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CEIPT (REV. 06/13) ............................................................ 5.1.1 FIELDS ON EMEDNY AUTHORIZATION CANCELLATION RECEIPT (REV. 07/11)............................ 5.2.1 FIELDS ON EMEDNY DVS PROFESSIONAL RECEIPT (REV. 07/11) ............................................... 5.3.1 FIELDS ON EMEDNY DVS DENTAL RECEIPT (REV. 07/11) .......................................................... 5.4.1 6.0 REFERENCE TABLES (REV. 03/14) .

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