| FIELD NAME |
TYPE |
SIZE |
DESCRIPTION |
| PRIOR PLAN HP ID |
X |
6 |
|
| RECIPIENT'S
CURRENT ENROLLMENT HP NAME |
X |
25 |
|
| EFFECTIVE
DATE OF CURRENT ENROLLMENT |
X |
8 |
CCYYMMDD |
| RECIPIENT'S
AHCCCS ID |
X |
9 |
|
| RECIPIENT'S NAME |
X |
33 |
LAST, FIRST, MI |
| RECIPIENT'S
DATE OF BIRTH |
X |
8 |
CCYYMMDD |