Violations Screen

Ref ID

Displays the Ref ID assigned to the patient via ALERT for PreCertification.  

First Name

Displays the First Name of the patient.

Last Name

Displays the Last Name of the patient.

DOB

Displays Date of Birth of the patient.

Immunization Admin Date

Displays the date of administration for the immunization in violation.

NDC Code

Displays the NDC Code submitted for the immunization in violation.

CVX Code

Displays the CVX Code submitted for the immunization in violation.

CPT Code

Displays the CPT Code submitted for the immunization in violation.

Trade Name

Displays the Trade Name submitted for the immunization in violation.

Vaccine Group

Displays the Vaccine Group submitted for the immunization in violation.

Manufacturer

Displays the Manufacturer submitted for the immunization in violation.

Clicking the cancel command button will return the user to the previous screen.