A.6 DATA ELEMENT NAMES
This section reflects the database status as of June 26, 1996. The data base will continue to be updated to reflect final changes due to go out in the July 1996 Membership Ballot #2, The database is available through HL7 Headquarters (see the last section in Chapter 1 for information on how to contact HL7).
Data_Element |
Item |
Seg |
Seq # |
Chp |
Len |
DT |
OPT |
REP |
QTY |
Table # |
Abnormal Flags |
00576 |
OBX |
008 |
7 |
5 |
ID |
O |
Yes |
5 |
0078 |
Accept Acknowledgement Type |
00015 |
MSH |
015 |
2 |
2 |
ID |
O |
No |
0155 |
|
Accident Location |
00529 |
ACC |
003 |
6 |
25 |
ST |
O |
No | ||
Accident Code |
00528 |
ACC |
002 |
6 |
60 |
CE |
O |
No |
0050 |
|
Accident Date/Time |
00527 |
ACC |
001 |
6 |
26 |
TS |
O |
No | ||
Accommodation Code |
00182 |
PV2 |
002 |
3 |
60 |
CE |
O |
No |
0129 |
|
Account ID |
00236 |
BLG |
003 |
4 |
100 |
CK |
O |
No | ||
Account Status |
00171 |
PV1 |
041 |
3 |
2 |
IS |
O |
No |
0117 |
|
Acknowledgement Code |
00018 |
MSA |
001 |
2 |
2 |
ID |
R |
No |
0008 |
|
Activation Date |
00680 |
STF |
012 |
8 |
26 |
CM |
O |
Yes | ||
Active/Inactive Flag |
00675 |
STF |
007 |
8 |
1 |
ID |
O |
No |
0183 |
|
Actual Dispense Units |
00338 |
RXD |
005 |
4 |
60 |
CE |
C |
No | ||
Actual Dosage Form |
00339 |
RXD |
006 |
4 |
60 |
CE |
O |
No | ||
Actual Dispense Amount |
00337 |
RXD |
004 |
4 |
20 |
NM |
R |
No | ||
Addendum Continuation Pointer |
00066 |
ADD |
001 |
2 |
64k |
ST |
O |
No | ||
Phone Number of Outside Site |
00614 |
OM1 |
029 |
8 |
400 |
TN |
O |
No | ||
Address |
00193 |
NK1 |
004 |
3 |
106 |
XAD |
O |
Yes | ||
Administered Dosage Form |
00350 |
RXA |
008 |
4 |
60 |
CE |
O |
No | ||
Administered Units |
00349 |
RXA |
007 |
4 |
60 |
CE |
C |
No | ||
Administered Per (Time Unit) |
00354 |
RXA |
012 |
4 |
20 |
ST |
C |
No | ||
Administered Amount |
00348 |
RXA |
006 |
4 |
20 |
NM |
R |
No | ||
Administered Code |
00347 |
RXA |
005 |
4 |
100 |
CE |
R |
No | ||
Administered-at Location |
00353 |
RXA |
011 |
4 |
200 |
CM |
C |
No | ||
Administering Provider |
00352 |
RXA |
010 |
4 |
200 |
XCN |
O |
No | ||
Administration Sub-ID Counter |
00344 |
RXA |
002 |
4 |
4 |
NM |
R |
No | ||
Administration Notes |
00343 |
RXG |
009 |
4 |
200 |
CE |
O |
Yes | ||
Administration Device |
00311 |
RXR |
003 |
4 |
60 |
CE |
O |
No |
0164 |
|
Administration Notes |
00343 |
RXA |
009 |
4 |
200 |
CE |
O |
Yes | ||
Administration Method |
00312 |
RXR |
004 |
4 |
60 |
CE |
O |
No |
0165 |
|
Admission Type |
00134 |
PV1 |
004 |
3 |
2 |
IS |
O |
No |
0007 |
|
Admit Source |
00144 |
PV1 |
014 |
3 |
3 |
IS |
O |
No |
0023 |
|
Admit Date/Time |
00174 |
PV1 |
044 |
3 |
26 |
TS |
O |
No | ||
Admit Reason |
00183 |
PV2 |
003 |
3 |
60 |
CE |
O |
No | ||
Admitting Doctor |
00147 |
PV1 |
017 |
3 |
60 |
XCN |
O |
Yes |
0010 |
|
Allergy Type |
00204 |
AL1 |
002 |
3 |
2 |
IS |
O |
No |
0127 |
|
Allergy Severity |
00206 |
AL1 |
004 |
3 |
2 |
IS |
O |
No |
0128 |
|
Allergy Code/Mnemonic/ Description |
00205 |
AL1 |
003 |
3 |
60 |
CE |
R |
No | ||
Allergy Reaction |
00207 |
AL1 |
005 |
3 |
15 |
ST |
O |
No | ||
Allow Substitutions |
00300 |
RXO |
009 |
4 |
1 |
ID |
O |
No |
0161 |
|
Alternate Visit ID |
00180 |
PV1 |
050 |
3 |
20 |
CX |
O |
No | ||
Alternate Patient ID - PID |
00107 |
PID |
004 |
3 |
12 |
ST |
O |
Yes | ||
Ambulatory Status |
00145 |
PV1 |
015 |
3 |
2 |
IS |
O |
Yes |
0009 |
|
Anesthesia Minutes |
00400 |
PR1 |
010 |
6 |
4 |
NM |
O |
No | ||
Anesthesia Code |
00399 |
PR1 |
009 |
6 |
2 |
IS |
O |
No |
0019 |
|
Anesthesiologist |
00398 |
PR1 |
008 |
6 |
120 |
XCN |
O |
Yes |
0010 |
|
Anticipated Price |
00285 |
RQ1 |
001 |
4 |
10 |
ST |
O |
No | ||
Appeal Reason |
00518 |
IN3 |
017 |
6 |
60 |
CE |
O |
No | ||
Application Acknowledgement Type |
00016 |
MSH |
016 |
2 |
2 |
ID |
O |
No |
0155 |
|
Assigned Patient Location |
00133 |
FT1 |
016 |
6 |
12 |
PL |
O |
No |
0079 |
|
Assigned Patient Location |
00133 |
PV1 |
003 |
3 |
12 |
PL |
O |
No | ||
Assignment of Benefits |
00445 |
IN1 |
020 |
6 |
2 |
IS |
O |
No |
0135 |
|
Assistant Result Interpreter |
00265 |
OBR |
033 |
4 |
200 |
XCN |
O |
Yes | ||
Attending Doctor |
00137 |
PV1 |
007 |
3 |
60 |
XCN |
O |
Yes |
0010 |
|
Authorization Information |
00439 |
IN1 |
014 |
6 |
55 |
CM |
O |
No | ||
Baby Coverage |
00490 |
IN2 |
019 |
6 |
1 |
ID |
O |
No |
0136 |
|
Backup Person ID |
00682 |
STF |
014 |
8 |
60 |
CE |
O |
Yes | ||
Bad Debt Recovery Amount |
00163 |
PV1 |
033 |
3 |
12 |
NM |
O |
No | ||
Bad Debt Transfer Amount |
00162 |
PV1 |
032 |
3 |
12 |
NM |
O |
No | ||
Bad Debt Agency Code |
00161 |
PV1 |
031 |
3 |
10 |
IS |
O |
No |
0021 |
|
Batch Security |
00088 |
BHS |
008 |
2 |
40 |
ST |
O |
No | ||
Batch Receiving Application |
00085 |
BHS |
005 |
2 |
15 |
ST |
O |
No | ||
Batch Creation Date/Time |
00087 |
BHS |
007 |
2 |
26 |
TS |
O |
No | ||
Batch Name/ID/Type |
00089 |
BHS |
009 |
2 |
20 |
ST |
O |
No | ||
Batch Comment |
00090 |
BTS |
002 |
2 |
80 |
ST |
O |
No | ||
Batch Control ID |
00091 |
BHS |
011 |
2 |
20 |
ST |
O |
No | ||
Batch Sending Facility |
00084 |
BHS |
004 |
2 |
20 |
ST |
O |
No | ||
Batch Totals |
00095 |
BTS |
003 |
2 |
100 |
CM |
O |
Yes | ||
Batch Sending Application |
00083 |
BHS |
003 |
2 |
15 |
ST |
O |
No | ||
Batch Message Count |
00093 |
BTS |
001 |
2 |
10 |
ST |
O |
No | ||
Batch Encoding Characters |
00082 |
BHS |
002 |
2 |
3 |
ST |
R |
No | ||
Batch Comment |
00090 |
BHS |
010 |
2 |
80 |
ST |
O |
No | ||
Batch Field Separator |
00081 |
BHS |
001 |
2 |
1 |
ST |
R |
No | ||
Batch Receiving Facility |
00086 |
BHS |
006 |
2 |
20 |
ST |
O |
No | ||
Bed Location |
00209 |
NPU |
001 |
3 |
12 |
PL |
R |
No | ||
Bed Status |
00170 |
NPU |
002 |
3 |
1 |
IS |
O |
No |
0116 |
|
Bed Status |
00170 |
PV1 |
040 |
3 |
1 |
IS |
B |
No |
0116 |
|
Billing Status |
00457 |
IN1 |
032 |
6 |
2 |
IS |
O |
No |
0022 |
|
Birth Order |
00128 |
PID |
025 |
3 |
2 |
NM |
O |
No | ||
Birth Place |
00126 |
PID |
023 |
3 |
60 |
ST |
O |
No | ||
Blood Deductible (43) |
00531 |
UB1 |
002 |
6 |
1 |
NM |
O |
No | ||
Blood Replaced Pints (41) |
00533 |
UB1 |
004 |
6 |
2 |
NM |
O |
No | ||
Blood Deductible |
00492 |
IN2 |
021 |
6 |
1 |
ST |
O |
No | ||
Blood Not Replaced Pints(42) |
00534 |
UB1 |
005 |
6 |
2 |
NM |
O |
No | ||
Blood Furnished Pints Of (40) |
00532 |
UB1 |
003 |
6 |
2 |
NM |
O |
No | ||
Business Phone Number |
00195 |
NK1 |
006 |
3 |
40 |
XTN |
O |
Yes | ||
Call Back Phone Number |
00228 |
ORC |
014 |
4 |
40 |
XTN |
O |
Yes |
2 | |
Case Manager |
00522 |
IN3 |
021 |
6 |
48 |
ST |
O |
No | ||
Certification Modify Date/Time |
00508 |
IN3 |
007 |
6 |
26 |
TS |
O |
No | ||
Certification Number |
00503 |
IN3 |
002 |
6 |
59 |
CX |
O |
No | ||
Certification Required |
00505 |
IN3 |
004 |
6 |
1 |
ID |
O |
No |
0136 |
|
Certification End Date |
00511 |
IN3 |
010 |
6 |
8 |
DT |
O |
No | ||
Certification Agency Phone Number |
00520 |
IN3 |
019 |
6 |
40 |
XTN |
O |
Yes | ||
Certification Date/Time |
00507 |
IN3 |
006 |
6 |
26 |
TS |
O |
No | ||
Certification Begin Date |
00510 |
IN3 |
009 |
6 |
8 |
DT |
O |
No | ||
Certification Agency |
00519 |
IN3 |
018 |
6 |
60 |
CE |
O |
No | ||
Certification Contact Phone Number |
00517 |
IN3 |
016 |
6 |
40 |
XTN |
O |
Yes | ||
Certification Contact |
00516 |
IN3 |
015 |
6 |
48 |
ST |
O |
No | ||
Certified By |
00504 |
IN3 |
003 |
6 |
60 |
XCN |
O |
Yes | ||
Champus Sponsor Name |
00480 |
IN2 |
009 |
6 |
48 |
XPN |
O |
Yes |
Champus Station |
00484 |
IN2 |
013 |
6 |
25 |
ST |
O |
No | ||
Champus Status |
00487 |
IN2 |
016 |
6 |
3 |
IS |
O |
No |
0142 |
|
Champus Service |
00485 |
IN2 |
014 |
6 |
14 |
IS |
O |
No |
0140 |
|
Champus ID Number |
00481 |
IN2 |
010 |
6 |
20 |
ST |
O |
No | ||
Champus Retire Date |
00488 |
IN2 |
017 |
6 |
8 |
DT |
O |
No | ||
Champus Organization |
00483 |
IN2 |
012 |
6 |
25 |
ST |
O |
No | ||
Champus Non-Avail Cert on File |
00489 |
IN2 |
018 |
6 |
1 |
ID |
O |
No |
0136 |
|
Champus Rank/Grade |
00486 |
IN2 |
015 |
6 |
2 |
IS |
O |
No |
0141 |
|
Charge To Practice |
00256 |
OBR |
023 |
4 |
40 |
CM |
O |
No | ||
Charge Type |
00235 |
BLG |
002 |
4 |
50 |
ID |
O |
No |
0122 |
|
Charge Price Indicator |
00151 |
PV1 |
021 |
3 |
2 |
IS |
O |
No |
0032 |
|
Citizenship |
00129 |
PID |
026 |
3 |
4 |
IS |
O |
Yes |
0171 |
|
Co Insurance Days (25) |
00535 |
UB1 |
006 |
6 |
2 |
NM |
O |
No | ||
Co-Insurance Days (9) |
00554 |
UB2 |
002 |
6 |
3 |
ST |
O |
No | ||
Portable |
00600 |
OM1 |
015 |
8 |
1 |
ID |
O |
No |
0136 |
|
Collection Volume |
00243 |
OBR |
009 |
4 |
20 |
CQ |
O |
No | ||
Collector Identifier |
00244 |
OBR |
010 |
4 |
60 |
XCN |
O |
Yes | ||
Combine Baby Bill |
00491 |
IN2 |
020 |
6 |
1 |
ID |
O |
No |
0136 |
|
Comment |
00098 |
NTE |
003 |
2 |
64k |
FT |
O |
Yes | ||
Company Plan Code |
00460 |
IN1 |
035 |
6 |
8 |
IS |
O |
No |
0042 |
|
Component Code |
00314 |
RXC |
002 |
4 |
100 |
CE |
R |
No | ||
Component Amount |
00315 |
RXC |
003 |
4 |
20 |
NM |
R |
No | ||
Component Units |
00316 |
RXC |
004 |
4 |
60 |
CE |
R |
No | ||
Condition Code (24-30) |
00555 |
UB2 |
003 |
6 |
2 |
IS |
O |
Yes |
7 |
0043 |
Condition Code (35-39) |
00536 |
UB1 |
007 |
6 |
2 |
IS |
O |
Yes |
5 |
0043 |
Observations Required to Interpret the Obs |
00616 |
OM1 |
031 |
8 |
200 |
CE |
O |
No | ||
Consent Code |
00403 |
PR1 |
013 |
6 |
60 |
CE |
O |
No |
0059 |
|
Consulting Doctor |
00139 |
PV1 |
009 |
3 |
60 |
XCN |
O |
Yes |
0010 |
|
Contact Role |
00196 |
NK1 |
007 |
3 |
60 |
CE |
O |
No |
0131 |
|
Continuation Pointer |
00014 |
MSH |
014 |
2 |
180 |
ST |
O |
No | ||
Continuation Pointer |
00014 |
DSC |
001 |
2 |
180 |
ST |
O |
No | ||
Contract Amount |
00156 |
PV1 |
026 |
3 |
12 |
NM |
O |
Yes | ||
Contract Period |
00157 |
PV1 |
027 |
3 |
3 |
NM |
O |
Yes | ||
Contract Code |
00154 |
PV1 |
024 |
3 |
2 |
IS |
O |
Yes |
0044 |
|
Contract Effective Date |
00155 |
PV1 |
025 |
3 |
8 |
DT |
O |
Yes | ||
Reflex Tests/Observations |
00619 |
OM1 |
034 |
8 |
200 |
CE |
O |
Yes | ||
Coord of Ben. Priority |
00447 |
IN1 |
022 |
6 |
2 |
ST |
O |
No | ||
Coordination of Benefits |
00446 |
IN1 |
021 |
6 |
2 |
IS |
O |
No |
0173 |
|
Country Code |
00017 |
MSH |
017 |
2 |
2 |
ID |
O |
No | ||
County Code |
00115 |
PID |
012 |
3 |
4 |
IS |
B |
No | ||
Courtesy Code |
00152 |
PV1 |
022 |
3 |
2 |
IS |
O |
No |
0045 |
|
Covered Days (7) |
00556 |
UB2 |
004 |
6 |
3 |
ST |
O |
No | ||
Covered Days (23) |
00537 |
UB1 |
008 |
6 |
3 |
NM |
O |
No | ||
Credit Rating |
00153 |
PV1 |
023 |
3 |
2 |
IS |
O |
No |
0046 |
|
Current Patient Balance |
00176 |
PV1 |
046 |
3 |
12 |
NM |
O |
No | ||
D/T of Most Recent Refill or Dose Dispensed |
00328 |
RXE |
018 |
4 |
26 |
TS |
C |
No | ||
Daily Deductible |
00501 |
IN2 |
030 |
6 |
25 |
CM |
O |
No | ||
Danger Code |
00246 |
OBR |
012 |
4 |
60 |
CE |
O |
No | ||
Data Line |
00063 |
DSP |
003 |
2 |
300 |
TX |
R |
No | ||
Date/Time of the Observation |
00582 |
OBX |
014 |
7 |
26 |
TS |
O |
No | ||
Effective Date/Time of Change in Test Procedure that make Results Non-Comparable |
00607 |
OM1 |
022 |
8 |
26 |
TS |
O |
No | ||
Date/Time Start of Administration |
00345 |
RXA |
003 |
4 |
26 |
TS |
R |
No | ||
Date/Time of Message |
00007 |
MSH |
007 |
2 |
26 |
TS |
O |
No | ||
Date/Time of Transaction |
00223 |
ORC |
009 |
4 |
26 |
TS |
O |
No | ||
Date Needed |
00284 |
RQD |
010 |
4 |
8 |
DT |
O |
No | ||
Date of Birth |
00110 |
STF |
006 |
8 |
26 |
TS |
O |
No | ||
Date/Time Dispensed |
00336 |
RXD |
003 |
4 |
26 |
TS |
R |
No | ||
Date Last Obs Normal Values |
00580 |
OBX |
012 |
7 |
26 |
TS |
O |
No | ||
Date/Time End of Administration |
00346 |
RXA |
004 |
4 |
26 |
TS |
R |
No | ||
Date of Birth |
00110 |
PID |
007 |
3 |
26 |
TS |
O |
No | ||
Date/Time Planned Event |
00101 |
EVN |
003 |
3 |
26 |
TS |
O |
No | ||
Date/Time of Event |
00100 |
EVN |
002 |
3 |
26 |
TS |
R |
No | ||
Date/Time Selection Qualifier |
00044 |
QRF |
008 |
2 |
12 |
ID |
O |
Yes |
0158 |
|
Days |
00512 |
IN3 |
011 |
6 |
3 |
CM |
O |
No |
0149 |
|
Deferred Response Date/Time |
00030 |
QRD |
006 |
2 |
26 |
TS |
O |
No | ||
Deferred Response Type |
00029 |
QRD |
005 |
2 |
1 |
ID |
O |
No |
0107 |
|
Delay Before L. R. Day |
00459 |
IN1 |
034 |
6 |
4 |
NM |
O |
No | ||
Delayed Acknowledgement Type |
00022 |
MSA |
005 |
2 |
1 |
ID |
O |
No |
0102 |
|
Delete Account Indicator |
00164 |
PV1 |
034 |
3 |
1 |
IS |
O |
No |
0111 |
|
Delete Account Date |
00165 |
PV1 |
035 |
3 |
8 |
DT |
O |
No | ||
Deliver To ID |
00283 |
RQD |
009 |
4 |
60 |
CE |
O |
No | ||
Deliver-to Location |
00299 |
RXO |
008 |
4 |
200 |
CM |
C |
No | ||
Deliver-to Location |
00299 |
RXE |
008 |
4 |
200 |
CM |
C |
No | ||
Department Code |
00367 |
FT1 |
013 |
6 |
60 |
CE |
O |
No |
0049 |
|
Department |
00676 |
STF |
008 |
8 |
200 |
CE |
O |
Yes |
0184 |
|
Dependent of Champus Recipient |
00482 |
IN2 |
011 |
6 |
1 |
ID |
O |
No | ||
Dept. Cost Center |
00281 |
RQD |
007 |
4 |
30 |
IS |
O |
No |
0 |
|
Kind of Quantity Observed |
00937 |
OM1 |
042 |
8 |
60 |
CE |
O |
No |
0254 |
|
Diagnosing Clinician |
00390 |
DG1 |
016 |
6 |
60 |
XCN |
O |
Yes | ||
Diagnosis/DRG Priority |
00389 |
DG1 |
015 |
6 |
2 |
NM |
O |
No | ||
Diagnosis Description |
00378 |
DG1 |
004 |
6 |
40 |
ST |
O |
No | ||
Diagnosis/DRG Type |
00380 |
DG1 |
006 |
6 |
2 |
IS |
R |
No |
0052 |
|
Diagnosis Code |
00377 |
DG1 |
003 |
6 |
60 |
CE |
O |
No |
0051 |
|
Diagnosis Date/Time |
00379 |
DG1 |
005 |
6 |
26 |
TS |
O |
No | ||
Diagnosis Coding Method |
00376 |
DG1 |
002 |
6 |
2 |
ID |
R |
No |
0053 |
|
Diagnosis Code |
00371 |
FT1 |
019 |
6 |
60 |
CE |
O |
Yes |
0051 |
|
Diagnostic Serv Sect ID |
00257 |
OBR |
024 |
4 |
10 |
ID |
O |
No |
0074 |
|
Diagnostic Related Group |
00382 |
DG1 |
008 |
6 |
4 |
IS |
O |
No |
0055 |
|
Diet, Supplement, or Preference Code |
00271 |
ODS |
003 |
4 |
60 |
CE |
R |
Yes |
20 | |
Diet Type |
00168 |
PV1 |
038 |
3 |
2 |
IS |
O |
No |
0114 |
|
Discharge Date/Time |
00175 |
PV1 |
045 |
3 |
26 |
TS |
O |
No | ||
Discharge Disposition |
00166 |
PV1 |
036 |
3 |
3 |
IS |
O |
No |
0112 |
|
Discharged to Location |
00167 |
PV1 |
037 |
3 |
25 |
IS |
O |
No |
0113 |
|
Dispense Sub-ID Counter |
00334 |
RXD |
001 |
4 |
4 |
NM |
R |
No | ||
Dispense Units |
00324 |
RXE |
011 |
4 |
60 |
CE |
C |
No | ||
Dispense Sub-ID |
00333 |
RXG |
002 |
4 |
4 |
NM |
O |
No | ||
Dispense Amount |
00323 |
RXE |
010 |
4 |
20 |
NM |
C |
No | ||
Dispense Notes |
00340 |
RXD |
009 |
4 |
200 |
CE |
C |
Yes | ||
Dispense/Give Code |
00335 |
RXD |
002 |
4 |
100 |
CE |
R |
No | ||
Dispense-to Location |
00299 |
RXD |
013 |
4 |
200 |
CM |
C |
No |
Dispense-To Location |
00299 |
RXG |
011 |
4 |
200 |
CM |
O |
No | ||
Dispensing Provider |
00341 |
RXD |
010 |
4 |
200 |
XCN |
O |
No | ||
Display Level |
00062 |
DSP |
002 |
2 |
4 |
SI |
O |
No | ||
Document Control Number |
00564 |
UB2 |
012 |
6 |
23 |
ST |
O |
Yes |
3 | |
DRG Grouper Review Code |
00384 |
DG1 |
010 |
6 |
2 |
IS |
O |
No |
0056 |
|
DRG Approval Indicator |
00383 |
DG1 |
009 |
6 |
2 |
ID? |
O |
No |
0136 |
|
Driver's Lic Num - Patient |
00123 |
PID |
020 |
3 |
25 |
CM |
O |
No | ||
E-mail Address |
00683 |
STF |
015 |
8 |
40 |
ST |
O |
Yes | ||
Effective Date/Time |
00662 |
MFI |
005 |
8 |
26 |
TS |
O |
No | ||
Typical Turn-Around Time |
00608 |
OM1 |
023 |
8 |
20 |
NM |
O |
No | ||
Effective Date/Time |
00662 |
MFE |
003 |
8 |
26 |
TS |
O |
No | ||
Eligibility Source |
00498 |
IN2 |
027 |
6 |
1 |
IS |
O |
No |
0144 |
|
Employer Information Data |
00475 |
IN2 |
004 |
6 |
1 |
IS |
O |
No |
0139 |
|
Encoding Characters |
00002 |
MSH |
002 |
2 |
4 |
ST |
R |
No | ||
End Date |
00198 |
NK1 |
009 |
3 |
8 |
DT |
O |
No | ||
Entered By |
00224 |
ORC |
010 |
4 |
120 |
XCN |
O |
No | ||
Entered Date/Time |
00661 |
MFI |
004 |
8 |
26 |
TS |
O |
No | ||
Enterer's Location |
00227 |
ORC |
013 |
4 |
80 |
PL |
O |
No | ||
Entering Organization |
00231 |
ORC |
017 |
4 |
60 |
CE |
O |
No | ||
Entering Device |
00232 |
ORC |
018 |
4 |
60 |
CE |
O |
No | ||
Error Condition |
00023 |
MSA |
006 |
2 |
100 |
CE |
O |
No | ||
Error Code and Location |
00024 |
ERR |
001 |
2 |
80 |
CM |
R |
Yes |
0060 |
|
Error Return Code and/or Text |
00669 |
MFA |
004 |
8 |
60 |
CE |
R |
No |
0181 |
|
Ethnic Group |
00125 |
PID |
022 |
3 |
3 |
IS |
O |
No |
0189 |
|
Event Completion Date/Time |
00668 |
MFA |
003 |
8 |
26 |
TS |
C |
No | ||
Event Reason Code |
00102 |
EVN |
004 |
3 |
3 |
IS |
O |
No |
0062 |
|
Event Type Code |
00099 |
EVN |
001 |
3 |
3 |
ID |
R |
No |
0003 |
|
Expected Sequence Number |
00021 |
MSA |
004 |
2 |
15 |
NM |
O |
No | ||
Expected Discharge Date |
00189 |
PV2 |
009 |
3 |
8 |
DT |
O |
No | ||
Expected Admit Date |
00188 |
PV2 |
008 |
3 |
8 |
DT |
O |
No | ||
Test/Observation Performance Schedule |
00625 |
OM1 |
040 |
8 |
60 |
ST |
O |
Yes | ||
Fee Schedule |
00370 |
FT1 |
017 |
6 |
1 |
IS |
O |
No |
0024 |
|
Field Separator |
00001 |
MSH |
001 |
2 |
1 |
ST |
R |
No | ||
File Security |
00074 |
FHS |
008 |
2 |
40 |
ST |
O |
No | ||
File Header Comment |
00076 |
FHS |
010 |
2 |
80 |
ST |
O |
No | ||
File Field Separator |
00067 |
FHS |
001 |
2 |
1 |
ST |
R |
No | ||
File Sending Application |
00069 |
FHS |
003 |
2 |
15 |
ST |
O |
No | ||
File Creation Date/Time |
00073 |
FHS |
007 |
2 |
26 |
TS |
O |
No | ||
File Encoding Characters |
00068 |
FHS |
002 |
2 |
4 |
ST |
R |
No | ||
File Sending Facility |
00070 |
FHS |
004 |
2 |
20 |
ST |
O |
No | ||
File Name/ID |
00075 |
FHS |
009 |
2 |
20 |
ST |
O |
No | ||
File Trailer Comment |
00080 |
FTS |
002 |
2 |
80 |
ST |
O |
No | ||
File Control ID |
00077 |
FHS |
011 |
2 |
20 |
ST |
O |
No | ||
File Receiving Facility |
00072 |
FHS |
006 |
2 |
20 |
ST |
O |
No | ||
File Batch Count |
00079 |
FTS |
001 |
2 |
10 |
NM |
O |
No | ||
File Receiving Application |
00071 |
FHS |
005 |
2 |
15 |
ST |
O |
No | ||
File-Level Event Code |
00660 |
MFI |
003 |
8 |
3 |
ID |
R |
No |
0178 |
|
Filler Order Number |
00217 |
OBR |
003 |
4 |
75 |
EI |
C |
No | ||
Filler Order Number |
00217 |
FT1 |
023 |
6 |
75 |
EI |
O |
No | ||
Filler Order Number |
00217 |
ORC |
003 |
4 |
75 |
EI |
C |
No | ||
Filler Field 1 |
00253 |
OBR |
020 |
4 |
60 |
ST |
O |
No | ||
Filler Field 2 |
00254 |
OBR |
021 |
4 |
60 |
ST |
O |
No | ||
Financial Class |
00150 |
PV1 |
020 |
3 |
50 |
CM |
O |
Yes |
0064 |
|
Patient Preparation |
00622 |
OM1 |
037 |
8 |
200 |
TX |
O |
No | ||
Give Rate Amount |
00332 |
RXE |
023 |
4 |
6 |
ST |
O |
No | ||
Give Amount - Minimum |
00318 |
RXE |
003 |
4 |
20 |
NM |
R |
No | ||
Give Rate Units |
00333 |
RXE |
024 |
4 |
60 |
CE |
O |
No | ||
Give Sub-ID Counter |
00342 |
RXG |
001 |
4 |
4 |
NM |
R |
No | ||
Give Sub-ID Counter |
00342 |
RXA |
001 |
4 |
4 |
NM |
R |
No | ||
Give Amount - Minimum |
00318 |
RXG |
005 |
4 |
20 |
NM |
R |
No | ||
Give Units |
00320 |
RXE |
005 |
4 |
60 |
CE |
R |
No | ||
Give Units |
00320 |
RXG |
007 |
4 |
60 |
CE |
R |
No | ||
Give Rate Units |
00333 |
RXG |
016 |
4 |
60 |
CE |
O |
No | ||
Give Rate Amount |
00332 |
RXG |
015 |
4 |
6 |
ST |
O |
No | ||
Give Code |
00317 |
RXG |
004 |
4 |
100 |
CE |
R |
No | ||
Give Per (Time Unit) |
00331 |
RXG |
014 |
4 |
20 |
ST |
C |
No | ||
Give Amount - Maximum |
00319 |
RXE |
004 |
4 |
20 |
NM |
O |
No | ||
Give Code |
00317 |
RXE |
002 |
4 |
100 |
CE |
R |
No | ||
Give Amount - Maximum |
00319 |
RXG |
006 |
4 |
20 |
NM |
O |
No | ||
Give Per (Time Unit) |
00331 |
RXE |
022 |
4 |
20 |
ST |
C |
No | ||
Give Dosage Form |
00321 |
RXE |
006 |
4 |
60 |
CE |
O |
No | ||
Give Dosage Form |
00321 |
RXG |
008 |
4 |
60 |
CE |
O |
No | ||
Group Number |
00433 |
IN1 |
008 |
6 |
12 |
ST |
O |
No | ||
Group Name |
00434 |
IN1 |
009 |
6 |
130 |
XON |
O |
Yes | ||
Grouper Version and Type |
00388 |
DG1 |
014 |
6 |
4 |
ST |
O |
No | ||
Guarantor Ph Num-Business |
00411 |
GT1 |
007 |
6 |
40 |
XTN |
O |
Yes | ||
Guarantor Priority |
00419 |
GT1 |
015 |
6 |
2 |
NM |
O |
No | ||
Guarantor Relationship |
00415 |
GT1 |
011 |
6 |
2 |
IS |
O |
No |
0063 |
|
Guarantor Organization |
00425 |
GT1 |
021 |
6 |
130 |
XON |
O |
Yes | ||
Guarantor Number |
00406 |
GT1 |
002 |
6 |
59 |
CX |
O |
Yes | ||
Guarantor Type |
00414 |
GT1 |
010 |
6 |
2 |
IS |
O |
No |
0068 |
|
Guarantor SSN |
00416 |
GT1 |
012 |
6 |
11 |
ST |
O |
No | ||
Guarantor Spouse Name |
00408 |
GT1 |
004 |
6 |
48 |
XPN |
O |
Yes | ||
Guarantor Sex |
00413 |
GT1 |
009 |
6 |
1 |
ID |
O |
No |
0001 |
|
Guarantor Ph Num- Home |
00410 |
GT1 |
006 |
6 |
40 |
XTN |
O |
Yes | ||
Guarantor Date - Begin |
00417 |
GT1 |
013 |
6 |
8 |
DT |
O |
No | ||
Guarantor Date - End |
00418 |
GT1 |
014 |
6 |
8 |
DT |
O |
No | ||
Guarantor Date/Time of Birth |
00412 |
GT1 |
008 |
6 |
26 |
TS |
O |
No | ||
Guarantor Address |
00409 |
GT1 |
005 |
6 |
106 |
XAD |
O |
Yes | ||
Guarantor Employ Phone Number |
00422 |
GT1 |
018 |
6 |
40 |
XTN |
O |
Yes | ||
Guarantor Name |
00407 |
GT1 |
003 |
6 |
48 |
XPN |
R |
Yes | ||
Guarantor Employee ID Number |
00423 |
GT1 |
019 |
6 |
20 |
CX |
O |
Yes | ||
Guarantor Employer Address |
00421 |
GT1 |
017 |
6 |
106 |
XAD |
O |
Yes | ||
Guarantor Employment Status |
00424 |
GT1 |
020 |
6 |
2 |
IS |
O |
No |
0066 |
|
Guarantor Employer Name |
00420 |
GT1 |
016 |
6 |
130 |
XPN |
O |
Yes | ||
Hospital Item Code |
00278 |
RQD |
004 |
4 |
60 |
CE |
C |
No | ||
Hospital Service |
00140 |
PV1 |
010 |
3 |
3 |
IS |
O |
No |
0069 |
|
Identification Date |
00208 |
AL1 |
006 |
3 |
8 |
DT |
O |
No | ||
Coded Representation of Method |
00599 |
OM1 |
014 |
8 |
200 |
CE |
O |
No | ||
Inactivation Date - STF |
00681 |
STF |
013 |
8 |
26 |
CM |
O |
Yes |
Insurance Plan ID |
00368 |
IN1 |
002 |
6 |
8 |
CE |
R |
No |
0072 |
|
Insurance Company Address |
00430 |
IN1 |
005 |
6 |
106 |
XAD |
O |
Yes | ||
Insurance Plan ID |
00368 |
FT1 |
014 |
6 |
8 |
IS |
O |
No |
0072 |
|
Insurance Amount |
00369 |
FT1 |
015 |
6 |
12 |
CP |
O |
No | ||
Insurance Company Name |
00429 |
IN1 |
004 |
6 |
130 |
XON |
O |
Yes | ||
Insurance Co. Contact Ppers |
00431 |
IN1 |
006 |
6 |
48 |
XPN |
O |
Yes | ||
Insurance Co Phone Number |
00432 |
IN1 |
007 |
6 |
40 |
XTN |
O |
Yes | ||
Insurance Company ID |
00428 |
IN1 |
003 |
6 |
59 |
CX |
R |
Yes | ||
Insured's Group Emp ID |
00436 |
IN1 |
011 |
6 |
130 |
XON |
O |
Yes | ||
Insured's Relationship to Patient |
00442 |
IN1 |
017 |
6 |
2 |
IS |
O |
No |
0063 |
|
Insured's Social Security Number |
00473 |
IN2 |
002 |
6 |
11 |
ST |
O |
No | ||
Insured's Group Emp Name |
00435 |
IN1 |
010 |
6 |
12 |
CX |
O |
Yes | ||
Insured's Sex |
00468 |
IN1 |
043 |
6 |
1 |
ID |
O |
No |
0001 |
|
Insured's Address |
00444 |
IN1 |
019 |
6 |
106 |
XAD |
O |
Yes | ||
Insured's Employment Status |
00467 |
IN1 |
042 |
6 |
60 |
CE |
O |
No |
0066 |
|
Insured's Employee ID |
00472 |
IN2 |
001 |
6 |
59 |
CX |
O |
Yes | ||
Insured's Date of Birth |
00443 |
IN1 |
018 |
6 |
26 |
TS |
O |
No | ||
Insured's Employer Address |
00469 |
IN1 |
044 |
6 |
106 |
XAD |
O |
No | ||
Insured's Employer Name |
00474 |
IN2 |
003 |
6 |
130 |
XCN |
O |
Yes | ||
Interest Code |
00158 |
PV1 |
028 |
3 |
2 |
IS |
O |
No |
0073 |
|
Contraindications to Observations |
00618 |
OM1 |
033 |
8 |
64k |
CE |
O |
No | ||
Item Natural Account Code |
00282 |
RQD |
008 |
4 |
30 |
IS |
O |
No |
0 |
|
Item Code - Internal |
00277 |
RQD |
002 |
4 |
60 |
CE |
C |
No | ||
Item Code - External |
00276 |
RQD |
003 |
4 |
60 |
CE |
C |
No | ||
Primary Language |
00118 |
PID |
015 |
3 |
60 |
CE |
O |
No |
0296 |
|
Lifetime Reserve Days |
00458 |
IN1 |
033 |
6 |
4 |
NM |
O |
No | ||
Logical Break Point |
00064 |
DSP |
004 |
2 |
2 |
ST |
O |
No | ||
Mail Claim Party |
00476 |
IN2 |
005 |
6 |
1 |
ID |
O |
Yes |
0137 |
|
Major Diagnostic Category |
00381 |
DG1 |
007 |
6 |
60 |
CE |
O |
No |
0118 |
|
Manufactured ID |
00286 |
RQ1 |
002 |
4 |
60 |
CE |
C |
No | ||
Manufacturer's Catalog |
00287 |
RQ1 |
003 |
4 |
16 |
ST |
C |
No | ||
Marital Status |
00119 |
PID |
016 |
3 |
1 |
IS |
O |
No |
0002 |
|
Master File Application Identifier |
00659 |
MFI |
002 |
8 |
6 |
ID |
O |
No |
0176 |
|
Master File Identifier |
00658 |
MFI |
001 |
8 |
60 |
CE |
R |
No |
0175 |
|
Medicaid Case Name |
00478 |
IN2 |
007 |
6 |
48 |
XPN |
O |
Yes | ||
Medicaid Case Number |
00479 |
IN2 |
008 |
6 |
15 |
ST |
O |
No | ||
Medicare Health Ins Card Number |
00477 |
IN2 |
006 |
6 |
15 |
ST |
O |
No | ||
Message Type |
00009 |
MSH |
009 |
2 |
7 |
CM |
R |
No |
0076 0003 |
|
Message Control ID |
00010 |
MSH |
010 |
2 |
20 |
ST |
R |
No | ||
Message Control ID |
00010 |
MSA |
002 |
2 |
20 |
ST |
R |
No | ||
MFN Control ID |
00665 |
MFE |
002 |
8 |
20 |
ST |
C |
No | ||
MFN Control ID |
00665 |
MFA |
002 |
8 |
20 |
ST |
C |
No | ||
Mother's Identifier |
00124 |
PID |
021 |
3 |
20 |
CX |
O |
No | ||
Mother's Maiden Name |
00109 |
PID |
006 |
3 |
48 |
XPN |
O |
No | ||
Multiple Birth Indicator |
00127 |
PID |
024 |
3 |
2 |
ID |
O |
No |
0136 |
|
Name |
00191 |
NK1 |
002 |
3 |
48 |
XPN |
O |
Yes | ||
Name of Insured |
00441 |
IN1 |
016 |
6 |
48 |
XPN |
O |
Yes | ||
Report Subheader |
00604 |
OM1 |
019 |
8 |
200 |
CE |
O |
No | ||
Nature of Abnormal Test |
00578 |
OBX |
010 |
7 |
2 |
ID |
O |
Yes |
0080 |
|
Needs Human Review |
00307 |
RXD |
014 |
4 |
1 |
ID |
O |
No |
0136 |
|
Needs Human Review |
00307 |
RXO |
016 |
4 |
1 |
ID |
O |
No |
0136 |
|
Needs Human Review |
00307 |
RXE |
020 |
4 |
1 |
ID |
O |
No |
0136 |
|
Needs Human Review |
00307 |
RXG |
012 |
4 |
1 |
ID |
O |
No |
0136 |
|
Next of Kin/Associated Parties Job Title |
00199 |
NK1 |
010 |
3 |
60 |
ST |
O |
No | ||
Next of Kin Job/Associated Parties Code/Class |
00200 |
NK1 |
011 |
3 |
20 |
CM |
O |
No | ||
Next of Kin/Associated Parties Employee Number |
00201 |
NK1 |
012 |
3 |
20 |
CX |
O |
No |
0327, 0328 |
|
Non Covered Days (24) |
00538 |
UB1 |
009 |
6 |
3 |
NM |
O |
No | ||
Non-Concur Effective Date/Time |
00514 |
IN3 |
013 |
6 |
26 |
TS |
O |
No | ||
Non-Concur Code/Description |
00513 |
IN3 |
012 |
6 |
60 |
CE |
O |
No |
0233 |
|
Non-Covered Insurance Code |
00495 |
IN2 |
024 |
6 |
8 |
ST |
O |
Yes |
0143 |
|
Non-Covered Days (8) |
00557 |
UB2 |
005 |
6 |
4 |
ST |
O |
No | ||
Notice of Admission Date |
00449 |
IN1 |
024 |
6 |
8 |
DT |
O |
No | ||
Notice of Admission Code |
00448 |
IN1 |
023 |
6 |
2 |
ID |
O |
No |
0136 |
|
Number Of Grace Days (90) |
00540 |
UB1 |
011 |
6 |
2 |
NM |
O |
No | ||
Number of Refills |
00304 |
RXO |
013 |
4 |
3 |
NM |
O |
No | ||
Number of Refills/Doses Dispensed |
00327 |
RXE |
017 |
4 |
20 |
NM |
C |
No | ||
Number of Refills |
00304 |
RXE |
012 |
4 |
3 |
NM |
O |
No | ||
Number of Refills Remaining |
00326 |
RXD |
008 |
4 |
20 |
NM |
C |
No | ||
Number of Refills Remaining |
00326 |
RXE |
016 |
4 |
20 |
NM |
C |
No | ||
Observ Result Status |
00579 |
OBX |
011 |
7 |
1 |
ID |
R |
No |
0085 |
|
Observation Sub-ID |
00572 |
OBX |
004 |
7 |
20 |
ST |
C |
No | ||
Telephone Number of Section |
00602 |
OM1 |
017 |
8 |
40 |
TN |
O |
No | ||
Observation Value |
00573 |
OBX |
005 |
7 |
65536 |
Varies |
C |
Yes | ||
Other Test/Observation IDs for the Observation |
00592 |
OM1 |
007 |
8 |
200 |
CE |
O |
No | ||
Observation Identifier |
00571 |
OBX |
003 |
7 |
590 |
CE |
R |
No | ||
Observation Date/Time |
00241 |
OBR |
007 |
4 |
26 |
TS |
C |
No | ||
Observation End Date/Time |
00242 |
OBR |
008 |
4 |
26 |
TS |
O |
No | ||
Interpretation of Observations |
00617 |
OM1 |
032 |
8 |
65536 |
TX |
O |
No | ||
Occur Span End Date (33) |
00548 |
UB1 |
019 |
6 |
8 |
DT |
O |
No | ||
Occur Span Start Date(33) |
00547 |
UB1 |
018 |
6 |
8 |
DT |
O |
No | ||
Occurrence Code & Date (32-35) |
00559 |
UB2 |
007 |
6 |
11 |
CM |
O |
Yes |
8 |
0153 |
Occurrence Span (33) |
00546 |
UB1 |
017 |
6 |
2 |
ID? |
O |
No |
0 |
|
Occurrence (28 32) |
00545 |
UB1 |
016 |
6 |
20 |
CM |
O |
Yes |
5 | |
Occurrence Span Code/Dates (36) |
00560 |
UB2 |
008 |
6 |
28 |
CM |
O |
Yes |
2 | |
Office/Home Address |
00679 |
STF |
011 |
8 |
106 |
AD |
O |
Yes |
2 | |
Operator |
00509 |
IN3 |
008 |
6 |
60 |
XCN |
O |
Yes | ||
Operator ID |
00103 |
EVN |
005 |
3 |
60 |
XCN |
O |
No |
0188 |
|
Order Status |
00219 |
ORC |
005 |
4 |
2 |
ID |
O |
No |
0038 |
|
Order Effective Date/Time |
00229 |
ORC |
015 |
4 |
26 |
TS |
O |
No | ||
Order Callback Phone Number |
00250 |
OBR |
017 |
4 |
40 |
XTN |
O |
Yes |
2 | |
Order Control Code Reason |
00230 |
ORC |
016 |
4 |
200 |
CE |
O |
No | ||
Order Control |
00215 |
ORC |
001 |
4 |
2 |
ID |
R |
No |
0119 |
|
Identity of Instrument Used to Perfrom this Study |
00598 |
OM1 |
013 |
8 |
60 |
CE |
O |
Yes | ||
Ordered By Code |
00373 |
FT1 |
021 |
6 |
120 |
XCN |
O |
No | ||
Ordering Provider's DEA Number |
00305 |
RXO |
014 |
4 |
60 |
XCN |
C |
No | ||
Ordering Provider's DEA Number |
00305 |
RXE |
013 |
4 |
60 |
XCN |
C |
No | ||
Ordering Provider |
00226 |
OBR |
016 |
4 |
80 |
XCN |
O |
Yes | ||
Ordering Provider |
00226 |
ORC |
012 |
4 |
120 |
XCN |
O |
No | ||
Organization Name |
00202 |
NK1 |
013 |
3 |
60 |
XON |
O |
Yes | ||
Other Names |
00593 |
OM1 |
008 |
8 |
200 |
ST |
R |
Yes |
Preferred Report Name for the Observation |
00594 |
OM1 |
009 |
8 |
30 |
ST |
O |
No | ||
Other QRY Subject Filter |
00041 |
QRF |
005 |
2 |
60 |
ST |
O |
Yes | ||
Outlier Cost |
00387 |
DG1 |
013 |
6 |
12 |
NM |
O |
No | ||
Outlier Type |
00385 |
DG1 |
011 |
6 |
60 |
CE |
O |
No |
0083 |
|
Outlier Days |
00386 |
DG1 |
012 |
6 |
3 |
NM |
O |
No | ||
Address of Outside Site(s) |
00613 |
OM1 |
028 |
8 |
1000 |
AD |
O |
No | ||
Parent Result |
00259 |
OBR |
026 |
4 |
200 |
CM |
O |
No | ||
Parent Number |
00261 |
OBR |
029 |
4 |
150 |
CM |
O |
No | ||
Parent |
00222 |
ORC |
008 |
4 |
200 |
CM |
O |
No | ||
Patient Type |
00148 |
FT1 |
018 |
6 |
2 |
IS |
O |
No |
0018 |
|
Procedure Medication |
00623 |
OM1 |
038 |
8 |
200 |
CE |
O |
No | ||
Patient Valuables |
00185 |
PV2 |
005 |
3 |
25 |
ST |
O |
Yes | ||
Patient Address |
00114 |
PID |
011 |
3 |
106 |
XAD |
O |
Yes | ||
Patient Type |
00148 |
PV1 |
018 |
3 |
2 |
IS |
O |
No |
0018 |
|
Patient Class |
00132 |
PV1 |
002 |
3 |
1 |
IS |
R |
No |
0004 |
|
Patient Valuables Location |
00186 |
PV2 |
006 |
3 |
25 |
ST |
O |
No | ||
Patient Alias |
00112 |
PID |
009 |
3 |
48 |
XPN |
O |
Yes | ||
Patient ID (External ID) |
00105 |
PID |
002 |
3 |
16 |
CK |
O |
No | ||
Patient ID (Internal ID) |
00106 |
PID |
003 |
3 |
20 |
CX |
R |
Yes | ||
Patient Name |
00108 |
PID |
005 |
3 |
48 |
XPN |
R |
No | ||
Patient Account Number |
00121 |
PID |
018 |
3 |
20 |
CX |
O |
No | ||
Payor Subscriber ID |
00497 |
IN2 |
026 |
6 |
59 |
CX |
O |
Yes | ||
Payor ID |
00496 |
IN2 |
025 |
6 |
59 |
CX |
O |
Yes | ||
Penalty |
00506 |
IN3 |
005 |
6 |
10 |
CM |
O |
No |
0148 |
|
Pending Location |
00172 |
PV1 |
042 |
3 |
12 |
PL |
O |
No | ||
Performed By Code |
00372 |
FT1 |
020 |
6 |
120 |
XCN |
O |
No |
0084 |
|
Specimen Required |
00589 |
OM1 |
004 |
8 |
1 |
ID |
R |
No |
0136 |
|
Pharmacist/Treatment Supplier's Verifier ID |
00306 |
RXE |
014 |
4 |
60 |
XCN |
O |
No | ||
Pharmacist Verifier ID |
00306 |
RXO |
015 |
4 |
60 |
XCN |
C |
No | ||
Pharmacy/Treatment Supplier Special Administration Instructions |
00343 |
RXG |
013 |
4 |
200 |
CE |
O |
Yes | ||
Pharmacy/Treatment Supplier Special Dispensing Instructions |
00330 |
RXD |
015 |
4 |
200 |
CE |
O |
Yes | ||
Pharmacy/Treatment Supplier's Special Dispensing Instructions |
00330 |
RXE |
021 |
4 |
200 |
CE |
O |
Yes | ||
Phone Number |
00194 |
NK1 |
005 |
3 |
40 |
XTN |
O |
Yes | ||
Confidentiality Code |
00615 |
OM1 |
030 |
8 |
1 |
ID |
O |
No |
0177 |
|
Phone |
00678 |
STF |
010 |
8 |
40 |
TN |
O |
Yes | ||
Phone Number - Business |
00117 |
PID |
014 |
3 |
40 |
XTN |
O |
Yes | ||
Phone Number - Home |
00116 |
PID |
013 |
3 |
40 |
XTN |
O |
Yes | ||
Physician Reviewer |
00515 |
IN3 |
014 |
6 |
60 |
XCN |
O |
Yes | ||
Placer Order Number |
00216 |
OBR |
002 |
4 |
75 |
EI |
C |
No | ||
Placer Order Number |
00216 |
ORC |
002 |
4 |
75 |
EI |
C |
No | ||
Placer Field 2 |
00252 |
OBR |
019 |
4 |
60 |
ST |
O |
No | ||
Placer Group Number |
00218 |
ORC |
004 |
4 |
75 |
EI |
O |
No | ||
Placer Field 1 |
00251 |
OBR |
018 |
4 |
60 |
ST |
O |
No | ||
Plan Type |
00440 |
IN1 |
015 |
6 |
2 |
IS |
O |
No |
0086 |
|
Plan Effective Date |
00437 |
IN1 |
012 |
6 |
8 |
DT |
O |
No | ||
Plan Expiration Date |
00438 |
IN1 |
013 |
6 |
8 |
DT |
O |
No | ||
Policy Type/Amount |
00500 |
IN2 |
029 |
6 |
25 |
CM |
O |
Yes |
0147 0193 |
|
Policy Number |
00461 |
IN1 |
036 |
6 |
15 |
ST |
O |
No | ||
Policy Deductible |
00462 |
IN1 |
037 |
6 |
12 |
CP |
O |
No | ||
Policy Limit - Amount |
00463 |
IN1 |
038 |
6 |
12 |
CP |
O |
No | ||
Policy Limit - Days |
00464 |
IN1 |
039 |
6 |
4 |
NM |
O |
No | ||
Observation Producing Department/Section |
00601 |
OM1 |
016 |
8 |
1 |
ID |
O |
Yes | ||
Primary Key Value - PRA |
00685 |
PRA |
001 |
8 |
20 |
ST |
R |
No | ||
Practioner Category |
00687 |
PRA |
003 |
8 |
3 |
ID |
O |
Yes | ||
Practitioner ID Numbers |
00690 |
PRA |
006 |
8 |
100 |
CM |
O |
Yes | ||
Practioner Group |
00686 |
PRA |
002 |
8 |
60 |
CE |
O |
Yes | ||
Pre-Admit Cert (PAC) |
00453 |
IN1 |
028 |
6 |
15 |
ST |
O |
No | ||
Pre-Certification Req/Window |
00521 |
IN3 |
020 |
6 |
40 |
CM |
O |
Yes |
0150 |
|
Preadmit Number |
00135 |
PV1 |
005 |
3 |
20 |
CX |
O |
No | ||
Preadmit Test Indicator |
00142 |
PV1 |
012 |
3 |
2 |
IS |
O |
No |
0087 |
|
Preferred Long Name for the Observation |
00596 |
OM1 |
011 |
8 |
200 |
ST |
O |
No | ||
Preferred Short Name or Mnemonic for Observation |
00595 |
OM1 |
010 |
8 |
8 |
ST |
O |
No | ||
Orderability |
00597 |
OM1 |
012 |
8 |
1 |
ID |
O |
No |
0136 |
|
Preferred Method of Contact |
00684 |
STF |
016 |
8 |
1 |
ID |
O |
No |
0185 |
|
Prescription Number |
00325 |
RXE |
015 |
4 |
20 |
ST |
C |
No | ||
Prescription Number |
00325 |
RXD |
007 |
4 |
20 |
NM |
C |
No | ||
Primary Key Value |
00667 |
MFE |
004 |
8 |
60 |
CE |
R |
Yes | ||
Primary Key Value |
00667 |
MFA |
005 |
8 |
60 |
CE |
R |
Yes | ||
Principal Result Interpreter |
00264 |
OBR |
032 |
4 |
200 |
XCN |
O |
No | ||
Prior Patient ID - Internal |
00211 |
MRG |
001 |
3 |
20 |
CX |
R |
Yes | ||
Prior Patient Account Number |
00213 |
MRG |
003 |
3 |
20 |
CX |
O |
No | ||
Prior Patient ID - External |
00214 |
MRG |
004 |
3 |
16 |
CX |
O |
No | ||
Prior Insurance Plan ID |
00471 |
IN1 |
046 |
6 |
8 |
ID |
O |
No |
0072 |
|
Prior Alternate Patient ID |
00212 |
MRG |
002 |
3 |
16 |
CX |
O |
Yes | ||
Prior Pending Location |
00181 |
PV2 |
001 |
3 |
12 |
PL |
O |
No | ||
Prior Temporary Location |
00173 |
PV1 |
043 |
3 |
12 |
PL |
O |
No | ||
Prior Patient Location |
00136 |
PV1 |
006 |
3 |
12 |
PL |
O |
No | ||
Priority |
00239 |
OBR |
005 |
4 |
2 |
ID |
X |
No | ||
Privileges |
00691 |
PRA |
007 |
8 |
200 |
CM |
O |
Yes | ||
Probability |
00577 |
OBX |
009 |
7 |
5 |
NM |
O |
No | ||
Procedure Practitioner |
00402 |
PR1 |
012 |
6 |
230 |
XCN |
O |
Yes |
0010 |
|
Procedure Priority |
00404 |
PR1 |
014 |
6 |
2 |
NM |
O |
No | ||
Procedure Minutes |
00397 |
PR1 |
007 |
6 |
4 |
NM |
O |
No | ||
Procedure Type |
00396 |
PR1 |
006 |
6 |
2 |
IS |
R |
No |
0230 |
|
Procedure Description |
00394 |
PR1 |
004 |
6 |
40 |
ST |
O |
No | ||
Factors that may Effect the Observation |
00624 |
OM1 |
039 |
8 |
200 |
TX |
O |
No | ||
Procedure Coding Method |
00392 |
PR1 |
002 |
6 |
2 |
IS |
R |
No |
0089 |
|
Procedure Code |
00393 |
PR1 |
003 |
6 |
80 |
CE |
R |
No |
0088 |
|
Procedure Date/Time |
00395 |
PR1 |
005 |
6 |
26 |
TS |
R |
No | ||
Processing Priority |
00610 |
OM1 |
025 |
8 |
40 |
ID |
O |
Yes |
0168 |
|
Processing ID |
00011 |
MSH |
011 |
2 |
1 |
ID |
R |
No |
0103 |
|
Reporting Priority |
00611 |
OM1 |
026 |
8 |
5 |
ID |
O |
No |
0176 |
|
Observation Description |
00591 |
OM1 |
006 |
8 |
200 |
CE |
O |
No | ||
Producer's ID |
00583 |
OBX |
015 |
7 |
60 |
CE |
O |
No | ||
Permitted Data Types |
00588 |
OM1 |
003 |
8 |
12 |
ID |
O |
Yes |
0125 |
|
Provider Billing |
00688 |
PRA |
004 |
8 |
1 |
ID |
O |
No |
0186 |
|
Provider's Pharmacy Instructions |
00297 |
RXO |
006 |
4 |
200 |
CE |
O |
Yes | ||
Provider's Administration Instructions |
00298 |
RXE |
007 |
4 |
200 |
CE |
O |
Yes | ||
Provider's Administration Instructions |
00298 |
RXO |
007 |
4 |
200 |
CE |
O |
Yes | ||
PSRO/UR Approved Stay To (89) |
00544 |
UB1 |
015 |
6 |
8 |
DT |
O |
No |
PSRO/UR Approved Stay Fm (88) |
00543 |
UB1 |
014 |
6 |
8 |
DT |
O |
No | ||
PSRO/UR Approval Indicator (87) |
00542 |
UB1 |
013 |
6 |
1 |
ID? |
O |
No |
0 |
|
Quantity/Timing |
00221 |
RXG |
003 |
4 |
200 |
TQ |
R |
No | ||
Quantity/Timing |
00221 |
RXE |
001 |
4 |
200 |
TQ |
R |
No | ||
Quantity/Timing |
00221 |
OBR |
027 |
4 |
200 |
TQ |
O |
Yes | ||
Quantity/Timing |
00221 |
ORC |
007 |
4 |
200 |
TQ |
O |
No | ||
Quantity Limited Request |
00031 |
QRD |
007 |
2 |
10 |
CQ |
R |
No |
0126 |
|
Query ID |
00028 |
QRD |
004 |
2 |
10 |
ST |
R |
No | ||
Query Results Level |
00036 |
QRD |
012 |
2 |
1 |
ID |
O |
No |
0108 |
|
Query Priority |
00027 |
QRD |
003 |
2 |
1 |
ID |
R |
No |
0091 |
|
Query Date/Time |
00025 |
QRD |
001 |
2 |
26 |
TS |
R |
No | ||
Query Format Code |
00026 |
QRD |
002 |
2 |
1 |
ID |
R |
No |
0106 |
|
R/U When Data End Date/Time |
00054 |
URS |
003 |
2 |
26 |
TS |
O |
No | ||
R/U Other Results Subject Definition |
00056 |
URS |
005 |
2 |
20 |
ST |
O |
Yes | ||
R/U What User Qualifier |
00055 |
URS |
004 |
2 |
20 |
ST |
O |
Yes | ||
R/U Where Subject Definition |
00052 |
URS |
001 |
2 |
20 |
ST |
R |
Yes | ||
R/U Results Level |
00051 |
URD |
007 |
2 |
1 |
ID |
O |
No |
0108 |
|
R/U Which Date/Time Qualifier |
00057 |
URS |
006 |
2 |
12 |
ID |
O |
Yes |
0156 |
|
R/U When Data Start Date/Time |
00053 |
URS |
002 |
2 |
26 |
TS |
O |
No | ||
R/U Display/Print Locations |
00050 |
URD |
006 |
2 |
20 |
ST |
O |
Yes | ||
R/U Who Subject Definition |
00047 |
URD |
003 |
2 |
60 |
XCN |
R |
Yes | ||
R/U Date/Time |
00045 |
URD |
001 |
2 |
26 |
TS |
O |
No | ||
R/U What Subject Definition |
00048 |
URD |
004 |
2 |
60 |
CE |
O |
Yes |
0048 |
|
R/U What Department Code |
00049 |
URD |
005 |
2 |
60 |
CE |
O |
Yes | ||
R/U Date/Time Selection Qualifier |
00059 |
URS |
008 |
2 |
12 |
ID |
O |
Yes |
0158 |
|
R/U Which Date/Time Status Qualifier |
00058 |
URS |
007 |
2 |
12 |
ID |
O |
Yes |
0157 |
|
Race |
00113 |
PID |
010 |
3 |
1 |
IS |
O |
No |
0005 |
|
Readmission Indicator |
00143 |
PV1 |
013 |
3 |
2 |
IS |
O |
No |
0092 |
|
Reason For Study |
00263 |
OBR |
031 |
4 |
300 |
CE |
O |
Yes | ||
Receiving Facility |
00006 |
MSH |
006 |
2 |
30 |
ST |
O |
No | ||
Receiving Application |
00005 |
MSH |
005 |
2 |
30 |
ST |
O |
No | ||
Record-Level Event Code |
00664 |
MFE |
001 |
8 |
3 |
ID |
R |
No |
0180 |
|
Record-Level Event Code |
00664 |
MFA |
001 |
8 |
3 |
ID |
R |
No |
0180 |
|
Reference File Control ID |
00078 |
FHS |
012 |
2 |
20 |
ST |
O |
No | ||
Reference Batch Control ID |
00092 |
BHS |
012 |
2 |
20 |
ST |
O |
No | ||
References Range |
00575 |
OBX |
007 |
7 |
10 |
ST |
O |
No | ||
Referring Doctor |
00138 |
PV1 |
008 |
3 |
60 |
XCN |
O |
Yes |
0010 |
|
Rules that Trigger Reflex Testing |
00620 |
OM1 |
035 |
8 |
80 |
ST |
O |
No | ||
Relationship |
00192 |
NK1 |
003 |
3 |
60 |
CE |
O |
No |
0063 |
|
Release Information Code |
00452 |
IN1 |
027 |
6 |
2 |
IS |
O |
No |
0093 |
|
Relevant Clinical Info. |
00247 |
OBR |
013 |
4 |
300 |
ST |
O |
No | ||
Religion |
00120 |
PID |
017 |
3 |
3 |
IS |
O |
No |
0006 |
|
Date/Time Stamp for any change in Def Attri for Obs |
00606 |
OM1 |
021 |
8 |
26 |
TS |
R |
No | ||
Report Priority |
00046 |
URD |
002 |
2 |
1 |
ID |
O |
No |
0109 |
|
Report Display Order |
00605 |
OM1 |
020 |
8 |
20 |
ST |
O |
No | ||
Outside Site(s) Where Observation may be Performed |
00612 |
OM1 |
027 |
8 |
200 |
CE |
O |
Yes | ||
Requested Dosage Form |
00296 |
RXO |
005 |
4 |
60 |
CE |
O |
No | ||
Requested Give Amount - Minimum |
00293 |
RXO |
002 |
4 |
20 |
NM |
R |
No | ||
Requested Dispense Units |
00303 |
RXO |
012 |
4 |
60 |
CE |
C |
No | ||
Requested Give Units |
00295 |
RXO |
004 |
4 |
60 |
CE |
R |
No | ||
Requested Give Amount - Maximum |
00294 |
RXO |
003 |
4 |
20 |
NM |
O |
No | ||
Requested Give Per (Time Unit) |
00308 |
RXO |
017 |
4 |
20 |
ST |
C |
No | ||
Requested Give Code |
00292 |
RXO |
001 |
4 |
100 |
CE |
R |
No | ||
Requested Dispense Code |
00301 |
RXO |
010 |
4 |
100 |
CE |
C |
No | ||
Requested Date/Time |
00240 |
OBR |
006 |
4 |
26 |
TS |
X |
No | ||
Requested Dispense Amount |
00302 |
RXO |
011 |
4 |
20 |
NM |
C |
No | ||
Requisition Unit of Measure |
00280 |
RQD |
006 |
4 |
60 |
CE |
O |
No | ||
Requisition Quantity |
00279 |
RQD |
005 |
4 |
6 |
NM |
O |
No | ||
Requisition Line Number |
00275 |
RQD |
001 |
4 |
4 |
SI |
O |
No | ||
Response Level Code |
00663 |
MFI |
006 |
8 |
2 |
ID |
R |
No |
0179 |
|
Response Flag |
00220 |
ORC |
006 |
4 |
1 |
ID |
O |
No |
0121 |
|
Responsible Observer |
00584 |
OBX |
016 |
7 |
80 |
XCN |
O |
No | ||
Result Status |
00258 |
OBR |
025 |
4 |
1 |
ID |
C |
No |
0123 |
|
Result ID |
00065 |
DSP |
005 |
2 |
20 |
TX |
O |
No | ||
Result Copies To |
00260 |
OBR |
028 |
4 |
150 |
XCN |
O |
Yes |
5 | |
Results Rpt/Status Chng - Date/Time |
00255 |
OBR |
022 |
4 |
26 |
TS |
C |
No | ||
Room Rate - Private |
00466 |
IN1 |
041 |
6 |
12 |
CP |
O |
No | ||
Room Rate - Semi-Private |
00465 |
IN1 |
040 |
6 |
12 |
CP |
O |
No | ||
Room Coverage Type/Amount |
00499 |
IN2 |
028 |
6 |
25 |
CM |
O |
Yes |
0145 0146 |
|
Route |
00309 |
RXR |
001 |
4 |
60 |
CE |
R |
No |
0162 |
|
Rpt of Eligibility Date |
00451 |
IN1 |
026 |
6 |
8 |
DT |
O |
No | ||
Rpt of Eigibility Code |
00450 |
IN1 |
025 |
6 |
2 |
ID |
O |
No |
0136 |
|
Fixed Canned Message |
00621 |
OM1 |
036 |
8 |
64k |
CE |
O |
No | ||
RX Component Type |
00313 |
RXC |
001 |
4 |
1 |
ID |
R |
No |
0166 |
|
Scheduled Date/Time |
00268 |
OBR |
036 |
4 |
26 |
TS |
O |
No | ||
Second Opinion Date |
00523 |
IN3 |
022 |
6 |
8 |
DT |
O |
No | ||
Second Opinion Documentation Received |
00525 |
IN3 |
024 |
6 |
1 |
IS |
O |
Yes |
0152 |
|
Second Opinion Physician |
00526 |
IN3 |
025 |
6 |
60 |
CN |
O |
Yes | ||
Second Opinion Status |
00524 |
IN3 |
023 |
6 |
1 |
IS |
O |
No |
0151 |
|
Security |
00008 |
MSH |
008 |
2 |
40 |
ST |
O |
No | ||
Sequence Number - Test/ Observation Master File |
00586 |
OM1 |
001 |
8 |
4 |
NM |
R |
No | ||
Sending Application |
00003 |
MSH |
003 |
2 |
15 |
ST |
O |
No | ||
Sending Facility |
00004 |
MSH |
004 |
2 |
20 |
ST |
O |
No | ||
Sequence Number |
00013 |
MSH |
013 |
2 |
15 |
NM |
O |
No | ||
Producer's Test/Observation ID |
00587 |
OM1 |
002 |
8 |
200 |
CE |
R |
No | ||
Service Period |
00270 |
ODS |
002 |
4 |
60 |
CE |
O |
Yes |
10 | |
Service Period |
00270 |
ODT |
002 |
4 |
60 |
CE |
O |
Yes |
10 | |
Service |
00677 |
STF |
009 |
8 |
200 |
CE |
O |
Yes | ||
Servicing Facility |
00169 |
PV1 |
039 |
3 |
2 |
IS |
O |
No |
0115 |
|
Set ID - PR1 |
00391 |
PR1 |
001 |
6 |
4 |
SI |
R |
No | ||
Set ID - OBX |
00569 |
OBX |
001 |
7 |
10 |
SI |
O |
No | ||
Set ID - PV1 |
00131 |
PV1 |
001 |
3 |
4 |
SI |
O |
No | ||
Set ID - OBR |
00237 |
OBR |
001 |
4 |
4 |
SI |
C |
No | ||
Set ID - NTE |
00096 |
NTE |
001 |
2 |
4 |
SI |
O |
No | ||
Set ID - UB2 |
00553 |
UB2 |
001 |
6 |
4 |
SI |
O |
No | ||
Set ID - UB1 |
00530 |
UB1 |
001 |
6 |
4 |
SI |
O |
No | ||
Set ID - PID |
00104 |
PID |
001 |
3 |
4 |
SI |
O |
No | ||
Set ID - AL1 |
00203 |
AL1 |
001 |
3 |
4 |
SI |
R |
No | ||
Set ID - NK1 |
00190 |
NK1 |
001 |
3 |
4 |
SI |
R |
No | ||
Set ID - DSP |
00061 |
DSP |
001 |
2 |
4 |
SI |
O |
No |
Set ID - DG1 |
00375 |
DG1 |
001 |
6 |
4 |
SI |
R |
No | ||
Set ID - FT1 |
00355 |
FT1 |
001 |
6 |
4 |
SI |
O |
No | ||
Set ID - IN1 |
00426 |
IN1 |
001 |
6 |
4 |
SI |
R |
No | ||
Set ID - GT1 |
00405 |
GT1 |
001 |
6 |
4 |
SI |
R |
No | ||
Set ID - IN3 |
00502 |
IN3 |
001 |
6 |
4 |
SI |
R |
No | ||
Sex |
00111 |
STF |
005 |
8 |
1 |
IS |
O |
No |
0001 |
|
Sex |
00111 |
PID |
008 |
3 |
1 |
IS |
O |
No |
0001 |
|
Site |
00310 |
RXR |
002 |
4 |
60 |
CE |
O |
No |
0163 |
|
Source of Comment |
00097 |
NTE |
002 |
2 |
8 |
ID |
O |
No |
0105 |
|
Spec Program Indicator (44) |
00541 |
UB1 |
012 |
6 |
2 |
ID? |
O |
No |
0 |
|
Special Coverage Approval Title |
00494 |
IN2 |
023 |
6 |
30 |
ST |
O |
No | ||
Special Coverage Approval Name |
00493 |
IN2 |
022 |
6 |
48 |
XPN |
O |
Yes | ||
Specialty |
00689 |
PRA |
005 |
8 |
100 |
CM |
O |
Yes |
0187 |
|
Producer ID |
00590 |
OM1 |
005 |
8 |
200 |
CE |
R |
No | ||
Specimen Source |
00249 |
OBR |
015 |
4 |
300 |
CM |
O |
No |
0070 |
|
Specimen Received Date/Time |
00248 |
OBR |
014 |
4 |
26 |
TS |
C |
No | ||
Specimen Action Code |
00245 |
OBR |
011 |
4 |
1 |
ID |
O |
No |
0065 |
|
SSN Number - Patient |
00122 |
PID |
019 |
3 |
16 |
ST |
O |
No | ||
Staff ID Code |
00672 |
STF |
002 |
8 |
60 |
CE |
O |
Yes | ||
Staff Type |
00674 |
STF |
004 |
8 |
2 |
ID |
O |
Yes |
0182 |
|
Staff Name |
00673 |
STF |
003 |
8 |
48 |
PN |
O |
No | ||
Start Date |
00197 |
NK1 |
008 |
3 |
8 |
DT |
O |
No | ||
Primary Key Value - STF |
00671 |
STF |
001 |
8 |
60 |
CE |
R |
No | ||
Substitute Allowed |
00291 |
RQ1 |
007 |
4 |
1 |
ID |
O |
No |
0136 |
|
Substitution Status |
00322 |
RXG |
010 |
4 |
1 |
ID |
O |
No |
0167 |
|
Substitution Status |
00322 |
RXD |
011 |
4 |
1 |
ID |
O |
No |
0167 |
|
Substitution Status |
00322 |
RXE |
009 |
4 |
1 |
ID |
O |
No |
0167 |
|
Surgeon |
00401 |
PR1 |
011 |
6 |
120 |
XCN |
O |
Yes |
0010 |
|
Taxable |
00290 |
RQ1 |
006 |
4 |
1 |
ID |
O |
No |
0136 |
|
Technician |
00266 |
OBR |
034 |
4 |
200 |
XCN |
O |
Yes | ||
Nature of Test/Observation |
00603 |
OM1 |
018 |
8 |
1 |
ID |
O |
No |
0174 |
|
Temporary Location |
00141 |
PV1 |
011 |
3 |
12 |
PL |
O |
No | ||
Description of Test Methods |
00626 |
OM1 |
041 |
8 |
64k |
TX |
O |
No | ||
Text Message |
00020 |
MSA |
003 |
2 |
80 |
ST |
O |
No | ||
Text Instruction |
00272 |
ODS |
004 |
4 |
80 |
ST |
O |
Yes |
2 | |
Text Instruction |
00272 |
ODT |
003 |
4 |
80 |
ST |
O |
No | ||
Total Payments |
00179 |
PV1 |
049 |
3 |
12 |
NM |
O |
No | ||
Total Adjustments |
00178 |
PV1 |
048 |
3 |
12 |
NM |
O |
No | ||
Total Charges |
00177 |
PV1 |
047 |
3 |
12 |
NM |
O |
No | ||
Total Daily Dose |
00329 |
RXE |
019 |
4 |
10 |
CQ |
C |
No | ||
Total Daily Dose |
00329 |
RXD |
012 |
4 |
10 |
CQ |
O |
No | ||
Transaction Quantity |
00364 |
FT1 |
010 |
6 |
6 |
NM |
O |
No | ||
Transaction Type |
00360 |
FT1 |
006 |
6 |
8 |
IS |
R |
No |
0017 |
|
Transaction Amount - Extended |
00365 |
FT1 |
011 |
6 |
12 |
CP |
O |
No | ||
Transaction Code |
00361 |
FT1 |
007 |
6 |
80 |
CE |
R |
No |
0132 |
|
Transaction Amount - Unit |
00366 |
FT1 |
012 |
6 |
12 |
CP |
O |
No | ||
Transaction Batch ID |
00357 |
FT1 |
003 |
6 |
10 |
ST |
O |
No | ||
Transaction Description - Alt |
00363 |
FT1 |
009 |
6 |
40 |
ST |
O |
No | ||
Transaction Date |
00358 |
FT1 |
004 |
6 |
26 |
TS |
R |
No | ||
Transaction Posting Date |
00359 |
FT1 |
005 |
6 |
26 |
TS |
O |
No | ||
Transaction Description |
00362 |
FT1 |
008 |
6 |
40 |
ST |
O |
No | ||
Transaction ID |
00356 |
FT1 |
002 |
6 |
12 |
ST |
O |
No | ||
Transcriptionist |
00267 |
OBR |
035 |
4 |
200 |
XCN |
O |
Yes | ||
Transfer to Bad Debt Date |
00160 |
PV1 |
030 |
3 |
8 |
DT |
O |
No | ||
Transfer to Bad Debt Code |
00159 |
PV1 |
029 |
3 |
1 |
IS |
O |
No |
0110 |
|
Transfer Reason |
00184 |
PV2 |
004 |
3 |
60 |
CE |
O |
No | ||
Transportation Mode |
00262 |
OBR |
030 |
4 |
20 |
ID |
O |
No |
0124 |
|
Tray Type |
00273 |
ODT |
001 |
4 |
60 |
CE |
R |
No |
0160 |
|
Type |
00269 |
ODS |
001 |
4 |
1 |
ID |
R |
No |
0159 |
|
Type of Agreement Code |
00456 |
IN1 |
031 |
6 |
2 |
IS |
O |
No |
0098 |
|
Processing Time |
00609 |
OM1 |
024 |
8 |
20 |
NM |
O |
No | ||
UB 82 Locator 45 |
00552 |
UB1 |
023 |
6 |
17 |
ST |
O |
No | ||
UB 82 Locator 9 |
00550 |
UB1 |
021 |
6 |
7 |
ST |
O |
No | ||
UB 82 Locator 27 |
00551 |
UB1 |
022 |
6 |
8 |
ST |
O |
No | ||
UB 82 Locator 2 |
00549 |
UB1 |
020 |
6 |
30 |
ST |
O |
No | ||
UB92 Locator 78 (State) |
00568 |
UB2 |
016 |
6 |
2 |
ST |
O |
Yes |
2 | |
UB92 Locator 57 (National) |
00567 |
UB2 |
015 |
6 |
27 |
ST |
O |
No | ||
UB92 Locator 11 (State) |
00562 |
UB2 |
010 |
6 |
12 |
ST |
O |
Yes |
2 | |
UB92 Locator 31 (National) |
00563 |
UB2 |
011 |
6 |
5 |
ST |
O |
No | ||
UB92 Locator 56 (State) |
00566 |
UB2 |
014 |
6 |
14 |
ST |
O |
Yes |
5 | |
UB92 Locator 49 (National) |
00565 |
UB2 |
013 |
6 |
4 |
ST |
O |
Yes |
23 | |
UB92 Locator 2 (State) |
00561 |
UB2 |
009 |
6 |
29 |
ST |
O |
Yes |
2 | |
Unit Cost |
00374 |
FT1 |
022 |
6 |
12 |
CP |
O |
No | ||
Units |
00574 |
OBX |
006 |
7 |
60 |
CE |
O |
No | ||
Universal Service Identifier |
00238 |
OBR |
004 |
4 |
200 |
CE |
R |
No | ||
User Defined Access Checks |
00581 |
OBX |
013 |
7 |
20 |
ST |
O |
No | ||
Value Type |
00570 |
OBX |
002 |
7 |
2 |
ID |
R |
No |
0125 |
|
Value Amount & Code (46-49) |
00539 |
UB1 |
010 |
6 |
12 |
CM |
O |
Yes |
8 |
0153 |
Value Amount & Code |
00558 |
UB2 |
006 |
6 |
11 |
CM |
O |
Yes |
12 | |
Vendor Catalog |
00288 |
RQ1 |
005 |
4 |
16 |
ST |
C |
No | ||
Vendor ID |
00289 |
RQ1 |
004 |
4 |
60 |
CE |
C |
No | ||
Verification By |
00455 |
IN1 |
030 |
6 |
60 |
XPN |
O |
No | ||
Verification Status |
00470 |
IN1 |
045 |
6 |
2 |
ST |
O |
No | ||
Verification Date/Time |
00454 |
IN1 |
029 |
6 |
26 |
TS |
O |
No | ||
Verified By |
00225 |
ORC |
011 |
4 |
120 |
XCN |
O |
No | ||
Version ID |
00012 |
MSH |
012 |
2 |
8 |
ID |
R |
No |
0104 |
|
Veterans Military Status |
00130 |
PID |
027 |
3 |
60 |
CE |
O |
No |
0172 |
|
VIP Indicator |
00146 |
PV1 |
016 |
3 |
2 |
IS |
O |
No |
0099 |
|
Visit User Code |
00187 |
PV2 |
007 |
3 |
2 |
IS |
O |
No |
0130 |
|
Visit Number |
00149 |
PV1 |
019 |
3 |
15 |
CK |
O |
No | ||
What Subject Filter |
00033 |
QRD |
009 |
2 |
60 |
CE |
R |
Yes |
0048 |
|
What Data Code Value Qual. |
00035 |
QRD |
011 |
2 |
20 |
ST |
O |
Yes | ||
What Department Data Code |
00034 |
QRD |
010 |
2 |
60 |
CE |
R |
Yes | ||
What User Qualifier |
00040 |
QRF |
004 |
2 |
60 |
ST |
O |
Yes | ||
When to Charge |
00234 |
BLG |
001 |
4 |
15 |
CM |
O |
No |
0100 |
|
When Data Start Date/Time |
00038 |
QRF |
002 |
2 |
26 |
TS |
O |
No | ||
When Data End Date/Time |
00039 |
QRF |
003 |
2 |
26 |
TS |
O |
No | ||
Where Subject Filter |
00037 |
QRF |
001 |
2 |
20 |
ST |
R |
Yes | ||
Which Date/Time Qualifier |
00042 |
QRF |
006 |
2 |
12 |
ID |
O |
Yes |
0156 |
|
Which Date/Time Status Qualifier |
00043 |
QRF |
007 |
2 |
12 |
ID |
O |
Yes |
0157 |
Who Subject Filter |
00032 |
QRD |
008 |
2 |
60 |
XCN |
R |
Yes | ||
Action By |
00233 |
ORC |
019 |
4 |
120 |
XCN |
O |
No | ||
Sequence Number - Test/ Observation Master File |
00586 |
OM2 |
001 |
8 |
4 |
NM |
O |
No | ||
Units of Measure |
00627 |
OM2 |
002 |
8 |
60 |
CE |
O |
No | ||
Range of Decimal Precision |
00628 |
OM2 |
003 |
8 |
10 |
NM |
O |
Yes | ||
Corresponding SI Units of Measure |
00629 |
OM2 |
004 |
8 |
60 |
CE |
O |
No | ||
SI Conversion Factor |
00630 |
OM2 |
005 |
8 |
60 |
TX |
O |
No | ||
Reference (Normal) Range - Ordinal & Continuous Obs |
00631 |
OM2 |
006 |
8 |
200 |
CM |
O |
No | ||
Critical Range for Ordinal & Continuous Obs |
00632 |
OM2 |
007 |
8 |
200 |
CM |
O |
No | ||
Absolute Range for Ordinal & Continuous Obs |
00633 |
OM2 |
008 |
8 |
200 |
CM |
O |
No | ||
Delta Check Criteria |
00634 |
OM2 |
009 |
8 |
200 |
CM |
O |
Yes | ||
Minimum Meaningful Increments |
00635 |
OM2 |
010 |
8 |
20 |
NM |
O |
No | ||
Sequence Number - Test/ Observation Master File |
00586 |
OM3 |
001 |
8 |
4 |
NM |
O |
No | ||
Preferred Coding System |
00636 |
OM3 |
002 |
8 |
5 |
ID |
O |
No | ||
Valid Coded "Answers" |
00637 |
OM3 |
003 |
8 |
60 |
CE |
O |
No | ||
Normal Text/Codes for Categorical Observations |
00638 |
OM3 |
004 |
8 |
200 |
CE |
O |
Yes | ||
Abnormal Text/Codes for Categorical Observations |
00639 |
OM3 |
005 |
8 |
200 |
CE |
O |
No | ||
Critical Text Codes for Categorical Observations |
00640 |
OM3 |
006 |
8 |
200 |
CE |
O |
No | ||
Data Type |
00641 |
OM3 |
007 |
8 |
2 |
ID |
O |
No | ||
Sequence Number - Test/ Observation Master File |
00586 |
OM4 |
001 |
8 |
4 |
NM |
O |
No | ||
Derived Specimen |
00642 |
OM4 |
002 |
8 |
60 |
ID |
O |
No |
0170 |
|
Container Description |
00643 |
OM4 |
003 |
8 |
60 |
TX |
O |
No | ||
Container Volume |
00644 |
OM4 |
004 |
8 |
20 |
NM |
O |
No | ||
Container Units |
00645 |
OM4 |
005 |
8 |
60 |
CE |
O |
No | ||
Specimen |
00646 |
OM4 |
006 |
8 |
60 |
CE |
O |
No | ||
Additive |
00647 |
OM4 |
007 |
8 |
60 |
CE |
O |
No | ||
Preparation |
00648 |
OM4 |
008 |
8 |
10K |
TX |
O |
No | ||
Special Handling Requirements |
00649 |
OM4 |
009 |
8 |
10K |
TX |
O |
No | ||
Normal Collection Volume |
00650 |
OM4 |
010 |
8 |
20 |
CQ |
O |
No | ||
Minimum Collection Volume |
00651 |
OM4 |
011 |
8 |
20 |
CQ |
O |
No | ||
Specimen Requirements |
00652 |
OM4 |
012 |
8 |
10K |
TX |
O |
No | ||
Specimen Priorities |
00653 |
OM4 |
013 |
8 |
60 |
ID |
O |
No |
0027 |
|
Specimen Retention Time |
00654 |
OM4 |
014 |
8 |
20 |
CQ |
O |
No | ||
Sequence Number - Test/ Observation Master File |
00586 |
OM5 |
001 |
8 |
4 |
NM |
O |
No | ||
Test/Observations Included w/an Ordered Test Battery |
00655 |
OM5 |
002 |
8 |
200 |
CE |
O |
Yes | ||
Observation ID Suffixes |
00656 |
OM5 |
003 |
8 |
200 |
ST |
O |
No | ||
Sequence Number - Test/ Observation Master File |
00586 |
OM6 |
001 |
8 |
4 |
NM |
O |
No | ||
Derivation Rule |
00657 |
OM6 |
002 |
8 |
10K |
TX |
O |
No | ||
Character Set |
00692 |
MSH |
018 |
2 |
6 |
ID |
O |
No |
0211 |
|
Principal Language of Message |
00693 |
MSH |
019 |
2 |
3 |
ID |
O |
No | ||
When Quantity/Timing Qualifier |
00694 |
QRF |
009 |
2 |
60 |
TQ |
O |
No | ||
R/U Quantity/Timing Qualifier |
00695 |
URS |
009 |
2 |
60 |
TQ |
O |
No | ||
Query Tag |
00696 |
VTQ |
001 |
2 |
32 |
ST |
O |
No | ||
Query/ Response Format Code |
00697 |
VTQ |
002 |
2 |
1 |
ID |
R |
No | ||
VT Query Name |
00698 |
VTQ |
003 |
2 |
60 |
CE |
R |
No | ||
Virtual Table Name |
00699 |
VTQ |
004 |
2 |
60 |
CE |
R |
No | ||
Selection Criteria |
00700 |
VTQ |
005 |
2 |
256 |
CM |
O |
Yes | ||
Column Value |
00703 |
RDT |
1-n |
2 |
Variable |
Variable |
R |
No | ||
Number of Columns per Row |
00701 |
RDF |
001 |
2 |
3 |
NM |
R |
No | ||
Column Description |
00702 |
RDF |
002 |
2 |
40 |
CM |
R |
Yes | ||
Query Tag |
00696 |
SPR |
001 |
2 |
32 |
ST |
O |
No | ||
Query/ Response Format Code |
00697 |
SPR |
002 |
2 |
1 |
ID |
R |
No |
0106 |
|
Stored Procedure Name |
00704 |
SPR |
003 |
2 |
60 |
CE |
R |
No | ||
Input Parameter List |
00705 |
SPR |
004 |
2 |
256 |
CM |
O |
Yes | ||
Query Tag |
00696 |
ERQ |
001 |
2 |
32 |
ST |
O |
No | ||
Event Identifier |
00706 |
ERQ |
002 |
2 |
60 |
CE |
R |
No | ||
Input Parameter List |
00705 |
ERQ |
003 |
2 |
256 |
CM |
O |
Yes | ||
Query Tag |
00696 |
QAK |
001 |
2 |
32 |
ST |
C |
No | ||
Query Response Status |
00708 |
QAK |
002 |
2 |
2 |
ID |
O |
No |
0208 |
|
Query Tag |
00696 |
EQL |
001 |
2 |
32 |
ST |
O |
No | ||
Query/Response Format Code |
00697 |
EQL |
002 |
2 |
1 |
ID |
R |
No | ||
EQL Query Name |
00709 |
EQL |
003 |
2 |
60 |
CE |
R |
No | ||
EQL Query Statement |
00710 |
EQL |
004 |
2 |
4096 |
ST |
R |
No | ||
Estimated Length of Inpatient Stay |
00711 |
PV2 |
010 |
3 |
3 |
NM |
O |
No | ||
Actual Length of Inpatient Stay |
00712 |
PV2 |
011 |
3 |
3 |
NM |
O |
No | ||
Visit Description |
00713 |
PV2 |
012 |
3 |
50 |
ST |
O |
No | ||
Referral Source Code |
00714 |
PV2 |
013 |
3 |
90 |
XCN |
O |
No | ||
Previous Service Date |
00715 |
PV2 |
014 |
3 |
8 |
DT |
O |
No | ||
Employment Illness Related Indicator |
00716 |
PV2 |
015 |
3 |
1 |
ID |
O |
No |
0136 |
|
Purge Status Code |
00717 |
PV2 |
016 |
3 |
1 |
IS |
O |
No |
0213 |
|
Purge Status Date |
00718 |
PV2 |
017 |
3 |
8 |
DT |
O |
No | ||
Special Program Code |
00719 |
PV2 |
018 |
3 |
2 |
IS |
O |
No |
0214 |
|
Retention Indicator |
00720 |
PV2 |
019 |
3 |
1 |
ID |
O |
No |
0136 |
|
Expected Number of Insurance Plans |
00721 |
PV2 |
020 |
3 |
1 |
NM |
O |
No | ||
Visit Publicity Code |
00722 |
PV2 |
021 |
3 |
1 |
IS |
O |
No |
0215 |
|
Visit Protection Indicator |
00723 |
PV2 |
022 |
3 |
1 |
ID |
O |
No |
0136 |
|
Clinic Organization Name |
00724 |
PV2 |
023 |
3 |
90 |
XON |
O |
Yes | ||
Patient Status Code |
00725 |
PV2 |
024 |
3 |
2 |
IS |
O |
No |
0216 |
|
Visit Priority Code |
00726 |
PV2 |
025 |
3 |
1 |
IS |
O |
No |
0217 |
|
Previous Treatment Date |
00727 |
PV2 |
026 |
3 |
8 |
DT |
O |
No | ||
Expected Discharge Disposition |
00728 |
PV2 |
027 |
3 |
2 |
IS |
O |
No |
0112 |
|
Signature on File Date |
00729 |
PV2 |
028 |
3 |
8 |
DT |
O |
No | ||
First Similar Illness Date |
00730 |
PV2 |
029 |
3 |
8 |
DT |
O |
No | ||
Patient Charge Adjustment Code |
00731 |
PV2 |
030 |
3 |
3 |
IS |
O |
No |
0218 |
|
Recurring Service Code |
00732 |
PV2 |
031 |
3 |
2 |
IS |
O |
No |
0219 |
|
Billing Media Code |
00733 |
PV2 |
032 |
3 |
1 |
ID |
O |
No |
0136 |
|
Expected Surgery Date & Time |
00734 |
PV2 |
033 |
3 |
26 |
TS |
O |
No | ||
Military Partnership Code |
00735 |
PV2 |
034 |
3 |
2 |
ID |
O |
No |
0136 |
|
Military Non-Availabiltiy Code |
00736 |
PV2 |
035 |
3 |
2 |
ID |
O |
No |
0136 |
|
Newborn Baby Indicator |
00737 |
PV2 |
036 |
3 |
1 |
ID |
O |
No |
0136 |
|
Baby Detained Indicator |
00738 |
PV2 |
037 |
3 |
1 |
ID |
O |
No |
0136 |
|
Nationalty |
00739 |
PID |
028 |
3 |
2 |
IS |
O |
No |
0212 |
|
Patient Death Date and Time |
00740 |
PID |
029 |
3 |
26 |
TS |
O |
No | ||
Patient Death Indicator |
00741 |
PID |
030 |
3 |
1 |
ID |
O |
No |
0136 |
|
Marital Status |
00119 |
NK1 |
014 |
3 |
1 |
IS |
O |
No |
0002 |
|
Sex |
00111 |
NK1 |
015 |
3 |
1 |
IS |
O |
No |
0001 |
|
Date/Time of Birth |
00110 |
NK1 |
016 |
3 |
26 |
TS |
O |
No | ||
Living Dependency |
00755 |
NK1 |
017 |
3 |
2 |
IS |
O |
Yes |
0223 |
|
Ambulatory Status |
00145 |
NK1 |
018 |
3 |
2 |
IS |
O |
Yes |
0009 |
|
Citizenship |
00129 |
NK1 |
019 |
3 |
4 |
IS |
O |
Yes |
0171 |
Primary Language |
00118 |
NK1 |
020 |
3 |
60 |
CE |
O |
No |
0296 |
|
Living Arrangement |
00742 |
NK1 |
021 |
3 |
2 |
IS |
O |
No |
0220 |
|
Publicity Indicator |
00743 |
NK1 |
022 |
3 |
80 |
IS |
O |
No |
0215 |
|
Protection Indicator |
00744 |
NK1 |
023 |
3 |
1 |
ID |
O |
No |
0136 |
|
Student Indicator |
00745 |
NK1 |
024 |
3 |
2 |
IS |
O |
No |
0231 |
|
Religion |
00120 |
NK1 |
025 |
3 |
3 |
IS |
O |
No |
0006 |
|
Mothers Maiden Name |
00746 |
NK1 |
026 |
3 |
48 |
XPN |
O |
No | ||
Nationality |
00739 |
NK1 |
027 |
3 |
2 |
IS |
O |
No |
0212 |
|
Ethnic Group |
00125 |
NK1 |
028 |
3 |
3 |
IS |
O |
No |
0189 |
|
Contact Reason |
00747 |
NK1 |
029 |
3 |
2 |
IS |
O |
Yes |
0222 |
|
Contact Persons Name |
00748 |
NK1 |
030 |
3 |
48 |
XPN |
O |
Yes | ||
Contact Persons Telephone Number |
00749 |
NK1 |
031 |
3 |
40 |
XTN |
O |
Yes | ||
Contact Persons Address |
00750 |
NK1 |
032 |
3 |
106 |
XAD |
O |
Yes | ||
Associated Partys Identifiers |
00751 |
NK1 |
033 |
3 |
32 |
CX |
O |
Yes | ||
Job Status |
00752 |
NK1 |
034 |
3 |
2 |
IS |
O |
No |
0311 |
|
Race |
00113 |
NK1 |
035 |
3 |
1 |
IS |
O |
No |
0005 |
|
Handicap |
00753 |
NK1 |
036 |
3 |
2 |
IS |
O |
No |
0295 |
|
Contact Person Social Security Number |
00754 |
NK1 |
037 |
3 |
16 |
ST |
O |
No | ||
Living Dependency |
00755 |
PD1 |
001 |
3 |
2 |
IS |
O |
Yes |
0223 |
|
Living Arrangement |
00742 |
PD1 |
002 |
3 |
2 |
IS |
O |
No |
0220 |
|
Patient Primary Facility |
00756 |
PD1 |
003 |
3 |
90 |
XON |
O |
Yes | ||
Patient Primary Care Provider Name & ID No. |
00757 |
PD1 |
004 |
3 |
90 |
XCN |
O |
Yes | ||
Student Indicator |
00745 |
PD1 |
005 |
3 |
2 |
IS |
O |
No |
0231 |
|
Handicap |
00753 |
PD1 |
006 |
3 |
2 |
IS |
O |
No |
0295 |
|
Living Will |
00759 |
PD1 |
007 |
3 |
2 |
IS |
O |
No |
0316 |
|
Organ Donor |
00760 |
PD1 |
008 |
3 |
2 |
IS |
O |
No |
0316 |
|
Separate Bill |
00761 |
PD1 |
009 |
3 |
2 |
ID |
O |
No |
0 |
|
Duplicate Patient |
00762 |
PD1 |
010 |
3 |
2 |
CM |
O |
Yes |
0 |
|
Entered By Code |
00765 |
FT1 |
024 |
6 |
120 |
XCN |
O |
No | ||
Diagnosis Classification |
00766 |
DG1 |
017 |
6 |
3 |
IS |
O |
No |
0228 |
|
Confidential Indicator |
00767 |
DG1 |
018 |
6 |
1 |
ID |
O |
No |
0136 |
|
Attestation Date/Time |
00768 |
DG1 |
019 |
6 |
26 |
TS |
O |
No | ||
Diagnostic Related Group |
00382 |
DRG |
001 |
6 |
60 |
CE |
O |
No |
0055 |
|
DRG Assigned Date/Time |
00769 |
DRG |
002 |
6 |
26 |
TS |
O |
No | ||
DRG Approval Indicator |
00383 |
DRG |
003 |
6 |
2 |
ID |
O |
No |
0136 |
|
DRG Grouper Review Code |
00384 |
DRG |
004 |
6 |
2 |
IS |
O |
No |
0056 |
|
Outlier Type |
00385 |
DRG |
005 |
6 |
60 |
CE |
O |
No |
0083 |
|
Outlier Days |
00386 |
DRG |
006 |
6 |
3 |
NM |
O |
No | ||
Outlier Cost |
00387 |
DRG |
007 |
6 |
12 |
CP |
O |
No | ||
DRG Payor |
00770 |
DRG |
008 |
6 |
1 |
IS |
O |
No |
0229 |
|
Outlier Reimbursement |
00771 |
DRG |
009 |
6 |
9 |
CP |
O |
No | ||
Associated Diagnosis Code |
00772 |
PR1 |
015 |
6 |
80 |
CE |
O |
No | ||
Guarantor Billing Hold Flag |
00773 |
GT1 |
022 |
6 |
1 |
ID |
O |
No |
0136 |
|
Guarantor Credit Rating Code |
00774 |
GT1 |
023 |
6 |
80 |
CE |
O |
No | ||
Guarantor Death Date And Time |
00775 |
GT1 |
024 |
6 |
26 |
TS |
O |
No | ||
Guarantor Death Flag |
00776 |
GT1 |
025 |
6 |
1 |
ID |
O |
No |
0136 |
|
Guarantor Charge Adjustment Code |
00777 |
GT1 |
026 |
6 |
80 |
CE |
O |
No |
0218 |
|
Guarantor Household Annual Income |
00778 |
GT1 |
027 |
6 |
10 |
CP |
O |
No | ||
Guarantor Household Size |
00779 |
GT1 |
028 |
6 |
3 |
NM |
O |
No | ||
Guarantor Employer ID Number |
00780 |
GT1 |
029 |
6 |
20 |
CX |
O |
Yes | ||
Guarantor Marital Status Code |
00781 |
GT1 |
030 |
6 |
1 |
ID |
O |
No | ||
Guarantor Hire Effective Date |
00782 |
GT1 |
031 |
6 |
8 |
DT |
O |
No | ||
Employment Stop Date |
00783 |
GT1 |
032 |
6 |
8 |
DT |
O |
No | ||
Living Dependency |
00755 |
GT1 |
033 |
6 |
2 |
IS |
O |
No |
0223 |
|
Ambulatory Status |
00145 |
GT1 |
034 |
6 |
2 |
ID |
O |
No |
0009 |
|
Citizenship |
00129 |
GT1 |
035 |
6 |
4 |
ID |
O |
No |
0171 |
|
Primary Language |
00118 |
GT1 |
036 |
6 |
60 |
CE |
O |
No | ||
Living Arrangement |
00742 |
GT1 |
037 |
6 |
2 |
IS |
O |
No |
0220 |
|
Publicity Indicator |
00743 |
GT1 |
038 |
6 |
80 |
CE |
O |
No |
0215 |
|
Protection Indicator |
00744 |
GT1 |
039 |
6 |
1 |
ID |
O |
No |
0136 |
|
Student Indicator |
00745 |
GT1 |
040 |
6 |
2 |
IS |
O |
No |
0231 |
|
Religion |
00120 |
GT1 |
041 |
6 |
3 |
IS |
O |
No |
0006 |
|
Mothers Maiden Name |
00746 |
GT1 |
042 |
6 |
30 |
ST |
O |
No | ||
Nationality |
00739 |
GT1 |
043 |
6 |
80 |
CE |
O |
No |
0212 |
|
Ethnic Group |
00125 |
GT1 |
044 |
6 |
3 |
IS |
O |
No |
0189 |
|
Contact Person Name |
00748 |
GT1 |
045 |
6 |
48 |
XPN |
O |
Yes | ||
Contact Persons Telephone Number |
00749 |
GT1 |
046 |
6 |
40 |
XTN |
O |
Yes | ||
Contact Reason |
00747 |
GT1 |
047 |
6 |
80 |
CE |
O |
No |
0222 |
|
Contact Relationship Code |
00784 |
GT1 |
048 |
6 |
2 |
IS |
O |
No |
0063 |
|
Job Title |
00785 |
GT1 |
049 |
6 |
20 |
ST |
O |
No | ||
Job Code/Class |
00786 |
GT1 |
050 |
6 |
20 |
CM |
O |
No | ||
Coverage Type |
01277 |
IN1 |
047 |
6 |
3 |
IS |
O |
No |
0309 |
|
Handicap |
00753 |
IN1 |
048 |
6 |
2 |
IS |
O |
No |
0310 |
|
Living Dependency |
00755 |
IN2 |
031 |
6 |
2 |
IS |
O |
No |
0223 |
|
Ambulatory Status |
00145 |
IN2 |
032 |
6 |
2 |
IS |
O |
No |
0009 |
|
Citizenship |
00129 |
IN2 |
033 |
6 |
4 |
IS |
O |
No |
0171 |
|
Primary Language |
00118 |
IN2 |
034 |
6 |
60 |
CE |
O |
No | ||
Living Arrangement |
00742 |
IN2 |
035 |
6 |
2 |
IS |
O |
No |
0220 |
|
Publicity Indicator |
00743 |
IN2 |
036 |
6 |
80 |
IS |
O |
No |
0215 |
|
Protection Indicator |
00744 |
IN2 |
037 |
6 |
1 |
ID |
O |
No |
0136 |
|
Student Indicator |
00745 |
IN2 |
038 |
6 |
2 |
IS |
O |
No |
0231 |
|
Religion |
00120 |
IN2 |
039 |
6 |
3 |
IS |
O |
No |
0006 |
|
Mothers Maiden Name |
00746 |
IN2 |
040 |
6 |
30 |
ST |
O |
No | ||
Nationality |
00739 |
IN2 |
041 |
6 |
80 |
CE |
O |
No |
0212 |
|
Ethnic Group |
00125 |
IN2 |
042 |
6 |
3 |
IS |
O |
No |
0189 |
|
Marital Status |
00119 |
IN2 |
043 |
6 |
1 |
IS |
O |
Yes |
0002 |
|
Employment Start Date |
00787 |
IN2 |
044 |
6 |
8 |
DT |
O |
No | ||
Employment Stop Date |
00783 |
IN2 |
045 |
6 |
8 |
DT |
O |
No | ||
Job Title |
00785 |
IN2 |
046 |
6 |
20 |
ST |
O |
No | ||
Job Code/Class |
00786 |
IN2 |
047 |
6 |
20 |
CM |
O |
No | ||
Job Status |
00752 |
IN2 |
048 |
6 |
2 |
IS |
O |
No | ||
Employer Contact Person Name |
00789 |
IN2 |
049 |
6 |
48 |
XPN |
O |
Yes |
0311 |
|
Employer Contact Person Phone Number |
00790 |
IN2 |
050 |
6 |
40 |
XTN |
O |
Yes | ||
Employer Contact Reason |
00791 |
IN2 |
051 |
6 |
2 |
ID |
O |
No |
0222 |
|
Insureds Contact Persons Name |
00792 |
IN2 |
052 |
6 |
48 |
XPN |
O |
Yes | ||
Insureds Contact Person Telephone Number |
00793 |
IN2 |
053 |
6 |
40 |
XTN |
O |
Yes | ||
Insureds Contact Person Reason |
00794 |
IN2 |
054 |
6 |
2 |
IS |
O |
Yes |
0222 |
|
Relationship To The Patient Start Date |
00795 |
IN2 |
055 |
6 |
8 |
DT |
O |
No | ||
Relationship To The Patient Stop Date |
00796 |
IN2 |
056 |
6 |
8 |
DT |
O |
Yes | ||
Insurance Co. Contact Reason |
00797 |
IN2 |
057 |
6 |
2 |
IS |
O |
No |
0232 |
Insurance Co Contact Phone Number |
00798 |
IN2 |
058 |
6 |
40 |
XTN |
O |
No | ||
Policy Scope |
00799 |
IN2 |
059 |
6 |
2 |
IS |
O |
No |
0312 |
|
Policy Source |
00800 |
IN2 |
060 |
6 |
2 |
IS |
O |
No |
0313 |
|
Patient Member Number |
00801 |
IN2 |
061 |
6 |
60 |
CX |
O |
No | ||
Guarantors Relationship To Insured |
00802 |
IN2 |
062 |
6 |
2 |
IS |
O |
No |
0063 |
|
Insureds Telephone Number - Home |
00803 |
IN2 |
063 |
6 |
40 |
XTN |
O |
Yes | ||
Insureds Employer Telephone Number |
00804 |
IN2 |
064 |
6 |
40 |
XTN |
O |
Yes | ||
Military Handicapped Program |
00805 |
IN2 |
065 |
6 |
2 |
ID? |
O |
No |
0 |
|
Suspend Flag |
00806 |
IN2 |
066 |
6 |
2 |
ID |
O |
No |
0136 |
|
Copay Limit Flag |
00807 |
IN2 |
067 |
6 |
2 |
ID |
O |
No |
0136 |
|
Stoploss Limit Flag |
00808 |
IN2 |
068 |
6 |
2 |
ID |
O |
No |
0136 |
|
Insured Organization Name And ID |
00809 |
IN2 |
069 |
6 |
130 |
XON |
O |
Yes | ||
Insured Employer Organization Name And ID |
00810 |
IN2 |
070 |
6 |
130 |
XON |
O |
Yes | ||
Race |
00113 |
IN2 |
071 |
6 |
1 |
IS |
O |
No |
0005 |
|
HCFA Patient Relationship to Insured |
00811 |
IN2 |
072 |
6 |
1 |
ID? |
O |
No |
0 |
|
Auto Accident State |
00812 |
ACC |
004 |
6 |
2 |
ID? |
O |
No |
0 |
|
Accident Job Related Indicator |
00813 |
ACC |
005 |
6 |
2 |
ID |
O |
No |
0136 |
|
Accident Death Indicator |
00814 |
ACC |
006 |
6 |
2 |
ID |
O |
No |
0136 |
|
Special Visit Count |
00815 |
UB2 |
017 |
6 |
3 |
NM |
O |
No | ||
Action Code |
00816 |
GOL |
001 |
12 |
2 |
ID |
R |
No |
0287 |
|
Action Date/Time |
00817 |
GOL |
002 |
12 |
26 |
TS |
R |
No | ||
Goal ID |
00818 |
GOL |
003 |
12 |
80 |
CE |
R |
No | ||
Goal Instance ID |
00819 |
GOL |
004 |
12 |
60 |
EI |
R |
No | ||
Episode of Care ID |
00820 |
GOL |
005 |
12 |
60 |
EI |
O |
No | ||
Master Goal List Number |
00821 |
GOL |
006 |
12 |
60 |
NM |
O |
No | ||
Date/Time Goal Established |
00822 |
GOL |
007 |
12 |
26 |
TS |
O |
No | ||
Expected Goal Achievement Date/Time |
00824 |
GOL |
008 |
12 |
26 |
TS |
O |
No | ||
Goal Classification |
00825 |
GOL |
009 |
12 |
80 |
CE |
O |
No | ||
Goal Management Discipline |
00826 |
GOL |
010 |
12 |
80 |
CE |
O |
No | ||
Current Goal Review Status |
00827 |
GOL |
011 |
12 |
80 |
CE |
O |
No | ||
Current Goal Review Date/Time |
00828 |
GOL |
012 |
12 |
26 |
TS |
O |
No | ||
Next Goal Review Date/Time |
00829 |
GOL |
013 |
12 |
26 |
TS |
O |
No | ||
Previous Goal Review Date/Time |
00830 |
GOL |
014 |
12 |
26 |
TS |
O |
No | ||
Goal Review Interval |
00831 |
GOL |
015 |
12 |
200 |
TQ |
O |
No | ||
Goal Evaluation |
00832 |
GOL |
016 |
12 |
80 |
CE |
O |
No | ||
Goal Evaluation Comment |
00833 |
GOL |
017 |
12 |
300 |
ST |
O |
Yes | ||
Goal Life Cycle Status |
00834 |
GOL |
018 |
12 |
80 |
CE |
O |
No | ||
Goal Life Cycle Status Date/Time |
00835 |
GOL |
019 |
12 |
26 |
TS |
O |
No | ||
Goal Target Type |
00836 |
GOL |
020 |
12 |
80 |
CE |
O |
Yes | ||
Goal Target Name |
00837 |
GOL |
021 |
12 |
8? |
XPN |
O |
Yes | ||
Action Code |
00816 |
PRB |
001 |
12 |
2 |
ID |
R |
No |
0287 |
|
Action Date/Time |
00817 |
PRB |
002 |
12 |
26 |
TS |
R |
No | ||
Problem ID |
00838 |
PRB |
003 |
12 |
80 |
CE |
R |
No | ||
Problem Instance ID |
00839 |
PRB |
004 |
12 |
60 |
EI |
R |
No | ||
Episode of Care ID |
00820 |
PRB |
005 |
12 |
60 |
EI |
O |
No | ||
Master Problem List Number |
00841 |
PRB |
006 |
12 |
60 |
NM |
O |
No | ||
Date/Time Problem Established |
00842 |
PRB |
007 |
12 |
26 |
TS |
O |
No | ||
Anticipated Problem Resolution Date/Time |
00843 |
PRB |
008 |
12 |
26 |
TS |
O |
No | ||
Actual Problem Resolution Date/Time |
00844 |
PRB |
009 |
12 |
26 |
TS |
O |
No | ||
Problem Classification |
00845 |
PRB |
010 |
12 |
80 |
CE |
O |
No | ||
Problem Management Discipline |
00846 |
PRB |
011 |
12 |
80 |
CE |
O |
Yes | ||
Problem Persistence |
00847 |
PRB |
012 |
12 |
80 |
CE |
O |
No | ||
Problem Confirmation Status |
00848 |
PRB |
013 |
12 |
80 |
CE |
O |
No | ||
Problem Life Cycle Status |
00849 |
PRB |
014 |
12 |
80 |
CE |
O |
No | ||
Problem Life Cycle Status Date/Time |
00850 |
PRB |
015 |
12 |
26 |
TS |
O |
No | ||
Problem Date of Onset |
00851 |
PRB |
016 |
12 |
26 |
TS |
O |
No | ||
Problem Onset Text |
00852 |
PRB |
017 |
12 |
80 |
ST |
O |
No | ||
Problem Ranking |
00853 |
PRB |
018 |
12 |
80 |
CE |
O |
No | ||
Certainty of Problem |
00854 |
PRB |
019 |
12 |
60 |
CE |
O |
No | ||
Probability of Problem (0-1) |
00855 |
PRB |
020 |
12 |
5 |
NM |
O |
No | ||
Individual Awareness of Problem |
00856 |
PRB |
021 |
12 |
80 |
CE |
O |
No | ||
Problem Prognosis |
00857 |
PRB |
022 |
12 |
80 |
CE |
O |
No | ||
Individual Awareness of Prognosis |
00858 |
PRB |
023 |
12 |
80 |
CE |
O |
No | ||
Family/Significant Other Awareness of Problem/Prognosis |
00859 |
PRB |
024 |
12 |
200 |
ST |
O |
No | ||
Security/Sensitivity |
00823 |
PRB |
025 |
12 |
80 |
CE |
O |
No | ||
Placer Appointment ID |
00860 |
ARQ |
001 |
10 |
75 |
EI |
R |
No | ||
Filler Appointment ID |
00861 |
ARQ |
002 |
10 |
75 |
EI |
C |
No | ||
Occurrence Number |
00862 |
ARQ |
003 |
10 |
5 |
NM |
C |
No | ||
Placer Group Number |
00863 |
ARQ |
004 |
10 |
75 |
CM |
O |
No | ||
Schedule ID |
00864 |
ARQ |
005 |
10 |
200 |
CE |
C |
No | ||
Request Event Reason |
00865 |
ARQ |
006 |
10 |
200 |
CE |
O |
No | ||
Appointment Reason |
00866 |
ARQ |
007 |
10 |
200 |
CE |
O |
No |
0276 |
|
Appointment Type |
00867 |
ARQ |
008 |
10 |
200 |
CE |
O |
No |
0277 |
|
Appointment Duration |
00868 |
ARQ |
009 |
10 |
20 |
NM |
O |
No | ||
Appointment Appointment Reason |
00869 |
ARQ |
010 |
10 |
200 |
CE |
O |
No | ||
Requested Start Date/Time Range |
00870 |
ARQ |
011 |
10 |
53 |
CM |
O |
Yes | ||
Priority |
00871 |
ARQ |
012 |
10 |
5 |
ST |
O |
No | ||
Repeating Interval |
00872 |
ARQ |
013 |
10 |
100 |
CM |
O |
No | ||
Repeating Interval Duration |
00873 |
ARQ |
014 |
10 |
5 |
ST |
O |
No | ||
Placer Contact Person |
00874 |
ARQ |
015 |
10 |
48 |
XCN |
R |
No | ||
Placer Contact Phone Number |
00875 |
ARQ |
016 |
10 |
40 |
XTN |
O |
Yes | ||
Placer Contact Address |
00876 |
ARQ |
017 |
10 |
106 |
XAD |
O |
No | ||
Placer Contact Location |
00877 |
ARQ |
018 |
10 |
80 |
PL |
O |
No | ||
Entered By Person |
00878 |
ARQ |
019 |
10 |
48 |
XCN |
R |
No | ||
Entered By Phone Number |
00879 |
ARQ |
020 |
10 |
40 |
XTN |
O |
Yes | ||
Entered By Location |
00880 |
ARQ |
021 |
10 |
80 |
PL |
O |
No | ||
Parent Placer Appointment ID |
00881 |
ARQ |
022 |
10 |
75 |
EI |
O |
No | ||
Placer Appointment ID |
00860 |
SCH |
001 |
10 |
75 |
EI |
R |
No | ||
Filler Appointment ID |
00861 |
SCH |
002 |
10 |
75 |
EI |
C |
No | ||
Occurrence Number |
00862 |
SCH |
003 |
10 |
5 |
NM |
C |
No | ||
Placer Group Number |
00863 |
SCH |
004 |
10 |
75 |
CM |
O |
No | ||
Schedule ID |
00864 |
SCH |
005 |
10 |
200 |
CE |
O |
No | ||
Event Reason |
00883 |
SCH |
006 |
10 |
200 |
CE |
R |
No | ||
Appointment Reason |
00866 |
SCH |
007 |
10 |
200 |
CE |
O |
No |
0276 |
|
Appointment Type |
00867 |
SCH |
008 |
10 |
200 |
CE |
O |
No |
0277 |
|
Appointment Duration |
00868 |
SCH |
009 |
10 |
20 |
NM |
O |
No | ||
Appointment Duration Units |
00869 |
SCH |
010 |
10 |
200 |
CE |
O |
No | ||
Appointment Timing Quantity |
00884 |
SCH |
011 |
10 |
200 |
TQ |
R |
Yes | ||
Placer Contact Person |
00874 |
SCH |
012 |
10 |
48 |
XCN |
O |
No | ||
Placer Contact Phone Number |
00875 |
SCH |
013 |
10 |
40 |
XTN |
O |
No |
Placer Contact Address |
00876 |
SCH |
014 |
10 |
106 |
XAD |
O |
No | ||
Placer Contact Location |
00877 |
SCH |
015 |
10 |
80 |
PL |
O |
No | ||
Filler Contact Person |
00885 |
SCH |
016 |
10 |
38 |
XCN |
R |
No | ||
Filler Contact Phone Number |
00886 |
SCH |
017 |
10 |
40 |
XTN |
O |
No | ||
Filler Contact Address |
00887 |
SCH |
018 |
10 |
106 |
XAD |
O |
No | ||
Filler Contact Location |
00888 |
SCH |
019 |
10 |
80 |
PL |
O |
No | ||
Parent Placer Appointment ID |
00881 |
SCH |
020 |
10 |
75 |
EI |
O |
No | ||
Parent Filler Appointment ID |
00882 |
SCH |
021 |
10 |
75 |
EI |
O |
No | ||
Filler Status Code |
00889 |
SCH |
022 |
10 |
200 |
CE |
O |
No |
0278 |
|
Parent Filler Appointment ID |
00882 |
ARQ |
023 |
10 |
75 |
EI |
O |
No | ||
Set ID - AIS |
00890 |
AIS |
001 |
10 |
4 |
SI |
R |
No | ||
Universal Service Identifier |
00238 |
AIS |
002 |
10 |
200 |
CE |
R |
No | ||
Start Date/Time |
01202 |
AIS |
003 |
10 |
26 |
TS |
C |
No | ||
Start Date/Time Offset |
00891 |
AIS |
004 |
10 |
20 |
NM |
C |
No | ||
Start Date/Time Offset Units |
00892 |
AIS |
005 |
10 |
200 |
CE |
C |
No | ||
Duration |
00893 |
AIS |
006 |
10 |
20 |
NM |
O |
No | ||
Duration Units |
00894 |
AIS |
007 |
10 |
200 |
CE |
O |
No | ||
Allow Substitution Code |
00895 |
AIS |
008 |
10 |
10 |
IS |
C |
No |
0279 |
|
Set ID - AIG |
00896 |
AIG |
001 |
10 |
4 |
SI |
R |
No | ||
Resource ID |
00897 |
AIG |
002 |
10 |
200 |
CE |
C |
No | ||
Resource Type |
00898 |
AIG |
003 |
10 |
200 |
CE |
R |
No | ||
Resource Group |
00899 |
AIG |
004 |
10 |
200 |
CE |
O |
Yes | ||
Resource Quantity |
00900 |
AIG |
005 |
10 |
5 |
NM |
O |
No | ||
Resource Quantity Units |
00901 |
AIG |
006 |
10 |
200 |
CE |
O |
No | ||
Start Date/Time |
01202 |
AIG |
007 |
10 |
26 |
TS |
C |
No | ||
Start Date/Time Offset |
00891 |
AIG |
008 |
10 |
20 |
NM |
C |
No | ||
Start Date/Time Offset Units |
00892 |
AIG |
009 |
10 |
200 |
CE |
C |
No | ||
Duration |
00893 |
AIG |
010 |
10 |
20 |
NM |
O |
No | ||
Duration Units |
00894 |
AIG |
011 |
10 |
200 |
CE |
O |
No | ||
Allow Substitution Code |
00895 |
AIG |
012 |
10 |
10 |
IS |
C |
No |
0279 |
|
Set ID - AIL |
00902 |
AIL |
001 |
10 |
4 |
SI |
R |
No | ||
Location Resource ID |
00903 |
AIL |
002 |
10 |
80 |
PL |
C |
No | ||
Location Type |
00904 |
AIL |
003 |
10 |
200 |
CE |
R |
No | ||
Location Group |
00905 |
AIL |
004 |
10 |
200 |
CE |
O |
No | ||
Start Date/Time |
01202 |
AIL |
005 |
10 |
26 |
TS |
C |
No | ||
Start Date/Time Offset |
00891 |
AIL |
006 |
10 |
20 |
NM |
C |
No | ||
Start Date/Time Offset Units |
00892 |
AIL |
007 |
10 |
200 |
CE |
C |
No | ||
Duration |
00893 |
AIL |
008 |
10 |
20 |
NM |
O |
No | ||
Duration Units |
00894 |
AIL |
009 |
10 |
200 |
CE |
O |
No | ||
Allow Substitution Code |
00895 |
AIL |
010 |
10 |
10 |
IS |
C |
No |
0279 |
|
Set ID - AIP |
00906 |
AIP |
001 |
10 |
4 |
SI |
R |
No | ||
Personnel Resource ID |
00913 |
AIP |
002 |
10 |
80 |
XCN |
C |
No | ||
Resource Role |
00907 |
AIP |
003 |
10 |
200 |
CE |
R |
No | ||
Resource Group |
00899 |
AIP |
004 |
10 |
200 |
CE |
O |
No | ||
Start Date/Time |
01202 |
AIP |
005 |
10 |
26 |
TS |
C |
No | ||
Start Date/Time Offset |
00891 |
AIP |
006 |
10 |
20 |
NM |
C |
No | ||
Start Date/Time Offset Units |
00892 |
AIP |
007 |
10 |
200 |
CE |
C |
No | ||
Duration |
00893 |
AIP |
008 |
10 |
20 |
NM |
O |
No | ||
Duration Units |
00894 |
AIP |
009 |
10 |
200 |
CE |
O |
No | ||
Time Selection Criteria |
00908 |
APR |
001 |
10 |
80 |
CM |
O |
Yes |
0294 |
|
Resource Selection Criteria |
00909 |
APR |
002 |
10 |
80 |
CM |
O |
Yes | ||
Location Selection Criteria |
00910 |
APR |
003 |
10 |
80 |
CM |
O |
Yes | ||
Slot Spacing Criteria |
00911 |
APR |
004 |
10 |
5 |
NM |
O |
No | ||
Filler Override Criteria |
00912 |
APR |
005 |
10 |
80 |
CM |
O |
Yes | ||
Set ID- TXA |
00914 |
TXA |
001 |
9 |
4 |
SI |
R |
No | ||
Document Type |
00915 |
TXA |
002 |
9 |
30 |
IS |
R |
No |
0270 |
|
Document Content Presentation |
00916 |
TXA |
003 |
9 |
2 |
ID |
C |
No |
0191 |
|
Activity Date/Time |
00917 |
TXA |
004 |
9 |
26 |
TS |
O |
No | ||
Primary Activity Provider Code/Name |
00918 |
TXA |
005 |
9 |
60 |
XCN |
C |
No | ||
Origination Date/Time |
00919 |
TXA |
006 |
9 |
26 |
TS |
O |
No | ||
Transcription Date/Time |
00920 |
TXA |
007 |
9 |
26 |
TS |
C |
No | ||
Edit Date/Time |
00921 |
TXA |
008 |
9 |
26 |
TS |
O |
Yes | ||
Originator Code/Name |
00922 |
TXA |
009 |
9 |
60 |
XCN |
O |
No | ||
Assigned Document Authenticator |
00923 |
TXA |
010 |
9 |
60 |
XCN |
O |
Yes | ||
Transcriptionist Code/Name |
00924 |
TXA |
011 |
9 |
48 |
XCN |
C |
No | ||
Unique Document Number |
00925 |
TXA |
012 |
9 |
30 |
EI |
R |
No | ||
Parent Document Number |
00926 |
TXA |
013 |
9 |
30 |
ST |
C |
No | ||
Placer Order Number |
00216 |
TXA |
014 |
9 |
75 |
CM |
O |
Yes | ||
Filler Order Number |
00217 |
TXA |
015 |
9 |
75 |
CM |
O |
No | ||
Unique Document File Name |
00927 |
TXA |
016 |
9 |
30 |
ST |
O |
No | ||
Document Completion Status |
00928 |
TXA |
017 |
9 |
2 |
ID |
R |
No |
0271 |
|
Document Confidentiality Status |
00929 |
TXA |
018 |
9 |
2 |
ID |
O |
No |
0272 |
|
Document Availability Status |
00930 |
TXA |
019 |
9 |
2 |
ID |
O |
No |
0273 |
|
Document Storage Status |
00932 |
TXA |
020 |
9 |
2 |
ID |
O |
No |
0275 |
|
Document Change Reason |
00933 |
TXA |
021 |
9 |
30 |
ID |
C |
No |
0 |
|
Authentication Person, Time Stamp |
00934 |
TXA |
022 |
9 |
60 |
CM |
C |
Yes | ||
Distributed Copies (Code and Name of Recipients) |
00935 |
TXA |
023 |
9 |
60 |
XCN |
O |
Yes | ||
Point versus Interval |
00938 |
OM1 |
043 |
8 |
60 |
CE |
O |
No |
0255 |
|
Challenge information |
00939 |
OM1 |
044 |
8 |
200 |
TX |
O |
No |
0256 0257 |
|
Relationship modifier |
00940 |
OM1 |
045 |
8 |
200 |
CE |
O |
No |
0258 |
|
Target anatomic site of test |
00941 |
OM1 |
046 |
8 |
200 |
CE |
O |
No | ||
Modality of imaging measurement |
00942 |
OM1 |
047 |
8 |
200 |
CE |
O |
No |
0259 |
|
LOC Primary Key Value |
00943 |
LOC |
001 |
8 |
20 |
CM |
R |
No | ||
Location Description |
00944 |
LOC |
002 |
8 |
48 |
ST |
O |
No | ||
Location Type |
00945 |
LOC |
003 |
8 |
2 |
ID |
R |
Yes |
0260 |
|
Parent Key Value |
00946 |
LOC |
004 |
8 |
20 |
CM |
O |
No | ||
Organization Name |
00947 |
LOC |
005 |
8 |
90 |
XON |
O |
No | ||
Location Address |
00948 |
LOC |
006 |
8 |
106 |
XAD |
O |
No | ||
Location Phone |
00949 |
LOC |
007 |
8 |
40 |
XTN |
O |
Yes | ||
Licensed Flag |
00950 |
LOC |
008 |
8 |
1 |
ID |
O |
No |
0136 |
|
License Number |
00951 |
LOC |
009 |
8 |
60 |
CE |
O |
Yes | ||
Implant Flag |
00952 |
LOC |
010 |
8 |
1 |
ID |
O |
No |
0136 |
|
Location Equipment |
00953 |
LOC |
011 |
8 |
3 |
ID |
O |
Yes |
0261 |
|
Shadow Flag |
00954 |
LOC |
012 |
8 |
2 |
ID |
O |
No |
0136 |
|
Privacy Level |
00955 |
LOC |
013 |
8 |
60 |
CE |
O |
No |
0262 |
|
Level Of Care |
00956 |
LOC |
014 |
8 |
60 |
CE |
O |
No |
0263 |
|
Infectious Disease Flag |
00957 |
LOC |
015 |
8 |
1 |
ID |
O |
No |
0136 |
|
Smoking Flag |
00958 |
LOC |
016 |
8 |
1 |
ID |
O |
No |
0136 |
|
Pharmacy |
00959 |
LOC |
017 |
8 |
90 |
XON |
O |
Yes | ||
Lab |
00960 |
LOC |
018 |
8 |
90 |
XON |
O |
Yes |
Dietary |
00961 |
LOC |
019 |
8 |
60 |
CE |
O |
Yes | ||
Location Aliases |
00962 |
LOC |
020 |
8 |
200 |
CM |
O |
Yes | ||
LDP Primary Key Value |
00963 |
LDP |
001 |
8 |
20 |
CM |
R |
No | ||
Location Department |
00964 |
LDP |
002 |
8 |
10 |
ID |
R |
No |
0264 |
|
Location Service |
00965 |
LDP |
003 |
8 |
3 |
ID |
O |
Yes | ||
Speciality Type |
00966 |
LDP |
004 |
8 |
60 |
CE |
O |
Yes |
0265 |
|
Valid Patient Classes |
00967 |
LDP |
005 |
8 |
1 |
IS |
O |
Yes |
0004 |
|
Active/Inactive Flag |
00675 |
LDP |
006 |
8 |
1 |
ID |
O |
No |
0183 |
|
Activation Date |
00969 |
LDP |
007 |
8 |
26 |
TS |
O |
No | ||
Inactivation Date - LDP |
00970 |
LDP |
008 |
8 |
26 |
TS |
O |
No | ||
Inactivated Reason |
00971 |
LDP |
009 |
8 |
80 |
ST |
O |
No | ||
Overflow Flag |
00972 |
LDP |
010 |
8 |
1 |
ID |
O |
No |
0136 |
|
Staffed Flag |
00973 |
LDP |
011 |
8 |
1 |
ID |
O |
No |
0136 |
|
Set-Up Flag |
00974 |
LDP |
012 |
8 |
1 |
ID |
O |
No |
0136 |
|
Gender Indicator |
00975 |
LDP |
013 |
8 |
1 |
ID |
O |
No |
0266 |
|
Visiting Hours |
00976 |
LDP |
014 |
8 |
80 |
CM |
O |
Yes |
0267 |
|
Teaching Flag |
00977 |
LDP |
015 |
8 |
1 |
ID |
O |
No |
0136 |
|
Contact Phone |
00978 |
LDP |
016 |
8 |
40 |
XTN |
O |
No | ||
LCC Primary Key Value |
00979 |
LCC |
001 |
8 |
20 |
CM |
R |
No | ||
Location Department |
00964 |
LCC |
002 |
8 |
10 |
ID |
R |
No |
0264 |
|
Accommodation Type |
00980 |
LCC |
003 |
8 |
60 |
CE |
O |
Yes | ||
Charge Code |
00981 |
LCC |
004 |
8 |
60 |
CE |
R |
Yes | ||
CDM Primary Key Value |
00982 |
CDM |
001 |
8 |
200 |
CE |
R |
No |
0132 |
|
Charge Code Alias |
00983 |
CDM |
002 |
8 |
200 |
CE |
O |
Yes | ||
Charge Description Short |
00984 |
CDM |
003 |
8 |
20 |
ST |
R |
No | ||
Charge Description Long |
00985 |
CDM |
004 |
8 |
250 |
ST |
O |
No | ||
Descr Override Indicator |
00986 |
CDM |
005 |
8 |
1 |
ID |
O |
No |
0268 |
|
Exploding Charges |
00987 |
CDM |
006 |
8 |
60 |
CE |
O |
Yes | ||
Procedure Code |
00988 |
CDM |
007 |
8 |
200 |
CE |
O |
Yes | ||
Active/Inactive Flag |
00675 |
CDM |
008 |
8 |
1 |
ID |
O |
No |
0183 |
|
Inventory Number |
00990 |
CDM |
009 |
8 |
60 |
CE |
O |
Yes | ||
Resource Load |
00991 |
CDM |
010 |
8 |
12 |
NM |
O |
No | ||
Contract Number |
00992 |
CDM |
011 |
8 |
200 |
CK |
O |
Yes | ||
Contract Organization |
00993 |
CDM |
012 |
8 |
200 |
XON |
O |
No | ||
CDM Primary Key Value |
00982 |
PRC |
001 |
8 |
200 |
CE |
R |
No |
0132 |
|
Facility ID |
00995 |
PRC |
002 |
8 |
60 |
CE |
O |
Yes | ||
Department |
00996 |
PRC |
003 |
8 |
60 |
CE |
O |
Yes | ||
Valid Patient Classes |
00967 |
PRC |
004 |
8 |
1 |
IS |
O |
Yes |
0004 |
|
Price |
00998 |
PRC |
005 |
8 |
12 |
CP |
C |
Yes | ||
Formula |
00999 |
PRC |
006 |
8 |
200 |
ST |
O |
Yes | ||
Minimum Quantity |
01000 |
PRC |
007 |
8 |
4 |
NM |
O |
No | ||
Maximum Quantity |
01001 |
PRC |
008 |
8 |
4 |
NM |
O |
No | ||
Minimum Price |
01002 |
PRC |
009 |
8 |
12 |
MO |
O |
No | ||
Maximum Price |
01003 |
PRC |
010 |
8 |
12 |
MO |
O |
No | ||
Effective Start Date |
01004 |
PRC |
011 |
8 |
26 |
TS |
O |
No | ||
Effective End Date |
01005 |
PRC |
012 |
8 |
26 |
TS |
O |
No | ||
Price Override Flag |
01006 |
PRC |
013 |
8 |
1 |
ID |
O |
No |
0268 |
|
Billing Category |
01007 |
PRC |
014 |
8 |
60 |
CE |
O |
Yes | ||
Chargeable Flag |
01008 |
PRC |
015 |
8 |
1 |
ID |
O |
No |
0136 |
|
Active/Inactive Flag |
00675 |
PRC |
016 |
8 |
1 |
ID |
O |
No |
0183 |
|
Cost |
00989 |
PRC |
017 |
8 |
12 |
MO |
O |
No | ||
Charge On Indicator |
01009 |
PRC |
018 |
8 |
1 |
ID |
O |
No |
0269 |
|
Room Fee Indicator |
00994 |
CDM |
013 |
8 |
1 |
ID |
O |
No |
0136 |
|
Set ID - CM0 |
01010 |
CM0 |
001 |
8 |
4 |
SI |
O |
No | ||
Sponsor Study ID |
01011 |
CM0 |
002 |
8 |
60 |
CE |
R |
No | ||
Alternate Study ID |
01012 |
CM0 |
003 |
8 |
60 |
CE |
O |
Yes |
3 | |
Title of Study |
01013 |
CM0 |
004 |
8 |
300 |
ST |
R |
No | ||
Chairman of Study |
01014 |
CM0 |
005 |
8 |
60 |
XCN |
O |
No | ||
Last IRB Approval Date |
01015 |
CM0 |
006 |
8 |
8 |
DT |
O |
No | ||
Total Accrual to Date |
01016 |
CM0 |
007 |
8 |
8 |
NM |
O |
No | ||
Last Accrual Date |
01017 |
CM0 |
008 |
8 |
8 |
DT |
O |
No | ||
Contact for Study |
01018 |
CM0 |
009 |
8 |
60 |
XCN |
O |
No | ||
Contact's Tel. Number |
01019 |
CM0 |
010 |
8 |
40 |
XTN |
O |
No | ||
Contact's Address |
01020 |
CM0 |
011 |
8 |
100 |
XAD |
O |
No | ||
Set ID - CM1 |
01021 |
CM1 |
001 |
8 |
4 |
SI |
R |
No | ||
Study Phase ID |
01051 |
CM1 |
002 |
8 |
60 |
CE |
R |
No | ||
Description of Study Phase |
01023 |
CM1 |
003 |
8 |
300 |
ST |
R |
No | ||
Set ID - CM2 |
01024 |
CM2 |
001 |
8 |
4 |
SI |
O |
No | ||
Scheduled Time Point |
01025 |
CM2 |
002 |
8 |
60 |
CE |
R |
No | ||
Description of Time Point |
01026 |
CM2 |
003 |
8 |
300 |
ST |
O |
No | ||
Events Scheduled This Time Point |
01027 |
CM2 |
004 |
8 |
60 |
CE |
R |
Yes |
200 | |
Number Of Sample Containers |
01028 |
OBR |
037 |
4 |
4 |
NM |
O |
No | ||
Transport Logistics Of Collected Sample |
01029 |
OBR |
038 |
4 |
60 |
CE |
O |
Yes | ||
Collectors Comment |
01030 |
OBR |
039 |
4 |
200 |
CE |
O |
Yes | ||
Transport Arrangement Responsibility |
01031 |
OBR |
040 |
4 |
60 |
CE |
O |
No | ||
Transport Arranged |
01032 |
OBR |
041 |
4 |
30 |
ID |
O |
No |
0224 |
|
Escort Required |
01033 |
OBR |
042 |
4 |
1 |
ID |
O |
No |
0225 |
|
Planned Patient Transport Comment |
01034 |
OBR |
043 |
4 |
200 |
CE |
O |
Yes | ||
Observation Method |
00936 |
OBX |
017 |
7 |
60 |
CE |
O |
Yes | ||
Sponsor Study ID |
01035 |
CSR |
001 |
7 |
60 |
EI |
R |
No | ||
Alternate Study ID |
01036 |
CSR |
002 |
7 |
60 |
EI |
O |
No | ||
Institution Registering the Patient |
01037 |
CSR |
003 |
7 |
60 |
CE |
O |
No | ||
Sponsor Patient ID |
01038 |
CSR |
004 |
7 |
30 |
CX |
R |
No | ||
Alternate Patient ID - CSR |
01039 |
CSR |
005 |
7 |
30 |
CX |
O |
No | ||
Date/Time of Patient Study Registration |
01040 |
CSR |
006 |
7 |
26 |
TS |
R |
No | ||
Person Performing Study Registration |
01041 |
CSR |
007 |
7 |
60 |
XCN |
O |
No | ||
Study Authorizing Provider |
01042 |
CSR |
008 |
7 |
60 |
XCN |
R |
No | ||
Date/time Patient Study Consent Signed |
01043 |
CSR |
009 |
7 |
26 |
TS |
C |
No | ||
Patient Study Eligibility Status |
01044 |
CSR |
010 |
7 |
60 |
CE |
C |
No | ||
Study Randomization Date/time |
01045 |
CSR |
011 |
7 |
26 |
TS |
O |
Yes |
3 | |
Study Randomized Arm |
01046 |
CSR |
012 |
7 |
200 |
CE |
O |
Yes |
3 | |
Stratum for Study Randomization |
01047 |
CSR |
013 |
7 |
200 |
CE |
O |
Yes |
3 | |
Patient Evaluability Status |
01048 |
CSR |
014 |
7 |
60 |
CE |
C |
No | ||
Date/time Ended Study |
01049 |
CSR |
015 |
7 |
26 |
TS |
C |
No | ||
Reason Ended Study |
01050 |
CSR |
016 |
7 |
60 |
CE |
C |
No | ||
Study Phase ID |
01051 |
CSP |
001 |
7 |
60 |
CE |
R |
No | ||
Date/time Study Phase Began |
01052 |
CSP |
002 |
7 |
26 |
TS |
R |
No | ||
Date/time Study Phase Ended |
01053 |
CSP |
003 |
7 |
26 |
TS |
O |
No | ||
Study Phase Evaluability |
01054 |
CSP |
004 |
7 |
60 |
CE |
C |
No | ||
Study Scheduled Time Point |
01055 |
CSS |
001 |
7 |
60 |
CE |
R |
No |
Study Scheduled Patient Time Point |
01056 |
CSS |
002 |
7 |
26 |
TS |
O |
No | ||
Study Quality Control Codes |
01057 |
CSS |
003 |
7 |
60 |
CE |
O |
Yes |
3 | |
Sponsor Study Identifier |
01058 |
CTI |
001 |
7 |
60 |
CE |
R |
No | ||
Study Phase Identifier |
01051 |
CTI |
002 |
7 |
60 |
CE |
C |
No | ||
Study Scheduled Time Point |
01055 |
CTI |
003 |
7 |
60 |
CE |
O |
No | ||
Sender Organization Name |
01059 |
PES |
001 |
7 |
80 |
XON |
O |
No | ||
Sender Individual Name |
01060 |
PES |
002 |
7 |
60 |
XCN |
O |
Yes | ||
Sender Address |
01062 |
PES |
003 |
7 |
200 |
XAD |
O |
Yes | ||
Sender Telephone |
01063 |
PES |
004 |
7 |
44 |
XTN |
O |
Yes | ||
Sender Event Identifier |
01064 |
PES |
005 |
7 |
30 |
ST |
O |
No | ||
Sender Sequence Number |
01065 |
PES |
006 |
7 |
2 |
NM |
O |
No | ||
Sender Event Description |
01066 |
PES |
007 |
7 |
600 |
FT |
O |
Yes | ||
Sender Comment |
01067 |
PES |
008 |
7 |
600 |
FT |
O |
No | ||
Sender Aware Date/Tme |
01068 |
PES |
009 |
7 |
26 |
TS |
O |
No | ||
Event Report Date |
01069 |
PES |
010 |
7 |
26 |
TS |
R |
No | ||
Event Report Timing/Type |
01070 |
PES |
011 |
7 |
3 |
ID |
O |
Yes |
2 |
0234 |
Event Report Source |
01071 |
PES |
012 |
7 |
1 |
ID |
O |
No |
0235 |
|
Event Reported To |
01072 |
PES |
013 |
7 |
1 |
ID |
O |
Yes |
0236 |
|
Event Identifiers Used |
01073 |
PEO |
001 |
7 |
60 |
CE |
O |
Yes | ||
Event Symptom/Diagnosis Code |
01074 |
PEO |
002 |
7 |
60 |
CE |
O |
Yes | ||
Event Onset Date/Time |
01075 |
PEO |
003 |
7 |
26 |
TS |
R |
No | ||
Event Exacerbation Date/Time |
01076 |
PEO |
004 |
7 |
26 |
TS |
O |
No | ||
Event Improved Date/Time |
01077 |
PEO |
005 |
7 |
26 |
TS |
O |
No | ||
Event Ended Data/Time |
01078 |
PEO |
006 |
7 |
26 |
TS |
O |
No | ||
Event Location Occurred Address |
01079 |
PEO |
007 |
7 |
106 |
XAD |
O |
No | ||
Event Qualification |
01080 |
PEO |
008 |
7 |
1 |
ID |
O |
Yes |
0237 |
|
Event Serious |
01081 |
PEO |
009 |
7 |
1 |
ID |
O |
No |
0238 |
|
Event Expected |
01082 |
PEO |
010 |
7 |
1 |
ID |
O |
No |
0239 |
|
Event Outcome |
01083 |
PEO |
011 |
7 |
1 |
ID |
R |
Yes |
0240 |
|
Patient Outcome |
01084 |
PEO |
012 |
7 |
1 |
ID |
O |
No |
0241 |
|
Event Description From Others |
01085 |
PEO |
013 |
7 |
600 |
FT |
O |
Yes | ||
Event From Original Reporter |
01086 |
PEO |
014 |
7 |
600 |
FT |
O |
Yes | ||
Event Description From Patient |
01087 |
PEO |
015 |
7 |
600 |
FT |
O |
Yes | ||
Event Description From Practitioner |
01088 |
PEO |
016 |
7 |
600 |
FT |
O |
Yes | ||
Event Description From Autopsy |
01089 |
PEO |
017 |
7 |
600 |
FT |
O |
Yes | ||
Cause Of Death |
01090 |
PEO |
018 |
7 |
60 |
CE |
O |
Yes | ||
Primary Observer Name |
01091 |
PEO |
019 |
7 |
46 |
XPN |
O |
No | ||
Primary Observer Address |
01092 |
PEO |
020 |
7 |
106 |
XAD |
O |
Yes | ||
Primary Observer Telephone |
01093 |
PEO |
021 |
7 |
40 |
XTN |
O |
Yes | ||
Primary Observers Qualification |
01094 |
PEO |
022 |
7 |
1 |
ID |
O |
No |
0242 |
|
Confirmation Provided By |
01095 |
PEO |
023 |
7 |
1 |
ID |
O |
No |
0242 |
|
Primary Observer Aware Date/Time |
01096 |
PEO |
024 |
7 |
26 |
TS |
O |
No | ||
Primary Observers iIdentity May Be Divulged |
01097 |
PEO |
025 |
7 |
1 |
ID |
O |
No |
0243 |
|
Implicated Product |
01098 |
PCR |
001 |
7 |
60 |
CE |
R |
No | ||
Generic Product |
01099 |
PCR |
002 |
7 |
1 |
IS |
O |
No |
0239 |
|
Product Class |
01100 |
PCR |
003 |
7 |
60 |
CE |
O |
No | ||
Total Duration Of Therapy |
01101 |
PCR |
004 |
7 |
8 |
CQ |
O |
No | ||
Product Manufacture Date |
01102 |
PCR |
005 |
7 |
26 |
TS |
O |
No | ||
Product Expiration Date |
01103 |
PCR |
006 |
7 |
26 |
TS |
O |
No | ||
Product Implantation Date |
01104 |
PCR |
007 |
7 |
26 |
TS |
O |
No | ||
Product Explantation Date |
01105 |
PCR |
008 |
7 |
26 |
TS |
O |
No | ||
Single Use Device |
01106 |
PCR |
009 |
7 |
8 |
IS |
O |
No |
0239 |
|
Indication For Product Use |
01107 |
PCR |
010 |
7 |
60 |
CE |
O |
No | ||
Product Problem |
01108 |
PCR |
011 |
7 |
8 |
IS |
O |
No |
0239 |
|
Product Serial/Lot Number |
01109 |
PCR |
012 |
7 |
30 |
ST |
O |
Yes |
3 | |
Product Available For Inspection |
01110 |
PCR |
013 |
7 |
1 |
IS |
O |
No |
0239 |
|
Product Evaluation Performed |
01111 |
PCR |
014 |
7 |
60 |
CE |
O |
No | ||
Product Evaluation Status |
01112 |
PCR |
015 |
7 |
60 |
CE |
O |
No |
0247 |
|
Product Evaluation Results |
01113 |
PCR |
016 |
7 |
60 |
CE |
O |
No | ||
Evaluated Product Source |
01114 |
PCR |
017 |
7 |
8 |
ID |
O |
No |
0248 |
|
Date Product Returned To Manufacturer |
01115 |
PCR |
018 |
7 |
26 |
TS |
O |
No | ||
Device Operator Qualifications |
01116 |
PCR |
019 |
7 |
1 |
ID |
O |
No |
0242 |
|
Relatedness Assessment |
01117 |
PCR |
020 |
7 |
1 |
ID |
O |
No |
0250 |
|
Action Taken In Response To The Event |
01118 |
PCR |
021 |
7 |
2 |
ID |
O |
Yes |
6 |
0251 |
Event Causality Observations |
01119 |
PCR |
022 |
7 |
2 |
ID |
O |
Yes |
6 |
0232 |
Indirect Exposure Mechanism |
01120 |
PCR |
023 |
7 |
1 |
ID |
O |
Yes |
3 |
0253 |
Requested Give Strength |
01121 |
RXO |
018 |
4 |
20 |
NM |
O |
No | ||
Requested Give Strength Units |
01122 |
RXO |
019 |
4 |
60 |
CE |
O |
No | ||
Indication |
01123 |
RXO |
020 |
4 |
200 |
CE |
O |
Yes | ||
Component Strength |
01124 |
RXC |
005 |
4 |
20 |
NM |
O |
No | ||
Component Strength Units |
01125 |
RXC |
006 |
4 |
60 |
CE |
O |
No | ||
Give Strength |
01126 |
RXE |
025 |
4 |
20 |
NM |
O |
No | ||
Give Strength Units |
01127 |
RXE |
026 |
4 |
60 |
CE |
O |
No | ||
Give Indication |
01128 |
RXE |
027 |
4 |
200 |
CE |
O |
Yes | ||
Dispense Package Size |
01220 |
RXE |
028 |
4 |
20 |
NM |
O |
No | ||
Dispense Package Size Unit |
01221 |
RXE |
029 |
4 |
60 |
CE |
O |
No | ||
Dispense Method |
01222 |
RXE |
030 |
4 |
2 |
ID |
O |
No |
0321 |
|
Actual Strength |
01132 |
RXD |
016 |
4 |
20 |
NM |
O |
No | ||
Actual Strength Unit |
01133 |
RXD |
017 |
4 |
60 |
CE |
O |
No | ||
Substance Lot Number |
01129 |
RXD |
018 |
4 |
20 |
ST |
O |
Yes | ||
Substance Expiration Date |
01130 |
RXD |
019 |
4 |
26 |
TS |
O |
Yes | ||
Substance Manufacturer Name |
01131 |
RXD |
020 |
4 |
60 |
CE |
O |
Yes | ||
Indication |
01123 |
RXD |
021 |
4 |
200 |
CE |
O |
Yes | ||
Give Strength |
01126 |
RXG |
017 |
4 |
20 |
NM |
O |
No | ||
Give Strength Units |
01127 |
RXG |
018 |
4 |
60 |
CE |
O |
No | ||
Substance Lot Number |
01129 |
RXG |
019 |
4 |
20 |
ST |
O |
Yes | ||
Substance Expiration Date |
01130 |
RXG |
020 |
4 |
26 |
TS |
O |
Yes | ||
Substance Manufacturer Name |
01131 |
RXG |
021 |
4 |
60 |
CE |
O |
Yes | ||
Indication |
01123 |
RXG |
022 |
4 |
200 |
CE |
O |
Yes | ||
Administered Strength |
01134 |
RXA |
013 |
4 |
20 |
NM |
O |
No | ||
Administered Strength Units |
01135 |
RXA |
014 |
4 |
60 |
CE |
O |
No | ||
Substance Lot Number |
01129 |
RXA |
015 |
4 |
20 |
ST |
O |
Yes | ||
Substance Expiration Date |
01130 |
RXA |
016 |
4 |
26 |
TS |
O |
Yes | ||
Substance Manufacturer Name |
01131 |
RXA |
017 |
4 |
60 |
CE |
O |
Yes | ||
Substance Refusal Reason |
01136 |
RXA |
018 |
4 |
200 |
CE |
O |
Yes | ||
Indication |
01123 |
RXA |
019 |
4 |
200 |
CE |
O |
Yes | ||
Referral Status |
01137 |
RF1 |
001 |
11 |
200 |
CE |
O |
No |
0283 |
|
Referral Priority |
01138 |
RF1 |
002 |
11 |
200 |
CE |
O |
No |
0280 |
|
Referral Type |
01139 |
RF1 |
003 |
11 |
200 |
CE |
O |
No |
0281 |
|
Referral Disposition |
01140 |
RF1 |
004 |
11 |
200 |
CE |
O |
Yes |
0282 |
Referral Category |
01141 |
RF1 |
005 |
11 |
200 |
CE |
O |
No |
0284 |
|
Referral Identifier |
01142 |
RF1 |
006 |
11 |
30 |
CM |
O |
No | ||
Effective Date |
01143 |
RF1 |
007 |
11 |
26 |
TS |
O |
No | ||
Expiration Date |
01144 |
RF1 |
008 |
11 |
26 |
TS |
O |
No | ||
Process Date |
01145 |
RF1 |
009 |
11 |
26 |
TS |
O |
No | ||
Authorizing Payor, Plan Code |
01146 |
AUT |
001 |
11 |
200 |
CE |
O |
No |
0072 |
|
Authorizing Payor, Company ID |
01147 |
AUT |
002 |
11 |
200 |
CE |
O |
No |
0285 |
|
Authorizing Payor, Company Name |
01148 |
AUT |
003 |
11 |
45 |
ST |
O |
No | ||
Authorization Effective Date |
01149 |
AUT |
004 |
11 |
26 |
TS |
O |
No | ||
Authorization Expiration Date |
01150 |
AUT |
005 |
11 |
26 |
TS |
O |
No | ||
Authorization Identifier |
01151 |
AUT |
006 |
11 |
30 |
CM |
O |
No | ||
Reimbursement Limit |
01152 |
AUT |
007 |
11 |
25 |
MO |
O |
No | ||
Requested Number of Treatments |
01153 |
AUT |
008 |
11 |
2 |
NM |
O |
No | ||
Authorized Number of Treatments |
01154 |
AUT |
009 |
11 |
2 |
NM |
O |
No | ||
Process Date |
01145 |
AUT |
010 |
11 |
26 |
TS |
O |
No | ||
Role |
01155 |
PRD |
001 |
11 |
200 |
CE |
R |
Yes |
0286 |
|
Provider Name |
01156 |
PRD |
002 |
11 |
106 |
PN |
O |
Yes | ||
Provider Address |
01157 |
PRD |
003 |
11 |
60 |
AD |
O |
No | ||
Provider Location |
01158 |
PRD |
004 |
11 |
60 |
CM |
O |
No | ||
Provider Phone Number |
01159 |
PRD |
005 |
11 |
20 |
TN |
O |
Yes | ||
Electronic Address |
01160 |
PRD |
006 |
11 |
60 |
CM |
O |
Yes | ||
Preferred Method of Contact |
01161 |
PRD |
007 |
11 |
200 |
CE |
O |
No |
0185 |
|
Provider Identifiers |
01162 |
PRD |
008 |
11 |
100 |
CM |
O |
Yes | ||
Effective Start Date of Role |
01163 |
PRD |
009 |
11 |
26 |
TS |
O |
No | ||
Effective End Date of Role |
01164 |
PRD |
010 |
11 |
26 |
TS |
O |
No | ||
Role |
01155 |
CTD |
001 |
11 |
200 |
CE |
R |
Yes |
0131 |
|
Contact Name |
01165 |
CTD |
002 |
11 |
106 |
PN |
O |
Yes | ||
Contact Address |
01166 |
CTD |
003 |
11 |
60 |
AD |
O |
No | ||
Contact Location |
01167 |
CTD |
004 |
11 |
60 |
CM |
O |
No | ||
Contact Phone Numbers |
01168 |
CTD |
005 |
11 |
20 |
TN |
O |
Yes | ||
Electronic Address |
01160 |
CTD |
006 |
11 |
60 |
CM |
O |
Yes | ||
Preferred Method of Contact |
01170 |
CTD |
007 |
11 |
200 |
CE |
O |
No |
0185 |
|
Contact Identifiers |
01171 |
CTD |
008 |
11 |
100 |
CM |
O |
Yes | ||
Allow Substitution Code |
00895 |
AIP |
010 |
10 |
10 |
IS |
C |
No |
0279 |
|
Role Instance ID |
01206 |
ROL |
001 |
12 |
60 |
EI |
R |
No | ||
Action Code |
00816 |
ROL |
002 |
12 |
2 |
ID |
R |
No |
0287 |
|
Role |
01197 |
ROL |
003 |
12 |
80 |
CE |
R |
No | ||
Role Person |
01198 |
ROL |
004 |
12 |
80 |
XCN |
R |
No | ||
Role Begin Date/Time |
01199 |
ROL |
005 |
12 |
26 |
TS |
O |
No | ||
Role End Date/Time |
01200 |
ROL |
006 |
12 |
26 |
TS |
O |
No | ||
Role Duration |
01201 |
ROL |
007 |
12 |
80 |
CE |
O |
No | ||
System Date/Time |
01172 |
NCK |
001 |
C |
26 |
TS |
R |
No | ||
Statistics Available |
01173 |
NST |
001 |
C |
1 |
ID |
R |
No |
0136 |
|
Source Identifier |
01174 |
NST |
002 |
C |
30 |
ST |
O |
No | ||
Source Type |
01175 |
NST |
003 |
C |
3 |
ID |
O |
No | ||
Statistics Start |
01176 |
NST |
004 |
C |
26 |
TS |
O |
No | ||
Statistics End |
01177 |
NST |
005 |
C |
26 |
TS |
O |
No | ||
Receive Character Count |
01178 |
NST |
006 |
C |
10 |
NM |
O |
No | ||
Send Character Count |
01179 |
NST |
007 |
C |
10 |
NM |
O |
No | ||
Messages Received |
01180 |
NST |
008 |
C |
10 |
NM |
O |
No | ||
Messages Sent |
01181 |
NST |
009 |
C |
10 |
NM |
O |
No | ||
Checksum Errors Received |
01182 |
NST |
010 |
C |
10 |
NM |
O |
No | ||
Length Errors Received |
01183 |
NST |
011 |
C |
10 |
NM |
O |
No | ||
Other Errors Received |
01184 |
NST |
012 |
C |
10 |
NM |
O |
No | ||
Connect Timeouts |
01185 |
NST |
013 |
C |
10 |
NM |
O |
No | ||
Receive Timeouts |
01186 |
NST |
014 |
C |
10 |
NM |
O |
No | ||
Network Errors |
01187 |
NST |
015 |
C |
10 |
NM |
O |
No | ||
Network Change Type |
01188 |
NSC |
001 |
C |
4 |
ID |
R |
No | ||
Current CPU |
01189 |
NSC |
002 |
C |
30 |
ST |
O |
No | ||
Current Fileserver |
01190 |
NSC |
003 |
C |
30 |
ST |
O |
No | ||
Current Application |
01191 |
NSC |
004 |
C |
30 |
ST |
O |
No | ||
Current Facility |
01192 |
NSC |
005 |
C |
30 |
ST |
O |
No | ||
New CPU |
01193 |
NSC |
006 |
C |
30 |
ST |
O |
No | ||
New Fileserver |
01194 |
NSC |
007 |
C |
30 |
ST |
O |
No | ||
New Application |
01195 |
NSC |
008 |
C |
30 |
ST |
O |
No | ||
New Facility |
01196 |
NSC |
009 |
C |
30 |
ST |
O |
No | ||
Set ID - RGS |
01203 |
RGS |
001 |
10 |
4 |
SI |
R |
No | ||
Resource Group ID |
01204 |
RGS |
002 |
10 |
200 |
CE |
O |
No | ||
Filler Status Code |
00889 |
AIS |
009 |
10 |
200 |
CE |
C |
No |
0278 |
|
Filler Status Code |
00889 |
AIG |
013 |
10 |
200 |
CE |
C |
No |
0278 |
|
Filler Status Code |
00889 |
AIL |
011 |
10 |
200 |
CE |
C |
No |
0278 |
|
Filler Status Code |
00889 |
AIP |
011 |
10 |
200 |
CE |
C |
No |
0278 |
|
Role Assumption Reason |
01205 |
ROL |
008 |
12 |
80 |
CE |
O |
No | ||
Action Code |
00816 |
PTH |
001 |
12 |
2 |
ID |
R |
No |
0287 |
|
Pathway ID |
01207 |
PTH |
002 |
12 |
80 |
CE |
R |
No | ||
Pathway Instance ID |
01208 |
PTH |
003 |
12 |
60 |
EI |
R |
No | ||
Pathway Established Date/Time |
01209 |
PTH |
004 |
12 |
26 |
TS |
R |
No | ||
Pathway Lifecycle Status |
01210 |
PTH |
005 |
12 |
80 |
CE |
O |
No | ||
Change Pathway Lifecycle Status Date/Time |
01211 |
PTH |
006 |
12 |
26 |
TS |
C |
No | ||
Variance Instance ID |
01212 |
VAR |
001 |
12 |
60 |
EI |
R |
No | ||
Documented Date/Time |
01213 |
VAR |
002 |
12 |
26 |
TS |
R |
No | ||
Stated Variance Date/Time |
01214 |
VAR |
003 |
12 |
26 |
TS |
O |
No | ||
Variance Originator |
01215 |
VAR |
004 |
12 |
60 |
XCN |
O |
No | ||
Variance Classification |
01216 |
VAR |
005 |
12 |
60 |
CE |
O |
No | ||
Variance Description |
01217 |
VAR |
006 |
12 |
512 |
ST |
O |
No | ||
Procedure Code |
00393 |
FT1 |
025 |
6 |
80 |
CE |
O |
No |
0088 |
|
Confidential Indicator |
00767 |
DRG |
010 |
6 |
1 |
ID |
O |
No |
0136 |
|
Guarantor Employer's Organization Name |
01232 |
GT1 |
051 |
6 |
013 |
XON |
O |
Yes | ||
Handicap |
00753 |
GT1 |
052 |
6 |
2 |
IS |
O |
No |
0310 |
|
Job Status |
00752 |
GT1 |
053 |
6 |
2 |
IS |
O |
No |
0311 |
|
Guarantor Financial Class |
01231 |
GT1 |
054 |
6 |
? |
CM |
O |
No | ||
Insured's ID Number |
01230 |
IN1 |
049 |
6 |
? |
CX |
O |
No | ||
Visit Indicator |
01226 |
PV1 |
051 |
3 |
1 |
IS |
O |
No |
0326 |
|
Other Healthcare Provider |
01274 |
PV1 |
052 |
3 |
60 |
XCN |
O |
Yes |
0010 |
|
Requested Give Rate Amount |
01218 |
RXO |
021 |
4 |
6 |
ST |
O |
No | ||
Requested Give Rate Units |
01219 |
RXO |
022 |
4 |
60 |
CE |
O |
No | ||
Dispense Package Size |
01220 |
RXD |
022 |
4 |
20 |
NM |
O |
No | ||
Dispense Package Size Unit |
01221 |
RXD |
023 |
4 |
60 |
CE |
O |
No | ||
Dispense Package Method |
01222 |
RXD |
024 |
4 |
2 |
ID |
O |
No |
0321 |
|
Completion Status |
01223 |
RXA |
020 |
4 |
2 |
ID |
O |
No |
0322 |
Action Code |
01224 |
RXA |
021 |
4 |
2 |
ID |
O |
No |
0323 |
|
System Entry Date/Time |
01225 |
RXA |
022 |
4 |
26 |
TS |
O |
No | ||
Employment Status |
01276 |
STF |
020 |
8 |
2 |
ID |
O |
No |
0066 |
|
Additional Insured on Auto |
01275 |
STF |
021 |
8 |
1 |
ID |
O |
No |
0136 |
|
Driver's License - Staff |
00123 |
STF |
022 |
8 |
25 |
CM |
O |
No | ||
Copy Auto Ins |
01229 |
STF |
023 |
8 |
1 |
ID |
O |
No |
0136 |
|
Location Relationship ID |
01227 |
LRL |
004 |
8 |
80 |
CE |
R |
No |
0325 |
|
Location Relationship Value |
01228 |
LRL |
005 |
8 |
80 |
CM |
R |
No | ||
Report Type |
01233 |
PSH |
001 |
7 |
60 |
ST |
R |
No |
0 | |
Report Form Identifier |
01234 |
PSH |
002 |
7 |
60 |
ST |
O |
No |
0 | |
Report Date |
01235 |
PSH |
003 |
7 |
26 |
TS |
R |
No |
0 | |
Report Interval Start Date |
01236 |
PSH |
004 |
7 |
26 |
TS |
O |
No |
0 | |
Report Interval End Date |
01237 |
PSH |
005 |
7 |
26 |
TS |
O |
No |
0 | |
Quantity Manufactured |
01238 |
PSH |
006 |
7 |
12 |
CQ |
O |
No |
0 | |
Quantity Distributed |
01239 |
PSH |
007 |
7 |
12 |
CQ |
O |
No |
0 | |
Quantity Distributed Method |
01240 |
PSH |
008 |
7 |
1 |
ID |
O |
No |
0 |
0329 |
Quantity Distributed Comment |
01241 |
PSH |
009 |
7 |
600 |
FT |
O |
No |
0 | |
Quantity in Use |
01242 |
PSH |
010 |
7 |
12 |
CQ |
O |
No |
0 | |
Quantity in Use Method |
01243 |
PSH |
011 |
7 |
1 |
ID |
O |
No |
0 |
0329 |
Quantity in Use Comment |
01244 |
PSH |
012 |
7 |
600 |
FT |
O |
No |
0 | |
Number of Product Experience Reports Filed by Facility |
01245 |
PSH |
013 |
7 |
2 |
NM |
O |
Yes |
8 | |
Number of Product Experience Reports Filed by Distributor |
01246 |
PSH |
014 |
7 |
2 |
NM |
O |
Yes |
8 | |
Manufacturer/Distributor |
01247 |
PDC |
001 |
7 |
80 |
XON |
R |
No |
0 | |
Country |
01248 |
PDC |
002 |
7 |
60 |
CE |
R |
No |
0 | |
Brand Name |
01249 |
PDC |
003 |
7 |
60 |
ST |
R |
No |
0 | |
Device Family Name |
01250 |
PDC |
004 |
7 |
60 |
ST |
O |
No |
0 | |
Generic Name |
01251 |
PDC |
005 |
7 |
60 |
CE |
O |
No |
0 | |
Model Identifier |
01252 |
PDC |
006 |
7 |
60 |
ST |
O |
Yes |
0 | |
Catalogue Identifier |
01253 |
PDC |
007 |
7 |
60 |
ST |
O |
No |
0 | |
Other Identifier |
01254 |
PDC |
008 |
7 |
60 |
ST |
O |
Yes |
0 | |
Product Code |
01255 |
PDC |
009 |
7 |
60 |
CE |
O |
No |
0 | |
Marketing Basis |
01256 |
PDC |
010 |
7 |
4 |
ID |
O |
No |
0 |
0330 |
Marketing Approval Identifier |
01257 |
PDC |
011 |
7 |
60 |
ST |
O |
No |
0 | |
Labeled Shelf Life |
01258 |
PDC |
012 |
7 |
12 |
CQ |
O |
No |
0 | |
Expected Shelf Life |
01259 |
PDC |
013 |
7 |
12 |
CQ |
O |
No |
0 | |
Date First Marked |
01260 |
PDC |
014 |
7 |
26 |
TS |
O |
No |
0 | |
Date Last Marked |
01261 |
PDC |
015 |
7 |
26 |
TS |
O |
No |
0 | |
Facility ID |
01262 |
FAC |
001 |
7 |
20 |
EI |
R |
No |
0 | |
Facility Type |
01263 |
FAC |
002 |
7 |
1 |
ID |
O |
No |
0 |
0331 |
Facility Address |
01264 |
FAC |
003 |
7 |
200 |
XAD |
R |
No |
0 | |
Facility Telecommunication |
01265 |
FAC |
004 |
7 |
44 |
XTN |
R |
No |
0 | |
Contact Person |
01266 |
FAC |
005 |
7 |
60 |
XCN |
O |
Yes |
0 | |
Contact Title |
01267 |
FAC |
006 |
7 |
60 |
ST |
O |
Yes |
0 | |
Contact Address |
01268 |
FAC |
007 |
7 |
200 |
XAD |
O |
Yes |
0 | |
Contact Telecommunication |
01269 |
FAC |
008 |
7 |
44 |
XTN |
O |
Yes |
0 | |
Signature Authority |
01270 |
FAC |
009 |
7 |
60 |
XCN |
R |
No |
0 | |
Signature Authority Title |
01271 |
FAC |
010 |
7 |
60 |
ST |
O |
No |
0 | |
Signature Authority Address |
01272 |
FAC |
011 |
7 |
200 |
XAD |
O |
No |
0 | |
Signature Authority Telecommunication |
01273 |
FAC |
012 |
7 |
44 |
XTN |
O |
No |
0 |