78 lines
4.0 KiB
Mathematica
78 lines
4.0 KiB
Mathematica
EASEZP64 ; ALB/AMA - Print 1010EZ, Version 6 or greater, Cont. ; 10/25/2000
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;;1.0;ENROLLMENT APPLICATION SYSTEM;**60,57**;Mar 15, 2001
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;
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;This routine carved 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) ; Entry point to print Page 3, called from EN^EASEZP6F
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N EASIGN,EASD
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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",$J,2))
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;
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D NET
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D CON
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D AOB
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D FT^EASEZP6F(.EALNE,.EAINFO)
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;
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Q
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;
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NET ; Print SECTION X - PREVIOUS CALENDAR YEAR NET WORTH
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;
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W !!?18,"SECTION X - PREVIOUS CALENDAR YEAR NET WORTH (Use a separate sheet for additional dependents)"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !?78,"|",?84,"VETERAN",?96,"|",?102,"SPOUSE",?114,"|",?120,"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. CASH, AMOUNT IN BANK ACCOUNTS (e.g., checking and savings accounts,",?78,"| $ ",$P(@EASD@("2E1"),U),?96,"| $ ",$P(@EASD@("2E1"),U,2),?114,"| $ ",$P(@EASD@("2E1"),U,3)
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W !,"certificates of deposit, individual retirement accounts, stocks and bonds)",?78,"|",?96,"|",?114,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"2. MARKET VALUE OF LAND AND BUILDINGS MINUS MORTGAGES AND LIENS (e.g., second",?78,"| $ ",$P(@EASD@("2E2"),U),?96,"| $ ",$P(@EASD@("2E2"),U,2),?114,"| $ ",$P(@EASD@("2E2"),U,3)
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W !,"homes and non-income-producing property. Do not count your primary home.)",?78,"|",?96,"|",?114,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"3. VALUE OF OTHER PROPERTY OR ASSETS (e.g., art, rare coins, collectibles)",?78,"| $ ",$P(@EASD@("2E3"),U),?96,"| $ ",$P(@EASD@("2E3"),U,2),?114,"| $ ",$P(@EASD@("2E3"),U,3)
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W !,"MINUS THE AMOUNT YOU OWE ON THESE ITEMS. INCLUDE VALUE OF FARM, RANCH, OR",?78,"|",?96,"|",?114,"|"
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W !,"BUSINESS ASSETS. Exclude household effects and family vehicles.",?78,"|",?96,"|",?114,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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;
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CON ; Print SECTION XI - CONSENT TO COPAYMENTS
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;
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W !!?49,"SECTION XI - CONSENT TO COPAYMENTS"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"If you are a 0% service-connected veteran and do not receive VA monetary benefits or a nonservice-connected veteran (and you are"
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W !,"not an Ex-POW, Purple Heart Recipient, WWI veteran or VA pensioner) and your household income (or combined income and net worth)"
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W !,"exceeds the established threshold, this application will be considered for enrollment, but only if you agree to pay VA copayments"
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W !,"for treatment of your nonservice-connected conditions. If you are such a veteran, by signing this application you are agreeing"
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W !,"to pay the applicable VA copayment as required by law.",!
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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;
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AOB ; Print SECTION XII - ASSIGNMENT OF BENEFITS
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;
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W !!?48,"SECTION XII - ASSIGNMENT OF BENEFITS"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"I understand that pursuant to 38 U.S.C. section 1729, VA is authorized to recover or collect from my health plan (HP) for the"
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W !,"reasonable charges of nonservice-connected VA medical care or services furnished or provided to me. I hereby authorize payment"
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W !,"directly to VA from any HP under which I am covered (including coverage provided under my spouse's HP) that is responsible for"
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W !,"payment of the charges for my medical care, including benefits otherwise payable to me or my spouse.",!
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !!?6,"ALL APPLICANTS MUST SIGN AND DATE THIS FORM. REFER TO INSTRUCTIONS WHICH DEFINE WHO CAN SIGN ON BEHALF OF THE VETERAN.",!
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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;
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W !,"SIGNATURE OF APPLICANT",?90,"| DATE"
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I $G(EASIGN)]"" W !,"SIGNATURE OF APPLICANT OR APPLICANT'S REPRESENTATIVE HAS BEEN VERIFIED",?90,"| ",EASIGN,!?90,"|"
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E W !?90,"|",!?90,"|"
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W ?131,$C(13) W:EALNE("ULC")="-" ! W EALNE("UL")
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Q
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