View Spend Down Medical Expense Evidence

Dummy Selected IPN TabDetailsHistory
Updated On[date-and-time]Updated By[User Name] [View History]
Effective Date of Change[Date] 
Approval Requested[True]Approval Status[Approved] [View History]

Person in Receipt of Service Details

Person in Receipt of Service[Full Name]

Additional Expense Details for Spend Down

Client Obligated Amount[Amount]Living at Home[True]
Amount Used For Spend Down[Amount] 
HMO[True]Expense Payment Status[field-value]
Medically Necessary[True]TPL[True]
Covered By Medical Assistance[True]State Provided[True]
Expense Classification[field-value]Hold[True]

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