| FileMan FileNo | FileMan Filename | Package | 
|---|---|---|
| 162.4 | VA FORM 10-7078 | Fee Basis | 
| Package | Total | FileMan Files | 
|---|---|---|
| Fee Basis | 2 | FEE BASIS PROGRAM(#161.8)[.5] FEE BASIS VENDOR(#161.2)[1] | 
| Registration | 2 | VA ADMITTING REGULATION(#43.4)[5] PATIENT(#2)[2] | 
| Kernel | 1 | NEW PERSON(#200)[.013, 8, 15, #162.492(1)] | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | REFERENCE NUMBER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************ 
  | 
| .013 | USER WHO CANCELLED | 0;13 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| .014 | DATE CANCELLED | 0;14 | DATE | 
  | 
| .5 | FEE PROGRAM | 0;11 | POINTER TO FEE BASIS PROGRAM FILE (#161.8) | ************************REQUIRED FIELD************************ FEE BASIS PROGRAM(#161.8)
  | 
| 1 | VENDOR | 0;2 | VARIABLE POINTER | ************************REQUIRED FIELD************************ FEE BASIS VENDOR(#161.2)  
  | 
| 2 | VETERAN | 0;3 | POINTER TO PATIENT FILE (#2) | ************************REQUIRED FIELD************************ PATIENT(#2)
  | 
| 3 | AUTHORIZATION FROM DATE | 0;4 | DATE | 
  | 
| 3.5 | DATE OF ADMISSION | 0;15 | DATE | 
  | 
| 4 | AUTHORIZATION TO DATE | 0;5 | DATE | ************************REQUIRED FIELD************************ 
  | 
| 4.5 | DATE OF DISCHARGE | 0;16 | DATE | 
  | 
| 5 | AUTHORITY | 0;6 | POINTER TO VA ADMITTING REGULATION FILE (#43.4) | ************************REQUIRED FIELD************************ VA ADMITTING REGULATION(#43.4)
  | 
| 6 | ESTIMATED AMOUNT | 0;7 | NUMBER | ************************REQUIRED FIELD************************ 
  | 
| 7 | AUTHORIZED SERVICES | 1;0 | WORD-PROCESSING #162.47 | 
  | 
| 8 | USER ENTERING | 0;8 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| 9 | STATUS | 0;9 | SET | 
 
  | 
| 10 | DATE OF ISSUE | 0;10 | DATE | 
  | 
| 12 | REASON FOR PENDING DISPOSITION | 0;12 | SET | 
 
  | 
| 15 | REFERRING PROVIDER | 0;17 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
  | 
| 16 | REFERRING PROVIDER NPI | COMPUTED | 
  | 
|
| 292 | USER AUDIT | LOG1;0 | DATE Multiple #162.492 | 162.492
  | 
| ICR LINK | Subscribing Package(s) | Fields Referenced | Description | 
|---|---|---|---|
| ICR #5104 |