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
Motherâs 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
Motherâs Maiden Name
0
False
0
XPN
Nationality
0
False
0
CE
Ethnic Group
0
False
0
CE
Contact Reason
0
False
0
CE
Contact Personâs Name
0
False
0
XPN
Contact Personâs Telephone Number
0
False
0
XTN
Contact Personâs Address
0
False
0
XAD
Next Of Kin/associated Partyâs 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
Motherâs Maiden Name
0
False
0
XPN
Nationality
0
False
0
CE
Ethnic Group
0
False
0
CE
Contact Personâs Name
0
False
0
XPN
Contact Personâs 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 Employerâs 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
Insuredâs Group Emp ID
0
False
0
CX
Insuredâs 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
Insuredâs Relationship To Patient
0
False
0
CE
Insuredâs Date Of Birth
0
False
0
TS
Insuredâs 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
Insuredâs Employment Status
0
False
0
CE
Insuredâs Sex
0
False
0
IS
Insuredâs Employerâs 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
Insuredâs ID Number
0
False
0
CX
IN2
Insurance Additional Information Segment
True
Insuredâs Employee ID
0
False
0
CX
Insuredâs Social Security Number
0
False
0
ST
Insuredâs Employerâs 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
Motherâs Maiden Name
0
False
0
XPN
Nationality
0
False
0
CE
Ethnic Group
0
False
0
CE
Marital Status
0
False
0
CE
Insuredâs 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
Insuredâs Contact Personâs Name
0
False
0
XPN
Insuredâs Contact Person Phone Number
0
False
0
XTN
Insuredâs 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
Guarantorâs Relationship To Insured
0
False
0
CE
Insuredâs Phone Number - Home
0
False
0
XTN
Insuredâs 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 Patientâs 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