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| 1 | REFDOC-v2.1.0.zip\NVCC\NVCC.WebUI.Tests | AuthorizationViewModelTests.cs | Thu Oct 19 17:36:42 2017 UTC |
| 2 | REFDOC-v2.1.0.zip\NVCC\NVCC.WebUI.Tests | AuthorizationViewModelTests.cs | Wed Nov 8 19:21:20 2017 UTC |
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| 1 | using Syst em.Collect ions.Gener ic; | |
| 2 | using NUni t.Framewor k; | |
| 3 | using NVCC .Models; | |
| 4 | using NVCC .WebUI.Mod els; | |
| 5 | ||
| 6 | namespace NVCC.WebUI .Tests | |
| 7 | { | |
| 8 | [TestF ixture] | |
| 9 | public class Aut horization ViewModelT ests | |
| 10 | { | |
| 11 | pr ivate stat ic IList<A uthorizati on> authLi st; | |
| 12 | ||
| 13 | [S etUp] | |
| 14 | pu blic void SetUp() | |
| 15 | { | |
| 16 | authList = new Lis t<Authoriz ation> | |
| 17 | { | |
| 18 | new Author ization | |
| 19 | { | |
| 20 | Author izationId = "0", | |
| 21 | Author izationTit le = "VHA CHOICE App roval", | |
| 22 | Author izationTex t = "LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE VA-F ORM 10-038 STANDARD TITLE: NON VA NOTE DA TE OF NOTE : OCT 16, 2015@10:00 ENTRY DAT E: OCT 16, 2015@10:0 0:50 AUTHO R: DURKEE- MURPHY,CYN TH EXP COS IGNER: URG ENCY: STAT US: COMPLE TED Depart ment of Ve terans Aff airs: VHA CHOICE APP ROVAL FOR MEDICAL CA RE VA-FORM 10-0386 P lease sele ct urgency : Routine Clinically Indicated Date: Sep 3,2015 De scription of Special ty: SCREEN ING MAMMO Eligibilit y Verifica tion: As t he authori zed VA rep resentativ e, I hereb y confirm that the V eteran is eligible f or Choice services b y checking basic eli gibility i n the Vete rans Choic e Viewer a pplication . Eligibil ity was ve rified on: Oct 16,20 15 Non-VA Care Progr am Manager or equiva lent: Name : CYNTHIA DURKEE-MUR PHY Title: Authoriza tion Clerk Veteran I nformation : Name: KA REN ANN TH OMAS DOB: APR 27,194 4 SSN: 543 -54-0934 S ervice-Con nected(SC) and/or Sp ecial Auth ority(SA): DS - Disa bilities E ligibility : NSC, VA PENSION VE RIFIED No REPORT ALL QUESTIONS RELATED T O THIS APP ROVAL TO T HE ISSUING VA OFFICE : VA POC N ame: Purch ased Care Division T elephone # : 360-759- 1674 From Station #: 648 Facil ity Name: VA Portlan d Healthca re System Street Add ress: VA P ortland He althcare S ystem City : Portland State: OR Zip: 9723 9 Fax: 360 -905-1731 In accorda nce with s ection 101 of the Ve terans Acc ess, Choic e, and Acc ountabilit y Act of 2 014 (the A ct) (Publi c Law 113- 146, 128 S tat. 1754) , as amend ed by the Department of Vetera ns Affairs (VA), the Expiring Authoritie s Act of 2 014 (Publi c Law 113- 175, 128 S tat. 1902) , the Cons olidated a nd Further Continuin g Appropri ations Act of 2015 ( Public Law 113 -235, 128 Stat. 2568), an d 38 CFR ? ? 17.1500- 1540, VA w ill pay fo r non-VA h ospital ca re and med ical servi ces that a re authori zed by VA for Vetera ns who are determine d by VA to meet the Veterans C hoice Prog ram eligib ility crit eria set f orth by se ction 101 of the Act and 38 CF R ? 17.151 0 and any other elig ibility st andards th at may app ly to part icular ser vices (suc h as healt h care for newborns of Veteran s under 38 CFR ? 17. 38(a)(xiv) and denta l benefits under ?? 17.160-17. 169). /es/ CYNTHIA D URKEE-MURP HY Purchas ed Care Vo ucher Exam iner Signe d: 10/16/2 015 10:03" | |
| 23 | }, | |
| 24 | new Autho rization | |
| 25 | { | |
| 26 | Author izationId = "1", | |
| 27 | Author izationTit le = "VHA CHOICE App roval", | |
| 28 | Author izationTex t= "LOCAL TITLE: VHA CHOICE AP PROVAL FOR MEDICAL C ARE VA-FOR M 10-038 S TANDARD TI TLE: NONVA NOTE DATE OF NOTE: OCT 26, 20 15@10:44 E NTRY DATE: OCT 26, 2 015@10:44: 48 AUTHOR: ONDRAK,AH NESTY EXP COSIGNER: URGENCY: S TATUS: COM PLETED Dep artment of Veterans Affairs: V HA CHOICE APPROVAL F OR MEDICAL CARE VA-F ORM 10-038 6 Please s elect urge ncy: Now C linically Indicated Date: Sep 25,2015 De scription of Special ty: Chirop ractic Eli gibility V erificatio n: As the authorized VA repres entative, I hereby c onfirm tha t the Vete ran is eli gible for Choice ser vices by c hecking ba sic eligib ility in t he Veteran s Choice V iewer appl ication. E ligibility was verif ied on: Oc t 7,2015 N on-VA Care Program M anager or equivalent : Name: Ah nesty Ondr ak Title: Authorizat ion Clerk Veteran In formation: Name: ERI C VICTOR F ARM DOB: A UG 2,1965 SSN: 544-7 4-4757 Ser vice-Conne cted(SC) a nd/or Spec ial Author ity(SA): D S - Disabi lities Eli gibility: SERVICE CO NNECTED 50 % to 100% VERIFIED T otal S/C % : 60 TRAUM ATIC BRAIN DISEASE 0 % S/C MIGR AINE HEADA CHES 50% S /C TINNITU S 10% S/C Yes REPORT ALL QUEST IONS RELAT ED TO THIS APPROVAL TO THE ISS UING VA OF FICE: VA P OC Name: P urchased C are Divisi on Telepho ne #: 360- 759-1674 F rom Statio n #: 648 F acility Na me: VA Por tland Heal thcare Sys tem Street Address: VA Portlan d Healthca re System City: Port land State : OR Zip: 97239 Fax: 360-905-1 731 In acc ordance wi th section 101 of th e Veterans Access, C hoice, and Accountab ility Act of 2014 (t he Act) (P ublic Law 113-146, 1 28 Stat. 1 754), as a mended by the Depart ment of Ve terans Aff airs (VA), the Expir ing Author ities Act of 2014 (P ublic Law 113-175, 1 28 Stat. 1 902), the Consolidat ed and Fur ther Conti nuing Appr opriations Act of 20 15 (Public Law 113 - 235, 128 S tat. 2568) , and 38 C FR ?? 17.1 500-1540, VA will pa y for non- VA hospita l care and medical s ervices th at are aut horized by VA for Ve terans who are deter mined by V A to meet the Vetera ns Choice Program el igibility criteria s et forth b y section 101 of the Act and 3 8 CFR ? 17 .1510 and any other eligibilit y standard s that may apply to particular services (such as h ealth care for newbo rns of Vet erans unde r 38 CFR ? 17.38(a)( xiv) and d ental bene fits under ?? 17.160 -17.169). /es/ AHNES TY ONDRAK Voucher Ex aminer Sig ned: 10/26 /2015 10:4 5" | |
| 29 | }, | |
| 30 | new Autho rization | |
| 31 | { | |
| 32 | Author izationId = "2", | |
| 33 | Author izationTit le = "VHA CHOICE App roval", | |
| 34 | Author izationTex t = "LOCAL TITLE: VH A CHOICE A PPROVAL FO R MEDICAL CARE VA-FO RM 10-038 STANDARD T ITLE: NONV A NOTE DAT E OF NOTE: OCT 12, 2 015@10:37 ENTRY DATE : OCT 12, 2015@10:37 :40 AUTHOR : VINCENT, CHRISTINA L EXP COSI GNER: URGE NCY: STATU S: COMPLET ED Departm ent of Vet erans Affa irs: VHA C HOICE APPR OVAL FOR M EDICAL CAR E VA-FORM 10-0386 Pl ease selec t urgency: STAT Clin ically Ind icated Dat e: Nov 19, 2015 Descr iption of Specialty: Orthopedi cs Eligibi lity Verif ication: A s the auth orized VA representa tive, I he reby confi rm that th e Veteran is eligibl e for Choi ce service s by check ing basic eligibilit y in the V eterans Ch oice Viewe r applicat ion. Eligi bility was verified on: Oct 12 ,2015 Non- VA Care Pr ogram Mana ger or equ ivalent: N ame: Chris tina Vince nt, RN Tit le: Other - Veteran Informatio n: Name: E RIC VICTOR FARM DOB: AUG 2,196 5 SSN: 544 -74-4757 S ervice-Con nected(SC) and/or Sp ecial Auth ority(SA): DS - Disa bilities E ligibility : SERVICE CONNECTED 50% to 100 % VERIFIED Total S/C %: 60 TIN NITUS 10% S/C TRAUMA TIC BRAIN DISEASE 0% S/C MIGRA INE HEADAC HES 50% S/ C No REPOR T ALL QUES TIONS RELA TED TO THI S APPROVAL TO THE IS SUING VA O FFICE: VA POC Name: Purchased Care Divis ion Teleph one #: 360 -759-1674 From Stati on #: 648 Facility N ame: VA Po rtland Hea lthcare Sy stem Stree t Address: VA Portla nd Healthc are System City: Por tland Stat e: OR Zip: 97239 Fax : 360-905- 1731 In ac cordance w ith sectio n 101 of t he Veteran s Access, Choice, an d Accounta bility Act of 2014 ( the Act) ( Public Law 113-146, 128 Stat. 1754), as amended by the Depar tment of V eterans Af fairs (VA) , the Expi ring Autho rities Act of 2014 ( Public Law 113-175, 128 Stat. 1902), the Consolida ted and Fu rther Cont inuing App ropriation s Act of 2 015 (Publi c Law 113 -235, 128 Stat. 2568 ), and 38 CFR ?? 17. 1500-1540, VA will p ay for non -VA hospit al care an d medical services t hat are au thorized b y VA for V eterans wh o are dete rmined by VA to meet the Veter ans Choice Program e ligibility criteria set forth by section 101 of th e Act and 38 CFR ? 1 7.1510 and any other eligibili ty standar ds that ma y apply to particula r services (such as health car e for newb orns of Ve terans und er 38 CFR ? 17.38(a) (xiv) and dental ben efits unde r ?? 17.16 0-17.169). /es/ CHRI STINA L VI NCENT Sign ed: 10/12/ 2015 10:38 " | |
| 35 | }, | |
| 36 | new Author ization | |
| 37 | { | |
| 38 | Author izationId = "3", | |
| 39 | Author izationTit le = "VHA CHOICE App roval", | |
| 40 | Author izationTex t = "LOCAL TITLE: VH A CHOICE A PPROVAL FO R MEDICAL CARE VA-FO RM 10-038 STANDARD T ITLE: NONV A NOTE DAT E OF NOTE: DEC 11, 2 015@15:50 ENTRY DATE : DEC 11, 2015@15:50 :06 AUTHOR : STIVASON ,JEFFERY G EXP COSIG NER: URGEN CY: STATUS : COMPLETE D TriWest Department of Vetera ns Affairs VHA CHOIC E APPROVAL FOR MEDIC AL CARE VA -FORM 10-0 386 Please select ur gency: Rou tine To fa cilitate U rgent Sche duling, pl ease inclu de an alte rnate poin t of conta ct's (diff erent than the NVCC staff memb er listed below) nam e, telepho ne number, and relat ionship to the patie nt (spouse , social w orker, tri age nurse, etc.) in space prov ided. Clin ically Ind icated Dat e: Dec 10, 2015 Descr iption of Specific S ervices an d Medical Specialist : ORTHOPED ICS ~ PAIN FUL ELBOW EVAL/TREAT MENT, POST -OP FOLLOW UP CARE, PHYSICAL T HERAPY. El igibility Verificati on: As the authorize d VA repre sentative, I hereby confirm th at the Vet eran is el igible for Choice se rvices by checking b asic eligi bility in the Vetera ns Choice Viewer app lication. Eligibilit y was veri fied on: D ec 11,2015 Non-VA Ca re Program Manager o r equivale nt: Name: JEFF STIVA SON Title: Authoriza tion Clerk Veteran I nformation : Name: ER IC VICTOR FARM DOB: AUG 2,1965 SSN: 544- 74-4757 Se rvice-Conn ected(SC) and/or Spe cial Autho rity(SA): Yes Local Health Car e Contract or: TriWes t Report a ll CRITICA L FINDINGS related t o this aut horization to the is suing offi ce below. ALL other questions regarding this autho rization s hould be d irected to : 1-866-60 6-8198 REP ORT ALL QU ESTIONS RE LATED TO T HIS APPROV AL TO THE ISSUING VA OFFICE: V A POC Name : Purchase d Care Div ision Tele phone #: 3 60-759-167 4 From Sta tion #: 64 8 Facility Name: VA Portland H ealthcare System Str eet Addres s: VA Port land Healt hcare Syst em City: P ortland St ate: OR Zi p: 97239 F ax: 360-90 5-1731 In accordance with sect ion 101 of the Veter ans Access , Choice, and Accoun tability A ct of 2014 (the Act) (Public L aw 113-146 , 128 Stat . 1754), a s amended by the Dep artment of Veterans Affairs (V A), the Ex piring Aut horities A ct of 2014 (Public L aw 113-175 , 128 Stat . 1902), t he Consoli dated and Further Co ntinuing A ppropriati ons Act of 2015 (Pub lic Law 11 3 -235, 12 8 Stat. 25 68), and 3 8 CFR ?? 1 7.1500-154 0, VA will pay for n on-VA hosp ital care and medica l services that are authorized by VA for Veterans who are de termined b y VA to me et the Vet erans Choi ce Program eligibili ty criteri a set fort h by secti on 101 of the Act an d 38 CFR ? 17.1510 a nd any oth er eligibi lity stand ards that may apply to particu lar servic es (such a s health c are for ne wborns of Veterans u nder 38 CF R ? 17.38( a)(xiv) an d dental b enefits un der ?? 17. 160-17.169 ). This or der is pla ced agains t the Pati ent Center ed Communi ty Care Co ntract in effect for this regi on: TriWes t: VA791-1 3-D-0054 / es/ JEFFER Y G STIVAS ON PCD-Vou cher Exami ner Signed : 12/11/20 15 15:52" | |
| 41 | }, | |
| 42 | new Author ization | |
| 43 | // Based o n VHA CHOI CE APPROVA L FOR MEDI CAL CARE V A-FORM 10- 0386 V3.0 U | |
| 44 | // generat ed on 8/29 /2016 from | |
| 45 | // Shared Templates -> NVCC -> Testing | |
| 46 | // for a t est patien t | |
| 47 | { | |
| 48 | Author izationId = "4", | |
| 49 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE VA-FORM 10-0386", | |
| 50 | Author izationTex t = " LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE VA-F ORM 10-038 \nSTANDARD TITLE: NO NVA NOTE \nDA TE OF NOTE : AUG 29, 2016@13:20 ENTRY DATE: AUG 29, 2016@ 13:22:07 \n AUTHOR: DIGGS,BRIA N S EXP COSIG NER: \n UR GENCY: STATUS : COMPLETE D \n\n Depar tment of V eterans Af fairs \n VHA C HOICE APPR OVAL FOR M EDICAL CAR E\n VA-FORM 10-0386\n\ nPlease se lect refer ral urgenc y: \nRouti ne\n\nIf U RGENT, ind icate time frame for appt: \n\n To facilit ate Urgent schedulin g, please include an alternate point \no f contact' s (differe nt than th e NVCC sta ff member listed bel ow) name,\ ntelephone number, a nd relatio nship to t he patient (social w orker, tri age nurse, \netc.) i n space pr ovided. \n Alternate point of c ontact 1-8 00-666-666 6\n\n\nCli nically In dicated Da te (CID):\ n\n08/31/2 016\n\nCat egory of C are/Type o f Speciali st: \n\nCa tegory: Cartogr aphy\nType of Spec: Orientier ing\n\nTyp e of Servi ce/Procedu re:\n\n T opoligical Mapping\n \nNumber o f Visits, Frequency and Durati on: \n\n As Needed\ n\n\n\n\n\ nEligibili ty Verific ation: \nA s the auth orized VA representa tive, I he reby confi rm that th e Veteran is \neligi ble for Ch oice servi ces. The V eteran's b asic eligi bility was verified\ nin the Ve terans Cho ice Viewer applicati on (VA Vie wer) on: A ug 29,2016 \n\nServic e-Connecte d(SC) and/ or Special Authority (SA):\nNo\ n\nContact local VA NVCC Offic e first to provide i nformation to VA or reach \nVA ordering provider. All contac t from Con tractor wi ll be docu mented in \nthe Vete ran's Reco rd by NVCC and VA Pr ovider not ified for awareness. \n\nRepor t all CRIT ICAL FINDI NGS relate d to this authorizat ion to the issuing o ffice \nbe low. ALL o ther quest ions regar ding this authorizat ion should be direct ed to: \n1 -866-606-8 198\n \nAO D/Emergenc y Contact After Hour s #: xxx-x xx-xxxx\n\ nFrom Stat ion #: XXX \nFacility Name: XXX \nStreet A ddress: XX X\nCity: X XX\nState: XXX\nZip: XXX\nFax: XXX\n\nVe teran Info rmation:\n Name: Zzte st, Cendy\ nDOB: xx/x x/xxxx\nSS N: xxx-xx- xxxx\nAddr ess: xxx M ain Street \nAnytown, USA\n\nPh one: xxx-x xx-xxxx\nV eteran Alt ernate Pho ne:yyy-yyy -yyyy\n\nV eteran Alt ernate Add ress: \n\n \nAlterna te POC for Veteran:( If availab le for VA internal u se)\nName: \nAddress : \n\nPhon e: \n\nIn accordance with sect ion 101 of the Veter ans Access , Choice, and \nAcco untability Act of 201 4 (the Act )(Public L aw 113-146 , 128 Stat . \n1754), as amende d by the D epartment of Veteran s Affairs (VA), the \nExpiring Authoriti es Act of 2014(Publi c Law 113- 175, 128 S tat. 1902) , \nthe Co nsolidated and Furth er Continu ing Approp riations A ct of 2015 \n(Public Law 113 - 235, 128 S tat. 2568) , and 38 C FR ?? 17.1 500-1540, \nVA will pay for no n-VA hospi tal care a nd medical services that are \ nauthorize d by VA fo r Veterans who are d etermined by VA to m eet the \n Veterans C hoice Prog ram eligib ility crit eria set f orth by se ction \n10 1 of the A ct and 38 CFR ? 17.1 510 and an y other el igibility \nstandard s that may apply to particular services (such as h ealth care \nfor new borns of V eterans un der 38 CFR ? 17.38(a )(xiv) and dental \n benefits u nder ?? 17 .160-17.16 9).\n \n/e s/ Brian S Diggs, Ph D\nProgram Analyst\n Signed: 08 /29/2016 1 3:25\n" | |
| 51 | }, | |
| 52 | new Author ization | |
| 53 | // Adapted from a no te from Sp okane, pro vided by S andra Grav elle, 2016 /09/13 | |
| 54 | // PPI has been reda cted | |
| 55 | // Manuall y converte d newlines to '\n' | |
| 56 | // Seems t o be based on versio n 3, but w ith "If UR GENT" chan ged to "If ROUTINE" | |
| 57 | { | |
| 58 | Author izationId = "5", | |
| 59 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE VA-FORM 10-038", | |
| 60 | Author izationTex t = "LOCAL TITLE: VH A CHOICE A PPROVAL FO R MEDICAL CARE VA-FO RM 10-038\ nSTANDARD TITLE: NON VA NOTE \nDAT E OF NOTE: SEP 13, 2 016@15:27 ENTRY DATE: SEP 13, 2016@1 5:27:32 \n AUTHOR: G RAVELLE,SA NDRA JO EXP COSIGN ER: \n URG ENCY: STATUS: COMPLETED \n\n Depart ment of Ve terans Aff airs \n VHA CH OICE APPRO VAL FOR ME DICAL CARE \n VA-FORM 1 0-0386\n\n Please sel ect referr al urgency : \nRoutin e\n\nIf RO UTINE, ind icate time frame for appt: \n\n To facilit ate Urgent schedulin g, please include an alternate point \no f contact' s (differe nt than th e NVCC sta ff member listed bel ow) name,\ ntelephone number, a nd relatio nship to t he patient (social w orker, tri age nurse, \netc.) i n space pr ovided. \n \n\nClinic ally Indic ated Date (CID):\n09 /12/2016\n \nCategory of Care/T ype of Spe cialist: \ n\nCategor y: NE UROLOGY\nT ype of Spe cialist: \ n NEUROLOG Y EEG DIAG NOSTIC\n\n Type of Se rvice/Proc edure:\n\n Dizzines s and Gidd iness(ICD- 10-CM R42. )\n\nNumbe r of Visit s, Frequen cy and Dur ation: \n\ n 1 VISIT FOR A 90 DAY EPISOD E OF CARE\ n\n\n\n\n\ nEligibili ty Verific ation: \nA s the auth orized VA representa tive, I he reby confi rm that th e Veteran is \neligi ble for Ch oice servi ces. The V eteran's b asic eligi bility was verified\ nin the Ve terans Cho ice Viewer applicati on (VA Vie wer) on: S ep 13,2016 \n\nServic e-Connecte d(SC) and/ or Special Authority (SA):\nNo\ n\nContact local VA NVCC Offic e first to provide i nformation to VA or reach \nVA ordering provider. All contac t from Con tractor wi ll be docu mented in \nthe Vete ran's Reco rd by NVCC and VA Pr ovider not ified for awareness. \n\nRepor t all CRIT ICAL FINDI NGS relate d to this authorizat ion to the issuing\n office bel ow. ALL ot her questi ons regard ing this a uthorizati on should be\ndirect ed to: 1-8 66-606-819 8\n\nAOD/E mergency C ontact Aft er Hours # : 509-434- 7010\n\nFr om Station #: 668\nF acility Na me: Mann Grandstaff VAMC\nStr eet Addres s: 4815 N Assembly S treet\nCit y: Spokane \nState: Wa shington\n Zip: 9920 5\nFax: 1 -509-484-7 941\n\nVet eran Infor mation:\nN ame: XXXX XXX,XXX XX XXX\nDOB: JAN 1,18 00\nSSN: XXX-XX-XX XX\nAddres s:123 Main Street\n SPOKANE VALLEY, WA 99212\nP hone: XXX XXX XXXX\n Veteran Al ternate Ph one:\n\nVe teran Alte rnate Addr ess: \n\n\ nAlternate POC for V eteran:(If available for VA in ternal use )\nName: \ nAddress: \n\nPhone: \nIn acco rdance wit h section 101 of the Veterans Access, Ch oice, and \nAccounta bilityAct of 2014 (t he Act)(Pu blic Law 1 13-146, 12 8 Stat. \n 1754), as amended by the Depar tment of V eterans Af fairs (VA) , the \nEx piring Aut horities A ct of 2014 (Public La w 113-175, 128 Stat. 1902), \n the Consol idated and Further C ontinuing Appropriat ions Act o f 2015 \n( Public Law 113 -235, 128 Stat. 2568), an d 38 CFR ? ? 17.1500- 1540, \nVA will pay for non-VA hospital care and m edical ser vices that are \naut horized by VA for Ve terans who are deter mined by V A to meet the \nVete rans Choic e Program eligibilit y criteria set forth by sectio n \n101 of the Act a nd 38 CFR ? 17.1510 and any ot her eligib ility \nst andards th at may app ly to part icular ser vices (suc h as healt h care \nf or newborn s of Veter ans under 38 CFR ? 1 7.38(a)(xi v) and den tal \nbene fits under ?? 17.160 -17.169).\ n\n/es/ SA NDRA JO GR AVELLE\nCL AIMS ASSIS TANT\nSign ed: 09/13/ 2016 15:30 \n" | |
| 61 | }, | |
| 62 | new Author ization | |
| 63 | // From a note from Atlanta, p rovided by Charles D emosthenes , 2016/09/ 16 | |
| 64 | // Manuall y converte d newlines to '\n' | |
| 65 | { | |
| 66 | Author izationId = "6", | |
| 67 | Author izationTit le = "", / / Local no te title u nknown | |
| 68 | Author izationTex t = " Depart ment of Ve terans Aff airs \n VHA CH OICE APPRO VAL FOR ME DICAL CARE \n VA-FORM 1 0-0386\n\n Please sel ect referr al urgency : \nRoutin e\n\nIf RO UTINE, ind icate time frame for appt: I th ink this s hould if N OT routine \n\nTo fac ilitate Ur gent sched uling, \np lease incl ude an alt ernate poi nt \nof co ntact's (d ifferent t han the NV CC staff m ember list ed below) name,\ntel ephone num ber, and r elationshi p to the p atient (so cial worke r, triage nurse, \ne tc.) in sp ace provid ed. \njoe nurse\n\n\ nClinicall y Indicate d Date (CI D):\n\n05/ 06/2016\n\ nCategory of Care/Ty pe of Spec ialty: \n\ nCategory: Orth opedist\n\ nType of S pecialist: \n\nOrthop edist\n\nT ype of Ser vice/Proce dure:\n\n Orthopedi c help\nDe scription of Special ty:\nALL O THER SPECI ALTIES: Or thopedics\ n\n\n \nNu mber of Vi sits, Freq uency and Duration: \n\n 4\n\ n\nVeteran or VAMC P referred P rovider Na me and Con tact Infor mation:\n Dr smith\ n\nEligibi lity Verif ication: \ nAs the au thorized V A represen tative, I hereby con firm that the Vetera n is \neli gible for Choice ser vices. The Veteran's basic eli gibility w as verifie d\nin the Veterans C hoice View er applica tion (VA V iewer) on: \nSep 16, 2016\n\nSe rvice-Conn ected(SC) and/or Spe cial Autho rity(SA):\ nNo\n\nCon tact local VA NVCC O ffice firs t to provi de informa tion to VA or reach \nVA order ing provid er. All co ntact from Contracto r will be documented in \nthe Veteran's Record by NVCC and V A Provider notified for awaren ess. \n\nR eport all CRITICAL F INDINGS re lated to t his author ization to the issui ng office \nbelow. A LL other q uestions r egarding t his author ization sh ould be di rected to: \n1-866-6 06-8198\n \nMOD/Emer gency Cont act After Hours #: 7 465\n\nFro m Station #: 508\nFa cility Nam e: Atlanta VA Medica l Center\n Street Add ress: 1670 Clairmont Road\nCit y: Decatur \nState: G A\nZip: 30 033\nFax: wer234\n\n Veteran In formation: \nName: HU MPTY JR ZZ DUMPTY\nDO B: JAN 1,1 945\nSSN: 000-00-888 8\nAddress : 1670 CLA IRMONT ROA D\nDECATUR , GEORGIA 30033\nPh one: (555) 555-5555\n Veteran Al ternate Ph one:3rewfs dc\n\nVete ran Altern ate Addres s: \nasdfx cz\n\n \nA lternate P OC for Vet eran:(If a vailable f or VA inte rnal use)\ nName: das fcxz\nAddr ess: \nasd fzcx\n\nPh one: dsafc vxz \n\nIn accordanc e with sec tion 101 o f the Vete rans Acces s, Choice, and \nAcc ountabilit yAct of 20 14 (the Ac t)(Public Law 113-14 6, 128 Sta t. \n1754) , as amend ed by the Department of Vetera ns Affairs (VA), the \nExpirin g Authorit ies Act of 2014(Publ ic Law 113 -175, 128 Stat. 1902 ), \nthe C onsolidate d and Furt her Contin uing Appro priations Act of 201 5 \n(Publi c Law 113 -235, 128 Stat. 2568 ), and 38 CFR §§ 17. 1500-1540, \nVA will pay for n on-VA hosp ital care and medica l services that are \nauthoriz ed by VA f or Veteran s who are determined by VA to meet the \ nVeterans Choice Pro gram eligi bility cri teria set forth by s ection \n1 01 of the Act and 38 CFR § 17. 1510 and a ny other e ligibility \nstandar ds that ma y apply to particula r services (such as health car e \nfor ne wborns of Veterans u nder 38 CF R § 17.38( a)(xiv) an d dental \ nbenefits under §§ 1 7.160-17.1 69).\n" | |
| 69 | }, | |
| 70 | new Author ization | |
| 71 | // From a diagnostic mammograp hy note fr om Atlanta , provided by Charle s Demosthe nes, 2016/ 09/17 | |
| 72 | // Line br eaks conve rted to '\ n' | |
| 73 | { | |
| 74 | Author izationId = "7", | |
| 75 | Author izationTit le = "", / / Local no te title u nknown | |
| 76 | Author izationTex t = " Depart ment of Ve terans Aff airs \n VHA CH OICE APPRO VAL FOR ME DICAL CARE \n VA-FORM 1 0-0386\n\n Please sel ect referr al urgency : \nRoutin e\n\nIf RO UTINE, ind icate time frame for appt: rout ine\n\nTo facilitate Urgent sc heduling, please inc lude an al ternate po int \nof c ontact's ( different than the N VCC staff member lis ted below) name,\nte lephone nu mber, and relationsh ip to the patient (s ocial work er, triage nurse, \n etc.) in s pace provi ded. \njoe \n\n\nClin ically Ind icated Dat e (CID):\n \n03/06/20 16\n\nCate gory of Ca re/Type of Specialty : \n\nCate gory: Mammograp hy\n\nType of Specia list:\n\nm ammorgraph y\n\nType of Service /Procedure :\n\n mam morgraphy\ nDescripti on of Spec ialty:\nCH OICE-FIRST DIAGNOSTI C MAMMOGRA M\nService : Radiolog y - DIAGNO STIC Mammo graphy\nDi agnosis: A bnormal ma mmogram R9 2.8 \n\nVi sits Autho rized: 6\n \nFax numb er: 404-72 8-4824\n\n Administra tive and c linical el igibility verified f or NVCC.\n Clinical a nd adminis trative el igibility verified f or Choice- Program. \ n\nApprove d one (1) diagnostic bilateral (or unila teral) mam mography. \n\nApp roved addi tional vie ws/supplem ental imag ing, visit s for imag ing, if \n clinically indicated , for susp icious fin dings or l esion(s).\ n\nApprove d breasts ultrasound , fine nee dle biopsy , or stere otactic\nb reast biop sy, includ ing visit to accompl ish diagno stic testi ng, if\ncl inically i ndicated. \n\nOne (1 ) follow-u p office v isit not t o exceed a level 2, is pre-app roved\nfor follow up post proc edure, if biopsy was performed , to discu ss patholo gy\nfindin gs and tre atment pla n.\n\nALL specimens submitted for pathol ogy evalua tion and r eport, as a result\n of an appr oved proce dure, are authorized for payme nt/reimbur sement as well. \n\ nAuthoriza tion inclu des all in -office as sociated l abs and ra diology te sts\nas cl inically i ndicated.\ n\nNo diag nostics, t reatments, procedure s, referra ls to othe r non-VA s pecialists , \netc., except as listed abo ve, are au thorized a t this tim e.\n\nUse critical f indings in structions to report abnormal results.\n Number of Visits, Fr equency an d Duration : \n\n 5\ n\n\n\n\n\ nEligibili ty Verific ation: \nA s the auth orized VA representa tive, I he reby confi rm that th e Veteran is \neligi ble for Ch oice servi ces. The V eteran's b asic eligi bility was verified\ nin the Ve terans Cho ice Viewer applicati on (VA Vie wer) on: \ nSep 16,20 16\n\nServ ice-Connec ted(SC) an d/or Speci al Authori ty(SA):\nY es\n\nCont act local VA NVCC Of fice first to provid e informat ion to VA or reach \ nVA orderi ng provide r. All con tact from Contractor will be d ocumented in \nthe V eteran's R ecord by N VCC and VA Provider notified f or awarene ss. \n\nRe port all C RITICAL FI NDINGS rel ated to th is authori zation to the issuin g office \ nbelow. AL L other qu estions re garding th is authori zation sho uld be dir ected to: \n1-866-60 6-8198\n \ nMOD/Emerg ency Conta ct After H ours #: 74 65\n\nFrom Station # : 508\nFac ility Name : Atlanta VA Medical Center\nS treet Addr ess: 1670 Clairmont Road\nCity : Decatur\ nState: GA \nZip: 300 33\nFax: a sd\n\nVete ran Inform ation:\nNa me: HUMPTY JR ZZDUMP TY\nDOB: J AN 1,1945\ nSSN: 000- 00-8888\nA ddress: 16 70 CLAIRMO NT ROAD\nD ECATUR, GE ORGIA 300 33\nPhone: (555)555- 5555\nVete ran Altern ate Phone: asd\n\nVet eran Alter nate Addre ss: \n\n \ nAlternate POC for V eteran:(If available for VA in ternal use )\nName: \ nAddress: \n\nPhone: \n\nIn ac cordance w ith sectio n 101 of t he Veteran s Access, Choice, an d \nAccoun tabilityAc t of 2014 (the Act)( Public Law 113-146, 128 Stat. \n1754), a s amended by the Dep artment of Veterans Affairs (V A), the \n Expiring A uthorities Act of 20 14(Public Law 113-17 5, 128 Sta t. 1902), \nthe Cons olidated a nd Further Continuin g Appropri ations Act of 2015 \ n(Public L aw 113 -23 5, 128 Sta t. 2568), and 38 CFR §§ 17.150 0-1540, \n VA will pa y for non- VA hospita l care and medical s ervices th at are \na uthorized by VA for Veterans w ho are det ermined by VA to mee t the \nVe terans Cho ice Progra m eligibil ity criter ia set for th by sect ion \n101 of the Act and 38 CF R § 17.151 0 and any other elig ibility \n standards that may a pply to pa rticular s ervices (s uch as hea lth care \ nfor newbo rns of Vet erans unde r 38 CFR § 17.38(a)( xiv) and d ental \nbe nefits und er §§ 17.1 60-17.169) .\n" | |
| 77 | }, | |
| 78 | new Author ization | |
| 79 | // From a mammograph y note fro m Atlanta, provided by Charles Demosthen es, 2016/0 9/17 | |
| 80 | // Line br eaks conve rted to '\ n' | |
| 81 | { | |
| 82 | Author izationId = "8", | |
| 83 | Author izationTit le = "", / / Local no te title u nknown | |
| 84 | Author izationTex t = " Depart ment of Ve terans Aff airs \n VHA CH OICE APPRO VAL FOR ME DICAL CARE \n VA-FORM 1 0-0386\n\n Please sel ect referr al urgency : \nRoutin e\n\nIf RO UTINE, ind icate time frame for appt: \n\n To facilit ate Urgent schedulin g, please include an alternate point \no f contact' s (differe nt than th e NVCC sta ff member listed bel ow) name,\ ntelephone number, a nd relatio nship to t he patient (social w orker, tri age nurse, \netc.) i n space pr ovided. \n \n\nClinic ally Indic ated Date (CID):\n\n 03/07/1800 \n\nCatego ry of Care /Type of S pecialty: \n\nCatego ry: m ammorgraph y\n\nType of Special ist:\n\n\n \nType of Service/Pr ocedure:\n \n mammor gaphy\nDes cription o f Specialt y:\nCHOICE -FIRST SCR EENING MAM MOGRAM\nSe rvice: Rad iology – S CREENING M ammography \nDiagnosi s: Mammogr aphy scree ning Z12.3 1 \n\nVisi ts Authori zed: 6\n\n Fax number : 404-728- 4824\n\nCl inical and administr ative elig ibility ve rified for NVCC.\nCl inical and administr ative elig ibility ve rified for Choice-Pr ogram. \n\ nApproved for one (1 ) screenin g bilatera l (or unil ateral) ma mmography. \n\nAp proved for additiona l views/su pplemental imaging, if clinica lly indica ted,\nfor suspicious findings or lesion( s). \n\nA pproved fo r diagnost ic mammogr aphy, brea st(s) ultr asound, fi ne needle\ nbiopsy(ie s), or ste reotactic breast bio psy(ies), if clinica lly indica ted,\nincl uding visi ts to comp lete suppl emental im aging. \n\ nApproved for one (1 ) follow-u p office v isit, not to exceed a level 2, \npost pro cedure, if biopsy wa s performe d, to disc uss pathol ogy findin gs\nand tr eatment pl an.\n\nALL specimen( s) submitt ed for pat hology eva luation an d report a s result\n from the a pproved pr ocedure(s) , are auth orized for payment/r eimburseme nt\nas wel l. \n\nAu thorizatio n includes all in-of fice assoc iated labs and radio logy tests , \nas cli nically in dicated.\n \nNo diagn ostics, tr eatments, procedures , referral s to other non-VA sp ecialists, \netc., ex cept as li sted above , are auth orized at this time. \n\nUse cr itical fin dings inst ructions t o report a bnormal re sults.\n\n \n \nNumb er of Visi ts, Freque ncy and Du ration: \n \n 6\n\n\ n\n\n\nEli gibility V erificatio n: \nAs th e authoriz ed VA repr esentative , I hereby confirm t hat the Ve teran is \ neligible for Choice services. The Veter an's basic eligibili ty was ver ified\nin the Vetera ns Choice Viewer app lication ( VA Viewer) on: \nSep 16,2016\n \nService- Connected( SC) and/or Special A uthority(S A):\nNo\n\ nContact l ocal VA NV CC Office first to p rovide inf ormation t o VA or re ach \nVA o rdering pr ovider. Al l contact from Contr actor will be docume nted in \n the Vetera n's Record by NVCC a nd VA Prov ider notif ied for aw areness. \ n\nReport all CRITIC AL FINDING S related to this au thorizatio n to the i ssuing off ice \nbelo w. ALL oth er questio ns regardi ng this au thorizatio n should b e directed to: \n1-8 66-606-819 8\n \nMOD/ Emergency Contact Af ter Hours #: 7465\n\ nFrom Stat ion #: 508 \nFacility Name: Atl anta VA Me dical Cent er\nStreet Address: 1670 Clair mont Road\ nCity: Dec atur\nStat e: GA\nZip : 30033\nF ax: adsf\n \nVeteran Informatio n:\nName: HUMPTY JR ZZDUMPTY\n DOB: JAN 1 ,1945\nSSN : 000-00-8 888\nAddre ss: 1670 C LAIRMONT R OAD\nDECAT UR, GEORGI A 30033\n Phone: (55 5)555-5555 \nVeteran Alternate Phone:asdf \n\nVetera n Alternat e Address: \nadsf\n\ n \nAltern ate POC fo r Veteran: (If availa ble for VA internal use)\nName : \nAddres s: \n\nPho ne: \n\nIn accordanc e with sec tion 101 o f the Vete rans Acces s, Choice, and \nAcc ountabilit yAct of 20 14 (the Ac t)(Public Law 113-14 6, 128 Sta t. \n1754) , as amend ed by the Department of Vetera ns Affairs (VA), the \nExpirin g Authorit ies Act of 2014(Publ ic Law 113 -175, 128 Stat. 1902 ), \nthe C onsolidate d and Furt her Contin uing Appro priations Act of 201 5 \n(Publi c Law 113 -235, 128 Stat. 2568 ), and 38 CFR §§ 17. 1500-1540, \nVA will pay for n on-VA hosp ital care and medica l services that are \nauthoriz ed by VA f or Veteran s who are determined by VA to meet the \ nVeterans Choice Pro gram eligi bility cri teria set forth by s ection \n1 01 of the Act and 38 CFR § 17. 1510 and a ny other e ligibility \nstandar ds that ma y apply to particula r services (such as health car e \nfor ne wborns of Veterans u nder 38 CF R § 17.38( a)(xiv) an d dental \ nbenefits under §§ 1 7.160-17.1 69).\n" | |
| 85 | }, | |
| 86 | new Author ization | |
| 87 | // Created by Brian Diggs on 9 /22/2016 f rom Note t itle: VCP- CHOICE PRO V AGRMT VA F 10-0386A | |
| 88 | // Manuall y removed line break s. | |
| 89 | { | |
| 90 | Author izationId = "9", | |
| 91 | Author izationTit le = "VCP- CHOICE PRO V AGRMT VA F 10-0386A ", | |
| 92 | Author izationTex t = "REFER RAL INFORM ATION\n D epartment of Veteran s Affairs \n VETER ANS CHOICE PROVIDER AGREEMENT AUTHORIZAT ION\n VA-FORM 10-0386a\n \nReason f or Use of Provider A greement:V eteran Req uested Spe cific Prov ider\n\nCo mmunity Pr ovider Nam e(s):\n D r. Bob\n\n Authorizat ion Number : xx\n\nVA Ordering Provider: Dr. Howard \n\nPleas e select r eferral ur gency: \nR outine\n\n To facilit ate Urgent schedulin g, please include an alternate point \no f contact' s (differe nt than th e NVCC sta ff member listed bel ow) name,\ ntelephone number, a nd relatio nship to t he patient (social w orker, tri age nurse, \netc.) i n space pr ovided. \n \n\nSecond ary Author ization Re quest(SAR) :\n\n \n \nServices and Timef rame Autho rized:\n\n Specialty: \n\n Car diology\n\ nType of S pecialist: \n\n Echo cardiograp hist\n\nTy pe of Serv ice/Proced ure:\n\n EEG\n\nNum ber of Vis its, Frequ ency and D uration: \ n\n x\n\n \nDate VA Requests s ervices un der Provid er Agreeme nt:\nSep 2 3,2016@06: 00\n\n\n\n \n\nVetera n Informat ion:\nName : ZZTEST,C ENDY\nDOB: JAN 5,195 4\nSSN: 00 0-00-0014\ nAddress: 1750 BLANK ENSHIP RD\ nPORTLAND, OR 98665 \nPhone: 3 602705995\ n\n \n\n\n \n(include name, add ress and p hone if kn own)\n\n\n Eligiblity Type(From initial a uthorizati on if appl icable):\n Veterans C hoice 40 M ile\n\nEli gibility V erificatio n: \nAs th e authoriz ed VA repr esentative , I hereby confirm t hat the Ve teran is \ neligible for Choice services. The Veter an's basic eligibili ty was ver ified\nin the Vetera ns Choice Viewer app lication ( VA Viewer) on: \n09/ 22/2016\n\ nVeteran O ther Healt h Insuranc e (OHI):\n \n Does V eteran hav e billable OHI?:\n\n No - Ve teran does not have billable O HI - VA Pr imary Paye r\n\n\n\nS ervice-Con nected(SC) and/or Sp ecial Auth ority(SA): \n Not a pplicable - Veteran does not h ave billab le OHI\n \n\nVA Co mmunity Ca re Manager or equiva lent:\n\nN ame: XX\n\ nTitle: XX \n\nVA Iss uing Offic e:\nVA Com munity Car e Contact #: XX\nAft er Hours P OC #: XX\n \nContact local VA C ommunity C are Office first to provide in formation to VA or \ nreach VA ordering p rovider. A ll contact from Comm unity Care Provider will be \n documented in the Ve teran's Re cord by VA Community Care staf f and VA O rdering \n Provider n otified fo r awarenes s. Report all CRITIC AL FINDING S related to this \n authorizat ion to the VA Commun ity Care O ffice abov e.\n\nFrom Station # : 648\nFac ility Name : Portland \nStreet A ddress: xx x\nCity: x xx\nState: xxx\nZip: xxx\nFax: xxx\n" | |
| 93 | }, | |
| 94 | new Author ization | |
| 95 | // Provide d by Rick Woods, 10/ 20/2016 | |
| 96 | // as "Tel e Mental H ealth" not e | |
| 97 | // "Just a n FYI ther e is going to be som e addition s made to the 10-038 6, but onl y for 3-6 pilot site s. I don’ t have a t imeline ye t. | |
| 98 | // I have made the t eam aware that I nee d to have you look a t the form first to make sure that the R EF DOC too l will wor k prior to moving fo rward." | |
| 99 | { | |
| 100 | Author izationId = "10", | |
| 101 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE FORM 10 -0386", | |
| 102 | Author izationTex t = " LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE FORM 10-0386 \nSTANDARD TITLE: NO NVA NOTE \nDA TE OF NOTE : OCT 20, 2016@10:39 ENTRY DATE: OCT 20, 2016@ 10:39:31 \n AUTHOR: WOODS,GARO LD R EXP COSIG NER: \n UR GENCY: STATUS : COMPLETE D \n\n Depar tment of V eterans Af fairs \n VHA C HOICE APPR OVAL FOR M EDICAL CAR E\n VA-FORM 10-0386\n\ nPlease se lect refer ral urgenc y: \nRouti ne\n\nIf R OUTINE, in dicate tim eframe for appt: AAA AAAAA\n\nT o facilita te Urgent scheduling , please i nclude an alternate point \nof contact's (differen t than the NVCC staf f member l isted belo w) name,\n telephone number, an d relation ship to th e patient (social wo rker, tria ge nurse, \netc.) in space pro vided. \n\ n\nClinica lly Indica ted Date ( CID):\n\n1 0/20/2016\ n\nTele Me ntal Healt h\nCogniti ve Behavio ral Therap y(CBT) \nV A Behavior al Health Provider N ame: AAAA \nVA Behav ioral Heal th Provide r Phone: A AAAA\nVA A OD/Emergen cy Contact After Hou rs #: AAA AAA\n\nNum ber of Vis its, Frequ ency and D uration: \ n\n AAAAA AAAAAAAAAA AAA\n\n\n\ n\n\nEligi bility Ver ification: \nAs the authorized VA repres entative, I hereby c onfirm tha t the Vete ran is \ne ligible fo r Choice s ervices. T he Veteran 's basic e ligibility was verif ied\nin th e Veterans Choice Vi ewer appli cation (VA Viewer) o n: Oct 20, 2016\n\nSe rvice-Conn ected(SC) and/or Spe cial Autho rity(SA):\ nNo\n\nCon tact local VA NVCC O ffice firs t to provi de informa tion to VA or reach \nVA order ing provid er. All co ntact from Contracto r will be documented in \nthe Veteran's Record by NVCC and V A Provider notified for awaren ess. \n\nR eport all CRITICAL F INDINGS re lated to t his author ization to the issui ng office \nbelow. A LL other q uestions r egarding t his author ization sh ould be di rected to: \n1-866-6 06-8198\n \nAOD/Emer gency Cont act After Hours #: 5 61-422-827 7 (AOD)\n\ nFrom Stat ion #: 548 \nFacility Name: WES T PALM BEA CH VA MEDI CAL CENTER \nStreet A ddress: 73 05 N. MILI TARY TRAIL \nCity: WE ST PALM BE ACH\nState : FLORIDA\ nZip: 3341 0\nFax: 56 1-422-1575 \n\nVetera n Informat ion:\nName : AA-TLAZL Y,DETLY L\ nDOB: NOV 23,1971\nS SN: 101-1 7-9793\nAd dress: \n1 735 VIARRI TZ DRIVE\n BOONVILLE MT 12345\n Phone: Hom e Phone# 4 04-656-112 2\nVeteran Alternate Phone:\n\ nVeteran A lternate A ddress: \n \n \nAlter nate POC f or Veteran :(If avail able for V A internal use)\nNam e: \nAddre ss: \n\nPh one: \n\nI n accordan ce with se ction 101 of the Vet erans Acce ss, Choice , and \nAc countabili ty Act of 2014 (the Act)(Publi c Law 113- 146, 128 S tat. \n175 4), as ame nded by th e Departme nt of Vete rans Affai rs (VA), t he \nExpir ing Author ities Act of 2014(Pu blic Law 1 13-175, 12 8 Stat. 19 02), \nthe Consolida ted and Fu rther Cont inuing App ropriation s Act of 2 015 \n(Pub lic Law 11 3 -235, 12 8 Stat. 25 68), and 3 8 CFR §§ 1 7.1500-154 0, \nVA wi ll pay for non-VA ho spital car e and medi cal servic es that ar e \nauthor ized by VA for Veter ans who ar e determin ed by VA t o meet the \nVeteran s Choice P rogram eli gibility c riteria se t forth by section \ n101 of th e Act and 38 CFR § 1 7.1510 and any other eligibili ty \nstand ards that may apply to particu lar servic es (such a s health c are \nfor newborns o f Veterans under 38 CFR § 17.3 8(a)(xiv) and dental \nbenefit s under §§ 17.160-17 .169).\n \ n/es/ Garo ld R Woods ,RN\nHealt h Informat ics Specia list\nSign ed: 10/20/ 2016 10:40 \n" | |
| 103 | }, | |
| 104 | new Author ization | |
| 105 | // Provide d by Rick Woods, 10/ 20/2016 | |
| 106 | // as "Oth er Service " note | |
| 107 | // "Just a n FYI ther e is going to be som e addition s made to the 10-038 6, but onl y for 3-6 pilot site s. I don’ t have a t imeline ye t. | |
| 108 | // I have made the t eam aware that I nee d to have you look a t the form first to make sure that the R EF DOC too l will wor k prior to moving fo rward." | |
| 109 | { | |
| 110 | Author izationId = "11", | |
| 111 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE FORM 10 -0386", | |
| 112 | Author izationTex t = " LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE FORM 10-0386 \nSTANDARD TITLE: NO NVA NOTE \nDA TE OF NOTE : OCT 20, 2016@10:41 ENTRY DATE: OCT 20, 2016@ 10:42:02 \n AUTHOR: WOODS,GARO LD R EXP COSIG NER: \n UR GENCY: STATUS : COMPLETE D \n\n Depar tment of V eterans Af fairs \n VHA C HOICE APPR OVAL FOR M EDICAL CAR E\n VA-FORM 10-0386\n\ nPlease se lect refer ral urgenc y: \nRouti ne\n\nIf R OUTINE, in dicate tim eframe for appt: XX\ n\nTo faci litate Urg ent schedu ling, plea se include an altern ate point \nof conta ct's (diff erent than the NVCC staff memb er listed below) nam e,\nteleph one number , and rela tionship t o the pati ent (socia l worker, triage nur se, \netc. ) in space provided. \n\n\nCli nically In dicated Da te (CID):\ n\n10/21/2 016\n\nSer vice other than Tele Mental He alth\nCate gory of Ca re/Type of Specialty :\n\nCateg ory: X XXXXXXXXXX XXXXXX\n\n Type of Sp ecialist:\ n\nXXXXXXX XXXXXXXXXX XXX\n\nTyp e of Servi ce/Procedu re:\n\n X XXXXXXXXXX XXXXXXXX\n \nNumber o f Visits, Frequency and Durati on: \n\n XXXXXXXXXX XXXXXXXXXX X\n\n\n\n\ n\nEligibi lity Verif ication: \ nAs the au thorized V A represen tative, I hereby con firm that the Vetera n is \neli gible for Choice ser vices. The Veteran's basic eli gibility w as verifie d\nin the Veterans C hoice View er applica tion (VA V iewer) on: Oct 20,20 16\n\nServ ice-Connec ted(SC) an d/or Speci al Authori ty(SA):\nN o\n\nConta ct local V A NVCC Off ice first to provide informati on to VA o r reach \n VA orderin g provider . All cont act from C ontractor will be do cumented i n \nthe Ve teran's Re cord by NV CC and VA Provider n otified fo r awarenes s. \n\nRep ort all CR ITICAL FIN DINGS rela ted to thi s authoriz ation to t he issuing office \n below. ALL other que stions reg arding thi s authoriz ation shou ld be dire cted to: \ n1-866-606 -8198\n \n AOD/Emerge ncy Contac t After Ho urs #: 561 -422-8277 (AOD)\n\nF rom Statio n #: 548\n Facility N ame: WEST PALM BEACH VA MEDICA L CENTER\n Street Add ress: 7305 N. MILITA RY TRAIL\n City: WEST PALM BEAC H\nState: FLORIDA\nZ ip: 33410\ nFax: 561- 422-1575\n \nVeteran Informatio n:\nName: AA-TLAZLY, DETLY L\nD OB: NOV 23 ,1971\nSSN : 101-17- 9793\nAddr ess: \n173 5 VIARRITZ DRIVE\nBO ONVILLE MT 12345\nPh one: Home Phone# 404 -656-1122\ nVeteran A lternate P hone:\n\nV eteran Alt ernate Add ress: \n\n \nAlterna te POC for Veteran:( If availab le for VA internal u se)\nName: \nAddress : \n\nPhon e: \n\nIn accordance with sect ion 101 of the Veter ans Access , Choice, and \nAcco untability Act of 20 14 (the Ac t)(Public Law 113-14 6, 128 Sta t. \n1754) , as amend ed by the Department of Vetera ns Affairs (VA), the \nExpirin g Authorit ies Act of 2014(Publ ic Law 113 -175, 128 Stat. 1902 ), \nthe C onsolidate d and Furt her Contin uing Appro priations Act of 201 5 \n(Publi c Law 113 -235, 128 Stat. 2568 ), and 38 CFR §§ 17. 1500-1540, \nVA will pay for n on-VA hosp ital care and medica l services that are \nauthoriz ed by VA f or Veteran s who are determined by VA to meet the \ nVeterans Choice Pro gram eligi bility cri teria set forth by s ection \n1 01 of the Act and 38 CFR § 17. 1510 and a ny other e ligibility \nstandar ds that ma y apply to particula r services (such as health car e \nfor ne wborns of Veterans u nder 38 CF R § 17.38( a)(xiv) an d dental \ nbenefits under §§ 1 7.160-17.1 69).\n \n/ es/ Garold R Woods,R N\nHealth Informatic s Speciali st\nSigned : 10/20/20 16 10:43\n " | |
| 113 | }, | |
| 114 | new Author ization | |
| 115 | // Provide d by Steph anie Bell, 05/03/201 7 | |
| 116 | // Urgency and Clini cally Indi cated Date were not being pars ed (UNK) | |
| 117 | // PHI/PII blocked o ut | |
| 118 | { | |
| 119 | Author izationId = "12", | |
| 120 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE FORM 10 -0386", | |
| 121 | Author izationTex t = " LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE FORM 10-0386\n STANDARD TITLE: NON VA NOTE\n DATE OF NO TE: MAY 03 , 2017@15: 20 ENTR Y DATE: MA Y 03, 2017 @15:20:40\ n AUTHOR: SUTTON,TUN IESA EXP COSIGN ER:\n URGE NCY: STATUS: C OMPLETED\n \n Depart ment of Ve terans Aff airs\n VHA CHOICE AP PROVAL FOR MEDICAL C ARE\n VA-F ORM 10-038 6\n \n Ple ase select referral urgency:\n Routine\n \n If ROU TINE, indi cate time frame for appt:\n \n To facili tate Urgen t scheduli ng, please include a n alternat e point\n of contact 's (differ ent than t he Local V A Office o f Communit y\n Care ( OCC) staff member li sted below ) name,tel ephone num ber, and\n relations hip to the patient ( social wor ker, triag e nurse, e tc.)\n in space prov ided.\n Dr . Fengming Zhong\n V A Attendin g Physicia n, Hematol ogy/Oncolo gy\n 973-6 76-1000\n \n \n Clin ically Ind icated Dat e (CID):\n \n 03/22/ 2017\n \n Category o f Care/Typ e of Speci alty:\n \n Category: Onco logy\n Typ e of Speci alist:\n ( e.g. Speci alist: Neu rologist v s Neurosur geon) Onco logist\n \ n Type of Service/Pr ocedure:\n \n Evalua tion and t reatment. Diagnosis: Thrombocy topenia\n \n PRIMARY VA CLINIC AL POINT O F CONTACT - INCLUDIN G FOR CRIT ICAL FINDI NGS: DR.\n FENGMING ZHONG, ATT ENDING PHY SICIAN, HE MATOLOGY/O NCOLOGY,97 3-676-\n 1 000X1311\n SECONDARY VA CLINIC AL POINT O F CONTACT: LOLITA GO NZALEZ, RN , NON VA C ARE\n OFFI CE (973) 6 76-1000 X2 292.\n \n Number of Visits, Fr equency an d Duration :\n \n 3 M ONTHS\n \n \n \n Eli gibility V erificatio n:\n As th e authoriz ed VA repr esentative , I hereby confirm\n that the Veteran is eligible for Choice services. The\n Vet eran's bas ic eligibi lity was v erified in the Veter ans\n Choi ce Viewer applicatio n (VC View er)\n on: May 3,2017 \n \n Cont act the Lo cal VA Off ice of Com munity Car e (OCC) fi rst to pro vide\n inf ormation t o VA or re ach VA ord ering prov ider. All contact fr om\n Contr actor will be docume nted in th e Veteran' s Record b y the Loca l\n VA Off ice of Com munity Car e (OCC) an d VA Provi der notifi ed for awa reness.\n \n Report all CRITIC AL FINDING S related to this au thorizatio n\n to the issuing o ffice belo w. ALL oth er questio ns regardi ng\n this authorizat ion should be direct ed to:\n \ n Local VA Office of Community Care (OCC ) Contact\ n \n Non-V A Care Pro gram Manag er or equi valent:\n Name: Erik a Tyree\n Title: Sup ervisory P rogram Ana lyst\n \n AOD/Emerge ncy Contac t After Ho urs Number :\n (973) 676-1000 X 3435/3436\ n \n \n Fr om Station #: 561\n Facility N ame: VA Ne w Jersey H ealth Care System\n Street Add ress: 385 Tremont Av enue\n Cit y: East Or ange\n Sta te: NJ\n Z ip: 07018\ n Fax:(973 ) 395-7517 \n \n Vete ran Inform ation:\n N ame: XXXXX XX,XXXXXX XXXXXX\n D OB: XXXXXX XXXXXXXX X X,XXXX\n S SN: XXX-XX -XXXX\n Ad dress: NNN XXXXXXX D RIVE\n ANY TOWN, US N NNNN\n Pho ne: (NNN)N NN-NNNN\n Veteran Al ternate Ph one:\n Vet eran Alter nate Addre ss:\n \n \ n Alternat e POC for Veteran:(I f availabl e for VA i nternal us e)\n Name: XXXXXX XX XXXXX\n Ad dress:\n N NN XXXXXXX Drive\n A nytown, US NNNNN\n \ n Phone: N NN-NNN-NNN N\n \n In accordance with sect ion 101 of the Veter ans Access , Choice, and\n Acco untability Act of 20 14 (the Ac t)(Public Law 113-14 6, 128 Sta t.\n 1754) , as amend ed by the Department of Vetera ns Affairs (VA), the \n Expirin g Authorit ies Act of 2014(Publ ic Law 113 -175, 128 Stat. 1902 ),\n the C onsolidate d and Furt her Contin uing Appro priations Act of 201 5\n (Publi c Law 113 -235, 128 Stat. 2568 ), and 38 CFR §§ 17. 1500-1540, \n VA will pay for n on-VA hosp ital care and medica l services that are\ n authoriz ed by VA f or Veteran s who are determined by VA to meet the\n Veterans Choice Pro gram eligi bility cri teria set forth by s ection\n 1 01 of the Act and 38 CFR § 17. 1510 and a ny other e ligibility \n standar ds that ma y apply to particula r services (such as health car e\n for ne wborns of Veterans u nder 38 CF R § 17.38( a)(xiv) an d dental\n benefits under §§ 1 7.160-17.1 69).\n \n /es/ TUNIE SA SUTTON\ n ADVANCED MEDICAL S UPPORT\n S igned: 05/ 03/2017 15 :24\n" | |
| 122 | } | |
| 123 | , new Auth orization | |
| 124 | // Provide d by Deira Ledesma-M artinez on 5/4/2017 | |
| 125 | // PHI/PII blocked o ut | |
| 126 | { | |
| 127 | Author izationId = "13", | |
| 128 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE FORM 10 -0386", | |
| 129 | Author izationTex t = " LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE FORM 10-0386 \n STANDAR D TITLE: N ONVA NOTE \n DATE OF NO TE: APR 17 , 2017@13: 45 ENT RY DATE: A PR 17, 201 7@13:45:55 \n A UTHOR: ATH ILL,LORI EX P COSIGNER : \n URGENCY: STA TUS: COMPL ETED \n \n Departmen t of Veter ans Affair s \n VHA C HOICE APPR OVAL FOR M EDICAL CAR E\n VA-FOR M 10-0386\ n \n Pleas e select r eferral ur gency: \n Routine\n \n If Rout ine, indic ate timefr ame for ap pt: \n \n To facilit ate schedu ling, plea se include an altern ate point \n of cont act's (dif ferent tha n the NVCC staff mem ber listed below) na me,\n tele phone numb er, and re lationship to the pa tient (soc ial worker , triage n urse, \n e tc.) in sp ace provid ed. \n Nam e: XXXXXX X,XXXXXXXX XXX (XXXX) \n 123 MAI N STREET\n ANYTOWN, USA 00000 \n Phone n umber: (0 00)000-000 0\n Work p hone numbe r: 000-00 0-0000\n \ n \n \n Cl inically I ndicated D ate (CID): \n \n 04/1 4/2017\n \ n Category of Care/T ype of Spe cialist: \ n \n Categ ory: PHYSICAL T HERAPY\n T ype of Spe cialist: \ n PHYSICAL THERAPIST \n \n Type of Servic e/Procedur e:\n \n TR EATMENT LO W BACK PAI N AND RIGH T FOOT PAI N\n \n PRI MARY VA CL INICAL POI NT OF CONT ACT - INCL UDING FOR CRITICAL F INDINGS :\ n NIGEL SH ENOY\n LON G RANGE PA GER #: 973 -281-0730\ n FAX #: 9 73-395-716 0\n 973.67 6.1000 X12 55\n \n SE CONDARY VA CLINICAL POINT OF C ONTACT: LO LITA GONZA LEZ, RN, N ON VA CARE \n OFFICE (973) 676 -1000 X229 2/FAX 973. 395.7517.\ n \n Numbe r of Visit s, Frequen cy and Dur ation: \n \n 8WEEKS\ n 3X A WEE K\n \n \n Veteran or VAMC Pref erred Prov ider Name and Contac t Informat ion:\n Pat ient prefe rs going t o the foll owing prov ider:\n Na me: Sports Care\n Ad dress: 319 6 John F. Kennedy Bl vd, Union City, NJ\n Phone: 20 1-223-4949 \n \n Elig ibility Ve rification : \n As th e authoriz ed VA repr esentative , I hereby confirm t hat the Ve teran is \ n eligible for Choic e services . The Vete ran's basi c eligibil ity was ve rified\n i n the Vete rans Choic e Viewer a pplication (VA Viewe r) on: Apr 17,2017\n \n Non-VA Care Prog ram Manage r or equiv alent:\n N ame: Erika Tyree \n Title: Sup ervisory P rogram Ana lyst\n \n Service-Co nnected(SC ) and/or S pecial Aut hority(SA) :\n Yes\n \n Contact local VA NVCC Offic e first to provide i nformation to VA or reach \n V A ordering provider. All conta ct from Co ntractor w ill be doc umented in \n the Ve teran's Re cord by NV CC and VA Provider n otified fo r awarenes s. \n \n R eport all CRITICAL F INDINGS re lated to t his author ization to the issui ng office \n below. ALL other questions regarding this autho rization s hould be d irected to : \n 1-866 -606-8198\ n \n AOD/E mergency C ontact Aft er Hours # : AOD 973. 676.1000 3 435/3436\n \n From S tation #: 561\n Faci lity Name: VA New Je rsey Healt h Care Sys tem\n Stre et Address : 385 Trem ont Avenue \n City: E ast Orange \n State: NJ\n Zip: 07018\n Fa x:(973) 39 5-7517\n \ n Veteran Informatio n:\n Name: XXXXXXXXX ,XXX X\n D OB: JAN 1, 1900\n SSN : 000-00-0 000\n Addr ess: 123 M AIN STREET \n ANYTOW N,USA 0000 0\n \n Pho ne: (000)0 00-0000 \n \n Vetera n Alternat e Address: \n N/A\n Cell: (000 )000-0000\ n \n \n Al ternate PO C for Vete ran:(If av ailable fo r VA inter nal use)\n Name: XXX XXXX,XXXXX XXXXXX (XX XX)\n Addr ess: \n 12 3 MAIN STR EET\n ANYT OWN, USA 00000\n Wo rk phone n umber: 00 0-000-0000 \n \n \n S econdary N ext of Kin Informati on:\n XXXX X,XXXXXXXX XXXX (XXX) \n 123 MAI N STREET\n ANYTOWON, USA 00000 \n Phone n umber: (0 00)000-000 0\n \n \n \n Phone: (000)000-0 000\n \n I n accordan ce with se ction 101 of the Vet erans Acce ss, Choice , and \n A ccountabil ity Act of 2014 (the Act)(Publ ic Law 113 -146, 128 Stat. \n 1 754), as a mended by the Depart ment of Ve terans Aff airs (VA), the \n Ex piring Aut horities A ct of 2014 (Public La w 113-175, 128 Stat. 1902), \n the Conso lidated an d Further Continuing Appropria tions Act of 2015 \n (Public L aw 113 -23 5, 128 Sta t. 2568), and 38 CFR §§ 17.150 0-1540, \n VA will p ay for non -VA hospit al care an d medical services t hat are \n authorize d by VA fo r Veterans who are d etermined by VA to m eet the \n Veterans Choice Pro gram eligi bility cri teria set forth by s ection \n 101 of the Act and 3 8 CFR § 17 .1510 and any other eligibilit y \n stand ards that may apply to particu lar servic es (such a s health c are \n for newborns of Veteran s under 38 CFR § 17. 38(a)(xiv) and denta l \n benef its under §§ 17.160- 17.169).\n \n /es/ L ORI ATHILL \n fee cle rk\n Signe d: 04/17/2 017 13:57\ n" | |
| 130 | } | |
| 131 | , new Auth orization | |
| 132 | // V5 of t he 10-0386 . This is the "April 21, 2017" release | |
| 133 | // Derived by hand t ranslating the file https:// URL . DNS /sites/cbo pc/BSM/NVC C/I/CT/CHO ICE-FIRST/ VHA%20CHOI CE%20APPRO VAL%20FOR% 20MEDICAL% 20CARE%20V A-FORM%201 0-0386%20V ERSION%203 .0/CPRS%20 Template%2 0VAF%2010- 0386%20(Ch oice%20Con tractor)%2 0Update%20 April%2019 ,%202017/V HA%20CHOIC E%20APPROV AL%20FOR%2 0MEDICAL%2 0CARE%20VA %20FORM%20 100386%20V 5.txml | |
| 134 | // substit uting the constant t ext fields . | |
| 135 | // Documen t retrieve d 2017-06- 12 | |
| 136 | { | |
| 137 | Author izationId = "14", | |
| 138 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE VA FORM 10-0386 V 5", | |
| 139 | Author izationTex t = " Depart ment of Ve terans Aff airs \n VH A CHOICE A PPROVAL FO R MEDICAL CARE\n VA- FORM 10-03 86\n \n Pl ease selec t referral urgency: \n {FLD:VA -10-0386-S CH URGENT- ROUTINE1}\ n \n If RO UTINE, ind icate time frame for appt: {FL D:VA-10-03 86 TEXT}\n \n {FLD:V A-10-0386 URGENT CON TACT INF3} \n {FLD:VA -WORD 70-3 }\n \n Cli nically In dicated Da te (CID):\ n (CID = V A Ordering Provider requests p atient see n on the d ate entere d\n below, as the fir st schedul ed appoint ment)\n {F LD:VA-NVCC DATE MONT H1}{FLD:VA -NVCC DAY NUMBER1}{F LD:VA-NVCC DATE YEAR 1}\n \n Ca tegory of Care/Type of Special ty: \n (e. g. CATEGOR Y: Optomet ry vs Opht halmology )\n Catego ry: { FLD:VA-10- 0386 TEXT REQ}\n Typ e of Speci alist:\n ( e.g. Speci alist: Neu rologist v s Neurosur geon) {FL D:VA-10-03 86 TEXT RE Q}\n \n Ty pe of Serv ice/Proced ure:\n (e. g. Mohs, C olonoscopy , Cardiac Stress Tes t, Surgery \n to inc lude post op Home He alth)\n {F LD:VA-10-0 386 WORD 7 0-3 REQ}\n \n Number of Visits , Frequenc y and Dura tion: \n ( e.g. 3 mon ths durati on, 2 visi ts a week for 6 week s, not to exceed 365 days)\n { FLD:VA-10- 0386 WORD 70-3 REQ}\ n (Please note: info rmation co ntained in this sect ion is for assistanc e in\n ide ntifying t he service required. It is NOT diagnosti cally vali d.)\n \n V eteran or VAMC Prefe rred Provi der Name a nd Contact Informati on:\n {FLD :VA-10-038 6 WORD 70- 3}\n \n El igibility Verificati on: \n As the author ized VA re presentati ve, I here by confirm \n that th e Veteran is eligibl e for Choi ce service s. The \n Veteran's basic elig ibility wa s verified in the Ve terans\n C hoice View er applica tion (VC V iewer) \n on: {FLD:V A-10-0386 DATE&T IME TODAY} \n \n Cont act the Lo cal VA Off ice of Com munity Car e (OCC) fi rst to pro vide\n inf ormation t o VA or re ach VA ord ering prov ider. All contact fr om \n Cont ractor wil l be docum ented in t he Veteran 's Record by the Loc al \n VA O ffice of C ommunity C are (OCC) and VA Pro vider noti fied for a wareness. \n \n Repo rt all CRI TICAL FIND INGS relat ed to this authoriza tion\n to the issuin g office b elow. ALL other ques tions rega rding \n t his author ization sh ould be di rected to: \n {FLD:V A-10-0386 EDIT 30-40 }\n \n Loc al VA Offi ce of Comm unity Care (OCC) Con tact \n Nu mber (Norm al Busines s Hours):\ n {FLD:VA- 10-0386 ED IT 30-40 R EQ}\n AOD/ Emergency Contact Af ter Hours Number: \n {FLD:VA-1 0-0386 EDI T 30-40 RE Q}\n \n \n From Stat ion #: \n Facility N ame: \n St reet Addre ss: \n Cit y: \n Stat e: \n Zip: \n Fax: \ n \n Veter an Informa tion:\n Na me: \n DOB : \n SSN: \n Address : \n Phone : \n Veter an Alterna te Phone:{ FLD:EDIT 2 0}\n Veter an Alterna te Address : \n {FLD: VA-WORD 35 -3}\n \n A lternate P OC for Vet eran:(If a vailable f or VA inte rnal use)\ n Name: {F LD:EDIT 50 1}\n Addre ss: \n {FL D:VA-WORD 35-3}\n Ph one: {FLD: EDIT 20}\n \n In acc ordance wi th section 101 of th e Veterans Access, C hoice, and \n Accoun tability A ct of 2014 (the Act) (Public La w 113-146, 128 Stat. \n 1754), as amende d by the D epartment of Veteran s Affairs (VA), the \n Expirin g Authorit ies Act of 2014(Publ ic Law 113 -175, 128 Stat. 1902 ), \n the Consolidat ed and Fur ther Conti nuing Appr opriations Act of 20 15 \n (Pub lic Law 11 3 -235, 12 8 Stat. 25 68), and 3 8 CFR §§ 1 7.1500-154 0, \n VA w ill pay fo r non-VA h ospital ca re and med ical servi ces that a re \n auth orized by VA for Vet erans who are determ ined by VA to meet t he \n Vete rans Choic e Program eligibilit y criteria set forth by sectio n \n 101 o f the Act and 38 CFR § 17.1510 and any o ther eligi bility \n standards that may a pply to pa rticular s ervices (s uch as hea lth care \ n for newb orns of Ve terans und er 38 CFR § 17.38(a) (xiv) and dental \n benefits u nder §§ 17 .160-17.16 9).\n" | |
| 140 | } | |
| 141 | , new Auth orization | |
| 142 | // V5 of t he 10-0386 a. This is the "Apri l 21, 2017 " release | |
| 143 | // Derived by hand t ranslating the file https:// URL . DNS /sites/cbo pc/BSM/NVC C/I/CT/CHO ICE-FIRST/ VHA%20CHOI CE%20APPRO VAL%20FOR% 20MEDICAL% 20CARE%20V A-FORM%201 0-0386%20V ERSION%203 .0/CPRS%20 Template%2 0VAF%2010- 0386a%20(V CP%20Provi der%20Agre ement)%20U pdate%20Ap ril%2019,% 202017/VCP CHOICE%20P ROV%20AGRM T%20VAF%20 100386A%20 V5.txml | |
| 144 | // substit uting the constant t ext fields . | |
| 145 | // Documen t retrieve d 2017-06- 12 | |
| 146 | { | |
| 147 | Author izationId = "15", | |
| 148 | Author izationTit le = "VCP- CHOICE PRO V AGRMT VA F 10-0386A V5", | |
| 149 | Author izationTex t = " D epartment of Veteran s Affairs\ n VETERANS CHOICE PR OVIDER AGR EEMENT AUT HORIZATION \n VA-FORM 10-0386a\ n \n Reaso n for use of Provide r Agreemen t:\n {FLD: VA-VCPA RE ASON FOR R ETURN}\n \ n Communit y Provider Name(s): \n {FLD:WP 2 LINE 50 REQ}\n \n Authoriza tion Numbe r: {FLD:EB 40R}\n \n VA Orderi ng Provide r: {FLD:EB 40R}\n \n Please se lect refer ral urgenc y\n {FLD:V C URGENCY RB}\n \n T o facilita te urgent scheduling , please i nclude an alternate \n point o f contact( s) (differ ent than t he Local V A Office o f \n Commu nity Care (OCC) staf f member l isted belo w) name, \ n telephon e number, and relati onship to the patien t \n (soci al worker, triage nu rse, etc.) in space provided.\ n {FLD:WP 2 LINE}\n \n Seconda ry Authori zation Req uest (SAR) :\n NOTE: All SARs r equire cli nical appr oval. Appr oved SARs require \n creation of 10-0386 a and 10-7 078/10-707 9. If SAR requires \n service s for new diagnosis or new pro vider, not ify VA ord ering \n p rovider to enter a n ew NVC con sult or VA internal consult \n request p er Choice process.\n If SAR re ferral, sp ecify type :\n {FLD:V CP SAR TYP E RB}\n \n Services and Timefr ame Author ized:\n Sp ecialty:\n (i.e. Car diology, D ermatology , Neurolog y)\n {FLD: WP 2 LINE 50 REQ}\n \n Type of Specialis t:\n (Must be specia lty specif ic: Neurol ogist vs. Neurosurge on)\n {FLD :WP 2 LINE 50 REQ}\n \n Type o f Service/ Procedure: \n (e.g. F ollow-up, Colonoscop y)\n {FLD: WP 2 LINE 50 REQ}\n \n Number of Visits, Frequency and Durat ion:\n (e. g. 1 consu ltation wi th 3 follo w-up visit s x 2 mont h)\n {FLD: WP 2 LINE 50 REQ}\n (Please no te: inform ation cont ained in t his sectio n is for \ n assistan ce in iden tifying th e service required. It is NOT \n diagnos tically va lid.)\n \n Date VA R equests se rvices und er Provide r Agreemen t:\n {FLD: DATE}\n \n Appointme nt Comment :\n (Enter reason ap pointment not schedu led at tim e authoriz ation comp leted)\n { FLD:WP 3 L INE}\n \n Veteran In formation: \n Name: \ n DOB: \n SSN: \n Ad dress: \n Phone: \n \n Veteran s Alternat e address/ phone\n {F LD:WP 3 FL 50}\n \n Alternate POC:\n (in clude name , address and phone if known)\ n {FLD:WP 3 FL 50}\n \n Eligib ility Type (From ini tial autho rization i f applicab le):\n {FL D:VCP ELIG IBILITY TY PE RB1}\n \n Eligibi lity Verif ication:\n As the au thorized V A represen tative, I hereby con firm that \n the Vet eran is el igible for Choice se rvices. T he Veteran 's \n basi c eligibil ity was ve rified in the Vetera ns Choice Viewer\n a pplication (VC Viewe r) on: {FL D:DATE }\n \n Local VA Office of Communi ty Care(OC C)Manager or equival ent:\n \n Name:{FLD: EB 40R}\n Title:{FLD :EB 40R}\n \n Local VA Office of Communi ty Care (O CC) Contac t \n Numbe r (Normal Business H ours):\n { FLD:VA-10- 0386 EDIT 30-40 REQ} \n After h ours Point of Contac t (POC) Nu mber: {FLD :EB 40R}\n \n Contac t the Loca l VA Offic e of Commu nity Care (OCC) firs t to \n pr ovide info rmation to VA or rea ch VA orde ring provi der. \n A ll contact from Comm unity Care Provider will be do cumented\n in the Ve teran's Re cord by th e Local VA Office of Community \n Care ( OCC) staff and VA Or dering Pro vider noti fied for \ n awarenes s. Report all CRITI CAL FINDIN GS related to this \ n authoriz ation to t he Local V A Office o f Communit y \n Care (OCC) abov e.\n \n Fr om station #: \n Fac ility Name : \n Stree t Address: \n City: \n State: \n Zip:\n Fax:\n" | |
| 150 | }, | |
| 151 | new Author ization() | |
| 152 | { | |
| 153 | // A n ote entere d for Z015 7 by Chris tina Vince nt | |
| 154 | // Thi s is the " lockeddown " version (I think) | |
| 155 | Author izationId = "16", | |
| 156 | Author izationTit le = "VHA CHOICE APP ROVAL FOR MEDICAL CA RE VA-FORM 10-0386", | |
| 157 | Author izationTex t = " LOCA L TITLE: V HA CHOICE APPROVAL F OR MEDICAL CARE VA-F ORM 10-038 \n STANDAR D TITLE: N ONVA NOTE \n DATE OF NO TE: JUL 12 , 2017@07: 25 ENT RY DATE: J UL 12, 201 7@07:25:52 \n A UTHOR: VIN CENT,CHRIS TINA L EX P COSIGNER : \n URGENCY: STA TUS: COMPL ETED \n \n \n Depart ment of Ve terans Aff airs \n VH A Choice A pproval fo r Medical Care \n VA -Form 10-0 386 \n \n Certain pr otected he alth infor mation (PH I) may be enclosed; specifical ly\n infor mation rel ated to HI V, sickle cell anemi a and subs tance abus e. This\n specific P HI may NOT be re-dis closed or used by th e recipien t person o r\n office for any p urpose oth er than th at for whi ch the dis closure wa s made. \n [Ref. 38 USC 7332(b )(2)(H)(ii )] The in formation is being d isclosed b y VA\n onl y for the treatment and care o f the name d patient in the hea lth record .\n Accoun ting of di sclosure m ust be mai ntained wh en require d. \n \n R eferral Ur gency:\n R outine\n I ndicate ti me frame f or appoint ment: \n \ n To facil itate \"Ur gent\" sch eduling, p lease incl ude an alt ernative p oint of\n contact's name, tele phone numb er (differ ent than t he Local V A Office o f\n Commun ity Care ( OCC) staff member li sted below ), and wha t their\n relationsh ip to the patient is (social w orker, tri age nurse, etc.) in the\n spac e provided : \n \n \n Clinicall y Indicate d Date (CI D): \n Jul 12,2017 \ n \n Categ ory of Car e/Type of Specialty: LAB \n \ n Type of Specialist : PT/INR \n \n Type of Servic e/Procedur e: ANTICO AGULATION SERVICES \ n \n Numbe r of Visit s, Frequen cy, and Du ration: 3 65 DAYS OR 52 VISITS Please\n see author ization te mplate for services included. \n \n \n E ligibility Verificat ion: \n As the autho rized VA r epresentat ive, I her eby confir m that the Veteran\n is eligib le for Cho ice servic es. The V eteran's b asic eligi bility was \n verifie d in the V eterans Ch oice Viewe r applicat ion (VC Vi ewer) on\n \n \n Con tact the L ocal VA Of fice of Co mmunity Ca re (OCC) f irst to pr ovide\n in formation to the VA or to reac h a VA ord ering prov ider. All contact\n from the contractor will be d ocumented in the Vet eran's rec ord by the \n Local V A Office o f Communit y Care (OC C) and the VA provid er will be \n notifie d for awar eness. \n \n Report all Critic al Finding s related to this au thorizatio n to the i ssuing\n o ffice belo w. All ot her questi ons regard ing this a uthorizati on should be\n direc ted to: A nti Coag C linic 503- 402-2919 \ n \n Local VA Office of Commun ity Care ( OCC) Manag er or Equi valent:\n Case Manag er Name: Valerie He ikinen, RN \n Title: Case Manag er \n \n L ocal VA Of fice of Co mmunity Ca re (OCC) C ontact\n C ontact Num ber (Norma l Business Hours): 3 60-759-167 4 Anti Co ag Clinic: \n 503-40 2-2919\n A OD/Emergen cy Contact After Hou rs Number: 503-220-8 262 or Ca scade Call \n Center: 1-800-94 9-1004 \n \n From St ation Numb er: 648\n Facility Name: VA PORTLAND H EALTH CARE SYSTEM\n Street Add ress: 371 0 SW US VE TERANS HOS PITAL ROAD \n City: PORTLAND\n State: O REGON\n Zi p: 97239\ n Fax: 36 0-905-1731 \n \n Vet eran Infor mation:\n Name: JIA NJI S ZZTE ST\n DOB: FEB 25,19 35\n SSN: 000-00-01 57\n Addre ss: 125 N W 20TH PL. \n SOMEWH ERE OREGON \n PORTLA ND, OR 97 209\n Phon e: 503-80 8-1917\n V eteran's A lternate P hone: \n V eteran's A lternate A ddress: \n \n Altern ate POC fo r Veteran: \n Name: \n Address : \n Phone : \n \n In accordanc e with sec tion 101 o f the Vete rans Acces s, Choice, and\n Acc ountabilit y Act of 2 014 (the A ct) (Publi c Law 113- 146, 128 S tat. 1754) ,\n as ame nded by th e Departme nt of Vete rans Affai rs (VA), t he Expirin g\n Author ities Act of 2014 (P ublic Law 113-175, 1 28 Stat. 1 902), the\ n Consolid ated and F urther Con tinuing Ap propriatio ns Act of 2015 (Publ ic Law\n 1 13 -235, 1 28 Stat. 2 568), and 38 CFR §§ 17.1500-15 40, VA wil l pay for\ n non-VA h ospital ca re and med ical servi ces that a re authori zed by VA for\n Vete rans who a re determi ned by VA to meet th e Veterans Choice Pr ogram\n el igibility criteria s et forth b y section 101 of the Act and 3 8 CFR §\n 17.1510 an d any othe r eligibil ity standa rds that m ay apply t o particul ar\n servi ces (such as health care for n ewborns of Veterans under 38 C FR §\n 17. 38(a)(xiv) and denta l benefits under §§ 17.160-17. 169).\n \n /es/ CHRI STINA L VI NCENT\n \n Signed: 0 7/12/2017 07:29\n" | |
| 158 | } | |
| 159 | }; | |
| 160 | ||
| 161 | } | |
| 162 | ||
| 163 | [T est] | |
| 164 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsScree ningMammo( ) | |
| 165 | { | |
| 166 | var expe ctedText = "SCREENIN G MAMMO"; | |
| 167 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[0]); | |
| 168 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 169 | } | |
| 170 | [T est] | |
| 171 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsChiro practicEli gibility() | |
| 172 | { | |
| 173 | var expe ctedText = "Chiropra ctic"; | |
| 174 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[1]); | |
| 175 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 176 | } | |
| 177 | [T est] | |
| 178 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsScree ningOrthop edics() | |
| 179 | { | |
| 180 | var expe ctedText = "Orthoped ics"; | |
| 181 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[2]); | |
| 182 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 183 | } | |
| 184 | [T est] | |
| 185 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsOrtho () | |
| 186 | { | |
| 187 | var expe ctedText = "ORTHOPED ICS PAINF UL ELBOW E VALTREATME NT POST-OP FOLLOW UP CARE PHYS ICAL THERA PY"; | |
| 188 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[3]); | |
| 189 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 190 | } | |
| 191 | [T est] | |
| 192 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsCarto graphy() | |
| 193 | { | |
| 194 | var expe ctedText = "Cartogra phy"; | |
| 195 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[4]); | |
| 196 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 197 | } | |
| 198 | [T est] | |
| 199 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsNeuro logy() | |
| 200 | { | |
| 201 | var expe ctedText = "NEUROLOG Y"; | |
| 202 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[5]); | |
| 203 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 204 | } | |
| 205 | [T est] | |
| 206 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsOrtho pedist() | |
| 207 | { | |
| 208 | var expe ctedText = "Orthoped ist"; | |
| 209 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[6]); | |
| 210 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 211 | } | |
| 212 | [T est] | |
| 213 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsMammo graphy() | |
| 214 | { | |
| 215 | var expe ctedText = "Mammogra phy"; | |
| 216 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[7]); | |
| 217 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 218 | } | |
| 219 | [T est] | |
| 220 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsmammo rgraphy() | |
| 221 | { | |
| 222 | var expe ctedText = "mammorgr aphy"; //[ sic] | |
| 223 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[8]); | |
| 224 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 225 | } | |
| 226 | [T est] | |
| 227 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsCardi ology() | |
| 228 | { | |
| 229 | var expe ctedText = "Cardiolo gy"; | |
| 230 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[9]); | |
| 231 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 232 | } | |
| 233 | [T est] | |
| 234 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsTeleM entalHealt h() | |
| 235 | { | |
| 236 | var expe ctedText = "Tele Men tal Health "; | |
| 237 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[10]); | |
| 238 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 239 | } | |
| 240 | [T est] | |
| 241 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsXXXXX XXXXXXXXXX XX() | |
| 242 | { | |
| 243 | var expe ctedText = "XXXXXXXX XXXXXXXXX" ; | |
| 244 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[11]); | |
| 245 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 246 | } | |
| 247 | [T est] | |
| 248 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsOncol ogy() | |
| 249 | { | |
| 250 | var expe ctedText = "Oncology "; | |
| 251 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[12]); | |
| 252 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 253 | } | |
| 254 | [T est] | |
| 255 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsPhysi calTherapy () | |
| 256 | { | |
| 257 | var expe ctedText = "PHYSICAL THERAPY"; | |
| 258 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[13]); | |
| 259 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 260 | } | |
| 261 | [T est] | |
| 262 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsField Reference( ) | |
| 263 | { | |
| 264 | // The n ominal exp ected resp onse is "{ FLD:VA-10- 0386 TEXT REQ}". How ever, the | |
| 265 | // curly braces an d colon ar e not pres ent in the expected text becau se the | |
| 266 | // metho d strips o ut (those) non-alpha numeric ch aracters. | |
| 267 | var expe ctedText = "FLDVA-10 -0386 TEXT REQ"; | |
| 268 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[14]); | |
| 269 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 270 | } | |
| 271 | [T est] | |
| 272 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText_Re turnsField Reference2 () | |
| 273 | { | |
| 274 | // The n ominal exp ected resp onse is "{ FLD:WP 2 L INE 50 REQ }". Howeve r, the | |
| 275 | // curly braces an d colon ar e not pres ent in the expected text becau se the | |
| 276 | // metho d strips o ut (those) non-alpha numeric ch aracters. | |
| 277 | var expe ctedText = "FLDWP 2 LINE 50 RE Q"; | |
| 278 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[15]); | |
| 279 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 280 | } | |
| 281 | [T est] | |
| 282 | pu blic void Descriptio nOfSpecial ty_GivenVa lidText16_ ReturnsLab () | |
| 283 | { | |
| 284 | var expe ctedText = "LAB"; | |
| 285 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[16]); | |
| 286 | Assert.A reEqual(ex pectedText , viewMode l.Descript ionOfSpeci alty); | |
| 287 | } | |
| 288 | ||
| 289 | [T est] | |
| 290 | pu blic void Urgency_Gi venValidTe xt_Returns Routine() | |
| 291 | { | |
| 292 | var expe ctedText = "Routine" ; | |
| 293 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[0]); | |
| 294 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 295 | } | |
| 296 | [T est] | |
| 297 | pu blic void Urgency_Gi venValidTe xt_Returns Now() | |
| 298 | { | |
| 299 | var expe ctedText = "Now"; | |
| 300 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[1]); | |
| 301 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 302 | } | |
| 303 | [T est] | |
| 304 | pu blic void Urgency_Gi venValidTe xt_Returns STAT() | |
| 305 | { | |
| 306 | var expe ctedText = "STAT"; | |
| 307 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[2]); | |
| 308 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 309 | } | |
| 310 | [T est] | |
| 311 | pu blic void Urgency_Gi venValidTe xt_Returns Routine2() | |
| 312 | { | |
| 313 | var expe ctedText = "Routine" ; | |
| 314 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[4]); | |
| 315 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 316 | } | |
| 317 | [T est] | |
| 318 | pu blic void Urgency_Gi venValidTe xt_Returns Routine3() | |
| 319 | { | |
| 320 | var expe ctedText = "Routine" ; | |
| 321 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[5]); | |
| 322 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 323 | } | |
| 324 | [T est] | |
| 325 | pu blic void Urgency_Gi venValidTe xt_Returns Routine4() | |
| 326 | { | |
| 327 | var expe ctedText = "Routine" ; | |
| 328 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[6]); | |
| 329 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 330 | } | |
| 331 | [T est] | |
| 332 | pu blic void Urgency_Gi venValidTe xt_Returns Routine5() | |
| 333 | { | |
| 334 | var expe ctedText = "Routine" ; | |
| 335 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[7]); | |
| 336 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 337 | } | |
| 338 | [T est] | |
| 339 | pu blic void Urgency_Gi venValidTe xt_Returns Routine6() | |
| 340 | { | |
| 341 | var expe ctedText = "Routine" ; | |
| 342 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[8]); | |
| 343 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 344 | } | |
| 345 | [T est] | |
| 346 | pu blic void Urgency_Gi venValidTe xt_Returns Routine7() | |
| 347 | { | |
| 348 | var expe ctedText = "Routine" ; | |
| 349 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[9]); | |
| 350 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 351 | } | |
| 352 | [T est] | |
| 353 | pu blic void Urgency_Gi venValidTe xt_Returns Routine8() | |
| 354 | { | |
| 355 | var expe ctedText = "Routine" ; | |
| 356 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[10]); | |
| 357 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 358 | } | |
| 359 | [T est] | |
| 360 | pu blic void Urgency_Gi venValidTe xt_Returns Routine9() | |
| 361 | { | |
| 362 | var expe ctedText = "Routine" ; | |
| 363 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[11]); | |
| 364 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 365 | } | |
| 366 | [T est] | |
| 367 | pu blic void Urgency_Gi venValidTe xt_Returns Routine10( ) | |
| 368 | { | |
| 369 | var expe ctedText = "Routine" ; | |
| 370 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[12]); | |
| 371 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 372 | } | |
| 373 | [T est] | |
| 374 | pu blic void Urgency_Gi venValidTe xt_Returns Routine11( ) | |
| 375 | { | |
| 376 | var expe ctedText = "Routine" ; | |
| 377 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[13]); | |
| 378 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 379 | } | |
| 380 | [T est] | |
| 381 | pu blic void Urgency_Gi venValidTe xt_Returns FieldRefer ence() | |
| 382 | { | |
| 383 | // The n ominal exp ected resp onse is "{ FLD:VA-10- 0386-SCH U RGENT-ROUT INE1}". Ho wever, the | |
| 384 | // curly braces an d colon ar e not pres ent in the expected text becau se the | |
| 385 | // metho d strips o ut (those) non-alpha numeric ch aracters. | |
| 386 | var expe ctedText = "FLDVA-10 -0386-SCH URGENT-ROU TINE1"; | |
| 387 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[14]); | |
| 388 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 389 | } | |
| 390 | [T est] | |
| 391 | pu blic void Urgency_Gi venValidTe xt_Returns FieldRefer ence2() | |
| 392 | { | |
| 393 | // The n ominal exp ected resp onse is "{ FLD:VC URG ENCY RB}". However, the | |
| 394 | // curly braces an d colon ar e not pres ent in the expected text becau se the | |
| 395 | // metho d strips o ut (those) non-alpha numeric ch aracters. | |
| 396 | var expe ctedText = "FLDVC UR GENCY RB"; | |
| 397 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[15]); | |
| 398 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 399 | } | |
| 400 | [T est] | |
| 401 | pu blic void Urgency_Gi venValidTe xt16_Retur nsRoutine( ) | |
| 402 | { | |
| 403 | var expe ctedText = "Routine" ; | |
| 404 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[16]); | |
| 405 | Assert.A reEqual(ex pectedText , viewMode l.Urgency) ; | |
| 406 | } | |
| 407 | ||
| 408 | [T est] | |
| 409 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturnsSep_ 3_2015() | |
| 410 | { | |
| 411 | var expe ctedText = "Sep 3,20 15"; | |
| 412 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[0]); | |
| 413 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 414 | } | |
| 415 | [T est] | |
| 416 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturnsSep_ 25_2015() | |
| 417 | { | |
| 418 | var expe ctedText = "Sep 25,2 015"; | |
| 419 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[1]); | |
| 420 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 421 | } | |
| 422 | [T est] | |
| 423 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturnsNov_ 19_2015() | |
| 424 | { | |
| 425 | var expe ctedText = "Nov 19,2 015"; | |
| 426 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[2]); | |
| 427 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 428 | } | |
| 429 | [T est] | |
| 430 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns8_31 _2016() | |
| 431 | { | |
| 432 | var expe ctedText = "08/31/20 16"; | |
| 433 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[4]); | |
| 434 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 435 | } | |
| 436 | [T est] | |
| 437 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns09_1 2_2016() | |
| 438 | { | |
| 439 | var expe ctedText = "09/12/20 16"; | |
| 440 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[5]); | |
| 441 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 442 | } | |
| 443 | [T est] | |
| 444 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns05_0 6_2016() | |
| 445 | { | |
| 446 | var expe ctedText = "05/06/20 16"; | |
| 447 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[6]); | |
| 448 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 449 | } | |
| 450 | [T est] | |
| 451 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns03_0 6_2016() | |
| 452 | { | |
| 453 | var expe ctedText = "03/06/20 16"; | |
| 454 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[7]); | |
| 455 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 456 | } | |
| 457 | [T est] | |
| 458 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns03_0 7_1800() | |
| 459 | { | |
| 460 | var expe ctedText = "03/07/18 00"; | |
| 461 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[8]); | |
| 462 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 463 | } | |
| 464 | [T est] | |
| 465 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturnsSept _23_2016() | |
| 466 | { | |
| 467 | var expe ctedText = "Sep 23,2 016@06:00" ; | |
| 468 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[9]); | |
| 469 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 470 | } | |
| 471 | [T est] | |
| 472 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns10_2 0_2016() | |
| 473 | { | |
| 474 | var expe ctedText = "10/20/20 16"; | |
| 475 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[10]); | |
| 476 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 477 | } | |
| 478 | [T est] | |
| 479 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns10_2 1_2016() | |
| 480 | { | |
| 481 | var expe ctedText = "10/21/20 16"; | |
| 482 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[11]); | |
| 483 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 484 | } | |
| 485 | [T est] | |
| 486 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns03_2 2_2017() | |
| 487 | { | |
| 488 | var expe ctedText = "03/22/20 17"; | |
| 489 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[12]); | |
| 490 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 491 | } | |
| 492 | [T est] | |
| 493 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturns04_1 4_2017() | |
| 494 | { | |
| 495 | var expe ctedText = "04/14/20 17"; | |
| 496 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[13]); | |
| 497 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 498 | } | |
| 499 | [T est] | |
| 500 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturnsFiel dReference () | |
| 501 | { | |
| 502 | var expe ctedText = "{FLD:VA- NVCC DATE MONTH1}{FL D:VA-NVCC DAY NUMBER 1}{FLD:VA- NVCC DATE YEAR1}"; | |
| 503 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[14]); | |
| 504 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 505 | } | |
| 506 | [T est] | |
| 507 | pu blic void Clinically IndicatedD ate_GivenV alidText_R eturnsFiel dReference 2() | |
| 508 | { | |
| 509 | var expe ctedText = "{FLD:DAT E}"; | |
| 510 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[15]); | |
| 511 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 512 | } | |
| 513 | [T est] | |
| 514 | pu blic void Clinically IndicatedD ate_GivenV alidText16 _ReturnsJu l122017() | |
| 515 | { | |
| 516 | var expe ctedText = "Jul 12,2 017"; | |
| 517 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[16]); | |
| 518 | Assert.A reEqual(ex pectedText , viewMode l.Clinical lyIndicate dDate); | |
| 519 | } | |
| 520 | ||
| 521 | [T est] | |
| 522 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sOct_16_20 15() | |
| 523 | { | |
| 524 | var exp ectedText = "Oct 16, 2015"; | |
| 525 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[0]); | |
| 526 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 527 | } | |
| 528 | [ Test] | |
| 529 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sOct_7_201 5() | |
| 530 | { | |
| 531 | var exp ectedText = "Oct 7,2 015"; | |
| 532 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[1]); | |
| 533 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 534 | } | |
| 535 | [ Test] | |
| 536 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sOct_12_20 15() | |
| 537 | { | |
| 538 | var exp ectedText = "Oct 12, 2015"; | |
| 539 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[2]); | |
| 540 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 541 | } | |
| 542 | [ Test] | |
| 543 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sAug_29_20 16() | |
| 544 | { | |
| 545 | var exp ectedText = "Aug 29, 2016"; | |
| 546 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[4]); | |
| 547 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 548 | } | |
| 549 | [ Test] | |
| 550 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sSep_13_20 16() | |
| 551 | { | |
| 552 | var exp ectedText = "Sep 13, 2016"; | |
| 553 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[5]); | |
| 554 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 555 | } | |
| 556 | [ Test] | |
| 557 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sSep_16_20 16() | |
| 558 | { | |
| 559 | var exp ectedText = "Sep 16, 2016"; | |
| 560 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[6]); | |
| 561 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 562 | } | |
| 563 | [ Test] | |
| 564 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sSep_16_20 16_2() | |
| 565 | { | |
| 566 | var exp ectedText = "Sep 16, 2016"; | |
| 567 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[7]); | |
| 568 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 569 | } | |
| 570 | [ Test] | |
| 571 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sSep_16_20 16_3() | |
| 572 | { | |
| 573 | var exp ectedText = "Sep 16, 2016"; | |
| 574 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[8]); | |
| 575 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 576 | } | |
| 577 | [ Test] | |
| 578 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return s09_22_201 6() | |
| 579 | { | |
| 580 | var exp ectedText = "09/22/2 016"; | |
| 581 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[9]); | |
| 582 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 583 | } | |
| 584 | [ Test] | |
| 585 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sOct_20_20 16() | |
| 586 | { | |
| 587 | var exp ectedText = "Oct 20, 2016"; | |
| 588 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[10]); | |
| 589 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 590 | } | |
| 591 | [ Test] | |
| 592 | p ublic void Eligibili tyVerifica tionDate_G ivenValidT ext_Return sOct_20_20 16B() | |
| 593 | { | |
| 594 | var exp ectedText = "Oct 20, 2016"; | |
| 595 | Authori zationView Model view Model = ne w Authoriz ationViewM odel(authL ist[11]); | |
| 596 | Assert. AreEqual(e xpectedTex t, viewMod el.Eligibl ityVerific ationDate) ; | |
| 597 | } | |
| 598 | [T est] | |
| 599 | pu blic void Eligibilit yVerificat ionDate_Gi venValidTe xt_Returns May_3_2017 () | |
| 600 | { | |
| 601 | var expe ctedText = "May 3,20 17"; | |
| 602 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[12]); | |
| 603 | Assert.A reEqual(ex pectedText , viewMode l.Eligibli tyVerifica tionDate); | |
| 604 | } | |
| 605 | [T est] | |
| 606 | pu blic void Eligibilit yVerificat ionDate_Gi venValidTe xt_Returns Apr_17_201 7() | |
| 607 | { | |
| 608 | var expe ctedText = "Apr 17,2 017"; | |
| 609 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[13]); | |
| 610 | Assert.A reEqual(ex pectedText , viewMode l.Eligibli tyVerifica tionDate); | |
| 611 | } | |
| 612 | [T est] | |
| 613 | pu blic void Eligibilit yVerificat ionDate_Gi venValidTe xt_Returns FieldRefer ence() | |
| 614 | { | |
| 615 | var expe ctedText = "{FLD:VA- 10-0386 DA TE&TIM E TODAY}"; | |
| 616 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[14]); | |
| 617 | Assert.A reEqual(ex pectedText , viewMode l.Eligibli tyVerifica tionDate); | |
| 618 | } | |
| 619 | [T est] | |
| 620 | pu blic void Eligibilit yVerificat ionDate_Gi venValidTe xt_Returns FieldRefer ence2() | |
| 621 | { | |
| 622 | var expe ctedText = "{FLD:DAT E }"; | |
| 623 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[15]); | |
| 624 | Assert.A reEqual(ex pectedText , viewMode l.Eligibli tyVerifica tionDate); | |
| 625 | } | |
| 626 | [T est] | |
| 627 | pu blic void Eligibilit yVerificat ionDate_Gi venValidTe xt16_Retur nsUnk() | |
| 628 | { | |
| 629 | var expe ctedText = "UNK"; | |
| 630 | Authoriz ationViewM odel viewM odel = new Authoriza tionViewMo del(authLi st[16]); | |
| 631 | Assert.A reEqual(ex pectedText , viewMode l.Eligibli tyVerifica tionDate); | |
| 632 | } | |
| 633 | ||
| 634 | } | |
| 635 | } |
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