| FIELD |
-
- FIELD ORDER: 1
- CAPTION: * * * ADD/EDIT A REFUSAL * * *
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 1,22
-
- FIELD ORDER: 6.5
- CAPTION: Br Tx Fac:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 6,50
-
- FIELD ORDER: 2.2
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$NAME^WVUTL1(WVDFN)_"("_$$AGE^WVUTL1(WVDFN)_")"_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 3,15
-
- FIELD ORDER: 3.2
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$CMGR^WVUTL1(WVDFN)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 4,15
-
- FIELD ORDER: 5.3
- CAPTION: Cx Tx Need :
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 5,1
-
- FIELD ORDER: 5.4
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$CNEED^WVUTL1(WVDFN,1)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 5,15
-
- FIELD ORDER: 4.3
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$PAPRG^WVUTL1(WVDFN,1)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 4,61
-
- FIELD ORDER: 2
- CAPTION: Patient Name:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 3,1
-
- FIELD ORDER: 2.8
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$SSN^WVUTL1(WVDFN)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 3,61
-
- FIELD ORDER: 6.4
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$BNEED^WVUTL1(WVDFN,1)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 6,15
-
- FIELD ORDER: 20
- CAPTION: --------------------------------------------------------------------------------
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 10,1
-
- FIELD ORDER: 19
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=$$EDC^WVUTL1(WVDFN)
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 9,1
-
- FIELD ORDER: 17
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$S($$DES^WVUTL1(WVDFN)="YES":"*DES DAUGHTER*",1:"")
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 9,61
-
- FIELD ORDER: 21
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$FACIL^WVUTL1A(WVDFN,"C")_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 5,61
-
- FIELD ORDER: 22
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$FACIL^WVUTL1A(WVDFN,"B")_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 6,61
-
- FIELD ORDER: 23
- CAPTION: MST :
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 8,1
-
- FIELD ORDER: 3
- CAPTION: Case Manager:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 4,1
-
- FIELD ORDER: 24
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$MST^WVUTL1A(WVDFN)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 8,15
-
- FIELD ORDER: 25
- CAPTION: Veteran:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 7,52
-
- FIELD ORDER: 26
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$VET^WVUTL1A(WVDFN)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 7,61
-
- FIELD ORDER: 27
- CAPTION: Elig Code :
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 7,1
-
- FIELD ORDER: 28
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$P($$ELIG^WVUTL9(WVDFN),U,2)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 7,15
-
- FIELD ORDER: 23.1
- CAPTION: CST:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 8,56
-
- FIELD ORDER: 23.2
- CAPTION: !M
- EXECUTABLE CAPTION: S Y=IOINHI_$$CST^WVUTL1A(WVDFN)_IOINORM
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 8,61
-
- FIELD ORDER: 5
- CAPTION: !M
- EXECUTABLE CAPTION: S Y="PAP Regimen:"
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 4,48
-
- FIELD ORDER: 6
- CAPTION: Br Tx Need :
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 6,1
-
- FIELD ORDER: 2.5
- CAPTION: SSN:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 3,56
-
- FIELD ORDER: 4.5
- CAPTION: Cx Tx Fac:
- FIELD TYPE: CAPTION ONLY
- CAPTION COORDINATE: 5,50
|
