File FEE_NOTIFICATION_REQUEST(162.2) Data List

DATE/TIME VENDOR USER ENTERING LEGAL DETERM. REQUEST STATUS MEDICAL ENTITLEMENT DATE OF MEDICAL DETERMINATION USER ENTERING MEDICAL DETERM. SUSPENSE CODE DESCRIPTION OF SUSPENSION ASSOCIATED 7078 REFERRING PROVIDER PERSON WHO CALLED USER AUDIT VETERAN DATE/TIME OF ADMISSION AUTHORIZED FROM DATE/TIME ADMITTING DIAGNOSIS ATTENDING PHYSICIAN ATTEN.PHYSICIAN PHONE NUMBER USER ENTERING NOTIFICATION LEGAL ENTITLEMENT DATE OF LEGAL DETERMINATION