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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

Mother’s 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 Person’s Name

00748

NK1

030

3

48

XPN

O

Yes



Contact Person’s Telephone Number

00749

NK1

031

3

40

XTN

O

Yes



Contact Person’s Address

00750

NK1

032

3

106

XAD

O

Yes



Associated Party’s 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

Mother’s 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 Person’s 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

Mother’s 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

Insured’s Contact Person’s Name

00792

IN2

052

6

48

XPN

O

Yes



Insured’s Contact Person Telephone Number

00793

IN2

053

6

40

XTN

O

Yes



Insured’s 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



Guarantor’s Relationship To Insured

00802

IN2

062

6

2

IS

O

No


0063

Insured’s Telephone Number - Home

00803

IN2

063

6

40

XTN

O

Yes



Insured’s 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



Collector’s 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 Observer’s 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 Observer’s 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


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