Forward Case

X007 - Forward Case

SED API version: 0.15.2 build 3
Model version: 4.1.0

1. Case Context * [ SC ]

Person Context* [ CC ]

Employer Context* [ CC ]

Reimbursement Context* [ SC ]

1.1.1. Family name(s) *

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1.1.2. Forename(s) *

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1.1.3. Date of birth *

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1.1.4. Sex *

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1.2.1. Name *

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1.2.2. Identification numbers [ CC ]

1.2.2.1. Identification number [ CC ]

1.2.2.1.1. Number *

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1.2.2.1.2. Type *

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1.2.2.1.Identification number

1.2.3. Address [ CC ]

1.2.3.1. Street

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1.2.3.2. Building Name

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1.2.3.3. Town *

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1.2.3.4. Postal Code

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1.2.3.5. Region

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1.2.3.6. Country *

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1.3.1. Reimbursement Request ID *

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1.3.2. Total number of individual claims *

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2. Forward Information * [ SED ]

2.1. Added Participant * [ CC ]

2.1.1. Institution ID *

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2.1.2. Institution Name *

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2.2. Removed Participant * [ CC ]

2.2.1. Institution ID *

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2.2.2. Institution Name *

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2.3. Reason

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2.4. Please provide more details if "99-Other" is selected

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