Service Invoice Request Line Item Details
| Reference Number | [Value] | Case Reference Number | [Value] |
|---|---|---|---|
| Service Authorization Reference Number | [Value] | Unit Amount | [Amount] |
| Start Date | [Date] | End Date | [Date] |
| Number Of Units | [field-value] | Invoice Amount | [Amount] |
| External Reference Number | [Value] |
Payee Details
| Payee Reference Number | [Value] | Payee Name | [A. Name] |
|---|
Client Details
| Client Reference Number | [Value] | Client Date Of Birth | [Date] |
|---|---|---|---|
| Client First Name | [First Forename] | Client Last Name | [Surname] |
Provider Details
| Provider Name | [A. Name] | Provider Reference Number | [Value] |
|---|