34
–3
5
DATE OF SERVICE
DDMMYY
080208
Press ENTER to accept default date. If a
different date is required, press CLEAR to
remove default date then enter correct date in
format ddmmyy and press ENTER.
REFERRING PROV. NO
Enter the referring provider number and press
ENTER, if there is no referring provider
number just press ENTER.
REF. OVERRIDE TYPE
1 NOT REQUIRED
2 LOST
3 EMERGENCY
If no referring provider number was entered
in the previous screen, select the number that
represents the REF. OVERRIDE TYPE.
REF. ISSUE DATE
DDMMYYYY
If REFERRING PROV. NO is entered, please
enter referral issue date and press ENTER.
REF. PERIOD TYPE
1 STANDARD
2 INDEFINITE
If REFERRING PROV. NO is entered, please
enter referral period type.
MBS ITEM 1
Select first MBS ITEM NUMBER. Select PREV or
NEXT from the menu by pressing the CHQ or
CR soft-function keys until you locate the MBS
ITEM NUMBER.
CHARGE AMOUNT 1
Press ENTER to accept the amount displayed,
or to enter a different amount, press CLEAR
then enter the amount and press ENTER.
ITEM OVERRIDE CODE 1
1 N/A
2 NOT DUPLICATE
3 NOT NORMAL A’CARE
Select appropriate item override code from
the list, if no item override code applies press
1 to select N/A.
RESTRICTIVE OVERRIDE CODE
1 N/A
2 SEPARATE SITES
3 NOT RELATED
4 NOT FOR COMPARISON
If N/A is selected in the previous screen, select
the appropriate restrictive override code, if no
restrictive override code applies press 1.
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