Any fields not required for the particular claim being lodged will be greyed out.
 DVA NumberDVA Number - is the Veterans File Number as it appears on the Veteran Card. Maximum of 9 characters long.
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 DisabilityDisability Indicator - Indicates whether the service rendered are for a White Card holder and the service is in accordance with the White Card Condition. The options are:
Checked: (True) Condition Treated relates to a condition for a White Card holder
Unchecked: (False) Condition does not relates to a condition for a White Card holder
Disability (text) - Free text used to provide details regarding the condition being treated. Maxmium of 100 characters long.
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 Activities of Daily LivingCognitive Behavioral Indicator - this indicates if the veteran requires Cognitive Behavioral assistance for the activities of daily living.
Eating Indicator - this indicates if the veteran requires assistance for Eating activities of daily living.
Personal Hygeine Indicator - this indicates if the veteran requires assistance for Personal Hygiene activities of daily living.
Toileting Continence Indicator - this indicates if the veteran requires assistance for Toileting activities of daily living.
Transfer Mobility Indicator - this indicates if the veteran requires assistance for Transfer Mobility activities of daily living.
Tool - The ADL Tool Used Indicator is used for recording the level of activities of daily living functional assessment measure.
The options are:
1: RUGS III
2: KATZ
3: ONI INI ACNA
4: FIM FAM
5: CNMDSA
6: Other
7: Reserved for future use
8: Reserved for future use
9: Reserved for future use
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