384 lines
18 KiB
Plaintext
384 lines
18 KiB
Plaintext
FirstRelease WVEHR VER VOE1.0
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Cache 31-Jan-2008 23:07:04 ZWR
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^ANRV(2040,0)="VIST ROSTER^2040IP^^"
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^ANRV(2041,0)="VIST PARAMETERS^2041P^1^1"
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^ANRV(2041,1,0)="1^^^^VHACO117AMIS@MED.VA.GOV"
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^ANRV(2041,"B",1,1)=""
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^ANRV(2041.5,0)="VIST EYE DIAGNOSIS^2041.5^14^14"
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^ANRV(2041.5,1,0)="CATARACT"
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^ANRV(2041.5,2,0)="CORNEAL DISEASE"
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^ANRV(2041.5,3,0)="DIABETIC RETINOPATHY"
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^ANRV(2041.5,4,0)="CHORIOID/RETINAL"
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^ANRV(2041.5,5,0)="GLAUCOMA"
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^ANRV(2041.5,6,0)="MACULAR DISEASE"
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^ANRV(2041.5,7,0)="RETINITIS PIGMENTOSA"
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^ANRV(2041.5,8,0)="OPTIC NERVE"
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^ANRV(2041.5,9,0)="RETINAL DETACHMENT"
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^ANRV(2041.5,10,0)="HISTOPLASMOSIS"
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^ANRV(2041.5,11,0)="OPTIC ATROPHY"
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^ANRV(2041.5,12,0)="OTHER"
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^ANRV(2041.5,13,0)="TRAUMA"
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^ANRV(2041.5,14,0)="APHAKIA"
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^ANRV(2041.5,"B","APHAKIA",14)=""
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^ANRV(2041.5,"B","CATARACT",1)=""
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^ANRV(2041.5,"B","CHORIOID/RETINAL",4)=""
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^ANRV(2041.5,"B","CORNEAL DISEASE",2)=""
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^ANRV(2041.5,"B","DIABETIC RETINOPATHY",3)=""
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^ANRV(2041.5,"B","GLAUCOMA",5)=""
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^ANRV(2041.5,"B","HISTOPLASMOSIS",10)=""
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^ANRV(2041.5,"B","MACULAR DISEASE",6)=""
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^ANRV(2041.5,"B","OPTIC ATROPHY",11)=""
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^ANRV(2041.5,"B","OPTIC NERVE",8)=""
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^ANRV(2041.5,"B","OTHER",12)=""
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^ANRV(2041.5,"B","RETINAL DETACHMENT",9)=""
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^ANRV(2041.5,"B","RETINITIS PIGMENTOSA",7)=""
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^ANRV(2041.5,"B","TRAUMA",13)=""
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^ANRV(2041.6,0)="VIST CHECKLIST OPTIONS^2041.6^5^5"
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^ANRV(2041.6,1,0)="YES"
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^ANRV(2041.6,2,0)="DECLINED"
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^ANRV(2041.6,3,0)="NOT ELIGIBLE"
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^ANRV(2041.6,4,0)="NOT AVAILABLE"
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^ANRV(2041.6,5,0)="PENDING"
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^ANRV(2041.6,"B","DECLINED",2)=""
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^ANRV(2041.6,"B","NOT AVAILABLE",4)=""
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^ANRV(2041.6,"B","NOT ELIGIBLE",3)=""
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^ANRV(2041.6,"B","PENDING",5)=""
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^ANRV(2041.6,"B","YES",1)=""
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^ANRV(2041.7,0)="VIST BENEFITS AND SERVICES CHECKLIST^2041.7P^^"
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^ANRV(2042,0)="VIST REFERRAL FACILITY^2042^17^15"
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^ANRV(2042,1,0)="AMERICAN LAKE (CENTER FOR SPECIAL NEEDS)"
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^ANRV(2042,2,0)="BIRMINGHAM (CENTER)"
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^ANRV(2042,3,0)="HINES (CENTER)"
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^ANRV(2042,4,0)="PALO ALTO (CENTER)"
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^ANRV(2042,5,0)="SAN JUAN (CENTER)"
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^ANRV(2042,6,0)="WACO (CENTER FOR SPECIAL NEEDS)"
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^ANRV(2042,7,0)="WEST HAVEN (CENTER)"
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^ANRV(2042,8,0)="WEST HAVEN (CENTER FOR SPECIAL NEEDS)"
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^ANRV(2042,9,0)="VICTORS (LOW VISION)"
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^ANRV(2042,10,0)="VISUAL SERVICES (STATE)"
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^ANRV(2042,11,0)="COMMUNITY AGENCY"
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^ANRV(2042,12,0)="GUIDE DOG SCHOOL"
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^ANRV(2042,13,0)="OTHER"
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^ANRV(2042,16,0)="TUCSON (CENTER)"
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^ANRV(2042,17,0)="AUGUSTA (CENTER)"
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^ANRV(2042,"B","AMERICAN LAKE (CENTER FOR SPEC",1)=""
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^ANRV(2042,"B","AUGUSTA (CENTER)",17)=""
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^ANRV(2042,"B","BIRMINGHAM (CENTER)",2)=""
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^ANRV(2042,"B","COMMUNITY AGENCY",11)=""
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^ANRV(2042,"B","GUIDE DOG SCHOOL",12)=""
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^ANRV(2042,"B","HINES (CENTER)",3)=""
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^ANRV(2042,"B","OTHER",13)=""
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^ANRV(2042,"B","PALO ALTO (CENTER)",4)=""
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^ANRV(2042,"B","SAN JUAN (CENTER)",5)=""
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^ANRV(2042,"B","TUCSON (CENTER)",16)=""
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^ANRV(2042,"B","VICTORS (LOW VISION)",9)=""
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^ANRV(2042,"B","VISUAL SERVICES (STATE)",10)=""
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^ANRV(2042,"B","WACO (CENTER FOR SPECIAL NEEDS",6)=""
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^ANRV(2042,"B","WEST HAVEN (CENTER FOR SPECIAL",8)=""
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^ANRV(2042,"B","WEST HAVEN (CENTER)",7)=""
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^ANRV(2042.5,0)="VIST REFERRAL ROSTER^2042.5P^^"
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^ANRV(2043,0)="VIST LETTER^2043^5^5"
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^ANRV(2043,1,0)="BRC APPLICATION LETTER^1"
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^ANRV(2043,1,1,0)="^^48^48^2980609^^^^"
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^ANRV(2043,1,1,1,0)=" "
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^ANRV(2043,1,1,2,0)=" "
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^ANRV(2043,1,1,3,0)="|NOWRAP|"
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^ANRV(2043,1,1,4,0)="|TODAY|"
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^ANRV(2043,1,1,5,0)=" "
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^ANRV(2043,1,1,6,0)=" "
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^ANRV(2043,1,1,7,0)="<Enter Name of Chief (Routing Symbol)>"
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^ANRV(2043,1,1,8,0)="|BLANK(0)|"
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^ANRV(2043,1,1,9,0)="Chief"
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^ANRV(2043,1,1,10,0)="|BLANK(0)|"
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^ANRV(2043,1,1,11,0)="Central Blind Rehabilitation Center"
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^ANRV(2043,1,1,12,0)="|BLANK(0)|"
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^ANRV(2043,1,1,13,0)="<Enter Your VA Medical Center>"
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^ANRV(2043,1,1,14,0)="|BLANK(0)|"
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^ANRV(2043,1,1,15,0)="<Enter Street Address>"
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^ANRV(2043,1,1,16,0)="|BLANK(0)|"
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^ANRV(2043,1,1,17,0)="<Enter City, State ZIP>"
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^ANRV(2043,1,1,18,0)="|BLANK(2)|"
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^ANRV(2043,1,1,19,0)=" "
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^ANRV(2043,1,1,20,0)="SUBJ: Application for Admission to a VA Blind Rehabilitation Program"
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^ANRV(2043,1,1,21,0)=" "
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^ANRV(2043,1,1,22,0)="1. VETERAN: |NAME|"
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^ANRV(2043,1,1,23,0)=" |NAME:SSN|"
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^ANRV(2043,1,1,24,0)=" "
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^ANRV(2043,1,1,25,0)="2. VIST BRC PROGRAM RECOMMENDATION: CENTER"
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^ANRV(2043,1,1,26,0)=" "
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^ANRV(2043,1,1,27,0)="3. PREVIOUS VA BLIND REHABILITATION: <Enter Year and Place>"
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^ANRV(2043,1,1,28,0)=" "
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^ANRV(2043,1,1,29,0)="4. Enclosed with this cover letter is the following BRC application"
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^ANRV(2043,1,1,30,0)="information:"
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^ANRV(2043,1,1,31,0)=" "
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^ANRV(2043,1,1,32,0)=" * VAF 10-10 (signed)"
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^ANRV(2043,1,1,33,0)=" * VIS Team Assessment"
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^ANRV(2043,1,1,34,0)=" * Eye Examination"
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^ANRV(2043,1,1,35,0)=" * History and Physical Examination"
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^ANRV(2043,1,1,36,0)=" * Relevant Lab, EKG and X-ray Reports"
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^ANRV(2043,1,1,37,0)=" * Audiology Examination"
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^ANRV(2043,1,1,38,0)=" * Required VA Forms"
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^ANRV(2043,1,1,39,0)=" "
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^ANRV(2043,1,1,40,0)="5. If you have any questions or concerns regarding this application,"
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^ANRV(2043,1,1,41,0)="please don't hesitate to contact me at FTS:<Enter Your Facility's Phone"
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^ANRV(2043,1,1,42,0)="Number>."
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^ANRV(2043,1,1,43,0)=" "
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^ANRV(2043,1,1,44,0)=" "
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^ANRV(2043,1,1,45,0)=" "
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^ANRV(2043,1,1,46,0)=" "
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^ANRV(2043,1,1,47,0)=" "
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^ANRV(2043,1,1,48,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
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^ANRV(2043,2,0)="CLAIM LETTER^1"
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^ANRV(2043,2,1,0)="^^41^41^2980611^^^^"
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^ANRV(2043,2,1,1,0)="|NOWRAP|"
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^ANRV(2043,2,1,2,0)="|BLANK(0)|"
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^ANRV(2043,2,1,3,0)="|CENTER(""Department of Veterans Affairs"")|"
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^ANRV(2043,2,1,4,0)="|BLANK(0)|"
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^ANRV(2043,2,1,5,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
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^ANRV(2043,2,1,6,0)="|BLANK(0)|"
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^ANRV(2043,2,1,7,0)="|CENTER(""<Enter Street Address>"")|"
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^ANRV(2043,2,1,8,0)="|BLANK(0)|"
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^ANRV(2043,2,1,9,0)="|CENTER(""<Enter City, State ZIP>"")|"
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^ANRV(2043,2,1,10,0)="|BLANK(2)|"
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^ANRV(2043,2,1,11,0)=" "
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^ANRV(2043,2,1,12,0)="|TODAY|"
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^ANRV(2043,2,1,13,0)=" "
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^ANRV(2043,2,1,14,0)=" "
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^ANRV(2043,2,1,15,0)="SUBJ: Re-evaluation of SC Condition"
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^ANRV(2043,2,1,16,0)=" "
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^ANRV(2043,2,1,17,0)=" "
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^ANRV(2043,2,1,18,0)="1. Identifying Information: Veteran: |NAME|"
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^ANRV(2043,2,1,19,0)=" Claim #: c-|NAME:CLAIM NUMBER|"
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^ANRV(2043,2,1,20,0)=" SS #: |NAME:SSN|"
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^ANRV(2043,2,1,21,0)=" "
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^ANRV(2043,2,1,22,0)=" "
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^ANRV(2043,2,1,23,0)="|WRAP|"
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^ANRV(2043,2,1,24,0)="2. |LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))| was seen by the VIS Team"
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^ANRV(2043,2,1,25,0)="on <Enter Date Veteran was seen by VIS Team>."
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^ANRV(2043,2,1,26,0)="|$S((NAME:SEX[""F""):""She"",1:""He"")| reports having decreased vision in both"
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^ANRV(2043,2,1,27,0)="eyes and is requesting a re-evaluation of |$S((NAME:SEX[""F""):""her"",1:""his"")|"
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^ANRV(2043,2,1,28,0)="current VA rating for vision loss. The veteran is currently rated"
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^ANRV(2043,2,1,29,0)="<Enter SC Percentage> SC for vision loss. Our eye clinic found the veteran's"
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^ANRV(2043,2,1,30,0)="best corrected central acuity to be <Enter Best Corrected Central Acuity> in"
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^ANRV(2043,2,1,31,0)="both eyes. Enclosed with this letter is a copy of the VIST eye exam."
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^ANRV(2043,2,1,32,0)=" "
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^ANRV(2043,2,1,33,0)="3. If you have any questions or concerns regarding this request please"
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^ANRV(2043,2,1,34,0)="don't hesitate to contact me at FTS: <Enter Your Facility's Phone Number>."
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^ANRV(2043,2,1,35,0)="Please send me a copy of your rating decision."
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^ANRV(2043,2,1,36,0)=" "
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^ANRV(2043,2,1,37,0)=" "
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^ANRV(2043,2,1,38,0)=" "
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^ANRV(2043,2,1,39,0)=" "
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^ANRV(2043,2,1,40,0)=" "
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^ANRV(2043,2,1,41,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
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^ANRV(2043,3,0)="IRS EXEMPTION^1"
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^ANRV(2043,3,1,0)="^^35^35^2980609^^^^"
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^ANRV(2043,3,1,1,0)="|NOWRAP|"
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^ANRV(2043,3,1,2,0)="|BLANK(0)|"
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^ANRV(2043,3,1,3,0)="|CENTER(""Department of Veterans Affairs"")|"
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^ANRV(2043,3,1,4,0)="|BLANK(0)|"
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^ANRV(2043,3,1,5,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
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^ANRV(2043,3,1,6,0)="|BLANK(0)|"
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^ANRV(2043,3,1,7,0)="|CENTER(""<Enter Street Address>"")|"
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^ANRV(2043,3,1,8,0)="|BLANK(0)|"
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^ANRV(2043,3,1,9,0)="|CENTER(""<Enter City, State ZIP>"")|"
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^ANRV(2043,3,1,10,0)=" "
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^ANRV(2043,3,1,11,0)=" "
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^ANRV(2043,3,1,12,0)="|TODAY|"
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^ANRV(2043,3,1,13,0)="|NOWRAP||BLANK(2)|"
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^ANRV(2043,3,1,14,0)="|LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))|"
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^ANRV(2043,3,1,15,0)="|LOWERCASE(NAME:STREET ADDRESS [LINE 1])|"
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^ANRV(2043,3,1,16,0)="|WRAP|"
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^ANRV(2043,3,1,17,0)="|LOWERCASE(NAME:CITY)_"", ""|"
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^ANRV(2043,3,1,18,0)="|NAME:STATE:ABBREVIATION_"" ""_ZIP CODE|"
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^ANRV(2043,3,1,19,0)="|NOWRAP|"
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^ANRV(2043,3,1,20,0)="|BLANK(2)|"
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^ANRV(2043,3,1,21,0)="To Whom It May Concern:"
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^ANRV(2043,3,1,22,0)=" "
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^ANRV(2043,3,1,23,0)=" "
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^ANRV(2043,3,1,24,0)="This is to advise that the veteran mentioned above is legally blind"
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^ANRV(2043,3,1,25,0)="according to records of this Medical Center. If there are any questions"
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^ANRV(2043,3,1,26,0)="with regard to the veteran's visual acuities or visual fields, you may"
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^ANRV(2043,3,1,27,0)="contact (Release of Information) at this Medical Center <Enter Your"
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^ANRV(2043,3,1,28,0)="Facility's Phone Number>. The veteran's legal blindness is permanent and"
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^ANRV(2043,3,1,29,0)="irreversible."
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^ANRV(2043,3,1,30,0)=" "
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^ANRV(2043,3,1,31,0)=" "
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^ANRV(2043,3,1,32,0)=" "
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^ANRV(2043,3,1,33,0)=" "
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^ANRV(2043,3,1,34,0)=" "
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^ANRV(2043,3,1,35,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
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^ANRV(2043,4,0)="INVITATION FOR VIST REVIEW^1"
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^ANRV(2043,4,1,0)="^^69^69^2980609^^^^"
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^ANRV(2043,4,1,1,0)=" "
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^ANRV(2043,4,1,2,0)=" "
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^ANRV(2043,4,1,3,0)="|NOWRAP|"
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^ANRV(2043,4,1,4,0)="|BLANK(0)|"
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^ANRV(2043,4,1,5,0)="|CENTER(""Department of Veterans Affairs"")|"
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^ANRV(2043,4,1,6,0)="|BLANK(0)|"
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^ANRV(2043,4,1,7,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
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^ANRV(2043,4,1,8,0)="|BLANK(0)|"
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^ANRV(2043,4,1,9,0)="|CENTER(""<Enter Street Address>"")|"
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^ANRV(2043,4,1,10,0)="|BLANK(0)|"
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^ANRV(2043,4,1,11,0)="|CENTER(""<Enter City, State ZIP>"")|"
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^ANRV(2043,4,1,12,0)=" "
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^ANRV(2043,4,1,13,0)=" "
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^ANRV(2043,4,1,14,0)="|TODAY|"
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^ANRV(2043,4,1,15,0)="|NOWRAP||BLANK(2)|"
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^ANRV(2043,4,1,16,0)="|LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))|"
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^ANRV(2043,4,1,17,0)="|LOWERCASE(NAME:STREET ADDRESS [LINE 1])|"
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^ANRV(2043,4,1,18,0)="|WRAP|"
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^ANRV(2043,4,1,19,0)="|LOWERCASE(NAME:CITY)_"", ""|"
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^ANRV(2043,4,1,20,0)="|NAME:STATE:ABBREVIATION_"" ""_ZIP CODE|"
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^ANRV(2043,4,1,21,0)="|NOWRAP|"
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^ANRV(2043,4,1,22,0)="|BLANK(2)|"
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^ANRV(2043,4,1,23,0)="|$S((NAME:SEX[""F""):""Dear Ms. ""_LOWERCASE($P(NAME,"","",1))_"":"",1:""Dear Mr. ""_LOWERCASE($P(NAME,"","",1))_"":"")|"
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^ANRV(2043,4,1,24,0)=" "
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^ANRV(2043,4,1,25,0)=" "
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^ANRV(2043,4,1,26,0)="The Visual Impairment Services Team (VIS Team), <Enter Your VAMC> is"
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^ANRV(2043,4,1,27,0)="pleased to offer your annual appointment to evaluate your overall health"
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^ANRV(2043,4,1,28,0)="status and to make certain you are receiving the specialized benefits"
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^ANRV(2043,4,1,29,0)="available through the Department of Veterans Affairs. This appointment"
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^ANRV(2043,4,1,30,0)="includes the following: (1) A complete physical examination; (2) An eye"
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^ANRV(2043,4,1,31,0)="examination; (3) A hearing evaluation; (4) A review of your prosthetic"
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^ANRV(2043,4,1,32,0)="needs as they relate to your blindness; and (5) An interview with the VIST"
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^ANRV(2043,4,1,33,0)="Coordinator who may be able to assist you with specific problems as they"
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^ANRV(2043,4,1,34,0)="relate to your sight loss."
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^ANRV(2043,4,1,35,0)=" "
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^ANRV(2043,4,1,36,0)="This annual review is entirely VOLUNTARY ON YOUR PART. IT DOES NOT IN ANY"
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^ANRV(2043,4,1,37,0)="WAY affect your status with the VA if you choose not to participate."
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^ANRV(2043,4,1,38,0)="However, we sincerely encourage you to take advantage of this opportunity."
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^ANRV(2043,4,1,39,0)=" "
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^ANRV(2043,4,1,40,0)="Please complete the form at the bottom of this letter and return it in the"
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^ANRV(2043,4,1,41,0)="enclosed prepaid envelope. Even if you choose not to request an"
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^ANRV(2043,4,1,42,0)="appointment, it would be appreciated if you would complete and return the"
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^ANRV(2043,4,1,43,0)="form."
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^ANRV(2043,4,1,44,0)=" "
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^ANRV(2043,4,1,45,0)="I personally look forward to an opportunity to meet with you if I have not"
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^ANRV(2043,4,1,46,0)="already done so."
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^ANRV(2043,4,1,47,0)=" "
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^ANRV(2043,4,1,48,0)="Sincerely,"
|
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^ANRV(2043,4,1,49,0)=" "
|
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^ANRV(2043,4,1,50,0)=" "
|
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^ANRV(2043,4,1,51,0)=" "
|
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^ANRV(2043,4,1,52,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
|
|
^ANRV(2043,4,1,53,0)=" "
|
|
^ANRV(2043,4,1,54,0)="***************************************************************************"
|
|
^ANRV(2043,4,1,55,0)="IF YOU HAVE QUESTIONS, PLEASE CALL <Enter VIST Coordinator's Name>, VIST"
|
|
^ANRV(2043,4,1,56,0)="COORDINATOR:"
|
|
^ANRV(2043,4,1,57,0)="TELEPHONE <Enter Your Facility's Phone Number>"
|
|
^ANRV(2043,4,1,58,0)="NAME:_____________________________________________________________________"
|
|
^ANRV(2043,4,1,59,0)="ADDRESS:__________________________________________________________________"
|
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^ANRV(2043,4,1,60,0)="__________________________________________________________________________"
|
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^ANRV(2043,4,1,61,0)="HOME OR CONTACT TELEPHONE #:___________________ BIRTHDATE:________________"
|
|
^ANRV(2043,4,1,62,0)="|WRAP|"
|
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^ANRV(2043,4,1,63,0)="SCHEDULE ME FOR"
|
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^ANRV(2043,4,1,64,0)="|YEAR(TODAY)|"
|
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^ANRV(2043,4,1,65,0)=": YES:___ NO:___ I PREFER THE MONTH OF:______________"
|
|
^ANRV(2043,4,1,66,0)="|NOWRAP|"
|
|
^ANRV(2043,4,1,67,0)="I AM NOT INTERESTED IN A VIST REVIEW BECAUSE:_____________________________"
|
|
^ANRV(2043,4,1,68,0)="__________________________________________________________________________"
|
|
^ANRV(2043,4,1,69,0)="SIGNATURE:____________________________________ DATE:______________________"
|
|
^ANRV(2043,5,0)="BRC FOLLOW-UP LETTER^1"
|
|
^ANRV(2043,5,1,0)="^^63^63^2980609^^^^"
|
|
^ANRV(2043,5,1,1,0)=" "
|
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^ANRV(2043,5,1,2,0)=" "
|
|
^ANRV(2043,5,1,3,0)="|NOWRAP|"
|
|
^ANRV(2043,5,1,4,0)="|BLANK(0)|"
|
|
^ANRV(2043,5,1,5,0)="|CENTER(""Department of Veterans Affairs"")|"
|
|
^ANRV(2043,5,1,6,0)="|BLANK(0)|"
|
|
^ANRV(2043,5,1,7,0)="|CENTER(""<Enter Your VA Medical Center>"")|"
|
|
^ANRV(2043,5,1,8,0)="|BLANK(0)|"
|
|
^ANRV(2043,5,1,9,0)="|CENTER(""<Enter Street Address>"")|"
|
|
^ANRV(2043,5,1,10,0)="|BLANK(0)|"
|
|
^ANRV(2043,5,1,11,0)="|CENTER(""<Enter City, State ZIP>"")|"
|
|
^ANRV(2043,5,1,12,0)=" "
|
|
^ANRV(2043,5,1,13,0)=" "
|
|
^ANRV(2043,5,1,14,0)="|TODAY|"
|
|
^ANRV(2043,5,1,15,0)="|NOWRAP||BLANK(2)|"
|
|
^ANRV(2043,5,1,16,0)="|LOWERCASE($P(NAME,"","",2)_"" ""_$P(NAME,"","",1))|"
|
|
^ANRV(2043,5,1,17,0)="|LOWERCASE(NAME:STREET ADDRESS [LINE 1])|"
|
|
^ANRV(2043,5,1,18,0)="|WRAP|"
|
|
^ANRV(2043,5,1,19,0)="|LOWERCASE(NAME:CITY)_"", ""|"
|
|
^ANRV(2043,5,1,20,0)="|NAME:STATE:ABBREVIATION_"" ""_ZIP CODE|"
|
|
^ANRV(2043,5,1,21,0)="|NOWRAP|"
|
|
^ANRV(2043,5,1,22,0)=" "
|
|
^ANRV(2043,5,1,23,0)=" "
|
|
^ANRV(2043,5,1,24,0)="|$S((NAME:SEX[""F""):""Dear Ms. ""_LOWERCASE($P(NAME,"","",1))_"":"",1:""Dear Mr. ""_LOWERCASE($P(NAME,"","",1))_"":"")|"
|
|
^ANRV(2043,5,1,25,0)=" "
|
|
^ANRV(2043,5,1,26,0)=" "
|
|
^ANRV(2043,5,1,27,0)="We hope you enjoyed your recent blind rehabilitation training and were"
|
|
^ANRV(2043,5,1,28,0)="able to take some new found knowledge home with you that will make living"
|
|
^ANRV(2043,5,1,29,0)="with your visual loss easier. For the benefit of the VIST Coordinator as"
|
|
^ANRV(2043,5,1,30,0)="well as the Blind Rehabilitation Center or Clinic, we would appreciate your"
|
|
^ANRV(2043,5,1,31,0)="assistance with answering the following questions as they relate to your"
|
|
^ANRV(2043,5,1,32,0)="return from Blind Rehabilitation:"
|
|
^ANRV(2043,5,1,33,0)=" "
|
|
^ANRV(2043,5,1,34,0)="l. Has there been a change in your vision or medical condition?"
|
|
^ANRV(2043,5,1,35,0)="______________________________________________________________________"
|
|
^ANRV(2043,5,1,36,0)=" "
|
|
^ANRV(2043,5,1,37,0)="2. Has there been a change in your financial situation?"
|
|
^ANRV(2043,5,1,38,0)="______________________________________________________________________"
|
|
^ANRV(2043,5,1,39,0)=" "
|
|
^ANRV(2043,5,1,40,0)="3. How are you using the skills learned at the Blind Rehabilitation Center"
|
|
^ANRV(2043,5,1,41,0)="or Clinic?____________________________________________________________"
|
|
^ANRV(2043,5,1,42,0)="______________________________________________________________________"
|
|
^ANRV(2043,5,1,43,0)=" "
|
|
^ANRV(2043,5,1,44,0)="4. What did your spouse or family member think of the family program at"
|
|
^ANRV(2043,5,1,45,0)="the Blind Center or Clinic?____________________________________________"
|
|
^ANRV(2043,5,1,46,0)=" "
|
|
^ANRV(2043,5,1,47,0)="5. Are you using the low vision aids issued to you? If so how?"
|
|
^ANRV(2043,5,1,48,0)="______________________________________________________________________"
|
|
^ANRV(2043,5,1,49,0)=" "
|
|
^ANRV(2043,5,1,50,0)="6. Are you continuing to have major problems coping with your vision loss?"
|
|
^ANRV(2043,5,1,51,0)="______________________________________________________________________"
|
|
^ANRV(2043,5,1,52,0)=" "
|
|
^ANRV(2043,5,1,53,0)="7. What are your goals and future plans?______________________________"
|
|
^ANRV(2043,5,1,54,0)="______________________________________________________________________"
|
|
^ANRV(2043,5,1,55,0)=" "
|
|
^ANRV(2043,5,1,56,0)="Thank you for your assistance. Please return this completed letter in the"
|
|
^ANRV(2043,5,1,57,0)="enclosed envelope."
|
|
^ANRV(2043,5,1,58,0)=" "
|
|
^ANRV(2043,5,1,59,0)="Sincerely Yours,"
|
|
^ANRV(2043,5,1,60,0)=" "
|
|
^ANRV(2043,5,1,61,0)=" "
|
|
^ANRV(2043,5,1,62,0)=" "
|
|
^ANRV(2043,5,1,63,0)="<Enter VIST Coordinator's Name>, VIST Coordinator"
|
|
^ANRV(2043,"B","BRC APPLICATION LETTER",1)=""
|
|
^ANRV(2043,"B","BRC FOLLOW-UP LETTER",5)=""
|
|
^ANRV(2043,"B","CLAIM LETTER",2)=""
|
|
^ANRV(2043,"B","INVITATION FOR VIST REVIEW",4)=""
|
|
^ANRV(2043,"B","IRS EXEMPTION",3)=""
|
|
^ANRV(2043.5,0)="VARO CLAIMS^2043.5P^^"
|
|
^ANRV(2044,0)="VIST LOCAL BENEFITS AND SERVICES^2044^5^5"
|
|
^ANRV(2044,1,0)="STATE SERVICES FOR THE BLIND"
|
|
^ANRV(2044,2,0)="LOCAL AGENCY FOR THE BLIND"
|
|
^ANRV(2044,3,0)="PROPERTY TAX EXEMPTION"
|
|
^ANRV(2044,4,0)="HUNTING/FISHING LICENSE"
|
|
^ANRV(2044,5,0)="TRANSIT PASS"
|
|
^ANRV(2044,"B","HUNTING/FISHING LICENSE",4)=""
|
|
^ANRV(2044,"B","LOCAL AGENCY FOR THE BLIND",2)=""
|
|
^ANRV(2044,"B","PROPERTY TAX EXEMPTION",3)=""
|
|
^ANRV(2044,"B","STATE SERVICES FOR THE BLIND",1)=""
|
|
^ANRV(2044,"B","TRANSIT PASS",5)=""
|
|
^ANRV(2048,0)="ANRV PATIENT REVIEW^2048P^^"
|
|
^ANRV(2048.1,0)="ANRV PATIENT REVIEW SECTIONS^2048.1^6^6"
|
|
^ANRV(2048.1,1,0)="1^SECTION 1"
|
|
^ANRV(2048.1,1,2)="1"
|
|
^ANRV(2048.1,2,0)="2^SECTION 2"
|
|
^ANRV(2048.1,2,2)="1"
|
|
^ANRV(2048.1,3,0)="3^SECTION 3"
|
|
^ANRV(2048.1,3,2)="1"
|
|
^ANRV(2048.1,4,0)="4^SECTION 4"
|
|
^ANRV(2048.1,4,2)="1"
|
|
^ANRV(2048.1,5,0)="5^SECTION 5"
|
|
^ANRV(2048.1,5,2)="1"
|
|
^ANRV(2048.1,6,0)="6^SECTION 6"
|
|
^ANRV(2048.1,6,2)="1"
|
|
^ANRV(2048.1,"B",1,1)=""
|
|
^ANRV(2048.1,"B",2,2)=""
|
|
^ANRV(2048.1,"B",3,3)=""
|
|
^ANRV(2048.1,"B",4,4)=""
|
|
^ANRV(2048.1,"B",5,5)=""
|
|
^ANRV(2048.1,"B",6,6)=""
|