| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .001 | entry number | 11 | Enter in this field the internal entry number associated with this status. | |||
| .01 | name(+) | 0;1 | FREE TEXT | B | Enter in this field the name of the financial test status. | |
| .019 | type of test(+) | 0;19 | POINTER | 408.33 | ||
| .02 | code(+) | 0;2 | FREE TEXT | C | Enter in this field the code associated with the financial test status. | |
| .03 | type of care(+) | 0;3 | SET OF CODES | D:DISCRETIONARY M:MANDATORY N:NOT APPLICABLE | Enter in this field the type of care the financial test status is associated with. | |
| 50 | description | D;0 | WORD-PROCESSING | Enter in this field the description associated with the financial test status. | ||
| 75 | effective date | E;0 | MULTIPLE | 408.3275 | Enter in this field the effective date of the financial test status. | |
| 100 | message | MSG;1 | FREE TEXT | Enter in this field the message associated with the financial test status. |