File ANNUAL_MEANS_TEST(408.31) Data List
| DATE OF TEST |
TYPE OF TEST |
PATIENT |
STATUS |
INCOME |
NET WORTH |
COMPLETED BY |
DATE/TIME COMPLETED |
CATEGORY CHANGED BY |
DATE/TIME CATEGORY CHANGED |
ADJUDICATION DATE/TIME |
AGREED TO PAY DEDUCTIBLE |
THRESHOLD A |
THRESHOLD B |
DECLINES TO GIVE INCOME INFO |
DEDUCTIBLE EXPENSES |
PREVIOUS YEARS THRESHOLD |
NO LONGER REQUIRED DATE |
TOTAL DEPENDENTS |
HARDSHIP? |
HARDSHIP REVIEW DATE |
APPROVED BY |
SOURCE OF INCOME TEST |
DATE VETERAN SIGNED TEST |
DATE IVM VERIFIED MT COMPLETED |
REFUSED TO SIGN |
GMT THRESHOLD |
MEANS TEST SIGNED? |
BULLETIN DATE |
PRIMARY INCOME TEST FOR YEAR? |
HARDSHIP EFFECTIVE DATE |
DATE/TIME TEST LAST EDITED |
TEST-DETERMINED STATUS |
SITE GRANTING HARDSHIP |
SITE CONDUCTING TEST |
LINKED RX COPAY/MEANS TEST |
REASON FOR EXEMPTION |
LINKED LTC CO-PAY/MEANS TEST |
HARDSHIP REASON |
1010EC FORM |
MEANS TEST VERSION |
HARDSHIP EXPIRED |
HARDSHIP EXPIRATION DATE |
INCOME DATA PURGED PER IRS/SSA |
BT FINANCIAL INDICATOR |
COMMENT |