False False False 0 0 1 False Patient query group Patient Query - Response group group dsdfs False YYYY MM DD HH mm SS (YYYY[MM[DD]] False YYYY MM DD DTM DateTime False YYYY MM DD HH mm SS .SSSS +/-ZZZZ Sequence ID Value 0 False False String Coded values for HL7 tables ID 0 False False String Coded Element Identifier -1 False False Composite ST Text -1 False False Composite ST Name of coding system -1 False False Composite ST Alternate Identifier -1 False False Composite ST Alternate Text -1 False False Composite ST Name of Coding System -1 False False Composite ST String Value 0 False False String Numeric Value 0 False False Double Time stamp Value -1 False False DateTime Time Stamp Coded value for user-defined tables Value 0 False False String Entity Identifier Entity Identifier -1 False False Composite ST Namespace ID -1 False False Composite IS Universal ID -1 False False Composite ST Universal ID Type -1 False False Composite ID MSH Event-Type Composite Event -1 False False Composite ID Type -1 False False Composite ID Processing Type Processing Type -1 False False Composite ID Processing Mode -1 False False Composite ID Extended composite ID with check digit ID -1 False False Composite ST Check Digit -1 False False Composite ST Code Identifying the check digit scheme employed -1 False False Composite ID Assigning Authority -1 False False Composite HD Identifier Type Code -1 False False Composite IS Assigning Facility -1 False False Composite HD Hierarchic Designator Namespace -1 False False Composite IS Universal ID -1 False False Composite ST Universal ID -1 False False Composite ID Extended person name Family Name -1 False False Composite ST Given Name -1 False False Composite ST Middle Initial or Name -1 False False Composite ST Suffix -1 False False Composite ST Prefix -1 False False Composite ST Degree -1 False False Composite ST Name Type Code -1 False False Composite ID Extended Address Street Address -1 False False Composite ST Other Designation -1 False False Composite ST City -1 False False Composite ST State or Province -1 False False Composite ST Zip or postal code -1 False False Composite ST Country -1 False False Composite ID Address type -1 False False Composite ID Other geographic designation -1 False False Composite ST Country/parish code -1 False False Composite IS Census Tract -1 False False Composite IS Extended telecommunications number Number -1 False False Composite ST Telecommunications use code -1 False False Composite ID Telecommunications equipment type -1 False False Composite ID Email Address -1 False False Composite ST Country Code -1 False False Composite NM Area/City Code -1 False False Composite NM Phone Number -1 False False Composite NM Extension -1 False False Composite NM Any Text -1 False False Composite ST Driver's License Number License Number -1 False False Composite ST Issuing province, country -1 False False Composite IS Expiration Date -1 False False Composite DT Date Value -1 False False DateTime Date Person location Point of Care -1 False False Composite IS Room -1 False False Composite IS Bed -1 False False Composite IS Facility -1 False False Composite HD Location Status -1 False False Composite IS Person Location Type -1 False False Composite IS Building -1 False False Composite IS Floor -1 False False Composite IS Location Description -1 False False Composite ST Extended composite ID number and name ID Number -1 False False Composite ST Family Name -1 False False Composite ST Given Name -1 False False Composite ST Middle Initial or Name -1 False False Composite ST Suffix -1 False False Composite ST Prefix -1 False False Composite ST Degree -1 False False Composite ST Source Table -1 False False Composite IS Assigning authority -1 False False Composite HD Name type code -1 False False Composite ID Identifier check digit -1 False False Composite ST Code identifying the check digit scheme employed -1 False False Composite ST Identifier type code -1 False False Composite IS Assigning Facility -1 False False Composite HD Financial class Financial class -1 False False Composite ID Effective date -1 False False Composite TS Composite - discouraged Field1 0 False False String Field2 0 False False String Field3 0 False False String Field4 0 False False String Field5 0 False False String Field6 0 False False String Timing/quantity Quantity -1 False False Composite CQ Interval -1 False False Composite ST Duration -1 False False Composite ST Start Date/time -1 False False Composite TS End Date/time -1 False False Composite TS Priority -1 False False Composite ID Condition -1 False False Composite ST Text -1 False False Composite TX Conjunction -1 False False Composite ID Order sequencing -1 False False Composite ST Composite Quantity with Units Quantity -1 False False Composite NM Units -1 False False Composite CE Text data Value 0 False False String Date/Time Value -1 False False DateTime DateTime Extended Composite Name and Identification Number for Organizations Organization Name 50 False False Composite ST Organization Name Type Code 20 False False Composite IS ID Number 4 False False Composite NM Identifier Check Digit 4 False False Composite NM Check Digit Scheme 3 False False Composite ID Assigning Authority 227 False False Composite HD Identifier Type Code 5 False False Composite ID Assigning Facility 227 False False Composite HD Name Representation Code 1 False False Composite ID Organization Identifier 20 False False Composite ST Encapsulated Data Source Application 1027 False False Composite HD Type of Data 11 True False Composite ID Data Subtype 32 False False Composite ID Encoding 6 True False Composite ID Data 65536 True False Composite TX Coded with Exceptions Identifier 20 False False Composite ST Text 199 False False Composite ST Name of Coding System 20 False False Composite ID Alternate Identifier 20 False False Composite ST Alternate Text 199 False False Composite ST Name of Alternate Coding System 20 False False Composite ID Coding System Version ID 10 False False Composite ST Alternate Coding System Version ID 10 False False Composite ST Original Text 199 False False Composite ST Value Range First Data Code Value 6 False False Composite ST Last Data Code Value 6 False False Composite ST Message Type Message Type 0 False False Composite ID Trigger Event 0 False False Composite ID Message Structure 0 False False Composite ID Version Identifier Version ID 0 False False Composite ID Internationalization Code 0 False False Composite CE International Version ID 0 False False Composite CE Error Segment ID 0 False False Composite ST Sequence 0 False False Composite NM Field Position 0 False False Composite NM Code Identifying Error 0 False False Composite CE Job Code/class Job Code 0 False False Composite IS Job Class 0 False False Composite IS Discharge Location Discharge Location 0 False False Composite IS Effective Date 0 False False Composite TS Composite Price Price 0 False False Composite MO Price Type 0 False False Composite ID From Value 0 False False Composite NM To Value 0 False False Composite NM Range Units 0 False False Composite CE Range Type 0 False False Composite ID Money Quantity 0 False False Composite NM Denomination 0 False False Composite ID Authorization Information Authorization Number 0 False False Composite ST Date 0 False False Composite TS Source 0 False False Composite ST Policy Type Policy Type 0 False False Composite IS Amount Class 0 False False Composite IS Amount 0 False False Composite NM Daily Deductible Delay Days 0 False False Composite NM Amount 0 False False Composite NM Number Of Days 0 False False Composite NM Room Coverage Room Type 0 False False Composite IS Amount Type 0 False False Composite IS Coverage Amount 0 False False Composite NM Penalty Penalty Type 0 False False Composite IS Penalty Amount 0 False False Composite NM Pre-certification Required Pre-certification Patient Type 0 False False Composite IS Pre-certification Required 0 False False Composite ID Pre-certification Window 0 False False Composite TS Day Type And Number Day Type 0 False False Composite IS Number Of Days 0 False False Composite NM Occurence Occurrence Code 0 False False Composite ID Occurrence Date 0 False False Composite DT Value Code And Amount Value Code 0 False False Composite IS Value Amount 0 False False Composite NM Occurence Span Occurrence Span Code 0 False False Composite CE Occurrence Span Start Date 0 False False Composite DT Occurrence Span Stop Date 0 False False Composite DT MSH Message Header True Field Separator 0 True 0 ST Encoding Characters 0 True 0 ST Sending Application 0 False 0 EI Sending Facility 0 False 0 EI Receiving Application 0 False 0 EI Receiving Facility 0 False 0 EI Date/Time of Message 0 False 0 TS Security 0 False 0 ST Message Type 0 True 0 CM_MSH Message Control ID 0 True 0 ST Processing ID 0 True 0 PT Version ID 0 True 0 ID Sequence Number 0 False 0 NM Continuation Pointer 0 False 0 ST Accept Acknowledgement Type 0 False 0 ID Application Acknowledgement Type 0 False 0 ID Country Code 0 False 0 ID Character Set 3 False 0 ID Principal Language of Message 0 False 0 CE MSA Message Acknowledgement True Acknowledgement Code 0 True 0 ID Message Control ID 0 True 0 ST Text Message 0 False 0 ST Expected Sequence Number 0 False 0 NM Delayed Acknowledgement Type 0 False 0 ID Error Condition 0 False 0 CE SFT Software Segment True Software Vendor Organization 0 True 567 XON Software Certified Version or Release Number 0 True 15 ST Software Product Name 0 True 20 ST Software Binary ID 0 True 20 ST Software Product Information 0 False 1024 TX Software Install Date 0 False 24 DTM UAC User Authentication Credential Segment True User Authentication Credential Type Code 0 True 705 CWE User Authentication Credential 0 True 65536 ED QRD Original-Style Query Definition True Query Date/Time 0 True 24 DTM Query Format Code 0 True 1 ID Query Priority 0 True 1 ID Query ID 0 True 10 ST Deferred Response Type 0 False 1 ID Deferred Response Date/Time 0 False 24 DTM Quantity Limited Request 0 True 10 CQ Who Subject Filter -1 True 250 XCN What Subject Filter -1 True 250 CWE What Department Data Code -1 True 250 CWE What Data Code Value Qual. -1 False 20 VR Query Results Level 0 False 1 ID QRF Original style query filter True Where Subject Filter -1 True 20 ST When Data Start Date/Time 0 False 0 DTM When Data End Date/Time 0 False 0 DTM What User Qualifier -1 False 60 ST Other QRY Subject Filter -1 False 60 ST Which Date/Time Qualifier -1 False 12 ID Which Date/Time Status Qualifier -1 False 12 ID Date/Time Selection Qualifier -1 False 12 ID When Quantity/Timing Qualifier 0 False 0 TQ Search Confidence Threshold 0 False 10 NM MSH Message Header Segment True Field Separator 0 True 0 ST Encoding Characters 0 True 0 ST Sending Application 0 False 0 HD Sending Facility 0 False 0 HD Receiving Application 0 False 0 HD Receiving Facility 0 False 0 HD Date/time Of Message 0 False 0 TS Security 0 False 0 ST Message Type 0 True 0 MSG Message Control ID 0 True 0 ST Processing ID 0 True 0 PT Version ID 0 True 0 VID Sequence Number 0 False 0 NM Continuation Pointer 0 False 0 ST Accept Acknowledgment Type 0 False 0 ID Application Acknowledgment Type 0 False 0 ID Country Code 0 False 0 ID Character Set 0 False 0 ID Principal Language Of Message 0 False 0 CE Alternate Character Set Handling Scheme 0 False 0 ID MSA Message Acknowledgment Segment True Acknowledgment Code 0 True 0 ID Message Control ID 0 True 0 ST Text Message 0 False 0 ST Expected Sequence Number 0 False 0 NM Delayed Acknowledgment Type 0 False 0 ID Error Condition 0 False 0 CE ERR Error Segment True Error Code And Location 0 True 0 ELD QAK Query Acknowledgement True Query Tag 0 False 0 ST Query Response Status 0 False 0 ID QRD Original-style Query Definition Segment True Query Date/time 0 True 0 TS Query Format Code 0 True 0 ID Query Priority 0 True 0 ID Query ID 0 True 0 ST Deferred Response Type 0 False 0 ID Deferred Response Date/time 0 False 0 TS Quantity Limited Request 0 True 0 CQ Who Subject Filter 0 True 0 XCN What Subject Filter 0 True 0 CE What Department Data Code 0 True 0 CE What Data Code Value Qual. 0 False 0 VR Query Results Level 0 False 0 ID QRF Original Style Query Filter Segment True Where Subject Filter 0 True 0 ST When Data Start Date/time 0 False 0 TS When Data End Date/time 0 False 0 TS What User Qualifier 0 False 0 ST Other Qry Subject Filter 0 False 0 ST Which Date/time Qualifier 0 False 0 ID Which Date/time Status Qualifier 0 False 0 ID Date/time Selection Qualifier 0 False 0 ID When Quantity/timing Qualifier 0 False 0 TQ EVN Event Type Segment True Event Type Code 0 False 0 ID Recorded Date/time 0 True 0 TS Date/time Planned Event 0 False 0 TS Event Reason Code 0 False 0 IS Operator ID 0 False 0 XCN Event Occurred 0 False 0 TS PID Patient Identification Segment True Set ID - Pid 0 False 0 SI Patient ID 0 False 0 CX Patient Identifier List 0 True 0 CX Alternate Patient ID - Pid 0 False 0 CX Patient Name 0 True 0 XPN Mother’s Maiden Name 0 False 0 XPN Date/time Of Birth 0 False 0 TS Sex 0 False 0 IS Patient Alias 0 False 0 XPN Race 0 False 0 CE Patient Address 0 False 0 XAD County Code 0 False 0 IS Phone Number - Home 0 False 0 XTN Phone Number - Business 0 False 0 XTN Primary Language 0 False 0 CE Marital Status 0 False 0 CE Religion 0 False 0 CE Patient Account Number 0 False 0 CX Ssn Number - Patient 0 False 0 ST Driver's License Number - Patient 0 False 0 DLN Mother's Identifier 0 False 0 CX Ethnic Group 0 False 0 CE Birth Place 0 False 0 ST Multiple Birth Indicator 0 False 0 ID Birth Order 0 False 0 NM Citizenship 0 False 0 CE Veterans Military Status 0 False 0 CE Nationality 0 False 0 CE Patient Death Date And Time 0 False 0 TS Patient Death Indicator 0 False 0 ID PD1 Patient Additional Demographic Segment True Living Dependency 0 False 0 IS Living Arrangement 0 False 0 IS Patient Primary Facility 0 False 0 XON Patient Primary Care Provider Name & ID No. 0 False 0 XCN Student Indicator 0 False 0 IS Handicap 0 False 0 IS Living Will 0 False 0 IS Organ Donor 0 False 0 IS Separate Bill 0 False 0 ID Duplicate Patient 0 False 0 CX Publicity Code 0 False 0 CE Protection Indicator 0 False 0 ID NK1 Next Of Kin / Associated Parties Segment- True Set ID - Nk1 0 True 0 SI Name 0 False 0 XPN Relationship 0 False 0 CE Address 0 False 0 XAD Phone Number 0 False 0 XTN Business Phone Number 0 False 0 XTN Contact Role 0 False 0 CE Start Date 0 False 0 DT End Date 0 False 0 DT Next Of Kin / Associated Parties Job Title 0 False 0 ST Next Of Kin / Associated Parties Job Code/class 0 False 0 JCC Next Of Kin / Associated Parties Employee Number 0 False 0 CX Organization Name - Nk1 0 False 0 XON Marital Status 0 False 0 CE Sex 0 False 0 IS Date/time Of Birth 0 False 0 TS Living Dependency 0 False 0 IS Ambulatory Status 0 False 0 IS Citizenship 0 False 0 CE Primary Language 0 False 0 CE Living Arrangement 0 False 0 IS Publicity Code 0 False 0 CE Protection Indicator 0 False 0 ID Student Indicator 0 False 0 IS Religion 0 False 0 CE Mother’s Maiden Name 0 False 0 XPN Nationality 0 False 0 CE Ethnic Group 0 False 0 CE Contact Reason 0 False 0 CE Contact Person’s Name 0 False 0 XPN Contact Person’s Telephone Number 0 False 0 XTN Contact Person’s Address 0 False 0 XAD Next Of Kin/associated Party’s Identifiers 0 False 0 CX Job Status 0 False 0 IS Race 0 False 0 CE Handicap 0 False 0 IS Contact Person Social Security Number 0 False 0 ST PV1 Patient Visit Segment- True Set ID - Pv1 0 False 0 SI Patient Class 0 True 0 IS Assigned Patient Location 0 False 0 PL Admission Type 0 False 0 IS Preadmit Number 0 False 0 CX Prior Patient Location 0 False 0 PL Attending Doctor 0 False 0 XCN Referring Doctor 0 False 0 XCN Consulting Doctor 0 False 0 XCN Hospital Service 0 False 0 IS Temporary Location 0 False 0 PL Preadmit Test Indicator 0 False 0 IS Re-admission Indicator 0 False 0 IS Admit Source 0 False 0 IS Ambulatory Status 0 False 0 IS Vip Indicator 0 False 0 IS Admitting Doctor 0 False 0 XCN Patient Type 0 False 0 IS Visit Number 0 False 0 CX Financial Class 0 False 0 FC Charge Price Indicator 0 False 0 IS Courtesy Code 0 False 0 IS Credit Rating 0 False 0 IS Contract Code 0 False 0 IS Contract Effective Date 0 False 0 DT Contract Amount 0 False 0 NM Contract Period 0 False 0 NM Interest Code 0 False 0 IS Transfer To Bad Debt Code 0 False 0 IS Transfer To Bad Debt Date 0 False 0 DT Bad Debt Agency Code 0 False 0 IS Bad Debt Transfer Amount 0 False 0 NM Bad Debt Recovery Amount 0 False 0 NM Delete Account Indicator 0 False 0 IS Delete Account Date 0 False 0 DT Discharge Disposition 0 False 0 IS Discharged To Location 0 False 0 DLD Diet Type 0 False 0 CE Servicing Facility 0 False 0 IS Bed Status 0 False 0 IS Account Status 0 False 0 IS Pending Location 0 False 0 PL Prior Temporary Location 0 False 0 PL Admit Date/time 0 False 0 TS Discharge Date/time 0 False 0 TS Current Patient Balance 0 False 0 NM Total Charges 0 False 0 NM Total Adjustments 0 False 0 NM Total Payments 0 False 0 NM Alternate Visit ID 0 False 0 CX Visit Indicator 0 False 0 IS Other Healthcare Provider 0 False 0 XCN PV2 Patient Visit - Additional Information Segment True Prior Pending Location 0 False 0 PL Accommodation Code 0 False 0 CE Admit Reason 0 False 0 CE Transfer Reason 0 False 0 CE Patient Valuables 0 False 0 ST Patient Valuables Location 0 False 0 ST Visit User Code 0 False 0 IS Expected Admit Date/time 0 False 0 TS Expected Discharge Date/time 0 False 0 TS Estimated Length Of Inpatient Stay 0 False 0 NM Actual Length Of Inpatient Stay 0 False 0 NM Visit Description 0 False 0 ST Referral Source Code 0 False 0 XCN Previous Service Date 0 False 0 DT Employment Illness Related Indicator 0 False 0 ID Purge Status Code 0 False 0 IS Purge Status Date 0 False 0 DT Special Program Code 0 False 0 IS Retention Indicator 0 False 0 ID Expected Number Of Insurance Plans 0 False 0 NM Visit Publicity Code 0 False 0 IS Visit Protection Indicator 0 False 0 ID Clinic Organization Name 0 False 0 XON Patient Status Code 0 False 0 IS Visit Priority Code 0 False 0 IS Previous Treatment Date 0 False 0 DT Expected Discharge Disposition 0 False 0 IS Signature On File Date 0 False 0 DT First Similar Illness Date 0 False 0 DT Patient Charge Adjustment Code 0 False 0 CE Recurring Service Code 0 False 0 IS Billing Media Code 0 False 0 ID Expected Surgery Date & Time 0 False 0 TS Military Partnership Code 0 False 0 ID Military Non-availability Code 0 False 0 ID Newborn Baby Indicator 0 False 0 ID Baby Detained Indicator 0 False 0 ID DB1 Disability Segment True Set ID - Db1 0 True 0 SI Disabled Person Code 0 False 0 IS Disabled Person Identifier 0 False 0 CX Disabled Indicator 0 False 0 ID Disability Start Date 0 False 0 DT Disability End Date 0 False 0 DT Disability Return To Work Date 0 False 0 DT Disability Unable To Work Date 0 False 0 DT OBX Observation/result Segment True Set ID - Obx 0 False 0 SI Value Type 0 True 0 ID Observation Identifier 0 True 0 CE Observation Sub-id 0 True 0 ST Observation Value 0 False 0 ST Units 0 False 0 CE References Range 0 False 0 ST Abnormal Flags 0 False 0 ID Probability 0 False 0 NM Nature Of Abnormal Test 0 False 0 ID Observation Result Status 0 True 0 ID Date Last Obs Normal Values 0 False 0 TS User Defined Access Checks 0 False 0 ST Date/time Of The Observation 0 False 0 TS Producer's ID 0 False 0 CE Responsible Observer 0 False 0 XCN Observation Method 0 False 0 CE AL1 Patient Allergy Information Segment True Set ID - Al1 0 True 0 SI Allergy Type 0 False 0 IS Allergy Code/mnemonic/description 0 True 0 CE Allergy Severity 0 False 0 IS Allergy Reaction 0 False 0 ST Identification Date 0 False 0 DT DG1 Diagnosis Segment True Set ID - Dg1 0 True 0 SI Diagnosis Coding Method 0 False 0 ID Diagnosis Code - Dg1 0 False 0 CE Diagnosis Description 0 False 0 ST Diagnosis Date/time 0 False 0 TS Diagnosis Type 0 True 0 IS Major Diagnostic Category 0 False 0 CE Diagnostic Related Group 0 False 0 CE Drg Approval Indicator 0 False 0 ID Drg Grouper Review Code 0 False 0 IS Outlier Type 0 False 0 CE Outlier Days 0 False 0 NM Outlier Cost 0 False 0 CP Grouper Version And Type 0 False 0 ST Diagnosis Priority 0 False 0 ID Diagnosing Clinician 0 False 0 XCN Diagnosis Classification 0 False 0 IS Confidential Indicator 0 False 0 ID Attestation Date/time 0 False 0 TS DRG Diagnosis Related Group Segment True Diagnostic Related Group 0 False 0 CE Drg Assigned Date/time 0 False 0 TS Drg Approval Indicator 0 False 0 ID Drg Grouper Review Code 0 False 0 IS Outlier Type 0 False 0 CE Outlier Days 0 False 0 NM Outlier Cost 0 False 0 CP Drg Payor 0 False 0 IS Outlier Reimbursement 0 False 0 CP Confidential Indicator 0 False 0 ID PR1 Procedures Segment True Set ID - Pr1 0 True 0 SI Procedure Coding Method 0 False 0 IS Procedure Code 0 True 0 CE Procedure Description 0 False 0 ST Procedure Date/time 0 True 0 TS Procedure Functional Type 0 True 0 IS Procedure Minutes 0 False 0 NM Anesthesiologist 0 False 0 XCN Anesthesia Code 0 False 0 IS Anesthesia Minutes 0 False 0 NM Surgeon 0 False 0 XCN Procedure Practitioner 0 False 0 XCN Consent Code 0 False 0 CE Procedure Priority 0 False 0 NM Associated Diagnosis Code 0 False 0 CE Procedure Code Modifier 0 False 0 CE ROL Role True Role Instance ID 0 True 0 EI Action Code 0 True 0 ID Role-rol 0 True 0 CE Role Person 0 True 0 XCN Role Begin Date/time 0 False 0 TS Role End Date/time 0 False 0 TS Role Duration 0 False 0 CE Role Action Reason 0 False 0 CE GT1 Guarantor Segment True Set ID - Gt1 0 True 0 SI Guarantor Number 0 False 0 CX Guarantor Name 0 True 0 XPN Guarantor Spouse Name 0 False 0 XPN Guarantor Address 0 False 0 XAD Guarantor Ph Num-home 0 False 0 XTN Guarantor Ph Num-business 0 False 0 XTN Guarantor Date/time Of Birth 0 False 0 TS Guarantor Sex 0 False 0 IS Guarantor Type 0 False 0 IS Guarantor Relationship 0 False 0 CE Guarantor Ssn 0 False 0 ST Guarantor Date - Begin 0 False 0 DT Guarantor Date - End 0 False 0 DT Guarantor Priority 0 False 0 NM Guarantor Employer Name 0 False 0 XPN Guarantor Employer Address 0 False 0 XAD Guarantor Employer Phone Number 0 False 0 XTN Guarantor Employee ID Number 0 False 0 CX Guarantor Employment Status 0 False 0 IS Guarantor Organization Name 0 False 0 XON Guarantor Billing Hold Flag 0 False 0 ID Guarantor Credit Rating Code 0 False 0 CE Guarantor Death Date And Time 0 False 0 TS Guarantor Death Flag 0 False 0 ID Guarantor Charge Adjustment Code 0 False 0 CE Guarantor Household Annual Income 0 False 0 CP Guarantor Household Size 0 False 0 NM Guarantor Employer ID Number 0 False 0 CX Guarantor Marital Status Code 0 False 0 CE Guarantor Hire Effective Date 0 False 0 DT Employment Stop Date 0 False 0 DT Living Dependency 0 False 0 IS Ambulatory Status 0 False 0 IS Citizenship 0 False 0 CE Primary Language 0 False 0 CE Living Arrangement 0 False 0 IS Publicity Code 0 False 0 CE Protection Indicator 0 False 0 ID Student Indicator 0 False 0 IS Religion 0 False 0 CE Mother’s Maiden Name 0 False 0 XPN Nationality 0 False 0 CE Ethnic Group 0 False 0 CE Contact Person’s Name 0 False 0 XPN Contact Person’s Telephone Number 0 False 0 XTN Contact Reason 0 False 0 CE Contact Relationship 0 False 0 IS Job Title 0 False 0 ST Job Code/class 0 False 0 JCC Guarantor Employer’s Organization Name 0 False 0 XON Handicap 0 False 0 IS Job Status 0 False 0 IS Guarantor Financial Class 0 False 0 FC Guarantor Race 0 False 0 CE IN1 Insurance Segment True Set ID - In1 0 True 0 SI Insurance Plan ID 0 True 0 CE Insurance Company ID 0 True 0 CX Insurance Company Name 0 False 0 XON Insurance Company Address 0 False 0 XAD Insurance Co Contact Person 0 False 0 XPN Insurance Co Phone Number 0 False 0 XTN Group Number 0 False 0 ST Group Name 0 False 0 XON Insured’s Group Emp ID 0 False 0 CX Insured’s Group Emp Name 0 False 0 XON Plan Effective Date 0 False 0 DT Plan Expiration Date 0 False 0 DT Authorization Information 0 False 0 AUI Plan Type 0 False 0 IS Name Of Insured 0 False 0 XPN Insured’s Relationship To Patient 0 False 0 CE Insured’s Date Of Birth 0 False 0 TS Insured’s Address 0 False 0 XAD Assignment Of Benefits 0 False 0 IS Coordination Of Benefits 0 False 0 IS Coord Of Ben. Priority 0 False 0 ST Notice Of Admission Flag 0 False 0 ID Notice Of Admission Date 0 False 0 DT Report Of Eligibility Flag 0 False 0 ID Report Of Eligibility Date 0 False 0 DT Release Information Code 0 False 0 IS Pre-admit Cert (pac) 0 False 0 ST Verification Date/time 0 False 0 TS Verification By 0 False 0 XCN Type Of Agreement Code 0 False 0 IS Billing Status 0 False 0 IS Lifetime Reserve Days 0 False 0 NM Delay Before L.r. Day 0 False 0 NM Company Plan Code 0 False 0 IS Policy Number 0 False 0 ST Policy Deductible 0 False 0 CP Policy Limit - Amount 0 False 0 CP Policy Limit - Days 0 False 0 NM Room Rate - Semi-private 0 False 0 CP Room Rate - Private 0 False 0 CP Insured’s Employment Status 0 False 0 CE Insured’s Sex 0 False 0 IS Insured’s Employer’s Address 0 False 0 XAD Verification Status 0 False 0 ST Prior Insurance Plan ID 0 False 0 IS Coverage Type 0 False 0 IS Handicap 0 False 0 IS Insured’s ID Number 0 False 0 CX IN2 Insurance Additional Information Segment True Insured’s Employee ID 0 False 0 CX Insured’s Social Security Number 0 False 0 ST Insured’s Employer’s Name And ID 0 False 0 XCN Employer Information Data 0 False 0 IS Mail Claim Party 0 False 0 IS Medicare Health Ins Card Number 0 False 0 ST Medicaid Case Name 0 False 0 XPN Medicaid Case Number 0 False 0 ST Military Sponsor Name 0 False 0 XPN Military ID Number 0 False 0 ST Dependent Of Military Recipient 0 False 0 CE Military Organization 0 False 0 ST Military Station 0 False 0 ST Military Service 0 False 0 IS Military Rank/grade 0 False 0 IS Military Status 0 False 0 IS Military Retire Date 0 False 0 DT Military Non-avail Cert On File 0 False 0 ID Baby Coverage 0 False 0 ID Combine Baby Bill 0 False 0 ID Blood Deductible 0 False 0 ST Special Coverage Approval Name 0 False 0 XPN Special Coverage Approval Title 0 False 0 ST Non-covered Insurance Code 0 False 0 IS Payor ID 0 False 0 CX Payor Subscriber ID 0 False 0 CX Eligibility Source 0 False 0 IS Room Coverage Type/amount 0 False 0 RMC Policy Type/amount 0 False 0 PTA Daily Deductible 0 False 0 DDI Living Dependency 0 False 0 IS Ambulatory Status 0 False 0 IS Citizenship 0 False 0 CE Primary Language 0 False 0 CE Living Arrangement 0 False 0 IS Publicity Code 0 False 0 CE Protection Indicator 0 False 0 ID Student Indicator 0 False 0 IS Religion 0 False 0 CE Mother’s Maiden Name 0 False 0 XPN Nationality 0 False 0 CE Ethnic Group 0 False 0 CE Marital Status 0 False 0 CE Insured’s Employment Start Date 0 False 0 DT Employment Stop Date 0 False 0 DT Job Title 0 False 0 ST Job Code/class 0 False 0 JCC Job Status 0 False 0 IS Employer Contact Person Name 0 False 0 XPN Employer Contact Person Phone Number 0 False 0 XTN Employer Contact Reason 0 False 0 IS Insured’s Contact Person’s Name 0 False 0 XPN Insured’s Contact Person Phone Number 0 False 0 XTN Insured’s Contact Person Reason 0 False 0 IS Relationship To The Patient Start Date 0 False 0 DT Relationship To The Patient Stop Date 0 False 0 DT Insurance Co. Contact Reason 0 False 0 IS Insurance Co Contact Phone Number 0 False 0 XTN Policy Scope 0 False 0 IS Policy Source 0 False 0 IS Patient Member Number 0 False 0 CX Guarantor’s Relationship To Insured 0 False 0 CE Insured’s Phone Number - Home 0 False 0 XTN Insured’s Employer Phone Number 0 False 0 XTN Military Handicapped Program 0 False 0 CE Suspend Flag 0 False 0 ID Copay Limit Flag 0 False 0 ID Stoploss Limit Flag 0 False 0 ID Insured Organization Name And ID 0 False 0 XON Insured Employer Organization Name And ID 0 False 0 XON Race 0 False 0 CE Hcfa Patient’s Relationship To Insured 0 False 0 CE IN3 Insurance Additional Information, Certification Segment True Set ID - In3 0 True 0 SI Certification Number 0 False 0 CX Certified By 0 False 0 XCN Certification Required 0 False 0 ID Penalty 0 False 0 PEN Certification Date/time 0 False 0 TS Certification Modify Date/time 0 False 0 TS Operator 0 False 0 XCN Certification Begin Date 0 False 0 DT Certification End Date 0 False 0 DT Days 0 False 0 DTN Non-concur Code/description 0 False 0 CE Non-concur Effective Date/time 0 False 0 TS Physician Reviewer 0 False 0 XCN Certification Contact 0 False 0 ST Certification Contact Phone Number 0 False 0 XTN Appeal Reason 0 False 0 CE Certification Agency 0 False 0 CE Certification Agency Phone Number 0 False 0 XTN Pre-certification Req/window 0 False 0 PCF Case Manager 0 False 0 ST Second Opinion Date 0 False 0 DT Second Opinion Status 0 False 0 IS Second Opinion Documentation Received 0 False 0 IS Second Opinion Physician 0 False 0 XCN ACC Accident Segment True Accident Date/time 0 False 0 TS Accident Code 0 False 0 CE Accident Location 0 False 0 ST Auto Accident State 0 False 0 CE Accident Job Related Indicator 0 False 0 ID Accident Death Indicator 0 False 0 ID UB1 Ub82 Data Segment True Set ID - Ub1 0 False 0 SI Blood Deductible (43) 0 False 0 NM Blood Furnished-pints Of (40) 0 False 0 NM Blood Replaced-pints (41) 0 False 0 NM Blood Not Replaced-pints(42) 0 False 0 NM Co-insurance Days (25) 0 False 0 NM Condition Code (35-39) 0 False 0 IS Covered Days - (23) 0 False 0 NM Non Covered Days - (24) 0 False 0 NM Value Amount & Code (46-49) 0 False 0 UVC Number Of Grace Days (90) 0 False 0 NM Special Program Indicator (44) 0 False 0 CE Psro/ur Approval Indicator (87) 0 False 0 CE Psro/ur Approved Stay-fm (88) 0 False 0 DT Psro/ur Approved Stay-to (89) 0 False 0 DT Occurrence (28-32) 0 False 0 OCD Occurrence Span (33) 0 False 0 CE Occur Span Start Date(33) 0 False 0 DT Occur Span End Date (33) 0 False 0 DT Ub-82 Locator 2 0 False 0 ST Ub-82 Locator 9 0 False 0 ST Ub-82 Locator 27 0 False 0 ST Ub-82 Locator 45 0 False 0 ST UB2 Ub92 Data Segment True Set ID - Ub2 0 False 0 SI Co-insurance Days (9) 0 False 0 ST Condition Code (24-30) 0 False 0 IS Covered Days (7) 0 False 0 ST Non-covered Days (8) 0 False 0 ST Value Amount & Code 0 False 0 UVC Occurrence Code & Date (32-35) 0 False 0 OCD Occurrence Span Code/dates (36) 0 False 0 OSP Ub92 Locator 2 (state) 0 False 0 ST Ub92 Locator 11 (state) 0 False 0 ST Ub92 Locator 31 (national) 0 False 0 ST Document Control Number 0 False 0 ST Ub92 Locator 49 (national) 0 False 0 ST Ub92 Locator 56 (state) 0 False 0 ST Ub92 Locator 57 (national) 0 False 0 ST Ub92 Locator 78 (state) 0 False 0 ST Special Visit Count 0 False 0 NM DSC Continuation Pointer Segment True Continuation Pointer 0 False 0 ST True False Message False False False 0 group MSH False False False 0 segment 0 SFT True True False 0 segment 2 UAC True False False 0 segment 3 QRD False False False 0 segment 4 QRF True False False 0 segment 5 MSH QRY 8 0 0 0 MSH A19 8 0 1 0 group -1 0 True False Message False False False 0 group MSH False False False 0 segment 6 MSA False False False 0 segment 7 ERR True False False 0 segment 8 QAK True False False 0 segment 9 QRD False False False 0 segment 10 QRF True False False 0 segment 11 Group1 False True False 0 group EVN True False False 0 segment 12 PID False False False 0 segment 13 PD1 True False False 0 segment 14 NK1 True True False 0 segment 15 PV1 False False False 0 segment 16 PV2 True False False 0 segment 17 DB1 True True False 0 segment 18 OBX True True False 0 segment 19 AL1 True True False 0 segment 20 DG1 True True False 0 segment 21 DRG True False False 0 segment 22 Group2 True True False 0 group PR1 False False False 0 segment 23 ROL True True False 0 segment 24 GT1 True True False 0 segment 25 Group3 True True False 0 group IN1 False False False 0 segment 26 IN2 True False False 0 segment 27 IN3 True True False 0 segment 28 ACC True False False 0 segment 29 UB1 True False False 0 segment 30 UB2 True False False 0 segment 31 DSC True False False 0 segment 32 MSH ADR 8 0 0 0 MSH A19 8 0 1 0 group -1 0 True False Message False False False 0 group MSH False False False 0 segment 0 group -1 0 0 48 92 69 6 HL7 True True 32 255 HL7 False 46 STANDARD VER 2 False True 3 False 2 False True MSH True 2 13 0 0 0 -1 -1 124 126 70 82 3 5 94 0 83 0 4 -1 38 0 84 0 7 -1 False False