| Parent File | Name | Number | Package |
|---|---|---|---|
| BT PATIENT ALTERNATE INCOME(#392.9) | ALTERNATE INCOME | 392.91 | Beneficiary Travel |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | ALTERNATE INCOME DATE | 0;1 | DATE | ************************REQUIRED FIELD************************
|
| 1 | ALTERNATE INCOME | 0;2 | NUMBER | ************************REQUIRED FIELD************************
|
| 2 | ALTERNATE INCOME REASON | 0;3 | SET | ************************REQUIRED FIELD************************
|
| 3 | ALTERNATE INCOME EXPIRATION | 0;4 | DATE | ************************REQUIRED FIELD************************
|