| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | patient name(+) | 0;1 | POINTER | 2 | B | Enter the patient's name, 'last four', or social security number. This is the name of the patient from the PATIENT file. |
| .5 | additional remarks | 5;0 | WORD-PROCESSING | This field holds the remarks entered for a 7131 request. It is a word processing field. | ||
| 1 | c-number | COMPUTED | The patient claim number, as it appears in the PATIENT file (#2). | |||
| 2 | soc sec number | COMPUTED | This is the patient's SSN as it appears in the PATIENT file. | |||
| 3 | admission date | 0;4 | DATE-TIME | G | This is the admission date this request is associated with. | |
| 4 | notice of discharge(+) | 0;5 | SET OF CODES | YES:YES NO:NO | This field indicates if a notice of discharge is requested. | |
| 4.5 | notice/dischg status | 0;9 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the status of the notice of discharge report. | |
| 4.6 | notice of discharge division | 6;9 | POINTER | 40.8 | This field is a pointer to the Medical Center Division file. It contains the division the Notice of Discharge requested on the 7131 has been transferred to. | |
| 4.7 | notice of discharge tran date | 7;9 | DATE-TIME | This field contains the date the Notice of Discharge was transferred to another division at a multi-divisional facility. | ||
| 4.8 | notice/dischg completion date | 0;10 | DATE-TIME | Date the notice of discharge was completed. | ||
| 4.9 | edit4.5 | 1;13 | FREE TEXT | Holds name of person who last edited the NOTICE OF DISCHARGE field. | ||
| 5 | hospital summary(+) | 0;6 | SET OF CODES | YES:YES NO:NO | Indicates whether a hospital summary has been selected. | |
| 5.5 | hospital summary status | 0;11 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the status of the hospital summary report. | |
| 5.6 | hospital summary division | 6;11 | POINTER | 40.8 | This field contains the division the Hospital Summary on the 7131 was transferred to. | |
| 5.7 | hospital summary tran date | 7;11 | DATE-TIME | This field contains the date the Hospital Summary was transferred to another division at a multi-divisional facility. | ||
| 5.8 | hosp summary completion date | 0;12 | DATE-TIME | The date the hospital summary was completed. | ||
| 5.9 | edit5.5 | 1;14 | FREE TEXT | Holds the name of the person who last edited the hospital summary status. | ||
| 6 | certificate (21-day)(+) | 0;7 | SET OF CODES | YES:YES NO:NO | Indicates whether a 21 day certificate is selected. | |
| 6.5 | (21-day) certificate status | 0;13 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the status of the 21 day certificate. | |
| 6.6 | certificate (21-day) division | 6;13 | POINTER | 40.8 | This field contains the division the 21 Day Certificate was transferred to on the 7131. | |
| 6.7 | certificate (21-day) tran date | 7;13 | DATE-TIME | This field contains the date the 21-Day Certificate was transferred to another division at a multi-divisional facility. | ||
| 6.8 | (21-day) completion date | 0;14 | DATE-TIME | Indicates the date the 21 day certificate was completed. | ||
| 6.81 | 21 day cert text | 3;0 | WORD-PROCESSING | This field contains the text of the 21 day certificate. | ||
| 6.82 | 21 day cert release status | 4;1 | SET OF CODES | R:RELEASED, READY TO PRINT P:PRINTED BY RO N:NEW | Indicates the various stages of the 21 day certificate process. There are three stages defined here; released and ready to be printed by the RO, printed by the RO, and new - ready for processing. | |
| 6.83 | 21 day cert mas release date | 4;2 | DATE-TIME | This is the date the certificate was released by MAS to the Regional Office. | ||
| 6.84 | 21 day cert released by | 4;3 | POINTER | 200 | This field contains the name of the person who released the 21 day certificate. | |
| 6.85 | date 21 day cert printed by ro | 4;4 | DATE-TIME | Contains the date the 21 day certificate was printed by the Regional Office. | ||
| 6.86 | 21 day cert to date | 4;5 | DATE-TIME | Contains the date to which the 21 day certificate length of stay was calculated. | ||
| 6.87 | 21 day cert ward | 4;6 | FREE TEXT | Contains the ward the patient was on when the 21 day certificate was generated. | ||
| 6.88 | 21 day cert bed | 4;7 | FREE TEXT | Contains the location of the bed the patient occupied when the certificate was generated. | ||
| 6.89 | 21 day cert printed by | 4;8 | FREE TEXT | This is the name of the Regional Office employee who printed the certificate. | ||
| 6.9 | edit6.5 | 1;15 | FREE TEXT | Holds the name of the person who last edited the 21 day certificate status. | ||
| 7 | other/exam (review remarks)(+) | 0;8 | SET OF CODES | YES:YES NO:NO | Indicates that the user should review the REMARKS section for further instructions concerning this request. | |
| 7.6 | other/exam listed in rem div | 6;15 | POINTER | 40.8 | This field contains the division the OTHER/EXAM Listed in Remarks was transferred to. | |
| 7.7 | other/exam listed tran date | 7;15 | DATE-TIME | This field contains the date the OTHER/EXAM Listed in Remarks was transferred to another division in a multi-divisional facility. | ||
| 8 | status of other/exam | 0;15 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the status of the OTHER/EXAM listed in the ADDITIONAL REMARKS field. | |
| 8.5 | other/exam completion date | 1;2 | DATE-TIME | This is the date that this report was completed. | ||
| 8.7 | edit8 | 1;16 | FREE TEXT | Holds the name of the person who last edited the STATUS OF EXAM CONDITIONS. | ||
| 9 | special report(+) | 0;16 | SET OF CODES | YES:YES NO:NO | Indicates whether a special report is requested. | |
| 9.6 | special report division | 6;17 | POINTER | 40.8 | This field contains the division the Special Report was transferred to. | |
| 9.7 | special report tran date | 7;17 | DATE-TIME | This field contains the date the Special Report was transferred to another division at a multi-divisional facility. | ||
| 10 | status of special report | 0;17 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the status of the special report. | |
| 10.5 | special report completion date | 1;3 | DATE-TIME | Contains the date on which the special report was completed. | ||
| 10.7 | edit10 | 1;17 | FREE TEXT | Holds the name of the person who last edited the STATUS OF SPECIAL REPORT. | ||
| 11 | competency report(+) | 0;18 | SET OF CODES | YES:YES NO:NO | Indicates whether or not a competency report has been selected. | |
| 11.6 | competency report division | 6;19 | POINTER | 40.8 | This field contains the division the Special Report was transferred to. | |
| 11.7 | competency report tran date | 7;19 | DATE-TIME | This field contains the date the Competency Report was transferred to another division at a multidivisional facility. | ||
| 12 | status of competency report | 0;19 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the current status of this report. | |
| 12.5 | competency rpt completion date | 1;4 | DATE-TIME | This is the date the competency report was completed by MAS. | ||
| 12.7 | edit12 | 1;18 | FREE TEXT | Holds the name of the person who last edited the STATUS OF COMPETENCY REPORT. | ||
| 13 | va form 21-2680(+) | 0;20 | SET OF CODES | YES:YES NO:NO | Indicates whether a VA FORM 21-2680 is requested. | |
| 13.6 | va form 21-2680 division | 6;21 | POINTER | 40.8 | This field contains the division the VA Form 21-2680 was transferred to. | |
| 13.7 | va form 21-2680 tran date | 7;21 | DATE-TIME | This field contains the date the VA Form 21-2680 was transferred to another division in a multidivisonal facility. | ||
| 14 | status of va form 21-2680 | 0;21 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the current status of this report. | |
| 14.5 | form 21-2680 completion date | 1;5 | DATE-TIME | The date this report was completed by MAS. | ||
| 14.7 | edit14 | 2;1 | FREE TEXT | Holds the name of the person who last edited STATUS OF VA FORM 21-2680. | ||
| 15 | asset information(+) | 0;22 | SET OF CODES | YES:YES NO:NO | Indicates whether asset information is requested. | |
| 15.6 | asset information division | 6;23 | POINTER | 40.8 | This field contains the division the Asset Information was transferred to. | |
| 15.7 | asset information tran date | 7;23 | DATE-TIME | This field contains the date the Asset Information was transferred to another division in a multidivisional facility. | ||
| 16 | status of asset information | 0;23 | SET OF CODES | P:PENDING C:COMPLETED | Status of the requested asset information report. | |
| 16.5 | asset info completion date | 1;6 | DATE-TIME | This is the date the asset information was completed by MAS. | ||
| 16.7 | edit16 | 2;2 | FREE TEXT | Holds the name of the person who last edited STATUS OF ASSET INFORMATION. | ||
| 17 | admission report(+) | 0;24 | SET OF CODES | YES:YES NO:NO | Indicates whether an admission report was requested. | |
| 17.4 | admission report status | 1;7 | SET OF CODES | P:PENDING C:COMPLETED | This is the current status of the admission report. | |
| 17.6 | admission report division | 6;7 | POINTER | 40.8 | This field contains the division the Asset Information was transferred to. | |
| 17.7 | admission report tran date | 7;7 | DATE-TIME | This field contains the date the Admission Report was transferred to another division at a multidivisional facility. | ||
| 17.8 | admission rpt completion date | 1;8 | DATE-TIME | This is the date the admission report was completed. | ||
| 17.9 | edit17.4 | 2;3 | FREE TEXT | Holds the name of the person who last edited the ADMISSION REPORT STATUS field. | ||
| 18 | opt treatment rpt (date range) | 0;25 | FREE TEXT | This will contain the date range that the user has selected for the OPT report. (This field is free text and intended to hold a From/To date range.) | ||
| 18.6 | opt treatment rpt division | 6;26 | POINTER | 40.8 | This field contains the division the OPT Treatment Rpt was transferred to on the 7131. | |
| 18.7 | opt treatment rpt tran date | 7;26 | DATE-TIME | This field contains the date the OPT Treatment Rpt was transferred to another division. | ||
| 19 | status of opt treatment rpt | 0;26 | SET OF CODES | P:PENDING C:COMPLETED | Contains the current status of the OPT report. | |
| 19.5 | opt treat rpt completion date | 1;9 | DATE-TIME | This is the date the OPT report was completed by MAS. | ||
| 19.7 | edit19 | 2;4 | FREE TEXT | Holds the name of the person who last edited the STATUS OF OPT TREATMENT RPT field. | ||
| 20 | beginning date/care (chap 17)(+) | 0;27 | SET OF CODES | YES:YES NO:NO | This field indicates whether the beginning date/care report is selected. | |
| 20.6 | beginning date/care division | 6;28 | POINTER | 40.8 | This field contains the division the Begining Date/Care (Chapt 17) was transferred to. | |
| 20.7 | beginning date/care tran date | 7;28 | DATE-TIME | This field contains the date the Beginning Date/Care was transferred to another division at a multidivisional facility. | ||
| 21 | status-beg date/care (chap 17) | 0;28 | SET OF CODES | P:PENDING C:COMPLETED | Indicates the current status of the beginning date/care report. | |
| 21.5 | beg/date/care completion date | 1;10 | DATE-TIME | This field holds the date the beginning date/care report was completed. | ||
| 21.7 | edit21 | 2;5 | FREE TEXT | Holds the name of the person who last edited the STATUS-BEG DATE/CARE field. | ||
| 22 | *additional remarks | 0;29 | FREE TEXT | This field is starred for deletion and is being replaced by a WP field. | ||
| 23 | date of request | 1;1 | DATE-TIME | E | This field contains the date the 7131 request was entered. | |
| 24 | date last status edit | 1;11 | DATE-TIME | This field contains the date the status of any of the reports was changed. | ||
| 25 | finalization date | 1;12 | DATE-TIME | F | This field contains the date that the 7131 was finalized. | |
| 26 | finalized by | 2;6 | FREE TEXT | This field contains the name of the user who finalized the 7131 request. | ||
| 27 | requesting location(+) | 2;7 | FREE TEXT | The name of the Regional Office that requested this 7131. | ||
| 28 | requested by(+) | 2;8 | FREE TEXT | The Regional Office employee who requested the 7131. | ||
| 29 | division(+) | 2;9 | POINTER | 40.8 | This field containts the division to which the 7131 request should be sent. | |
| 30 | document type(+) | 2;10 | SET OF CODES | L:ACTIVITY DATE A:ADMISSION DATE | Stores the document type of the 7131 request; either admission date or activity date. |
Not Referenced