TABLE: Cash – Refund Request Data Fields

Field	Format	Required?	Min	Max	Comments
Amount	DEC	Y			Greater than 0.
AddressVerificationInfo	See below fields	N			Complex element type.
Street1	AN	N	1	150	The primary street address associated with the card.
Street2	AN	N	1	150	Secondary street address associated with the card.
Street3	AN	N	1	150
City	AN	N	1	50	The city associated with the address of the card.
State	AN	N	1	2	The state associated with the address of the card.
Zip	AN	N	1	15
Country	AN	N	1	30	See Country Codes.
Company	AN	N	1	30
MerchantID	AN	Y	1	50	The unique ID associated with your InstaMed Outlet, which will be given by your Implementations Manager.
StoreID	AN	Y	1	50	See MerchantID comments.
TerminalID	AN	Y	1	50	See MerchantID comments.
TransactionID	AN	N	1	50	Not currently used.
TransactionNumber	AN	N	1	50	Not currently used.
BatchID	AN	N	1	20	Not currently used.
Patient		N			Complex element type.
PatientID	AN	N	1	50	A unique identifier for the patient, which is typically sourced from the Patient Accounting System.
PatientFirstName	AN	N	1	50
PatientLastName	AN	N	1	50
PatientMiddleName	AN	N	1	50
AdditionalInfo1	AN	N	1	100	User-defined fields to be captured with the payment transaction.
AdditionalInfo2	AN	N	1	100	See AdditionalInfo1 comments.
AdditionalInfo3	AN	N	1	100	See AdditionalInfo1 comments.
AdditionalInfo4	AN	N	1	100	See AdditionalInfo1 comments.
AdditionalInfo5	AN	N	1	100	See AdditionalInfo1 comments.
AdditionalInfo6	AN	N	1	100	See AdditionalInfo1 comments.
ReasonCode	AN	N	1	50	Not currently used.
ReasonText	AN	N	1	400	Not currently used.
PaymentType	AN	N	1	20	i.e., Cash or Check.
Payee	AN	N	1	50	Not currently used.
MarketSegment	AN	N	1	50	Not currently used.
TransactionStatus	AN	N	1	50	Not currently used.
TransactionCode	AN	N	1	50
PaymentPlanID	AN	N	1	50	Not currently used.
InstaMedAccountID	AN	N	1	100	Not currently used.

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