| Name | Description | Type | Additional information |
|---|---|---|---|
| PolicyNo | string |
None. |
|
| PatientMemberId | string |
None. |
|
| Relationship | string |
None. |
|
| PatientName | string |
None. |
|
| ClaimType | string |
None. |
|
| AdmissionDate | date |
None. |
|
| DischargeDate | date |
None. |