The Master Data Model for Veteran Care

Developer Documentation » VDM » Patient-2

Patient (2)

The PATIENT file contains all the patients followed by the medical center/ Outpatient clinic. At a minimum each patient entry must have a NAME,DATE OF BIRTH and SOCIAL SECURITY NUMBER. In order to add a new patient to the PATIENT file the user must also indicate whether or not the patient is requesting to receive care as a VETERAN of the U.S. Armed Forces and specify the TYPE of patient being added to the system. For the most part the information contained in this file is demographic in nature, i.e.,address,employment,service history,etc.,however data concerning admissions,appointments,etc.,is also stored in this file. The ADMISSION sub-field is scheduled to be moved into the new PATIENT MOVEMENT file by the end of calendar year 1989. Care should be used when removing a patient from the PATIENT file since virtually all other DHCP modules do utilize data from this file. Of the many fields in the file you will note that many are preceeded by an asterisk. Those fields are scheduled to be removed from the file due to either lack of use or replacement by another field/file in the next release.

Global:

Domain: Patients

Properties

Label/Field Name Field # Description Datatype Attributes Range
Name
  name
.01 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.
STRING INDEXED
REQUIRED
 
Sex
  sex
.02 Enter ‘M’ if this applicant is a male,or ‘F’ if female. ENUMERATION INDEXED MALE: M
FEMALE: F
Self Identified Gender
  self_identified_gender
.024 This SELF IDENTIFIED GENDER value indicates the patient’s view of their sexual orientation,if they choose to provide it. ENUMERATION   Transmale/Transman/Female-to-Male: TM
Transfemale/Transwoman/Male-to-Female: TF
individual chooses not to answer: N
Other: O
Female: F
Male: M
Date Of Birth
  date_of_birth
.03 Enter the patient’s DATE OF BIRTH which must be later than 12/31/1870.
DATE OF BIRTH cannot be a date after the beneficiary ‘Ineligible Date’
or a date after the ‘Enrollment Application Date’.
DATE-TIME INDEXED  
Marital Status
  marital_status
.05 Select from the available listing this applicant’s current
marital status.
POINTER   Marital_Status-11
Race
  race
.06 This field is no longer being populated and the values that are on file
were collected prior to installation of patch DG5.3415.
POINTER   Race-10
Occupation
  occupation
.07 If applicable,enter this applicant’s current occupation
[1-30 characters].
STRING    
Religious Preference
  religious_preference
.08 Select from the available listing the religious preference of this
applicant.
POINTER   Religion-13
Duplicate Status
  duplicate_status
.081 This field is currently not being utilized. It will be active when
Patient Merge/Purge options are available to the user. Duplicate
Status field will be defined at that time.
ENUMERATION   CHECK DUPLICATE RECORDS FILE: 1
NO UNRESOLVED DUPLICATES: 0
Patient Merged To
  patient_merged_to
.082 This field is currently not being utilized. It will be active when
Patient Merge/Purge options are available to the user. Patient Merged
To: field will be defined at that time.
POINTER   Patient-2
Check For Duplicate
  check_for_duplicate
.083 This field is currently not being utilized. It will be active when
Patient Merge/Purge options are available to the user. Check for
Duplicate field will be defined at that time.
BOOLEAN   true: 1
Social Security Number
  social_security_number
.09 Answer with the individual’s social security number. Answer must be 9
numbers in length. The SSN will be sent to the SSA for verification.
This will be displayed next to the SSN. Once an SSN has received a
status of Verified,it is locked from user updating and a “VERIFIED”
will be displayed by the SSN field. Only the Identity Management Data
QUality Team are able to change a beneficiary’s (veteran/non veteran)
SSN. If an Invalid per SSA status is received for the SSN,then an
“INVALID” will appear next to the invalid SSN of the individual.
Facilities should make every effort to obtain the accurate SSN from the
individual for any invalid or pseudo SSN entry.

If a valid SSN is not known,then a “P” will be entered at the SSN
prompt for the system to automatically assign a Pseudo-SSN. If a
Pseudo SSN is entered,a Reason for entering it will be required.
STRING INDEXED  
Pseudo Ssn Reason
  pseudo_ssn_reason
.0906 This field is used to document the reason the individual was assigned a
pseudo SSN. Based on your selection,the Pseudo SSN Report (Patient)
option located in the Registration Menu can provide you a current
report of the reasons entered at this prompt. The following reasons
are available for selection:

Refused to Provide - use this reason when the individual was asked for
his/her SSN and refused to provide the number.

SSN Unknown/Follow-up required - use this reason when the individual
is not available to ask/answer the request for SSN. The facility
should initiate Follow-up activity to obtain the SSN.

No SSN Assigned - use this reason when the individual has not been
assigned an SSN. This generally applies to spouse or dependents of
veterans who are not US citizens and infrequently,non-citizen
beneficiaries.
ENUMERATION   NO SSN ASSIGNED: N
SSN UNKNOWN/FOLLOW-UP REQUIRED: S
REFUSED TO PROVIDE: R
Ssn Verification Status
  ssn_verification_status
.0907 This field designates whether or not the SSN has been verified. This field
will be received in the HL7 record. It is not editable by the user. Once
the SSN is verified by the SSA,it is no longer editable.
ENUMERATION   VERIFIED: 4
INVALID: 2
Remarks
  remarks
.091 If so desired,you may enter a short remark about this applicant between
3-60 characters. The remark entered should be significant and tact should
be exercised since this field is viewable to virtually all other users who
have the ability to ‘call up’ a patient for any purpose.
STRING    
Place Of Birth [City]
  place_of_birth_city
.092 Enter the city in which this applicant was born (or foreign
country if born outside the U.S.) [2-20 characters].
STRING    
Place Of Birth [State]
  place_of_birth_state
.093 If the applicant was born within the U.S. select from the
available listing the state in which s/he was born.
POINTER   State-5
Who Entered Patient
  who_entered_patient
.096 The name of the user who first entered this applicant into the patient
file.
POINTER   New_Person-200
Date Entered Into File
  date_entered_into_file
.097 This field stores the date this patient was initially stored into the
PATIENT file. This is filled in automatically once a patient is
successfully added to the database.
DATE-TIME    
How Was Patient Entered?
  how_was_patient_entered
.098 How was the patient entered into the system. ENUMERATION   10-10T REGISTRATION: 1
Ward Location
  ward_location
.1 The ward location on which this patient is currently residing if an
inpatient [2-30 characters].
STRING INDEXED  
Room-Bed
  roombed
.101 If desired,for this inpatient,enter the room and bed indicator to which
s/he is assigned in ‘ROOM-BED’ format.
STRING INDEXED  
Current Movement
  current_movement
.102 This field contains the internal entry number of the PATIENT MOVEMENT
file denoting the most recent movement for an inpatient. This field
is only stored for current inpatients. It must NOT be edited as this
could affect the integrity of many options within MAS and other packages.
When displaying this field,the date/time of the most recent movement
will display.
POINTER   Patient_Movement-405
Treating Specialty
  treating_specialty
.103 From the available listing choose the treating specialty to which this
inpatient is currently assigned.
POINTER INDEXED Facility_Treating_Specialty-45_7
Provider
  provider
.104 From the available listing select the provider who is currently treating
this patient.
POINTER INDEXED New_Person-200
Attending Physician
  attending_physician
.1041 This field contains the attending physician currently responsible for the
care of this patient. This field is maintained automatically for all
inpatients and must not be edited. Once a patient is discharged,the
data in this field is removed.
POINTER INDEXED New_Person-200
Current Admission
  current_admission
.105 This field contains the internal entry number of the PATIENT MOVEMENT file
denoting the current admission for an inpatient. This field is only
stored for current inpatients. It must NOT be edited as this could affect
the integrity of many options within MAS and other DHCP packages. When
displaying this field,the date/time of the current admission will be
displayed.
POINTER INDEXED Patient_Movement-405
Last Dmms Episode Number
  last_dmms_episode_number
.106 This field was added at the request of the DMMS package developed at the
Birmingham ISC. It will be utilized in a future release of that package.
NUMERIC    
Lodger Ward Location
  lodger_ward_location
.107 The ward on which the patient currently resides if the patient is a lodger. STRING    
Current Room
  current_room
.108 This field contains a pointer to the ROOM-BED file denoting the current
room-bed in which this inpatient resides. This field is filled in only
for inpatients. It must NOT be edited as editing could adversely affect
the operation of the MAS package as well as other DHCP packages. This
field is filled in automatically by the module.
POINTER   RoomBed-405_4
Exclude From Facility Dir
  exclude_from_facility_dir
.109 Denotes whether or not the patient wished to be excluded from the
Facility Directory for current admission. This field is only stored for
current inpatients. It must NOT be edited as this could affect the
integrity of many options within PIMS and other packages.
BOOLEAN   false: 0
true: 1
Street Address [Line 1]
  street_address_line_1
.111 Enter the first line of this applicant’s residence street address
[3-35 characters].
STRING    
Zip+4
  zip4
.1112 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789).
STRING    
Street Address [Line 2]
  street_address_line_2
.112 Enter the second line of this applicant’s residence street address
[3-30 characters] if the space provided in ‘street address’ was
not sufficient.
STRING    
Street Address [Line 3]
  street_address_line_3
.113 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.
STRING    
City
  city
.114 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.
STRING    
State
  state
.115 From the available listing choose the state in which this applicant
resides.
POINTER   State-5
Zip Code
  zip_code
.116 Enter the zip code [5 numerics] for the city in which this applicant
resides.
STRING    
County
  county
.117 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.
NUMERIC    
Province
  province
.1171 Enter a Province if the patient has provided one for his/her foreign
address.

The entry can be alphanumeric and up to 20 characters in length.
STRING    
Postal Code
  postal_code
.1172 Enter with patient’s postal code if the patient has provided one for
his/her foreign address.

The entry can be alphanumeric and up to 10 characters in length.
STRING    
Country
  country
.1173 Enter the country where the patient’s permanent address is located.

If entering an Army/Air Force Post Office (APO) or a Fleet Post Office
(FPO) address select United States as the country.
POINTER   Country_Code-779_004
Address Change Dt/Tm
  address_change_dt_tm
.118 This field will hold the date and time of the last Address Update. DATE-TIME    
Address Change Source
  address_change_source
.119 This field will hold the source of the Last address change. ENUMERATION   USPS: USPS
VOA: VOA
VAMC: VAMC
HBSC: HBSC
BVA: BVA
LACS: LACS
HEC: HEC
NCOA: NCOA
VAINS: VAINS
Address Change Site
  address_change_site
.12 This field will hold the Site that last changed this patient’s address.
This field is only populated when the Address Source is listed as VAMC.
POINTER   Institution-4
Bad Address Indicator
  bad_address_indicator
.121 The Bad Address Indicator field applies to the address at which the patient
resides. This field should be set as follows (if applicable):

“UNDELIVERABLE” - Bad Address based on returned mail.
“HOMELESS” - Patient is known to be homeless.
“OTHER” - Other Bad Address Reason

Setting this field will prevent a Bad Address from being shared with HEC
and other VAMC facilities.


Once the Bad Address Indicator is set,incoming “newer” addresses will
automatically remove the Bad Address Indicator,and allow the “updated”
address to be transmitted to HEC and other VAMC facilities. To manually
remove the Bad Address Indicator enter the “@” symbol.
ENUMERATION   ADDRESS NOT FOUND: 4
OTHER: 3
UNDELIVERABLE: 1
HOMELESS: 2
Temporary Address Active?
  temporary_address_active
.12105 Enter ‘Y’ if you wish to enter a temporary address for this applicant at
this time,or ‘N’ if not. A ‘NO’ response will cause the temporary
address ‘Start Date’ and ‘End Date’ fields to be automatically deleted
while all other temporary address data will remain on file for future
use.
BOOLEAN   false: N
true: Y
Temporary Street [Line 1]
  temporary_street_line_1
.1211 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
enter the first line of the temporary street address for this
applicant [2-30 characters] otherwise nothing may be entered. This
field cannot be deleted as long as the need for a temporary address
is indicated.
STRING    
Temporary Address County
  temporary_address_county
.12111 If a state is entered for the temporary residence,enter the county in
which that residence resides. If a state does not exist for the temporary
address,a county can not be entered.
NUMERIC    
Temporary Zip+4
  temporary_zip4
.12112 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789).
STRING    
Temporary Address Change Dt/Tm
  temporary_address_change_dt_tm
.12113 This field will hold the date and time of the last Temporary Address
Update.
DATE-TIME    
Temporary Address Change Site
  temporary_address_change_site
.12114 This field will hold the Site that last changed this patient’s temporary
address.
POINTER   Institution-4
Temporary Street [Line 2]
  temporary_street_line_2
.1212 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
enter the second line of the temporary street address [2-30
characters],if necessary,otherwise nothing may be entered. This
field may not be deleted as long as the need for a temporary
address is indicated.
STRING    
Temporary Street [Line 3]
  temporary_street_line_3
.1213 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
enter the third line of the temporary street address [2-30
characters],if necessary,otherwise nothing may be entered.
This field may not be deleted as long as the need for a temporary
address is indicated.
STRING    
Temporary City
  temporary_city
.1214 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
enter the city in which the temporary address lies [2-30 characters],
otherwise nothing may be entered. This field may not be deleted as
long as the need for a temporary address is indicated.
STRING    
Temporary State
  temporary_state
.1215 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
select from the available listing the state in which the temporary
address lies,otherwise nothing may be entered. This field may
not be deleted as long as the need for a temporary address is
indicated.
POINTER   State-5
Temporary Zip Code
  temporary_zip_code
.1216 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
enter the zip code assigned to the temporary city [5 numerics],
otherwise nothing may be entered. This field may not be deleted
as long as the need for a temporary address is indicated.
STRING    
Temporary Address Start Date
  temporary_address_start_date
.1217 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.
DATE-TIME    
Temporary Address End Date
  temporary_address_end_date
.1218 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.
DATE-TIME    
Temporary Phone Number
  temporary_phone_number
.1219 If the WANT TO ENTER A TEMPORARY ADDRESS prompt is answered YES
enter the telephone number at which the applicant can be
contacted [4-20 characters] during his/her absence from permanent
residence,otherwise nothing may be entered. This field may not
be deleted as long as the need for a temporary address is indicated.
STRING    
Address Change User
  address_change_user
.122 The name of the user who has changed this patient’s primary address. POINTER   New_Person-200
Temporary Address Province
  temporary_address_province
.1221 Enter a Province if the patient has provided one for his/her foreign
address.

The entry can be alphanumeric and up to 20 characters in length.
STRING    
Temporary Address Postal Code
  temporary_address_postal_code
.1222 Enter with patient’s postal code if the patient has provided one for
his/her foreign address.

The entry can be alphanumeric and up to 10 characters in length.
STRING    
Temporary Address Country
  temporary_address_country
.1223 Enter the country where the patient’s temporary address is located.

If entering an Army/Air Force Post Office (APO) or a Fleet Post Office
(FPO) address select United States as the country.
POINTER   Country_Code-779_004
Phone Number [Residence]
  phone_number_residence
.131 Enter the telephone number [4-20 characters] to this applicant’s
place of residence.
STRING INDEXED  
Cellular Number Change Source
  cellular_number_change_source
.1311 This field will hold the source of the last Cellular number
change.
ENUMERATION   HBSC: HBSC
VAMC: VAMC
VOA: VOA
HEC: HEC
Cellular Number Change Site
  cellular_number_change_site
.13111 This field will hold the site that last changed this
patient’s Cellular number. This field is only populated
when the Cellular Number Change Source is listed as VAMC.
POINTER   Institution-4
Pager Number Change Dt/Tm
  pager_number_change_dt_tm
.1312 This field will contain the date and time of the last
Pager number update.
DATE-TIME    
Pager Number Change Source
  pager_number_change_source
.1313 This field will hold the source of the last Pager number
change.
ENUMERATION   HBSC: HBSC
VAMC: VAMC
VOA: VOA
HEC: HEC
Pager Number Change Site
  pager_number_change_site
.1314 This field will hold the site that last changed this
patient’s Pager number. This field is only populated
when the Pager Number Change Source is listed as VAMC.
POINTER   Institution-4
Confidential Phone Number
  confidential_phone_number
.1315 If the ‘Confidential Address Active’ prompt is answered
YES,enter the telephone number of the confidential
address at which the patient is located [4-20 characters].
STRING    
Email Address Indicator
  email_address_indicator
.1316 This field indicates whether or not the Veteran has an Email address. BOOLEAN   true: Y
false: N
Email Address Indicator Dt/Tm
  email_address_indicator_dt_tm
.1317 This field contains the date and time of the last Email Address Indicator response. DATE-TIME    
Phone Number [Work]
  phone_number_work
.132 Enter the office phone number [4-20 characters] where this applicant
can be reached while employed,if employed.
STRING    
Residence Number Change Dt/Tm
  residence_number_change_dt_tm
.1321 This field will contain the date and time of
the last Residence phone number update.
DATE-TIME    
Residence Number Change Source
  residence_number_change_source
.1322 This field will hold the source of the last
Residence phone number change.
ENUMERATION   HBSC: HBSC
VAMC: VAMC
VOA: VOA
HEC: HEC
Residence Number Change Site
  residence_number_change_site
.1323 This field will hold the site that last changed
this patient’s Residence phone number. This
field is only populated when the Residence
Number Change Source is listed as VAMC.
POINTER   Institution-4
Email Address
  email_address
.133   STRING    
Phone Number [Cellular]
  phone_number_cellular
.134 Enter the telephone number [4-20 characters] to the applicant’s
mobile phone.
STRING    
Pager Number
  pager_number
.135 Enter the applicant’s pager number [4-20 characters]. STRING    
Email Address Change Dt/Tm
  email_address_change_dt_tm
.136 This field will contain the date and time of the last
EMAIL address update.
DATE-TIME    
Email Address Change Source
  email_address_change_source
.137 This field will hold the source of the last EMAIL address change. ENUMERATION   HBSC: HBSC
VAMC: VAMC
VOA: VOA
HEC: HEC
Email Address Change Site
  email_address_change_site
.138 This field will hold the site that last changed this
patient’s EMAIL address. This field is only populated
when the EMAIL Address Source is listed as VAMC.
POINTER   Institution-4
Cellular Number Change Dt/Tm
  cellular_number_change_dt_tm
.139 This field will contain the date and time of the last
Cellular number update.
DATE-TIME    
Current Means Test Status
  current_means_test_status
.14 This field is computed by the system. It contains the current
means test status for a patient.
POINTER INDEXED Means_Test_Status-408_32
Confidential Address Category
  confidential_address_category
.141 This is a multiple valued field containing the confidential address
categories for this applicant.
OBJECT   Confidential_Address_Category-2_141
Confidential Address Active?
  confidential_address_active
.14105 Enter ‘Y’ if you wish to enter a confidential address for this applicant
at this time. A ‘NO’ response will cause the Confidential Start Date
and Confidential End Date fields to be automatically deleted while other
confidential address information will remain on file for future use.
BOOLEAN   false: N
true: Y
Confidential Street [Line 1]
  confidential_street_line_1
.1411 If the ‘Confidential Address Active’ prompt is answered YES,the
user will be prompted for the first line of the confidential street
address. This field cannot be deleted as long as the need for a
confidential address is indicated.
STRING    
Confidential Address County
  confidential_address_county
.14111 If the ‘Confidential Address Active’ prompt is answered YES,
enter the county for the applicant’s confidential address.
NUMERIC    
Confidential Addr Change Dt/Tm
  confidential_addr_change_dt_tm
.14112 This field will hold the date and time of the last Confidential Address
Update.

Any change to the following Confidential Address fields will trigger an
update: Confidential Street [Line 1],Confidential Street [Line 2],
Confidential Street [Line 3],Confidential Address City,Confidential
Address State,Confidential Address Zip Code,Confidential Start Date,
Confidential End Date,Confidential Address Active?,Confidential Address
County,Confidential Addr Province,Confidential Addr Postal Code,
Confidential Addr Country and Confidential Phone Number
DATE-TIME    
Confidential Addr Change Site
  confidential_addr_change_site
.14113 This field will hold the Site that last changed this patient’s
confidential address.
POINTER   Institution-4
Confidential Addr Province
  confidential_addr_province
.14114 Enter a Province if the patient has provided one for his/her foreign
address.

The entry can be alphanumeric and up to 20 characters in length.
STRING    
Confidential Addr Postal Code
  confidential_addr_postal_code
.14115 Enter with patient’s postal code if the patient has provided one for
his/her foreign address.

The entry can be alphanumeric and up to 10 characters in length.
STRING    
Confidential Addr Country
  confidential_addr_country
.14116 Enter the country where the patient’s confidential address is located.

If entering an Army/Air Force Post Office (APO) or a Fleet Post Office
(FPO) address select United States as the country.
POINTER   Country_Code-779_004
Confidential Street [Line 2]
  confidential_street_line_2
.1412 If the ‘Confidential Address Active’ prompt is answered YES,
the user will be prompted for the second line of the confidential
street address [2-30 characters]. The second line of the street
address is optional and may be left blank.
STRING    
Confidential Street [Line 3]
  confidential_street_line_3
.1413 If the ‘Confidential Address Active’ prompt is answered YES,
the user will be prompted for the third line of the confidential
street address. The third line of the street address is optional
and may be left blank.
STRING    
Confidential Address City
  confidential_address_city
.1414 If the ‘Confidential Address Active’ prompt is answered YES,enter
the confidential address city for this applicant [2-30 characters].
This field may not be deleted as long as the need for a confidential
address is indicated.
STRING    
Confidential Address State
  confidential_address_state
.1415 If the ‘Confidential Address Active’ prompt is answered YES,
the user will be asked to select the confidential address state
from the available listing. This field may not be deleted as
long as the need for a confidential address is indicated.
POINTER   State-5
Confidential Address Zip Code
  confidential_address_zip_code
.1416 If the ‘Confidential Address Active’ prompt is answered YES,
the user will be asked to enter the zip code assigned to the
city for the confidential address. This field may not be deleted
as long as the need for a confidential address is indicated.
STRING    
Confidential Start Date
  confidential_start_date
.1417 If the ‘Confidential Address Active’ prompt is answered YES,
enter the date to begin contacting the applicant at the
confidential address.
DATE-TIME    
Confidential End Date
  confidential_end_date
.1418 If the ‘Confidential Address Active’ prompt is answered YES,enter
the date the applicant will no longer be contacted at this address.
DATE-TIME    
Ineligible Date
  ineligible_date
.152 If this applicant is ineligible for treatment enter the effective date.
Only users who hold the designated security key may enter/edit this
field. The Ineligible Date cannot be prior to the beneficiary Date of
Birth.
DATE-TIME    
Missing Person Date
  missing_person_date
.153 This field contains the date this patient was initially listed as missing. DATE-TIME    
Missing Or Ineligible
  missing_or_ineligible
.16 This is a word processing field to contain information on the patient’s
ineligibility or information about this missing patient.
STRING    
Ineligible Twx Source
  ineligible_twx_source
.1651 Choose from the available listing the source of the TWX which
informed you that this applicant was ineligible for treatment.
An ineligible date must be specified in order to enter/edit this
field and the user must hold the designated security key. This
field may not be deleted as long as an ineligible date is on file.
ENUMERATION   REGIONAL OFFICE: 2
VAMC: 1
RPC: 3
Ineligible Twx City
  ineligible_twx_city
.1653 Enter the city from which the TWX which informed you this applicant
was ineligible for treatment originated [3-30 characters]. An ineligible
date must be specified in order to enter/edit this field and the user
must hold the designated security key. This field may not be deleted
as long as an ineligible date is on file.
STRING    
Ineligible Twx State
  ineligible_twx_state
.1654 Enter the state from which the TWX which informed you this applicant
was ineligible for treatment originated. An ineligible date must be
specified in order to enter/edit this field and the user must hold
the designated security key. This field may not be deleted as long
as an ineligible date is on file.
POINTER   State-5
Ineligible Varo Decision
  ineligible_varo_decision
.1656 Enter the VARO decision concerning this applicant’s ineligibility
[between 3-75 characters]. An ineligible date must be specified in
order to enter/edit this field and the user must hold the designated
security key. This field may not be deleted as long as an ineligible
date is on file.
STRING    
Missing Person Twx Source
  missing_person_twx_source
.1657 If this patient is missing,enter the source of the TWX that originally
listed the patient as missing.
ENUMERATION   REGIONAL OFFICE: 2
VAMC: 1
RPC: 3
Missing Person Twx City
  missing_person_twx_city
.1658 If this patient is missing,enter the city where the TWX reporting the
patient as missing was originated.
STRING    
Missing Person Twx State
  missing_person_twx_state
.1659 If this patient is missing,enter the state where the TWX reporting the
patient as missing was originated.
POINTER   State-5
Fee Hospital I.D.
  fee_hospital_id
.172 This field is not used by any DHCP packages and has been *‘d for deletion
with the release of MAS v5.2. It will be removed in a future release of
MAS.
ENUMERATION   CANCELLED: C
ISSUED: I
Emergency Response Indicator
  emergency_response_indicator
.181 Enter the appropriate ER Indicator to identify patients from impacted
zip code areas designated by FEMA.
ENUMERATION INDEXED HURRICANE KATRINA: K
K-Work Phone Number
  kwork_phone_number
.21011 If the person designated as next of kin for this patient is employed,
enter the phone number at which the NOK can be reached while at work.
STRING    
Primary Nok Change Date/Time
  primary_nok_change_date_time
.21012 This field will hold the date and time of the last Primary Next of Kin
Update.
DATE-TIME    
K-Name Of Primary Nok
  kname_of_primary_nok
.211 Enter the primary next of kin’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
K2-Work Phone Number
  k2work_phone_number
.211011 If the person designated as secondary next of kin for this patient is
employed,enter the phone number that individual can be reached at while
at work.
STRING    
Secondary Nok Change Date/Time
  secondary_nok_change_date_time
.211012 This field will hold the date and time of the last Secondary Next of Kin
Update.

Any change to the following Secondary Next of Kin fields will trigger an
update: K2-Name Of Secondary NOK,K2-Relationship To Patient,K2-Street
Address [Line 1],K2-Street Address [Line 2],K2-Street Address [Line 3],
K2-City,K2-State,K2-Zip Code,K2-Phone Number,K2-Address Same As
Patient’s? and K2-Work Phone Number
DATE-TIME    
K-Relationship To Patient
  krelationship_to_patient
.212 If a primary next-of-kin is specified enter the relationship of
that person to the applicant [1-30 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a
‘next of kin’ name is on file.
STRING    
K-Address Same As Patient'S?
  kaddress_same_as_patients
.2125 Enter ‘Y’ if the next-of-kin should be contacted at the same address
and phone number as the applicant,otherwise enter ‘N’.
BOOLEAN   false: N
true: Y
K-Street Address [Line 1]
  kstreet_address_line_1
.213 If a primary next-of-kin is specified enter the first line of
that person’s street address [3-30 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a
‘next of kin’ name is on file.
STRING    
K-Street Address [Line 2]
  kstreet_address_line_2
.214 If a primary next-of-kin is specified enter the second line of
that person’s street address [3-30 characters],if necessary,
otherwise nothing may be entered. This field cannot be deleted
as long as a ‘next of kin’ name is on file.
STRING    
K-Street Address [Line 3]
  kstreet_address_line_3
.215 If a primary next-of-kin is specified enter the third line of
that person’s street address [3-30 characters],if necessary,
otherwise nothing may be entered. This field cannot be deleted
as long as a ‘next of kin’ name is on file.
STRING    
K-City
  kcity
.216 If a primary next-of-kin is specified enter the city in which
that person resides [3-30 characters],otherwise nothing may
be entered. This field cannot be deleted as long as a ‘next
of kin’ name is on file.
STRING    
K-State
  kstate
.217 If a primary next-of-kin is specified select from the available
listing the state in which that person resides,otherwise
nothing may be entered. This field cannot be deleted as long
as a ‘next of kin’ name is on file.
POINTER   State-5
K-Zip Code
  kzip_code
.218 If a primary next-of-kin is specified enter the zip code
[5 numerics] in which his/her city lies,otherwise nothing
may be entered. This field cannot be deleted as long as a
‘next of kin’ name is on file.
STRING    
K-Phone Number
  kphone_number
.219 If a primary next-of-kin is specified enter that person’s
telephone number [4-20 characters],otherwise nothing may
be entered. This field cannot be deleted as long as a
‘next of kin’ name is on file.
STRING    
K2-Name Of Secondary Nok
  k2name_of_secondary_nok
.2191 Enter the secondary next of kin’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
K2-Relationship To Patient
  k2relationship_to_patient
.2192 If a secondary next-of-kin is specified enter the relationship of that
person to the applicant [1-30 characters]. This field cannot be
deleted as long as a secondary NOK is on file.
STRING    
K2-Address Same As Patient'S?
  k2address_same_as_patients
.21925 Enter ‘Y’ if the secondary NOK should be contacted at the same
address and phone number as the applicant,otherwise enter ‘N’.
BOOLEAN   false: N
true: Y
K2-Street Address [Line 1]
  k2street_address_line_1
.2193 If a secondary NOK is specified enter the first line of that person’s
street address [3-30 characters],otherwise nothing may be entered.
This field cannot be deleted as long as a secondary NOK is on file.
STRING    
K2-Street Address [Line 2]
  k2street_address_line_2
.2194 If a secondary NOK is specified enter the second line of that person’s
street address [3-30 characters],if necessary,otherwise nothing may
be entered. This field cannot be deleted as long as a secondary NOK
is on file.
STRING    
K2-Street Address [Line 3]
  k2street_address_line_3
.2195 If a secondary NOK is specified enter the third line of that person’s
street address [3-30 characters],if necessary,otherwise nothing may
be entered. This field cannot be deleted as long as a secondary NOK
is on file.
STRING    
K2-City
  k2city
.2196 If a secondary NOK is specified enter the city in which that person
resides [3-30 characters],otherwise nothing may be entered. This
field cannot be deleted as long as a secondary NOK is on file.
STRING    
K2-State
  k2state
.2197 If a secondary NOK is specified select from the available listing
the state in which that person resides,otherwise nothing may be
entered. This field cannot be deleted as long as a secondary NOK
is on file.
POINTER   State-5
K2-Zip Code
  k2zip_code
.2198 If a secondary NOK is specified enter the zip code for the city
in which that person resides [5 numerics],otherwise nothing may
be entered. This field cannot be deleted as long as a secondary
NOK is on file.
STRING    
K2-Phone Number
  k2phone_number
.2199 If a secondary NOK is specified enter the telephone number at which
that person may be reached [3-20 characters],otherwise nothing may
be entered. This field cannot be deleted as long as a secondary
NOK is on file.
STRING    
E-Zip+4
  ezip4
.2201 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789).
This is related to the Emergency Contact Address.
STRING    
D-Zip+4
  dzip4
.2202 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789). This is related to the designee
for personal effects’ address.
STRING    
K2-Zip+4
  k2zip4
.2203 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789). This is related to the secondary
next-of-kin’s address.
STRING    
E2-Zip+4
  e2zip4
.2204 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789). This is related to the secondary
emergency contact’s address.
STRING    
Employer Zip+4
  employer_zip4
.2205 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789). This is related to the patient
employer’s address.
STRING    
Spouse'S Emp Zip+4
  spouses_emp_zip4
.2206 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789). This is related to the spouse’s
employer’s address.
STRING    
K-Zip+4
  kzip4
.2207 Answer with either the 5 digit format (e.g. 12345) or the nine digit
format (e.g. 12345-6789 or 123456789). This is related to the primary
emergency contact’s address.
STRING    
Father'S Name
  fathers_name
.2401 Enter the father’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
Mother'S Name
  mothers_name
.2402 Enter the mother’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
Mother'S Maiden Name
  mothers_maiden_name
.2403 Enter the mother’s maiden name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
Entry of the LAST name only is permitted and the comma may be omitted.
If the response contains no comma,one will be appended to the value.
Including the comma,the value must be at least 3 characters in length.
STRING    
Spouse'S Employer Name
  spouses_employer_name
.251 For this married applicant (marital status must be married) enter
the name of his/her spouse’s employer [3-20 characters].
STRING    
Spouse'S Occupation
  spouses_occupation
.2514 If this patient’s spouse is currently employed,enter the spouse’s
occupation here. Otherwise,leave this field blank.
STRING    
Spouse'S Employment Status
  spouses_employment_status
.2515 Choose from the available list the choice that most correctly indicates
the current employment status for this patient’s spouse.
ENUMERATION   EMPLOYED PART TIME: 2
SELF EMPLYED: 4
RETIRED: 5
UNKNOWN: 9
NOT EMPLOYED: 3
EMPLOYED FULL TIME: 1
ACTIVE MILITARY DUTY: 6
Spouse'S Retirement Date
  spouses_retirement_date
.2516 For this veteran applicant’s spouse,enter the date s/he retired from
her/his place of employment.
DATE-TIME    
Spouse'S Emp Street [Line 1]
  spouses_emp_street_line_1
.252 If applicant is married and a spouse’s employer name has been entered
enter the first line of the spouse’s employer’s street address [3-35
characters,otherwise nothing may be entered. This field may not be
deleted as long as a spouse’s employer’s name is on file.
STRING    
Spouse'S Emp Street [Line 2]
  spouses_emp_street_line_2
.253 If applicant is married and a spouse’s employer name has been entered
enter the second line of the spouse’s employer’s street address [3-35
characters,if necessary,otherwise nothing may be entered. This
field may not be deleted as long as a spouse’s employer’s name is on
file.
STRING    
Spouse'S Emp Street [Line 3]
  spouses_emp_street_line_3
.254 If applicant is married and a spouse’s employer name has been entered
enter the third line of the spouse’s employer’s street address [3-35
characters,if necessary,otherwise nothing may be entered. This
field may not be deleted as long as a spouse’s employer’s name is on
file.
STRING    
Spouse'S Employer'S City
  spouses_employers_city
.255 If applicant is married and a spouse’s employer name has been entered
enter the spouse’s employer city [2-20 characters],otherwise nothing
may be entered. This field may not be deleted as long as a spouse’s
employer’s name is on file.
STRING    
Spouse'S Employer'S State
  spouses_employers_state
.256 If applicant is married and a spouse’s employer name has been entered
select from the available listing the spouse’s employer’s state. This
field may not be deleted as long as a spouse’s employer’s name is on
file.
POINTER   State-5
Spouse'S Emp Zip Code
  spouses_emp_zip_code
.257 If applicant is married and spouse’s employer name has been entered
enter the spouse’s employer zip code [5 numerics],otherwise nothing
may be entered. This field may not be deleted as long as a spouse’s
employer’s name is on file.
STRING    
Spouse'S Emp Phone Number
  spouses_emp_phone_number
.258 If applicant is married and spouse’s employer name has been entered
enter the spouse’s employer telephone number [4-20 characters],
otherwise nothing may be entered. This field may not be deleted as
long as a spouse’s employer’s name is on file.
STRING    
Zip+4 (Civil)
  zip4_civil
.290012 Enter the zip code of the address where the person responsible for
handling this patient’s funds resides. Answer with either the 5 digit
format (e.g. 12345) or the nine digit format (e.g. 12345-6789 or
123456789).
STRING    
Zip+4 (Va)
  zip4_va
.29013 If this patient has a VA guardian responsible for handling the patient’s
funds,enter the guardian’s zip code here. Answer with either the 5
digit format (e.g. 12345) or the nine digit format (e.g. 12345-6789 or
123456789).
STRING    
Date Ruled Incompetent (Va)
  date_ruled_incompetent_va
.291 Enter the date this patient was ruled to be incompetent to handle his
VA funds. The Date Ruled Incompetent cannot be after the Date of Death.
DATE-TIME    
Institution (Va)
  institution_va
.2911 Enter the VA facility or institution responsible for this patient’s VA
funds.
POINTER   Institution-4
Guardian (Va)
  guardian_va
.2912 Enter the name of the VA representative responsible for this patient’s
funds.
STRING    
Relationship (Va)
  relationship_va
.2913 Enter the relationship to the patient of the VA representative responsible
for handling this patient’s funds.
STRING    
Street Address 1 (Va)
  street_address_1_va
.2914 Enter the first line of the street address of the VA representative
responsible for handling this patient’s funds.
STRING    
Street Address 2 (Va)
  street_address_2_va
.2915 Enter the second line of the street address of the VA representative
responsible for handling this patient’s funds.
STRING    
City (Va)
  city_va
.2916 Enter the city in which the person reponsible for handling this patient’s
funds resides.
STRING    
State (Va)
  state_va
.2917 Enter the state in which the person responsible for handling this patient’s
funds resides.
POINTER   State-5
Zip (Va)
  zip_va
.2918 If this patient has a VA guardian responsible for handling the patient’s
funds,enter the guardian’s zip code here.
STRING    
Phone (Va)
  phone_va
.2919 If this patient has a VA guardian responsible for handling the patient’s
funds,enter the guardian’s phone number here.
STRING    
Date Ruled Incompetent (Civil)
  date_ruled_incompetent_civil
.292 If this patient was ruled incompetent to handle his funds,enter the
date he was ruled incompetent. The Date Ruled Incompetent cannot be
after the Date of Death.
DATE-TIME    
Institution (Civil)
  institution_civil
.2921 If this patient has been ruled incompetant to handle his financial matters,
enter the instituition reponsible for handling the funds on the patient’s
behalf.
STRING    
Guardian (Civil)
  guardian_civil
.2922 If this patient has been ruled incompetant to handle his financial matters,
enter the name of the individual responsible for handling the funds on the
patient’s behalf.
STRING    
Relationship (Civil)
  relationship_civil
.2923 If this patient has been ruled incompetant to handle his financial funds,
and someone else is responsible for handling the funds,enter the
relationship of that person to the patient.
STRING    
Street Address 1 (Civil)
  street_address_1_civil
.2924 Enter the first line of the street address of the person responsible for
handling this patient’s funds.
STRING    
Street Address 2 (Civil)
  street_address_2_civil
.2925 Enter the second line of the street address of the person responsible for
handling this patient’s funds.
STRING    
City (Civil)
  city_civil
.2926 Enter the city in which the person responsible for this patient’s funds
resides.
STRING    
State (Civil)
  state_civil
.2927 Enter the state in which the person responsible for handling this patient’s
funds resides.
POINTER   State-5
Zip (Civil)
  zip_civil
.2928 Enter the zip code of the address where the person responsible for
handling this patient’s funds resides.
STRING    
Phone (Civil)
  phone_civil
.2929 If this patient has been ruled incompetant to handle his money and another
person has been assigned to handle the patient’s financial matters,enter
that person’s phone number here.
STRING    
Rated Incompetent?
  rated_incompetent
.293 This field was originated for the use of AMIE (Automated Medical
Information Exchange). One will receive from DVB the information
on whether the patient was rated incompetent by the VA. This may
differ from the date rated incompetent field in the patient file.
BOOLEAN   false: 0
true: 1
Service Connected?
  service_connected
.301 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.
BOOLEAN   false: N
true: Y
Sc Award Date
  sc_award_date
.3012 This field contains the effective date of service connection,based on
the VBA decision. This can be obtained either through HINQ or the
award letter.
DATE-TIME    
P&T Effective Date
  pt_effective_date
.3013 Enter the Effective Date the patient was awarded P&T disability status
by VARO.
This field is optional (not required). But if entered,the date needs
to be a precise date,i.e. a day,month and year MUST be included.
P&T Effective Date can not be a date prior to the Veteran’s ‘Date of
Birth’,a future date,or a date after the Veteran’s ‘Date of Death’.
DATE-TIME    
Eff. Date Combined Sc% Eval.
  eff_date_combined_sc_eval
.3014 Data will be filed automatically from HL7 message from the HEC. This is
the date that the combined Service Connected Disability % was awarded.
DATE-TIME    
Service Connected Percentage
  service_connected_percentage
.302 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.
NUMERIC    
Receiving Va Disability?
  receiving_va_disability
.3025 For this veteran applicant enter ‘Y’ if s/he is in receipt of a disability
payment,’N’ if not,or ‘U’ if unknown. Once monetary benefits have been
verified only users who hold the designated security key may enter/edit
this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Va Disability
  amount_of_va_disability
.303 For this veteran applicant who is in receipt of disability payment
(RECEIPT OF DISABILITY PAYMENT prompt must be answered YES) enter
the amount received [a number between 0-99999]. Once monetary
benefits are verified only users who hold the designated security
key may enter/edit this field. Any dollar amomount on file cannot
be deleted as long as receipt of disability payment is indicated.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
P&T
  pt
.304 This field will contain YES if the patient is determined to be
permanently and totally disabled by VARO due to a service connected
condition.

Answering “YES” will prompt you to enter a P&T Effective Date.
BOOLEAN   false: N
true: Y
Unemployable
  unemployable
.305 Is this patient rated unemployable by the VARO due to a service connected
condition?
BOOLEAN   false: N
true: Y
Monetary Ben. Verify Date
  monetary_ben_verify_date
.306 Once monetary benefits,and amounts,are verified enter the date of
verification. All monetary benefits data fields will become uneditable
to any user who does not hold the designated security key once the
benefits are verified. Only users who hold the designated security
key may enter/edit this field.
DATE-TIME    
Ineligible Reason
  ineligible_reason
.307 If this applicant is ineligible for treatment enter the reason
[not to exceed 40 characters]. An ineligible date must be specified
in order to enter/edit this field and the user must hold the
designated security key. This field may not be deleted as long as
an ineligible date is on file.
STRING    
Agency/Allied Country
  agency_allied_country
.309 For this applicant whose eligibility code is either ‘OTHER FEDERAL
AGENCY’ or ‘ALLIED VETERAN’ select from the available listing
the federal agency or allied country,as appropriate,which best
classifies this applicant.
POINTER   Other_Federal_Agency-35
*Category Of Beneficiary
  category_of_beneficiary
.31 This field is no longer used by the MAS package. It was previously
updated via a cross-reference on the CATEGORY OF BENEFICIARY field in
the PTF file. In a prior release of MAS,the use of category of
beneficiary was discontinued and period of service is now solely used.
In a future release of MAS,this field will be removed along with
the ACB cross-reference on the PATIENT file and the cross-reference in
the PTF file which sets this data.
POINTER INDEXED Category_Of_Beneficiary-45_82
Employer Name
  employer_name
.3111 If employment status is indicated and is not unemployed enter the
employer name [1-30 characters],otherwise nothing may be entered.
STRING    
Employment Status
  employment_status
.31115 Enter the patient’s current employment status. Choose from the available
choices.
ENUMERATION   EMPLOYED PART TIME: 2
SELF EMPLOYED: 4
RETIRED: 5
UNKNOWN: 9
NOT EMPLOYED: 3
EMPLOYED FULL TIME: 1
ACTIVE MILITARY DUTY: 6
Date Of Retirement
  date_of_retirement
.31116 For this veteran applicant,enter the date s/he retired from
her/his place of employment.
DATE-TIME    
Government Agency
  government_agency
.3112 If this patient is currently employed by a government agency,respond yes
to this question. If the patient is employed by the private sector or
currently is unemployed,respond no.
BOOLEAN   false: N
true: Y
Employer Street [Line 1]
  employer_street_line_1
.3113 If employment status is indicated,applicant is not unemployed and
an employer name is entered enter the first line of the employer
street address [1-30 characters],otherwise nothing may be entered.
This field cannot be deleted as long as an employer name is on file.
STRING    
Employer Street [Line 2]
  employer_street_line_2
.3114 If employment status is indicated,applicant is not unemployed and
an employer name is entered enter the second line of the employer
street address [1-30 characters],if necessary,otherwise nothing
may be entered. This field cannot be deleted as long as an employer
name is on file.
STRING    
Employer Street [Line 3]
  employer_street_line_3
.3115 If employment status is indicated,applicant is not unemployed and
an employer name is entered enter the third line of the employer
street address [1-30 characters],if necessary,otherwise nothing
may be entered. This field cannot be deleted as long as an employer
name is on file.
STRING    
Employer City
  employer_city
.3116 If employment status is indicated,applicant is not unemployed and
an employer name is entered enter the employer city [1-30 characters],
otherwise nothing may be entered. This field cannot be deleted as
long as an employer name is on file.
STRING    
Employer State
  employer_state
.3117 If employment status is indicated,applicant is not unemployed and
an employer name is entered select from the available listing the
employer state,otherwise nothing may be entered. This field
cannot be deleted as long as an employer name is on file.
POINTER   State-5
Employer Zip Code
  employer_zip_code
.3118 If employment status is indicated,applicant is not unemployed and
an employer name is entered enter the employer zip code [5 numerics],
otherwise nothing may be entered. This field cannot be deleted as
long as an employer name is on file.
STRING    
Employer Phone Number
  employer_phone_number
.3119 If employment status is indicated,applicant is not unemployed and
an employer name is entered enter the employer telephone number
[3-20 characters],otherwise nothing may be entered. This field
cannot be deleted as long as an employer name is on file.
STRING    
*Claim Folder Location
  claim_folder_location
.312 For this veteran applicant enter,if applicable,the location of
his/her VA claim folder [2-40 characters].
STRING    
Insurance Type
  insurance_type
.3121 From the available listing enter the type of insurance under which this
applicant is covered regardless of who holds the policy.
OBJECT   Insurance_Type-2_312
Claim Number
  claim_number
.313 If the applicant is a veteran enter his/her claim number as 7-8 numerics
or by entering the characters ‘SS’ if his/her claim number is the same
as his/her social security number. Once eligibility has been verified
only users who hold the designated security key may enter/edit this field.
STRING    
Claim Folder Location
  claim_folder_location-2-_314
.314 This is the location of the patient’s claim folder. It must be an entry
in the INSTITUTION File.
Valid facility types:
RO (Regional Office)
RO&IC (Regional Office and Insurance Center)
RO-OC (Regional Office - Outpatient Clinic)
RPC (Record Processing Center)
M&ROC (Medical and Regional Office Center)
M&ROC (M&RO) (Medical and Regional Office Center)
POINTER   Institution-4
Covered By Health Insurance?
  covered_by_health_insurance
.3192 Enter ‘Y’ if this applicant is covered by a health insurance policy
regardless of who holds policy (applicant,spouse,employer,etc.),
‘N’ if s/he isn’t covered by any policy,or ‘U’ if unknown.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Vietnam Service Indicated?
  vietnam_service_indicated
.32101 For this veteran applicant enter ‘Y’ if s/he actually served in the
Republic of Vietnam,’N’ if not,or ‘U’ if unknown. Once the service
record has been verified only users who hold the designated security
key may enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Agent Orange Expos. Indicated?
  agent_orange_expos_indicated
.32102 For this veteran applicant enter ‘Y’ if s/he was exposed to the chemical
agent orange,’N’ if not,or ‘U’ if unknown. Exposure cannot be claimed
unless the Period of Service (field .323) is answered VIETNAM ERA,which
entails those serving in the Korean DMZ between January 1,1968 and
December 31,1969 or Vietnam.

Once the service record has been verified only users who hold the
designated security key may enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Radiation Exposure Indicated?
  radiation_exposure_indicated
.32103 Enter ‘Y’ if the veteran was exposed to ionizing radiation 1) at a
nuclear device testing site (e.g. the Pacific Islands,NM or NV) or
2) as a POW or while serving in Hiroshima and/or Nagasaki,Japan
from August 6,1945 through July 1,1946,or 3) served at
Department of Energy plants at Paducah,KY,Portsmouth,OH or
the K25 area at Oak Ridge,TN for at least 250 days before
February 1,1992 or 4) served at Longshot,Milrow,or
Cannikin underground nuclear tests at Amchitka Island,AK
prior to January 1,1974.

Veterans exposed by method #3 or #4 are not eligible for
copay exemption or enrollment in priority 6 based on their IR exposure.

Enter ‘N’ if not exposed or ‘U’ if unknown.

Once the record has been verified only HEC users
may enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Vietnam From Date
  vietnam_from_date
.32104 For this veteran applicant who served in the Republic of Vietnam (DID
YOU SERVE IN VIETNAM prompt must be answered YES) enter the date on which
service in vietnam commenced [between February 28,1961 and May 7,1975].
Once the service record is verified only users who hold the designated
security key may enter/edit this field. As long as Vietnam service is
indicated this date may not be deleted.
DATE-TIME    
Vietnam To Date
  vietnam_to_date
.32105 For this veteran applicant who served in the Republic of Vietnam (DID
YOU SERVE IN VIETNAM prompt must be answered YES) enter the date on which
service in Vietnam ended [between February 28,1961 and May 7,1975]. Once
the service record is verified only user who hold the designated security
key may enter/edit this field. As long as Vietnam service is indicated
this date may not be deleted.
DATE-TIME    
Agent Orange Registration Date
  agent_orange_registration_date
.32107 For this veteran applicant who was exposed to agent orange (EXPOSED TO
AGENT ORANGE prompt must be answered YES) enter the date registered.
Once the service record is verified only users who hold the designated
security key may enter/edit this field. As long as agent orange
exposure is indicated this field may not be deleted.
DATE-TIME    
Agent Orange Reported To C.O.
  agent_orange_reported_to_co
.32108 Enter the date on which this patient’s claim of exposure to Agent Orange was
initially reported to VA Central Office.
DATE-TIME    
Agent Orange Exam Date
  agent_orange_exam_date
.32109 For this veteran applicant who was exposed to agent orange (EXPOSED TO
AGENT ORANGE prompt must be answered YES) enter the date s/he was examined
for this exposure,if any. Once the service record is verified only
users who hold the designated security key may enter/edit this
field. As long as agent orange exposure is indicated this field
may not be deleted.
DATE-TIME    
Agent Orange Registration #
  agent_orange_registration_number
.3211 For this veteran applicant who was exposed to agent orange (EXPOSED TO
AGENT ORANGE prompt must be answered YES) enter the registration number
assigned [a number between 1-999999]. Once the service record has been
verified only users who hold the designated security key may
enter/edit this field. This field cannot be deleted as long as
agent orange exposure is indicated.
NUMERIC    
Radiation Registration Date
  radiation_registration_date
.32111 For this veteran applicant who was exposed to ionizing radiation
(WERE YOU EXPOSED TO RADIATION prompt must be answered YES) enter the
date registered. Once the service record is verified only users who
hold the designated security key may enter/edit this field. This field
cannot be deleted as long as ionizing radiation exposure is
indicated.
DATE-TIME    
Proj 112/Shad
  proj_112_shad
.32115   BOOLEAN   false: 0
true: 1
Radiation Exposure Method
  radiation_exposure_method
.3212 This field represents the method by which the
exposure to ionizing radiation occurred.
ENUMERATION   H/N AND ATMOSPHERIC TESTING: 4
OTHER: 7
HIROSHIMA/NAGASAKI: 2
EXPOSURE AT NUCLEAR FACILITY: 6
UNDERGROUND NUCLEAR TESTING: 5
ATMOSPHERIC NUCLEAR TESTING: 3
Agent Orange Exposure Location
  agent_orange_exposure_location
.3213 For this veteran applicant who was exposed to agent orange (EXPOSED TO
AGENT ORANGE prompt must be answered YES) enter the location where the
exposure occurred. Once the service record has been verified only users
who hold the designated security key may enter/edit this field. This
field cannot be deleted as long as agent orange exposure is indicated.
ENUMERATION   VIETNAM: V
OTHER: O
KOREAN DMZ: K
Filipino Veteran Proof
  filipino_veteran_proof
.3214 Enter in this field the documentation that was provided in order to
establish US citizenship,lawful permanent US residency,and/or VA
Compensation at full-dollar rate for a Filipino Veteran (i.e.,a
veteran whose Branch of Service is F. Commonwealth,F. Guerilla,or F.
Scouts New)
ENUMERATION   NO PROOF: NO
REPORT OF BIRTH ABROAD OF US CITIZEN: BA
US BIRTH CERTIFICATE: BC
VERIFICATION OF PERMANENT RESIDENCY: PR
VA COMPENSATION AT FULL DOLLAR RATE: VA
US PASSPORT: PP
VERIFICATION OF NATURALIZATION: NA
Service [Oef Or Oif]
  service_oef_or_oif
.3215 This contains the information relating to the deployment of the
patient to a conflict location for the operations Iraqi and Enduring
Freedom (OIF,OEF respectively). It also includes records of conflict
that can be identified as being EITHER OIF OR OEF,but the specific
location cannot be determined.
OBJECT   Service_Oef_Or_Oif-2_3215
Military Service Episode
  military_service_episode
.3216 This contains the definitive military service episode history for the
patient and is updated from the Health Eligibility Center (HEC) system.
HEC is the authoritative source for this data and it may not be edited in
VistA except to add new episodes.
OBJECT   Military_Service_Episode-2_3216
Service Verification Date
  service_verification_date
.322 Once the service record has been verified enter the date of verification.
All service record data will become uneditable to any user who does not
hold the designated security key once the service record is verified.
Only users who hold the designated security key may enter/edit this field.
DATE-TIME    
Persian Gulf Service?
  persian_gulf_service
.32201 If this patient served in the Persian Gulf during the war (anytime after
August 2,1990),enter yes here. If the patient did not serve in the
Persian Gulf during this timeframe,enter no. Enter unknown if this
information could not be obtained from the patient.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Persian Gulf From Date
  persian_gulf_from_date
.322011 If this patient served in the Persian Gulf during the war (PERSIAN
GULF SERVICE? is answered YES),respond with the date the patient
began serving there. The date must be on or after August 2,1990.
DATE-TIME    
Persian Gulf To Date
  persian_gulf_to_date
.322012 If this patient served in the Persian Gulf during the war,enter the date
the patient’s service in that region ended. The date must be after the
date selected as PERSIAN GULF FROM DATE which must be on or after August
2,1990.
DATE-TIME    
Southwest Asia Conditions?
  southwest_asia_conditions
.322013 Enter “Y” if veteran claims need for care of conditions related to
service in SW Asia. Enter “N” if veteran did not serve in SW Asia or
does not claim need for care of conditions related to service in SW
Asia. Enter “U” when veteran served in SW Asia,but is unsure of
whether conditions may be related to that service. SW Asia Theater
of operations is defined as: Iraq,Kuwait,Saudi Arabia,the neutral
zone between Iraq and Saudi Arabia,Bahrain,Qatar,the United Arab
Emirates,Oman,the Gulf of Aden,the Gulf of Oman,the Persian Gulf,
the Arabian Sea,the Red Sea,and the airspace above these locations.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Sw Asia Cond Registration Date
  sw_asia_cond_registration_date
.322014 This is the date on which the patient registered for being exposed to
Conditions related to service in SW Asia. This date must be after
8/1/1990.
DATE-TIME    
Sw Asia Cond Exam Date
  sw_asia_cond_exam_date
.322015 This is the date on which an examination for exposure to Conditions
related to service in SW Asia was performed on the patient.
DATE-TIME    
Somalia Service Indicated?
  somalia_service_indicated
.322016 If this patient served in the Somalia,enter yes here. If the patient
did not serve in Somalia,enter no. Enter unknown if this information
could not be obtained from the patient.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Somalia From Date
  somalia_from_date
.322017 If this patient served in Somalia (SOMALIA SERVICE INDICATED? is
answered YES),enter the date this patient’s service in Somalia
began. This date must be on or after September 28,1992.
DATE-TIME    
Somalia To Date
  somalia_to_date
.322018 This is the last date of service in Somalia. This date must be on or
after September 28,1992.
DATE-TIME    
Yugoslavia Service Indicated?
  yugoslavia_service_indicated
.322019 Field stores code indicating if patient served in the Yugolslavia Conflict. ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Yugoslavia From Date
  yugoslavia_from_date
.32202 Enter the date that service in the Yugoslavia Conflict began for this
patient. Earliest possible date is 6/22/1992.
DATE-TIME    
Yugoslavia To Date
  yugoslavia_to_date
.322021 The date service in the Yugoslavia Conflict ended for this patient. DATE-TIME    
Lebanon Service Indicated?
  lebanon_service_indicated
.3221 Did this patient serve in Lebanon between the dates of August 23,1982
and February 26,1984?
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Lebanon From Date
  lebanon_from_date
.3222 For this veteran applicant who served in Lebanon,enter the date which
the applicant’s service in Lebanon began. The date must be on or after
October 1,1983.
.
DATE-TIME    
Lebanon To Date
  lebanon_to_date
.3223 For this patient,enter the date the patient’s service in Lebanon ended.
The ‘LEBANON SERVICE INDICATED?’ field must be answered yes and the date
in this field must be after October 1,1983.
DATE-TIME    
Grenada Service Indicated?
  grenada_service_indicated
.3224 Enter yes if this patient served in Grenada between the dates of October
23,1983 and November 21,1983.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Grenada From Date
  grenada_from_date
.3225 Enter the date which this patient began service in Grenada. The
‘GRENADA SERVICE INDICATED?’ field must be answered YES and the date
entered here must be between October 23,1983 and November 21,1983.
DATE-TIME    
Grenada To Date
  grenada_to_date
.3226 Enter the date which this patient’s service in Grenada ended. The
‘GRENADA SERVICE INDICATED?’ field must be yes and this date must be
between October 23,1983 and November 21,1983.
DATE-TIME    
Panama Service Indicated?
  panama_service_indicated
.3227 Respond yes if this patient served in Panama between the dates of
December 20,1989 and January 31,1990. Enter no if the patient did not
serve in Panama during this timeframe. Otherwise,enter unknown if this
information could not be obtained from the patient.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Panama From Date
  panama_from_date
.3228 If this patient served in Panama (PANAMA SERVICE INDICATED? is answered
YES),enter the date this patient’s service in Panama began. The date
must be between December 20,1989 and January 31,1990.
DATE-TIME    
Panama To Date
  panama_to_date
.3229 If this patient served during the conflict in Panama (PANAMA SERVICE
INDICATED? is YES),enter the date the patient’s service there ended.
The date must be between December 20,1989 and January 31,1990.
DATE-TIME    
Period Of Service
  period_of_service
.323 From the available listing select the period of service which best
classifies this applicant. The selections displayed are limited
based on the eligibility code which must have been entered in order
to select a period of service. Once the service record is verified
only those users who hold the designated security key may enter/edit
this field.
POINTER INDEXED Period_Of_Service-21
Service Discharge Type [Last]
  service_discharge_type_last
.324 For this veteran applicant select from the available listing
the discharge type which s/he received for his/her most recent
episode of military service. Once the service record is verified
only those users who hold the designated security key may enter/edit
this field.
POINTER   Type_Of_Discharge-25
Service Branch [Last]
  service_branch_last
.325 For this veteran applicant select from the available listing
the branch of service served in during his/her most recent
episode of military service. Once the service record is verified
only those users who hold the designated security key may
enter/edit this field.
POINTER   Branch_Of_Service-23
Service Entry Date [Last]
  service_entry_date_last
.326 For this veteran applicant enter the date s/he commenced his/her
most recent episode of military service. If the military service
component is ACTIVATED NATIONAL GUARD or ACTIVATED RESERVE,the
period entered should be the period of activation,so this date is
their first day of active duty for the episode. Once the service
record is verified only those users who hold the designated
security key may enter/edit this field.
DATE-TIME    
Service Separation Date [Last]
  service_separation_date_last
.327 For this veteran applicant enter the date s/he ended his/her
most recent episode of military service. If the military
service component is ACTIVATED NATIONAL GUARD or ACTIVATED
RESERVE,the period entered should be the period of activation,
so this date is their last day of active duty for this episode.
Once the service record is verified only those users who hold
the designated security key may enter/edit this field.
DATE-TIME    
Service Number [Last]
  service_number_last
.328 For this veteran applicant enter the service number assigned during
his/her most recent episode of military service as either 1-15
characters or enter ‘SS’ if the social security number and service
number are the same. Once the service record has been verified only
those users who hold the designated security key may enter/edit this
field.
STRING    
Service Second Episode?
  service_second_episode
.3285 For this veteran applicant enter ‘Y’ if s/he has more than one episode of
military service,or ‘N’ if not. Once the service record is verified
only users who hold the designated security key may enter/edit this field.
BOOLEAN   false: N
true: Y
Service Discharge Type [Ntl]
  service_discharge_type_ntl
.329 For this veteran applicant who has at least two episodes of military
service (ANY OTHER PERIODS OF SERVICE prompt must be answered YES)
select from the available listing the type of discharge received from
his/her next to last episode of military service. Once the service
record is verified only those users who hold the designated security
key may enter/edit this field. This field cannot be deleted as long
as more than one episode of military service is indicated.
POINTER   Type_Of_Discharge-25
Service Branch [Ntl]
  service_branch_ntl
.3291 For this veteran applicant who has at least two episodes of military
service (ANY OTHER PERIODS OF SERVICE prompt must be answered YES)
select from the available listing the branch of service s/he served
in during his/her next to last episode of military service. Once the
service record is verified only those users who hold the designated
security key may enter/edit this field. This field cannot be deleted
as long as more than one episode of military service is indicated.
POINTER   Branch_Of_Service-23
Service Component [Last]
  service_component_last
.32911 For this veteran applicant enter the military service component for
his/her most recent episode of military service. Once the service
record has been verified only those users who hold the designated
security key may enter/edit this field.
NATIONAL GUARD IS ONLY VALID FOR BRANCH OF SERVICE ARMY AND AIR FORCE.
ENUMERATION   ACTIVATED RESERVE: V
ACTIVATED NG: G
REGULAR: R
Service Component [Ntl]
  service_component_ntl
.32912 For this veteran applicant who has at least two episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) enter
the military service component for the next to last episode of
service. Once the service record is verified only those users who
hold the designated security key may enter/edit this field. This field
cannot be deleted as long as more than two episodes of military service
are indicated.
NATIONAL GUARD IS ONLY VALID FOR BRANCH OF SERVICE ARMY AND AIR FORCE.
ENUMERATION   ACTIVATED RESERVE: V
ACTIVATED NG: G
REGULAR: R
Service Component [Nntl]
  service_component_nntl
.32913 For this veteran applicant who has at least three episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) enter
the military service component for the third most recent episode of
service. Once the service record is verified only those users who hold
the designated security key may enter/edit this field. This field cannot
be deleted as long as more than two episodes of military service are
indicated.
NATIONAL GUARD IS ONLY VALID FOR BRANCH OF SERVICE ARMY AND AIR FORCE.
ENUMERATION   ACTIVATED RESERVE: V
ACTIVATED NG: G
REGULAR: R
Service Entry Date [Ntl]
  service_entry_date_ntl
.3292 For this veteran applicant who has at least two episodes of military
service (ANY OTHER PERIODS OF SERVICE prompt must be answered YES)
enter the date on which the next to last episode of service commenced.
If the military service component is ACTIVATED NATIONAL GUARD or
ACTIVATED RESERVE,the period entered should be the period of
activation,so this date is their first day of active duty for the
episode. Once the service record is verified only those users
who hold the designated security key may enter/edit this field.
This field cannot be deleted as long as more than one episode of
military service is indicated.
DATE-TIME    
Service Separation Date [Ntl]
  service_separation_date_ntl
.3293 For this veteran applicant who has at least two episodes of military
service (ANY OTHER PERIODS OF SERVICE prompt must be answered YES)
enter the date on which the next to last episode of service ended.
If the military service component is ACTIVATED NATIONAL GUARD or
ACTIVATED RESERVE,the period entered should be the period of
activation,so this date is their last day of active duty for
this episode. Once the service record is verified only those users
who hold the designated security key may enter/edit this field. This
field cannot be deleted as long as more than one episode of military
service is indicated.
DATE-TIME    
Service Number [Ntl]
  service_number_ntl
.3294 For this veteran applicant who has at least two episodes of military
service (ANY OTHER PERIODS OF SERVICE prompt must be answered YES)
enter the service number assigned to that next to last episode of
service [1-15 characters]. Once the service record is verified only
those users who hold the designated security key may enter/edit this
field. This field cannot be deleted as long as more than one episode
of military service is indicated.
STRING    
Service Third Episode?
  service_third_episode
.32945 Enter ‘Y’ if this veteran applicant has at least three episodes of
military service,or ‘N’ if not. The ANY OTHER PERIODS OF SERVICE
prompt must be answered YES in order to enter a third episode of
military service. Once the service record is verified only those
users who hold the designated security key may enter/edit this field.
BOOLEAN   false: N
true: Y
Service Discharge Type [Nntl]
  service_discharge_type_nntl
.3295 For this veteran applicant who has at least three episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) select
from the available listing the discharge type received from the third most
recent episode of military service. Once the service record is verified
only those users who hold the designated security key may enter/edit
this field. This field cannot be deleted as long as more than two
episodes of military service are indicated.
POINTER   Type_Of_Discharge-25
Service Branch [Nntl]
  service_branch_nntl
.3296 For this veteran applicant who has at least three episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) select
from the available listing the service branch served in during his/her
third most recent episode of service. Once the service record is
verified only those users who hold the designated security key may
enter/edit this field. This field cannot be deleted as long as more
than two episodes of military service are indicated.
POINTER   Branch_Of_Service-23
Service Entry Date [Nntl]
  service_entry_date_nntl
.3297 For this veteran applicant who has at least three episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) enter
the date on which the third most recent episode of service commenced.
If the military service component is ACTIVATED NATIONAL GUARD or
ACTIVATED RESERVE,the period entered should be the period of
activation,so this date is their first day of active duty for the
episode. Once the service record is verified only those users who
hold the designated security key may enter/edit this field. This
field cannot be deleted as long as more than two episodes of military
service are indicated.
DATE-TIME    
Service Separation Date [Nntl]
  service_separation_date_nntl
.3298 For this veteran applicant who has at least three episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) enter
the date on which the third most recent episode of service ended. If
the military service component is ACTIVATED NATIONAL GUARD or ACTIVATED
RESERVE,the period entered should be the period of activation,so this
date is their last day of active duty for this episode. Once the
service record is verified only those users who hold the designated
security key may enter/edit this field. This field cannot be deleted
as long as more than two episodes of military service are indicated.
DATE-TIME    
Service Number [Nntl]
  service_number_nntl
.3299 For this veteran applicant who has at least three episodes of military
service (ANOTHER PERIOD OF SERVICE prompt must be answered YES) enter
the service number assigned for the third most recent episode of service
[1-15 characters]. Once the service record is verified only those users
who hold the designated security key may enter/edit this field. This
field cannot be deleted as long as more than two episodes of military
service are indicated.
STRING    
E-Work Phone Number
  ework_phone_number
.33011 If the emergency contact for this patient is employed,enter the phone
number at which this individual may be reached while at work.
STRING    
E-Contact Change Date/Time
  econtact_change_date_time
.33012 This field will hold the date and time of the last Emergency Contact
Update.

Any change to the following Emergency Contact fields will trigger an
update: E-Name,E-Relationship To Patient,E-Street Address [Line 1],
E-Street Address [Line 2],E-Street Address [Line 3],E-City,E-State,
E-Zip Code,E-Phone Number,E-Emer. Contact Same As NOK? and E-Work Phone
Number
DATE-TIME    
E-Emer. Contact Same As Nok?
  eemer_contact_same_as_nok
.3305 If a primary NOK is defined enter ‘Y’ if that person is also the primary
emergency contact,otherwise enter ‘N’ for no.
BOOLEAN   false: N
true: Y
E-Name
  ename
.331 Enter the primary emergency contact’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
E2-Work Phone Number
  e2work_phone_number
.331011 If the person designated as the secondary emergency contact is employed,
enter the person’s work phone number.
STRING    
E2-Name Of Secondary Contact
  e2name_of_secondary_contact
.3311 Enter the secondary emergency contact’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
E2-Contact Change Date/Time
  e2contact_change_date_time
.33112 This field will hold the date and time of the last Secondary Emergency
Contact Update.

Any change to the following Secondary Emergency Contact fields will
trigger an update: E2-Name Of Secondary Contact,E2-Relationship To
Patient,E2-Street Address [Line 1],E2-Street Address [Line 2],E2-Street
Address [Line 3],E2-City,E2-State,E2-Zip Code,E2-Phone Number and
E2-Work Phone Number
DATE-TIME    
E2-Relationship To Patient
  e2relationship_to_patient
.3312 If a secondary emergency contact is specified enter the relationship
of that person to the applicant [2-30 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a secondary
emergency contact is on file.
STRING    
E2-Street Address [Line 1]
  e2street_address_line_1
.3313 If a secondary emergency contact is specified enter the first line
of that person’s street address [3-30 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a secondary
emergency contact is on file.
STRING    
E2-Street Address [Line 2]
  e2street_address_line_2
.3314 If a secondary emergency contact is specified enter the second line
of that person’s street address [3-30 characters],if necessary,otherwise
nothing may be entered. This field cannot be deleted as long as a
secondary emergency contact is on file.
STRING    
E2-Street Address [Line 3]
  e2street_address_line_3
.3315 If a secondary emergency contact is specified enter the third line
of that person’s street address [3-30 characters],if necessary,
otherwise nothing may be entered. This field cannot be deleted as
long as a secondary emergency contact is on file.
STRING    
E2-City
  e2city
.3316 If a secondary emergency contact is specified enter the city in
which that person resides [3-30 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a secondary
emergency contact is on file.
STRING    
E2-State
  e2state
.3317 If a secondary emergency contact is specified select from the
available listing the state in which that person resides,
otherwise nothing may be entered. This field cannot be deleted
as long as a secondary emergency contact is on file.
POINTER   State-5
E2-Zip Code
  e2zip_code
.3318 If a secondary emergency contact is specified enter the zip
code for the city in which s/he resides [5 numerics],otherwise
nothing may be entered. This field cannot be deleted as long
as a secondary emergency contact is on file.
STRING    
E2-Phone Number
  e2phone_number
.3319 If a secondary emergency contact is specified enter the telephone
number at which that person may be reached [3-20 characters],
otherwise nothing may be entered. This field cannot be deleted as
long as a secondary emergency contact is on file.
STRING    
E-Relationship To Patient
  erelationship_to_patient
.332 If a primary emergency contact is specified enter the relationship
of that person to the applicant [3-35 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a primary
emergency contact is on file.
STRING    
E-Street Address [Line 1]
  estreet_address_line_1
.333 If a primary emergency contact is specified enter the first line
of that person’s street address [3-30 characters],otherwise
nothing may be entered. This field cannot be deleted as long as
a primary emergency contact is on file.
STRING    
E-Street Address [Line 2]
  estreet_address_line_2
.334 If a primary emergency contact is specified enter the second line
of that person’s street address [3-30 characters],if necessary,
otherwise nothing may be entered. This field cannot be deleted as
long as a primary emergency contact is on file.
STRING    
E-Street Address [Line 3]
  estreet_address_line_3
.335 If a primary emergency contact is specified enter the third line
of that person’s street address [3-30 characters],if necessary,
otherwise nothing may be entered. This field cannot be deleted as
long as a primary emergency contact is on file.
STRING    
E-City
  ecity
.336 If a primary emergency contact is specified enter the city in
which that person resides [3-30 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a
primary emergency contact is on file.
STRING    
E-State
  estate
.337 If a primary emergency contact is specified select from the
available listing the state in which that person resides,
otherwise nothing may be entered. This field cannot be deleted
as long as a primary emergency contact is on file.
POINTER   State-5
E-Zip Code
  ezip_code
.338 If a primary emergency contact is specified enter the zip code
for the city in which s/he resides [5 numerics],otherwise
nothing may be entered. This field cannot be deleted as long as
a primary emergency contact is on file.
STRING    
E-Phone Number
  ephone_number
.339 If a primary emergency contact is specified enter the telephone
number [3-20 characters] at which that person may be reached,
otherwise nothing may be entered. This field cannot be deleted
as long as a primary emergency contact is on file.
STRING    
D-Work Phone Number
  dwork_phone_number
.34011 If the person designated to receive the patient’s personal effects is
employed,enter the phone number at which that person may be reached
while at work.
STRING    
D-Designee Same As Nok?
  ddesignee_same_as_nok
.3405 If a primary NOK is defined enter ‘Y’ if that person is also the
designee appointed by the applicant,otherwise enter ‘N’ for no.
BOOLEAN   false: N
true: Y
D-Name Of Designee
  dname_of_designee
.341 Enter the designee’s name in ‘LAST,FIRST MIDDLE SUFFIX’ format.
This value must be 3-35 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.
STRING    
Designee Change Date/Time
  designee_change_date_time
.3412 This field will hold the date and time of the last Designee Update.

Any change to the following Designee fields will trigger an update:
D-Name Of Designee,D-Relationship To Patient,D-Street Address [Line 1],
D-Street Address [Line 2],D-Street Address [Line 3],D-City,D-State,
D-Zip Code,D-Phone Number,D-Designee Same As Nok?,D-Work Phone Number
DATE-TIME    
D-Relationship To Patient
  drelationship_to_patient
.342 If a designee is specified enter the relationship of that person to
the applicant [3-30 characters],otherwise nothing may be entered.
This field cannot be deleted as long as a designee is on file.
STRING    
D-Street Address [Line 1]
  dstreet_address_line_1
.343 If a designee is specified enter the first line of that person’s street
address [3-30 characters],otherwise nothing may be entered. This
field cannot be deleted as long as a designee is on file.
STRING    
D-Street Address [Line 2]
  dstreet_address_line_2
.344 If a designee is specified enter the second line of that person’s
street address [3-30 characters],if necessary,otherwise nothing
may be entered. This field cannot be deleted as long as a designee
is on file.
STRING    
D-Street Address [Line 3]
  dstreet_address_line_3
.345 If a designee is specified enter the third line of that person’s
street address [3-30 characters],if necessary,otherwise nothing
may be entered. This field cannot be deleted as long as a designee
is on file.
STRING    
D-City
  dcity
.346 If a designee is specified enter the city in which that person
resides [1-30 characters],otherwise nothing may be entered.
This field cannot be deleted as long as a designee is on file.
STRING    
D-State
  dstate
.347 If a designee is specified select from the available listing
the state in which that person resides. This field cannot
be deleted as long as a designee is on file.
POINTER   State-5
D-Zip Code
  dzip_code
.348 If a designee is specified enter the zip code for the city in
which s/he resides [5 numerics],otherwise nothing may be
entered. This field cannot be deleted as long as a designee
is on file.
STRING    
D-Phone Number
  dphone_number
.349 If a designee is specified enter the telephone number at which
that person may be reached [3-20 characters],otherwise nothing
may be entered. This field cannot be deleted as long as a
designee is on file.
STRING    
Date Of Death
  date_of_death
.351 Enter the date the patient died. Date needs to be a precise date,i.e.
a day,month,and year MUST be included.
Date of Death can not be prior to
P&T Effective Date
Date Ruled Incompetent (Civil and VA)
Date of Birth
DATE-TIME INDEXED  
Death Entered By
  death_entered_by
.352 This field records the date a patient’s death was initially entered into
the DHCP system. This field is created automatically by the MAS module
when a date of death is entered either through the ‘Death Entry’ option or
through the ‘Discharge a Patient’ option.
POINTER   New_Person-200
Source Of Notification
  source_of_notification
.353
This is a set of codes that represents who/what notified the VA of
the Date of Death.
ENUMERATION   VBA: 4
INPATIENT AT VAMC: 1
NON-VA MEDICAL FACILITY: 2
OTHER: 9
NEXT OF KIN/FAMILY/FRIEND: 8
VA INSURANCE: 5
NCA: 7
SSA: 6
DEATH CERTIFICATE ON FILE: 3
Date Of Death Last Updated
  date_of_death_last_updated
.354 This is a date/time value that represents the date/time the date of death
field (.351) was last modified/entered/deleted.
DATE-TIME    
Last Edited By
  last_edited_by
.355 This is the local user ID of the person that last made a modification to
the date of death (.351) field.
POINTER   New_Person-200
Collateral Sponsor'S Name
  collateral_sponsors_name
.3601 If this patient is a collateral responsible for picking up medications
or information regarding another patient,that patient’s name should be
entered here.

This sponsor must be a veteran and must exist in the patient file.
POINTER   Patient-2
Military Disability Retirement
  military_disability_retirement
.3602   BOOLEAN   false: 0
true: 1
Discharge Due To Disability
  discharge_due_to_disability
.3603   BOOLEAN   false: 0
true: 1
Primary Eligibility Code
  primary_eligibility_code
.361 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 response to the CURRENT PH INDICATOR field (#.531)
is YES and the veteran is not service connected and is not a Prisoner
of War,you must select PURPLE HEART RECIPIENT as the eligibility code.

4. 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.

5. 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 1907.
POINTER   Eligibility_Code-8
Eligibility Status
  eligibility_status
.3611 Select from the available listing the appropriate eligibility status
for this applicant. Only users who hold the designated security key
may enter/edit this field.
ENUMERATION   PENDING VERIFICATION: P
PENDING RE-VERIFICATION: R
VERIFIED: V
Eligibility Status Date
  eligibility_status_date
.3612 Enter the effective date of the eligibility status (ELIG STATUS
prompt). Only users who hold the designated security key may
enter/edit this field.
DATE-TIME    
Eligibility Verif. Source
  eligibility_verif_source
.3613 This field is used to restrict site ability to edit certain data elements when
HEC has verified eligibility data.
ENUMERATION   VISTA: V
HEC: H
Eligibility Interim Response
  eligibility_interim_response
.3614 If an interim response has been received concerning this applicant’s
eligibility status enter the date received. Only users who hold the
designated security key may enter/edit this field.
DATE-TIME    
Eligibility Verif. Method
  eligibility_verif_method
.3615 Enter the method in which the eligibility for this applicant was verified
[between 2-50 characters]. Only users who hold the designated security
key may enter/edit this field.
STRING    
Eligibility Status Entered By
  eligibility_status_entered_by
.3616 When eligibility is verified (ELIG STATUS=”VERIFIED”) the name of the
user who certified the verification.
POINTER   New_Person-200
User Enrollee Valid Through
  user_enrollee_valid_through
.3617 This field contains the Fiscal Year that the veteran’s User Enrollee
Status is valid through. This field is populated by the system,no user
input is required.
DATE-TIME    
User Enrollee Site
  user_enrollee_site
.3618 This field contains the Site that determined the User Enrollee
information for the Veteran. This field is populated by the system,no
user input is required.
POINTER   Institution-4
Disability Ret. From Military?
  disability_ret_from_military
.362   ENUMERATION   YES,RECEIVING MILITARY RETIREMENT IN LIEU OF VA COMPENSATION: 2
YES,RECEIVING MILITARY RETIREMENT: 1
UNKNOWN: 3
NO: 0
Receiving A&A Benefits?
  receiving_aa_benefits
.36205 For this veteran applicant enter ‘Y’ if s/he is on A&A,’N’ if not,or
‘U’ if unknown. Once monetary benefits have been verified only users
who hold the designated security key may enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Aid & Attendance
  amount_of_aid__attendance
.3621 For this veteran applicant who is receiving A&A benefits (ARE YOU IN
RECEIPT OF A&A prompt must be answered YES) enter the amount received
[numeric 0-99999]. Once monetary benefits are verified only users who
hold the designated security key may enter/edit this field. Any dollar
amount on file cannot be deleted as long as receipt of A&A benefits
is indicated.

f you wish to enter a monthly amount either preceed or follow the dollar
figure with an asterisk and I’ll multiply it out for you.
NUMERIC    
Receiving Housebound Benefits?
  receiving_housebound_benefits
.36215 For this veteran applicant enter ‘Y’ if s/he is housebound,’N’ if not,
or ‘U’ if unknown. Once monetary benefits have been verified only users
who hold the designated security key may enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Housebound
  amount_of_housebound
.3622 For this veteran applicant who is housebound (ARE YOU IN RECEIPT OF HB
BENEFITS prompt must be answered YES) enter the amount received
[a number between 0-99999]. Once monetary benefits are verified only
users who hold the designated security key may enter/edit this field. This
field cannot be deleted as long as receipt of housebound benefits is
indicated.

If you wish to enter a monthly amount either preceed of follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
Receiving Social Security?
  receiving_social_security
.36225 For this veteran applicant enter ‘Y’ is s/he is in receipt of social
security benefits,’N’ if not,or ‘U’ if unknown. Once monetary benefits
have been verified only users who hold the designated security key may
enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
*Amount Of Social Security
  amount_of_social_security
.3623 For this veteran applicant who is in receipt of social security
insurance (IN RECEIPT OF SOCIAL SECURITY prompt must be answered YES)
enter the amount received [a number between 0-99999]. Once monetary
benefits are verified only users who hold the designated security key
may enter/edit this field. This field may not be deleted as long as
receipt of social security benefits is indicated.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
Receiving A Va Pension?
  receiving_a_va_pension
.36235 For this veteran applicant enter ‘Y’ if s/he is in receipt of a pension
from the Dept of Veterans Affairs,’N’ if not,or ‘U’ if unknown.
Answering “yes” will prompt you to enter a Pension Award Effective Date
and Pension Award Reason. Once monetary benefits have been verified
only users holding the designated security key may enter/edit
this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Va Pension
  amount_of_va_pension
.3624 For this veteran applicant who is in receipt of a pension from the
Dept of Veterans Affairs (ARE YOU RECEIVING A VA PENSION prompt must
be answered YES) enter the amount received [a number between 0-99999].
Once monetary benefits are verified only users who hold the designated
security key may enter/edit this field. This field may not be deleted
as long as receipt of VA pension is indicated.

If you wish to enter a monthly amount either precede or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
*Amount Of Military Retirement
  amount_of_military_retirement
.3625 For this veteran who is in receipt of military retirement (IN RECEIPT
OF MILIT RETIREMENT prompt must be answered YES) enter the amount
received [a number between 0-99999]. Once monetary benefits are
verified only users who hold the designated security key may enter/edit
this field. This field cannot be deleted as long as receipt of military
retirement is indicated.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
Receiving Military Retirement?
  receiving_military_retirement
.36255 For this veteran applicant enter ‘Y’ if s/he receives a military
retirement,’N’ if not,or ‘U’ if unknown. Once monetary benefits have
been verified only users who hold the designated security key may
enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Gi Insurance
  amount_of_gi_insurance
.3626 For this veteran applicant who does have GI insurance (DO YOU HAVE GI
INSURANCE prompt must be answered YES) enter the amount received [a
number between 1 and 999999]. Once monetary benefits are verified only
users who hold the designated security key may enter/edit this field.
This field cannot be deleted as long as the veteran is identified as
holding GI insurance.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
Gi Insurance Policy?
  gi_insurance_policy
.36265 For this veteran applicant enter ‘Y’ if s/he has GI insurance,’N’ if not,
or ‘U’ if unknown. Once monetary benefits have been verified only users
who hold the designated security key may enter/edit this field.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Ssi
  amount_of_ssi
.3627 For this veteran applicant enter the dollar amount of social security
insurance s/he receives [a number between 1-99999]. Leave blank if
none received. Once monetary benefits have been verified only users
who hold the designated security key may enter/edit this field.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
Receiving Sup. Security (Ssi)?
  receiving_sup_security_ssi
.36275 This field contains a yes or no reponse indicating whether this patient
receives supplemental social security insurance. This field is being *‘d
for deletion and will be removed in a future release of MAS. This data
is no longer updated by the MAS package.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Amount Of Other Retirement
  amount_of_other_retirement
.3628 For this veteran applicant enter the amount of other retirement s/he
is in receipt of [a number between 1-99999]. Leave blank if none
received. Once monetary benefits have been verified only users who
hold the designated security key may enter/edit this field.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiple it out for you.
NUMERIC    
Type Of Other Retirement
  type_of_other_retirement
.36285 For this veteran applicant choose from the available list the type
of other retirement s/he is in receipt of,if any. Once monetary
benefits have been verified only users who hold the designated
security key may enter/edit this field.
ENUMERATION   CIVIL: C
COMBINATIONS OF TYPES: X
OTHER: O
MILITARY: M
RAILROAD: R
BLACK LUNG: B
Amount Of Other Income
  amount_of_other_income
.3629 For this veteran applicant enter the amount of other personal income
s/he is in receipt of [a number between 1-999999]. Leave blank if
none. Once monetary benefits have been verified only users who hold
the designated security key may enter/edit this field.

If you wish to enter a monthly amount either preceed or follow it with
an asterisk and I’ll multiply it out for you.
NUMERIC    
Total Annual Va Check Amount
  total_annual_va_check_amount
.36295 If this applicant is receiving A&A,Housebound,Pension,and/or
Disability payments from the VA (at least one of the YES/NO questions
relating to the above must be answered YES),enter the annual amount
received (0-99999). Once monetary benefits are verified,only users who
hold the designated security key may enter/edit this field. This field
may not be deleted as long as recipt of VA funds is indicated by one of
the four fields related to A&A,Housebound,Pension,and Disability. If
you wish to enter a monthly amount either precede or follow it with an
asterisk and I’ll multiply it out for you.
NUMERIC    
Primary Long Id
  primary_long_id
.363 This field contains the patient’s long ID associated with
the patient’s PRIMARY ELIGIBILITY CODE. For most patients
this is the Social Security Number.

No user input is needed for this field. It is automatically
updated when the PRIMARY ELIGIBILITY CODE field is entered
and edited.
STRING    
Primary Short Id
  primary_short_id
.364 This field contains the patient’s short ID associated with
the patient’s PRIMARY ELIGIBILITY CODE. For most patients
this is the last four digits of the Social Security Number.

No user input is needed for this field. It is automatically
updated when the PRIMARY ELIGIBILITY CODE field is entered
and edited.
STRING    
Service Dental Injury?
  service_dental_injury
.368 For this veteran applicant enter ‘Y’ if a dental injury was incurred
while serving in the U.S. Armed Forces,or ‘N’ if not. Once the
service record is verified only users who hold the designated security
key may enter/edit this field.
BOOLEAN   false: N
true: Y
Service Teeth Extracted?
  service_teeth_extracted
.369 For this veteran applicant enter ‘Y’ if teeth were extracted while
serving in the U.S. Armed Forces,or ‘N’ if not. Once the service
record is verified only users who hold the designated security key
may enter/edit this field.
BOOLEAN   false: N
true: Y
Date Of Dental Treatment
  date_of_dental_treatment
.37 For this veteran applicant who either incurred a dental injury
(DENTAL INJURY IN SERVICE prompt must be answered YES) or had
teeth extracted (TEETH EXTRACTED IN SERVICE prompt must be answered
YES) while serving in the U.S. Armed Forces enter the date of dental
treatment received. Once the service record is verified only users
who hold the designated security key may enter/edit this field.
OBJECT   Date_Of_Dental_Treatment-2_11
Rated Disabilities (Va)
  rated_disabilities_va
.3721 From the available listing choose and enter conditions for which the
applicant has been verified as being service connected. Only users who
hold the designated security key may enter/edit this field.
OBJECT   Rated_Disabilities_Va-2_04
Service Connected Conditions
  service_connected_conditions
.3731 Enter conditions as stated by applicant for which s/he claims service
connection [1-30 characters].
OBJECT   Service_Connected_Conditions-2_05
Eligible For Medicaid?
  eligible_for_medicaid
.381 Enter yes if this patient is eligible to receive medicaid coverage.
Otherwise,answer no.
BOOLEAN   false: 0
true: 1
Date Medicaid Last Asked
  date_medicaid_last_asked
.382 Enter the date/time the ‘ELIGIBLE FOR MEDICAID’ question was last asked of
this veteran. This data must be asked on a yearly basis as it affects the
requirement for a means test (a negative response results in a means test
not being required).

This field will be stored automatically by the MAS module when editing
data on registration or load/edit screen 7. It will not appear for editing.
DATE-TIME    
Medicaid Number
  medicaid_number
.383 This is the patient’s assigned MEDICAID number. STRING    
Pension Award Effective Date
  pension_award_effective_date
.3851 It is the Effective Date that the patient was awarded VA Pension
Entitlement of Original Award by VBA. This field is optional.
But if entered,must be a precise date (Month/Day/Year)
(00/00/0000). This date cannot be a future date. This date
also cannot be before the veteran’s 16th birthday.
DATE-TIME    
Pension Award Reason
  pension_award_reason
.3852 Enter the Pension Award Reason only if VA Pension (#.36235) field
is equal to “Yes”. VistA users are only allowed to enter a
Pension Award Reason of “Original Award” (106). This field is
optional. If Pension Award Reason is entered,an Award Date
must be entered.
POINTER   Pension_Award_Reasons-27_18
Pension Terminated Date
  pension_terminated_date
.3853 The date that the Pension was terminated.
The Pension Terminated Date is not editable.
DATE-TIME    
Pension Terminated Reason 1
  pension_terminated_reason_1
.3854 The first Reason for the Pension Termination.
This field is not editable.
POINTER   Pension_Award_Reasons-27_18
Pension Terminated Reason 2
  pension_terminated_reason_2
.3855 The second Reason for the Pension Termination.
This field is not editable.
POINTER   Pension_Award_Reasons-27_18
Pension Terminated Reason 3
  pension_terminated_reason_3
.3856 The third Reason for the Pension Termination.
This field is not editable.
POINTER   Pension_Award_Reasons-27_18
Pension Terminated Reason 4
  pension_terminated_reason_4
.3857 The fourth Reason for the Pension Termination.
This field is not editable.
POINTER   Pension_Award_Reasons-27_18
Class Ii Dental Indicator
  class_ii_dental_indicator
.3858 Class II Dental Indication is for Veterans
having a SC non-compensable dental
condition(s) or disability shown to have been
in existence at the time of discharge or
release from active duty (after September
30,1981). Treatment may be authorized,as
reasonably necessary,for a one-time
correction of the SC non-compensable
condition under certain conditions
(38 CFR § 17.16).
BOOLEAN   false: N
true: Y
Dental Appl Due Before Date
  dental_appl_due_before_date
.3859 An application for Class II Dental treatment
must be made within 180 days after discharge
or release (38 CFR § 17.160).
DATE-TIME    
Pension Indicator Lock
  pension_indicator_lock
.386 This field is used to restrict the site’s
ability to edit the Pension Indicator field
‘RECEIVING A VA PENSION?’(#.36253) field. Once
an incoming message is received from ESR with
any Pension Data,the Pension Indicator field
becomes ‘display only’ and is not editable
by the VistA user.
BOOLEAN   false: N
true: Y
Pension Award Lock
  pension_award_lock
.3861 This field is used to restrict the site’s
ability to edit the Pension Award fields
‘PENSION AWARD EFFECTIVE DATE’(#.3851) field
and ‘PENSION AWARD REASON’(#.3852) field.
Once an incoming message is received from ESR
with a ‘PENSION AWARD EFFECTIVE DATE’(#.3851)
field and with a ‘PENSION AWARD REASON’
(#.3852) field of ‘ORIGINAL AWARD’,or with
a ‘PENSION TERMINATED REASON’(#.3854,#.3855,
#.3856 or #.3857) field that does not have a
NULL value,then the ‘PENSION AWARD EFFECTIVE
DATE’ (#.3851) field and ‘PENSION AWARD
REASON’ (#.3852) field become ‘display only’
and are not editable by the VistA user.
BOOLEAN   false: N
true: Y
Veteran Catastrophically Disabled?
  veteran_catastrophically_disabled
.39 This field states whether or not the patient is a veteran who has been
determined to meet the criteria for CATASTROPHICALLY DISABLED.
BOOLEAN   false: N
true: Y
Decided By
  decided_by
.391 The name of the VA staff physician who made the determination that the patient
was catastrophically disabled.
STRING    
Date Of Decision
  date_of_decision
.392 The date the catastrophic disability determination was made. DATE-TIME    
Facility Making Determination
  facility_making_determination
.393 The VAMC that made the catastrophic disability determination. POINTER   Institution-4
Review Date
  review_date
.394 The date that a review to determine Catastrophic Disability was made.
This review may be a medical record review or physical exam review.
DATE-TIME    
Method Of Determination
  method_of_determination
.395 Added in order to document the review method of how the decision
to assign a CD status was determined.

Determination may be made by reviewing the veteran’s medical record
or by performing a physical examination of the veteran.
In the future,the capability to fully automate the record review
process will be added to the system.
ENUMERATION   PHYSICAL EXAMINATION: 3
MEDICAL RECORD REVIEW: 2
Date Veteran Requested Cd Eval
  date_veteran_requested_cd_eval
.3951 Documents the date the veteran requested Catastrophically Disabled
evaluation.
DATE-TIME    
Date Facility Initiated Review
  date_facility_initiated_review
.3952 Documents the date the VA facility initiated the Catastrophically
Disabled review.
DATE-TIME    
Date Veteran Was Notified
  date_veteran_was_notified
.3953 Documents the date the veteran was notified of the Catastrophically
Disabled decision by the VA facility.
DATE-TIME    
Cd Status Diagnoses
  cd_status_diagnoses
.396 This file contains one or more Diagnoses,which
provide the Catastrophic Disability Reasons
the patient has been found to be catastrophically disabled.
POINTER   Catastrophic_Disability_Reasons-27_17
Cd Status Procedures
  cd_status_procedures
.397 The status procedure must be a valid procedure in the CD Reasons File (#27.17). OBJECT   Cd_Status_Procedures-2_397
Cd Status Conditions
  cd_status_conditions
.398 This field contains one or more Conditions,which provide the
Catastrophic Disability Reasons the patient has been found to be
catastrophically disabled.
OBJECT   Cd_Status_Conditions-2_398
Cd History Date
  cd_history_date
.399 Documents the Catastrophically Disabled History dates for the patient. OBJECT   Cd_History_Date-2_399
Cd Descriptors
  cd_descriptors
.401 This field contains one or more Descriptors,which provide the
Catastrophic Disability Reasons the patient has been found to be
catastrophically disabled.
POINTER   Catastrophic_Disability_Reasons-27_17
Pow Status Indicated?
  pow_status_indicated
.525 For this veteran applicant enter ‘Y’ if s/he was confined as a prisoner
of war,’N’ if not,or ‘U’ if unknown. Once the POW Status is verified
by the HEC,it is no longer editable.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Pow Confinement Location
  pow_confinement_location
.526 For this veteran applicant who was confined as a prisoner of war
(WERE YOU A PRISONER OF WAR prompt must be answered YES) enter the
war during which confined. Once the service record is verified only
those users who hold the designated security key may enter/edit this
field. This field cannot be deleted as long as applicant is
identified as a former POW.
POINTER   Pow_Period-22
Pow From Date
  pow_from_date
.527 For this veteran applicant who was confined as a prisoner of war
(WERE YOU A PRISONER OF WAR prompt must be answered YES) enter the
date on which confinement commenced. Once
the service record is verified only those users who hold the designated
security key may enter/edit this field. This field cannot be
deleted as long as applicant is identified as a former POW.
DATE-TIME    
Pow To Date
  pow_to_date
.528 For this veteran applicant who was confined as a prisoner of war
(WERE YOU A PRISONER OF WAR prompt must be answered YES) enter the
date on which confinement ended. Once the
service record is verified only those users who hold the designated
security key may enter/edit this field. This field cannot be
deleted as long as applicant is identified as a former POW.
DATE-TIME    
Pow Status Verified
  pow_status_verified
.529 This field contains the date/time that the POW status was received
from HEC. Once the POW status has been received from HEC,it can
no longer be edited by the site.
DATE-TIME    
Combat Service Indicated?
  combat_service_indicated
.5291 For this veteran applicant enter ‘Y’ if s/he served in a combat
zone,or ‘N’ if not. Once the service record is verified only
users who hold the designated security key may enter/edit this
field.
BOOLEAN   false: N
true: Y
Combat Service Location
  combat_service_location
.5292 For this veteran applicant who served in a combat zone (IN COMBAT
prompt must be answered YES) enter the zone in which s/he
served. Once the service record is verified only those users
who hold the designated security key may enter/edit this field.
This field cannot be deleted as long as combat service is
indicated.
POINTER   Pow_Period-22
Combat From Date
  combat_from_date
.5293 For this veteran who served in a combat zone (IN COMBAT prompt
must be answered YES) enter the date on which combat service
commenced. Once the service record is
verified only those users who hold the designated security key
may enter/edit this field. This field cannot be deleted as long
as combat service is indicated.
DATE-TIME    
Combat To Date
  combat_to_date
.5294 For this veteran who served in a combat zone (IN COMBAT prompt must
be answered YES) enter the date on which combat service ended.
Once the service record is verified
only those users who hold the designated security key may
enter/edit this field. This field cannot be deleted as long as
combat service is indicated.
DATE-TIME    
Combat Veteran End Date
  combat_veteran_end_date
.5295 This field represents the last day for combat vet eligibility. This field
will only be populated by cross-reference when the veteran’s combat vet
eligibility has been determined. This value will remain after the combat
vet eligibility period has expired.
DATE-TIME    
Cv Date Edited
  cv_date_edited
.5296 The CV DATE EDITED field will be stuffed with the current date
whenever the COMBAT VET END DATE field (.5295) is changed.
DATE-TIME INDEXED  
Current Ph Indicator
  current_ph_indicator
.531 This field can be entered by the local site if currently null. Subsequent
editing can be done only by the HEC. A response of ‘Yes’ can be entered
only if the patient is a veteran,
BOOLEAN INDEXED false: N
true: Y
Current Purple Heart Status
  current_purple_heart_status
.532 This field cannot be edited locally. If Current Purple Heart Indicator is
set to ‘Yes’ by the local site,a Current Purple Heart Status of ‘Pending’
will be stuffed into the field. Other editing or updating is done by the
HEC.
ENUMERATION INDEXED CONFIRMED: 3
IN PROCESS: 2
PENDING: 1
Current Purple Heart Remarks
  current_purple_heart_remarks
.533 This field cannot be edited locally. If Current Purple Heart Indicator
isset to ‘No’ by the local site,a Current Purple Heart Remarks of ‘VAMC’
will be stuffed into the field. Other editing or updating is done by the
HEC.
ENUMERATION   UNDELIVERABLE MAIL: 6
VAMC: 5
ENTERED IN ERROR: 3
UNACCEPTABLE DOCUMENTATION: 1
NO DOCUMENTATION REC'D: 2
UNSUPPORTED PURPLE HEART: 4
Ph Division
  ph_division
.535 When site enters a value for CURRENT PH Indicator,a prompt
for PH Division will appear. This field will point to the
INSTITUTION file (#4),and will hold the division where the
PH request was initiated.
POINTER   Institution-4
Current Moh Indicator
  current_moh_indicator
.541 This field cannot be edited in VistA. It is set by the Z11 Upload from
HEC. A response of ‘YES’ or ‘NO’ is indicated only if the patient is a
veteran.
BOOLEAN   false: N
true: Y
Test Patient Indicator
  test_patient_indicator
.6 This field is set by the ‘ATP’ cross reference on the Social Security Number
field (.09) when an SSN containing five leading zeros is entered.
BOOLEAN   false: 0
true: 1
Alias
  alias
1 If this applicant is known by any name other than that entered in
the NAME field enter that/those other name(s) here. Any entry
to this field will be cross-referenced and the applicant may be
called up using this alias.
OBJECT   Alias-2_01
Name Components
  name_components
1.01   POINTER   Name_Components-20
K-Name Components
  kname_components
1.02   POINTER   Name_Components-20
K2-Name Components
  k2name_components
1.03   POINTER   Name_Components-20
Father'S Name Components
  fathers_name_components
1.04   POINTER   Name_Components-20
Mother'S Name Components
  mothers_name_components
1.05   POINTER   Name_Components-20
Mothers Maiden Name Components
  mothers_maiden_name_components
1.06   POINTER   Name_Components-20
E-Name Components
  ename_components
1.07   POINTER   Name_Components-20
E2-Name Components
  e2name_components
1.08   POINTER   Name_Components-20
D-Name Components
  dname_components
1.09   POINTER   Name_Components-20
Race Information
  race_information
2   OBJECT   Race_Information-2_02
Enrollment Clinic
  enrollment_clinic
3 This multiple field contains the data relating to clinic enrollments for
this patient.
OBJECT   Enrollment_Clinic-2_001
Ethnicity Information
  ethnicity_information
6   OBJECT   Ethnicity_Information-2_06
Current Enrollment
  current_enrollment
27.01 The patient’s current enrollment. POINTER   Patient_Enrollment-27_11
Preferred Facility
  preferred_facility
27.02 The facility that the patient chooses to designate as his preferred
location for care.
The facility must have one of the following facility types:
CBOC (Community Based Outpatient Clinic)
HCS (Health Care System)
HEALTHCARE (VA Boston Health Care System)
M&ROC (Medical and Regional Office Center)
MOC (Mobile Outpatient Clinic)
MORC (Mobile Outreach Clinic)
NETWORK (VA Healthcare Network Upstate NY)
NHC (Nursing Home Care)
OC (Outpatient Clinic - Independent)
OCMC (Outpatient Clinic - Subordinate)
OCS (Outpatient Clinic Substation)
OPC (Out Patient Clinic)
ORC (Outreach Clinic)
RO-OC (Regional Office - Outpatient Clinic)
SATELLITE (Satellite Outpatient Clinic)
SOC (Satellite Outpatient Clinic)
VAMC (VA Medical Center)
VANPH (Neural Psychiatric Hospital)
VA ROSEBERG (VA Roseburg Health Care System)
POINTER   Institution-4
Source Designation
  source_designation
27.03 Source designation contains the value of the place the Preferred Facility
field (#27.02) was assigned for the patient. Source designation is
automatically assigned by the system. The VistA system can only assign
a Preferred Facility if the current Source Designation is VistA or
Primary Care Provider (PCP) Inactive.
ENUMERATION   PCP INACTIVE: PI
VISTA: V
PCP ACTIVE: PA
ESR: E
*Reactions
  reactions
53   BOOLEAN   false: N
true: Y
*Height(Cm)
  heightcm
57.1   NUMERIC    
*Weight(Kg)
  weightkg
57.2   NUMERIC    
Spinal Cord Injury
  spinal_cord_injury
57.4 If this patient does not have a spinal cord injury,enter X for not
applicable in this field. Otherwise,if the patient does have a spinal
cord injury,choose from the other available choices the one
ENUMERATION   QUADRIPLEGIA-NONTRAUMATIC: 4
QUADRIPLEGIA-TRAUMATIC: 2
NOT APPLICABLE: X
PARAPLEGIA-TRAUMATIC: 1
PARAPLEGIA-NONTRAUMATIC: 3
Laboratory Reference
  laboratory_reference
63 This field contains the internal entry number of this patient in the
LAB DATA file. This data is entered and maintained by the laboratory
package and must NOT be edited under any circumstances. Editing of this
data could cause severe repercussions in the laboratory package.
POINTER   Lab_Data-63
Lab Referral Ref
  lab_referral_ref
67 This field contains the pointer reference to the Referral file of the
Laboratory Package. This field is set by the laboratory accessioning
software and should not be edited.

Changing of this pointer will result IN misidentification of patients that
could have dire medical repercussions.
POINTER   Referral_Patient-67
Cnh Current
  cnh_current
148 This field is used to denote when a patient is currently in a contract
nursing home. Answer yes if the patient is in a contract nursing home
currently. Otherwise,answer no.
BOOLEAN   false: N
true: Y
Dental Classification
  dental_classification
220 For Dental Package POINTER   Dental_Classification-220_2
Dental Eligibility Expiration
  dental_eligibility_expiration
220.1 For Dental Eligibility DATE-TIME    
Patient Eligibilities
  patient_eligibilities
361 This multiple contains all eligibilities under which this patient can
receive care. This includes his primary eligibility and all other
eligibilities he may have.
OBJECT   Patient_Eligibilities-2_0361
Type
  type-391
391 Enter the patient type for this patient. This is selectable from the
distributed entries in the TYPE OF PATIENT file. The type selected should
be the primary one selectable. For example,if the patient is both an
NSC veteran and an employee,the patient type should be NSC VETERAN,not
employee.

This field is used by the registration screen processor to determine which
screens will be editable for this patient. The selection of which screens
can be viewed for which types of patients can be made through the ‘Patient
Type Update’ option.
POINTER   Type_Of_Patient-391
Condition
  condition
401.3 Enter ‘S’ if the patient is seriouslly ill and should be displayed on the
Seriouslly Ill Roster. Enter ‘@’ to delete patient from seriouslly ill
status.
ENUMERATION INDEXED SERIOUSLY ILL: S
Date Entered On Si List
  date_entered_on_si_list
401.4 Enter the date the patient was placed on the Seriouslly Ill list. DATE-TIME    
*Current Pc Practitioner
  current_pc_practitioner
404.01 This field stores the patient’s Current Primary Care Practitioner. POINTER   New_Person-200
*Current Pc Team
  current_pc_team
404.02 This field contains the patients’s Primary Care Team. POINTER   Team-404_51
Ph Date/Time Updated
  ph_date_time_updated
534   OBJECT   Ph_Date_Time_Updated-2_0534
Integration Control Number
  integration_control_number
991.01 Machine to machine identifier for a patient. NUMERIC INDEXED  
Icn Checksum
  icn_checksum
991.02 This checksum is the calculated checksum for the Integration Control
Number. It verifies the integrity of the ICN.
STRING    
Coordinating Master Of Record
  coordinating_master_of_record
991.03 The coordinating site for the patient. POINTER INDEXED Institution-4
Locally Assigned Icn
  locally_assigned_icn
991.04 DESIGNATES THAT THE ICN BELONGING TO THIS PATIENT IS LOCAL BOOLEAN INDEXED true: 1
Subscription Control Number
  subscription_control_number
991.05 This field points to a list of subscribers to this patient’s data. For
example,see details of the MPI/PD messaging implementation. The subscriber
list is specific to this patient. Do not change the subscription control
number without remembering to update the current subscriber list in file
774 (SUBSCRIPTION CONTROL). Use only documented API calls to create a new
subscription control number for a patient.
POINTER INDEXED Subscription_Control-774
Cmor Activity Score
  cmor_activity_score
991.06 This score is used to determine the Coordinating Master of Record. NUMERIC    
Score Calculation Date
  score_calculation_date
991.07 This is the last date that the CMOR ACTIVITY SCORE was calculated
at this site.
DATE-TIME    
Temporary Id Number
  temporary_id_number
991.08 The Department of Defense (DoD) Defense Eligibility Enrollment Reporting
System (DEERS) uses a Temporary Identification Number for individuals
(e.g.,babies) who do not have or have not provided a Social Security
Number (SSN) when the record is added to DEERS. It is used for military
dependents only. This DoD TEMPORARY ID NUMBER will be used by the Master
Veteran Index to support the linking of patient records across VA and DoD.
STRING    
Foreign Id Number
  foreign_id_number
991.09 The Department of Defense (DoD) Defense Eligibility Enrollment Reporting
System (DEERS) uses a Foreign Identification Number for foreign military
and foreign nationals when the record is added to DEERS. This DoD
FOREIGN ID NUMBER will be used by the Master Veteran Index to support the
linking of patient records without a given Social Security Number (SSN)
across VA and DoD.
STRING    
Full Icn
  full_icn
991.1 This field can only be edited by CIRN!

The entire Integration Control Number (ICN),which is based on the ASTM
E-1714 standard format of a 16 digit identifier,1 character delimiter,
6 digit checksum,followed by an optional 6 digit encryption scheme.

ICN is a machine to machine identifier for a patient.
STRING INDEXED  
Full Icn History
  full_icn_history
991.91 Maintains the history of all of the full Integration Control Numbers
(ICNs) assigned to patients.
STRING    
Icn History
  icn_history
992   OBJECT   Icn_History-2_0992
Cmor History
  cmor_history
993   OBJECT   Cmor_History-2_0993
Multiple Birth Indicator
  multiple_birth_indicator
994 The MULTIPLE BIRTH INDICATOR will designate whether or not
the patient is part of a multiple birth (i.e. to identify
twins,etc.).
ENUMERATION   *MULTIPLE BIRTH*: Y
NO: N
Disposition Log-In Date/Time
  disposition_login_date_time
1000 The date/time at which this applicant applied for medical benefits,e.g.,
was registered for care using the ‘Registration’ option of ADT.

This multiple contains information on each registration entered for this
patient including the date of registration,date of disposition,and type
of disposition.
OBJECT   Disposition_LogIn_Date_Time-2_101
Received Va Care Previously?
  received_va_care_previously
1010.15 Enter ‘Y’ if this veteran has previously received care in another VA
facility,otherwise enter ‘N’.
BOOLEAN   false: N
true: Y
Most Recent Date Of Care
  most_recent_date_of_care
1010.151 If this veteran has previously received care in another VA facility
enter the date of care in that facility.
DATE-TIME    
Appointment Request Date
  appointment_request_date
1010.1511 This field contains the date the VA enrolling a patient for the first time
was notified that the patient requests an appointment with a provider.
DATE-TIME INDEXED  
Most Recent Location Of Care
  most_recent_location_of_care
1010.152 If this veteran have previously received care in another VA facility
select from the available listing the name of the facility (or facility
number) in which care was rendered most recently.
POINTER   Institution-4
2Nd Most Recent Date Of Care
  _2nd_most_recent_date_of_care
1010.153 If this applicant has received care in more than one other VA facility
enter the date of care received in the next to most recent facility.
DATE-TIME    
2Nd Most Recent Location
  _2nd_most_recent_location
1010.154 If this veteran has received care in more than one other VA facility
select from the available listing the name of the facility (or facility
number) in which the next to most recent care was received.
POINTER   Institution-4
Most Recent 1010Ez
  most_recent_1010ez
1010.156 This field was added via patch DG5.3597,distributed with EAS1.051.

The purpose of this field is to link the PATIENT file record with
the Veteran’s latest 1010EZ Application to this site. The 1010EZ
data is retained in 1010EZ HOLDING File (#712). The internal entry
number to file #712 is stored in the MOST RECENT 1010EZ field.
POINTER   _1010Ez_Holding-712
Combat Indicated On 1010Ez
  combat_indicated_on_1010ez
1010.157 This field was added via patch DG5.3597,distributed with EAS1.051.

The purpose of this field is to store within the PATIENT file the
applicant’s answer to the 1010EZ question:

DID YOU SERVE IN COMBAT AFTER 11/11/1998?

This field may contain any of the following:

0 for “NO”
1 for “YES”
null (i.e.,not answered)
BOOLEAN   false: 0
true: 1
Disability Discharge On 1010Ez
  disability_discharge_on_1010ez
1010.158 This field was added via patch DG5.3597,distributed with EAS1.051.

The purpose of this field is to store within the PATIENT file the
applicant’s answer to the 1010EZ question:

WAS DISCHARGE FROM MILITARY FOR A DISABILITY INCURRED OR
AGGRAVATED IN THE LINE OF DUTY?

This field may contain any of the following:

0 for “NO”
1 for “YES”
null (i.e.,not answered)
BOOLEAN   false: 0
true: 1
Appointment Request On 1010Ez
  appointment_request_on_1010ez
1010.159 Enter a ‘Y’ if the veteran applicant has requested an appointment with a
VA doctor or provider and wants to be seen as soon as one becomes
available. Enter a ‘N’ if the veteran applicant has not requested an
appointment.

This question may ONLY be entered ONCE for the veteran. The answer to
this question CANNOT be changed after the initial entry.
BOOLEAN   false: 0
true: 1
Appointment Request Status
  appointment_request_status
1010.161 This field is the status of the veteran’s new appointment requested.
This field is entered by the user through the new enrollee appointment
request option.
ENUMERATION   CANCELLED: C
IN PROCESS/VETERAN CONTACTED: I
FILLED: F
EWL: E
Date Status Last Edited
  date_status_last_edited
1010.162 This is the date appointment request status was last edited. This field is
updated by the computer whenever anyone edits the status information.
DATE-TIME    
Appointment Request Comment
  appointment_request_comment
1010.163 This field is entered by the user through the new enrollee appointment
request option.
STRING    
Date Comment Last Edited
  date_comment_last_edited
1010.164 This is the date appointment request comment was last edited. This field
is updated by the computer whenever anyone edits the comment information.
DATE-TIME    
Fugitive Felon Flag
  fugitive_felon_flag
1100.01 This field is in support of Pub. L. 107-103,section 505,and is used to
flag a patient who has a fugitive felon warrant outstanding. This
information will be provided to the appropriate personnel to enter.
Access to this field requires the DGFFP ACCESS key. This field should
not be updated directly,but should be entered through the appropriate
Fugitive Felon Program options.
BOOLEAN INDEXED true: 1
Fff Entered By
  fff_entered_by
1100.02 This field contains the user who entered the current Fugtitive Felon Flag
for this patient. It is automatically entered when the FUGITIVE FELON
FLAG field (#1100.01) is entered.
POINTER   New_Person-200
Fff Date Entered
  fff_date_entered
1100.03 Date/Time the FUGITIVE FELON FLAG field (#1100.01) was entered. This
field is automatically set when the FUGITIVE FELON FLAG field (#1100.01)
is set.
DATE-TIME    
Fff Removed By
  fff_removed_by
1100.04 This field contains the user who removed the current Fugitive Felon Flag
for this patient. It is automatically entered when the FUGITIVE FELON FLAG
field (#1100.01) is deleted.
POINTER   New_Person-200
Fff Date Removed
  fff_date_removed
1100.05 Date/Time the FUGITIVE FELON FLAG Field (#1100.01) was removed. This
field is automatically set when the FUGITIVE FELON FLAG field (#1100.01)
is deleted.
DATE-TIME    
Fff Removal Remarks
  fff_removal_remarks
1100.09 If the FFF flag has been cleared for this patient,this field contains a short reason as to why the flag was cleared. This is a free text field which allows up to 80 characters to be entered. STRING    
Appointment
  appointment
1900 This multiple contains information on appointments this patient has had or
is scheduled to have. This information includes the date/time of the
appointment,the clinic,and the reason for the appointment.
OBJECT   Appointment-2_98
Veteran (Y/N)?
  veteran_y_n
1901 Enter ‘Y’ if this applicant is over 17 years of age and is a veteran,
‘N’ if not. If applicant is under 17 years of age and is a veteran
only those users holding the designated security may identify him/her
as a veteran. Once eligibility is verified only those users who
hold the designated security key may enter/edit this field.
BOOLEAN   false: N
true: Y
Archived Data
  archived_data
1903 This multiple is not presently used by the MAS module. Archiving
capabilities for the patient file are not yet available.

This multiple was distributed in 1987,but the archiving routines were
not distributed.
OBJECT   Archived_Data-2_12
Vts Patient Flag
  vts_patient_flag
3000 This field indicates whether or not the patient is or wants to be part of the Veteran
Transportation Service (VTS).
BOOLEAN   false: 0
true: 1
Initial Ods Treatment Received
  initial_ods_treatment_received
11500.01 Enter the date/time this patient was initially entered as ODS. This field
will automatically be created when ODS is selected as the PERIOD OF SERVICE
for this patient.
DATE-TIME    
Recalled To Active Duty
  recalled_to_active_duty
11500.02 Was this operation desert shield patient recalled to active duty? If so
select from national guard or reserves. If not,answer no.
ENUMERATION   NATIONAL GUARD: 1
RESERVES: 2
NO: 0
Rank
  rank-2
  Enter the grade/rank of this operation desert shield patient.      
Network Identifier
  network_identifier
537025 This field holds the synonym values from the Network Health Exchange
Authorized Site file indicating where a particular patient has been found
to have data.
STRING    

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Sub-Files

Confidential Address Category (2.141)

ID
Confidential_Address_Category-2_141

Properties

Label/Field Name Field # Description Datatype Attributes Range
Confidential Address Category
  confidential_address_category
.01 If the ‘Confidential Address Active’ prompt is answered YES,
select the confidential address category for this applicant’s
confidential communications.
ENUMERATION INDEXED
REQUIRED
ELIGIBILITY/ENROLLMENT: 1
MEDICAL RECORDS: 4
APPOINTMENT/SCHEDULING: 2
COPAYMENTS/VETERAN BILLING: 3
ALL OTHERS: 5
Confidential Category Active
  confidential_category_active
1 If the applicant’s confidential communications for this category should
be sent to the confidential address,Confidential Category Active field
should be set to yes. If not,select N or No.
BOOLEAN   false: N
true: Y

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Insurance Type (2.312)

ID
Insurance_Type-2_312

Properties

Label/Field Name Field # Description Datatype Attributes Range
Insurance Type
  insurance_type
.01 Choose from the available listing the name(s) of the insurance
company(ies) under which this applicant is covered.
POINTER INDEXED
REQUIRED
Insurance_Company-36
Group Plan
  group_plan
.18 Select the plan under which this patient is covered by the specified
insurance company. If this is a group plan then there may already be
an entry for this plan that you may select. Or,you may add a new
plan. If this is an individual plan then it will be associated with
only this patient.
POINTER   Group_Insurance_Plan-355_3
Coordination Of Benefits
  coordination_of_benefits
.2   ENUMERATION   PRIMARY: 1
TERTIARY: 3
SECONDARY: 2
*Subscriber Id
  subscriber_id
1 Enter the Subscriber’s Primary ID number. This number is assigned
by the payer and can be found on the subscriber’s insurance card.

This field is scheduled for deletion in May 2015.
STRING    
Date Entered
  date_entered
1.01 This is the date this entry was added. It will be created by the system
whenever a new policy is added. Entries created prior the installation
of IB v2.0 will not have an entry in this field.
DATE-TIME    
Entered By
  entered_by
1.02 This the user who added this entry. It will be entered by the system
whenever a new policy is added. Entries created prior the installation
of IB v2.0 will not have an entry in this field.
POINTER   New_Person-200
Date Last Verified
  date_last_verified
1.03 Insurance coverage is generally verified by calling the insurer and
requesting an explanation of benefits. When coverage has been
verified the person verifying the coverage should use the options to
verify the coverage in VISTA.

This is the date that this policy for this patient was last verified
with the insurance company. It is important to update the verification
date regularly so that other users will know how current the information
in VISTA is.
DATE-TIME    
Verified By
  verified_by
1.04 This is the user that last contacted the insurance company to verify
the policy. It is updated by using the appropriate DHCP options.
It is important to update the verification date and user so that other
users will know the insurance policy information is current.
POINTER   New_Person-200
Date Last Edited
  date_last_edited
1.05 This is the date this policy was last edited. This field is updated by
the computer whenever anyone edits this patient’s policy information.
DATE-TIME    
Last Edited By
  last_edited_by
1.06 This is the user that last edited the policy. This field is updated by
the computer whenever anyone edits this patients policy information.
POINTER   New_Person-200
Comment - Patient Policy
  comment__patient_policy
1.08 This is a place to record a short comment about this patients policy.
It is specific to this patient and to this policy. The answer must be
3 to 80 characters.
STRING    
Source Of Information
  source_of_information
1.09 Enter the last source of this information.
If the insurance information was obtained by patient interview,then
enter interview,etc. If the information was initially or previously
obtained by one source but updated by another source,then enter the
most recent source of the information.

The data in this field will be initially set to INTERVIEW with IB v2.
The data may be passed to Accounts Receivable and/or the MCCR NDB.

If this field is being edited through the use of the pre-registration
software,the default for this field will be set to PRE-REGISTRATION.
POINTER   Source_Of_Information-355_12
Date Of Source Of Information
  date_of_source_of_information
1.1   DATE-TIME    
*Group Number
  group_number
2 Enter any other appropriate number which identifies this policy,i.e.,
group number/code,under which this applicant is covered. Answer must
be between 1 and 17 characters.

This field is moved to the HEALTH INSURANCE POLICY file (355.3) beginning
with IB v2.0. It will be deleted with the first release 18 months after
the release of IB V2.
STRING    
Send Bill To Employer
  send_bill_to_employer
2.01 If the employer of the person who holds this policy requires that
they pre-processed for the insurance policy then enter ‘YES’. You
will then be allowed to enter the company name and address that
these bills should be sent to. The bills will then automatically use
this address.

If the employer does not require this,or unknown,enter ‘NO’. The bills
will then be sent to the insurance company.

If the policy is held by other than the patient then this will not be the
patient’s employer but the employer of the person who is insured.
BOOLEAN   false: 0
true: 1
Subscriber'S Employer Name
  subscribers_employer_name
2.015 This is the name of the employer that will appear on the UB-04 if the
bills should be sent to the employer for pre-processing.
STRING    
Employer Claims Street Address
  employer_claims_street_address
2.02 This is the street address of the employer who should receive claims to be
pre-processed before the are forwarded to the insurance carrier.
The answer should be 3 to 30 characters.
STRING    
Employ Claim St Address Line 2
  employ_claim_st_address_line_2
2.03 This is line 2 of the street address for employers who pre-process
insurance claims before they are forwarded to the insurance carrier
for processing. Answer must be 3-30 characters.
STRING    
Employ Claim St Address Line 3
  employ_claim_st_address_line_3
2.04 This is line 3 of the street address for employers who pre-process
insurance claims before they are forwarded to the insurance carrier
for processing. Answer must be 3-30 characters.
STRING    
Employer Claims City
  employer_claims_city
2.05 If the employer of the person who holds this policy pre-processes
insurance claims prior to forwarding to the insurance carrier enter
the city that claim should be sent to. This will be printed on the
claim form. Answer must be 3 to 20 characters.
STRING    
Employer Claims State
  employer_claims_state
2.06 If the employer of the person who holds this policy pre-processes
insurance claims prior to forwarding to the insurance carrier enter
the state that the claim should be sent to. This will be printed on the
claim form. Answer must be 3 to 20 characters.
POINTER   State-5
Employer Claims Zip Code
  employer_claims_zip_code
2.07 Enter the zip code of the mailing address for this employer.
Answer with either the 5 digit zip code (format 12345) or with the 9
digit zip code (in format 123456789 or 12345-6789).
STRING    
Employer Claims Phone
  employer_claims_phone
2.08 Enter the phone number of the employer. This should be the phone number
of the person to contact regarding insurance claims.
STRING    
Esghp
  esghp
2.1 Enter ‘Yes’ if this policy is part of a plan that is sponsored or
provided by the insured’s current or past employer.
BOOLEAN   false: 0
true: 1
Employment Status
  employment_status
2.11 If this is an Employer Sponsored Group Health Plan then this should be the
employment status of the insured with the employer that sponsors the plan.
ENUMERATION   SELF EMPLOYED: 4
PART TIME: 2
RETIRED: 5
UNKNOWN: 9
NOT EMPLOYED: 3
FULL TIME: 1
ACTIVE MILITARY: 6
Retirement Date
  retirement_date
2.12 If this is an Employer Sponsored Group Health Plan then this should be
the date the insured retired from the employer that sponsors the plan.
DATE-TIME    
Insurance Expiration Date
  insurance_expiration_date
3 If this insurance policy under which this applicant is covered expires on
a specified date enter that date,otherwise,leave this field blank.
DATE-TIME    
Insured'S Dob
  insureds_dob
3.01 The field is used to store the date of birth of the insured person.
The field value may be printed in block 11a of the CMS-1500 claim
form. This is a required field for billing ChampUS patients.
DATE-TIME    
Insured'S Branch
  insureds_branch
3.02 This field may be used to store the service branch of the insured
person. The field will be used primarily for CHAMPUS policies,
where the subscriber,or sponsor,may be an active duty member
of the military. The field value may be printed in block 11b
of the CMS-1500 claim form.
POINTER   Branch_Of_Service-23
Insured'S Rank
  insureds_rank
3.03 This field contains the insured person’s military rank. The
field will be used primarily for CHAMPUS policies,where the
subscriber,or sponsor,may be an active duty member of the
military. The field value may be printed in block 11c of
the CMS-1500 claim form.
STRING    
Policy Not Billable
  policy_not_billable
3.04 This field is used primarily for CHAMPUS policies. If the patient is
covered under CHAMPUS,but it is known that claims should never be
submitted to the CHAMPUS Fiscal Intermediary,then entering YES in
this field will cause Pharmacy claims to the FI not to be created.
BOOLEAN   false: 0
true: 1
Insured'S Ssn
  insureds_ssn
3.05 This field contains the policyholder’s social security number,
if it is different than the Subscriber ID. For CHAMPUS policies,
this value may be automatically inserted into this field from
the PATIENT (#2) or SPONSOR PERSON (#355.82) files.
STRING    
Insured'S Street 1
  insureds_street_1
3.06 This field contains the first street address of the policyholder. STRING    
Insured'S Street 2
  insureds_street_2
3.07 This field contains the second line of the street address of
the policyholder.
STRING    
Insured'S City
  insureds_city
3.08 This field contains the city of the policyholder. STRING    
Insured'S State
  insureds_state
3.09 This field contains the state of the policyholder. POINTER   State-5
Insured'S Zip
  insureds_zip
3.1 This field contains the zip code of the policyholder. STRING    
Insured'S Phone
  insureds_phone
3.11 This field contains the phone number of the policyholder. STRING    
Insured'S Sex
  insureds_sex
3.12 This field is used in insurance billing to help verify the
policy coverage when the bill is submitted to the carrier.
If the patient is the policy holder,this value should match
the patient’s sex. If the patient’s spouse or other relative
is the policy holder,the appropriate value should be
determined and entered.
ENUMERATION   MALE: M
FEMALE: F
Insured'S Country
  insureds_country
3.13 This field contains the country code of the policyholder. STRING    
Insured'S Country Subdivision
  insureds_country_subdivision
3.14 This field contains the country subdivision code of the policyholder. STRING    
Primary Care Provider
  primary_care_provider
4.01 This is the patient’s Primary Care Provider within their managed care
network that may refer the patient to the VA.
STRING    
Primary Provider Phone
  primary_provider_phone
4.02 This is the phone number of the Primary Care Provider that may refer the
patient to the VA.
STRING    
Pt. Relationship - Hipaa
  pt_relationship__hipaa
4.03 Enter the code which best describes the patient’s relationship
to the person who holds this policy (or insured).
ENUMERATION   INJURED PLAINTIFF: 41
ORGAN DONOR: 39
SELF: 18
CHILD: 19
FATHER: 33
SIGNIFICANT OTHER: 29
MOTHER: 32
EMPLOYEE: 20
SPOUSE: 01
LIFE PARTNER: 53
OTHER RELATIONSHIP: G8
Eiv Auto-Update
  eiv_autoupdate
4.04 Flag that determines how the last update to INSURANCE TYPE sub-file was
done. Value of “YES” means that data was last updated via eIV
auto-update,value of “NO” means that data was last updated via other
means.
BOOLEAN   false: 0
true: 1
Pharmacy Relationship Code
  pharmacy_relationship_code
4.05 This is the relationship of the patient to the cardholder.

Code Description
—- ———–
0 Not Specified
1 Cardholder - The individual that is enrolled in and receives
benefits from a health plan
2 Spouse - Patient is the husband/wife/partner of the cardholder
3 Child - Patient is a child of the cardholder
4 Other - Relationship to cardholder is not precise
POINTER   Bps_Ncpdp_Patient_Relationship_Code-9002313_19
Pharmacy Person Code
  pharmacy_person_code
4.06 This is the code that is assigned by the payer to identify the patient.
The payer may use a unique person code to identify each specific person on
the pharmacy insurance policy. This code may also describe the patient’s
relationship to the cardholder.

Enrollment Standard Examples:

001 = Cardholder
002 = Spouse
003 - 999 = Dependents and Others (including second spouses,etc.)
STRING    
Patient Id
  patient_id
5.01 This is the patient’s primary ID number for this insurance company.
Enter this field when the patient and the subscriber are different
and the patient has been given a unique ID number. If issued by
this payer,the number should be present on the patient’s insurance
card.

This data will print in box 8a on the UB-04 for institutional claims
when the patient and the subscriber are different.
STRING    
Subscriber'S Sec Qualifier(1)
  subscribers_sec_qualifier1
5.02 Enter the subscriber secondary ID qualifier# 1. The qualifier
describes the type of ID number.

Up to 3 secondary ID’s and qualifiers may be entered,but you
cannot use the same qualifier more than once.
SY is not a valid qualifier when the payer is Medicare.
ENUMERATION   Insurance Policy Number: IG
Client Number: 23
Social Security Number: SY
Subscriber'S Sec Id(1)
  subscribers_sec_id1
5.03 Enter the subscriber’s secondary ID #1. You may enter up to 3 secondary
ID’s and qualifiers.
STRING    
Subscriber'S Sec Qualifier(2)
  subscribers_sec_qualifier2
5.04 Enter the subscriber secondary ID qualifier# 2. The qualifier
describes the type of ID number.

Up to 3 secondary ID’s and qualifiers may be entered,but you
cannot use the same qualifier more than once.
SY is not a valid qualifier when the payer is Medicare.
ENUMERATION   Insurance Policy Number: IG
Client Number: 23
Social Security Number: SY
Subscriber'S Sec Id(2)
  subscribers_sec_id2
5.05 Enter the subscriber’s secondary ID #2. You may enter up to 3 secondary
ID’s and qualifiers.
STRING    
Subscriber'S Sec Qualifier(3)
  subscribers_sec_qualifier3
5.06 Enter the subscriber secondary ID qualifier# 3. The qualifier
describes the type of ID number.

Up to 3 secondary ID’s and qualifiers may be entered,but you
cannot use the same qualifier more than once.
SY is not a valid qualifier when the payer is Medicare.
ENUMERATION   Insurance Policy Number: IG
Client Number: 23
Social Security Number: SY
Subscriber'S Sec Id(3)
  subscribers_sec_id3
5.07 Enter the subscriber’s secondary ID #3. You may enter up to 3 secondary
ID’s and qualifiers.
STRING    
Patient'S Sec Qualifier(1)
  patients_sec_qualifier1
5.08 Enter the patient secondary ID qualifier# 1. The qualifier
describes the type of ID number. This should only be used when
the patient and the subscriber are different.

Up to 3 secondary ID’s and qualifiers may be entered,but you
cannot use the same qualifier more than once.
SY is not a valid qualifier when the payer is Medicare.
ENUMERATION   Insurance Policy Number: IG
Client Number: 23
Social Security Number: SY
Patient'S Secondary Id(1)
  patients_secondary_id1
5.09 Enter the patient secondary ID #1. You may enter up to 3 secondary
ID’s and qualifiers. This should only be used when the patient and
the subscriber are different.
STRING    
Patient'S Sec Qualifier(2)
  patients_sec_qualifier2
5.1 Enter the patient secondary ID qualifier# 2. The qualifier
describes the type of ID number. This should only be used when
the patient and the subscriber are different.

Up to 3 secondary ID’s and qualifiers may be entered,but you
cannot use the same qualifier more than once.
SY is not a valid qualifier when the payer is Medicare.
ENUMERATION   Insurance Policy Number: IG
Client Number: 23
Social Security Number: SY
Patient'S Secondary Id(2)
  patients_secondary_id2
5.11 Enter the patient secondary ID #2. You may enter up to 3 secondary
ID’s and qualifiers. This should only be used when the patient and
the subscriber are different.
STRING    
Patient'S Sec Qualifier(3)
  patients_sec_qualifier3
5.12 Enter the patient secondary ID qualifier# 3. The qualifier
describes the type of ID number. This should only be used when
the patient and the subscriber are different.

Up to 3 secondary ID’s and qualifiers may be entered,but you
cannot use the same qualifier more than once.
SY is not a valid qualifier when the payer is Medicare.
ENUMERATION   Insurance Policy Number: IG
Client Number: 23
Social Security Number: SY
Patient'S Secondary Id(3)
  patients_secondary_id3
5.13 Enter the patient secondary ID #3. You may enter up to 3 secondary
ID’s and qualifiers. This should only be used when the patient and
the subscriber are different.
STRING    
Whose Insurance
  whose_insurance
6 Enter ‘v’ if this insurance policy is held by the veteran (applicant),
’s’ if the veteran is married and the spouse holds the policy,or ‘o’
if someone other than the veteran or his/her spouse hold the policy,i.e.,
employer.
ENUMERATION   VETERAN: v
SPOUSE: s
OTHER: o
Name Of Insured
  name_of_insured
7.01 Enter the name of the individual for which this insurance policy was
issued. If the patient and the insurance subscriber are the same,then
this field will be defaulted from the patient name field.

The name must contain a comma and be entered in Last,First format.
STRING    
Subscriber Id
  subscriber_id-2_312-7_02
7.02 Enter the Subscriber’s Primary ID number. This number is assigned by the
payer and can be found on the subscriber’s insurance card.
STRING    
Effective Date Of Policy
  effective_date_of_policy
8 Enter the date that this insurance policy initially went into effect (the
date the patient acquired this policy).
DATE-TIME    
Requested Service Date
  requested_service_date
8.01 This is the Eligibility/Service Date that is received on the eIV
Response message. If it is not present on the Response message then this
is the Eligibility Date that was sent on the Inquiry message.
DATE-TIME    
Requested Service Type
  requested_service_type
8.02 This is the Service Type that is received on the Response message. POINTER   X12_271_Service_Type-365_013
Group Reference Information
  group_reference_information
9 Subscriber/Dependent additional identification data. OBJECT   Group_Reference_Information-2_3129
Group Provider Info
  group_provider_info
10 Entries in this sub-file identify the characteristics of a provider. OBJECT   Group_Provider_Info-2_332
Health Care Code Information
  health_care_code_information
11 To supply information related to the delivery of health care. OBJECT   Health_Care_Code_Information-2_31211
Military Info Status Code
  military_info_status_code
12.01 Code to indicate the status of the military information sent by the payer. POINTER   X12_271_Military_Personnel_Info_Status_Code-365_039
Military Employment Status
  military_employment_status
12.02 Code showing the general military employment status of an
employee/claimant.
POINTER   X12_271_Military_Employment_Status_Code-365_046
Military Govt Affiliation Code
  military_govt_affiliation_code
12.03 Code specifying the military service affiliation. POINTER   X12_271_Military_Govt_Service_Affiliation-365_041
Military Personnel Description
  military_personnel_description
12.04 This field further identifies the exact military unit. STRING    
Military Service Rank Code
  military_service_rank_code
12.05 Code specifying the military service rank. POINTER   X12_271_Military_Service_Rank-365_042
Date Time Period Format Qual
  date_time_period_format_qual
12.06 Code qualifier indicating the date format,time format,or date and time
format respective of the DATE TIME PERIOD field (#12.07).
POINTER   X12_271_Date_Format_Qualifier-365_032
Date Time Period
  date_time_period
12.07 Expression of a date or range of dates that indicates the date span of
military service.
STRING    
*Group Name
  group_name
15 If this insurance policy is a group policy,enter the name of the group.

This field is moved to the HEALTH INSURANCE POLICY file (355.3) beginning
with IB v2.0. It will be deleted with the first release 18 months after
the release of IB V2.
STRING    
Pt. Relationship To Insured
  pt_relationship_to_insured
16 Select the relationship code that describes the relationship this
patient has to the holder of this insurance policy. If the policy
belongs to the patient enter ‘01’ for patient. If the policy
belongs to the spouse enter ‘02’ for spouse,etc.
ENUMERATION   PATIENT: 01
ORGAN DONOR: 11
NATURAL CHILD: 03
DO NOT USE: 18
FATHER: 33
INJURED PLANTIFF: 15
SIGNIFICANT OTHER: 34
MOTHER: 32
EMPLOYEE: 08
SPOUSE: 02
LIFE PARTNER: 35
OTHER RELATIONSHIP: 36
*Name Of Insured
  name_of_insured-2_312-17
17 Enter the name of the individual for which this insurance policy was
issued. If the patient and the insurance subscriber are the same,
then this field will be defaulted from the patient name field.

The name must contain a comma and be entered in Last,First format.

This field is scheduled for deletion in May 2015.
STRING    
Eligibility/Benefit
  eligibility_benefit
60 This multiple contains all of the eligibility and benefit data
for a specific insured person returned from the Payer.
OBJECT   Eligibility_Benefit-2_322

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Group Reference Information (2.3129)

ID
Group_Reference_Information-2_3129

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 This field contains a sequential number generated at the time a record is
stored in the subfile.
NUMERIC INDEXED
REQUIRED
 
Reference Id (Group)
  reference_id_group
.02 Subscriber Supplemental Identifier. STRING    
Ref Id Qualifier (Group)
  ref_id_qualifier_group
.03 Describes the type of reference ID at the REFERENCE ID (GROUP) (#.02)
field.
POINTER   X12_271_Reference_Identification-365_028
Description
  description
.04 A free-form description to clarify the Reference ID in the REFERENCE ID
(GROUP) (#.02) field. It will be populated with the Plan,Group or Plan
Network Name.
STRING    

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Group Provider Info (2.332)

ID
Group_Provider_Info-2_332

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 This field contains a sequential number generated at the time a record is
stored in the subfile.
NUMERIC INDEXED
REQUIRED
 
Provider Code
  provider_code
.02 Code that identifies the type of provider (e.g.,”AD” for Admitting). POINTER   X12_271_Provider_Code-365_024
Prov Reference Id
  prov_reference_id
.03 Provider specialty type identifier. STRING    

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Health Care Code Information (2.31211)

ID
Health_Care_Code_Information-2_31211

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 This field contains a sequential number generated at the time a record is
stored in the subfile.
NUMERIC INDEXED
REQUIRED
 
Diagnosis Code
  diagnosis_code
.02 Diagnosis Code sent by the payer in response to the insurance eligibility
inquiry.
POINTER   Icd_Diagnosis-80
Diagnosis Code Qualifier
  diagnosis_code_qualifier
.03 Diagnosis Type Code identifying a specific industry code list ICD-9 or
ICD-10.
STRING    
Primary Or Secondary?
  primary_or_secondary
.04 This field indicates whether the code in the DIAGNOSIS CODE (#.02) field
is a primary or secondary diagnosis.
ENUMERATION   PRIMARY: P
SECONDARY: S

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Eligibility/Benefit (2.322)

ID
Eligibility_Benefit-2_322

Properties

Label/Field Name Field # Description Datatype Attributes Range
Eb Number
  eb_number
.01 This is a sequential number corresponding to the Set-ID for all
of the eligibility/benefit (X.12 EB segments) segments coming
into VISTA.
NUMERIC INDEXED
REQUIRED
 
Eligibility/Benefit Info
  eligibility_benefit_info
.02 This field contains a code identifying the eligibility status
of the individual or the benefit returned by the Payer.
POINTER   X12_271_Eligibility_Benefit-365_011
Coverage Level
  coverage_level
.03 This field identifies the level of coverage of benefits. POINTER   X12_271_Coverage_Level-365_012
*Service Type
  service_type
.04 This field is a code identifying the classification of service. POINTER   X12_271_Service_Type-365_013
Insurance Type
  insurance_type
.05 This is a code identifying the type of insurance policy within
a specific insurance program.
POINTER   X12_271_Insurance_Type-365_014
Plan Coverage Description
  plan_coverage_description
.06 This code is a description or number that identifies the plan
or coverage.
STRING    
Time Period Qualifier
  time_period_qualifier
.07 This is a code for the time period category that determines
for how long the benefits are available.
POINTER   X12_271_Time_Period_Qualifier-365_015
Monetary Amount
  monetary_amount
.08 This field is populated if eligibility or benefit must be
qualified by a monetary amount.
STRING    
Percent
  percent
.09 This field is used if eligibility or benefit must be qualified
by a percentage.
NUMERIC    
Quantity Qualifier
  quantity_qualifier
.1 This field is used to identify the type of units that are being
conveyed in the QUANTITY field (#.11).
POINTER   X12_271_Quantity_Qualifier-365_016
Quantity
  quantity
.11 This field number is used for the quantity value as qualified by
the QUANTITY QUALIFIER field.
STRING    
Authorization/Certification
  authorization_certification
.12 This field indicates that an authorization or certification
is required per plan provisions.
POINTER   X12271_Yes_No_Response_Code-365_033
In Plan
  in_plan
.13 This field indicates the plan network indicator. A YES value indicates
the benefits identified are considered In-Plan-Network. A NO value
indicates that the benefits identified are considered
Out-Of-Plan-Network. A “U” value indicates it is unknown whether the
benefits identified are part of the Plan Network.
POINTER   X12271_Yes_No_Response_Code-365_033
Procedure Coding Method
  procedure_coding_method
1.01 Two character code describing procedure coding method. POINTER   X12_271_Procedure_Coding_Method-365_035
Procedure Code
  procedure_code
1.02 Identification code for the procedure. STRING    
Procedure Modifier 1
  procedure_modifier_1
1.03 Identifies special circumstances related to the procedure; first modifier. STRING    
Procedure Modifier 2
  procedure_modifier_2
1.04 Identifies special circumstances related to the procedure; second
modifier.
STRING    
Procedure Modifier 3
  procedure_modifier_3
1.05 Identifies special circumstances related to the procedure; third modifier. STRING    
Procedure Modifier 4
  procedure_modifier_4
1.06 Identifies special circumstances related to the procedure; fourth
modifier.
STRING    
Notes
  notes
2 This field contains any additional text about the eligibility
benefit information. It is transcribed from X.12 271 MSG segments.
STRING    
Entity Id Code
  entity_id_code
3.01 X12 Entity Identifier Code. POINTER   X12_271_Entity_Identifier_Code-365_022
Entity Type
  entity_type
3.02 Entity Type Qualifier. POINTER   X12_271_Entity_Type_Qualifier-365_043
Name
  name
3.03 Name of person or organization. STRING    
Entity Id
  entity_id
3.04 Entity identifier. STRING    
Entity Id Qualifier
  entity_id_qualifier
3.05 Code designating the system/method used for Identification. POINTER   X12_271_Identification_Qualifier-365_023
Entity Relationship Code
  entity_relationship_code
3.06 Benefit Related Entity’s relationship to the patient. POINTER   X12_271_Entity_Relationship_Code-365_031
Address Line 1
  address_line_1
4.01 Entity address,line 1. STRING    
Address Line 2
  address_line_2
4.02 Entity address,line 2. STRING    
City
  city
4.03 Entity address,city. STRING    
State
  state
4.04 Entity address,state or province code. POINTER   State-5
Zip
  zip
4.05 Entity address,zip or postal code. STRING    
Country Code
  country_code
4.06 Entity address,country code. STRING    
Location
  location
4.07 Entity address,location identifier. STRING    
Location Qualifier
  location_qualifier
4.08 Entity address,location qualifier. POINTER   X12_271_Location_Qualifer-365_034
Subdivision Code
  subdivision_code
4.09 Entity address,country subdivision code. STRING    
Provider Code
  provider_code
5.01 Code identifying the type of provider. POINTER   X12_271_Provider_Code-365_024
Reference Id
  reference_id
5.02 Reference identifier. STRING    
Reference Id Qualifier
  reference_id_qualifier
5.03 Reference identifier type. POINTER   X12_271_Reference_Identification-365_028
Contact Information
  contact_information
6 This multiple contains contact information for an eligibility/benefit
entity.
OBJECT   Contact_Information-2_3226
Healthcare Services Delivery
  healthcare_services_delivery
7 Healthcare services delivery multiple. OBJECT   Healthcare_Services_Delivery-2_3227
Subscriber Dates
  subscriber_dates
8 Subscriber dates multiple. OBJECT   Subscriber_Dates-2_3228
Subscriber Additional Info
  subscriber_additional_info
9 Additional subscriber information multiple. OBJECT   Subscriber_Additional_Info-2_3229
Subscriber Reference Id
  subscriber_reference_id
10 Subscriber reference id multiple. OBJECT   Subscriber_Reference_Id-2_32291
Service Types
  service_types
11   POINTER   X12_271_Service_Type-365_013

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Contact Information (2.3226)

ID
Contact_Information-2_3226

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 Sequential entry number. NUMERIC INDEXED
REQUIRED
 
Name
  name
.02 Name of the contact. STRING    
*Communication Number
  communication_number
.03 Phone,fax,email,etc.

This field is scheduled for deletion in May 2015.
STRING    
Communication Qualifier
  communication_qualifier
.04 Code describing type of communication number. POINTER   X12_271_Contact_Qualifier-365_021
Communication Number
  communication_number-2_3226-1
1 Phone,fax,email,URL STRING    

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Healthcare Services Delivery (2.3227)

ID
Healthcare_Services_Delivery-2_3227

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 Sequential entry number. NUMERIC INDEXED
REQUIRED
 
Benefit Quantity
  benefit_quantity
.02 Numeric value of benefit quantity as qualified by QUANTITY QUALIFIER
field.
NUMERIC    
Quantity Qualifier
  quantity_qualifier
.03 Benefit quantity qualifier. POINTER   X12_271_Quantity_Qualifier-365_016
Sample Selection Modulus
  sample_selection_modulus
.04 Sampling frequency in terms of a modulus of the Unit of Measure. Qualified
by UNITS OF MEASUREMENT field.
STRING    
Units Of Measurement
  units_of_measurement
.05 Units of measurement for frequency of the benefits. POINTER   X12_271_Units_Of_Measurement-365_029
Time Periods
  time_periods
.06 Number of time periods as qualified by TIME PERIOD QUALIFIER field. NUMERIC    
Time Period Qualifier
  time_period_qualifier
.07 Code that defines a time period. POINTER   X12_271_Time_Period_Qualifier-365_015
Delivery Frequency
  delivery_frequency
.08 Code that defines frequency of deliveries. POINTER   X12_271_Delivery_Frequency_Code-365_025
Delivery Pattern
  delivery_pattern
.09 Code that defines pattern of deliveries. POINTER   X12_271_Delivery_Pattern-365_036

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Subscriber Dates (2.3228)

ID
Subscriber_Dates-2_3228

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 Sequential number of ZSD segment. NUMERIC INDEXED
REQUIRED
 
Date
  date
.02 Date or range of dates. STRING    
Date Qualifier
  date_qualifier
.03 Code describing the type of date. POINTER   X12_271_Date_Qualifier-365_026
Date Format
  date_format
.04 Format of the date representation. POINTER   X12_271_Date_Format_Qualifier-365_032

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Subscriber Additional Info (2.3229)

ID
Subscriber_Additional_Info-2_3229

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 Sequential number of ZII segment. NUMERIC INDEXED
REQUIRED
 
Place Of Service
  place_of_service
.02 Place of service code. POINTER   Place_Of_Service-353_1
Diagnosis
  diagnosis
.03 Diagnosis code. POINTER   Icd_Diagnosis-80
Qualifier
  qualifier
.04 Additional information qualifier. POINTER   X12_271_Code_List_Qualifier-365_044
Nature Of Injury Code
  nature_of_injury_code
.05 Code that represents the nature of the patient injury. POINTER   X12_271_Nature_Of_Injury_Codes-365_045
Nature Of Injury Category
  nature_of_injury_category
.06 Specifies the situation or category to which the code applies. STRING    
Nature Of Injury Text
  nature_of_injury_text
.07 Describes the injured body part or parts. STRING    

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Subscriber Reference Id (2.32291)

ID
Subscriber_Reference_Id-2_32291

Properties

Label/Field Name Field # Description Datatype Attributes Range
Sequence
  sequence
.01 Sequential number of ZRF segment. NUMERIC INDEXED
REQUIRED
 
Reference Id
  reference_id
.02 Reference id value. STRING    
Reference Id Qualifier
  reference_id_qualifier
.03 Code describing the type of reference id. POINTER   X12_271_Reference_Identification-365_028
Description
  description
.04 Short description of reference id. STRING    

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Service [Oef Or Oif] (2.3215)

ID
Service_Oef_Or_Oif-2_3215

Properties

Label/Field Name Field # Description Datatype Attributes Range
Location Of Service
  location_of_service
.01 This is the operation in which the patient was in combat during the
specified time period.
ENUMERATION INDEXED
REQUIRED
UNKNOWN OEF/OIF: 3
OIF: 1
OEF: 2
Oef/Oif From Date
  oef_oif_from_date
.02 If the service indicated is OEF or UNKNOWN OEF/OIF,this date must be on
or after 9/01/2001 and the end date must be after 9/11/2001. If the
service indicated is OIF,this date must be on or after 3/01/2003 and
the end date must be after 3/19/2003.

The meaning of this date depends on where the information was obtained
from. If the data came from the VIS,Environmental Medicine or FHIE
systems,this is the start date of military pay for the assignment to
the OEF/OIF operation. If it came from any other source,it is the date
the patient was actually deployed to the OEF/OIF area.
DATE-TIME    
Oef/Oif To Date
  oef_oif_to_date
.03 If the service indicated is OEF or UNKNOWN OEF/OIF,this date must be on
or after 9/11/2001. If the service indicated is OIF,this date must be on
or after 3/19/2003.

The meaning of this date depends on where the information was obtained
from. If the data came from the VIS,Environmental Medicine or FHIE
systems,this is the military pay end date for the assignment to
the OEF/OIF operation. If it came from any other source,it is the date
the patient actually left the OEF/OIF area.
DATE-TIME    
Data Locked
  data_locked
.04 This is a flag that indicates the data is ‘locked’ at the site and can’t
be changed or deleted. This flag is set to 1 if the source of the data
is the HEC system.
BOOLEAN   false: 0
true: 1
Recorded Date/Time
  recorded_date_time
.05 This is a time stamp for when the data was last added/updated. DATE-TIME    
Entered By Site
  entered_by_site
.06 This is the facility where the data was originally entered. If the
data’s source was not from a facility,it will be assumed to be generated
from HEC (CEV) and this field will be blank.
POINTER   Institution-4

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Military Service Episode (2.3216)

ID
Military_Service_Episode-2_3216

Properties

Label/Field Name Field # Description Datatype Attributes Range
Service Entry Date
  service_entry_date
.01 For this veteran applicant,enter the date s/he commenced this episode of
military service. If the military service component is ACTIVATED NATIONAL
GUARD or ACTIVATED RESERVE,the period entered should be the period of
activation,so this date is their first day of active duty for the
episode.

If the military service episode has been sent from the Health Eligibility
Center (HEC),the data will be locked and cannot be edited or deleted.
DATE-TIME INDEXED
REQUIRED
 
Service Separation Date
  service_separation_date
.02 For this veteran applicant,enter the date s/he ended this episode of
military service. If the military service component is ACTIVATED NATIONAL
GUARD or ACTIVATED RESERVE,the period entered should be the period of
activation,so this date is their last day of active duty for this
episode.

If the military service episode has been sent from the Health Eligibility
Center (HEC),the data will be locked and cannot be edited or deleted.
DATE-TIME    
Service Branch
  service_branch
.03 Enter the service branch for this episode of military service.

If the military service episode has been sent from the Health Eligibility
Center (HEC),the data will be locked and cannot be edited or deleted.
POINTER   Branch_Of_Service-23
Service Component
  service_component
.04 For this veteran applicant,enter the military service component for this
episode of military service.

If the military service episode has been sent from the Health Eligibility
Center (HEC),the data will be locked and cannot be edited or deleted.

NATIONAL GUARD IS ONLY VALID FOR BRANCH OF SERVICE ARMY AND AIR FORCE.
ENUMERATION   ACTIVATED RESERVE: V
ACTIVATED NG: G
REGULAR: R
Service Number
  service_number
.05 Enter the service number for this episode of military service. STRING    
Service Discharge Type
  service_discharge_type
.06 For this veteran applicant,select from the available list the discharge
type which s/he received for this episode of military service.

If the military service episode has been sent from the Health Eligibility
Center (HEC),the data will be locked and cannot be edited or deleted.
POINTER   Type_Of_Discharge-25
Data Locked
  data_locked
.07 When a military service episode is sent from HEC,the Data Locked field
will be set to ‘1’ (YES). The data in the military service episode can no
longer be changed or deleted.
BOOLEAN   false: 0
true: 1

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Date Of Dental Treatment (2.11)

ID
Date_Of_Dental_Treatment-2_11

Properties

Label/Field Name Field # Description Datatype Attributes Range
Date Of Dental Treatment
  date_of_dental_treatment
.01   DATE-TIME REQUIRED  
Condition
  condition
2 Enter the patient’s condition on the date in which they received dental
treatment. Also enter the place of treatment and from whom the
treatment was received. This field allows entry of 3-100 characters.
STRING    
Date Condition First Noticed
  date_condition_first_noticed
3 Enter the date the patient states s/he first noticed this dental
condition.
DATE-TIME    

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Rated Disabilities (Va) (2.04)

ID
Rated_Disabilities_Va-2_04

Properties

Label/Field Name Field # Description Datatype Attributes Range
Rated Disabilities (Va)
  rated_disabilities_va
.01 From the available listing choose and enter conditions for which the
applicant has been verified as being service connected.
POINTER REQUIRED Disability_Condition-31
Disability %
  disability_
2 Enter the percentage at which the VA rated this disability for this
patient. Only users who hold the designated security key may enter/edit
this field.
NUMERIC    
Service Connected
  service_connected
3 Enter whether or not this rated disability was rated as service connected.
Only users who hold the designated security key may enter/edit this field.
BOOLEAN   false: 0
true: 1
Extremity Affected
  extremity_affected
4   ENUMERATION   RIGHT UPPER: RU
LEFT LOWER: LL
BOTH LOWER: BL
LEFT UPPER: LU
RIGHT LOWER: RL
BOTH UPPER: BU
Original Effective Date
  original_effective_date
5 Data will be stuffed from messages from the HEC. This field indicates
the first date that this disability was evaluated.
DATE-TIME    
Current Effective Date
  current_effective_date
6 Data will be stuffed from messages from the HEC. This field indicates
the most recent date that this disability was evaluated.
DATE-TIME    

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Service Connected Conditions (2.05)

ID
Service_Connected_Conditions-2_05

Properties

Label/Field Name Field # Description Datatype Attributes Range
Service Connected Conditions
  service_connected_conditions
.01 Enter conditions as stated by applicant for which s/he claims service
connection.
STRING REQUIRED  
Percentage
  percentage
.02 Enter the percentage that the patient states this disability was rated
at.
NUMERIC    

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Cd Status Procedures (2.397)

ID
Cd_Status_Procedures-2_397

Properties

Label/Field Name Field # Description Datatype Attributes Range
Cd Status Procedures
  cd_status_procedures
.01 This is for storage of either CPT procedure or ICD procedure codes. ICD
codes must be for the correct coding system,as determined by procedure
date and stored in file 27.17 piece 9.
POINTER INDEXED
REQUIRED
Catastrophic_Disability_Reasons-27_17
Affected Extremity
  affected_extremity
1 This is the affected extremity for this procedure. ENUMERATION   Right Lower Extremity: RLE
Bilateral Lower Extremity: BLE
Left Lower Extremity: LLE
Left Upper Extremity: LUE
Bilateral Upper Extremity: BUE
Right Upper Extremity: RUE

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Cd Status Conditions (2.398)

ID
Cd_Status_Conditions-2_398

Properties

Label/Field Name Field # Description Datatype Attributes Range
Cd Status Conditions
  cd_status_conditions
.01 The veteran shall be determined Catastrophically Disabled if
he/she has one of the following conditions:
- Dependent in three or more ADLs,with at least three of the
dependencies being permanent,using the Katz Scale.
- A score of 10 or lower using the Folstein Mini-Mental State
Examination.
- A score of 2 or lower on at least 4 of the 13 motor items
using the Functional Independence Measure (FIM)
- A score of 30 or lower using the Global Assessment of Functions
in (GAF)
POINTER INDEXED
REQUIRED
Catastrophic_Disability_Reasons-27_17
Score
  score
1 NOTE: This field does not always contain the veteran’s raw test
score. Sometimes you must enter specific information about the
score that may apply to the determination of Catastrophic Disability.
See the help text above for more details.
NUMERIC    
Permanent Indicator
  permanent_indicator
2 This field contains the Permanent Indicator,which documents the
Catastrophic Disability Conditions.
ENUMERATION   UNKNOWN: 3
PERMANENT: 1
NOT PERMANENT: 2

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Cd History Date (2.399)

ID
Cd_History_Date-2_399

Properties

Label/Field Name Field # Description Datatype Attributes Range
Cd History Date
  cd_history_date
.01 This sub-file stores the history of the PATIENT’s Catastrophic Disability
Eligibility information.
DATE-TIME INDEXED
REQUIRED
 
Veteran Catastrophically Disabled?
  veteran_catastrophically_disabled
.39 Documents the Catastrophically Disabled status in the CD History. BOOLEAN   false: N
true: Y
Decided By
  decided_by
.391 Captures a historical value of DECIDED BY (#.391) field in PATIENT file. STRING    
Date Of Decision
  date_of_decision
.392 Captures historical value of PATIENT field #.392 DATE OF DECISION. DATE-TIME    
Facility Making Determination
  facility_making_determination
.393 Captures a historical value of the FACILITY MAKING DETERMINATION field
(#.393) of the PATIENT file.
POINTER   Institution-4
Review Date
  review_date
.394 Captures a historical value of the PATIENT file’s REVIEW DATE field
(#.394).
DATE-TIME    
Method Of Determination
  method_of_determination
.395 This sub-field stores the historical value of the PATIENT file’s METHOD
OF DETERMINATION field (#.395).
ENUMERATION   AUTOMATED RECORD REVIEW: 1
PHYSICAL EXAMINATION: 3
MEDICAL RECORD REVIEW: 2
Date Veteran Requested Cd Eval
  date_veteran_requested_cd_eval
.3951 Documents the Date the Veteran Requested CD Evaluation for CD History. DATE-TIME    
Date Facility Initiated Review
  date_facility_initiated_review
.3952 Documents the date the facility initiated the Catastrophically Disabled
review for CD History.
DATE-TIME    
Date Veteran Was Notified
  date_veteran_was_notified
.3953 Documents the date the Veteran was notified of the Catastrophically
Disabled status for CD History.
DATE-TIME    
Cd Reason
  cd_reason
.396 Documents the Catastrophically Disabled Reason for CD History. OBJECT   Cd_Reason-2_409

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Cd Reason (2.409)

ID
Cd_Reason-2_409

Properties

Label/Field Name Field # Description Datatype Attributes Range
Cd Reason
  cd_reason
.01 This sub-field will contain pointers to the CD REASONS file (#27.17),
as well as the supporting data stored in the CD STATUS DIAGNOSES (#.396),
PROCEDURES (#.397) and CONDITIONS (#.398) fields.
POINTER INDEXED
REQUIRED
Catastrophic_Disability_Reasons-27_17
Affected Extremity
  affected_extremity
1 This is the extremity affected by the CD. ENUMERATION   RIGHT LOWER EXTREMITY: RLE
Bilateral Lower Extremity: BLE
LEFT LOWER EXTREMITY: LLE
LEFT UPPER EXTREMITY: LUE
Bilateral Upper Extremity: BLU
RIGHT UPPER EXTREMITY: RUE
Score
  score
2 This field stores a historical value for the SCORE subfield (#1) of the
CD STATUS CONDITIONS field (#.398) of the PATIENT file (#2).
NUMERIC    
Permanent Indicator
  permanent_indicator
3 This subfield stores a historical value of the PERMANENT INDICATOR subfield
(#2) of the CD STATUS CONDITIONS field (#.398) of the PATIENT file (#2).
ENUMERATION   UNKNOWN: 3
PERMANENT: 1
NOT PERMANENT: 2

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Alias (2.01)

ID
Alias-2_01

Properties

Label/Field Name Field # Description Datatype Attributes Range
Alias
  alias
.01 Enter the alias 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.
STRING REQUIRED  
Alias Ssn
  alias_ssn
1 If the patient was also known under a name other than that listed in
the NAME field of the PATIENT file,enter the social security number
used when the patient used this alias.
STRING    
Alias Components
  alias_components
100.03   POINTER   Name_Components-20

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Race Information (2.02)

ID
Race_Information-2_02

Properties

Label/Field Name Field # Description Datatype Attributes Range
Race Information
  race_information
.01 Patient’s race POINTER INDEXED
REQUIRED
Race-10
Method Of Collection
  method_of_collection
.02 Method used to collect patient’s race POINTER   Race_And_Ethnicity_Collection_Method-10_3

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Enrollment Clinic (2.001)

ID
Enrollment_Clinic-2_001

Properties

Label/Field Name Field # Description Datatype Attributes Range
Enrollment Clinic
  enrollment_clinic
.01   POINTER INDEXED
REQUIRED
Hospital_Location-44
Enrollment Data
  enrollment_data
1 This multiple contains the pertinant data relating to this patients
enrollment in this clinic. Data contained in this multiple includes
the date the patient was enrolled,the date of discharge from the clinic
and whether the patient was seen on an outpatient or ambulatory care basis.
OBJECT   Enrollment_Data-2_011
Current Status
  current_status
2 This field will contain ‘I’ for inactive if this patient is no longer
enrolled in this clinic (patient has been discharged from the clinic).
ENUMERATION   INACTIVE: I

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Enrollment Data (2.011)

ID
Enrollment_Data-2_011

Properties

Label/Field Name Field # Description Datatype Attributes Range
Date Of Enrollment
  date_of_enrollment
.01 Enter the date this patient was initially enrolled in this clinic. DATE-TIME REQUIRED  
Opt Or Ac
  opt_or_ac
1 Enter O if the patient is being seen by this clinic on an outpatient
basis. Enter A if the patient is being seen for ambulatory care.
ENUMERATION   OPT: O
AC: A
Date Of Discharge
  date_of_discharge
3 This field contains the date this patient was discharged from this clinic. DATE-TIME    
Reason For Discharge
  reason_for_discharge
4 If the patient has been discharged from this clinic,this field contains the
reason the patient was discharged. This is a free text field which
allows up to 80 characters to be entered.
STRING    
Review Date
  review_date
5 Enter the date on which this patients enrollment in this particular
clinic was last reviewed.
DATE-TIME    

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Ethnicity Information (2.06)

ID
Ethnicity_Information-2_06

Properties

Label/Field Name Field # Description Datatype Attributes Range
Ethnicity Information
  ethnicity_information
.01 Patient’s ethnicity POINTER INDEXED
REQUIRED
Ethnicity-10_2
Method Of Collection
  method_of_collection
.02 Method used to collect patient’s ethnicity POINTER   Race_And_Ethnicity_Collection_Method-10_3

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Patient Eligibilities (2.0361)

ID
Patient_Eligibilities-2_0361

Properties

Label/Field Name Field # Description Datatype Attributes Range
Eligibility
  eligibility
.01 Enter all eligibilities under which this patient may receive care. The
patients primary eligibility as well as all other eligibilities he is
entitled to is stored in this multiple.
POINTER INDEXED
REQUIRED
Eligibility_Code-8
Long Id
  long_id
.03 This field contains the patient’s long ID associated with
the patient’s ELIGIBILITY. For most eligibilities this is the
Social Security Number.

This field is triggered by the ‘ELIGILBILTY(#.01)’ field. It is
user defined only if this eligibility’s id format allows this
user interaction as indicated by the ‘PROMPT USER FOR ID?(#.02)’
field of the ‘IDENTIFICATION FORMAT(#8.1)’ file.
STRING    
Short Id
  short_id
.04 This field contains the patient’s short ID associated with
the patient’s ELIGIBILITY. For most eligibilities,this is the
last four digits of the Social Security Number.

This field is uneditable and triggered by the ‘LONG ID(#.03)’ field.
STRING    

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Ph Date/Time Updated (2.0534)

ID
Ph_Date_Time_Updated-2_0534

Properties

Label/Field Name Field # Description Datatype Attributes Range
Ph Date/Time Updated
  ph_date_time_updated
.01 This field is automatically stuffed with the current date and time
whenever the Purple Heart data is updated. This may be done initially by
the local site,then subsequently by HEC.
DATE-TIME INDEXED
REQUIRED
 
Ph?
  ph
1 Field will be stuffed with the CURRENT PURPLE HEART INDICATOR at the
date/time of the update.
BOOLEAN   false: N
true: Y
Ph Status
  ph_status
2 Field will be stuffed with CURRENT PURPLE HEART STATUS (if any) at
date/time of the update.
ENUMERATION   CONFIRMED: 3
IN PROCESS: 2
PENDING: 1
Ph Remarks
  ph_remarks
3 Field will be stuffed with CURRENT PURPLE HEART REMARKS field,if any,at
time of update.
ENUMERATION   UNDELIVERABLE MAIL: 6
VAMC: 5
ENTERED IN ERROR: 3
UNACCEPTABLE DOCUMENTATION: 1
NO DOCUMENTATION REC'D: 2
UNSUPPORTED PURPLE HEART: 4
Ph User
  ph_user
4 Field will be stuffed with the user who updated PH information. If
local user,then the value will be the free text user name from the
NEW PERSON file. If updated by the HEC,then the value will be
“HEC User”.
STRING    

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Icn History (2.0992)

ID
Icn_History-2_0992

Properties

Label/Field Name Field # Description Datatype Attributes Range
Icn History
  icn_history
.01 ICN History,to track changes in Integration Control Number for each
patient. This will be used by mumps code to perform lookups when ICN
can’t be found to see if it was used previously.
NUMERIC REQUIRED  
Icn Checksum
  icn_checksum
1 ICN Checksum for ICN entered in multiple. NUMERIC    
Cmor
  cmor
2 CMOR at the time of the ICN change. POINTER   Institution-4
Date/Time Of Change
  date_time_of_change
3 Date/Time of change to the ICN. DATE-TIME    

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Cmor History (2.0993)

ID
Cmor_History-2_0993

Properties

Label/Field Name Field # Description Datatype Attributes Range
Cmor History
  cmor_history
.01 Primary Care site for patient at time of change. NUMERIC REQUIRED  
Cmor Activity Score
  cmor_activity_score
1 CMOR score at time of change. NUMERIC    
Cmor Score Calculation Date
  cmor_score_calculation_date
2 Date CMOR score was last calculated at time of change. DATE-TIME    
Cmor Change Date
  cmor_change_date
3 Date CMOR was changed. DATE-TIME    

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Disposition Log-In Date/Time (2.101)

ID
Disposition_LogIn_Date_Time-2_101

Properties

Label/Field Name Field # Description Datatype Attributes Range
Log In Date/Time
  log_in_date_time
.01 The date/time the patient was registered using the ‘Register a Patient’
option in ADT should be entered into this field. Registrations must be
entered using the ADT module and should not be entered or edited using
VA FileMan options.
DATE-TIME INDEXED
REQUIRED
 
10-10T Registration
  _1010t_registration
.2 Was the patient registered using the 10-10T BOOLEAN   false: 0
true: 1
Status
  status
1 ter the appropriate code indicating the status of the patient’s visit.
Enter 0 if this patient had a 1010 visit (application for care). Enter
1 if the patient’s visit was not scheduled. Enter 2 if no exam was needed.
This data is used by the AMIS 400 series reports.
ENUMERATION   APPLICATION WITHOUT EXAM: 2
10/10 VISIT: 0
UNSCHEDULED: 1
Type Of Benefit Applied For
  type_of_benefit_applied_for
2 Enter the type of care this patient has applied for whether it be inpatient
(dom,hospital,or nursing home) or outpatient (dental,or non-dental).
ENUMERATION   OUTPATIENT MEDICAL: 3
DOMICILIARY: 2
HOSPITAL: 1
OUTPATIENT DENTAL: 4
NURSING HOME CARE: 5
Type Of Care Applied For
  type_of_care_applied_for
2.1 Enter the type of care that the patient is requesting service for. If
the patient will be receiving treatment for plastic surgery,dental care,
sterilization,or pregnancy,enter that choice. Otherwise,enter all
other.
ENUMERATION   STERILIZATION: 3
PREGNANCY: 4
DENTAL: 1
PLASTIC SURGERY: 2
ALL OTHER: 5
Facility Applying To
  facility_applying_to
3 Enter the facility (division) at which this patient will be receiving
care. This is a pointer to the MEDICAL CENTER DIVISION file.
POINTER   Medical_Center_Division-40_8
Who Entered 10/10
  who_entered_10_10
4 The user who entered the registration (1010 application) for this patient
will automatically be stored in this field. This field can be used for
tracking purposes. It should NOT be edited.
POINTER   New_Person-200
Log Out Date Time
  log_out_date_time
5 Enter in this field the date/time the patient was dispositioned. DATE-TIME    
Disposition
  disposition
6 Enter the type of disposition this patient had. Choose from the available
list whether the patient was scheduled for a future appointment,admitted
to your facility or another facility,or was released from care without
exam,for example. Many other choices also exist.
POINTER   Disposition-37
Reason For Late Disposition
  reason_for_late_disposition
8 As part of the ‘MAS Parameter Entry/Edit’ option,a site can determine how
may hours must elapse before a disposition is considered to be entered
late. If the time between the registration (log-in) date/time and the
disposition (log-out) date/time is found to be more than the number of
hours specified in the MAS parameters,the user will be prompted with
a reason for the late disposition. This is a pointer to the DISPOSITION
LATE REASON file.
POINTER   Disposition_Late_Reason-30
Who Dispositioned
  who_dispositioned
9 When a user dispositions a patient,the name of the user will automatically
be entered into this field. This field can be used for tracking purposes
at the site and should not be edited.
POINTER   New_Person-200
Description Of Incident
  description_of_incident
10 If the patient was injured in an accident,a brief description (from 3-250
characters) should be entered detailing what caused the injury.
STRING    
*Eligible For Medicaid
  eligible_for_medicaid
12 If this patient is eligible for medicaid,enter yes in this field.
Otherwise,entere no. This field is used for billing purposes.
BOOLEAN   false: 0
true: 1
Registration Eligibility Code
  registration_eligibility_code
13 When a patient is registered,the user registering the patient will be
asked for the patient’s eligibility under which they are receiving care.
The default will be the primary eligibility code. However,if the patient
also has other entitled eligibilities (employee,for example),one of
the other eligibilities may also be entered.
POINTER   Eligibility_Code-8
Elig Verified At Registration
  elig_verified_at_registration
14 If the eligibility was verified at the time of registration,this field
will be YES. Otherwise,it will be NO.
BOOLEAN   false: 0
true: 1
Sc At Registration
  sc_at_registration
15 If the patient being registered was SC (as determined by the SERVICE
CONNECTED? field on screen 7 of registration) at the time this application
was entered,YES will be stuffed into this field. Otherwise NO will be
filled in here.
BOOLEAN   false: 0
true: 1
Sc% At Registration
  sc_at_registration-2_101-16
16 If the patient was service connected at the time of this registration (as
determined by the SERVICE CONNECTED? field on registration screen 7),the
service connected percentage should be entered here. The default value
will be the percentage entered on registration screen 7.
NUMERIC    
Amis 420 Segment
  amis_420_segment
17 The AMIS 400 series reports are generated based on data in the DISPOSITION
LOG-IN DATE/TIME multiple. When an application is dispositioned,it is
deterined by the module which AMIS segment (401-420) this registration
should fall into. This information is created automatically by the MAS
module.
POINTER   Amis_Segment-391_1
Outpatient Encounter
  outpatient_encounter
18   POINTER   Outpatient_Encounter-409_68
Encounter Conversion Status
  encounter_conversion_status
19 This field indicates whether or not this disposition was converted
during the ACRP Database Conversion (SD5.3211).

The field is set to ‘1’ after the disposition has been converted
by the conversion software.
ENUMERATION   NOT CONVERTED: 0
CONVERTED: 1
Need Related To Occupation
  need_related_to_occupation
20 If the need for care is related to an injury or condition acquired while
the patient was performing work-related duties,yes should be entered here.
Otherwise,no should be entered.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Workmen'S Comp Claim Filed
  workmens_comp_claim_filed
21 If the injury or condition for which this patient is being treated occurred
while performing duties necessary for his/her job and the patient entered
a workmen’s compensation claim for this injury or condition,enter yes
here. Otherwise,enter no.
BOOLEAN   false: N
true: Y
Workmen'S Comp Claim Number
  workmens_comp_claim_number
22 If this patient is being seen for an injury or condition s/he received
while performing work related duties and s/he filed a claim with workmen’s
compensation,enter the claim number here. Otherwise,leave this field
blank.
STRING    
Need Related To An Accident
  need_related_to_an_accident
23 If the injury or condition for which this patient is being treated was the
result of an accident,enter yes here. Otherwise,answer no.
ENUMERATION   UNKNOWN: U
YES: Y
NO: N
Injury Caused By
  injury_caused_by
24 If the reason this patient is being seen at the medical center is due to
an injury sustained,enter what caused the injury. Otherwise,leave this
field blank.
STRING    
Injuring Parties Insurance
  injuring_parties_insurance
25 If the reason this patient is being seen at this medical center is due to
an injury sustained and there is a liable party,enter that party’s
insurance policy number. Otherwise,leave this field blank.
POINTER   Insurance_Company-36
Filed Against Injuring Party
  filed_against_injuring_party
26 If this patient is being seen is due to an injury resulting from another
person’s negligence,enter yes here if a claim has been filed against the
other party’s insurance company. Otherwise,answer no.
BOOLEAN   false: N
true: Y
Attorney'S Name
  attorneys_name
30 Enter the attorney’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.
STRING    
A-Address 1
  aaddress_1
31 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the first line the street address for the attorney.
STRING    
A-Address 2
  aaddress_2
32 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the second line of the street address for the attorney.
STRING    
A-Address 3
  aaddress_3
33 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the third line of the street address for the attorney.
STRING    
A-City
  acity
34 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the city where the attorney practices.
STRING    
A-State
  astate
35 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the the state where the attorney practices.
POINTER   State-5
A-Zip Code
  azip_code
36 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the zip code of the attorney’s address.
STRING    
A-Phone
  aphone
37 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the the attorney’s business phone number.
STRING    
A-Zip+4
  azip4
38 If the patient is being treated for an injury sustained due to the
negligence of another and the patient has an attorney covering the
incident,enter the zip code of the attorney’s address. Answer with
either the 5 digit format (e.g. 12345) or the nine digit format (e.g.
12345-6789 or 123456789).
STRING    
Active
  active
50 If this registration is currently active (not dispostioned) a 1 will be
stored in this field. Otherwise,the field should be left blank.
ENUMERATION INDEXED ACTIVE: 1
Attorney'S Name Components
  attorneys_name_components
100.21   POINTER   Name_Components-20
Ods At Registration?
  ods_at_registration
11500.01 Enter yes if this patient was an ODS patient at the time of this registration. Otherwise,respond no.
this registration. Otherwise,respond no.
BOOLEAN   false: 0
true: 1
Ods Registration Entry
  ods_registration_entry-2_101
  Enter the entry in the ODS REGISTRATIONS file which corresponds to this registration.      

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Appointment (2.98)

ID
Appointment-2_98

Properties

Label/Field Name Field # Description Datatype Attributes Range
Appointment Date/Time
  appointment_date_time
.001 This displays date/time function as defined in file manager. The
date/time of the appointment.
IEN    
Clinic
  clinic
.01   POINTER REQUIRED Hospital_Location-44
Status
  status
3 This field contains the current status of the patient’s appointment. If
the field is blank,it means the appointment has not been no-showed or
cancelled and the patient was not an inpatient at the time of the
appointment. This field is set automatically by the scheduling module and
must NOT be edited.
ENUMERATION   INPATIENT APPOINTMENT: I
NO ACTION TAKEN: NT
NO-SHOW: N
CANCELLED BY PATIENT & AUTO-REBOOK: PCA
NO-SHOW & AUTO RE-BOOK: NA
CANCELLED BY CLINIC: C
CANCELLED BY CLINIC & AUTO RE-BOOK: CA
CANCELLED BY PATIENT: PC
Lab Date/Time
  lab_date_time
5 If this patient is scheduled for laboratory tests in conjunction with this
appointment,enter the date/time the patient should report to the lab for
these tests.
DATE-TIME    
X-Ray Date/Time
  xray_date_time
6 If this patient is scheduled for x-rays in conjunction with this
appointment,enter the date/time the patient should report to radiology
for these x-rays.
DATE-TIME    
Ekg Date/Time
  ekg_date_time
7 If this patient is scheduled for EKG tests in conjuction with this clinic
appointment,enter the date/time the patient should report for these tests.
DATE-TIME    
Routing Slip Printed
  routing_slip_printed
8 If a routing sheet was printed for this appointment,this field will
contain a yes. Otherwise this field will contain a no. This is created
automatically by the scheduling module.
BOOLEAN   true: Y
Routing Slip Print Date
  routing_slip_print_date
8.5 If a routing sheet was printed for this visit,the date it was printed will
be stored here. This is stored automatically by the MAS module.
DATE-TIME    
Purpose Of Visit
  purpose_of_visit
9 Choose from the list of available choices the reason this patient has
this clinic appointment. Enter 1010 if this patient was sent to the
clinic after a 1010 application (registration). Enter C&P if this patient
is being seen for a comp and pension exam. Enter scheduled visit if this
patient is being seen for a previously scheduled appointment or unsched.
visit if the patient is a walk-in.
ENUMERATION   10-10: 2
UNSCHED. VISIT: 4
C&P: 1
SCHEDULED VISIT: 3
Appointment Type
  appointment_type
9.5 Enter from the available choices the type of appointment this patient is
scheduled for. This is a pointer to the APPOINTMENT TYPE file.
POINTER   Appointment_Type-409_1
Special Survey Disposition
  special_survey_disposition
10 If this patinet is claiming exposure to agent orange or ionizing radiation,
enter the special survey disposition,indicating whether his treatment was
related to that exposure,here.
NUMERIC    
Number Of Collateral Seen
  number_of_collateral_seen
11 If this patient is a collateral,enter the number assigned to that
collateral.
NUMERIC    
Auto-Rebooked Appt. Date/Time
  autorebooked_appt_date_time
12 If this appointment was cancelled and automatically rebooked for a future
date,this field will contain the date/time for which this appointment
was rescheduled. This field is created automatically by the scheduling
module and should not be edited.
DATE-TIME    
Collateral Visit
  collateral_visit
13 If this patient was seen as a collateral for another patient,enter YES
in this field. Otherwise,enter NO.
BOOLEAN   true: 1
No-Show/Cancelled By
  noshow_cancelled_by
14 If this appointment was listed as a no-show and was that no-show was
subsequently cancelled,this field will contain the user that cancelled
the no-show. This field is set automatically by the MAS module and should
not be edited.
POINTER   New_Person-200
No-Show/Cancel Date/Time
  noshow_cancel_date_time
15 If this appointment was listed as a no-show and that no-show was
subsequently cancelled,this field will contain the date/time the no-show
was cancelled. This field is set automatically by the scheduling module
and should not be edited.
DATE-TIME    
Cancellation Reason
  cancellation_reason
16 If this appointment was cancelled,this field will contain the reason the
appointment was cancelled. Choose from the available entries in the
CANCELLATION REASONS file.
POINTER   Cancellation_Reasons-409_2
Cancellation Remarks
  cancellation_remarks
17 If this appointment was cancelled,additional remarks as to the reason
the appointment was cancelled can be entered. This is optional.
STRING    
Appt. Cancelled
  appt_cancelled
18 Field is set when user cancels another appointment set at the same time
in another clinic for the same patient. This field reflects the clinic
in which the patient had a scheduled appointment which was cancelled to
set this appointment.
POINTER   Hospital_Location-44
Data Entry Clerk
  data_entry_clerk
19 This field contains the name of the user that entered the appointment
into the scheduling system. This field is created automatically by the
scheduling module and should not be edited.
POINTER   New_Person-200
Date Appt. Made
  date_appt_made
20 This field contains the date the appointment was entered into sheduling
system. This field is creatd automatically by the scheduling module and
should not be edited.
DATE-TIME    
Outpatient Encounter
  outpatient_encounter
21   POINTER   Outpatient_Encounter-409_68
Encounter Forms Printed
  encounter_forms_printed
22 Used by the Print Manager to indicate that it has printed
the encounter forms and other reports required by the division and
clinic for the appointment.
BOOLEAN   false: 0
true: 1
Encounter Forms As Add-Ons
  encounter_forms_as_addons
23 Used by the Print Manager to indicate that it has printed
the encounter forms and other reports required by the division and
clinic for the appointment and they were printed as an add-on.
BOOLEAN   false: 0
true: 1
Encounter Conversion Status
  encounter_conversion_status
23.1 This field indicates whether or not this appointment was converted
during the ACRP Database Conversion (SD5.3211).

The field is set to ‘1’ after the appointment has been converted
by the conversion software.
ENUMERATION   NOT CONVERTED: 0
CONVERTED: 1
Appointment Type Sub-Category
  appointment_type_subcategory
24 This field contains the sub-category associated with this appoitment. POINTER   Sharing_Agreement_SubCategory-35_2
Scheduling Request Type
  scheduling_request_type
25   ENUMERATION   AUTO REBOOK: A
MULTIPLE APPT. BOOKING: M
OTHER THAN 'NEXT AVA.' (CLINICIAN REQ.): C
'NEXT AVAILABLE' APPT.: N
OTHER THAN 'NEXT AVA.' (PATIENT REQ.): P
WALKIN APPT.: W
OTHER THAN 'NEXT AVA.' APPT.: O
Next Ava. Appt. Indicator
  next_ava_appt_indicator
26   ENUMERATION   'NEXT AVA.' APPT. INDICATED BY USER: 1
'NEXT AVA.' APPT. INDICATED BY CALCULATION: 2
NOT INDICATED TO BE A 'NEXT AVA.' APPT.: 0
'NEXT AVA.' APPT. INDICATED BY USER & CALCULATION: 3
Desired Date Of Appointment
  desired_date_of_appointment
27   DATE-TIME    
Follow-Up Visit
  followup_visit
28   BOOLEAN   false: 0
true: 1

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Archived Data (2.12)

ID
Archived_Data-2_12

Properties

Label/Field Name Field # Description Datatype Attributes Range
Data Type
  data_type
.01 This field identifies the type of data that was archived ENUMERATION INDEXED
REQUIRED
SPECIAL SURVEY DISP: SSD
APPOINTMENT: S
CLINIC ENROLLMENT: DE
Date Of Archive
  date_of_archive
1 This multiple contains data pertaining to each specific archive (the
date,the beginning and ending archiving dates,and the tape numbers).
OBJECT   Date_Of_Archive-2_13

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Date Of Archive (2.13)

ID
Date_Of_Archive-2_13

Properties

Label/Field Name Field # Description Datatype Attributes Range
Date Of Archive
  date_of_archive
.01 Enter the date/time the archiving utility was run.

This field is not currently used. The archiving software was not
distributed.
DATE-TIME REQUIRED  
Tape #
  tape_number
1 Enter the sequential number of the tape on which this archiving data
was put.
STRING    
Begin Archive Date
  begin_archive_date
2 Enter the date the user chose to begin the scheduling archive. DATE-TIME    
End Archive Date
  end_archive_date
3 Enter the ending date the user chose for the scheduling archive. DATE-TIME    
Number Of Records Archived
  number_of_records_archived
4 The number of records archived. This is created automatically by the
software.

This software has not been released and this field is not presently
used in DHCP.
NUMERIC    

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Document generated on August 31st 2017, 2:55:41 pm