| PATIENT NAME | ADDITIONAL REMARKS | C-NUMBER | STATUS OF SPECIAL REPORT | SPECIAL REPORT COMPLETION DATE | EDIT10 | COMPETENCY REPORT | COMPETENCY REPORT DIVISION | COMPETENCY REPORT TRAN DATE | STATUS OF COMPETENCY REPORT | COMPETENCY RPT COMPLETION DATE | EDIT12 | VA FORM 21-2680 | VA FORM 21-2680 DIVISION | VA FORM 21-2680 TRAN DATE | STATUS OF VA FORM 21-2680 | FORM 21-2680 COMPLETION DATE | EDIT14 | ASSET INFORMATION | ASSET INFORMATION DIVISION | ASSET INFORMATION TRAN DATE | STATUS OF ASSET INFORMATION | ASSET INFO COMPLETION DATE | EDIT16 | ADMISSION REPORT | ADMISSION REPORT STATUS | ADMISSION REPORT DIVISION | ADMISSION REPORT TRAN DATE | ADMISSION RPT COMPLETION DATE | EDIT17.4 | OPT TREATMENT RPT (DATE RANGE) | OPT TREATMENT RPT DIVISION | OPT TREATMENT RPT TRAN DATE | STATUS OF OPT TREATMENT RPT | OPT TREAT RPT COMPLETION DATE | EDIT19 | SOC SEC NUMBER | BEGINNING DATE/CARE (CHAP 17) | BEGINNING DATE/CARE DIVISION | BEGINNING DATE/CARE TRAN DATE | STATUS-BEG DATE/CARE (CHAP 17) | BEG/DATE/CARE COMPLETION DATE | EDIT21 | *ADDITIONAL REMARKS | DATE OF REQUEST | DATE LAST STATUS EDIT | FINALIZATION DATE | FINALIZED BY | REQUESTING LOCATION | REQUESTED BY | DIVISION | ADMISSION DATE | DOCUMENT TYPE | NOTICE OF DISCHARGE | NOTICE/DISCHG STATUS | NOTICE OF DISCHARGE DIVISION | NOTICE OF DISCHARGE TRAN DATE | NOTICE/DISCHG COMPLETION DATE | EDIT4.5 | HOSPITAL SUMMARY | HOSPITAL SUMMARY STATUS | HOSPITAL SUMMARY DIVISION | HOSPITAL SUMMARY TRAN DATE | HOSP SUMMARY COMPLETION DATE | EDIT5.5 | CERTIFICATE (21-DAY) | (21-DAY) CERTIFICATE STATUS | CERTIFICATE (21-DAY) DIVISION | CERTIFICATE (21-DAY) TRAN DATE | (21-DAY) COMPLETION DATE | 21 DAY CERT TEXT | 21 DAY CERT RELEASE STATUS | 21 DAY CERT MAS RELEASE DATE | 21 DAY CERT RELEASED BY | DATE 21 DAY CERT PRINTED BY RO | 21 DAY CERT TO DATE | 21 DAY CERT WARD | 21 DAY CERT BED | 21 DAY CERT PRINTED BY | EDIT6.5 | OTHER/EXAM (REVIEW REMARKS) | OTHER/EXAM LISTED IN REM DIV | OTHER/EXAM LISTED TRAN DATE | STATUS OF OTHER/EXAM | OTHER/EXAM COMPLETION DATE | EDIT8 | SPECIAL REPORT | SPECIAL REPORT DIVISION | SPECIAL REPORT TRAN DATE |
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