| Parent File | Name | Number | Package |
|---|---|---|---|
| 9002071.01 | OTHER PROVIDER (NOT ON-FILE) | 9002071.03 | Contract Health Management Information System |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | OTHER PROVIDER (NOT ON-FILE) | 0;1 | FREE TEXT |
|
| 2 | MAILING ADDRESS-STREET | 0;2 | FREE TEXT |
|
| 3 | MAILING ADDRESS-CITY | 0;3 | FREE TEXT |
|
| 4 | MAILING ADDRESS-STATE | 0;4 | POINTER TO STATE FILE (#5) | STATE(#5)
|
| 5 | MAILING ADDRESS-ZIP | 0;5 | FREE TEXT |
|
| 6 | EST. CHARGES (THIS PROVIDER) | 0;6 | NUMBER |
|
| 7 | ACTUAL CHARGES (THIS PROVIDER) | 0;7 | NUMBER |
|