| NAME |
LOST HEARING AID REPORT |
| TYPE ABBREVIATION |
L |
| PATIENT OR STATION |
STATION |
| ORDER MESSAGE |
AN APPROVED REPORT OF SURVEY MUST BE FORWARDED TO: DDC (905C) |
| DISPLAY COSTS? |
DO NOT DISPLAY COSTS |
| INACTIVE |
ACTIVE |
| SHORT NAME |
LOST A |
| ASK TO VIEW ADDRESS |
DO NOT ASK TO VIEW ADDRESS |
| ITEM EDIT STRING |
.05;.1 |
| EDIT FIELDS |
-
- EDIT FIELD NUMBER: 1
- FIELD NUMBER IN 791810: .08
- REQUIRED FOR COMPLETION: REQUIRED FOR COMPLETION
- PROMPT: Reported By
- VARIABLE NAME: RMPFADP
-
- EDIT FIELD NUMBER: 2
- FIELD NUMBER IN 791810: .09
- REQUIRED FOR COMPLETION: REQUIRED FOR COMPLETION
- PROMPT: Report Date
- VARIABLE NAME: RMPFODP
-
- EDIT FIELD NUMBER: 3
- FIELD NUMBER IN 791810: S RMPFMOD=""
- VARIABLE NAME: RMPFRMK
-
- EDIT FIELD NUMBER: 4
- FIELD NUMBER IN 791810: 10.01
- PROMPT: Remarks
- VARIABLE NAME: RMPFRMK
|
| PRODUCT GROUP(S) |
|
| AVAILABLE TO ROES MENU # |
|
| DISABILITIES ALLOWED |
|
| ITEM REQUIREMENTS STRING |
.01;.05;.1 |
| SPECIAL REQUIREMENTS MODULE |
REG |
