| PATIENT NAME | DATE | FORM 4 MAIL MESSAGE DATE | FORM 4 TRANSMIT FLAG EDIT DATE | FORM 4 TRANSMIT FLAG EDIT DUZ | FORM 4 RE-TRANS BATCH MM MSG # | FORM 4 RE-TRANSMIT DATE | QA INDICATOR | CLINIC NUMBER | PROVIDER | OUTPATIENT ENCOUNTER | CPT | DX | TYPE OF VISIT | COMMENTS | CANCELLED APPOINTMENT | FORM 4 TRANSMIT STATUS | FORM 4 FILED IN HBHC(634) DATE | FORM 4 BATCH INITIAL MM MSG # |
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