STANDARD DATA DICTIONARY #396.9 -- FORM 28-8861 FILE 6/27/25 PAGE 1
STORED IN ^DVB(396.9, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.7)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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The FORM 28-8861 file contains data from veteran's Chapter 31 Request for Medical Services requests. The 8861 requests are tied to
consults created through CPRS.
DD ACCESS: @
RD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
CROSS
REFERENCED BY: REQUEST DATE(B), PATIENT(C)
INDEXED BY: REQUEST STATUS & REQUEST DATE (ARSDT)
396.9,.01 REQUEST DATE 0;1 DATE
INPUT TRANSFORM: S %DT="ETXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 06, 2012
HELP-PROMPT: Enter the date of the request.
DESCRIPTION: Date of 8861 Request for Medical Services, Chapter 31. The request date defaults to the current
date.
CROSS-REFERENCE: 396.9^B
1)= S ^DVB(396.9,"B",$E(X,1,30),DA)=""
2)= K ^DVB(396.9,"B",$E(X,1,30),DA)
RECORD INDEXES: ARSDT (#890)
396.9,1 ROUTING LOCATION 0;2 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8) (Required)
LAST EDITED: AUG 07, 2012
HELP-PROMPT: Enter routing location where Form 8861 request should be sent to.
DESCRIPTION:
This is the VHA facility that will provide medical services for the veteran.
396.9,2 COMPLETION DATE 0;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 01, 2012
HELP-PROMPT: Select the date the request was completed.
DESCRIPTION:
This is the date the requested was completed. The value will be supplied by the system.
396.9,3 REGIONAL OFFICE 0;4 POINTER TO INSTITUTION FILE (#4) (Required)
LAST EDITED: JUL 02, 2012
HELP-PROMPT: Select the Regional Office of the requestor.
DESCRIPTION: This is the Regional Office of the user that submits the 8861 request. This value is entered by the
system.
396.9,4 PATIENT 0;5 POINTER TO PATIENT FILE (#2)
LAST EDITED: APR 12, 2012
HELP-PROMPT: Select the patient.
DESCRIPTION:
This is the veteran to whom the request pertains.
CROSS-REFERENCE: 396.9^C
1)= S ^DVB(396.9,"C",$E(X,1,30),DA)=""
2)= K ^DVB(396.9,"C",$E(X,1,30),DA)
This cross-reference will be used to sort 8861 Request records by patient name.
396.9,5 REHAB OBJECTIVE OF VETERAN 1;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>245!($L(X)<1) X
LAST EDITED: APR 05, 2012
HELP-PROMPT: Answer must be 1-245 characters in length.
DESCRIPTION: The Rehabilitation Objective of Veteran states what the veteran hopes to achieve through
rehabilitation.
396.9,6 REASON FOR REFERRAL 2;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>75!($L(X)<1) X
LAST EDITED: MAY 11, 2012
HELP-PROMPT: Answer must be 1-75 characters in length.
DESCRIPTION:
Describe the reason for referral.
396.9,7 ANTICIPATED DATE OF REHAB 0;6 DATE (Required)
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 11, 2012
HELP-PROMPT: Enter Anticipated Date of Rehabilitation.
DESCRIPTION:
This is the date the veteran is expected to achieve rehabilitation.
396.9,8 MEDICAL SERVICES REQUESTED 2;2 POINTER TO MEDICAL SERVICES REQUESTED FILE (#396.918) (Required)
LAST EDITED: JUN 14, 2012
HELP-PROMPT: Select a medical service for this request.
DESCRIPTION: This is the medical service requested as the type of exam being requested. Only one item can be
selected.
396.9,8.1 OTHER REASON 6;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: APR 05, 2012
HELP-PROMPT: Answer must be 1-50 characters in length. Enter Other Reason for Referral if value is not on list
of Medical Services Requested in previous prompt.
DESCRIPTION: This field will be used if the Medical Service Requested is not in the list provided and you choose
"Other" for Medical Services Requested (previous prompt).
396.9,9 PREFERRED SCHEDULE DATE 2;3 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 11, 2012
HELP-PROMPT: Enter the date the veteran needs to be seen by only when a Preferred Schedule Date Reason is
entered also.
DESCRIPTION:
This is the date the veteran needs to be seen by.
396.9,10 PREFERRED SCHED DATE REASON 2;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: MAY 11, 2012
HELP-PROMPT: Answer must be 1-50 characters in length. Only required when a Preferred Schedule Date is entered.
DESCRIPTION:
Used to describe why the veteran needs to be seen by the entered Preferred Schedule Date.
396.9,11 POINT OF CONTACT 2;5 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 05, 2012
HELP-PROMPT: Select the Point of Contact user.
DESCRIPTION: The Point of Contact is the same as the person that submits Form 8861. The POC is printed on the
Status Report and would be contacted with any questions about the request.
396.9,12 COMMENTS/NOTES 3;0 WORD-PROCESSING #396.912 (IGNORE "|")
LAST EDITED: APR 05, 2012
HELP-PROMPT: Enter any comments or notes regarding this request.
DESCRIPTION:
This field is used for communications between the VHA and Vocational Rehab POC.
396.9,13 REQUEST STATUS 4;1 SET (Required)
'N' FOR NEW;
'P' FOR PENDING;
'X' FOR CANCELLED;
'C' FOR COMPLETE;
'A' FOR ALL;
LAST EDITED: JUN 14, 2012
HELP-PROMPT: Enter the status of the request.
DESCRIPTION: This is the status of the 8861 Request. "A" for "ALL" is only for choosing a status for the Status
Report.
RECORD INDEXES: ARSDT (#890)
396.9,14 CONSULTS 5;0 POINTER Multiple #396.914 (Add New Entry without Asking)
DESCRIPTION:
This field associates the request with a record in the Request/Consultation file.
396.914,.01 CONSULT 0;1 POINTER TO REQUEST/CONSULTATION FILE (#123)
LAST EDITED: JUN 06, 2012
HELP-PROMPT: Select a consult to associate with the request.
DESCRIPTION:
This field associates the request with a record or records in the Request/Consultation file.
CROSS-REFERENCE: 396.914^B
1)= S ^DVB(396.9,DA(1),5,"B",$E(X,1,30),DA)=""
2)= K ^DVB(396.9,DA(1),5,"B",$E(X,1,30),DA)
396.914,.02 LAST STATUS 5;1 POINTER TO ORDER STATUS FILE (#100.01)
LAST EDITED: JUN 06, 2012
HELP-PROMPT: The system stores the last known status of the consult here.
DESCRIPTION:
When the status of the consult changes in file #123, field #8, the new status is stored here.
396.9,15 CANCELLATION DATE 4;2 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 14, 2012
HELP-PROMPT: Enter the date the request is cancelled.
DESCRIPTION:
This is the date that the request is cancelled.
396.9,16 CANCELLATION REASON 4;3 SET
'DUP' FOR DUPLICATE MEDICAL REQUEST;
'VET' FOR VETERAN WITHDREW MEDICAL REQUEST FOR SERVICES;
'ADQ' FOR ADEQUATE MEDICAL EVIDENCE RECEIVED;
'DIED' FOR VETERAN DIED;
'OTH' FOR OTHER;
LAST EDITED: JUN 14, 2012
HELP-PROMPT: Select the reason the request was cancelled.
DESCRIPTION:
This is the reason the request was cancelled.
396.9,17 ADDITIONAL REMARKS 4;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<3) X
LAST EDITED: JUN 01, 2012
HELP-PROMPT: Answer must be 3-50 characters in length. Provide additional information about the reason for the
cancellation.
DESCRIPTION:
This is additional information for the cancelled request.
FILES POINTED TO FIELDS
INSTITUTION (#4) REGIONAL OFFICE (#3)
MEDICAL CENTER DIVISION (#40.8) ROUTING LOCATION (#1)
MEDICAL SERVICES REQUESTED
(#396.918) MEDICAL SERVICES REQUESTED (#8)
NEW PERSON (#200) POINT OF CONTACT (#11)
ORDER STATUS (#100.01) CONSULTS:LAST STATUS (#.02)
PATIENT (#2) PATIENT (#4)
REQUEST/CONSULTATION (#123) CONSULTS:CONSULT (#.01)
File #396.9
Record Indexes:
ARSDT (#890) RECORD REGULAR IR SORTING ONLY
Short Descr: Performs sorting on request status & date.
Description: This cross-reference will perform sorting on the Request Status and Request Date fields.
Set Logic: S ^DVB(396.9,"ARSDT",$E(X(1),1,10),$E(X(2),1,12),DA)=""
Set Cond: Q
Kill Logic: K ^DVB(396.9,"ARSDT",$E(X(1),1,10),$E(X(2),1,12),DA)
Kill Cond: Q
Whole Kill: K ^DVB(396.9,"ARSDT")
X(1): REQUEST STATUS (396.9,13) (Subscr 1) (Len 10) (forwards)
X(2): REQUEST DATE (396.9,.01) (Subscr 2) (Len 12) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):