File BENEFICIARY_TRAVEL_MANUAL_DEDUCTIBLE_WAIVER(392.7) Data List
WAIVER REQUEST DATE AND TIME
PATIENT NAME
WAIVER STATUS
GRANTED/DENIED BY
WAIVER APPROVAL/DENIAL DATE
WAIVER ENTERED BY
WAIVER REMARKS
EXPIRATION DATE
DATE ENTERED
DELETION DATE
WAIVER DELETED BY
DELETION REMARKS
