| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | name(+) | 0;1 | FREE TEXT | B | Enter the patient's name in 'LAST,FIRST MIDDLE SUFFIX' format. This value must be 3-30 characters in length and may contain only uppercase alpha characters, spaces, apostrophes, hyphens and one comma. All other characters and parenthetical text will be removed. | |
| .02 | sex | 1;1 | SET OF CODES | M:MALE F:FEMALE | Enter 'M' if this applicant is a male, or 'F' if female. | |
| .03 | date of birth | 1;2 | DATE-TIME | Enter the applicant's date of birth between December 31, 1870 and today's date. | ||
| .09 | social security number | 1;3 | FREE TEXT | Enter the applicants social security number as nine digits, i.e., 123456789. If the social security number is unknown and you need to assign a pseudo SSN follow it with a 'P', i.e., 123456789P. Simply enter a 'P' if you wish the system to determine the proper pseudo SSN. Pseudo SSN's are determined as follows: 1. Based on the following table assign the first three numbers of the pseudo SSN based on the patient's three initials in first-middle-last initial order. For example, if the name is 'SMITH,JOHN P' the table would be used to convert JPS (the initials for JOHN P SMITH) into 467. ALPHA NUMBER ALPHA NUMBER ----- ------ ----- ------ A,B,C 1 D,E,F 2 G,H,I 3 J,K,L 4 M,N,O 5 P,Q,R 6 S,T,U 7 V,W,X 8 Y,Z 9 NO INITIAL 0 2. Using the patient's date of birth convert it to six numerics in month-day-year order. Where a month, day or year consists of less than one numeric, i.e., JUNE=6, preceed it by a zero, i.e., JUNE=06. If the month and/or year of birth are unknown indicate them as '00'. EXAMPLES -------- Patient Name DOB Pseudo SSN ------------ --- ---------- SMITH,JOHN P Jan 3, 1917 467010317P SMITH,JOHN P Jan 1917 467010017P SMITH,JOHN P 1917 467000017P SMITH,JOHN Dec 15, 1945 407121545P | ||
| .1 | requesting station number(+) | .1;1 | NUMERIC | This is the Station Number of the requesting facility. When acknowledgement messages are returned, the domain to which they are to be sent can be derived from this value. | ||
| .111 | street address [line 1] | ADDR;1 | FREE TEXT | Enter the first line of this applicant's residence street address [3-35 characters]. | ||
| .112 | street address [line 2] | ADDR;2 | FREE TEXT | Enter the second line of this applicant's residence street address [3-30 characters] if the space provided in 'street address' was not sufficient. | ||
| .113 | street address [line 3] | ADDR;3 | FREE TEXT | Enter the third line of this applicant's residence street address [3-30 characters] if the space provided in 'street address' and 'street address 2' was not sufficient. | ||
| .114 | city | ADDR;4 | FREE TEXT | Enter the city in which this applicant resides [2-15 characters]. If the space provided is not sufficient please abbreviate the city to the best of your ability. | ||
| .115 | state | ADDR;5 | POINTER | 5 | From the available listing choose the state in which this applicant resides. | |
| .116 | zip code | ADDR;6 | NUMERIC | Enter the zip code [5 numerics] for the city in which this applicant resides. | ||
| .117 | county | ADDR;7 | POINTER | 5.1 | If a state of residence is entered select from the available listing the county in which this applicant resides. If no state (or a non-state) is entered no selection is possible. | |
| .1217 | temporary address start date | ADDR;9 | DATE-TIME | If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES enter the date on which the applicant will commence being contacted at the temporary address indicated, otherwise nothing may be entered. This field may not be deleted as long as the need for a temporary address is indicated. | ||
| .1218 | temporary address end date | ADDR;10 | DATE-TIME | If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES enter the date as of which the applicant will no longer be contacted at that temporary address, otherwise nothing may be entered. This field may not be deleted as long as the need for a temporary address is indicated. | ||
| .131 | phone number | ADDR;8 | FREE TEXT | Enter the telephone number [4-20 characters] to this applicant's place of residence. | ||
| .2 | transmission date/time | .1;2 | DATE-TIME | The date and time (including seconds) of the moment of transmission. | ||
| .3 | coversheet requested | .1;3 | BOOLEAN | Y:YES | This is a flag to indicate if a request has been made to print a coversheet with the transmitted details of the patient to be transferred. If the flag has been set to YES, the request can be notified as Accepted. | |
| .301 | service connected? | 2;1 | BOOLEAN | Y:YES N:NO | Enter 'Y' if this applicant is service connected, 'N' if not. Applicants identified as being non-veterans cannot be entered as service connected. Once eligibility has been verified only users holding the designated security key may enter/edit this field. | |
| .302 | service connected percentage | 2;2 | NUMERIC | If this applicant is service connected (SERVICE CONNECTED prompt must be answered YES) enter the service connected percentage [a number between 0-100]. Once eligibility has been verified only users who hold the designated security key may enter/edit this field. Field may not be deleted as long as service connection is indicated. | ||
| .361 | primary eligibility code | 2;3 | FREE TEXT | Select from the available listing the appropriate eligibility code for this applicant. For non-veteran applicants a wide variety of choices are available. For veteran applicants the choices are screened [in the following order] dependent on the responses to other prompts: 1. If the SERVICE CONNECTED prompt (field .301) is answered YES only the following two choices are available: a. If the SERVICE CONNECTED PERCENTAGE prompt (field .302) entered is 50% or greater 'SERVICE CONNECTED 50% TO 100%' can be selected. b. Otherwise, the percentage is assumed to be less than 50% and only 'SC, LESS THAN 50%' may be entered. 2. If the response to the WERE YOU A PRISONER OF WAR field (# .525) is YES and the veteran is not service connected, you must select PRISONER OF WAR as the eligibility code. 3. If the veteran is receiving VA benefits, but does not meet the criteria in items 1 and 2 above, then the following choices may be presented for selection: If RECEIVING A&A BENEFITS is answered YES, the eligibility code AID & ATTENDANCE may be selected. If the RECEIVING HOUSEBOUND BENEFITS is answered YES ,the eligibility code HOUSEBOUND may be selected. If the above two prompts were answered NO, but the RECEIVING A VA PENSION prompt was answered YES, only the NSC, VA PENSION prompt may be selected. 4. If none of the above pertain to this veteran, then the NSC eligibility will be available for selection. ** Dependent on the birthdate of the applicant, the following two eligibility codes may be displayed along with those shown in items 3 through 5 above: WORLD WAR I and MEXICAN BORDER WAR. These would display for veterans not meeting the criteria in items 1 and 2, but whose date of birth is prior to 1920. | ||
| .4 | comments | COMM;0 | WORD-PROCESSING | |||
| .5 | sending facility transfer id | 0;2 | FREE TEXT | Identifying reference to the transfer file on the transmitting facility (#409.35). | ||
| 1 | status | 2;4 | SET OF CODES | P:PENDING E:EWL C:CLOSED R:REMOVED T:TRANSFERRED | The current stage in the transfer process. Possible values are P - PENDING: where a transfer request has been received but no action has yet been taken E - EWL: the transfer patient has been place on the Electronic Wait List C - CLOSED: the transfer has been completed T - TRANSFERRED: the transfer patient has been the subject of request to another facility R - REMOVED: the transfer request has been cancelled T - TRANSFERRED: the transfer patient has been the subject of request to another facility | |
| 2 | facility transferred to | 2;6 | NUMERIC | The stop code of the facility if the patient for this transfer has become the subject of a further tranfer elsewhere | ||
| 4 | wait list type | WL;1 | SET OF CODES | 1:PCMM TEAM ASSIGNMENT 2:PCMM POSITION ASSIGNMENT 3:SERVICE/SPECIALTY 4:SPECIFIC CLINIC | Set of codes as on the WAIT LIST ENTRY file (#409.3) | |
| 5 | wait list type extension | WL;2 | FREE TEXT | A free text expansion of the attribute associated with the WAIT LIST TYPE. E.g. A Wait List Type of 3: SERVICE/SPECIALTY would typically hold the relevant Specialty. | ||
| 22 | desired date of appointment | WL;3 | DATE-TIME | Desired Date of Appointment taken from the Wait List Entry file from the transmitting facility. | ||
| 409.3 | sd wait list entry | 2;5 | POINTER | 409.3 | C | Pointer to the associated EWL entry |
| 991.01 | integration control number | 1;4 | NUMERIC | Machine to machine identifier for a patient. Included in the hope of making a match with the same patient on the receiving system. |
Not Referenced