Videresend sag

X007 - Videresend sag

SED API version: 0.16.2 build 2
Model version: 4.2.0

Sagens sammenhæng * [ SC ]

Person, baggrund * [ CC ]

Arbejdsgiver, baggrund * [ CC ]

Baggrund for refusion * [ SC ]

Efternavn(e) *

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Fornavn(e) *

[ BDT ] {{metaSection.forename.$$error}} {{metaSection.forename.$$warning}}

Fødselsdato *

[ BDT ] {{metaSection.dateBirth.$$error}} {{metaSection.dateBirth.$$warning}}

Køn *

[ ENUM ] {{metaSection.sex.$$error}} {{metaSection.sex.$$warning}}

Navn *

[ CDT ] {{metaSection.name.$$error}} {{metaSection.name.$$warning}}

Identifikationsnumre [ CC ]

Identifikationsnummer [ CC ]

Nummer *

[ CDT ] {{metaSection.number.$$error}} {{metaSection.number.$$warning}}

Type *

[ ENUM ] {{metaSection.type.$$error}} {{metaSection.type.$$warning}}

Identifikationsnummer

Adresse [ CC ]

Gade

[ CDT ] {{metaSection.street.$$error}} {{metaSection.street.$$warning}}

Navn på bygning

[ CDT ] {{metaSection.buildingName.$$error}} {{metaSection.buildingName.$$warning}}

By *

[ CDT ] {{metaSection.town.$$error}} {{metaSection.town.$$warning}}

Postnummer

[ CDT ] {{metaSection.postalCode.$$error}} {{metaSection.postalCode.$$warning}}

Region

[ CDT ] {{metaSection.region.$$error}} {{metaSection.region.$$warning}}

Land *

[ ENUM ] {{metaSection.country.$$error}} {{metaSection.country.$$warning}}

ID for refusionsanmodning *

[ BDT ] {{metaSection.reimbursementRequestID.$$error}} {{metaSection.reimbursementRequestID.$$warning}}

Samlet antal individuelle krav *

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Fremsend oplysninger * [ SED ]

Tilføjet ny part/aktør * [ CC ]

Institutions-ID *

[ BDT ] {{metaSection.institutionID.$$error}} {{metaSection.institutionID.$$warning}}

Institutionens navn *

[ CDT ] {{metaSection.institutionName.$$error}} {{metaSection.institutionName.$$warning}}

Fjernet part/aktør * [ CC ]

Institutions-ID *

[ BDT ] {{metaSection.institutionID.$$error}} {{metaSection.institutionID.$$warning}}

Institutionens navn *

[ CDT ] {{metaSection.institutionName.$$error}} {{metaSection.institutionName.$$warning}}

Begrundelse

[ ENUM ] {{metaSection.reason.$$error}} {{metaSection.reason.$$warning}}

Hvis "99 - andet" er valgt, anføres flere oplysninger

[ CDT ] {{metaSection.pleaseProvideMoreDetailsIf99OtherSelected.$$error}} {{metaSection.pleaseProvideMoreDetailsIf99OtherSelected.$$warning}}

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