| Name | Description | Type | Additional information |
|---|---|---|---|
| Name | string |
None. |
|
| Address | string |
None. |
|
| Telephone | string |
None. |
|
| Fax | string |
None. |
|
| string |
None. |
||
| BenefitAssignment | string |
None. |
|
| NoClamEmailAffInd | boolean |
None. |