ASSISTIVE DEVICE REGISTRATION (20)    ORDER TYPE (791810.1)

Name Value
NAME ASSISTIVE DEVICE REGISTRATION
TYPE ABBREVIATION G
PATIENT OR STATION PATIENT
DISPLAY COSTS? DO NOT DISPLAY COSTS
SHORT NAME ASSTR
NON-CONTRACT ITEMS ASSUME NON-CONTRACT ITEMS
ASK TO VIEW ADDRESS ASK TO VIEW ADDRESS
ITEM EDIT STRING .05;.03;.02;.11;101
EDIT FIELDS
  • EDIT FIELD NUMBER:   1
    FIELD NUMBER IN 791810:   .08
    REQUIRED FOR COMPLETION:   REQUIRED FOR COMPLETION
    PROMPT:   Request. By
    VARIABLE NAME:   RMPFADP
  • EDIT FIELD NUMBER:   2
    FIELD NUMBER IN 791810:   .09
    REQUIRED FOR COMPLETION:   REQUIRED FOR COMPLETION
    PROMPT:   Req. Date
    VARIABLE NAME:   RMPFODP
  • EDIT FIELD NUMBER:   3
    FIELD NUMBER IN 791810:   2.01
    REQUIRED FOR COMPLETION:   REQUIRED FOR COMPLETION
    PROMPT:   Dis. Code
    VARIABLE NAME:   RMPFDC
  • EDIT FIELD NUMBER:   4
    FIELD NUMBER IN 791810:   S RMPFMOD=""
  • EDIT FIELD NUMBER:   5
    FIELD NUMBER IN 791810:   10.01
    PROMPT:   Remarks
    VARIABLE NAME:   RMPFRMK
PRODUCT GROUP(S)
AVAILABLE TO ROES MENU #
DISABILITIES ALLOWED
  • AMP
  • AO
  • BLD
  • DEAF
  • ORTH
ITEM REQUIREMENTS STRING .01;.03;.11