| Parent File | Name | Number | Package |
|---|---|---|---|
| 9000046.11 | ADDITIONAL DAYS AUTHORIZED | 9000046.1201 | IHS Patient |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | DATE AUTH OBTAINED | 0;1 | DATE |
|
| .02 | REFERENCE NUMBER | 0;2 | FREE TEXT |
|
| .03 | CONTACT PERSON | 0;3 | FREE TEXT |
|
| .04 | CONTACT PHONE | 0;4 | FREE TEXT |
|
| .05 | CONTACT E-MAIL | 0;5 | FREE TEXT |
|
| .06 | CONTACT FAX | 0;6 | FREE TEXT |
|
| .07 | NUMBER OF DAYS AUTHORIZED | 0;7 | NUMBER |
|
| .08 | NUMBER OF VISITS AUTHORIZED | 0;8 | NUMBER |
|
| 101 | ADDITIONAL DAYS NOTES | 2;0 | WORD-PROCESSING #9000046.12201 |