Parent File | Name | Number | Package |
---|---|---|---|
FEE BASIS PATIENT(#161) | AUTHORIZATION | 161.01 | Fee Basis |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | FROM DATE | 0;1 | DATE |
|
.02 | TO DATE | 0;2 | DATE | ************************REQUIRED FIELD************************
|
.021 | AUTHORIZATION REMARKS | 2;0 | WORD-PROCESSING #161.06 |
|
.03 | FEE PROGRAM | 0;3 | POINTER TO FEE BASIS PROGRAM FILE (#161.8) | ************************REQUIRED FIELD************************ FEE BASIS PROGRAM(#161.8)
|
.04 | VENDOR | 0;4 | POINTER TO FEE BASIS VENDOR FILE (#161.2) | FEE BASIS VENDOR(#161.2)
|
.055 | ASSOCIATED 7078/583 | 0;9 | VARIABLE POINTER | VA FORM 10-7078(#162.4) FEE BASIS UNAUTHORIZED CLAIMS(#162.7)
|
.06 | DISCHARGE TYPE | 0;15 | SET |
|
.065 | PATIENT TYPE CODE | 0;18 | SET |
|
.07 | PURPOSE OF VISIT CODE | 0;7 | POINTER TO FEE BASIS PURPOSE OF VISIT FILE (#161.82) | ************************REQUIRED FIELD************************ FEE BASIS PURPOSE OF VISIT(#161.82)
|
.08 | DX LINE 1 | 0;8 | FREE TEXT |
|
.085 | DX LINE 2 | 3;1 | FREE TEXT |
|
.086 | DX LINE 3 | 3;2 | FREE TEXT |
|
.087 | ICD DIAGNOSIS | C;2 | POINTER TO ICD DIAGNOSIS FILE (#80) | ************************REQUIRED FIELD************************ ICD DIAGNOSIS(#80)
|
.095 | TREATMENT TYPE CODE | 0;13 | SET | ************************REQUIRED FIELD************************
|
.096 | ACCIDENT RELATED (Y/N) | 0;19 | FREE TEXT |
|
.097 | POTENTIAL COST RECOVERY CASE | 0;20 | FREE TEXT | ************************REQUIRED FIELD************************
|
1 | PRINT AUTHORIZATION (Y/N) | C;1 | FREE TEXT |
|
2 | TYPE OF CARE | 0;14 | SET |
|
3 | DATE PRINTED | 1;2 | DATE |
|
100 | CLERK | 100;1 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
101 | PRIMARY SERVICE AREA | 0;5 | POINTER TO INSTITUTION FILE (#4) | ************************REQUIRED FIELD************************ INSTITUTION(#4)
|
102 | AUSTIN DELETE FLAG | ADEL;1 | FREE TEXT |
|
103 | DATE DELETE MRA TRANSMITTED | ADEL;2 | DATE |
|
104 | REFERRING PROVIDER | 0;21 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
105 | CONTRACT | 0;22 | POINTER TO FEE BASIS CONTRACT FILE (#161.43) | FEE BASIS CONTRACT(#161.43)
|
292 | USER AUDIT | LOG1;0 | DATE Multiple #161.192 | 161.192
|
293 | DATA AUDIT | LOG2;0 | DATE Multiple #161.193 | 161.193
|