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Veterans Benefits AdministrationM21-1, Part III - page 27 / 71

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M21-1, Part III February 25, 2005

Change 131

PIES PROGRAMMED REQUESTS FOR SELECTION

REQUEST

 CODECODE NARRATIVEWHEN TO USE

C01CLINICAL RECORDS.  FURNISH ACTIVEWhen inpatient clinical records are needed

DUTY INPATIENT CLINICAL RECORDSbecause outpatient file does not contain any

FOR <ALLEGATION>FROMor sufficient documentation about

<MM/DD/YYYY> TO <MM/DD/YYYY> AThospitalization.  See subparagraph 4.01i for

<CLINIC/HOSPITAL NAME OR NUMBER>existing clinical files.

C02MILITARY RETIREE OUTPATIENT.When post-separation treatment files for

FURNISH RECORDS FOR <ALLEGATION>retirees are needed.

FROM <MM/DD/YYYY> TO <MM/DD/YYYY>

AT <HOSPITAL NAME OR NUMBER>.

C03INPATIENT DEPENDENT MEDICAL RECORDSWhen the claimant alleges inpatient

FURNISH INPATIENT DEPENDENT MEDICALtreatment for a condition while a dependent

RECORDS FOR <<ALLEGATION>> of a servicemember.  The records are

<<HOSPITAL NAME OR NUMBER>>stored by month and year of treatment

<<FROM <<MM/DD/YYYY>><< TOunder the sponsor’s name, SSN

<<MM/DD/YYYY>><< SPONSOR’S NAME>>and/or SN, if applicable

<<SPONSOR’S SSN/SN>>

<<RELATIONSHIP TO SPONSOR>>

C04OUTPATIENT DEPENDENT MEDICAL When the claimant alleges outpatient

RECORDS FURNISH OUTPATIENT DEPENDENT treatment for a condition while a dependent RECORDS FOR <<ALLEGATION>>  of a servicemember.  The records are stored  

<<CLINIC/HOSPITAL NAME OR NUMBER>>  by year and last place of treatment under

<<DATE OF LAST YEAR TREATED AT THIS  the sponsor’s name, SSN and/or SN, if

FACILITY – MM/DD/YYYY>>  applicable.

<<SPONSOR’S NAME>> SPONSOR’S SSN/SN>>

<<SPONSOR’S BRANCH OF SERVICE>>

<<RELATIONSHIP TO SPONSOR>>

M01MEDICAL/DENTAL.  FURNISH COMPLETEOutpatient medical and dental records

MEDICAL/DENTAL RECORD <SMRS>.existing at NPRC will be furnished.

M02ENTRANCE PHYSICAL.  FURNISHUse when the outpatient medical records are

ENTRANCE PHYSICALS—CHECK negative and physical condition upon

MICROFICHE.enlistment is needed.

M03SEPARATION/RETIREMENT PHYSICAL.Use when the outpatient medical records are

FURNISH SEPARATION/RETIREMENTnegative and physical condition upon

PHYSICALS—CHECK MICROFICHE.discharge is needed.  Remember that

beginning in the mid 1970s, discharge

physicals are not always performed.

4-K-2

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