| Parent File | Name | Number | Package | 
|---|---|---|---|
| VIST REFERRAL ROSTER(#2042.5) | REFERRAL DATE | 2042.51 | Visual Impairment Service Team | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | REFERRAL DATE | 0;1 | DATE | 
  | 
| 1 | PLACE OF REFERRAL | 0;2 | POINTER TO VIST REFERRAL FACILITY FILE (#2042) | VIST REFERRAL FACILITY(#2042)
  | 
| 2 | TYPE OF REFERRAL (AMIS) | 2;1 | SET | 
 
  | 
| 3 | STATUS OF APPLICATION | 2;2 | SET | 
 
  | 
| 4 | DATE OF NOTIFICATION | 0;3 | DATE | 
  | 
| 5 | BLIND REHAB ADMISSION DATE | 0;4 | DATE | 
  | 
| 6 | BLIND REHAB DISCHARGE DATE | 0;5 | DATE | 
  | 
| 7 | TYPE OF DISCHARGE | 0;6 | SET | 
 
  |