Routine: FBAA79A

Package	Total	Call Graph
VA FileMan	2	^DIWP ^DIWW
Kernel	1	$$FMTE^XLFDT

Package	Total	Caller Graph
Fee Basis	1	FBAA79

Name	Field # of Occurrence
^DIWP	FBAA79A+4
^DIWW	FBAA79A+5
$$FMTE^XLFDT	FBAA79A+34

Interaction Calls

Name	Line Occurrences
Function Call: WRITE	Prompt: !,?40,"FOR VA USE ONLY",!,UL Line Location: FBAA79A+6
Function Call: WRITE	Prompt: !," (5) STATE CODE \| (6) COUNTY CODE \| (7) TYPE OF \| (8) YEAR OF BIRTH \| (9) WAR \| (10) PURPOSE \|",!,?16,"\|",?34,"\|",?37,"PATIENT",?48,"\|",?68,"\|",?78,"\|",?93,"\|" Line Location: FBAA79A+7
Function Call: WRITE	Prompt: !,?7,FBI(5),?16,"\|",?23,CC,?34,"\|",?41,FBPATT,?48,"\|",?58,YOB,?68,"\|",?74,POS,?78,"\|",?87,POV,?93,"\|",!,UL Line Location: FBAA79A+8
Function Call: WRITE	Prompt: !,"STATION OF JURISDICTION",?48,"\|",?78,"\|",?80," (11) CODE",?100,"\| (12) SEX",!,?48,"\|",?78,"\|",?100,"\|"," ",$S(SEX="F":"FEMALE",1:"MALE") Line Location: FBAA79A+9
Function Call: WRITE	Prompt: !,"Veterans Administration",?48,"\|",?78,"\|",?100,"\|",$E(UL,101,120) Line Location: FBAA79A+10
Function Call: WRITE	Prompt: !,FBS(2),?48,"\|",?78,"\|",?80,$S(CODE=1:"SHORT TERM - 1",CODE=2:"HOME NURSING - 2",CODE=3:"ID CARD STATUS - 3",1:""),?100,"\| (13) POW" Line Location: FBAA79A+11
Function Call: WRITE	Prompt: !,?48,$E(UL,49,120) Line Location: FBAA79A+13
Function Call: WRITE	Prompt: !,?48,"\| APPROVED BY (Name and Title)",?110,"(",$S($D(^VA(200,DUZ,0)):$P(^(0),"^",2),1:""),")",!,?48,"\|" Line Location: FBAA79A+14
Function Call: WRITE	Prompt: !,"TELEPHONE: ",FBS(7),?48,"\|",?50,FBS(8),!,?48,"\|",?50,FBS(9),!,UL Line Location: FBAA79A+15
Function Call: WRITE	Prompt: !,?32,"Information On Veterans Administration Program",! Line Location: FBAA79A+16
Function Call: WRITE	Prompt: !,"Acceptance of this request to render the prescribed services will constitute an agreement which is subject",!,"to the following: ",! Line Location: FBAA79A+17
Function Call: WRITE	Prompt: !,?3,"I. SERVICES. If services are not initiated, please return this document to the Station of Jurisdiction with a brief" Line Location: FBAA79A+18
Function Call: WRITE	Prompt: !,?5,"explanation. Unless approved by the VA, services are limited in type and extent to those shown.",! Line Location: FBAA79A+19
Function Call: WRITE	Prompt: !,?3,"II. PERIOD OF VALIDITY. Service must be performed within the period of validity indicated.",!,?5,"If a longer time is needed, please request an extension.",! Line Location: FBAA79A+20
Function Call: WRITE	Prompt: !,?3,"III. REPORTS. Clinical reports are required when an examination only has been requested. Please ",!,?5,"submit reports promptly to the Station Of Jurisdiction.",! Line Location: FBAA79A+21
Function Call: WRITE	Prompt: !,?3,"IV. STATEMENT OF ACCOUNTS. Submit a Statement of Account in your usual manner. Your statement must",!,?5,"include: (1) Patient's Name; (2) Identification NO.; (3) Treatment (CPT) and Dates Rendered; and (4) Fees.",! Line Location: FBAA79A+22
Function Call: WRITE	Prompt: !,?3,"V. FEES. Fees claimed may not exceed those made to the general public for like services.",! Line Location: FBAA79A+23
Function Call: WRITE	Prompt: !,?3,"VI. PAYMENT. Payment by the VA for services rendered and approved is payment in full.",! Line Location: FBAA79A+24
Function Call: WRITE	Prompt: !,?3,"VII. HOSPITALIZATION. When a need for hospital care is indicated, please call the Station of Jurisdiction",!,?5,"for assistance in admitting the veteran to a VA hospital.",! Line Location: FBAA79A+25
Function Call: WRITE	Prompt: !,?3,"VIII. INQUIRIES. Additional information when required may be obtained by contacting the Station Of Jurisdiction.",! Line Location: FBAA79A+26
Function Call: WRITE	Prompt: !,?3,"IX. When submitting claims for payment you must include the NPI and Taxonomy Code of the rendering practitioner, and" Line Location: FBAA79A+27
Function Call: WRITE	Prompt: !,?5,"the NPI and Taxonomy Code of your organization. If, under the HIPAA NPI Final Rule" Line Location: FBAA79A+28
Function Call: WRITE	Prompt: !,?5,"[http://www.cms.hhs.gov/NationalProvIdentStand], your organization is an ""atypical"" provider furnishing services such as" Line Location: FBAA79A+29
Function Call: WRITE	Prompt: !,?5,"taxi, home and vehicle modifications, insect control, habilitation, and respite services and is therefore ineligible" Line Location: FBAA79A+30
Function Call: WRITE	Prompt: !,?5,"for an NPI, it is important that you indicate ""Ineligible for NPI"" on your claim form ." Line Location: FBAA79A+31
Function Call: WRITE	Prompt: !,UL Line Location: FBAA79A+32
Function Call: WRITE	Prompt: !?3,"VA Form 10-7079" Line Location: FBAA79A+33
Function Call: WRITE	Prompt: ?85,"Date Printed: ",$$FMTE^XLFDT(DT),! Line Location: FBAA79A+34

Name	Line Occurrences (* Changed, ! Killed)
^FBAAA - [#161]	FBAA79A+4
^UTILITY($J	FBAA79A+3!
^VA(200 - [#200]	FBAA79A+14

>>	Not killed explicitly
*	Changed
!	Killed
~	Newed

Name	Field # of Occurrence
>> CC	FBAA79A+8
>> CODE	FBAA79A+11
>> DFN	FBAA79A+4
>> DIWF	FBAA79A+3*
>> DIWL	FBAA79A+3*
DT	FBAA79A+34
DUZ	FBAA79A+14
>> FBI(5	FBAA79A+8
>> FBK	FBAA79A+4
>> FBPATT	FBAA79A+8
>> FBRR	FBAA79A+4*
>> FBS(2	FBAA79A+11
>> FBS(3	FBAA79A+12, FBAA79A+13
>> FBS(4	FBAA79A+13
>> FBS(6	FBAA79A+13
>> FBS(7	FBAA79A+15
>> FBS(8	FBAA79A+15
>> FBS(9	FBAA79A+15
FBXX	FBAA79A+4*, FBAA79A+5!
>> POS	FBAA79A+8
>> POV	FBAA79A+8
>> POW	FBAA79A+12, FBAA79A+13
>> SEX	FBAA79A+9
>> SSTCD	FBAA79A+13
>> UL	FBAA79A+6, FBAA79A+8, FBAA79A+10, FBAA79A+13, FBAA79A+15, FBAA79A+32
>> X	FBAA79A+4*
>> YOB	FBAA79A+8

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Package: Fee Basis

Routine: FBAA79A

Information

Source Information

Call Graph

Call Graph Total: 3

Caller Graph

Legends:

Package Component Superscript legend

Caller Graph Total: 1

External References

Interaction Calls

Global Variables Directly Accessed

Naked Globals

Local Variables

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