Reimbursement Receipt / Closing Notification

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Local case numbers [ CC ]

1.1. Local Case Number [ CC ]

1.1.1. Country *

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1.1.2. Case number *

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1.1.3. Institution [ CC ]

1.1.3.1. Institution ID *

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1.1.3.2. Institution Name *

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1.1.Local Case Number

2. General information * [ SED ]

2.1. Reimbursement request ID *

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2.2. Reimbursement payment notification ID *

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2.3. Reimbursement receipt or closing notification ID *

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2.4. Amount received * [ CC ]

2.4.1. Amount *

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2.4.2. Currency *

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2.5. Date of payment received *

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3. Reimbursement request closed * [ SED ]

3.1. Reimbursement request closed *

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3.2. Please fill in the following if "Reimbursement request closed" = "No" : [ SED ]

3.2.1. Reason for not closing reimbursement request

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3.2.2. Please fill in the following if "Reason for not closing reimbursement request" = "04 - Other reason" : [ SED ]

3.2.2.1. Reason

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