308 lines
11 KiB
Plaintext
308 lines
11 KiB
Plaintext
English French Notes Complete/Exclude
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does not exist, AMIE Exam
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Pension:
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Claim Folder Loc:
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------- Admission data -------
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Current
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Prior
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------ Admission date -------
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---- Admitting diagnosis ----
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------- Discharge date -------
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------- Discharge type -------
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-------- Bed Service ---------
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PATIENT LOOKUP
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Which would you prefer
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has both Admission and Non Admission information.
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0,0,0,2,0^Searching file for existing 7131 requests for
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0,0,0,2:2,0^No selection made!
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Select 1-
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or '^' to Exit or Return to continue
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Is this the correct information?
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Display Admission or Activity information
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Date Range will allow the user to select the specific dates.
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All Dates will show the user all possible information.
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1,0,0,2,0^There is a 7131 already on file for
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0,0,0,1:1,0^Status is
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Do you want to delete the existing 7131 for this date:
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Answer YES or No. You may not have two 7131s for the same admission date.
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Do you want to add a NEW 7131
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'YES' to enter a new 7131. 'NO' to search for an existing one.
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Are you sure you want to edit this 7131 request:
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'YES' to edit the 7131 request.
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1,0,0,2,0^Unable to add this new record!
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Enter Patient name:
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0,0,0,2:1,1^The following is a list of Admission dates for
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0,0,0,2:1,1^The following is a list of activity dates for
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Stop Code(s)
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1,0,0,2:1,0^There is a problem with the Disposition Login information. Contact IRM
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Disposition Login
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Date Range
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For REMOTE SITE (Press RETURN for all sites) :
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Are you sure you want ALL REMOTE SITES:
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Enter Y to get all remote sites N for just one
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BEGINNING date:
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ENDING date:
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1,0,0,2:2,0^Invalid dates! Ending must not be before beginning.
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0,0,0,3,0^Notice to MAS on
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0,0,0,1,0^There were no new 7131 requests
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AMIE New Req for
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0,0,0,1:3,1^AMIE New Request Report
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Amie new request rpt
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CLAIM NO:
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ACTIVITY DATE:
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REQUEST DATE:
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Items Requested:
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(Not specified)
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This record was FINALIZED on
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**Request is incomplete, contact the Regional Office to complete**
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Record Processing Notes:
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AMIE 7131 NEW REQUEST REPORT FOR
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* LONG VERSION *
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, DIVISION NOT GIVEN
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, UNABLE TO DETERMINE DIVISION
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to stop
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0,0,0,4:1,0^AMIE 7131 NEW REQUEST REPORT FOR
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**Long Version**
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UNABLE TO DETERMINE
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VARO 7131 NEW REQUEST REPORT FOR
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* SHORT VERSION *
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ACT/ADM DATE
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DOCUMENT TYPE:
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** REGIONAL OFFICE MUST EDIT THE INCOMPLETE REQUEST LISTED ABOVE **
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Select version
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Long
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ACTIVITY DATE
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You have no user number.
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21-DAY CERTIFICATE TEXT ENTRY/EDITING
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This record is now released.
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DVBA 21-DAY CERT CLERK
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You do not have the proper key to use this option.
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Wrong request type !
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This is an ACTIVITY DATE request, not ADMISSION DATE.
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This request has already been FINALIZED and the text may not be changed.
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No 21-day certificate has been requested for this Veteran.
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This Veteran has a 21-day certificate requested but
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it has not yet been processed.
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This certificate has been released to the RO
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but has not been printed.
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and has already been printed.
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but the status is unknown.
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Admit date:
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DVBA RELEASE 21-DAY CERT
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Ok to release this 21-day certificate text
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Enter Y to go ahead and release this certificate to the RO
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or N to be able to make corrections and release later.
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7131 Report Requesting
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Select Report:
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initially mark the report as 'YES'. If the number is selected again then it
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will be changed to 'NO' or vice versa
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Vet already discharged - you cannot request Notice of Discharge.
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Cannot select 'Notice of Discharge', 'Hospital Summary', 'Certificate (21-day)', or 'Admission Report' for an activity date.
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The patient has no Claim Folder Location in the Patient File.
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Notice of Discharge would not be returned.
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The patient's Claim Folder Location has no Station Number in file #4.
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Please check the Claim Folder Location and its entry in file #4.
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21 Day Certificate would not be returned.
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1,0,0,2,0^You have not selected any reports for this 7131 request
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0,0,0,1:2,0^or have selected number 4 but not entered any remarks.
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);29Routing Location;.5;23///
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Do you want to file this request
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AMIE SITE PARAMETER EDITING
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Enter SITE NAME:
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VARO REPORT
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FOR PENSION
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SPECIAL
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AMIE PENSION/A&A REPORT
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REGIONAL OFFICE SPECIAL REPORT
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FOR A&A AND PENSION
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This report prints only Veterans receiving A&A or Pension.
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Do you want (A)&A or (P)ension ?
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Must be either A for A&A
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or P for Pension or
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or [RETURN] to escape.
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(NOT COMPLETE)
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Enter E to end,
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to EXIT or RETURN to continue
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Sort by Regional Office number
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Enter Y to sort by the Regional Office number you
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select or enter N to get ALL Regional Offices reported.
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Regional Office number:
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Must be 1-3 numbers.
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The entry of future dates is NOT allowed.
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Invalid date sequence. Beginning date must be before the ending date.
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Admission date:
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Finalized
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Activity date:
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You have no division code. Please contact the site manager.
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Your division code is invalid.
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Your division has no station number defined in the INSTITUTION file.
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Please consult IRM to request a unique station number for your division.
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DVBA;ADVB;DVBB;ADVB
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Are you sure you want to DELETE the existing 7131 for this date
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and log a NEW one
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Enter Y to delete the finalized 7131 request that
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exists for this date and log a new one.
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Enter N to leave the existing 7131 as is.
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Activity or admission date is missing ! Cannot reopen.
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You may now enter a new 7131 for this date.
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No site parameters have been setup in file 396.1.
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Do you want (A)&A, (P)ension, (S)ervice-connected, or AL(L) discharges ? S//
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Must be A for A&A, P for Pension, S for Service-connected, or L for All
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SERVICE-CONNECTED
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DISCHARGE REPORT
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Are you sure you want to delete this request
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7131 entry deleted.
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<Return to continue>
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Notice of discharge
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Hospital Summary
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Certificate (21-day)
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Other/Exam (Review Remarks)
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Special Report
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Competency Report
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VA Form 21-2680
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Asset Information
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Admission Report
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Beginning Date Care
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Original processing date
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Adm.
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Act.
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1,0,0,2,0^Record is currently in use!
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1,0,0,2:2,0^There is no Admission or Non Admission information
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for this date range!
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1,0,0,2:2,0^You must select a 7131 with Pending reports!
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Activity Date:
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1,0,0,2,0^The admission you selected is an ASIH admission.
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0,0,0,1,0^This means the veteran was admitted from a Nursing
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0,0,0,1,0^ Home or Domiciliary. It is suggested that you
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0,0,0,1,0^ review the veteran's claim folder before requesting
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0,0,0,1,0^This parameter can be adjusted to allow the site to keep 2507 requests
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0,0,0,1,0^for up to 999 days. The site can not select to retain the requests
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0,0,0,1,0^for less than 120 days. Selection of a number of days between
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0,0,0,1:2,0^120 and 999 is the allowable response.
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NOT a stand-alone program !
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Eligibility data:
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Please review previous information entered as well as
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entering additional REQUIRED information:
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RSaR
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RFXaR
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FXOaR
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NJ3,0XOaR
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SERVICE ENTRY DATE [LAST]
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SERVICE SEPARATION DATE [LAST]
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Need to edit the information you've just entered
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Enter Y to go back and correct any errors or
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you may enter N to proceed.
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FaR
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DAYS TO
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FINALIZED BY
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Requisition
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Operator
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Current Division
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Notice/Discharge:
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Hospital Summary:
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21-day Certificate:
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Other/Exam:
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Special Report:
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Competency Report:
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Form 21-2680:
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Asset Information:
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Admission Report:
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OPT Treatment Rpt:
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Beg Date/Care:
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REMARKS:
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NOTICE/DISCHG STATUS
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P:PENDING;C:COMPLETED;
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NOTICE/DISCHG COMPLETION DATE
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EDIT4.5
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Completed status must have date.
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HOSPITAL SUMMARY STATUS
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HOSP SUMMARY COMPLETION DATE
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EDIT5.5
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(21-DAY) CERTIFICATE STATUS
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(21-DAY) COMPLETION DATE
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EDIT6.5
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STATUS OF OTHER/EXAM
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OTHER/EXAM COMPLETION DATE
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STATUS OF SPECIAL REPORT
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SPECIAL REPORT COMPLETION DATE
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STATUS OF COMPETENCY REPORT
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COMPETENCY RPT COMPLETION DATE
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STATUS OF VA FORM 21-2680
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FORM 21-2680 COMPLETION DATE
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STATUS OF ASSET INFORMATION
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ASSET INFO COMPLETION DATE
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ADMISSION REPORT STATUS
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ADMISSION RPT COMPLETION DATE
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EDIT17.4
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STATUS OF OPT TREATMENT RPT
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OPT TREAT RPT COMPLETION DATE
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STATUS-BEG DATE/CARE (CHAP 17)
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BEG/DATE/CARE COMPLETION DATE
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DVBA*2.7*4 - APE x-ref cleanup process
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APE x-ref cleanup queued...task=
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DVBA*2.7*4
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Start Time of process:
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Results of search in DA^DFN^Request Date^Exam Type format
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No bad APE x-refs found!
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End Time:
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NOTHING WAS KILLED!! D EN^DVBAYAPE TO HAVE KILLS EXECUTED
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DVBA*2.7*4
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Diagnostic
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has run
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Department of Veterans Affairs
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Abbreviated
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Full
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Exam Worksheet
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ALIMENTARY APPENDAGES (DIGESTIVE)
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Date of exam: ____________________
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Place of exam: ___________________
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Type of Exam:
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Narrative:
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Detailed description of chronic, active symptomatology in the
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subjective complaints
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portion of this or the main examination is
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critical to the degree of disability assigned for the veteran.
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A. Medical history:
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B. Subjective complaints:
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C. Objective findings:
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Specific evaluation information required by the rating board
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(if the information requested is included elsewhere, do not
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repeat here):
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1. Abdominal discomfort -
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2. Food intolerance -
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5. Degree of pain -
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8. Weight loss -
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9. Generalized weakness -
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Diagnostic/clinical test results:
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Diagnosis:
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Signature: ______________________________
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Date: _________________________
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Compensation and Pension Exam for
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When only pure tone results should be used to evaluate
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hearing loss, the Chief of the Audiology Clinic should
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certify that language difficulties or other problems make
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the use of both pure tone average and speech discrimination
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A. Audiological history:
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Pure tone thresholds at indicated frequencies (air conduction):
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========== RIGHT EAR ========== + ========== LEFT EAR ===========
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* The pure tone threshold at 500 Hz is not currently used for evaluation
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purposes but is used in determining whether or not a ratable hearing
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loss exists.
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** - average of B, C, D, and E
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Speech recognition score:
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1. Maryland CNC word list _______ % right ear _______ % left ear
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2. W-22 word list _______ % right ear _______ % left ear
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(Only if specifically requested by the regional office)
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Note whether tinnitus is present and if so, indicate the following:
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Date/circumstance of onset
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Unilateral vs bilateral
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Constant vs periodic (indicate frequency)
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Severity and effect on daily life
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Veteran account of loudness/pitch
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Note whether audiologic results indicate an ear or hearing problem
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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