Parent File | Name | Number | Package |
---|---|---|---|
WORKMAN'S COMPENSATION(#9000042) | DATE OF WC INJURY | 9000042.11 | IHS Patient |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | DATE OF WC INJURY | 0;1 | DATE | ************************REQUIRED FIELD************************
|
.02 | DESC OF INJURY | 0;2 | FREE TEXT |
|
.03 | CLAIM FILED | 0;3 | SET |
|
.04 | CLAIM NUMBER | 0;4 | FREE TEXT |
|
.05 | NAME OF PATIENT'S ATTORNEY | 0;5 | FREE TEXT |
|
.06 | PATIENT'S EMPLOYER | 0;6 | POINTER TO EMPLOYER FILE (#9999999.75) | EMPLOYER(#9999999.75)
|
.07 | DATE CASE CLOSED | 0;7 | DATE |
|
.08 | TYPE OF ACCIDENT | 0;8 | FREE TEXT |
|
.09 | CLAIM STATUS | 0;9 | SET |
|
.11 | ENTITY | 0;10 | POINTER TO INSURER FILE (#9999999.18) | INSURER(#9999999.18)
|
.12 | GROUP NAME | 0;11 | POINTER TO EMPLOYER GROUP INSURANCE FILE (#9999999.77) | EMPLOYER GROUP INSURANCE(#9999999.77)
|
.13 | EFFECTIVE DATE | 0;12 | DATE |
|
.14 | EXPIRATION DATE | 0;13 | DATE |
|
.15 | NOTES | 1;1 | FREE TEXT |
|
201 | DATE LAST WORKED | 2;1 | DATE |
|
202 | DISABILITY START DATE | 2;2 | DATE |
|
203 | DISABILITY END DATE | 2;3 | DATE |
|
204 | WORK RETURN AUTH DATE | 2;4 | DATE |
|
205 | CONTACT INFO | 2;5 | FREE TEXT |
|