| Name | Description | Type | Additional information |
|---|---|---|---|
| RxNumber | string |
None. |
|
| Quantity | decimal number |
None. |
|
| DaySupply | decimal number |
None. |
|
| AmountPaid | decimal number |
None. |
|
| ClaimDate | date |
None. |
|
| Attachments | Collection of IFormFile |
None. |