H020 - Krav om - Refusion - Administrativ kontrol/medicinske oplysninger
Artikel 87 i forordning (EF) nr. 987/2009
SED API version: 0.16.2 build 2
Model version: 4.2.0
Overordnet krav
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[ SED ]
Kreditorinstitution
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[ CC ]
Institutions-ID
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[ BDT ]
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Institutionens navn
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[ CDT ]
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Samlet reference fastsat af kreditorinstitutionen
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[ CDT ]
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Samlet antal regninger
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[ PRIM ]
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Samlet beløb på kravet i kreditorinstitutionens valuta
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[ SED ]
Beløb
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[ BDT ]
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Valuta
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[ ENUM ]
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Betalingsfrist
[ BDT ]
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Debitorinstitution
[ CC ]
Institutions-ID
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[ BDT ]
{{metaSection.institutionID.$$error}}
{{metaSection.institutionID.$$warning}}
Institutionens navn
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[ CDT ]
{{metaSection.institutionName.$$error}}
{{metaSection.institutionName.$$warning}}
Bankoplysninger
[ CC ]
IBAN
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[ BDT ]
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BIC-SWIFT
[ BDT ]
{{metaSection.BICSWIFT.$$error}}
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Krav
[ SED ]
Person
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[ CC ]
Personoplysninger
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[ CC ]
Efternavn(e)
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[ BDT ]
{{metaSection.familyName.$$error}}
{{metaSection.familyName.$$warning}}
Fornavn(e)
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[ BDT ]
{{metaSection.forename.$$error}}
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Fødselsdato
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[ BDT ]
{{metaSection.dateBirth.$$error}}
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Køn
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{{option.name}}
[ ENUM ]
{{metaSection.sex.$$error}}
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Efternavn(e) ved fødslen
[ BDT ]
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Fornavn(e) ved fødslen
[ BDT ]
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Personnummer
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[ CC ]
PIN for person i den kompetente medlemsstat
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[ BDT ]
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PIN for person i opholds- eller bopælsmedlemsstaten
[ BDT ]
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Refusion
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[ SED ]
Med henvisning til Deres
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[ ENUM ]
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Udstedt den
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[ BDT ]
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Kreditorinstitutionens fakturanummer
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[ CDT ]
{{metaSection.invoiceNumberCreditorInstitution.$$error}}
{{metaSection.invoiceNumberCreditorInstitution.$$warning}}
Fakturabeløb i kreditorinstitutionens valuta
*
[ CC ]
Beløb
*
[ BDT ]
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Valuta
*
{{$select.selected[ 'name']}}
[ ENUM ]
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