FBCHPRC1 ;AISC/DMK-PRINT REPORT OF CONTACT CONT ;08/02/88
;;3.5;FEE BASIS;;JAN 30, 1995
;;Per VHA Directive 10-93-142, this routine should not be modified.
W ?70,"Page ",FB("PG"),!
W ?40,L,?58,L,!,?8,">> REPORT OF CONTACT <<",?40,L,$E(FBSITE,1,18),?58,L,?60,$P(VADM(2),"^",2),!,?40,L,$E(FBSITE,19,30),?58,L,"DOB: ",$P(VADM(3),"^",2),!,Q,!,?3," Name of Veteran",?34,L,"Telephone No. of Vet.",?58,L,"Date of Contact",!
W ?34,L,?58,L,!,?3,$E(VADM(1),1,30),?34,L,VAPA(8),?58,L,?61,FB(4),!,Q,!,?3," Address of Veteran",?58,L,"Type of Contact",!,?3,VAPA(1),?58,L,!,?3,VAPA(4),",",$P(VAPA(5),"^",2)
W " ",$S('+$G(VAPA(11)):VAPA(6),$P(VAPA(11),U,2)]"":$P(VAPA(11),U,2),1:VAPA(6)),?58,L
W ?63,$S(FB(6)="T":"Telephone",1:"Personal"),!,Q,!,?3," Person Contacted",?58,L,"Telephone Number of",!,?3,FB(7),?58,L," Person Contacted",!,?3,FB(8),?58,L,?61,FB(18)
W !?3,$S(FB(9)]"":FB(9),1:FB(10)_", "_$S(FB(11)="":"Unknown",$D(^DIC(5,FB(11),0)):$P(^(0),"^"),1:"Unknown")_", "_FB(12)) I FB(9)="" W !,Q
I FB(9)]"" W !?3,FB(10),", ",$S($D(^DIC(5,+FB(11),0)):$P(^(0),"^"),1:"Unknown"),", ",FB(12),!,Q
W !?15,"NOTIFICATION OF ADMISSION TO PRIVATE HOSPITAL",!?14,$E(Q,1,47)
W !?3,"AUTHORIZATION FROM DATE/TIME: ",FB(5),!?3,"DATE/TIME OF ADMISSION: ",FB(19),!?9,"NAME of HOSPITAL: ",FBVEN,!?18,"ADDRESS: ",FBVEN(1),?54,"PHONE: ",FBVEN(6),!?27,$S(FBVEN(2)]"":FBVEN(2),1:FBVEN(3)_", "_FBVEN(4)_" "_FBVEN(5))
I FBVEN(2)]"" W !?27,FBVEN(3),", ",FBVEN(4)," ",FBVEN(5)
W !?9,"PHYSICIAN'S NAME: ",$S(FB(13)="":"Not Entered",1:FB(13))
W ?50,"PHONE: ",FB(14)
W !?6,"TENTATIVE DIAGNOSIS: ",FB(15),!?11,"INSURANCE TYPE: ",FB(16),!?3,"MODE of TRANSPORTATION: ",FB(17)
W !,?3,"ELIGIBILITY: ",$P(VAEL(1),"^",2),", " I $O(VAEL(1,0)) F J=0:0 S J=$O(VAEL(1,J)) Q:J'>0 S X=$P(VAEL(1,J),"^",2)_", " W:$X+$L(X)>80 !,?16 W X
W !,Q D RPTC^FBCHPRC
BOT W ! S BOT=IOSL-($Y+11) F BT=1:1:BOT W !
W ?3,"APPROVED/DISAPPROVED",!!?2,"______________________"
W !?3,$$SIGBLK^FBAAPRC($P(FB1(0),U,6))
W !,Q,!,?6,"Division or Section",?40,L," Executed by(signature and title)",!,?7,"FEE BASIS SECTION",?40,L," ",!,Q,!?3,"VA form 119C"
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HFBCHPRC1 2130 printed Sep 23, 2025@19:33:53 Page 2
FBCHPRC1 ;AISC/DMK-PRINT REPORT OF CONTACT CONT ;08/02/88
+1 ;;3.5;FEE BASIS;;JAN 30, 1995
+2 ;;Per VHA Directive 10-93-142, this routine should not be modified.
+3 WRITE ?70,"Page ",FB("PG"),!
+4 WRITE ?40,L,?58,L,!,?8,">> REPORT OF CONTACT <<",?40,L,$EXTRACT(FBSITE,1,18),?58,L,?60,$PIECE(VADM(2),"^",2),!,?40,L,...
... $EXTRACT(FBSITE,19,30),?58,L,"DOB: ",$PIECE(VADM(3),"^",2),!,Q,!,?3," Name of Veteran",?34,L,"Telephone No. of Vet.",?58,L,"Date of Contact",!
+5 WRITE ?34,L,?58,L,!,?3,$EXTRACT(VADM(1),1,30),?34,L,VAPA(8),?58,L,?61,FB(4),!,Q,!,?3," Address of Veteran",?58,L,"Type of Contact",!,?3,VAPA(1),?58,L,!,?3,VAPA(4),",",$PIECE(VAPA(5),"^",2)
+6 WRITE " ",$SELECT('+$GET(VAPA(11)):VAPA(6),$PIECE(VAPA(11),U,2)]"":$PIECE(VAPA(11),U,2),1:VAPA(6)),?58,L
+7 WRITE ?63,$SELECT(FB(6)="T":"Telephone",1:"Personal"),!,Q,!,?3," Person Contacted",?58,L,"Telephone Number of",!,?3,FB(7),?58,L," Person Contacted",!,?3,FB(8),?58,L,?61,FB(18)
+8 WRITE !?3,$SELECT(FB(9)]"":FB(9),1:FB(10)_", "_$SELECT(FB(11)="":"Unknown",$DATA(^DIC(5,FB(11),0)):$PIECE(^(0),"^"),1:"Unknown")_", "_FB(12))
IF FB(9)=""
WRITE !,Q
+9 IF FB(9)]""
WRITE !?3,FB(10),", ",$SELECT($DATA(^DIC(5,+FB(11),0)):$PIECE(^(0),"^"),1:"Unknown"),", ",FB(12),!,Q
+10 WRITE !?15,"NOTIFICATION OF ADMISSION TO PRIVATE HOSPITAL",!?14,$EXTRACT(Q,1,47)
+11 WRITE !?3,"AUTHORIZATION FROM DATE/TIME: ",FB(5),!?3,"DATE/TIME OF ADMISSION: ",FB(19),!?9,"NAME of HOSPITAL: ",FBVEN,!?18,"ADDRESS: ",FBVEN(1),?54,"PHONE: ",FBVEN(6),!?27,$SELECT(FBVEN(2)]"":FBVEN(2),1:FBVEN(3)_", "_FBVEN(4)_" "_FBVEN(5))
+12 IF FBVEN(2)]""
WRITE !?27,FBVEN(3),", ",FBVEN(4)," ",FBVEN(5)
+13 WRITE !?9,"PHYSICIAN'S NAME: ",$SELECT(FB(13)="":"Not Entered",1:FB(13))
+14 WRITE ?50,"PHONE: ",FB(14)
+15 WRITE !?6,"TENTATIVE DIAGNOSIS: ",FB(15),!?11,"INSURANCE TYPE: ",FB(16),!?3,"MODE of TRANSPORTATION: ",FB(17)
+16 WRITE !,?3,"ELIGIBILITY: ",$PIECE(VAEL(1),"^",2),", "
IF $ORDER(VAEL(1,0))
FOR J=0:0
SET J=$ORDER(VAEL(1,J))
if J'>0
QUIT
SET X=$PIECE(VAEL(1,J),"^",2)_", "
if $X+$LENGTH(X)>80
WRITE !,?16
WRITE X
+17 WRITE !,Q
DO RPTC^FBCHPRC
BOT WRITE !
SET BOT=IOSL-($Y+11)
FOR BT=1:1:BOT
WRITE !
+1 WRITE ?3,"APPROVED/DISAPPROVED",!!?2,"______________________"
+2 WRITE !?3,$$SIGBLK^FBAAPRC($PIECE(FB1(0),U,6))
+3 WRITE !,Q,!,?6,"Division or Section",?40,L," Executed by(signature and title)",!,?7,"FEE BASIS SECTION",?40,L," ",!,Q,!?3,"VA form 119C"
+4 QUIT
