U020_Child

U020_Child - U020_Child

SED API version: 0.14.2 PREVIEW build 3
Model version: 4.0.16

1. Individual claim *

1.1. Person *

1.1.1. Person identification *

1.1.1.1. Family name(s) *

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1.1.1.2. Forename(s) *

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1.1.1.3. Date of birth *

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1.1.1.4. Sex *

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1.1.1.5. Family name(s) at birth

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1.1.1.6. Forename(s) at birth

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1.1.1.7. PIN of the person in each institution

1.1.1.7.1. Personal Identification Number(s) *

1.1.1.7.1.1. Country *

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1.1.1.7.1.2. Personal Identification Number (PIN) *

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1.1.1.7.1.3. Sector

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1.1.1.7.1.4. Institution

1.1.1.7.1.4.1. Institution ID *

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1.1.1.7.1.4.2. Institution Name *

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1.1.1.7.1.Personal Identification Number(s)

1.1.1.8. If PIN not provided for every institution, please provide

1.1.1.8.1. Place of birth

1.1.1.8.1.1. Town *

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1.1.1.8.1.2. Region

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1.1.1.8.1.3. Country *

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1.1.1.8.2. Father's family name at birth

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1.1.1.8.3. Forename of father

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1.1.1.8.4. Mother's family name at birth

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1.1.1.8.5. Forename of mother

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1.1.2. Additional information on the person

1.1.2.1. Nationality

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1.2. Reimbursement request ID *

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1.3. Sequential number of Individual claim *

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1.4. Institution which certified insurance record *

1.4.1. Institution ID *

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1.4.2. Institution Name *

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1.5. Working periods considered *

1.5.1. Working period considered *

1.5.1.1. Start Date *

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1.5.1.2. End Date *

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1.5.1.Working period considered

1.6. Reimbursement period *

1.6.1. Start Date *

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1.6.2. End Date *

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1.7. Last payment date *

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1.8. Requested amount for reimbursement *

1.8.1. Amount *

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1.8.2. Currency *

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