| Name | Value |
|---|---|
| NAME | DG LTC INPT DOM CANCEL |
| ABBREVIATION | LTC IDOM |
| CHARGE CATEGORY | DOMICILIARY |
| SEQUENCE NUMBER | CANCEL |
| CANCELLATION ACTION TYPE | DG LTC INPT DOM CANCEL |
| UPDATE ACTION TYPE | DG LTC INPT DOM UPDATE |
| NEW ACTION TYPE | DG LTC INPT DOM NEW |
| BILLING GROUP | LTC INPT |