| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | transaction id(+) | 0;1 | FREE TEXT | B | ||
| 1 | patient name | 0;2 | POINTER | 470 | ||
| 2 | patient transaction # | 0;3 | NUMERIC | |||
| 3 | amount | 0;4 | NUMERIC | |||
| 4 | transaction date(+) | 0;5 | DATE-TIME | AD | ||
| 5 | date transaction entered(+) | 0;6 | DATE-TIME | AC | ||
| 5.5 | days between dates | COMPUTED | ||||
| 6 | reference | 0;7 | FREE TEXT | |||
| 7 | deposit/withdrawal(+) | 0;8 | SET OF CODES | D:DEPOSIT W:WITHDRAWAL | ||
| 8 | cash/check/other(+) | 0;9 | SET OF CODES | 1:CASH 2:CHECK 3:OTHER | ||
| 9 | source | 0;10 | SET OF CODES | P:PRIVATE SOURCE G:GRATUITOUS B:BOTH | ||
| 10 | form(+) | 0;11 | POINTER | 470.2 | ||
| 11 | private source amt | 0;12 | NUMERIC | |||
| 12 | gratuitous amount | 0;13 | NUMERIC | |||
| 13 | patient funds clerk(+) | 0;14 | POINTER | 200 | ||
| 13.5 | validation code | 0;17 | NUMERIC | Field contains the validation code for verification of electronic signature. | ||
| 13.7 | validation version | 0;22 | NUMERIC | This field contains the version number used to encode the Electronic Signature Code. | ||
| 14 | electronic signature | 0;15 | FREE TEXT | |||
| 15 | remarks | 0;16 | FREE TEXT | |||
| 16 | balance carried forward amt | 0;18 | NUMERIC | |||
| 17 | pvt source bal carried fwd | 0;19 | NUMERIC | |||
| 18 | gratuitous bal carried fwd | 0;20 | NUMERIC | |||
| 19 | deferral date | 0;21 | DATE-TIME | |||
| 20 | sig conversion completed | 0;22 | BOOLEAN | 0:NO 1:YES | ||
| 21 | signature code date/time | 0;23 | DATE-TIME |
Not Referenced