135 lines
7.1 KiB
Mathematica
135 lines
7.1 KiB
Mathematica
EASEZP63 ; ALB/AMA - Print 1010EZ, Version 6 or greater, Cont. ; 10/25/2000
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;;1.0;ENROLLMENT APPLICATION SYSTEM;**51,60,57**;Mar 15, 2001
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;
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;This routine copied from EASEZPF3; if the version # of the 1010EZ
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;application is 6.0 or greater, then this routine will be executed.
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;
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EN(EALNE,EAINFO,EASDG) ; Entry point to print Page 3, called from EN^EASEZP6F
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; Input
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; EALNE - Array of line formats for output
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; EAINFO - Application Data array, see SETUP^EASEZRPF
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; EASDG - Flag variable to signify request to print from DG options
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;
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N EASIGN
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;
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I $$GET1^DIQ(712,EAINFO("EASAPP")_",",4)]"" D
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. S EASIGN=$$GET1^DIQ(712,EAINFO("EASAPP")_",",4.1)
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S EASIGN=$G(EASIGN)
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;
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D HDR^EASEZP6F(.EALNE,.EAINFO)
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S EASD=$NA(^TMP("EASEZ",$J,2))
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;
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D FIN
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D DEP
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D INC
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D EXP
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D FT^EASEZP6F(.EALNE,.EAINFO)
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;
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Q
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;
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FIN ; Print out VA 10-10EZ Section VI, Financial Disclosure information
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;
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W !!?50,"SECTION VI - FINANCIAL DISCLOSURE"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"Failure to disclose your previous year's financial information may affect your eligibility for health care benefits. Your financial"
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W !,"information is used by VA to accurately determine if you should be responsible for copayments for office visits, pharmacy,"
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W !,"inpatient, nursing home and long term care, and for some veterans, priority for enrollment. You are not required to provide this"
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W !,"information. However, completing the financial dislosure section results in a more accurate determination of your eligibility for"
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W !,"health care services/benefits."
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;
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N EAN,EAY S (EAY,EAN)="___"
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;IF NO ENTRY, THEN NO MEANS TEST, SO NO ANSWER
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;IF @EASD@(998)="Y", THEN VET DECLINES TO GIVE INFO, SO ANSWER "NO"
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I $D(@EASD@(998)) D
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. S:@EASD@(998)="YES" EAN=" X "
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. S:@EASD@(998)="NO" EAY=" X "
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;
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W !!?3,EAN," NO, I DO NOT WISH TO PROVIDE INFORMATION IN SECTIONS VII THROUGH X. I understand that VA is currently not enrolling veterans"
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W !,"who decline to provide financial information unless other special eligibility factors exist. However, if I am enrolled, I agree to"
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W !,"pay the applicable VA copayments. (Sign and date the application in Section XII.)"
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;
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W !!?3,EAY," YES, I WILL PROVIDE SPECIFIC INCOME AND/OR ASSET INFORMATION TO ESTABLISH MY ELIGIBILITY FOR CARE. (Complete all sections"
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W !,"below that apply to you with last calendar year's information. Sign and date the application in Section XII.)"
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W !?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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;
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DEP ; Print out VA 10-10EZ Section VII, Dependent Information
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;
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W !!?24,"SECTION VII - DEPENDENT INFORMATION (Use a separate sheet for additional dependents)"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1. SPOUSE'S NAME (Last, First, Middle Name)",?60,"|2. CHILD'S NAME (Last, First, Middle Name)"
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W !?4,$P(@EASD@(1),U),?60,"| ",@EASD@(2)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1A. SPOUSE'S MAIDEN NAME",?60,"|2A. CHILD'S RELATIONSHIP TO YOU"
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W !?4,$P(@EASD@(1),U,2),?60,"| ",@EASD@(9)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1B. SPOUSE'S SOCIAL SECURITY NUMBER",?60,"|2B. CHILD'S SOCIAL SECURITY NUMBER",?99,"|2C. DATE CHILD BECAME YOUR"
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W !?4,@EASD@(3),?60,"| ",@EASD@(7),?99,"| DEPENDENT ",@EASD@(11)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1C. SPOUSE'S DATE OF BIRTH (mm/dd/yyyy)",?44,"|1D. DATE OF MARRIAGE (mm/dd/yyyy)",?84,"|2D. CHILD'S DATE OF BIRTH (mm/dd/yyyy)"
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W !?4,@EASD@(4),?44,"| ",@EASD@(10),?84,"| ",@EASD@(5)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1E. SPOUSE'S ADDRESS AND TELEPHONE NUMBER (Street, City, State, ZIP)",?84,"|2E. WAS CHILD PREMANENTLY AND TOTALLY"
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W !?4,$P(@EASD@(6),U),?84,"| DISABLED BEFORE THE AGE OF 18? ",@EASD@(14)
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W ?131,$C(13) W:EALNE("ULC")="-" ! N Z F Z=1:1:85 W " "
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W $E(EALNE("UL"),1,47)
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;
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W !?4,$P(@EASD@(6),U,2),?84,"|2F. IF CHILD IS BETWEEN 18 AND 23 YEARS"
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W !?4,@EASD@(8),?84,"| OF AGE, DID CHILD ATTEND SCHOOL LAST"
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W !?84,"| CALENDAR YEAR? ",@EASD@(15)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"3. IF YOUR SPOUSE OR DEPENDENT CHILD DID NOT LIVE WITH YOU LAST",?65,"|2G. EXPENSES PAID BY YOUR DEPENDENT CHILD FOR COLLEGE, VOCATIONAL"
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W !?3,"YEAR, ENTER THE AMOUNT YOU CONTRIBUTED TO THEIR SUPPORT",?65,"| REHABILITATION OR TRAINING (e.g., tuition, books, materials)"
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W !?6,"SPOUSE $ ",$P(@EASD@(12),U),?35,"CHILD $ ",$P(@EASD@(12),U,2),?65,"|",?73,"$ ",@EASD@(13)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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;
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INC ; Print out VA 10-10EZ Section VIII, Gross Annual Income information
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;
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I $G(EASDG),+@EASD@(999) W !!?6,"SECTION VIII - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN (INCOME YEAR: ",@EASD@(999),")"
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E W !!?17,"SECTION VIII - PREVIOUS CALENDAR YEAR GROSS ANNUAL INCOME OF VETERAN, SPOUSE AND DEPENDENT CHILDREN"
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W !?30,"(Use a separate sheet for additional dependents' financial information)"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !?76,"VETERAN",?97,"SPOUSE",?117,"CHILD 1"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1. GROSS ANNUAL INCOME FROM EMPLOYMENT (wages, bonuses, tips, etc.)",?69,"| $ ",$P(@EASD@("2C1"),U),?90,"| $ ",$P(@EASD@("2C1"),U,2),?110,"| $ ",$P(@EASD@("2C1"),U,3)
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W !,"EXCLUDING INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"|",?90,"|",?110,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"2. NET INCOME FROM YOUR FARM, RANCH, PROPERTY OR BUSINESS",?69,"| $ ",$P(@EASD@("2C3"),U),?90,"| $ ",$P(@EASD@("2C3"),U,2),?110,"| $ ",$P(@EASD@("2C3"),U,3)
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"3. LIST OTHER INCOME AMOUNTS (Social Security, compensation,",?69,"| $ ",$P(@EASD@("2C2"),U),?90,"| $ ",$P(@EASD@("2C2"),U,2),?110,"| $ ",$P(@EASD@("2C2"),U,3)
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W !,"pension, interest, dividends. Exclude welfare)",?69,"|",?90,"|",?110,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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;
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EXP ; Print out VA 10-10EZ Section IX, Deductible Expense Information
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;
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I $G(EASDG),+@EASD@(999) W !!?27,"SECTION IX - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES (INCOME YEAR: ",@EASD@(999),")"
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E W !!?38,"SECTION IX - PREVIOUS CALENDAR YEAR DEDUCTIBLE EXPENSES"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"1. TOTAL NON-REIMBURSED MEDICAL EXPENSES PAID BY YOU OR YOUR SPOUSE (e.g., payments for doctors, dentists,",?110,"| $ ",@EASD@("2D1")
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W !,"medications, Medicare, health insurance, hospital and nursing home) VA will calculate a deductible and the",?110,"|"
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W !,"net medical expenses you may claim.",?110,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"2. AMOUNT YOU PAID LAST CALENDAR YEAR FOR FUNERAL AND BURIAL EXPENSES FOR YOUR DECEASED SPOUSE OR DEPENDENT",?110,"| $ ",@EASD@("2D2")
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W !,"CHILD (Also enter spouse or child's information in Section VII.)",?110,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"3. AMOUNT YOU PAID LAST CALENDAR YEAR FOR YOUR COLLEGE OR VOCATIONAL EDUCATIONAL EXPENSES (e.g., tuition,",?110,"| $ ",@EASD@("2D3")
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W !,"books, fees, materials) DO NOT LIST YOUR DEPENDENT'S EDUCATIONAL EXPENSES",?110,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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