Other Insurance # (Secondary Payer):	{{additional?.otherInsuranceNumber_SecondaryPayer}}
Other Insurance Plan (Secondary Payer):	{{additional?.otherInsurancePlan_SecondaryPayer}}
Other Insurance # (Tertiary Payer):	{{additional?.otherInsuranceNumber_TertiaryPayer}}
Other Insurance Plan (Tertiary Payer):	{{additional?.otherInsurancePlan_TertiaryPayer}}
Ambulance Transport Reason:	{{additional?.ambulanceTransportReason}}
Admission Date:	{{additional?.admissionDate}}
Discharge Date:	{{additional?.dischargeDate}}
Covered Days:	{{additional?.coveredDays}}
Provider DRG:	{{additional?.ProviderDRG}}
Attending Physician:	{{additional?.attendingPhysician}}
Treasury Payment Date (PD):	{{additional?.treasuryPaymentDate_Pd}}
Total Paid Amount per PD:	{{additional?.totalPaidAmtPerPD}}
Check / EFT / TRN:	{{additional?.check_EFT_TRN}}