U027_Master

U027_Master - U027_Master

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

1. Local case numbers

1.1. Local Case Number

1.1.1. Country *

1.1.2. Case number *

1.1.3. Institution

1.1.3.1. Institution ID *

1.1.3.2. Institution Name *

1.1.Local Case Number

2. Information on charging interest *

2.1. Reimbursement request ID *

3. Charging of interest accepted *

3.1. Charging of interest accepted *

3.2. Please fill in the following if "Charging of interest accepted " = "03 - Non accepted" :

3.2.1. Specify the reason for non-acceptance

3.2.2. Please fill in the following if "Charging of interest accepted " = "03 - Non accepted" AND "Specify the reason for non acceptance" = "04 - Other" :

3.2.2.1. Additional information

{{ row.severity }} : {{ row.message }}