • Line Location: INS+2
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INS+3
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INS+3
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INS+3
Function Call: WRITE
  • Prompt: !,"17A. Veteran's Health Insurance Co.",?65,"|18A. Spouse's Health Insurance Co."
  • Line Location: INS+5
Function Call: WRITE
  • Prompt: !?1,@EASD@("17A"),?65,"| ",@EASD@("18A")
  • Line Location: INS+6
Function Call: WRITE
  • Prompt: !
  • Line Location: INS+7
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INS+8
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INS+8
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INS+8
Function Call: WRITE
  • Prompt: !,"17B. Name of Policy Holder ",@EASD@("17B"),?65,"|18B. Name of Policy Holder ",@EASD@("18B")
  • Line Location: INS+10
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INS+11
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INS+11
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INS+11
Function Call: WRITE
  • Prompt: !,"17C. Policy Number",?32,"|17D. Group Code",?65,"|18C. Policy Number",?98,"|18D. Group Code"
  • Line Location: INS+13
Function Call: WRITE
  • Prompt: !,@EASD@("17C"),?32,"| ",@EASD@("17D"),?65,"| ",@EASD@("18C"),?98,"| ",@EASD@("18D")
  • Line Location: INS+14
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: INS+15
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: INS+15
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: INS+15
Function Call: WRITE
  • Prompt: !,"19A. Name, Address and Relationship Of Next of Kin",?80,"|19B. Home Telephone ",@EASD@("19B")
  • Line Location: NOK+1
Function Call: WRITE
  • Prompt: !?1,$P(@EASD@("19A"),U)," - ",$P(@EASD@("19A"),U,3),?80,"|19C. Work Telephone ",@EASD@("19C")
  • Line Location: NOK+2
Function Call: WRITE
  • Prompt: !?1,$P(@EASD@("19A"),U,2),?80,"|"
  • Line Location: NOK+3
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NOK+4
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NOK+4
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NOK+4
Function Call: WRITE
  • Prompt: !,"20A. Name, Adress and Relationship Of Emergency Contact",?80,"|20B. Home Telephone ",@EASD@("20B")
  • Line Location: NOK+6
Function Call: WRITE
  • Prompt: !?1,$P(@EASD@("20A"),U)," - ",$P(@EASD@("20A"),U,3),?80,"|20C. Work Telephone ",@EASD@("20C")
  • Line Location: NOK+7
Function Call: WRITE
  • Prompt: !?1,$P(@EASD@("20A"),U,2),?80,"|"
  • Line Location: NOK+8
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NOK+9
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NOK+9
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NOK+9
Function Call: WRITE
  • Prompt: !,"21. I DESIGNATE THE FOLLOWING INDIVIDUAL TO RECEIVE POSSESSION OF ALL MY PERSONAL PROPERTY LEFT ON PREMISES UNDER VA CONTROL AFTER"
  • Line Location: NOK+11
Function Call: WRITE
  • Prompt: !," MY DEPARTURE OR AT THE TIME OF MY DEATH. (This does not constitute a will or transfer of title.) ",@EASD@(21)
  • Line Location: NOK+12
Function Call: WRITE
  • Prompt: ?131,$C(13)
  • Line Location: NOK+13
Function Call: WRITE
  • Prompt: !
  • Condition for execution: EALNE("ULC")="-"
  • Line Location: NOK+13
Function Call: WRITE
  • Prompt: EALNE("UL")
  • Line Location: NOK+13
Function Call: WRITE
  • Prompt: !,"22A. Is Need For Care Due To On The Job Injury ",@EASD@("22A"),?65,"|22B. Is Need For Care Due To Accident ",@EASD@("22B")
  • Line Location: NOK+15
Info |  Source |  Entry Points |  Interaction Calls