| Name | Value |
|---|---|
| NAME | CHOICE (OPT) CANCEL |
| ABBREVIATION | CAN CCCO |
| CHARGE CATEGORY | CHOICE OPT |
| SEQUENCE NUMBER | CANCEL |
| CANCELLATION ACTION TYPE | CHOICE (OPT) CANCEL |
| UPDATE ACTION TYPE | CHOICE (OPT) UPDATE |
| NEW ACTION TYPE | CHOICE (OPT) NEW |
| BILLING GROUP | OPT COPAY |
| INACTIVE | 1 |