| Label | Type | Description | Mandatory |
| Updated On | CURAM_DATETIME | The date on which the last update was made to the evidence. | No |
| Effective Date of Change | CURAM_DATE | Date which the evidence becomes effective | No |
| Approval Requested | CURAM_INDICATOR | Approval Requested | No |
|
| Updated By |
| Label | Type | Description | Mandatory |
| Updated By | USER_NAME | | No |
|
|
|
| Person in Receipt of Service Details |
| Label | Type | Description | Mandatory |
| Person in Receipt of Service | FULL_NAME | This field allows you to search for the person in receipt of service from the list of registered case participants. The system automatically creates a case participant role of type "person in receipt of service". | No |
|
| Additional Expense Details for Spend Down |
| Label | Type | Description | Mandatory |
| Client Obligated Amount | CURAM_AMOUNT | The amount of the Medical Expense for which the client has the responsibility (obligation) to pay. | No |
| Living at Home | CURAM_INDICATOR | If the person in receipt of service is living at home with the person who has the responsibility for payment of the expense, select the Living at Home selection box. | No |
| Amount Used For Spend Down | CURAM_AMOUNT | The monetary amount of the expense which has already been used towards Spend Down. If none of the expense has been used for SpendDown, this field is blank. | No |
| HMO | CURAM_INDICATOR | If the household member has an HMO, select the HMO selection box. | No |
| Expense Payment Status | ISP_SPENDDOWN_MED_EXP_PAY_STATUS_CODE | The payment status of the expense is "paid", "part paid", or "unpaid". | No |
| Medically Necessary | CURAM_INDICATOR | If the expense is considered to be medically necessary, select the Medically Necessary selection box. | No |
| TPL | CURAM_INDICATOR | If there is a Third Party liability associated with the expense, select the TPL selection box. | No |
| Covered By Medical Assistance | CURAM_INDICATOR | If the expense is considered to be covered by Medical Assistance, select the Covered By Medical Assistance selection box. | No |
| State Provided | CURAM_INDICATOR | If the expense is considered to be State provided, select the State Provided selection box. | No |
| Expense Classification | ISP_SPENDDOWN_MED_EXP_CLASS_TYPE_CODE | The expense is classified as either Incurred or Deductible. If left blank, the classification will be determined automatically by system. | No |
| Hold | CURAM_INDICATOR | If the client has requested to hold the expense from use until further notification, select the Hold selection box. | No |
|
| Comments |
| Label | Type | Description | Mandatory |
| Comments | COMMENTS | | No |
|
