line_item_form

A form that has been filled out to provide documentation

Primary Key:

• line_item_form_id

Foreign Keys:

• line_item_id => line_item.line_item_id

Indexes:

• line_item_form_uq (Unique) - line_item_id, form_type_qualifier, form_identifier

Column	Data Type	Nullable	Indexed	Description
line_item_form_id	bigint	No	Yes	-
line_item_id	bigint	No	Yes	-
form_type_qualifier	code_list_qualifier_type	No	Yes	Identifies the code source used for the form identification code. Examples include the 'AS' Home Health form and 'UT' for CMS DMERC Certificate of Medical Necessity form types (From LQ01 / NCPDP 369-2Q)
form_identifier	text	No	Yes	Identifies the type of form used to provide documentation (From LQ02)
request_period_begin_date	date	Yes	No	Beginning date of the request period (From NCPDP 374-2V)
request_period_revised_date	date	Yes	No	Effective date of the revision (From NCPDP 375-2W)
request_status	request_status_type	Yes	No	Status of the request (From NCPDP 373-2U)
length_of_need_units	unit_type	Yes	No	Units used for length of need (From NCPDP 371-2S)
length_of_need	numeric	Yes	No	Length of time the patient is expected to need the item (From NCPDP 370-2R)
date_signed	text	No	No	Date the form was signed (From NCPDP 372-2T)
supporting_documentation	text	No	No	Free text field for supporting documentation (From NCPDP 376-2X)