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InfoFileMan FileNo | FileMan Filename | Package |
---|---|---|
161.5 | FEE CH REPORT OF CONTACT | Fee Basis |
Package | Total | FileMan Files |
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Fee Basis | 2 | FEE NOTIFICATION/REQUEST(#162.2)[.01] FEE BASIS VENDOR(#161.2)[1] |
Kernel | 2 | STATE(#5)[10] NEW PERSON(#200)[18, #161.517(2)] |
Beneficiary Travel | 1 | BENEFICIARY TRAVEL MODE OF TRANSPORTATION(#392.4)[16] |
Registration | 1 | PATIENT(#2)[2] |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | ASSOCIATED REQUEST | 0;1 | POINTER TO FEE NOTIFICATION/REQUEST FILE (#162.2) | FEE NOTIFICATION/REQUEST(#162.2)
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1 | VENDOR | 0;2 | POINTER TO FEE BASIS VENDOR FILE (#161.2) | ************************REQUIRED FIELD************************ FEE BASIS VENDOR(#161.2)
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2 | VETERAN | 0;3 | POINTER TO PATIENT FILE (#2) | PATIENT(#2)
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3 | INITIAL DATE OF CONTACT | 0;4 | DATE |
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4 | AUTHORIZATION FROM DATE | 0;5 | DATE |
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5 | TYPE OF CONTACT | 0;6 | SET | ************************REQUIRED FIELD************************
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6 | PERSON CONTACTED | 0;7 | FREE TEXT |
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6.5 | PHONE # OF PERSON CONTACTED | 1;4 | FREE TEXT |
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7 | STREET ADDRESS[1] OF CONTACT | 0;8 | FREE TEXT |
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8 | STREET ADDRESS[2] OF CONTACT | 0;9 | FREE TEXT |
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9 | CITY OF CONTACT | 0;10 | FREE TEXT |
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10 | STATE OF CONTACT | 0;11 | POINTER TO STATE FILE (#5) | STATE(#5)
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11 | ZIP CODE OF CONTACT | 0;12 | FREE TEXT |
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12 | ATTENDING PHYSICIAN | 0;13 | FREE TEXT |
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13 | ATTEND.PHYSICIAN TELEPHONE NO. | 0;14 | FREE TEXT |
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14 | TENTATIVE DIAGNOSIS | 1;1 | FREE TEXT |
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15 | INSURANCE TYPE | 1;2 | FREE TEXT |
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16 | MODE OF TRANSPORTATION | 1;3 | POINTER TO BENEFICIARY TRAVEL MODE OF TRANSPORTATION FILE (#392.4) | BENEFICIARY TRAVEL MODE OF TRANSPORTATION(#392.4)
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16.5 | VETERAN HAVE OTHER INSURANCE | 1;5 | FREE TEXT |
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17 | DATE/TIME OF CONTACT | 2;0 | DATE Multiple #161.517 | 161.517
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18 | APPROVING OFFICIAL | 1;6 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
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19 | DATE/TIME OF ADMISSION | 1;7 | DATE |
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