2KLEANCLAIMS 5010 (UB04) 02-12.@&A6+@PB????tblClaim| F'w.@Pj_@TPF0 TQrdQuickRep QuickReportLeftTopWidth0Height  Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRightDataSetformReport.tblClaim Font.CharsetDEFAULT_CHARSET Font.Color clWindowText Font.Height Font.NameArial Font.Style Functions.Strings PAGENUMBER COLUMNNUMBER REPORTTITLEFunctions.DATA00''Options FirstPageHeaderLastPageFooter Page.ColumnsPage.Orientation poPortraitPage.PaperSizeLetter Page.Values@ @@ @@@PrinterSettings.CopiesPrinterSettings.DuplexPrinterSettings.FirstPagePrinterSettings.LastPagePrinterSettings.OutputBinAuto PrintIfEmpty ReportTitle 2KLEANCLAIMS 5010 (UB04) 02-12 SnapToGrid UnitsPixelsZoomdUseReportDesigner Claim.Chart Number Claim.EMC Receiver 1Claim.Billing Code Claim.Indicator 1 Claim.Date CreatedClaim.ProviderClaim.Insurance Carrier 1 Claim.Claim NumberClaim.Batch Number 1"Insurance Carrier 1;Claim Status 1Band1`wwZx$@Z rbPageHeaderwZx$@ZTPF0TQrdBandBand1LeftTopWidthHeight Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Frame.StylepsDash AlignToBottomColorclAquaForceNewColumn ForceNewPage Size.Values8 @ @BandType rbPageHeader BandCaption Claim HeaderCaptionBand1DBText52aderwZx$@ZTPF0 TQrdDBTextDBText52Left&TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@UUUUUU @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FontSize Patient.Signature on FileFalseSignature on file+Case/Insurance Carrier #1.Signature on FileSignature on fileSignature on File+Case/Insurance Carrier #1.Signature on File Print namePatient.Full NameDBText35aderwZx$@ZTPF0 TQrdDBTextDBText35LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU @* @UUUUUUu@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FontSize Insured 1.Signature on FileSignature on file3Case/Insurance Carrier #1.Insured Signature on File Print nameInsured 1.Full Name3Case/Insurance Carrier #1.Insured Signature on FileSignature on fileSignature on FileName4t35aderwZx$@ZTPF0 TQrdDBTextName4LeftGTop.Width HeightHint.File: Claim/Insurance Carrier #1 Field: Name Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@K@j@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblLUInsurance1 DataFieldName Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Insurance Carrier #1FontSize Full_Name_LFM2Zx$@ZTPF0 TQrdDBTextFull_Name_LFM2Left TopWidthHeightHint$File: Patient Field: Full Name LFM Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@@@>@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataField Full Name LFM Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNamePatientFontSize  Street_15_LFM2Zx$@ZTPF0 TQrdDBText Street_15Left TopWidthHeightHintFile: Patient Field: Street 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@b@UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataFieldStreet 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNamePatientFontSize City1t_15_LFM2Zx$@ZTPF0 TQrdDBTextCity1Left TopWidthHeightHintFile: Patient Field: City Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@6@>@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataFieldCity Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNamePatientFontSize  Zip_Code2_LFM2Zx$@ZTPF0 TQrdDBText Zip_Code2Left TopWidthpHeightHintFile: Patient Field: Zip Code Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@@*@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataFieldZip Code Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNamePatientFontSize DBText402_LFM2Zx$@ZTPF0 TQrdDBTextDBText40Left5Top|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@:@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeMedicaidXDBText702_LFM2Zx$@ZTPF0 TQrdDBTextDBText7LeftTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@r@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeChampsVAXDBText312_LFM2Zx$@ZTPF0 TQrdDBTextDBText31LeftTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@Ĝ@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeGroupXClaim/Insurance Carrier #1.TypeHMOXClaim/Insurance Carrier #1.TypePPOXDBText332_LFM2Zx$@ZTPF0 TQrdDBTextDBText33Left]Top|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeOtherXClaim/Insurance Carrier #1.TypeBlue Cross/ShieldXDBText372_LFM2Zx$@ZTPF0 TQrdDBTextDBText37Left-Top|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeFECAXDBText132_LFM2Zx$@ZTPF0 TQrdDBTextDBText13Left Top|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeMedicareXState1132_LFM2Zx$@ZTPF0 TQrdDBTextState1LeftTopWidth HeightHintFile: Patient Field: State Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataFieldState Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNamePatientFontSize Phone_122_LFM2Zx$@ZTPF0 TQrdDBTextPhone_12LeftJTopWidthHeightHintFile: Patient Field: Phone 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUU]@UUUUUUM@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataFieldPhone 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNamePatientFontSize Date_of_Birth3Zx$@ZTPF0 TQrdDBTextDate_of_Birth3TagLeftTopWidthXHeightHint$File: Patient Field: Date of Birth Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@VUUUUU @VUUUUU@ AlignmenttaCenter AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPatient DataField Date of Birth Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNamePatientFontSize DBText30Birth3Zx$@ZTPF0 TQrdDBTextDBText30LeftETopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@VUUUUU @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  Patient.SexMaleXDBText10Birth3Zx$@ZTPF0 TQrdDBTextDBText1LeftmTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@n@VUUUUU @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  Patient.SexFemaleXDBText36Birth3Zx$@ZTPF0 TQrdDBTextDBText36LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUY@TUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #1SelfXDBText26Birth3Zx$@ZTPF0 TQrdDBTextDBText2LeftETopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@TUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #1ChildXDBText10Birth3Zx$@ZTPF0 TQrdDBTextDBText10LeftmTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@n@TUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #1OtherXDBText90Birth3Zx$@ZTPF0 TQrdDBTextDBText9Left%TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@TUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #1SpouseXPolicy_Number__11Zx$@ZTPF0 TQrdDBTextPolicy_Number__11LeftTop}Width HeightHint$File: Case Field: Policy Number #1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU @UUUUUU]@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldPolicy Number #1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize Full_Name_LFM3_11Zx$@ZTPF0 TQrdDBTextFull_Name_LFM3LeftTopWidthHeightHint&File: Insured 1 Field: Full Name LFM Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@@ֽ@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataField Full Name LFM Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Insured 1FontSize  Street_12_LFM3_11Zx$@ZTPF0 TQrdDBText Street_12LeftTopWidth HeightHint!File: Insured 1 Field: Street 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@R @TUUUUU@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataFieldStreet 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Insured 1FontSize City2t_12_LFM3_11Zx$@ZTPF0 TQrdDBTextCity2LeftTopWidthHeightHintFile: Insured 1 Field: City Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUUu@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataFieldCity Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Insured 1FontSize State2_12_LFM3_11Zx$@ZTPF0 TQrdDBTextState2Left<TopWidth8HeightHintFile: Insured 1 Field: State Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU- @@*@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataFieldState Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Insured 1FontSize  Zip_Code3_LFM3_11Zx$@ZTPF0 TQrdDBText Zip_Code3LeftTopWidthxHeightHint!File: Insured 1 Field: Zip Code Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@H @UUUUUU]@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataFieldZip Code Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Insured 1FontSize Phone_133_LFM3_11Zx$@ZTPF0 TQrdDBTextPhone_13LeftTopWidthHeightHint File: Insured 1 Field: Phone 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @UUUUUU]@UUUUUUM@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataFieldPhone 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Insured 1FontSize Date_of_Birth2_11Zx$@ZTPF0 TQrdDBTextDate_of_Birth2TagLeftkTop7WidthpHeightHint&File: Insured 1 Field: Date of Birth Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@*@ AlignmenttaCenter AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured1 DataField Date of Birth Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Insured 1FontSize Group_Number__121Zx$@ZTPF0 TQrdDBTextGroup_Number__12LeftTopWidthHeightHint#File: Case Field: Group Number #1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU @UUUUUU5@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldGroup Number #1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize DBText32mber__121Zx$@ZTPF0 TQrdDBTextDBText32LeftTop5WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUI @d@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  Insured 1.SexMaleXDBText16mber__121Zx$@ZTPF0 TQrdDBTextDBText16LeftETop5WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU' @d@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  Insured 1.SexFemaleXDBText21mber__121Zx$@ZTPF0 TQrdDBTextDBText21Left TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Marital StatusSingleXDBText19mber__121Zx$@ZTPF0 TQrdDBTextDBText19Left=TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Marital StatusMarriedXDBText15mber__121Zx$@ZTPF0 TQrdDBTextDBText15LefteTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@$@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Marital StatusDivorcedXCase.Marital StatusUnknownXCase.Marital StatusWidowedXCase.Marital StatusLegally separatedXDBText85mber__121Zx$@ZTPF0 TQrdDBTextDBText8Left TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUU]@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Employment Status Full timeXCase.Employment Status Part timeXDBText22mber__121Zx$@ZTPF0 TQrdDBTextDBText22Left=TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Student Status Full timeXDBText20mber__121Zx$@ZTPF0 TQrdDBTextDBText20LeftmTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@n@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Student Status Part timeXDBText50mber__121Zx$@ZTPF0 TQrdDBTextDBText5Left=Top8WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@`@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to EmploymentXDBText23mber__121Zx$@ZTPF0 TQrdDBTextDBText23Left5TopUWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@d@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to AccidentAutoXDBText42mber__121Zx$@ZTPF0 TQrdDBTextDBText42Left5ToptWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@d@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to AccidentYesXPolicy_Number__22Zx$@ZTPF0 TQrdDBTextPolicy_Number__22LeftTop8WidthHeightHint$File: Case Field: Policy Number #2 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@`@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldPolicy Number #2 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize Date_of_Birth1_22Zx$@ZTPF0 TQrdDBTextDate_of_Birth1TagLeft TopVWidthXHeightHint&File: Insured 2 Field: Date of Birth Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@8@VUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured2 DataField Date of Birth Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Insured 2FontSize DBText12Birth1_22Zx$@ZTPF0 TQrdDBTextDBText12LeftTopVWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@8@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  Insured 2.SexMaleXDBText32Birth1_22Zx$@ZTPF0 TQrdDBTextDBText3LeftTopVWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@r@8@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  Insured 2.SexFemaleXName3t32Birth1_22Zx$@ZTPF0 TQrdDBTextName3LeftTopsWidthHeightHint8File: Insured 2/Employer Field: Name (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUU@f@R@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblIns2Employer DataFieldName Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameInsured 2/EmployerFontSize Claim.Insurance Carrier 2 Plan_Name3rth1_22Zx$@ZTPF0 TQrdDBText Plan_Name3LeftTopWidthHeightHintEFile: Claim/Insurance Carrier #2 Field: Plan Name (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@F @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblLUInsurance2 DataField Plan Name Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Insurance Carrier #2FontSize $Claim/Insurance Carrier #2.Plan NameClaim/Insurance Carrier #2.NameDate_Similar_Symptoms1x$@ZTPF0 TQrdDBTextDate_Similar_Symptoms1TagLeftTopWidthXHeightHint;File: Case Field: Date Similar Symptoms (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@ @VUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldDate Similar Symptoms Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameCaseFontSize DTP 438 NOT USEDDTP 438 NOT USED Street_11lar_Symptoms1x$@ZTPF0 TQrdDBText Street_11LeftGTop>Width HeightHint2File: Claim/Insurance Carrier #1 Field: Street 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@K@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblLUInsurance1 DataFieldStreet 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Insurance Carrier #1FontSize DBText281lar_Symptoms1x$@ZTPF0 TQrdDBTextDBText28LefteTopUWidth HeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@$@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to AccidentAutoCase.Accident StateDBText171lar_Symptoms1x$@ZTPF0 TQrdDBTextDBText17LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@L @H @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insurance Carrier #2XDBText181lar_Symptoms1x$@ZTPF0 TQrdDBTextDBText18LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@, @ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insurance Carrier #2XName5t181lar_Symptoms1x$@ZTPF0 TQrdDBTextName5LeftTopUWidth HeightHint&File: Insured 1/Employer Field: Name Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblIns1Employer DataFieldName Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameInsured 1/EmployerFontSize DBText271lar_Symptoms1x$@ZTPF0 TQrdDBTextDBText27LeftToptWidth HeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@N @@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize )Case/Insurance Carrier #1.ETS Record CodeC)Case/Insurance Carrier #1.ETS Record CodeC#Case/Insurance Carrier #1.Plan Name#Case/Insurance Carrier #1.Plan Name)Case/Insurance Carrier #1.ETS Record CodeC#Case/Insurance Carrier #1.Plan NameCase/Insurance Carrier #1.NameDate_Unable_to_Work_From2x$@ZTPF0 TQrdDBTextDate_Unable_to_Work_From2TagLeftTopWidth`HeightHint,File: Case Field: Date Unable to Work From Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldDate Unable to Work From Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameCaseFontSize Date_Unable_to_Work_To2m2x$@ZTPF0 TQrdDBTextDate_Unable_to_Work_To2TagLeftTopWidth`HeightHint*File: Case Field: Date Unable to Work To Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldDate Unable to Work To Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameCaseFontSize Hospital_Date_From1_To2m2x$@ZTPF0 TQrdDBTextHospital_Date_From1TagLeftTopWidthJHeightHint&File: Case Field: Hospital Date From Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldHospital Date From Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameCaseFontSize Hospital_Date_To2m1_To2m2x$@ZTPF0 TQrdDBTextHospital_Date_To2TagLeftTopWidth`HeightHint$File: Case Field: Hospital Date To Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldHospital Date To Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameCaseFontSize  Legacy_11Date_To2m1_To2m2x$@ZTPF0 TQrdDBText Legacy_11LeftTopWidthqHeightHint4File: Case/Referring Provider/Pins Field: Legacy 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@.@ @UUUUUU}@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.qryReferringPrvPins DataFieldLegacy 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Referring Provider/PinsFontSize  Full_Name1ate_To2m1_To2m2x$@ZTPF0 TQrdDBText Full_Name1Left TopWidthHeightHint0File: Case/Referring Provider Field: Full Name Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblReferringProvider DataField Full Name Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Referring ProviderFontSize DBText4me1ate_To2m1_To2m2x$@ZTPF0 TQrdDBTextDBText4LeftTop.WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Outside Lab WorkXDBText43e1ate_To2m1_To2m2x$@ZTPF0 TQrdDBTextDBText43LeftTop.WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@, @ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Outside Lab WorkXDBText73e1ate_To2m1_To2m2x$@ZTPF0 TQrdDBTextDBText73LeftTop`WidthFHeightHintFile: (none) Field: (none) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUUUUUUU @UUUUUU5@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Code_113e1ate_To2m1_To2m2x$@ZTPF0 TQrdDBTextCode_11LeftTopNWidthhHeightHint>File: Claim/Diagnosis Code 3 Field: Code 1 (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUY@UUUUUU! @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblDiag3 DataFieldCode 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Diagnosis Code 3FontSize -Claim/Insurance Carrier #1.Diagnosis Code Set2Claim/Diagnosis Code 3.Code 2-Claim/Insurance Carrier #1.Diagnosis Code Set3Claim/Diagnosis Code 3.Code 3Code_133e1ate_To2m1_To2m2x$@ZTPF0 TQrdDBTextCode_13LeftToplWidthhHeightHint>File: Claim/Diagnosis Code 4 Field: Code 1 (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUY@VUUUUU @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblDiag4 DataFieldCode 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Diagnosis Code 4FontSize -Claim/Insurance Carrier #1.Diagnosis Code Set2Claim/Diagnosis Code 4.Code 2-Claim/Insurance Carrier #1.Diagnosis Code Set3Claim/Diagnosis Code 4.Code 3Code_153e1ate_To2m1_To2m2x$@ZTPF0 TQrdDBTextCode_15LeftToplWidthhHeightHint>File: Claim/Diagnosis Code 2 Field: Code 1 (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@VUUUUU @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblDiag2 DataFieldCode 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Diagnosis Code 2FontSize -Claim/Insurance Carrier #1.Diagnosis Code Set2Claim/Diagnosis Code 2.Code 2-Claim/Insurance Carrier #1.Diagnosis Code Set3Claim/Diagnosis Code 2.Code 3Prior_Authorization_No1m2x$@ZTPF0 TQrdDBTextPrior_Authorization_No1LeftToplWidth HeightHint*File: Case Field: Prior Authorization No Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU @VUUUUU @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldPrior Authorization No Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize Medicaid_Resubmission_No2x$@ZTPF0 TQrdDBTextMedicaid_Resubmission_No2LefteTopPWidthhHeightHint,File: Case Field: Medicaid Resubmission No Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@$@ @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldMedicaid Resubmission No Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize DBText44_Resubmission_No2x$@ZTPF0 TQrdDBTextDBText44LeftTop.Width`HeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Outside Lab WorkCase.Lab ChargesCode_124_Resubmission_No2x$@ZTPF0 TQrdDBTextCode_12LeftTopMWidthhHeightHint>File: Claim/Diagnosis Code 1 Field: Code 1 (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@ @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblDiag1 DataFieldCode 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Diagnosis Code 1FontSize -Claim/Insurance Carrier #1.Diagnosis Code Set2Claim/Diagnosis Code 1.Code 2-Claim/Insurance Carrier #1.Diagnosis Code Set3Claim/Diagnosis Code 1.Code 3Medicaid_Original_Ref_No1x$@ZTPF0 TQrdDBTextMedicaid_Original_Ref_No1LeftTopPWidthHeightHint,File: Case Field: Medicaid Original Ref No Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @ @VUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldMedicaid Original Ref No Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize DBText49_Original_Ref_No1x$@ZTPF0 TQrdDBTextDBText49TagLeftTopWidthpHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU5@* @*@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FontSize Patient.Signature on FilePatient.Signature on FilePatient.SOF DateClaim.Date CreatedPatient.Signature on FilePatient.SOF DatePatient.SOF DateFull_Name_LFM4nal_Ref_No1x$@ZTPF0 TQrdDBTextFull_Name_LFM4Left TopWidth HeightHint&File: Insured 2 Field: Full Name LFM Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsured2 DataField Full Name LFM Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Insured 2FontSize DBText38e_LFM4nal_Ref_No1x$@ZTPF0 TQrdDBTextDBText38LeftHTop]Width HeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize *Claim/Insurance Carrier #1.ETS Record Code*Claim/Insurance Carrier #1.ETS Record Code*Claim/Insurance Carrier #1.ETS Record CodeF City_Line2LFM4nal_Ref_No1x$@ZTPF0 TQrdDBText City_Line2LeftHTopNWidth HeightHint3File: Claim/Insurance Carrier #1 Field: City Line Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@`@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblLUInsurance1 DataField City Line Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameClaim/Insurance Carrier #1FontSize PrimaryClaimsPayerID1_No1x$@ZTPF0 TQrdDBTextPrimaryClaimsPayerID1LeftRTop\Width HeightHint=File: Case/Insurance Carrier #1 Field: PrimaryClaimsPayerID Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@j@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblInsurance1 DataFieldPrimaryClaimsPayerID Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Insurance Carrier #1FontSize  Claim_Number2PayerID1_No1x$@ZTPF0 TQrdDBText Claim_Number2LeftTop.Width\HeightHint!File: Claim Field: Claim Number Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUU@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblClaim DataField Claim Number Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaimFontSize DBText6umber2PayerID1_No1x$@ZTPF0 TQrdDBTextDBText6LeftmTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@2@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim/Insurance Carrier #1.TypeChampusX Local_Use_B22PayerID1_No1x$@ZTPF0 TQrdDBText Local_Use_B2Left Top.WidthvHeightHintFile: Case Field: Local Use B Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@ @b@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataField Local Use B Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize EMC_Payor_Number2rID1_No1x$@ZTPF0 TQrdDBTextEMC_Payor_Number2LeftTopWidth~HeightHintLFile: Claim/Insurance Carrier #2 Field: EMC Payor Number (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUU @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblLUInsurance2 DataFieldEMC Payor Number Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaim/Insurance Carrier #2FontSize Case.Policy #2 Crossover ClaimX&Claim/Insurance Carrier #2.EMC Extra 1DBText11r_Number2rID1_No1x$@ZTPF0 TQrdDBTextDBText11LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@F @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize MEDICARE SECONDARY REASONBECOMES AVAILIBLEADD HEREWAITING ON MCKESSONWAITING ON MCKESSON DBText50r_Number2rID1_No1x$@ZTPF0 TQrdDBTextDBText50LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize *Claim/Insurance Carrier #2.ETS Record CodeCMB*Claim/Insurance Carrier #2.ETS Record CodeDMC*Claim/Insurance Carrier #2.ETS Record CodeGBL*Claim/Insurance Carrier #2.ETS Record CodeHCHPractice.Practice NamePractice.Practice NameCIGroup_Number__222rID1_No1x$@ZTPF0 TQrdDBTextGroup_Number__22LeftTop9WidthHeightHint#File: Case Field: Group Number #2 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUU @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldGroup Number #2 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCaseFontSize National_Provider_Identifier1$@ZTPF0 TQrdDBTextNational_Provider_Identifier1LeftTopWidthqHeightHintCFile: Case/Referring Provider Field: National Provider Identifier Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@.@UUUUUUA @UUUUUU}@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblReferringProvider DataFieldNational Provider Identifier Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Referring ProviderFontSize DBText53_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText53LeftTop>WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUU@ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABOZDBText46_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText46LeftTop>WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABELDBText51_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText51Left\Top>WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@j@ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABACDBText54_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText54LeftTopNWidth HeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUU@`@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABSpecial Ambulance NoteDBText55_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText55LeftTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUU@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABPatient Weight 999DBText56_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText56Left"Top\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize AB Ambulance Transport Code I R T XDBText57_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText57Left2Top\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@J@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABAmbulance Reason Code A B C D EDBText58_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText58LeftBTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize AB Mileage 9999DBText59_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText59LeftiTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize AB07DBText60_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText60Left}Top\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU]@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABCondition Response Code Y NDBText66_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText66LeftTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ҿ@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABCondition IndicatorDBText78_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText78LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUY @ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  HADMITMIN HADMITMINCase.Hospital Date From00DBText99_Provider_Identifier1$@ZTPF0 TQrdDBTextDBText99LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUe @ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize HADMITHRHADMITHRCase.Hospital Date From11Admission_Type1er_Identifier1$@ZTPF0 TQrdDBTextAdmission_Type1LeftTopWidthHeightHint(File: Claim/UB04 Field: Admission_Type Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblUB04 DataFieldAdmission_Type Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Claim/UB04FontSize Admission_Source2_Identifier1$@ZTPF0 TQrdDBTextAdmission_Source2LeftTopWidthHeightHint*File: Claim/UB04 Field: Admission_Source Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@. @ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblUB04 DataFieldAdmission_Source Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Claim/UB04FontSize Discharge_Status2_Identifier1$@ZTPF0 TQrdDBTextDischarge_Status2LeftTopWidthHeightHint*File: Claim/UB04 Field: Discharge_Status Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUs @ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblUB04 DataFieldDischarge_Status Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Claim/UB04FontSize DischargeHour1us2_Identifier1$@ZTPF0 TQrdDBTextDischargeHour1LeftTopWidthHeightHint-File: Custom Case Data Field: DischargeHour Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUe @ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCustomCase DataField DischargeHour Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCustom Case DataFontSize DBText29eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText29LeftTop.WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@Z@j@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize DELAY REASON CODENEEDEDXXDELAY REASON CODENEEDEDDBText41eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText41LeftGTopnWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@K@UUUUUU@VUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim Office Number 2010BBNeededFYDBText98eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText98LeftdTopnWidthUHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@z@UUUUUU@UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Claim Office Number 2010BBNeeded The NumberDBText14eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText14LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUY@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #2SelfXDBText63eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText63Left%TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #2SpouseXDBText64eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText64LeftETopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #2ChildXDBText65eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText65LeftmTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@n@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Insured Relationship #2OtherXDBText62eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText62LeftzTop>WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUe@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Attachment Control NumberCase.Attachment Control NumberDBText67eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText67LeftTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABCondition Indicator 2DBText68eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText68LeftTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABCondition Indicator 3DBText69eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText69LeftTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABCondition Indicator 4DBText70eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText70LeftTop\WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@j@j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize ABCondition Indicator 5DBText71eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText71LeftTopnWidthQHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUU@UUUUUU@P@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  CORRECTEDNEEDED CORRECTEDDBText72eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText72LeftQTopnWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@P@UUUUUU@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  CORRECTEDNEEDED7DBText74eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText74Left\TopnWidthZHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@j@UUUUUU@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  CORRECTEDNEEDED TESTREFICNDBText75eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText75Left Top8WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@`@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to EmploymentTRUEXDBText61eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText61Left TopUWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to AccidentAutoXDBText77eHour1us2_Identifier1$@ZTPF0 TQrdDBTextDBText77Left ToptWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Related to AccidentYesXDate_of_Injury_Illness2ifier1$@ZTPF0 TQrdDBTextDate_of_Injury_Illness2TagLeft TopWidthVHeightHint*File: Case Field: Date of Injury/Illness Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@UUUUUU] @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCase DataFieldDate of Injury/Illness Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropNameCaseFontSize DBText76Injury_Illness2ifier1$@ZTPF0 TQrdDBTextDBText76LeftTop WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case/Referring Provider.Extra 222DBText79Injury_Illness2ifier1$@ZTPF0 TQrdDBTextDBText79LeftTop!WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@UUUUUU? @J@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case/Referring Provider.Extra 22!Case/Referring Provider.Full NameDischargeHour2_Illness2ifier1$@ZTPF0 TQrdDBTextDischargeHour2LeftTopWidthHeightHint-File: Custom Case Data Field: DischargeHour Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUY @ @j@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblCustomCase DataField DischargeHour Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCustom Case DataFontSize  DBText107Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText107LeftTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@X @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 31ANEEDED31ADBText817Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText81LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@N @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 31BNEEDED31B DBText114Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText114LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 18NEEDED18DBText834Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText83LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@J@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 19NEEDED19DBText824Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText82Left1TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 20NEEDED20DBText914Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText91LeftITopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU%@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 21NEEDED21DBText924Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText92LeftbTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 22NEEDED22DBText804Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText80LeftzTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUUe@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 23NEEDED23DBText904Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText90LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ҿ@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 24NEEDED24DBText844Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText84LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 25NEEDED25DBText854Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText85LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 26NEEDED26DBText864Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText86LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 27NEEDED27DBText884Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText88LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CONDITION CODE BOX 28NEEDED28DBText954Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText95Left"Top|WidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@X @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 31ANEEDED31ADATEXDBText974Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText97Left"TopWidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@N @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 31BNEEDED31BDATEXDBText874Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText87LefthTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@X @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 32ANEEDED32ADBText944Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText94LefthTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU@N @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 32BNEEDED32BDBText934Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText93LeftTop|WidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@X @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 32ANEEDED32ADATEXDBText244Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText24LeftTopWidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@N @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 32BNEEDED32BDATEXDBText894Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText89LeftTopnWidthFHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@. @UUUUUU@UUUUUU5@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  TYPE OF BILL TYPE OF BILL999 DBText100Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText100LeftTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@X @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 33ANEEDED33A DBText103Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText103LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@N @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 33BNEEDED33BDBText963Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText96LeftTop|WidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@X @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 33ANEEDED33ADATEX DBText101Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText101LeftTopWidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@N @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 33BNEEDED33BDATEX DBText106Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText106Left6Top|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@VUUUUU @X @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 34ANEEDED34A DBText104Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText104Left6TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@VUUUUU @N @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE CODE 34BNEEDED34B DBText105Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText105LeftUTop|WidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@X @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 34ANEEDED34ADATEXDBText455Hour2_Illness2ifier1$@ZTPF0 TQrdDBTextDBText45LeftUTopWidthBHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@@N @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize OCCURENCE DATE 34BNEEDED34BDATEX DBText102Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText102LeftTop|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @X @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  VALUE CODE 1NEEDEDVC1 DBText108Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText108LeftTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @N @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  VALUE CODE 2NEEDEDVC2 DBText109Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText109LeftTop|WidthEHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@* @X @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize VALUE AMOUNT 1NEEDEDVALUAMT1 DBText111Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText111LeftTopWidthEHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@* @N @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize VALUE AMOUNT 2NEEDEDVALUAMT2 DBText110Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText110Left Top|WidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @X @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  VALUE CODE 3NEEDEDVC3 DBText113Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText113Left TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @N @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  VALUE CODE 4NEEDEDVC4 DBText112Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText112Left)Top|WidthEHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @X @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize VALUE AMOUNT 3NEEDEDVALUAMT3 DBText115Hour2_Illness2ifier1$@ZTPF0 TQrdDBText DBText115Left)TopWidthEHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @N @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize VALUE AMOUNT 4NEEDEDVALUAMT4Band2t115Hour2_Illness2ifier1$@Z rbGroupHeader2_Illness2ifier1$@ZTPF0TQrdBandBand2LeftTopWidthHeight Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Frame.StylepsDash AlignToBottomColorclLimeForceNewColumn ForceNewPage Size.Values @BandType rbGroupHeader BandCaptionTransaction HeaderCaptionBand2Band3upHeader2_Illness2ifier1$@Z rbSubDetailer2_Illness2ifier1$@ZTPF0 TQrdSubDetailBand3LeftTopWidthHeight Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Frame.StylepsDash AlignToBottomColorclAquaForceNewColumn ForceNewPage Size.ValuesUUUUUUU@ @MasterformReport.QuickReportDataSetformReport.tblTransaction HeaderBandformReport.Band2 PrintBefore PrintIfEmpty BandCaptionTransaction Detail Date_From2ler2_Illness2ifier1$@ZTPF0 TQrdDBText Date_From2TagLeftTopWidthXHeightHint$File: Transaction Field: Date From Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@VUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Date From Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName TransactionFontSize Procedure_Code2Illness2ifier1$@ZTPF0 TQrdDBTextProcedure_Code2LeftTopWidthJHeightHint;File: Transaction Field: Procedure Code (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@8@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataFieldProcedure Code Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize ,Case/Insurance Carrier #1.Procedure Code Set3!Transaction/Procedure Code.Code 3,Case/Insurance Carrier #1.Procedure Code Set2!Transaction/Procedure Code.Code 2Amount2re_Code2Illness2ifier1$@ZTPF0 TQrdDBTextAmount2TagLeftKTopWidthQHeightHint!File: Transaction Field: Amount Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@P@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataFieldAmount Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize Date_To2e_Code2Illness2ifier1$@ZTPF0 TQrdDBTextDate_To2TagLeft.TopWidthXHeightHint"File: Transaction Field: Date To Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@j@VUUUUU@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataFieldDate To Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName TransactionFontSize  Modifier_12ode2Illness2ifier1$@ZTPF0 TQrdDBText Modifier_12LeftTopWidthHeightHint%File: Transaction Field: Modifier 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@.@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Modifier 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize  Modifier_22ode2Illness2ifier1$@ZTPF0 TQrdDBText Modifier_22LeftTopWidthHeightHint%File: Transaction Field: Modifier 2 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@Ĝ@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Modifier 2 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize Place_of_Service2lness2ifier1$@ZTPF0 TQrdDBTextPlace_of_Service2LeftTopWidthHeightHint+File: Transaction Field: Place of Service Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU-@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataFieldPlace of Service Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize  Modifier_31rvice2lness2ifier1$@ZTPF0 TQrdDBText Modifier_31LeftTopWidthHeightHint%File: Transaction Field: Modifier 3 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUY@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Modifier 3 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize Minutes1_31rvice2lness2ifier1$@ZTPF0 TQrdDBTextMinutes1LeftTopWidth<HeightHint4File: Transaction Field: Minutes (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataFieldMinutes Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName TransactionFontSize Transaction.Minutes0Transaction.Units Revenue_Code2ice2lness2ifier1$@ZTPF0 TQrdDBText Revenue_Code2Left%TopWidth HeightHint'File: Transaction Field: Revenue_Code Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Revenue_Code Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize  Legacy_12ode2ice2lness2ifier1$@ZTPF0 TQrdDBText Legacy_12Left%TopWidthhHeightHint3File: Case/Assigned Provider/Pins Field: Legacy 1 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.qryAssignedPrvPins DataFieldLegacy 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Assigned Provider/PinsFontSize  Modifier_42e2ice2lness2ifier1$@ZTPF0 TQrdDBText Modifier_42LeftTopWidthHeightHint%File: Transaction Field: Modifier 4 Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Modifier 4 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName TransactionFontSize  Entry_Number2ice2lness2ifier1$@ZTPF0 TQrdDBText Entry_Number2LeftTopWidthEHeightHint'File: Transaction Field: Entry Number Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblTransaction DataField Entry Number Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName TransactionFontSize Band4_Number2ice2lness2ifier1$@Z rbPageFooter2ice2lness2ifier1$@ZTPF0TQrdBandBand4LeftTopWidthHeight Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Frame.StylepsDash AlignToBottom ColorclLimeForceNewColumn ForceNewPage Size.Values@ @BandType rbPageFooter BandCaption Claim FooterCaptionBand4 Chart_Number1ice2lness2ifier1$@ZTPF0 TQrdDBText Chart_Number1LeftTopWidthyHeightHint!File: Claim Field: Chart Number Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblClaim DataField Chart Number Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaimFontSize  Group_ID_11r1ice2lness2ifier1$@ZTPF0 TQrdDBText Group_ID_11LeftTopZWidthhHeightHint1File: Claim Field: Group ID 1 (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @@UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblClaim DataField Group ID 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameClaimFontSize Claim.Group ID 1Claim.Provider PIN 1Name1_ID_11r1ice2lness2ifier1$@ZTPF0 TQrdDBTextName1LeftTop%WidthHeightHint3File: Case/Facility Field: Name (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@r@@B@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblFacility DataFieldName Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Case/FacilityFontSize Practice.Practice NameCase/Facility.Name Street_1311r1ice2lness2ifier1$@ZTPF0 TQrdDBText Street_13LeftTop5WidthHeightHint7File: Case/Facility Field: Street 1 (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@r@:@B@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblFacility DataFieldStreet 1 Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropName Case/FacilityFontSize Practice.Practice NameCase/Facility.Name City_Line11r1ice2lness2ifier1$@ZTPF0 TQrdDBText City_Line1LeftTopMWidthHeightHint8File: Case/Facility Field: City Line (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@r@@UUUUUUa@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblFacility DataField City Line Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Case/FacilityFontSize Practice.Practice NameCase/Facility.NameDBText26e11r1ice2lness2ifier1$@ZTPF0 TQrdDBTextDBText26LeftTopBWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@VUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FontSize 11Claim/Provider.Full NameDBText39e11r1ice2lness2ifier1$@ZTPF0 TQrdDBTextDBText39Left$TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU%@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Accept Assignment #1XDBText47e11r1ice2lness2ifier1$@ZTPF0 TQrdDBTextDBText47LeftTTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@UUUUUUU@UUUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize Case.Accept Assignment #1X Any_Charge2r1ice2lness2ifier1$@ZTPF0TQrdExpr Any_Charge2LeftoTopWidth]HeightHint%File: Transaction Field: Any Charge Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU@@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretch Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ColorclWhiteMasterformReport.Band3 ParentFontResetAfterPrint TransparentWordWrap ExpressionSUM(tblTransaction.Any Charge)Mask0.00 FilePropName Transaction DataField Any ChargeDataSetformReport.tblTransaction OperationSUMFontSize Any_Charge3r1ice2lness2ifier1$@ZTPF0TQrdExpr Any_Charge3LeftTopWidthXHeightHint%File: Transaction Field: Any Charge Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@ @VUUUUU@ AlignmenttaRightJustify AlignToBandAutoSize AutoStretch Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ColorclWhiteMasterformReport.Band3 ParentFontResetAfterPrint TransparentWordWrap ExpressionSUM(tblTransaction.Any Charge)Mask0.00 FilePropName Transaction DataField Any ChargeDataSetformReport.tblTransaction OperationSUMFontSize DBText34ge3r1ice2lness2ifier1$@ZTPF0 TQrdDBTextDBText34TagLeft:Top]WidthTHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUu@@@@ AlignmenttaCenter AlignToBandAutoSize AutoStretchColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FontSize  Claim/Provider.Signature on File Claim/Provider.Signature on FileClaim/Provider.SOF DateClaim.Date Created Claim/Provider.Signature on FileClaim/Provider.SOF DateClaim/Provider.SOF Date Full_Name23r1ice2lness2ifier1$@ZTPF0 TQrdDBText Full_Name2Left TopxWidthHeightHint2File: Case/Supervising Provider Field: Full Name Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSet!formReport.tblSupervisingProvider DataField Full Name Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Supervising ProviderFontSize UPIN1Name23r1ice2lness2ifier1$@ZTPF0 TQrdDBTextUPIN1LeftTopxWidthqHeightHint?File: Case/Supervising Provider Field: UPIN (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@.@@UUUUUU}@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSet!formReport.tblSupervisingProvider DataFieldUPIN Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Supervising ProviderFontSize Case/Supervising Provider.Code'Case/Supervising Provider/Pins.Legacy 1UPINID1N1Name23r1ice2lness2ifier1$@ZTPF0 TQrdDBTextID1LeftTopjWidtheHeightHintFile: Case/Facility Field: ID Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@r@:@UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblFacility DataFieldID Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Case/FacilityFontSize National_Provider_Identifier2$@ZTPF0 TQrdDBTextNational_Provider_Identifier2LeftTopjWidtheHeightHint9File: Case/Facility Field: National Provider Identifier Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU-@:@UUUUUU@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblFacility DataFieldNational Provider Identifier Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation ReplacementText FilePropName Case/FacilityFontSize National_Provider_Identifier3$@ZTPF0 TQrdDBTextNational_Provider_Identifier3LeftFTopxWidthqHeightHintEFile: Case/Supervising Provider Field: National Provider Identifier Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@@UUUUUU}@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSet!formReport.tblSupervisingProvider DataFieldNational Provider Identifier Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Supervising ProviderFontSize DBText48_Provider_Identifier3$@ZTPF0 TQrdDBTextDBText48Left TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@UUUUUUE@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  EPSDT CLM-12NEEDED01 First_Name1ovider_Identifier3$@ZTPF0 TQrdDBText First_Name1LefttTopWidthdHeightHint4File: Case/Primary Care Provider Field: First Name Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUUu@UUUUUUE@J@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPrimaryProvider DataField First Name Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Primary Care ProviderFontSize  Last_Name11ovider_Identifier3$@ZTPF0 TQrdDBText Last_Name1LeftTopWidthdHeightHint3File: Case/Primary Care Provider Field: Last Name Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUUE@J@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPrimaryProvider DataField Last Name Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Primary Care ProviderFontSize National_Provider_Identifier4$@ZTPF0 TQrdDBTextNational_Provider_Identifier4LeftTopWidthdHeightHintFFile: Case/Primary Care Provider Field: National Provider Identifier Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@UUUUUUE@J@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhiteDataSetformReport.tblPrimaryProvider DataFieldNational Provider Identifier Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuation FilePropNameCase/Primary Care ProviderFontSize Text1nal_Provider_Identifier4$@ZTPF0 TQrdLabelText1LeftTopWidthHeightHintStatic text field Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@ @UUUUUUE@UUUUUUu@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchCaptionXXXXColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap FontSize Text2nal_Provider_Identifier4$@ZTPF0 TQrdLabelText2LeftTop$WidthHeightHintStatic text field Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU @@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchCaption ColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap FontSize Text3nal_Provider_Identifier4$@ZTPF0 TQrdLabelText3LeftTop4WidthHeightHintStatic text field Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.Values@UUUUUU @UUUUUU@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchCaption ColorclWhite Font.CharsetDEFAULT_CHARSET Font.ColorclBlack Font.Height Font.NameArial Font.Style ParentFont TransparentWordWrap FontSize  DBText120Provider_Identifier4$@ZTPF0 TQrdDBText DBText120Left"TopWidth HeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUUE@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  EPSDT CRC-02NEEDED2DBText250Provider_Identifier4$@ZTPF0 TQrdDBTextDBText25Left0TopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@@UUUUUUE@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  EPSDT CRC-03NEEDED03 DBText116Provider_Identifier4$@ZTPF0 TQrdDBText DBText116LeftITopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@UUUUUU%@UUUUUUE@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  EPSDT CRC-04NEEDED04 DBText117Provider_Identifier4$@ZTPF0 TQrdDBText DBText117LeftaTopWidthHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@R@UUUUUUE@@ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize  EPSDT CRC-05NEEDED05 DBText118Provider_Identifier4$@ZTPF0 TQrdDBText DBText118Left TopWidthXHeightHint-File: (none) Field: (none) (Has expressions) Frame.ColorclBlack Frame.DrawTopFrame.DrawBottomFrame.DrawLeftFrame.DrawRight Size.ValuesUUUUUU@VUUUUU@p@p @ Alignment taLeftJustify AlignToBandAutoSize AutoStretchColorclWhite Font.Charset ANSI_CHARSET Font.ColorclBlack Font.Height Font.Name Courier New Font.Style ParentFont TransparentWordWrap ReplacePunctuationFontSize CORRECTED DESCRIPTIONNEEDEDCORRECTED DESCRIPTION