Page 32

Page 32 – State Health Official Letter

ESC COA Code or Condition LPV ENC (APTC & MC) QNC 5Yr Bar Apply 5Yr Bar Met 13, 328, 386 CP Y N/P P P P 13, 328, 386 IN, PR Y P Y P P 13, 328, 386 CM Y N Y Y Y/N/P 13, 328, 386 Any COA other than: DE, EXC, T2, T3, T4, T5, T6, FSM, MIS, PAL, CP, IN, PR, CM, PI, CC, CH, DT, ML, OP Y N N X X 15, 368, 369, 374, 385 Country code = CUB or HTI Y/P P P P P 189 Country code = CUB or HTI Y P P P P 15, 189, 369, 374 Country code other than CUB or HTI (or empty) Y N N X X 368 Country code other than CUB or HTI (or empty) N/P N N/P X/P X/P 385 Country code other than CUB or HTI (or empty) P N N X X 18, 20 Country code = CUB or HTI Y P Y N X 18, 20 Country code other than CUB or HTI (or empty) Y N Y N X 188, 376, 387 N/A N N N X X 22, 122, 168, 372, 373, 375, 380, 382, 384 N/A Y N N X X 228 N/A P N N X X 248, 249 CQ1, CQ2, CQ3 Y Y Y N X 248, 249 COA other than CQ1, CQ2, CQ3, or No COA Y Y Y Y Y/N/P 250 COA = WHP; Country code = CUB or HTI Y Y Y N X 250 COA = WHP; Country code is empty Y P P P P 250 COA = WHP; Country code other than CUB or HTI Y N Y/N/P Y/P/X Y/N/P/X 250, 288, 381, 401, 402 HHP, CHP, RCU, RHT Y Y Y N X 250, 288, 381, 401, 402 SQ4, SQ5, OAR Y N Y/P N/P X/P 250, 288, 381, 401, 402 UHP; Country code = UKRAI, UKR, or UP Y N Y/P N/P X/P