Vaccines & Immunizations

 IIS: HL7 Local Business Rule Template

   HL7 2.5.1, release 1.3 - VXU_V04 template [XLS-949 KB/2 pages]

Note: This spreadsheet is designed to track local IIS business rules applied during an HL7 2.5.1 VXU transmission. The related "VXU_V04 Detail" tab has mapped out the entire VXU profile provided in the CDC Implementation Guide. It is not anticipated that your IIS will support all of these segments and fields. Many of the fields have been listed as "Optional" or "Not supported" but have been included for completeness. Components and sub-components have also been included for further detail.
The purpose of this spreadsheet is to quickly and accurately identify where your IIS further constrains the CDC IG and what the local business rules are on a given field. This spreadsheet is likely better viewed electronically rather than as printed media based on its size and the use of Excel filters.

Order id Segment Seq Name Type DT Len CDC usage Local usage Local usage constraint CDC card Local card Local card constraint Tbl Fixed value Expected value Predicate 1001 MSH 1 Field Separator F ST 1 R R No [1 .. 1] [1 .. 1] No True   | 1002 MSH 2 Encoding Characters F ST 4 R R No [1 .. 1] [1 .. 1] No True   ^~\& 1003 MSH 3 Sending Application F HD 227 RE RE No [0 .. 1] [0 .. 1] No 0361 1004 MSH 3.1 Namespace ID C IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 1005 MSH 3.2 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No If namespace id is empty, then this field shall be populated with an OID 1006 MSH 3.3 Universal ID Type C ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 If universal id is populated, then this field shall be populated with ISO. 1007 MSH 4 Sending Facility F HD 227 RE RE No [0 .. 1] [0 .. 1] No 0362 1008 MSH 4.1 Namespace ID C IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 1009 MSH 4.2 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If namespace id is empty, then this field shall be populated with an OID. 1010 MSH 4.3 Universal ID Type C ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 1011 MSH 5 Receiving Application F HD 227 RE RE No [0 .. 1] [0 .. 1] No 0361 1012 MSH 5.1 Namespace ID C IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 1013 MSH 5.2 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If namespace id is empty then this field shall be populated with an OID. 1014 MSH 5.3 Universal ID Type C ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 1015 MSH 6 Receiving Facility F HD 227 RE RE No [0 .. 1] [0 .. 1] No 0362 1016 MSH 6.1 Namespace ID C IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 1017 MSH 6.2 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If namespace id is null then this field shall be populated with an OID. 1018 MSH 6.3 Universal ID Type C ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 1019 MSH 7 Date/Time Of Message F TS 26 R R No [1 .. 1] [1 .. 1] No 1020 MSH 7.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 1021 MSH 7.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No   0529 1022 MSH 8 Security F ST 40 O O No [0 .. 1] [0 .. 1] No 1023 MSH 9 Message Type F MSG 15 R R No [1 .. 1] [1 .. 1] No 1024 MSH 9.1 Message Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0076 True   VXU 1025 MSH 9.2 Trigger Event C ID 3 R R No [1 .. 1] [1 .. 1] No 0003 True   V04 1026 MSH 9.3 Message Structure C ID 7 R R No [1 .. 1] [1 .. 1] No 0354 True   VXU_V04 1027 MSH 10 Message Control ID F ST 20 R R No [1 .. 1] [1 .. 1] No 1028 MSH 11 Processing ID F PT 3 R R No [1 .. 1] [1 .. 1] No 1029 MSH 11.1 Processing ID C ID 1 R R No [1 .. 1] [1 .. 1] No 0103   P 1030 MSH 11.2 Processing Mode C ID 1 X X No [0 .. 0] [0 .. 0] No 0207 1031 MSH 12 Version ID F VID 973 R R No [1 .. 1] [1 .. 1] No 1032 MSH 12.1 Version ID C ID 5 R R No [1 .. 1] [1 .. 1] No 0104   2.5.1 1033 MSH 12.2 Internationalization Code C CE 483 O O No [0 .. 1] [0 .. 1] No 0399 1034 MSH 12.2.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 1035 MSH 12.2.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 1036 MSH 12.2.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 1037 MSH 12.2.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 1038 MSH 12.2.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 1039 MSH 12.2.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 1040 MSH 12.3 International Version ID C CE 483 O O No [0 .. 1] [0 .. 1] No 1041 MSH 12.3.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 1042 MSH 12.3.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 1043 MSH 12.3.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 1044 MSH 12.3.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 1045 MSH 12.3.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 1046 MSH 12.3.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 1047 MSH 13 Sequence Number F NM 15 O O No [0 .. 1] [0 .. 1] No 1048 MSH 14 Continuation Pointer F ST 180 O O No [0 .. 1] [0 .. 1] No 1049 MSH 15 Accept Acknowledgment Type F ID 2 RE RE No [0 .. 1] [0 .. 1] No 0155   NE 1050 MSH 16 Application Acknowledgment Type F ID 2 RE RE No [0 .. 1] [0 .. 1] No 0155   AL 1051 MSH 17 Country Code F ID 3 O O No [0 .. 1] [0 .. 1] No 0399 1052 MSH 18 Character Set F ID 16 O O No [0 .. 1] [0 .. 1] No 0211 1053 MSH 19 Principal Language Of Message F CE 483 O O No [0 .. 1] [0 .. 1] No 1054 MSH 19.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 1055 MSH 19.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 1056 MSH 19.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 1057 MSH 19.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 1058 MSH 19.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 1059 MSH 19.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 1060 MSH 20 Alternate Character Set Handling Scheme F ID 20 O O No [0 .. 1] [0 .. 1] No 0356 1061 MSH 21 Message Profile Identifier F EI 427 O O No [0 .. *] [0 .. *] No 1062 MSH 21.1 Entity Identifier C ST 199 RE RE No [0 .. 1] [0 .. 1] No 1063 MSH 21.2 Namespace ID C IS 20 C C No [0 .. 1] [0 .. 1] No 0363 1064 MSH 21.3 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No 1065 MSH 21.4 Universal ID Type C ID 6 C C No [0 .. 1] [0 .. 1] No 0301 2001 SFT 1 Software Vendor Organization F XON 567 R R No [1 .. 1] [1 .. 1] No 2002 SFT 1.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 2003 SFT 1.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 2004 SFT 1.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 2005 SFT 1.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 2006 SFT 1.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 2007 SFT 1.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 2008 SFT 1.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 2009 SFT 1.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 2010 SFT 1.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 2011 SFT 1.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 2012 SFT 1.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 2013 SFT 1.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 2014 SFT 1.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 2015 SFT 1.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 2016 SFT 1.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 2017 SFT 1.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 2018 SFT 2 Software Certified Version or Release Number F ST 15 R R No [1 .. 1] [1 .. 1] No 2019 SFT 3 Software Product Name F ST 20 R R No [1 .. 1] [1 .. 1] No 2020 SFT 4 Software Binary ID F ST 20 R R No [1 .. 1] [1 .. 1] No 2021 SFT 5 Software Product Information F TX 1024 O O No [0 .. 1] [0 .. 1] No 2022 SFT 6 Software Install Date F TS 26 O O No [0 .. 1] [0 .. 1] No 2023 SFT 6.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 2024 SFT 6.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No   0529 3001 PID 1 Set ID - PID F SI 4 RE RE No [0 .. 1] [0 .. 1] No 3002 PID 2 Patient ID F CX 1913 X X No [0 .. 0] [0 .. 0] No 3003 PID 3 Patient Identifier List F CX 1913 R R No [1 .. *] [1 .. *] No 3004 PID 3.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 3005 PID 3.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 3006 PID 3.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 If check digit is populated, then this field shall be populated. 3007 PID 3.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 3008 PID 3.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3009 PID 3.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No   If namespace id is empty, then this field shall be populated with an OID. 3010 PID 3.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 3011 PID 3.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 3012 PID 3.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 3013 PID 3.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3014 PID 3.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3015 PID 3.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 3016 PID 3.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 3017 PID 3.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 3018 PID 3.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 3019 PID 3.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3020 PID 3.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3021 PID 3.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3022 PID 3.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3023 PID 3.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3024 PID 3.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3025 PID 3.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 3026 PID 3.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 3027 PID 3.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 3028 PID 3.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 3029 PID 3.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3030 PID 3.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3031 PID 3.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3032 PID 3.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3033 PID 3.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3034 PID 3.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3035 PID 3.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 3036 PID 3.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 3037 PID 3.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 3038 PID 4 Alternate Patient ID - PID F CX 1913 X X No [0 .. 0] [0 .. 0] No 3039 PID 5 Patient Name F XPN 1044 R R No [1 .. *] [1 .. *] No 3040 PID 5.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 3041 PID 5.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 3042 PID 5.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 3043 PID 5.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 3044 PID 5.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 3045 PID 5.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 3046 PID 5.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 3047 PID 5.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 3048 PID 5.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 3049 PID 5.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 3050 PID 5.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 3051 PID 5.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 3052 PID 5.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 3053 PID 5.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 3054 PID 5.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3055 PID 5.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3056 PID 5.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3057 PID 5.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3058 PID 5.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3059 PID 5.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3060 PID 5.1 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 3061 PID 5.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 3062 PID 5.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 3063 PID 5.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 3064 PID 5.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3065 PID 5.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 3066 PID 5.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 3067 PID 5.13.3 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3068 PID 5.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 3069 PID 6 Mother's Maiden Name F XPN 1044 RE RE No [0 .. 1] [0 .. 1] No 3070 PID 6.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 3071 PID 6.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 3072 PID 6.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 3073 PID 6.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 3074 PID 6.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 3075 PID 6.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 3076 PID 6.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 3077 PID 6.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 3078 PID 6.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 3079 PID 6.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 3080 PID 6.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 3081 PID 6.7 Name Type Code C ID 1 RE RE No [1 .. 1] [1 .. 1] No 0200 3082 PID 6.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 3083 PID 6.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 3084 PID 6.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3085 PID 6.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3086 PID 6.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3087 PID 6.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3088 PID 6.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3089 PID 6.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3090 PID 6.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 3091 PID 6.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 3092 PID 6.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 3093 PID 6.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 3094 PID 6.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3095 PID 6.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 3096 PID 6.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 3097 PID 6.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3098 PID 6.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 3099 PID 7 Date/Time of Birth F TS 26 R R No [1 .. 1] [1 .. 1] No 3100 PID 7.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 3101 PID 7.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3102 PID 8 Administrative Sex F IS 1 RE RE No [0 .. 1] [0 .. 1] No 0001 3103 PID 9 Patient Alias F XPN 1044 X X No [0 .. 0] [0 .. 0] No 3104 PID 10 Race F CE 483 RE RE No [0 .. *] [0 .. *] No 0005 3105 PID 10.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3106 PID 10.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If seq 1 is populated, then this field should be populated. 3107 PID 10.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396   If seq 1 is populated, then this field shall be populated. 3108 PID 10.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3109 PID 10.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If seq 4 is populated, then this field should be populated. 3110 PID 10.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396   If seq 4 is populated, then this field shall be populated. 3111 PID 11 Patient Address F XAD 578 RE RE No [0 .. *] [0 .. *] No 3112 PID 11.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No 3113 PID 11.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No 3114 PID 11.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No 3115 PID 11.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No 3116 PID 11.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No 3117 PID 11.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No 3118 PID 11.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No 3119 PID 11.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No 3120 PID 11.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399 3121 PID 11.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190 3122 PID 11.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No 3123 PID 11.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289 3124 PID 11.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288 3125 PID 11.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 3126 PID 11.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 3127 PID 11.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 3128 PID 11.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 3129 PID 11.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3130 PID 11.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 3131 PID 11.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 3132 PID 11.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3133 PID 12 County Code F IS 4 X X No [0 .. 0] [0 .. 0] No 0289 3134 PID 13 Phone Number - Home F XTN 651 RE RE No [0 .. *] [0 .. *] No 3135 PID 13.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 3136 PID 13.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 3137 PID 13.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 3138 PID 13.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If telecommunication type is NET, then this field should be populated. 3139 PID 13.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 3140 PID 13.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No   If telecommunication type code is not NET, then this field should be populated. 3141 PID 13.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No   If telecommunication type code is not NET, then this field should be populated. 3142 PID 13.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 3143 PID 13.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 3144 PID 13.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 3145 PID 13.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 3146 PID 13.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 3147 PID 14 Phone Number - Business F XTN 651 O O No [0 .. *] [0 .. *] No 3148 PID 14.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 3149 PID 14.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 3150 PID 14.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 3151 PID 14.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If telecommunication type code is NET, then this field should be populated. 3152 PID 14.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 3153 PID 14.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No   If telecommunication type code is not NET, then this field should be populated. 3154 PID 14.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No   If telecommunication type code is not NET, then this field should be populated. 3155 PID 14.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 3156 PID 14.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 3157 PID 14.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 3158 PID 14.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 3159 PID 14.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 3160 PID 15 Primary Language F CE 483 O O No [0 .. 1] [0 .. 1] No 0296 3161 PID 15.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3162 PID 15.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3163 PID 15.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3164 PID 15.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3165 PID 15.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3166 PID 15.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3167 PID 16 Marital Status F CE 483 O O No [0 .. 1] [0 .. 1] No 0002 3168 PID 16.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3169 PID 16.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3170 PID 16.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3171 PID 16.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3172 PID 16.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3173 PID 16.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3174 PID 17 Religion F CE 483 O O No [0 .. 1] [0 .. 1] No 0006 3175 PID 17.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3176 PID 17.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3177 PID 17.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3178 PID 17.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3179 PID 17.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3180 PID 17.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3181 PID 18 Patient Account Number F CX 1913 O O No [0 .. 1] [0 .. 1] No 3182 PID 18.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 3183 PID 18.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 3184 PID 18.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 3185 PID 18.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 3186 PID 18.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3187 PID 18.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3188 PID 18.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 3189 PID 18.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 3190 PID 18.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 3191 PID 18.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3192 PID 18.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3193 PID 18.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 3194 PID 18.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 3195 PID 18.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 3196 PID 18.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 3197 PID 18.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3198 PID 18.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3199 PID 18.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3200 PID 18.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3201 PID 18.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3202 PID 18.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3203 PID 18.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 3204 PID 18.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 3205 PID 18.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 3206 PID 18.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 3207 PID 18.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3208 PID 18.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3209 PID 18.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3210 PID 18.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3211 PID 18.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3212 PID 18.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3213 PID 18.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 3214 PID 18.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 3215 PID 18.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 3216 PID 19 SSN Number - Patient F ST 16 X X No [0 .. 0] [0 .. 0] No 3217 PID 20 Driver's License Number - Patient F DLN 66 X X No [0 .. 0] [0 .. 0] No 3218 PID 21 Mother's Identifier F CX 1913 X X No [0 .. 0] [0 .. 0] No 3219 PID 21.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 3220 PID 21.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 3221 PID 21.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 3222 PID 21.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 3223 PID 21.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3224 PID 21.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3225 PID 21.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 3226 PID 21.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 3227 PID 21.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 3228 PID 21.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3229 PID 21.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3230 PID 21.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 3231 PID 21.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 3232 PID 21.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 3233 PID 21.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 3234 PID 21.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3235 PID 21.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3236 PID 21.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3237 PID 21.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3238 PID 21.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3239 PID 21.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3240 PID 21.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 3241 PID 21.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 3242 PID 21.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 3243 PID 21.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 3244 PID 21.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3245 PID 21.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3246 PID 21.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3247 PID 21.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 3248 PID 21.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 3249 PID 21.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3250 PID 21.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 3251 PID 21.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 3252 PID 21.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 3253 PID 22 Ethnic Group F CE 483 RE RE No [0 .. 1] [0 .. 1] No 0189 3254 PID 22.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3255 PID 22.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If seq 1 is populated, then this field should be populated. 3256 PID 22.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396   If seq 1 is populated, then this field shall be populated. 3257 PID 22.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3258 PID 22.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If seq 1 is populated, then this field should be populated. 3259 PID 22.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396   If seq 1 is populated, then this field shall be populated. 3260 PID 23 Birth Place F ST 60 O O No [0 .. 1] [0 .. 1] No 3261 PID 24 Multiple Birth Indicator F ID 1 RE RE No [0 .. 1] [0 .. 1] No 0136 3262 PID 25 Birth Order F NM 2 CE CE No [0 .. 1] [0 .. 1] No If multiple birth indicator = Y, then this field should be populated. 3263 PID 26 Citizenship F CE 483 O O No [0 .. 1] [0 .. 1] No 0171 3264 PID 26.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3265 PID 26.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3266 PID 26.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3267 PID 26.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3268 PID 26.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3269 PID 26.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3270 PID 27 Veterans Military Status F CE 483 O O No [0 .. 1] [0 .. 1] No 0172 3271 PID 27.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3272 PID 27.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3273 PID 27.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3274 PID 27.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3275 PID 27.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3276 PID 27.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3277 PID 28 Nationality F CE 483 O O No [0 .. 1] [0 .. 1] No 0212 3278 PID 29 Patient Death Date and Time F TS 26 RE RE No [0 .. 1] [0 .. 1] No 3279 PID 29.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 3280 PID 29.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3281 PID 30 Patient Death Indicator F ID 1 CE CE No [0 .. 1] [0 .. 1] No 0136 3282 PID 31 Identity Unknown Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 3283 PID 32 Identity Reliability Code F IS 20 O O No [0 .. 1] [0 .. 1] No 0445 3284 PID 33 Last Update Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 3285 PID 33.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 3286 PID 33.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 3287 PID 34 Last Update Facility F HD 241 O O No [0 .. 1] [0 .. 1] No 3288 PID 34.1 Namespace ID C IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 3289 PID 34.2 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If namespace id is populated, then this field shall be populated with an OID. 3290 PID 34.3 Universal ID Type C ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 3291 PID 35 Species Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0446 3292 PID 36 Breed Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0447 3293 PID 37 Strain F ST 80 O O No [0 .. 1] [0 .. 1] No 3294 PID 38 Production Class Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0429 3295 PID 38.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3296 PID 38.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3297 PID 38.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3298 PID 38.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3299 PID 38.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3300 PID 38.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3301 PID 39 Tribal Citizenship F CWE 705 O O No [0 .. 1] [0 .. 1] No 0171 3302 PID 39.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3303 PID 39.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3304 PID 39.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3305 PID 39.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 3306 PID 39.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 3307 PID 39.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 3308 PID 39.7 Coding System Version ID C ST 10 C C No [0 .. 1] [0 .. 1] No 3309 PID 39.8 Alternate Coding System Version ID C ST 10 O O No [0 .. 1] [0 .. 1] No 3310 PID 39.9 Original Text C ST 199 O O No [0 .. 1] [0 .. 1] No 4001 PD1 1 Living Dependency F IS 2 O O No [0 .. 1] [0 .. 1] No 0223     4002 PD1 2 Living Arrangement F IS 2 O O No [0 .. 1] [0 .. 1] No 0220     4003 PD1 3 Patient Primary Facility F XON 563 O O No [0 .. 1] [0 .. 1] No       4004 PD1 3.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No     4005 PD1 3.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204     4006 PD1 3.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No         4007 PD1 3.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No     4008 PD1 3.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061     4009 PD1 3.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363       4010 PD1 3.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     4011 PD1 3.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4012 PD1 3.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     4013 PD1 3.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203     4014 PD1 3.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       4015 PD1 3.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     4016 PD1 3.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4017 PD1 3.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     4018 PD1 3.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     4019 PD1 3.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No     4020 PD1 4 Patient Primary Care Provider Name & ID No. F XCN 2945 O O No [0 .. 1] [0 .. 1] No         4021 PD1 5 Student Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0231     4022 PD1 6 Handicap F IS 2 O O No [0 .. 1] [0 .. 1] No 0295     4023 PD1 7 Living Will Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0315     4024 PD1 8 Organ Donor Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0316     4025 PD1 9 Separate Bill F ID 1 O O No [0 .. 1] [0 .. 1] No 0136     4026 PD1 10 Duplicate Patient F CX 1913 O O No [0 .. 1] [0 .. 1] No       4027 PD1 10.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No     4028 PD1 10.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     4029 PD1 10.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061     4030 PD1 10.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363       4031 PD1 10.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     4032 PD1 10.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4033 PD1 10.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     4034 PD1 10.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203     4035 PD1 10.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       4036 PD1 10.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     4037 PD1 10.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4038 PD1 10.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     4039 PD1 10.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No     4040 PD1 10.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No     4041 PD1 10.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       4042 PD1 10.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     4043 PD1 10.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4044 PD1 10.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     4045 PD1 10.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     4046 PD1 10.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4047 PD1 10.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     4048 PD1 10.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     4049 PD1 10.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     4050 PD1 10.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     4051 PD1 10.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       4052 PD1 10.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     4053 PD1 10.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4054 PD1 10.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     4055 PD1 10.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     4056 PD1 10.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4057 PD1 10.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     4058 PD1 10.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     4059 PD1 10.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     4060 PD1 10.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     4061 PD1 11 Publicity Code F CE 483 RE RE No [0 .. 1] [0 .. 1] No 0215       4062 PD1 11.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     4063 PD1 11.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     If seq 1 is populated, then this field should be populated. 4064 PD1 11.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     If seq 1 is populated, then this field shall be populated. 4065 PD1 11.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     4066 PD1 11.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     If seq 4 is populated, then this field should be populated. 4067 PD1 11.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     If seq 4 is populated, then this field shall be populated. 4068 PD1 12 Protection Indicator F ID 1 RE RE No [0 .. 1] [0 .. 1] No 0136     4069 PD1 13 Protection Indicator Effective Date F DT 8 CE CE No [0 .. 1] [0 .. 1] No     if protection indicator is populated, then this field should be populated. 4070 PD1 14 Place of Worship F XON 563 O O No [0 .. 1] [0 .. 1] No       4071 PD1 14.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No     4072 PD1 14.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204     4073 PD1 14.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No         4074 PD1 14.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No     4075 PD1 14.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061     4076 PD1 15.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363       4077 PD1 14.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     4078 PD1 14.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4079 PD1 14.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     4080 PD1 14.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203     4081 PD1 14.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       4082 PD1 14.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     4083 PD1 14.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     4084 PD1 14.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     4085 PD1 14.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     4086 PD1 14.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No     4087 PD1 15 Advance Directive Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0435       4088 PD1 15.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     4089 PD1 15.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     4090 PD1 15.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     4091 PD1 15.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     4092 PD1 15.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     4093 PD1 15.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     4094 PD1 16 Immunization Registry Status F IS 1 RE RE No [0 .. 1] [0 .. 1] No 0441     4095 PD1 17 Immunization Registry Status Effective Date F DT 8 CE CE No [0 .. 1] [0 .. 1] No     If the registry status is populated, then this field should be populated. 4096 PD1 18 Publicity Code Effective Date F DT 8 CE CE No [0 .. 1] [0 .. 1] No     If the publicity code is populated, then this field should be populated. 4097 PD1 19 Military Branch F IS 5 O O No [0 .. 1] [0 .. 1] No 0140     4098 PD1 20 Military Rank/Grade F IS 2 O O No [0 .. 1] [0 .. 1] No 0141     4099 PD1 21 Military Status F IS 3 O O No [0 .. 1] [0 .. 1] No 0142     5001 NK1 1 Set ID - NK1 F SI 4 R R No [1 .. 1] [1 .. 1] No     5002 NK1 2 Name F XPN 1044 R R No [1 .. *] [1 .. *] No       5003 NK1 2.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No       5004 NK1 2.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No     5005 NK1 2.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No     5006 NK1 2.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No     5007 NK1 2.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No     5008 NK1 2.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No     5009 NK1 2.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No     5010 NK1 2.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No     5011 NK1 2.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No     5012 NK1 2.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No     5013 NK1 2.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360         5014 NK1 2.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200     5015 NK1 2.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     5016 NK1 2.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448       5017 NK1 2.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5018 NK1 2.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5019 NK1 2.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5020 NK1 2.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5021 NK1 2.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5022 NK1 2.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5023 NK1 2.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         5024 NK1 2.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444     5025 NK1 2.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5026 NK1 2.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5027 NK1 2.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5028 NK1 2.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5029 NK1 2.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5030 NK1 2.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5031 NK1 2.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No     5032 NK1 3 Relationship F CE 483 R R No [1 .. 1] [1 .. 1] No 0063       5033 NK1 3.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5034 NK1 3.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     if seq 1 is populated this field may be populated. 5035 NK1 3.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     If seq 1 is populated, then this field shall be populated. 5036 NK1 3.4 Alternate Identifier C ST 1 RE RE No [0 .. 1] [0 .. 1] No     5037 NK1 3.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5038 NK1 3.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5039 NK1 4 Address F XAD 578 RE RE No [0 .. *] [0 .. *] No       5040 NK1 4.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No       5041 NK1 4.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No     5042 NK1 4.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No     5043 NK1 4.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No     5044 NK1 4.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No     5045 NK1 4.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No     5046 NK1 4.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No     5047 NK1 4.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No     5048 NK1 4.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399     5049 NK1 4.7 Address Type C ID 1 R R No [1 .. 1] [1 .. 1] No 0190     5050 NK1 4.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No     5051 NK1 4.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289     5052 NK1 4.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288     5053 NK1 4.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     5054 NK1 4.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         5055 NK1 4.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5056 NK1 4.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5057 NK1 4.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5058 NK1 4.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5059 NK1 4.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5060 NK1 4.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5061 NK1 5 Phone Number F XTN 651 RE RE No [0 .. *] [0 .. *] No       5062 NK1 5.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No         5063 NK1 5.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201     5064 NK1 5.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202     5065 NK1 5.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No     If telecommunication use code = NET, then this field shall be populated. 5066 NK1 5.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No     5067 NK1 5.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No     If telecommunication type code is not NET, then this field should be populated. 5068 NK1 5.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No     If telecommunication type code is not NET, then this field should be populated. 5069 NK1 5.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No     5070 NK1 5.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No     5071 NK1 5.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No     5072 NK1 5.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No     5073 NK1 5.12 Unformatted Telephone number C ST 0 O O No [0 .. 1] [0 .. 1] No         5074 NK1 6 Business Phone Number F XTN 651 O O No [0 .. *] [0 .. *] No       5075 NK1 6.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No         5076 NK1 6.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201     5077 NK1 6.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202     5078 NK1 6.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5079 NK1 6.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No     5080 NK1 6.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No     5081 NK1 6.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No     5082 NK1 6.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No     5083 NK1 6.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No     5084 NK1 6.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No     5085 NK1 6.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No     5086 NK1 6.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No     5087 NK1 7 Contact Role F CE 483 O O No [0 .. 1] [0 .. 1] No 0131       5088 NK1 7.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5089 NK1 7.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5090 NK1 7.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5091 NK1 7.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5092 NK1 7.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5093 NK1 7.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5094 NK1 8 Start Date F DT 8 O O No [0 .. 1] [0 .. 1] No     5095 NK1 9 End Date F DT 8 O O No [0 .. 1] [0 .. 1] No     5096 NK1 10 Next of Kin / Associated Parties Job Title F ST 60 O O No [0 .. 1] [0 .. 1] No     5097 NK1 11 Next of Kin / Associated Parties Job Code/Class F JCC 292 O O No [0 .. 1] [0 .. 1] No 0327 / 032       5098 NK1 11.1 Job Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0327     5099 NK1 11.2 Job Class C IS 20 O O No [0 .. 1] [0 .. 1] No 0328     5100 NK1 11.3 Job Description Text C TX 250 O O No [0 .. 1] [0 .. 1] No     5101 NK1 12 Next of Kin / Associated Parties Employee Number F CX 1913 O O No [0 .. 1] [0 .. 1] No       5102 NK1 12.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No     5103 NK1 12.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     5104 NK1 12.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061     5105 NK1 12.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363       5106 NK1 12.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     5107 NK1 12.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5108 NK1 12.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     5109 NK1 12.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203     5110 NK1 12.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       5111 NK1 12.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     5112 NK1 12.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5113 NK1 12.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     5114 NK1 12.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No     5115 NK1 12.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No     5116 NK1 12.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       5117 NK1 12.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5118 NK1 12.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5119 NK1 12.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5120 NK1 12.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5121 NK1 12.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5122 NK1 12.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5123 NK1 12.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     5124 NK1 12.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     5125 NK1 12.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     5126 NK1 12.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       5127 NK1 12.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5128 NK1 12.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5129 NK1 12.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5130 NK1 12.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5131 NK1 12.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5132 NK1 12.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5133 NK1 12.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     5134 NK1 12.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     5135 NK1 12.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     5136 NK1 13 Organization Name - NK1 F XON 563 O O No [0 .. 1] [0 .. 1] No       5137 NK1 13.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No     5138 NK1 13.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204     5139 NK1 13.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No         5140 NK1 13.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No     5141 NK1 13.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061     5142 NK1 13.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363       5143 NK1 13.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     5144 NK1 13.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5145 NK1 13.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     5146 NK1 13.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203     5147 NK1 13.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       5148 NK1 13.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     5149 NK1 13.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5150 NK1 13.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     5151 NK1 13.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     5152 NK1 13.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No     5153 NK1 14 Marital Status F CE 483 O O No [0 .. 1] [0 .. 1] No 0002       5154 NK1 14.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5155 NK1 14.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5156 NK1 14.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5157 NK1 14.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5158 NK1 14.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5159 NK1 14.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5160 NK1 15 Administrative Sex F IS 1 O O No [0 .. 1] [0 .. 1] No 0001     5161 NK1 16 Date/Time of Birth F TS 26 O O No [0 .. 1] [0 .. 1] No       5162 NK1 16.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No     5163 NK1 16.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5164 NK1 17 Living Dependency F IS 2 O O No [0 .. 1] [0 .. 1] No 0223     5165 NK1 18 Ambulatory Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0009     5166 NK1 19 Citizenship F CE 483 O O No [0 .. 1] [0 .. 1] No 0171       5167 NK1 19.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5168 NK1 19.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5169 NK1 19.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5170 NK1 19.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5171 NK1 19.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5172 NK1 19.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5173 NK1 20 Primary Language F CE 483 O O No [0 .. 1] [0 .. 1] No 0296       5174 NK1 20.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5175 NK1 20.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5176 NK1 20.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5177 NK1 20.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5178 NK1 20.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5179 NK1 20.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5180 NK1 21 Living Arrangement F IS 2 O O No [0 .. 1] [0 .. 1] No 0220     5181 NK1 22 Publicity Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0215       5182 NK1 22.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5183 NK1 22.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5184 NK1 22.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5185 NK1 22.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5186 NK1 22.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5187 NK1 22.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5188 NK1 23 Protection Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136     5189 NK1 24 Student Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0231     5190 NK1 25 Religion F CE 483 O O No [0 .. 1] [0 .. 1] No 0006       5191 NK1 25.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5192 NK1 25.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5193 NK1 25.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5194 NK1 25.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5195 NK1 25.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5196 NK1 25.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5197 NK1 26 Mother's Maiden Name F XPN 1044 O O No [0 .. 1] [0 .. 1] No       5198 NK1 26.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No       5199 NK1 26.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No     5200 NK1 26.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No     5201 NK1 26.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No     5202 NK1 26.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No     5203 NK1 26.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No     5204 NK1 26.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No     5205 NK1 26.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No     5206 NK1 26.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No     5207 NK1 26.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No     5208 NK1 26.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360         5209 NK1 26.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200     5210 NK1 26.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     5211 NK1 26.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448       5212 NK1 26.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5213 NK1 26.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5214 NK1 26.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5215 NK1 26.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5216 NK1 26.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5217 NK1 26.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5218 NK1 26.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         5219 NK1 26.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444     5220 NK1 26.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5221 NK1 26.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5222 NK1 26.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5223 NK1 26.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5224 NK1 26.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5225 NK1 26.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5226 NK1 26.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No     5227 NK1 27 Nationality F CE 483 O O No [0 .. 1] [0 .. 1] No 0212       5228 NK1 27.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5229 NK1 27.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5230 NK1 27.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5231 NK1 27.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5232 NK1 27.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5233 NK1 27.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5234 NK1 28 Ethnic Group F CE 483 O O No [0 .. 1] [0 .. 1] No 0189       5235 NK1 28.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5236 NK1 28.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5237 NK1 28.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5238 NK1 28.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5239 NK1 28.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5240 NK1 28.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5241 NK1 29 Contact Reason F CE 483 O O No [0 .. 1] [0 .. 1] No 0222       5242 NK1 29.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5243 NK1 29.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5244 NK1 29.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5245 NK1 29.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5246 NK1 29.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5247 NK1 29.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5248 NK1 30 Contact Person's Name F XPN 1044 O O No [0 .. 1] [0 .. 1] No       5249 NK1 30.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No       5250 NK1 30.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No     5251 NK1 30.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No     5252 NK1 30.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No     5253 NK1 30.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No     5254 NK1 30.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No     5255 NK1 30.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No     5256 NK1 30.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No     5257 NK1 30.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No     5258 NK1 30.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No     5259 NK1 30.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360         5260 NK1 30.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200     5261 NK1 30.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     5262 NK1 30.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448       5263 NK1 30.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5264 NK1 30.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5265 NK1 30.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5266 NK1 30.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5267 NK1 30.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5268 NK1 30.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5269 NK1 30.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         5270 NK1 30.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444     5271 NK1 30.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5272 NK1 30.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5273 NK1 30.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5274 NK1 30.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5275 NK1 30.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5276 NK1 30.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5277 NK1 30.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No     5278 NK1 31 Contact Person's Telephone Number F XTN 651 O O No [0 .. 1] [0 .. 1] No       5279 NK1 31.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No         5280 NK1 31.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201     5281 NK1 31.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202     5282 NK1 31.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5283 NK1 31.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No     5284 NK1 31.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No     5285 NK1 31.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No     5286 NK1 31.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No     5287 NK1 31.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No     5288 NK1 31.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No     5289 NK1 31.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No     5290 NK1 31.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No     5291 NK1 32 Contact Person's Address F XAD 578 O O No [0 .. 1] [0 .. 1] No       5292 NK1 32.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No       5293 NK1 32.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No     5294 NK1 32.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No     5295 NK1 32.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No     5296 NK1 32.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No     5297 NK1 32.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No     5298 NK1 32.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No     5299 NK1 32.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No     5300 NK1 32.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399     5301 NK1 32.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190     5302 NK1 32.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No     5303 NK1 32.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289     5304 NK1 32.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288     5305 NK1 32.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     5306 NK1 32.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         5307 NK1 32.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5308 NK1 32.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5309 NK1 32.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5310 NK1 32.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       5311 NK1 32.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     5312 NK1 32.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         5313 NK1 33 Next of Kin/Associated Party's Identifiers F CX 1913 O O No [0 .. 1] [0 .. 1] No       5314 NK1 33.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No     5315 NK1 33.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     5316 NK1 33.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061     5317 NK1 33.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363       5318 NK1 33.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 3000     5319 NK1 33.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5320 NK1 33.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     5321 NK1 33.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203     5322 NK1 33.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       5323 NK1 33.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     5324 NK1 33.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5325 NK1 33.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     5326 NK1 33.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No     5327 NK1 33.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No     5328 NK1 33.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       5329 NK1 33.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5330 NK1 33.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5331 NK1 33.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5332 NK1 33.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5333 NK1 33.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5334 NK1 33.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5335 NK1 33.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     5336 NK1 33.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     5337 NK1 33.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     5338 NK1 33.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       5339 NK1 33.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5340 NK1 33.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5341 NK1 33.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5342 NK1 33.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     5343 NK1 33.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     5344 NK1 33.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5345 NK1 33.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     5346 NK1 33.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     5347 NK1 33.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     5348 NK1 34 Job Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0311     5349 NK1 35 Race F CE 483 O O No [0 .. 1] [0 .. 1] No 0005       5350 NK1 35.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5351 NK1 35.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5352 NK1 35.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5353 NK1 35.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     5354 NK1 35.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     5355 NK1 35.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     5356 NK1 36 Handicap F IS 2 O O No [0 .. 1] [0 .. 1] No 0295     5357 NK1 37 Contact Person Social Security Number F ST 16 O O No [0 .. 1] [0 .. 1] No     5358 NK1 38 Next of Kin Birth Place F ST 250 O O No [0 .. 1] [0 .. 1] No     5359 NK1 39 VIP Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0099     6001 PV1 1 Set ID - PV1 F SI 4 O O No [0 .. 1] [0 .. 1] No     6002 PV1 2 Patient Class F IS 1 R R No [1 .. 1] [1 .. 1] No 0004   R   6003 PV1 3 Assigned Patient Location F PL 1230 O O No [0 .. 1] [0 .. 1] No       6004 PV1 3.1 Point of Care C IS 20 O O No [0 .. 1] [0 .. 1] No 0302     6005 PV1 3.2 Room C IS 20 O O No [0 .. 1] [0 .. 1] No 0303     6006 PV1 3.3 Bed C IS 20 O O No [0 .. 1] [0 .. 1] No 0304     6007 PV1 3.4 Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6008 PV1 3.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6009 PV1 3.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6010 PV1 3.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6011 PV1 3.5 Location Status C IS 20 O O No [0 .. 1] [0 .. 1] No 0306     6012 PV1 3.6 Person Location Type C IS 20 C C No [0 .. 1] [0 .. 1] No 0305     6013 PV1 3.7 Building C IS 20 O O No [0 .. 1] [0 .. 1] No 0307     6014 PV1 3.8 Floor C IS 20 O O No [0 .. 1] [0 .. 1] No 0308     6015 PV1 3.9 Location Description C ST 199 O O No [0 .. 1] [0 .. 1] No     6016 PV1 3.10 Comprehensive Location Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No       6017 PV1 3.10.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No     6018 PV1 3.10.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363     6019 PV1 3.10.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6020 PV1 3.10.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301     6021 PV1 3.11 Assigning Authority for Location C HD 227 O O No [0 .. 1] [0 .. 1] No       6022 PV1 3.11.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6023 PV1 3.11.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6024 PV1 3.11.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6025 PV1 4 Admission Type F IS 2 O O No [0 .. 1] [0 .. 1] No 0007     6026 PV1 5 Preadmit Number F CX 1913 O O No [0 .. 1] [0 .. 1] No       6027 PV1 5.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No     6028 PV1 5.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     6029 PV1 5.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061     6030 PV1 5.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363       6031 PV1 5.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6032 PV1 5.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6033 PV1 5.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6034 PV1 5.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203     6035 PV1 5.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6036 PV1 5.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6037 PV1 5.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6038 PV1 5.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6039 PV1 5.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No     6040 PV1 5.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No     6041 PV1 5.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       6042 PV1 5.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6043 PV1 5.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6044 PV1 5.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6045 PV1 5.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6046 PV1 5.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6047 PV1 5.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6048 PV1 5.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6049 PV1 5.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6050 PV1 5.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6051 PV1 5.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       6052 PV1 5.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6053 PV1 5.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6054 PV1 5.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6055 PV1 5.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6056 PV1 5.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6057 PV1 5.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6058 PV1 5.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6059 PV1 5.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6060 PV1 5.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6061 PV1 6 Prior Patient Location F PL 1230 O O No [0 .. 1] [0 .. 1] No       6062 PV1 6.1 Point of Care C IS 20 O O No [0 .. 1] [0 .. 1] No 0302     6063 PV1 6.2 Room C IS 20 O O No [0 .. 1] [0 .. 1] No 0303     6064 PV1 6.3 Bed C IS 20 O O No [0 .. 1] [0 .. 1] No 0304     6065 PV1 6.4 Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6066 PV1 6.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6067 PV1 6.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6068 PV1 6.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6069 PV1 6.5 Location Status C IS 20 O O No [0 .. 1] [0 .. 1] No 0306     6070 PV1 6.6 Person Location Type C IS 20 C C No [0 .. 1] [0 .. 1] No 0305     6071 PV1 6.7 Building C IS 20 O O No [0 .. 1] [0 .. 1] No 0307     6072 PV1 6.8 Floor C IS 20 O O No [0 .. 1] [0 .. 1] No 0308     6073 PV1 6.9 Location Description C ST 199 O O No [0 .. 1] [0 .. 1] No     6074 PV1 6.10 Comprehensive Location Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No       6075 PV1 6.10.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No     6076 PV1 6.10.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363     6077 PV1 6.10.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6078 PV1 6.10.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301     6079 PV1 6.11 Assigning Authority for Location C HD 227 O O No [0 .. 1] [0 .. 1] No       6080 PV1 6.11.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6081 PV1 6.11.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6082 PV1 6.11.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6083 PV1 7 Attending Doctor F XCN 2945 O O No [0 .. 1] [0 .. 1] No 0010       6084 PV1 7.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No     6085 PV1 7.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No       6086 PV1 7.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No     6087 PV1 7.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No     6088 PV1 7.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No     6089 PV1 7.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No     6090 PV1 7.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No     6091 PV1 7.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No     6092 PV1 7.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No     6093 PV1 7.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No     6094 PV1 7.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No     6095 PV1 7.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360         6096 PV1 7.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297     6097 PV1 7.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363       6098 PV1 7.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6099 PV1 7.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6100 PV1 7.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6101 PV1 7.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200     6102 PV1 7.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     6103 PV1 7.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061     6104 PV1 7.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203     6105 PV1 7.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6106 PV1 7.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6107 PV1 7.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6108 PV1 7.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6109 PV1 7.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     6110 PV1 7.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448       6111 PV1 7.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6112 PV1 7.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6113 PV1 7.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6114 PV1 7.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6115 PV1 7.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6116 PV1 7.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6117 PV1 7.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         6118 PV1 7.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444     6119 PV1 7.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6120 PV1 7.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6121 PV1 7.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6122 PV1 7.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6123 PV1 7.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6124 PV1 7.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6125 PV1 7.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No     6126 PV1 7.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       6127 PV1 7.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6128 PV1 7.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6129 PV1 7.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6130 PV1 7.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6131 PV1 7.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6132 PV1 7.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6133 PV1 7.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6134 PV1 7.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6135 PV1 7.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6136 PV1 7.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       6137 PV1 7.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6138 PV1 7.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6139 PV1 7.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6140 PV1 7.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6141 PV1 7.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6142 PV1 7.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6143 PV1 7.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6144 PV1 7.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6145 PV1 7.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6146 PV1 8 Referring Doctor F XCN 2945 O O No [0 .. 1] [0 .. 1] No 0010       6147 PV1 8.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No     6148 PV1 8.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No       6149 PV1 8.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No     6150 PV1 8.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No     6151 PV1 8.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No     6152 PV1 8.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No     6153 PV1 8.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No     6154 PV1 8.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No     6155 PV1 8.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No     6156 PV1 8.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No     6157 PV1 8.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No     6158 PV1 8.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360         6159 PV1 8.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297     6160 PV1 8.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363       6161 PV1 8.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6162 PV1 8.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6163 PV1 8.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6164 PV1 8.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200     6165 PV1 8.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     6166 PV1 8.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061     6167 PV1 8.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203     6168 PV1 8.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6169 PV1 8.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6170 PV1 8.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6171 PV1 8.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6172 PV1 8.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     6173 PV1 8.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448       6174 PV1 8.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6175 PV1 8.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6176 PV1 8.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6177 PV1 8.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6178 PV1 8.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6179 PV1 8.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6180 PV1 8.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         6181 PV1 8.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444     6182 PV1 8.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6183 PV1 8.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6184 PV1 8.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6185 PV1 8.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6186 PV1 8.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6187 PV1 8.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6188 PV1 8.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No     6189 PV1 8.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       6190 PV1 8.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6191 PV1 8.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6192 PV1 8.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6193 PV1 8.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6194 PV1 8.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6195 PV1 8.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6196 PV1 8.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6197 PV1 8.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6198 PV1 8.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6199 PV1 8.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       6200 PV1 8.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6201 PV1 8.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6202 PV1 8.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6203 PV1 8.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6204 PV1 8.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6205 PV1 8.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6206 PV1 8.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6207 PV1 8.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6208 PV1 8.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6209 PV1 9 Consulting Doctor F XCN 2945 O O No [0 .. 1] [0 .. 1] No 0010         6210 PV1 10 Hospital Service F IS 3 O O No [0 .. 1] [0 .. 1] No 0069     6211 PV1 11 Temporary Location F PL 1230 O O No [0 .. 1] [0 .. 1] No       6212 PV1 11.1 Point of Care C IS 20 O O No [0 .. 1] [0 .. 1] No 0302     6213 PV1 11.2 Room C IS 20 O O No [0 .. 1] [0 .. 1] No 0303     6214 PV1 11.3 Bed C IS 20 O O No [0 .. 1] [0 .. 1] No 0304     6215 PV1 11.4 Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6216 PV1 11.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6217 PV1 11.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6218 PV1 11.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6219 PV1 11.5 Location Status C IS 20 O O No [0 .. 1] [0 .. 1] No 0306     6220 PV1 11.6 Person Location Type C IS 20 C C No [0 .. 1] [0 .. 1] No 0305     6221 PV1 11.7 Building C IS 20 O O No [0 .. 1] [0 .. 1] No 0307     6222 PV1 11.8 Floor C IS 20 O O No [0 .. 1] [0 .. 1] No 0308     6223 PV1 11.9 Location Description C ST 199 O O No [0 .. 1] [0 .. 1] No     6224 PV1 11.10 Comprehensive Location Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No       6225 PV1 11.10.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No     6226 PV1 11.10.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363     6227 PV1 11.10.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6228 PV1 11.10.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301     6229 PV1 11.11 Assigning Authority for Location C HD 227 O O No [0 .. 1] [0 .. 1] No       6230 PV1 11.11.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6231 PV1 11.11.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6232 PV1 11.11.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6233 PV1 12 Preadmit Test Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0087     6234 PV1 13 Re-admission Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0092     6235 PV1 14 Admit Source F IS 6 O O No [0 .. 1] [0 .. 1] No 0023     6236 PV1 15 Ambulatory Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0009     6237 PV1 16 VIP Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0099     6238 PV1 17 Admitting Doctor F XCN 2945 O O No [0 .. 1] [0 .. 1] No 0010       6239 PV1 17.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No     6240 PV1 17.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No       6241 PV1 17.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No     6242 PV1 17.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No     6243 PV1 17.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No     6244 PV1 17.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No     6245 PV1 17.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No     6246 PV1 17.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No     6247 PV1 17.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No     6248 PV1 17.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No     6249 PV1 17.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No     6250 PV1 17.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360         6251 PV1 17.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297     6252 PV1 17.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363       6253 PV1 17.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6254 PV1 17.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6255 PV1 17.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6256 PV1 17.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200     6257 PV1 17.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     6258 PV1 17.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061     6259 PV1 17.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203     6260 PV1 17.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6261 PV1 17.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6262 PV1 17.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6263 PV1 17.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6264 PV1 17.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465     6265 PV1 17.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448       6266 PV1 17.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6267 PV1 17.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6268 PV1 17.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6269 PV1 17.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6270 PV1 17.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6271 PV1 17.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6272 PV1 17.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No         6273 PV1 17.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444     6274 PV1 17.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6275 PV1 17.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6276 PV1 17.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6277 PV1 17.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6278 PV1 17.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6279 PV1 17.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6280 PV1 17.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No     6281 PV1 17.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       6282 PV1 17.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6283 PV1 17.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6284 PV1 17.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6285 PV1 17.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6286 PV1 17.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6287 PV1 17.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6288 PV1 17.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6289 PV1 17.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6290 PV1 17.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6291 PV1 17.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       6292 PV1 17.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6293 PV1 17.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6294 PV1 17.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6295 PV1 17.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6296 PV1 17.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6297 PV1 17.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6298 PV1 17.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6299 PV1 17.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6300 PV1 17.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6301 PV1 18 Patient Type F IS 2 O O No [0 .. 1] [0 .. 1] No 0018     6302 PV1 19 Visit Number F CX 1913 O O No [0 .. 1] [0 .. 1] No       6303 PV1 19.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No     6304 PV1 19.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     6305 PV1 19.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061     6306 PV1 19.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363       6307 PV1 19.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6308 PV1 19.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6309 PV1 19.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6310 PV1 19.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203     6311 PV1 19.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6312 PV1 19.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6313 PV1 19.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6314 PV1 19.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6315 PV1 19.7 Effective Date C DT 8 R R No [1 .. 1] [1 .. 1] No     6316 PV1 19.8 Expiration Date C DT 8 R R No [1 .. 1] [1 .. 1] No     6317 PV1 19.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       6318 PV1 19.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6319 PV1 19.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6320 PV1 19.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6321 PV1 19.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6322 PV1 19.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6323 PV1 19.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6324 PV1 19.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6325 PV1 19.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6326 PV1 19.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6327 PV1 19.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       6328 PV1 19.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6329 PV1 19.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6330 PV1 19.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6331 PV1 19.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6332 PV1 19.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6333 PV1 19.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6334 PV1 19.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6335 PV1 19.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6336 PV1 19.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6337 PV1 20 Financial Class F FC 50 O O No [1 .. *] [1 .. *] No 0064       6338 PV1 20.1 Financial Class Code C IS 20 R R No [1 .. 1] [1 .. 1] No 0064     6339 PV1 20.2 Effective Date C TS 26 RE RE No [0 .. 1] [0 .. 1] No       6340 PV1 20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6341 PV1 20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6342 PV1 21 Charge Price Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0032     6343 PV1 22 Courtesy Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0045     6344 PV1 23 Credit Rating F IS 2 O O No [0 .. 1] [0 .. 1] No 0046     6345 PV1 24 Contract Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0044     6346 PV1 25 Contract Effective Date F DT 8 O O No [0 .. 1] [0 .. 1] No     6347 PV1 26 Contract Amount F NM 12 O O No [0 .. 1] [0 .. 1] No     6348 PV1 27 Contract Period F NM 3 O O No [0 .. 1] [0 .. 1] No     6349 PV1 28 Interest Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0073     6350 PV1 29 Transfer to Bad Debt Code F IS 4 O O No [0 .. 1] [0 .. 1] No 0110     6351 PV1 30 Transfer to Bad Debt Date F DT 8 O O No [0 .. 1] [0 .. 1] No     6352 PV1 31 Bad Debt Agency Code F IS 10 O O No [0 .. 1] [0 .. 1] No 0021     6353 PV1 32 Bad Debt Transfer Amount F NM 12 O O No [0 .. 1] [0 .. 1] No     6354 PV1 33 Bad Debt Recovery Amount F NM 12 O O No [0 .. 1] [0 .. 1] No     6355 PV1 34 Delete Account Indicator F IS 1 O O No [0 .. 1] [0 .. 1] No 0111     6356 PV1 35 Delete Account Date F DT 8 O O No [0 .. 1] [0 .. 1] No     6357 PV1 36 Discharge Disposition F IS 3 O O No [0 .. 1] [0 .. 1] No 0112     6358 PV1 37 Discharged to Location F DLD 47 O O No [0 .. 1] [0 .. 1] No 0113       6359 PV1 37.1 Discharge Location C IS 20 R R No [1 .. 1] [1 .. 1] No 0113     6360 PV1 37.2 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No       6361 PV1 37.2.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No     6362 PV1 37.2.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6363 PV1 38 Diet Type F CE 483 O O No [0 .. 1] [0 .. 1] No 0114       6364 PV1 38.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     6365 PV1 38.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     6366 PV1 38.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6367 PV1 38.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No     6368 PV1 38.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No     6369 PV1 38.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6370 PV1 39 Servicing Facility F IS 2 O O No [0 .. 1] [0 .. 1] No 0115     6371 PV1 40 Bed Status F IS 1 O O No [0 .. 1] [0 .. 1] No 0116         6372 PV1 41 Account Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0117     6373 PV1 42 Pending Location F PL 1230 O O No [0 .. 1] [0 .. 1] No       6374 PV1 42.1 Point of Care C IS 20 O O No [0 .. 1] [0 .. 1] No 0302     6375 PV1 42.2 Room C IS 20 O O No [0 .. 1] [0 .. 1] No 0303     6376 PV1 42.3 Bed C IS 20 O O No [0 .. 1] [0 .. 1] No 0304     6377 PV1 42.4 Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6378 PV1 42.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6379 PV1 42.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6380 PV1 42.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6381 PV1 42.5 Location Status C IS 20 O O No [0 .. 1] [0 .. 1] No 0306     6382 PV1 42.6 Person Location Type C IS 20 C C No [0 .. 1] [0 .. 1] No 0305     6383 PV1 42.7 Building C IS 20 O O No [0 .. 1] [0 .. 1] No 0307     6384 PV1 42.8 Floor C IS 20 O O No [0 .. 1] [0 .. 1] No 0308     6385 PV1 42.9 Location Description C ST 199 O O No [0 .. 1] [0 .. 1] No     6386 PV1 42.10 Comprehensive Location Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No       6387 PV1 42.10.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No     6388 PV1 42.10.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363     6389 PV1 42.10.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6390 PV1 42.10.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301     6391 PV1 42.11 Assigning Authority for Location C HD 227 O O No [0 .. 1] [0 .. 1] No       6392 PV1 42.11.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6393 PV1 42.11.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6394 PV1 42.11.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6395 PV1 43 Prior Temporary Location F PL 1230 O O No [0 .. 1] [0 .. 1] No       6396 PV1 43.1 Point of Care C IS 20 O O No [0 .. 1] [0 .. 1] No 0302     6397 PV1 43.2 Room C IS 20 O O No [0 .. 1] [0 .. 1] No 0303     6398 PV1 43.3 Bed C IS 20 O O No [0 .. 1] [0 .. 1] No 0304     6399 PV1 43.4 Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6400 PV1 43.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6401 PV1 43.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6402 PV1 43.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6403 PV1 43.5 Location Status C IS 20 O O No [0 .. 1] [0 .. 1] No 0306     6404 PV1 43.6 Person Location Type C IS 20 C C No [0 .. 1] [0 .. 1] No 0305     6405 PV1 43.7 Building C IS 20 O O No [0 .. 1] [0 .. 1] No 0307     6406 PV1 43.8 Floor C IS 20 O O No [0 .. 1] [0 .. 1] No 0308     6407 PV1 43.9 Location Description C ST 199 O O No [0 .. 1] [0 .. 1] No     6408 PV1 43.10 Comprehensive Location Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No       6409 PV1 43.10.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No     6410 PV1 43.10.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363     6411 PV1 43.10.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6412 PV1 43.10.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301     6413 PV1 43.11 Assigning Authority for Location C HD 227 O O No [0 .. 1] [0 .. 1] No       6414 PV1 43.11.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6415 PV1 43.11.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6416 PV1 43.11.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6417 PV1 44 Admit Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No       6418 PV1 44.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No     6419 PV1 44.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6420 PV1 45 Discharge Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No       6421 PV1 45.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No     6422 PV1 45.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529         6423 PV1 46 Current Patient Balance F NM 12 O O No [0 .. 1] [0 .. 1] No     6424 PV1 47 Total Charges F NM 12 O O No [0 .. 1] [0 .. 1] No     6425 PV1 48 Total Adjustments F NM 12 O O No [0 .. 1] [0 .. 1] No     6426 PV1 49 Total Payments F NM 12 O O No [0 .. 1] [0 .. 1] No     6427 PV1 50 Alternate Visit ID F CX 1913 O O No [0 .. 1] [0 .. 1] No 0203       6428 PV1 50.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No     6429 PV1 50.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No     6430 PV1 50.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061     6431 PV1 50.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363       6432 PV1 50.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6433 PV1 50.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6434 PV1 50.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6435 PV1 50.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203     6436 PV1 50.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No       6437 PV1 50.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300     6438 PV1 50.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6439 PV1 50.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301     6440 PV1 50.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No     6441 PV1 50.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No     6442 PV1 50.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No       6443 PV1 50.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6444 PV1 50.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6445 PV1 50.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6446 PV1 50.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6447 PV1 50.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6448 PV1 50.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6449 PV1 50.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6450 PV1 50.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6451 PV1 50.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6452 PV1 50.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No       6453 PV1 50.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6454 PV1 50.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6455 PV1 50.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6456 PV1 50.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No     6457 PV1 50.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No     6458 PV1 50.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396     6459 PV1 50.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No     6460 PV1 50.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No     6461 PV1 50.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No     6462 PV1 51 Visit Indicator F IS 1 O O No [0 .. 1] [0 .. 1] No 0326     6463 PV1 52 Other Healthcare Provider F XCN 2945 O O No [0 .. 1] [0 .. 1] No 0010         7001 PV2 1 Prior Pending Location F PL 1230 C C No [0 .. 1] [0 .. 1] No 7002 PV2 1.1 Point of Care C IS 20 O O No [0 .. 1] [0 .. 1] No 0302 7003 PV2 1.2 Room C IS 20 O O No [0 .. 1] [0 .. 1] No 0303 7004 PV2 1.3 Bed C IS 20 O O No [0 .. 1] [0 .. 1] No 0304 7005 PV2 1.4 Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 7006 PV2 1.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 7007 PV2 1.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7008 PV2 1.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 7009 PV2 1.5 Location Status C IS 20 O O No [0 .. 1] [0 .. 1] No 0306 7010 PV2 1.6 Person Location Type C IS 20 C C No [0 .. 1] [0 .. 1] No 0305 7011 PV2 1.7 Building C IS 20 O O No [0 .. 1] [0 .. 1] No 0307 7012 PV2 1.8 Floor C IS 20 O O No [0 .. 1] [0 .. 1] No 0308 7013 PV2 1.9 Location Description C ST 199 O O No [0 .. 1] [0 .. 1] No 7014 PV2 1.10 Comprehensive Location Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No 7015 PV2 1.10.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No 7016 PV2 1.10.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363 7017 PV2 1.10.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7018 PV2 1.10.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301 7019 PV2 1.11 Assigning Authority for Location C HD 227 O O No [0 .. 1] [0 .. 1] No 7020 PV2 1.11.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 7021 PV2 1.11.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7022 PV2 1.11.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 7023 PV2 2 Accommodation Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0129 7024 PV2 2.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7025 PV2 2.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7026 PV2 2.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7027 PV2 2.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7028 PV2 2.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7029 PV2 2.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7030 PV2 3 Admit Reason F CE 483 O O No [0 .. 1] [0 .. 1] No 7031 PV2 3.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7032 PV2 3.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7033 PV2 3.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7034 PV2 3.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7035 PV2 3.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7036 PV2 3.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7037 PV2 4 Transfer Reason F CE 483 O O No [0 .. 1] [0 .. 1] No 7038 PV2 4.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7039 PV2 4.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7040 PV2 4.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7041 PV2 4.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7042 PV2 4.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7043 PV2 4.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7044 PV2 5 Patient Valuables F ST 25 O O No [0 .. *] [0 .. *] No 7045 PV2 6 Patient Valuables Location F ST 25 O O No [0 .. 1] [0 .. 1] No 7046 PV2 7 Visit User Code F IS 2 O O No [0 .. *] [0 .. *] No 0130 7047 PV2 8 Expected Admit Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 7048 PV2 8.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 7049 PV2 8.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7050 PV2 9 Expected Discharge Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 7051 PV2 9.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 7052 PV2 9.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7053 PV2 10 Estimated Length of Inpatient Stay F NM 3 O O No [0 .. 1] [0 .. 1] No 7054 PV2 11 Actual Length of Inpatient Stay F NM 3 O O No [0 .. 1] [0 .. 1] No 7055 PV2 12 Visit Description F ST 50 O O No [0 .. 1] [0 .. 1] No 7056 PV2 13 Referral Source Code F XCN 2945 O O No [0 .. *] [0 .. *] No 7057 PV2 13.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 7058 PV2 13.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 7059 PV2 13.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 7060 PV2 13.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 7061 PV2 13.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 7062 PV2 13.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 7063 PV2 13.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 7064 PV2 13.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 7065 PV2 13.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 7066 PV2 13.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 7067 PV2 13.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 7068 PV2 13.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 7069 PV2 13.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 7070 PV2 13.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 7071 PV2 13.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 7072 PV2 13.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7073 PV2 13.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 7074 PV2 13.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 7075 PV2 13.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 7076 PV2 13.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 7077 PV2 13.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 7078 PV2 13.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 7079 PV2 13.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 7080 PV2 13.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7081 PV2 13.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 7082 PV2 13.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 7083 PV2 13.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 7084 PV2 13.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 7085 PV2 13.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7086 PV2 13.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7087 PV2 13.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 7088 PV2 13.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7089 PV2 13.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7090 PV2 13.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 7091 PV2 13.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 7092 PV2 13.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 7093 PV2 13.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 7094 PV2 13.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7095 PV2 13.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 7096 PV2 13.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 7097 PV2 13.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7098 PV2 13.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 7099 PV2 13.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 7100 PV2 13.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 7101 PV2 13.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7102 PV2 13.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7103 PV2 13.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 7104 PV2 13.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7105 PV2 13.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7106 PV2 13.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 7107 PV2 13.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 7108 PV2 13.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 7109 PV2 13.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 7110 PV2 13.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 7111 PV2 13.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7112 PV2 13.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7113 PV2 13.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 7114 PV2 13.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7115 PV2 13.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7116 PV2 13.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 7117 PV2 13.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 7118 PV2 13.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 7119 PV2 14 Previous Service Date F DT 8 O O No [0 .. 1] [0 .. 1] No 7120 PV2 15 Employment Illness Related Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7121 PV2 16 Purge Status Code F IS 1 O O No [0 .. 1] [0 .. 1] No 0213 7122 PV2 17 Purge Status Date F DT 8 O O No [0 .. 1] [0 .. 1] No 7123 PV2 18 Special Program Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0214 7124 PV2 19 Retention Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7125 PV2 20 Expected Number of Insurance Plans F NM 1 O O No [0 .. 1] [0 .. 1] No 7126 PV2 21 Visit Publicity Code F IS 1 O O No [0 .. 1] [0 .. 1] No 0215 7127 PV2 22 Visit Protection Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7128 PV2 23 Clinic Organization Name F XON 563 O O No [0 .. *] [0 .. *] No 7129 PV2 23.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 7130 PV2 23.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 7131 PV2 23.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 7132 PV2 23.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 7133 PV2 23.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 7134 PV2 23.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 7135 PV2 23.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 7136 PV2 23.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7137 PV2 23.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 7138 PV2 23.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 7139 PV2 23.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 7140 PV2 23.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 7141 PV2 23.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 7142 PV2 23.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 7143 PV2 23.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 7144 PV2 23.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 7145 PV2 24 Patient Status Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0216 7146 PV2 25 Visit Priority Code F IS 1 O O No [0 .. 1] [0 .. 1] No 0217 7147 PV2 26 Previous Treatment Date F DT 8 O O No [0 .. 1] [0 .. 1] No 7148 PV2 27 Expected Discharge Disposition F IS 2 O O No [0 .. 1] [0 .. 1] No 0112 7149 PV2 28 Signature on File Date F DT 8 O O No [0 .. 1] [0 .. 1] No 7150 PV2 29 First Similar Illness Date F DT 8 O O No [0 .. 1] [0 .. 1] No 7151 PV2 30 Patient Charge Adjustment Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0218 7152 PV2 30.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7153 PV2 30.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7154 PV2 30.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7155 PV2 30.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7156 PV2 30.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7157 PV2 30.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7158 PV2 31 Recurring Service Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0219 7159 PV2 32 Billing Media Code F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7160 PV2 33 Expected Surgery Date and Time F TS 26 O O No [0 .. 1] [0 .. 1] No 7161 PV2 33.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 7162 PV2 33.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7163 PV2 34 Military Partnership Code F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7164 PV2 35 Military Non-Availability Code F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7165 PV2 36 Newborn Baby Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7166 PV2 37 Baby Detained Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 7167 PV2 38 Mode of Arrival Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0430 7168 PV2 38.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7169 PV2 38.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7170 PV2 38.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7171 PV2 38.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7172 PV2 38.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7173 PV2 38.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7174 PV2 39 Recreational Drug Use Code F CE 483 O O No [0 .. *] [0 .. *] No 0431 7175 PV2 39.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7176 PV2 39.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7177 PV2 39.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7178 PV2 39.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7179 PV2 39.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7180 PV2 39.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7181 PV2 40 Admission Level of Care Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0432 7182 PV2 40.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7183 PV2 40.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7184 PV2 40.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7185 PV2 40.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7186 PV2 40.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7187 PV2 40.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7188 PV2 41 Precaution Code F CE 483 O O No [0 .. *] [0 .. *] No 0433 7189 PV2 41.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7190 PV2 41.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7191 PV2 41.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7192 PV2 41.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7193 PV2 41.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7194 PV2 41.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7195 PV2 42 Patient Condition Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0434 7196 PV2 42.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7197 PV2 42.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7198 PV2 42.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7199 PV2 42.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7200 PV2 42.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7201 PV2 42.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7202 PV2 43 Living Will Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0315 7203 PV2 44 Organ Donor Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0316 7204 PV2 45 Advance Directive Code F CE 483 O O No [0 .. *] [0 .. *] No 0435 7205 PV2 45.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7206 PV2 45.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7207 PV2 45.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7208 PV2 45.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 7209 PV2 45.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 7210 PV2 45.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 7211 PV2 46 Patient Status Effective Date F DT 8 O O No [0 .. 1] [0 .. 1] No 7212 PV2 47 Expected LOA Return Date/Time F TS 26 C C No [0 .. 1] [0 .. 1] No 7213 PV2 47.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 7214 PV2 47.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7215 PV2 48 Expected Pre-admission Testing Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 7216 PV2 48.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 7217 PV2 48.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 7218 PV2 49 Notify Clergy Code F IS 20 O O No [0 .. *] [0 .. *] No 0534 8001 GT1 1 Set ID - GT1 F SI 4 R R No [1 .. 1] [1 .. 1] No 8002 GT1 2 Guarantor Number F CX 1913 O O No [0 .. *] [0 .. *] No 8003 GT1 1.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 8004 GT1 1.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 8005 GT1 1.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 8006 GT1 1.4 Assigning Agency or Department C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 8007 GT1 1.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8008 GT1 1.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8009 GT1 1.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8010 GT1 1.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 8011 GT1 1.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 8012 GT1 1.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8013 GT1 1.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8014 GT1 1.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8015 GT1 1.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 8016 GT1 1.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 8017 GT1 1.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 8018 GT1 1.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8019 GT1 1.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8020 GT1 1.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8021 GT1 1.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8022 GT1 1.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8023 GT1 1.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8024 GT1 1.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 8025 GT1 1.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 8026 GT1 1.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 8027 GT1 1.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 8028 GT1 1.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8029 GT1 1.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8030 GT1 1.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8031 GT1 1.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8032 GT1 1.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8033 GT1 1.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8034 GT1 1.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 8035 GT1 1.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 8036 GT1 1.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 8037 GT1 3 Guarantor Name F XPN 1044 R R No [1 .. *] [1 .. *] No 8038 GT1 3.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 8039 GT1 3.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 8040 GT1 3.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 8041 GT1 3.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 8042 GT1 3.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 8043 GT1 3.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 8044 GT1 3.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 8045 GT1 3.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 8046 GT1 3.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 8047 GT1 3.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 8048 GT1 3.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 8049 GT1 3.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 8050 GT1 3.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8051 GT1 3.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 8052 GT1 3.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8053 GT1 3.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8054 GT1 3.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8055 GT1 3.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8056 GT1 3.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8057 GT1 3.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8058 GT1 3.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8059 GT1 3.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 8060 GT1 3.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8061 GT1 3.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8062 GT1 3.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8063 GT1 3.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8064 GT1 3.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8065 GT1 3.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8066 GT1 3.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 8067 GT1 4 Guarantor Spouse Name F XPN 1044 O O No [0 .. *] [0 .. *] No 8068 GT1 4.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 8069 GT1 4.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 8070 GT1 4.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 8071 GT1 4.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 8072 GT1 4.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 8073 GT1 4.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 8074 GT1 4.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 8075 GT1 4.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 8076 GT1 4.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 8077 GT1 4.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 8078 GT1 4.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 8079 GT1 4.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 8080 GT1 4.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8081 GT1 4.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 8082 GT1 4.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8083 GT1 4.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8084 GT1 4.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8085 GT1 4.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8086 GT1 4.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8087 GT1 4.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8088 GT1 4.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8089 GT1 4.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 8090 GT1 4.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8091 GT1 4.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8092 GT1 4.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8093 GT1 4.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8094 GT1 4.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8095 GT1 4.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8096 GT1 4.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 8097 GT1 5 Guarantor Address F XAD 578 O O No [0 .. *] [0 .. *] No 8098 GT1 5.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No 8099 GT1 5.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No 8100 GT1 5.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No 8101 GT1 5.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No 8102 GT1 5.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No 8103 GT1 5.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No 8104 GT1 5.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No 8105 GT1 5.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No 8106 GT1 5.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399 8107 GT1 5.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190 8108 GT1 5.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No 8109 GT1 5.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289 8110 GT1 5.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288 8111 GT1 5.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8112 GT1 5.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8113 GT1 5.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8114 GT1 5.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8115 GT1 5.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8116 GT1 5.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8117 GT1 5.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8118 GT1 5.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8119 GT1 6 Guarantor Ph Num - Home F XTN 651 O O No [0 .. *] [0 .. *] No 8120 GT1 6.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 8121 GT1 6.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 8122 GT1 6.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 8123 GT1 6.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8124 GT1 6.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 8125 GT1 6.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 8126 GT1 6.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 8127 GT1 6.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 8128 GT1 6.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 8129 GT1 6.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 8130 GT1 6.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 8131 GT1 6.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 8132 GT1 7 Guarantor Ph Num - Business F XTN 651 O O No [0 .. *] [0 .. *] No 8133 GT1 7.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 8134 GT1 7.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 8135 GT1 7.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 8136 GT1 7.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8137 GT1 7.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 8138 GT1 7.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 8139 GT1 7.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 8140 GT1 7.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 8141 GT1 7.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 8142 GT1 7.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 8143 GT1 7.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 8144 GT1 7.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 8145 GT1 8 Guarantor Date/Time Of Birth F TS 26 O O No [0 .. 1] [0 .. 1] No 8146 GT1 8.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 8147 GT1 8.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8148 GT1 9 Guarantor Administrative Sex F IS 1 O O No [0 .. 1] [0 .. 1] No 0001 8149 GT1 10 Guarantor Type F IS 2 O O No [0 .. 1] [0 .. 1] No 0068 8150 GT1 11 Guarantor Relationship F CE 483 O O No [0 .. 1] [0 .. 1] No 0063 8151 GT1 11.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8152 GT1 11.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8153 GT1 11.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8154 GT1 11.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8155 GT1 11.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8156 GT1 11.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8157 GT1 12 Guarantor SSN F ST 11 O O No [0 .. 1] [0 .. 1] No 8158 GT1 13 Guarantor Date - Begin F DT 8 O O No [0 .. 1] [0 .. 1] No 8159 GT1 14 Guarantor Date - End F DT 8 O O No [0 .. 1] [0 .. 1] No 8160 GT1 15 Guarantor Priority F NM 2 O O No [0 .. 1] [0 .. 1] No 8161 GT1 16 Guarantor Employer Name F XPN 1044 O O No [0 .. *] [0 .. *] No 8162 GT1 16.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 8163 GT1 16.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 8164 GT1 16.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 8165 GT1 16.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 8166 GT1 16.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 8167 GT1 16.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 8168 GT1 16.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 8169 GT1 16.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 8170 GT1 16.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 8171 GT1 16.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 8172 GT1 16.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 8173 GT1 16.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 8174 GT1 16.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8175 GT1 16.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 8176 GT1 16.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8177 GT1 16.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8178 GT1 16.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8179 GT1 16.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8180 GT1 16.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8181 GT1 16.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8182 GT1 16.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8183 GT1 16.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 8184 GT1 16.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8185 GT1 16.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8186 GT1 16.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8187 GT1 16.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8188 GT1 16.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8189 GT1 16.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8190 GT1 16.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 8191 GT1 17 Guarantor Employer Address F XAD 578 O O No [0 .. *] [0 .. *] No 8192 GT1 17.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No 8193 GT1 17.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No 8194 GT1 17.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No 8195 GT1 17.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No 8196 GT1 17.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No 8197 GT1 17.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No 8198 GT1 17.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No 8199 GT1 17.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No 8200 GT1 17.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399 8201 GT1 17.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190 8202 GT1 17.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No 8203 GT1 17.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289 8204 GT1 17.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288 8205 GT1 17.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8206 GT1 17.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8207 GT1 17.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8208 GT1 17.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8209 GT1 17.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8210 GT1 17.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8211 GT1 17.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8212 GT1 17.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8213 GT1 18 Guarantor Employer Phone Number F XTN 651 O O No [0 .. *] [0 .. *] No 8214 GT1 18.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 8215 GT1 18.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 8216 GT1 18.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 8217 GT1 18.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8218 GT1 18.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 8219 GT1 18.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 8220 GT1 18.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 8221 GT1 18.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 8222 GT1 18.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 8223 GT1 18.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 8224 GT1 18.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 8225 GT1 18.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 8226 GT1 19 Guarantor Employee ID Number F CX 1913 O O No [0 .. *] [0 .. *] No 8227 GT1 19.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 8228 GT1 19.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 8229 GT1 19.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 8230 GT1 19.4 Assigning Agency or Department C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 8231 GT1 19.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8232 GT1 19.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8233 GT1 19.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8234 GT1 19.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 8235 GT1 19.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 8236 GT1 19.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8237 GT1 19.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8238 GT1 19.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8239 GT1 19.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 8240 GT1 19.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 8241 GT1 19.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 8242 GT1 19.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8243 GT1 19.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8244 GT1 19.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8245 GT1 19.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8246 GT1 19.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8247 GT1 19.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8248 GT1 19.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 8249 GT1 19.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 8250 GT1 19.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 8251 GT1 19.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 8252 GT1 19.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8253 GT1 19.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8254 GT1 19.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8255 GT1 19.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8256 GT1 19.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8257 GT1 19.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8258 GT1 19.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 8259 GT1 19.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 8260 GT1 19.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 8261 GT1 20 Guarantor Employment Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0066 8262 GT1 21 Guarantor Organization Name F XON 563 O O No [0 .. *] [0 .. *] No 8263 GT1 21.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 8264 GT1 21.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 8265 GT1 21.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 8266 GT1 21.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 8267 GT1 21.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 8268 GT1 21.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 8269 GT1 21.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8270 GT1 21.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8271 GT1 21.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8272 GT1 21.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 8273 GT1 21.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 8274 GT1 21.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8275 GT1 21.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8276 GT1 21.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8277 GT1 21.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8278 GT1 21.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 8279 GT1 22 Guarantor Billing Hold Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 8280 GT1 23 Guarantor Credit Rating Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0341 8281 GT1 23.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8282 GT1 23.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8283 GT1 23.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8284 GT1 23.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8285 GT1 23.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8286 GT1 23.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8287 GT1 24 Guarantor Death Date And Time F TS 26 O O No [0 .. 1] [0 .. 1] No 8288 GT1 24.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 8289 GT1 24.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8290 GT1 25 Guarantor Death Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 8291 GT1 26 Guarantor Charge Adjustment Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0218 8292 GT1 26.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8293 GT1 26.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8294 GT1 26.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8295 GT1 26.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8296 GT1 26.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8297 GT1 26.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8298 GT1 27 Guarantor Household Annual Income F CP 543 O O No [0 .. 1] [0 .. 1] No 8299 GT1 27.1 Price C MO 20 R R No [1 .. 1] [1 .. 1] No 8300 GT1 27.1.1 Quantity S NM 16 O O No [0 .. 1] [0 .. 1] No 8301 GT1 27.1.2 Denomination S ID 3 O O No [0 .. 1] [0 .. 1] No 8302 GT1 27.2 Price Type C ID 2 O O No [0 .. 1] [0 .. 1] No 0205 8303 GT1 27.3 From Value C NM 16 O O No [0 .. 1] [0 .. 1] No 8304 GT1 27.4 To Value C NM 16 O O No [0 .. 1] [0 .. 1] No 8305 GT1 27.5 Range Units C CE 483 O O No [0 .. 1] [0 .. 1] No 8306 GT1 27.5.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8307 GT1 27.5.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8308 GT1 27.5.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8309 GT1 27.5.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8310 GT1 27.5.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8311 GT1 27.5.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8312 GT1 27.6 Range Type C ID 1 O O No [0 .. 1] [0 .. 1] No 0298 8313 GT1 28 Guarantor Household Size F NM 3 O O No [0 .. 1] [0 .. 1] No 8314 GT1 29 Guarantor Employer ID Number F CX 1913 O O No [0 .. *] [0 .. *] No 8315 GT1 29.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 8316 GT1 29.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 8317 GT1 29.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 8318 GT1 29.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 8319 GT1 29.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8320 GT1 29.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8321 GT1 29.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8322 GT1 29.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 8323 GT1 29.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 8324 GT1 29.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8325 GT1 29.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8326 GT1 29.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8327 GT1 29.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 8328 GT1 29.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 8329 GT1 29.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 8330 GT1 29.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8331 GT1 29.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8332 GT1 29.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8333 GT1 29.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8334 GT1 29.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8335 GT1 29.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8336 GT1 29.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 8337 GT1 29.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 8338 GT1 29.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 8339 GT1 29.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 8340 GT1 29.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8341 GT1 29.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8342 GT1 29.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8343 GT1 29.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8344 GT1 29.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8345 GT1 29.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8346 GT1 29.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 8347 GT1 29.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 8348 GT1 29.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 8349 GT1 30 Guarantor Marital Status Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0002 8350 GT1 30.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8351 GT1 30.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8352 GT1 30.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8353 GT1 30.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8354 GT1 30.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8355 GT1 30.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8356 GT1 31 Guarantor Hire Effective Date F DT 8 O O No [0 .. 1] [0 .. 1] No 8357 GT1 32 Employment Stop Date F DT 8 O O No [0 .. 1] [0 .. 1] No 8358 GT1 33 Living Dependency F IS 2 O O No [0 .. 1] [0 .. 1] No 0223 8359 GT1 34 Ambulatory Status F IS 2 O O No [0 .. *] [0 .. *] No 0009 8360 GT1 35 Citizenship F CE 483 O O No [0 .. *] [0 .. *] No 0171 8361 GT1 35.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8362 GT1 35.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8363 GT1 35.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8364 GT1 35.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8365 GT1 35.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8366 GT1 35.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8367 GT1 36 Primary Language F CE 483 O O No [0 .. 1] [0 .. 1] No 0296 8368 GT1 36.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8369 GT1 36.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8370 GT1 36.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8371 GT1 36.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8372 GT1 36.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8373 GT1 36.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8374 GT1 37 Living Arrangement F IS 2 O O No [0 .. 1] [0 .. 1] No 0220 8375 GT1 38 Publicity Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0215 8376 GT1 38.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8377 GT1 38.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8378 GT1 38.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8379 GT1 38.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8380 GT1 38.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8381 GT1 38.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8382 GT1 39 Protection Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 8383 GT1 40 Student Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0231 8384 GT1 41 Religion F CE 483 O O No [0 .. 1] [0 .. 1] No 0006 8385 GT1 41.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8386 GT1 41.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8387 GT1 41.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8388 GT1 41.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8389 GT1 41.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8390 GT1 41.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8391 GT1 42 Mother's Maiden Name F XPN 1044 O O No [0 .. *] [0 .. *] No 8392 GT1 42.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 8393 GT1 42.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 8394 GT1 42.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 8395 GT1 42.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 8396 GT1 42.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 8397 GT1 42.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 8398 GT1 42.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 8399 GT1 42.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 8400 GT1 42.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 8401 GT1 42.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 8402 GT1 42.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 8403 GT1 42.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 8404 GT1 42.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8405 GT1 42.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 8406 GT1 42.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8407 GT1 42.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8408 GT1 42.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8409 GT1 42.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8410 GT1 42.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8411 GT1 42.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8412 GT1 42.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8413 GT1 42.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 8414 GT1 42.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8415 GT1 42.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8416 GT1 42.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8417 GT1 42.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8418 GT1 42.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8419 GT1 42.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8420 GT1 42.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 8421 GT1 43 Nationality F CE 483 O O No [0 .. 1] [0 .. 1] No 0212 8422 GT1 43.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8423 GT1 43.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8424 GT1 43.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8425 GT1 43.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8426 GT1 43.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8427 GT1 43.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8428 GT1 44 Ethnic Group F CE 483 O O No [0 .. *] [0 .. *] No 0189 8429 GT1 44.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8430 GT1 44.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8431 GT1 44.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8432 GT1 44.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8433 GT1 44.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8434 GT1 44.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8435 GT1 45 Contact Person's Name F XPN 1044 O O No [0 .. *] [0 .. *] No 8436 GT1 45.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 8437 GT1 45.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 8438 GT1 45.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 8439 GT1 45.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 8440 GT1 45.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 8441 GT1 45.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 8442 GT1 45.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 8443 GT1 45.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 8444 GT1 45.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 8445 GT1 45.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 8446 GT1 45.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 8447 GT1 45.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 8448 GT1 45.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8449 GT1 45.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 8450 GT1 45.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8451 GT1 45.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8452 GT1 45.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8453 GT1 45.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 8454 GT1 45.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8455 GT1 45.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8456 GT1 45.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 8457 GT1 45.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 8458 GT1 45.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8459 GT1 45.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8460 GT1 45.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8461 GT1 45.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 8462 GT1 45.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8463 GT1 45.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8464 GT1 45.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 8465 GT1 46 Contact Person's Telephone Number F XTN 651 O O No [0 .. *] [0 .. *] No 8466 GT1 46.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 8467 GT1 46.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 8468 GT1 46.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 8469 GT1 46.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8470 GT1 46.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 8471 GT1 46.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 8472 GT1 46.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 8473 GT1 46.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 8474 GT1 46.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 8475 GT1 46.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 8476 GT1 46.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 8477 GT1 46.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 8478 GT1 47 Contact Reason F CE 483 O O No [0 .. 1] [0 .. 1] No 0222 8479 GT1 47.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8480 GT1 47.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8481 GT1 47.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8482 GT1 47.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8483 GT1 47.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8484 GT1 47.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8485 GT1 48 Contact Relationship F IS 3 O O No [0 .. 1] [0 .. 1] No 0063 8486 GT1 49 Job Title F ST 20 O O No [0 .. 1] [0 .. 1] No 8487 GT1 50 Job Code/Class F JCC 292 O O No [0 .. 1] [0 .. 1] No 8488 GT1 50.1 Job Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0327 8489 GT1 50.2 Job Class C IS 20 O O No [0 .. 1] [0 .. 1] No 0328 8490 GT1 50.3 Job Description Text C TX 250 O O No [0 .. 1] [0 .. 1] No 8491 GT1 51 Guarantor Employer's Organization Name F XON 563 O O No [0 .. *] [0 .. *] No 8492 GT1 51.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 8493 GT1 51.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 8494 GT1 51.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 8495 GT1 51.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 8496 GT1 51.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 8497 GT1 51.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 8498 GT1 51.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8499 GT1 51.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8500 GT1 51.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8501 GT1 51.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 8502 GT1 51.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 8503 GT1 51.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 8504 GT1 51.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 8505 GT1 51.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 8506 GT1 51.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 8507 GT1 51.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 8508 GT1 52 Handicap F IS 2 O O No [0 .. 1] [0 .. 1] No 0295 8509 GT1 53 Job Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0311 8510 GT1 54 Guarantor Financial Class F FC 50 O O No [0 .. 1] [0 .. 1] No 8511 GT1 54.1 Financial Class Code C IS 20 R R No [1 .. 1] [1 .. 1] No 0064 8512 GT1 54.2 Effective Date C TS 26 RE RE No [0 .. 1] [0 .. 1] No 8513 GT1 54.2.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 8514 GT1 54.2.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 8515 GT1 55 Guarantor Race F CE 483 O O No [0 .. *] [0 .. *] No 0005 8516 GT1 55.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8517 GT1 55.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8518 GT1 55.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8519 GT1 55.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 8520 GT1 55.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 8521 GT1 55.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 8522 GT1 56 Guarantor Birth Place F ST 250 O O No [0 .. 1] [0 .. 1] No 8523 GT1 57 VIP Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0099 9001 IN1 1 Set ID - IN1 F SI 4 R R No [1 .. 1] [1 .. 1] No 9002 IN1 2 Insurance Plan ID F CE 483 R R No [1 .. 1] [1 .. 1] No 0072 9003 IN1 2.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 9004 IN1 2.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9005 IN1 2.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9006 IN1 2.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 9007 IN1 2.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9008 IN1 2.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9009 IN1 3 Insurance Company ID F CX 1913 R R No [1 .. *] [1 .. *] No 9010 IN1 3.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 9011 IN1 3.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 9012 IN1 3.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 9013 IN1 3.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 9014 IN1 3.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9015 IN1 3.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9016 IN1 3.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9017 IN1 3.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 9018 IN1 3.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9019 IN1 3.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9020 IN1 3.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9021 IN1 3.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9022 IN1 3.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 9023 IN1 3.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 9024 IN1 3.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 9025 IN1 3.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9026 IN1 3.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9027 IN1 3.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9028 IN1 3.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9029 IN1 3.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9030 IN1 3.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9031 IN1 3.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9032 IN1 3.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9033 IN1 3.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9034 IN1 3.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 9035 IN1 3.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9036 IN1 3.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9037 IN1 3.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9038 IN1 3.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9039 IN1 3.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9040 IN1 3.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9041 IN1 3.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9042 IN1 3.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9043 IN1 3.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9044 IN1 4 Insurance Company Name F XON 563 O O No [0 .. *] [0 .. *] No 9045 IN1 4.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 9046 IN1 4.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 9047 IN1 4.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 9048 IN1 4.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 9049 IN1 4.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 9050 IN1 4.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 9051 IN1 4.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9052 IN1 4.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9053 IN1 4.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9054 IN1 4.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 9055 IN1 4.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9056 IN1 4.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9057 IN1 4.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9058 IN1 4.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9059 IN1 4.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9060 IN1 4.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 9061 IN1 5 Insurance Company Address F XAD 578 O O No [0 .. *] [0 .. *] No 9062 IN1 5.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No 9063 IN1 5.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No 9064 IN1 5.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No 9065 IN1 5.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No 9066 IN1 5.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No 9067 IN1 5.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No 9068 IN1 5.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No 9069 IN1 5.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No 9070 IN1 5.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399 9071 IN1 5.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190 9072 IN1 5.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No 9073 IN1 5.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289 9074 IN1 5.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288 9075 IN1 5.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9076 IN1 5.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 9077 IN1 5.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9078 IN1 5.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9079 IN1 5.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9080 IN1 5.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9081 IN1 5.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9082 IN1 5.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9083 IN1 6 Insurance Co Contact Person F XPN 1044 O O No [0 .. *] [0 .. *] No 9084 IN1 6.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 9085 IN1 6.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 9086 IN1 6.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 9087 IN1 6.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 9088 IN1 6.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 9089 IN1 6.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 9090 IN1 6.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 9091 IN1 6.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 9092 IN1 6.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 9093 IN1 6.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 9094 IN1 6.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 9095 IN1 6.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 9096 IN1 6.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9097 IN1 6.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 9098 IN1 6.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9099 IN1 6.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9100 IN1 6.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9101 IN1 6.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9102 IN1 6.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9103 IN1 6.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9104 IN1 6.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 9105 IN1 6.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 9106 IN1 6.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9107 IN1 6.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9108 IN1 6.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9109 IN1 6.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9110 IN1 6.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9111 IN1 6.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9112 IN1 6.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 9113 IN1 7 Insurance Co Phone Number F XTN 651 O O No [0 .. *] [0 .. *] No 9114 IN1 7.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 9115 IN1 7.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 9116 IN1 7.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 9117 IN1 7.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9118 IN1 7.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 9119 IN1 7.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 9120 IN1 7.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 9121 IN1 7.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 9122 IN1 7.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 9123 IN1 7.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 9124 IN1 7.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 9125 IN1 7.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 9126 IN1 8 Group Number F ST 12 O O No [0 .. 1] [0 .. 1] No 9127 IN1 9 Group Name F XON 563 O O No [0 .. *] [0 .. *] No 9128 IN1 9.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 9129 IN1 9.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 9130 IN1 9.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 9131 IN1 9.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 9132 IN1 9.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 9133 IN1 9.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 9134 IN1 9.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9135 IN1 9.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9136 IN1 9.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9137 IN1 9.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 9138 IN1 9.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9139 IN1 9.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9140 IN1 9.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9141 IN1 9.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9142 IN1 9.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9143 IN1 9.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 9144 IN1 10 Insured's Group Emp ID F CX 1913 O O No [0 .. *] [0 .. *] No 9145 IN1 10.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 9146 IN1 10.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 9147 IN1 10.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 9148 IN1 10.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 9149 IN1 10.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9150 IN1 10.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9151 IN1 10.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9152 IN1 10.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 9153 IN1 10.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9154 IN1 10.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9155 IN1 10.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9156 IN1 10.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9157 IN1 10.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 9158 IN1 10.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 9159 IN1 10.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 9160 IN1 10.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9161 IN1 10.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9162 IN1 10.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9163 IN1 10.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9164 IN1 10.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9165 IN1 10.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9166 IN1 10.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9167 IN1 10.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9168 IN1 10.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9169 IN1 10.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 9170 IN1 10.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9171 IN1 10.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9172 IN1 10.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9173 IN1 10.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9174 IN1 10.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9175 IN1 10.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9176 IN1 10.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9177 IN1 10.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9178 IN1 10.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9179 IN1 11 Insured's Group Emp Name F XON 563 O O No [0 .. *] [0 .. *] No 9180 IN1 11.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 9181 IN1 11.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 9182 IN1 11.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 9183 IN1 11.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 9184 IN1 11.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 9185 IN1 11.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 9186 IN1 11.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9187 IN1 11.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9188 IN1 11.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9189 IN1 11.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 9190 IN1 11.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9191 IN1 11.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9192 IN1 11.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9193 IN1 11.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9194 IN1 11.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9195 IN1 11.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 9196 IN1 12 Plan Effective Date F DT 8 O O No [0 .. 1] [0 .. 1] No 9197 IN1 13 Plan Expiration Date F DT 8 O O No [0 .. 1] [0 .. 1] No 9198 IN1 14 Authorization Information F AUI 239 O O No [0 .. 1] [0 .. 1] No 9199 IN1 14.1 Authorization Number C ST 30 O O No [0 .. 1] [0 .. 1] No 9200 IN1 14.2 Date C DT 8 R R No [1 .. 1] [1 .. 1] No 9201 IN1 14.3 Source C ST 199 O O No [0 .. 1] [0 .. 1] No 9202 IN1 15 Plan Type F IS 3 O O No [0 .. 1] [0 .. 1] No 0086 9203 IN1 16 Name Of Insured F XPN 1044 O O No [0 .. *] [0 .. *] No 9204 IN1 16.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 9205 IN1 16.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 9206 IN1 16.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 9207 IN1 16.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 9208 IN1 16.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 9209 IN1 16.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 9210 IN1 16.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 9211 IN1 16.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 9212 IN1 16.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 9213 IN1 16.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 9214 IN1 16.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 9215 IN1 16.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 9216 IN1 16.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9217 IN1 16.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 9218 IN1 16.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9219 IN1 16.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9220 IN1 16.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9221 IN1 16.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9222 IN1 16.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9223 IN1 16.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9224 IN1 16.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 9225 IN1 16.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 9226 IN1 16.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9227 IN1 16.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9228 IN1 16.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9229 IN1 16.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9230 IN1 16.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9231 IN1 16.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9232 IN1 16.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 9233 IN1 17 Insured's Relationship To Patient F CE 483 O O No [0 .. 1] [0 .. 1] No 0063 9234 IN1 17.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 9235 IN1 17.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9236 IN1 17.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9237 IN1 17.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 9238 IN1 17.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9239 IN1 17.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9240 IN1 18 Insured's Date Of Birth F TS 26 O O No [0 .. 1] [0 .. 1] No 9241 IN1 18.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 9242 IN1 18.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9243 IN1 19 Insured's Address F XAD 578 O O No [0 .. *] [0 .. *] No 9244 IN1 19.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No 9245 IN1 19.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No 9246 IN1 19.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No 9247 IN1 19.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No 9248 IN1 19.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No 9249 IN1 19.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No 9250 IN1 19.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No 9251 IN1 19.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No 9252 IN1 19.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399 9253 IN1 19.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190 9254 IN1 19.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No 9255 IN1 19.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289 9256 IN1 19.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288 9257 IN1 19.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9258 IN1 19.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 9259 IN1 19.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9260 IN1 19.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9261 IN1 19.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9262 IN1 19.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9263 IN1 19.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9264 IN1 19.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9265 IN1 20 Assignment Of Benefits F IS 2 O O No [0 .. 1] [0 .. 1] No 0135 9266 IN1 21 Coordination Of Benefits F IS 2 O O No [0 .. 1] [0 .. 1] No 0173 9267 IN1 22 Coord Of Ben. Priority F ST 2 O O No [0 .. 1] [0 .. 1] No 9268 IN1 23 Notice Of Admission Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 9269 IN1 24 Notice Of Admission Date F DT 8 O O No [0 .. 1] [0 .. 1] No 9270 IN1 25 Report Of Eligibility Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 9271 IN1 26 Report Of Eligibility Date F DT 8 O O No [0 .. 1] [0 .. 1] No 9272 IN1 27 Release Information Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0093 9273 IN1 28 Pre-Admit Cert (PAC) F ST 15 O O No [0 .. 1] [0 .. 1] No 9274 IN1 29 Verification Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 9275 IN1 29.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 9276 IN1 29.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9277 IN1 30 Verification By F XCN 2945 O O No [0 .. *] [0 .. *] No 9278 IN1 30.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 9279 IN1 30.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 9280 IN1 30.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 9281 IN1 30.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 9282 IN1 30.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 9283 IN1 30.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 9284 IN1 30.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 9285 IN1 30.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 9286 IN1 30.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 9287 IN1 30.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 9288 IN1 30.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 9289 IN1 30.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 9290 IN1 30.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 9291 IN1 30.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 9292 IN1 30.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9293 IN1 30.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9294 IN1 30.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9295 IN1 30.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 9296 IN1 30.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 9297 IN1 30.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 9298 IN1 30.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 9299 IN1 30.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9300 IN1 30.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9301 IN1 30.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9302 IN1 30.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9303 IN1 30.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9304 IN1 30.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 9305 IN1 30.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9306 IN1 30.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9307 IN1 30.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9308 IN1 30.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9309 IN1 30.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9310 IN1 30.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9311 IN1 30.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 9312 IN1 30.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 9313 IN1 30.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9314 IN1 30.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9315 IN1 30.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9316 IN1 30.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9317 IN1 30.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9318 IN1 30.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9319 IN1 30.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 9320 IN1 30.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 9321 IN1 30.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9322 IN1 30.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9323 IN1 30.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9324 IN1 30.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9325 IN1 30.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9326 IN1 30.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9327 IN1 30.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9328 IN1 30.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9329 IN1 30.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9330 IN1 30.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 9331 IN1 30.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9332 IN1 30.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9333 IN1 30.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9334 IN1 30.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9335 IN1 30.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9336 IN1 30.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9337 IN1 30.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9338 IN1 30.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9339 IN1 30.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9340 IN1 31 Type Of Agreement Code F IS 2 O O No [0 .. 1] [0 .. 1] No 0098 9341 IN1 32 Billing Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0022 9342 IN1 33 Lifetime Reserve Days F NM 4 O O No [0 .. 1] [0 .. 1] No 9343 IN1 34 Delay Before L.R. Day F NM 4 O O No [0 .. 1] [0 .. 1] No 9344 IN1 35 Company Plan Code F IS 8 O O No [0 .. 1] [0 .. 1] No 0042 9345 IN1 36 Policy Number F ST 15 O O No [0 .. 1] [0 .. 1] No 9346 IN1 37 Policy Deductible F CP 543 O O No [0 .. 1] [0 .. 1] No 9347 IN1 37.1 Price C MO 20 R R No [1 .. 1] [1 .. 1] No 9348 IN1 37.1.1 Quantity S NM 16 O O No [0 .. 1] [0 .. 1] No 9349 IN1 37.1.2 Denomination S ID 3 O O No [0 .. 1] [0 .. 1] No 9350 IN1 37.2 Price Type C ID 2 O O No [0 .. 1] [0 .. 1] No 0205 9351 IN1 37.3 From Value C NM 16 O O No [0 .. 1] [0 .. 1] No 9352 IN1 37.4 To Value C NM 16 O O No [0 .. 1] [0 .. 1] No 9353 IN1 37.5 Range Units C CE 483 O O No [0 .. 1] [0 .. 1] No 9354 IN1 37.5.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9355 IN1 37.5.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9356 IN1 37.5.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9357 IN1 37.5.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9358 IN1 37.5.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9359 IN1 37.5.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9360 IN1 37.6 Range Type C ID 1 O O No [0 .. 1] [0 .. 1] No 0298 9361 IN1 38 Policy Limit - Amount F CP 543 X X No [0 .. 0] [0 .. 0] No 9362 IN1 39 Policy Limit - Days F NM 4 O O No [0 .. 1] [0 .. 1] No 9363 IN1 40 Room Rate - Semi-Private F CP 543 X X No [0 .. 0] [0 .. 0] No 9364 IN1 41 Room Rate - Private F CP 543 X X No [0 .. 0] [0 .. 0] No 9365 IN1 42 Insured's Employment Status F CE 483 O O No [0 .. 1] [0 .. 1] No 0066 9366 IN1 42.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 9367 IN1 42.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9368 IN1 42.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9369 IN1 42.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 9370 IN1 42.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 9371 IN1 42.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9372 IN1 43 Insured's Administrative Sex F IS 1 O O No [0 .. 1] [0 .. 1] No 0001 9373 IN1 44 Insured's Employer's Address F XAD 578 O O No [0 .. *] [0 .. *] No 9374 IN1 44.1 Street Address C SAD 184 RE RE No [0 .. 1] [0 .. 1] No 9375 IN1 44.1.1 Street or Mailing Address S ST 120 R R No [1 .. 1] [1 .. 1] No 9376 IN1 44.1.2 Street Name S ST 50 O O No [0 .. 1] [0 .. 1] No 9377 IN1 44.1.3 Dwelling Number S ST 12 O O No [0 .. 1] [0 .. 1] No 9378 IN1 44.2 Other Designation C ST 120 RE RE No [0 .. 1] [0 .. 1] No 9379 IN1 44.3 City C ST 50 RE RE No [0 .. 1] [0 .. 1] No 9380 IN1 44.4 State or Province C ST 50 RE RE No [0 .. 1] [0 .. 1] No 9381 IN1 44.5 Zip or Postal Code C ST 12 RE RE No [0 .. 1] [0 .. 1] No 9382 IN1 44.6 Country C ID 3 O O No [0 .. 1] [0 .. 1] No 0399 9383 IN1 44.7 Address Type C ID 3 R R No [1 .. 1] [1 .. 1] No 0190 9384 IN1 44.8 Other Geographic Designation C ST 50 O O No [0 .. 1] [0 .. 1] No 9385 IN1 44.9 County/Parish Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0289 9386 IN1 44.10 Census Tract C IS 20 O O No [0 .. 1] [0 .. 1] No 0288 9387 IN1 44.11 Address Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 9388 IN1 44.12 Address Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 9389 IN1 44.13 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9390 IN1 44.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9391 IN1 44.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9392 IN1 44.14 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 9393 IN1 44.14.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 9394 IN1 44.14.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 9395 IN1 45 Verification Status F ST 2 O O No [0 .. 1] [0 .. 1] No 9396 IN1 46 Prior Insurance Plan ID F IS 8 O O No [0 .. 1] [0 .. 1] No 0072 9397 IN1 47 Coverage Type F IS 3 O O No [0 .. 1] [0 .. 1] No 0309 9398 IN1 48 Handicap F IS 2 O O No [0 .. 1] [0 .. 1] No 0295 9399 IN1 49 Insured's ID Number F CX 1913 O O No [0 .. *] [0 .. *] No 9400 IN1 49.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 9401 IN1 49.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 9402 IN1 49.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 9403 IN1 49.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 9404 IN1 49.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9405 IN1 49.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9406 IN1 49.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9407 IN1 49.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 9408 IN1 49.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 9409 IN1 49.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 9410 IN1 49.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9411 IN1 49.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 9412 IN1 49.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 9413 IN1 49.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 9414 IN1 49.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 9415 IN1 49.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9416 IN1 49.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9417 IN1 49.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9418 IN1 49.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9419 IN1 49.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9420 IN1 49.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9421 IN1 49.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9422 IN1 49.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9423 IN1 49.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9424 IN1 49.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 9425 IN1 49.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9426 IN1 49.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9427 IN1 49.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9428 IN1 49.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 9429 IN1 49.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 9430 IN1 49.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 9431 IN1 49.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 9432 IN1 49.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 9433 IN1 49.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 9434 IN1 50 Signature Code F IS 1 O O No [0 .. 1] [0 .. 1] No 0535 9435 IN1 51 Signature Code Date F DT 8 O O No [0 .. 1] [0 .. 1] No 9436 IN1 52 Insured's Birth Place F ST 250 O O No [0 .. 1] [0 .. 1] No 9437 IN1 53 VIP Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0099 10001 IN2 1 Insured's Employee ID F CX 1913 O O No [0 .. *] [0 .. *] No 10002 IN2 1.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 10003 IN2 1.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 10004 IN2 1.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 10005 IN2 1.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 10006 IN2 1.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10007 IN2 1.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10008 IN2 1.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10009 IN2 1.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 10010 IN2 1.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10011 IN2 1.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10012 IN2 1.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10013 IN2 1.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10014 IN2 1.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10015 IN2 1.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10016 IN2 1.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 10017 IN2 1.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10018 IN2 1.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10019 IN2 1.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10020 IN2 1.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10021 IN2 1.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10022 IN2 1.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10023 IN2 1.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10024 IN2 1.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10025 IN2 1.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10026 IN2 1.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 10027 IN2 1.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10028 IN2 1.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10029 IN2 1.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10030 IN2 1.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10031 IN2 1.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10032 IN2 1.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10033 IN2 1.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10034 IN2 1.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10035 IN2 1.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10036 IN2 2 Insured's Social Security Number F ST 11 O O No [0 .. 1] [0 .. 1] No 10037 IN2 3 Insured's Employer's Name and ID F XCN 2945 O O No [0 .. *] [0 .. *] No 10038 IN2 3.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 10039 IN2 3.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 10040 IN2 3.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10041 IN2 3.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10042 IN2 3.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10043 IN2 3.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10044 IN2 3.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10045 IN2 3.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10046 IN2 3.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10047 IN2 3.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10048 IN2 3.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10049 IN2 3.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10050 IN2 3.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 10051 IN2 3.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 10052 IN2 3.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10053 IN2 3.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10054 IN2 3.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10055 IN2 3.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 10056 IN2 3.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 10057 IN2 3.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 10058 IN2 3.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 10059 IN2 3.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10060 IN2 3.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10061 IN2 3.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10062 IN2 3.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10063 IN2 3.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10064 IN2 3.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10065 IN2 3.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10066 IN2 3.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10067 IN2 3.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10068 IN2 3.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10069 IN2 3.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10070 IN2 3.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10071 IN2 3.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10072 IN2 3.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 10073 IN2 3.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10074 IN2 3.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10075 IN2 3.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10076 IN2 3.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10077 IN2 3.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10078 IN2 3.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10079 IN2 3.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10080 IN2 3.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 10081 IN2 3.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10082 IN2 3.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10083 IN2 3.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10084 IN2 3.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10085 IN2 3.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10086 IN2 3.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10087 IN2 3.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10088 IN2 3.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10089 IN2 3.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10090 IN2 3.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 10091 IN2 3.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10092 IN2 3.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10093 IN2 3.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10094 IN2 3.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10095 IN2 3.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10096 IN2 3.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10097 IN2 3.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10098 IN2 3.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10099 IN2 3.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10100 IN2 4 Employer Information Data F IS 1 O O No [0 .. 1] [0 .. 1] No 0139 10101 IN2 5 Mail Claim Party F IS 1 O O No [0 .. *] [0 .. *] No 0137 10102 IN2 6 Medicare Health Ins Card Number F ST 15 O O No [0 .. 1] [0 .. 1] No 10103 IN2 7 Medicaid Case Name F XPN 1044 O O No [0 .. *] [0 .. *] No 10104 IN2 7.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 10105 IN2 7.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10106 IN2 7.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10107 IN2 7.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10108 IN2 7.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10109 IN2 7.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10110 IN2 7.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 10111 IN2 7.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10112 IN2 7.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10113 IN2 7.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10114 IN2 7.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10115 IN2 7.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 10116 IN2 7.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10117 IN2 7.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10118 IN2 7.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10119 IN2 7.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10120 IN2 7.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10121 IN2 7.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10122 IN2 7.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10123 IN2 7.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10124 IN2 7.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10125 IN2 7.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 10126 IN2 7.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10127 IN2 7.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10128 IN2 7.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10129 IN2 7.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10130 IN2 7.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10131 IN2 7.13.1 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10132 IN2 7.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10133 IN2 8 Medicaid Case Number F ST 15 O O No [0 .. 1] [0 .. 1] No 10134 IN2 9 Military Sponsor Name F XPN 1044 O O No [0 .. *] [0 .. *] No 10135 IN2 9.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 10136 IN2 9.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10137 IN2 9.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10138 IN2 9.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10139 IN2 9.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10140 IN2 9.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10141 IN2 9.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 10142 IN2 9.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10143 IN2 9.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10144 IN2 9.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10145 IN2 9.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10146 IN2 9.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 10147 IN2 9.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10148 IN2 9.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10149 IN2 9.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10150 IN2 9.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10151 IN2 9.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10152 IN2 9.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10153 IN2 9.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10154 IN2 9.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10155 IN2 9.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10156 IN2 9.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 10157 IN2 9.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10158 IN2 9.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10159 IN2 9.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10160 IN2 9.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10161 IN2 9.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10162 IN2 9.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10163 IN2 9.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10164 IN2 10 Military ID Number F ST 20 O O No [0 .. 1] [0 .. 1] No 10165 IN2 11 Dependent Of Military Recipient F CE 483 O O No [0 .. 1] [0 .. 1] No 0342 10166 IN2 11.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10167 IN2 11.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10168 IN2 11.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10169 IN2 11.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10170 IN2 11.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10171 IN2 11.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10172 IN2 12 Military Organization F ST 25 O O No [0 .. 1] [0 .. 1] No 10173 IN2 13 Military Station F ST 25 O O No [0 .. 1] [0 .. 1] No 10174 IN2 14 Military Service F IS 14 O O No [0 .. 1] [0 .. 1] No 0140 10175 IN2 15 Military Rank/Grade F IS 2 O O No [0 .. 1] [0 .. 1] No 0141 10176 IN2 16 Military Status F IS 3 O O No [0 .. 1] [0 .. 1] No 0142 10177 IN2 17 Military Retire Date F DT 8 O O No [0 .. 1] [0 .. 1] No 10178 IN2 18 Military Non-Avail Cert On File F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10179 IN2 19 Baby Coverage F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10180 IN2 20 Combine Baby Bill F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10181 IN2 21 Blood Deductible F ST 1 O O No [0 .. 1] [0 .. 1] No 10182 IN2 22 Special Coverage Approval Name F XPN 1044 O O No [0 .. *] [0 .. *] No 10183 IN2 22.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 10184 IN2 22.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10185 IN2 22.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10186 IN2 22.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10187 IN2 22.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10188 IN2 22.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10189 IN2 22.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 10190 IN2 22.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10191 IN2 22.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10192 IN2 22.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10193 IN2 22.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10194 IN2 22.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 10195 IN2 22.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10196 IN2 22.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10197 IN2 22.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10198 IN2 22.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10199 IN2 22.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10200 IN2 22.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10201 IN2 22.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10202 IN2 22.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10203 IN2 22.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10204 IN2 22.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 10205 IN2 22.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10206 IN2 22.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10207 IN2 22.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10208 IN2 22.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10209 IN2 22.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10210 IN2 22.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10211 IN2 22.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10212 IN2 23 Special Coverage Approval Title F ST 30 O O No [0 .. 1] [0 .. 1] No 10213 IN2 24 Non-Covered Insurance Code F IS 8 O O No [0 .. *] [0 .. *] No 0143 10214 IN2 25 Payor ID F CX 1913 O O No [0 .. *] [0 .. *] No 10215 IN2 25.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 10216 IN2 25.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 10217 IN2 25.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 10218 IN2 25.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 10219 IN2 25.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10220 IN2 25.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10221 IN2 25.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10222 IN2 25.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 10223 IN2 25.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10224 IN2 25.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10225 IN2 25.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10226 IN2 25.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10227 IN2 25.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10228 IN2 25.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10229 IN2 25.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 10230 IN2 25.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10231 IN2 25.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10232 IN2 25.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10233 IN2 25.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10234 IN2 25.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10235 IN2 25.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10236 IN2 25.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10237 IN2 25.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10238 IN2 25.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10239 IN2 25.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 10240 IN2 25.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10241 IN2 25.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10242 IN2 25.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10243 IN2 25.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10244 IN2 25.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10245 IN2 25.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10246 IN2 25.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10247 IN2 25.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10248 IN2 25.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10249 IN2 26 Payor Subscriber ID F CX 1913 O O No [0 .. *] [0 .. *] No 10250 IN2 26.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 10251 IN2 26.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 10252 IN2 26.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 10253 IN2 26.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 10254 IN2 26.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10255 IN2 26.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10256 IN2 26.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10257 IN2 26.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 10258 IN2 26.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10259 IN2 26.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10260 IN2 26.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10261 IN2 26.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10262 IN2 26.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10263 IN2 26.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10264 IN2 26.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 10265 IN2 26.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10266 IN2 26.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10267 IN2 26.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10268 IN2 26.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10269 IN2 26.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10270 IN2 26.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10271 IN2 26.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10272 IN2 26.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10273 IN2 26.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10274 IN2 26.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 10275 IN2 26.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10276 IN2 26.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10277 IN2 26.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10278 IN2 26.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10279 IN2 26.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10280 IN2 26.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10281 IN2 26.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10282 IN2 26.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10283 IN2 26.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10284 IN2 27 Eligibility Source F IS 1 O O No [0 .. 1] [0 .. 1] No 0144 10285 IN2 28 Room Coverage Type/Amount F RMC 82 O O No [0 .. *] [0 .. *] No 10286 IN2 28.1 Room Type C IS 20 R R No [1 .. 1] [1 .. 1] No 0145 10287 IN2 28.2 Amount Type C IS 20 O O No [0 .. 1] [0 .. 1] No 0146 10288 IN2 28.3 Coverage Amount C NM 0 X X No [0 .. 0] [0 .. 0] No 10289 IN2 28.4 Money or Percentage C MOP 23 R R No [1 .. 1] [1 .. 1] No 10290 IN2 28.4.1 Money or Percentage Indicator S ID 2 R R No [1 .. 1] [1 .. 1] No 0148 10291 IN2 28.4.2 Money or Percentage Quantity S NM 16 R R No [1 .. 1] [1 .. 1] No 10292 IN2 28.4.3 Currency Denomination S ID 3 O O No [0 .. 1] [0 .. 1] No 10293 IN2 29 Policy Type/Amount F PTA 56 O O No [0 .. *] [0 .. *] No 10294 IN2 29.1 Policy Type C IS 5 R R No [1 .. 1] [1 .. 1] No 0147 10295 IN2 29.2 Amount Class C IS 9 O O No [0 .. 1] [0 .. 1] No 0193 10296 IN2 29.3 Money or Percentage Quantity C NM 0 X X No [0 .. 0] [0 .. 0] No 10297 IN2 29.4 Money or Percentage C MOP 23 R R No [1 .. 1] [1 .. 1] No 10298 IN2 29.4.1 Money or Percentage Indicator S ID 2 R R No [1 .. 1] [1 .. 1] No 0148 10299 IN2 29.4.2 Money or Percentage Quantity S NM 16 R R No [1 .. 1] [1 .. 1] No 10300 IN2 29.4.3 Currency Denomination S ID 3 O O No [0 .. 1] [0 .. 1] No 10301 IN2 30 Daily Deductible F DDI 29 O O No [0 .. 1] [0 .. 1] No 10302 IN2 30.1 Delay Days C NM 3 O O No [0 .. 1] [0 .. 1] No 10303 IN2 30.2 Monetary Amount C MO 20 R R No [1 .. 1] [1 .. 1] No 10304 IN2 30.1 Quantity S NM 16 O O No [0 .. 1] [0 .. 1] No 10305 IN2 30.2 Denomination S ID 3 O O No [0 .. 1] [0 .. 1] No 10306 IN2 30.3 Number of Days C NM 4 O O No [0 .. 1] [0 .. 1] No 10307 IN2 31 Living Dependency F IS 2 O O No [0 .. 1] [0 .. 1] No 0223 10308 IN2 32 Ambulatory Status F IS 2 O O No [0 .. *] [0 .. *] No 0009 10309 IN2 33 Citizenship F CE 483 O O No [0 .. *] [0 .. *] No 0171 10310 IN2 33.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10311 IN2 33.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10312 IN2 33.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10313 IN2 33.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10314 IN2 33.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10315 IN2 33.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10316 IN2 34 Primary Language F CE 483 O O No [0 .. 1] [0 .. 1] No 0296 10317 IN2 34.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10318 IN2 34.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10319 IN2 34.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10320 IN2 34.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10321 IN2 34.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10322 IN2 34.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10323 IN2 35 Living Arrangement F IS 2 O O No [0 .. 1] [0 .. 1] No 0220 10324 IN2 36 Publicity Code F CE 483 O O No [0 .. 1] [0 .. 1] No 0215 10325 IN2 36.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10326 IN2 36.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10327 IN2 36.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10328 IN2 36.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10329 IN2 36.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10330 IN2 36.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10331 IN2 37 Protection Indicator F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10332 IN2 38 Student Indicator F IS 2 O O No [0 .. 1] [0 .. 1] No 0231 10333 IN2 39 Religion F CE 483 O O No [0 .. 1] [0 .. 1] No 0006 10334 IN2 39.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10335 IN2 39.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10336 IN2 39.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10337 IN2 39.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10338 IN2 39.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10339 IN2 39.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10340 IN2 40 Mother's Maiden Name F XPN 1044 O O No [0 .. *] [0 .. *] No 10341 IN2 40.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 10342 IN2 40.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10343 IN2 40.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10344 IN2 40.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10345 IN2 40.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10346 IN2 40.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10347 IN2 40.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 10348 IN2 40.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10349 IN2 40.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10350 IN2 40.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10351 IN2 40.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10352 IN2 40.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 10353 IN2 40.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10354 IN2 40.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10355 IN2 40.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10356 IN2 40.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10357 IN2 40.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10358 IN2 40.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10359 IN2 40.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10360 IN2 40.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10361 IN2 40.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10362 IN2 40.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 10363 IN2 40.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10364 IN2 40.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10365 IN2 40.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10366 IN2 40.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10367 IN2 40.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10368 IN2 40.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10369 IN2 40.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10370 IN2 41 Nationality F CE 483 O O No [0 .. 1] [0 .. 1] No 0212 10371 IN2 41.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10372 IN2 41.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10373 IN2 41.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10374 IN2 41.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10375 IN2 41.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10376 IN2 41.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10377 IN2 42 Ethnic Group F CE 483 O O No [0 .. *] [0 .. *] No 0189 10378 IN2 42.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10379 IN2 42.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10380 IN2 42.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10381 IN2 42.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10382 IN2 42.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10383 IN2 42.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10384 IN2 43 Marital Status F CE 483 O O No [0 .. *] [0 .. *] No 0002 10385 IN2 43.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10386 IN2 43.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10387 IN2 43.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10388 IN2 43.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10389 IN2 43.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10390 IN2 43.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10391 IN2 44 Insured's Employment Start Date F DT 8 O O No [0 .. 1] [0 .. 1] No 10392 IN2 45 Employment Stop Date F DT 8 O O No [0 .. 1] [0 .. 1] No 10393 IN2 46 Job Title F ST 20 O O No [0 .. 1] [0 .. 1] No 10394 IN2 47 Job Code/Class F JCC 292 O O No [0 .. 1] [0 .. 1] No 10395 IN2 47.1 Job Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0327 10396 IN2 47.2 Job Class C IS 20 O O No [0 .. 1] [0 .. 1] No 0328 10397 IN2 47.3 Job Description Text C TX 250 O O No [0 .. 1] [0 .. 1] No 10398 IN2 48 Job Status F IS 2 O O No [0 .. 1] [0 .. 1] No 0311 10399 IN2 49 Employer Contact Person Name F XPN 1044 O O No [0 .. *] [0 .. *] No 10400 IN2 49.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 10401 IN2 49.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10402 IN2 49.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10403 IN2 49.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10404 IN2 49.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10405 IN2 49.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10406 IN2 49.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 10407 IN2 49.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10408 IN2 49.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10409 IN2 49.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10410 IN2 49.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10411 IN2 49.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 10412 IN2 49.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10413 IN2 49.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10414 IN2 49.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10415 IN2 49.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10416 IN2 49.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10417 IN2 49.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10418 IN2 49.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10419 IN2 49.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10420 IN2 49.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10421 IN2 49.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 10422 IN2 49.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10423 IN2 49.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10424 IN2 49.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10425 IN2 49.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10426 IN2 49.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10427 IN2 49.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10428 IN2 49.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10429 IN2 50 Employer Contact Person Phone Number F XTN 651 O O No [0 .. *] [0 .. *] No 10430 IN2 50.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 10431 IN2 50.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 10432 IN2 50.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 10433 IN2 50.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10434 IN2 50.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 10435 IN2 50.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 10436 IN2 50.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 10437 IN2 50.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 10438 IN2 50.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 10439 IN2 50.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 10440 IN2 50.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 10441 IN2 50.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 10442 IN2 51 Employer Contact Reason F IS 2 O O No [0 .. 1] [0 .. 1] No 0222 10443 IN2 52 Insured's Contact Person's Name F XPN 1044 O O No [0 .. *] [0 .. *] No 10444 IN2 52.1 Family Name C FN 194 R R No [1 .. 1] [1 .. 1] No 10445 IN2 52.1.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 10446 IN2 52.1.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 10447 IN2 52.1.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 10448 IN2 52.1.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 10449 IN2 52.1.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 10450 IN2 52.2 Given Name C ST 30 R R No [1 .. 1] [1 .. 1] No 10451 IN2 52.3 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 10452 IN2 52.4 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 10453 IN2 52.5 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 10454 IN2 52.6 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 10455 IN2 52.7 Name Type Code C ID 1 RE RE No [0 .. 1] [0 .. 1] No 0200 10456 IN2 52.8 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10457 IN2 52.9 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 10458 IN2 52.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10459 IN2 52.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10460 IN2 52.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10461 IN2 52.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10462 IN2 52.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10463 IN2 52.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10464 IN2 52.10 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 10465 IN2 52.11 Name Assembly Order C ID 1 O O No [0 .. 1] [0 .. 1] No 0444 10466 IN2 52.12 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10467 IN2 52.12.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10468 IN2 52.12.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10469 IN2 52.13 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 10470 IN2 52.13.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 10471 IN2 52.13.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 10472 IN2 52.14 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 10473 IN2 53 Insured's Contact Person Phone Number F XTN 651 O O No [0 .. *] [0 .. *] No 10474 IN2 53.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 10475 IN2 53.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 10476 IN2 53.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 10477 IN2 53.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10478 IN2 53.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 10479 IN2 53.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 10480 IN2 53.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 10481 IN2 53.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 10482 IN2 53.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 10483 IN2 53.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 10484 IN2 53.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 10485 IN2 53.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 10486 IN2 54 Insured's Contact Person Reason F IS 2 O O No [0 .. *] [0 .. *] No 0222 10487 IN2 55 Relationship to the Patient Start Date F DT 8 O O No [0 .. 1] [0 .. 1] No 10488 IN2 56 Relationship to the Patient Stop Date F DT 8 O O No [0 .. *] [0 .. *] No 10489 IN2 57 Insurance Co. Contact Reason F IS 2 O O No [0 .. 1] [0 .. 1] No 0232 10490 IN2 58 Insurance Co Contact Phone Number F XTN 651 O O No [0 .. 1] [0 .. 1] No 10491 IN2 58.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 10492 IN2 58.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 10493 IN2 58.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 10494 IN2 58.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10495 IN2 58.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 10496 IN2 58.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 10497 IN2 58.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 10498 IN2 58.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 10499 IN2 58.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 10500 IN2 58.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 10501 IN2 58.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 10502 IN2 58.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 10503 IN2 59 Policy Scope F IS 2 O O No [0 .. 1] [0 .. 1] No 0312 10504 IN2 60 Policy Source F IS 2 O O No [0 .. 1] [0 .. 1] No 0313 10505 IN2 61 Patient Member Number F CX 1913 O O No [0 .. 1] [0 .. 1] No 10506 IN2 61.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 10507 IN2 61.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 10508 IN2 61.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 10509 IN2 61.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 10510 IN2 61.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10511 IN2 61.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10512 IN2 61.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10513 IN2 61.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 10514 IN2 61.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10515 IN2 61.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10516 IN2 61.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10517 IN2 61.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10518 IN2 61.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10519 IN2 61.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 10520 IN2 61.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 10521 IN2 61.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10522 IN2 61.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10523 IN2 61.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10524 IN2 61.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10525 IN2 61.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10526 IN2 61.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10527 IN2 61.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10528 IN2 61.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10529 IN2 61.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10530 IN2 61.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 10531 IN2 61.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10532 IN2 61.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10533 IN2 61.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10534 IN2 61.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 10535 IN2 61.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10536 IN2 61.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10537 IN2 61.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 10538 IN2 61.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 10539 IN2 61.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 10540 IN2 62 Guarantor's Relationship to Insured F CE 483 O O No [0 .. 1] [0 .. 1] No 0063 10541 IN2 62.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10542 IN2 62.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10543 IN2 62.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10544 IN2 62.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10545 IN2 62.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10546 IN2 62.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10547 IN2 63 Insured's Phone Number - Home F XTN 651 O O No [0 .. *] [0 .. *] No 10548 IN2 63.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 10549 IN2 63.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 10550 IN2 63.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 10551 IN2 63.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10552 IN2 63.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 10553 IN2 63.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 10554 IN2 63.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 10555 IN2 63.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 10556 IN2 63.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 10557 IN2 63.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 10558 IN2 63.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 10559 IN2 63.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 10560 IN2 64 Insured's Employer Phone Number F XTN 651 O O No [0 .. *] [0 .. *] No 10561 IN2 64.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 10562 IN2 64.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 10563 IN2 64.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 10564 IN2 64.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10565 IN2 64.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 10566 IN2 64.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 10567 IN2 64.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 10568 IN2 64.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 10569 IN2 64.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 10570 IN2 64.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 10571 IN2 64.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 10572 IN2 64.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 10573 IN2 65 Military Handicapped Program F CE 483 O O No [0 .. 1] [0 .. 1] No 0343 10574 IN2 65.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10575 IN2 65.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10576 IN2 65.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10577 IN2 65.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10578 IN2 65.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10579 IN2 65.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10580 IN2 66 Suspend Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10581 IN2 67 Copay Limit Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10582 IN2 68 Stoploss Limit Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 00136 10583 IN2 69 Insured Organization Name and ID F XON 563 O O No [0 .. *] [0 .. *] No 10584 IN2 69.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 10585 IN2 69.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 10586 IN2 69.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 10587 IN2 69.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 10588 IN2 69.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 10589 IN2 69.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 10590 IN2 69.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10591 IN2 69.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10592 IN2 69.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10593 IN2 69.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 10594 IN2 69.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10595 IN2 69.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10596 IN2 69.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10597 IN2 69.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10598 IN2 69.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10599 IN2 69.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 10600 IN2 70 Insured Employer Organization Name and ID F XON 563 O O No [0 .. *] [0 .. *] No 10601 IN2 70.1 Organization Name C ST 50 O O No [0 .. 1] [0 .. 1] No 10602 IN2 70.2 Organization Name Type Code C IS 20 O O No [0 .. 1] [0 .. 1] No 0204 10603 IN2 70.3 ID Number C NM 0 X X No [0 .. 0] [0 .. 0] No 10604 IN2 70.4 Check Digit C NM 1 O O No [0 .. 1] [0 .. 1] No 10605 IN2 70.5 Check Digit Scheme C ID 3 O O No [0 .. 1] [0 .. 1] No 0061 10606 IN2 70.6 Assigning Authority C HD 227 O O No [0 .. 1] [0 .. 1] No 0363 10607 IN2 70.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10608 IN2 70.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10609 IN2 70.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10610 IN2 70.7 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 10611 IN2 70.8 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 10612 IN2 70.8.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 10613 IN2 70.8.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 10614 IN2 70.8.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 10615 IN2 70.9 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 10616 IN2 70.10 Organization Identifier C ST 20 O O No [0 .. 1] [0 .. 1] No 10617 IN2 71 Race F CE 483 O O No [0 .. *] [0 .. *] No 0005 10618 IN2 71.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10619 IN2 71.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10620 IN2 71.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10621 IN2 71.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10622 IN2 71.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10623 IN2 71.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10624 IN2 72 CMS Patient's Relationship to Insured F CE 483 O O No [0 .. 1] [0 .. 1] No 0344 10625 IN2 72.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10626 IN2 72.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10627 IN2 72.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 10628 IN2 72.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 10629 IN2 72.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 10630 IN2 72.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11001 IN3 1 Set ID - IN3 F SI 4 R R No [1 .. 1] [1 .. 1] No 11002 IN3 2 Certification Number F CX 1913 O O No [0 .. 1] [0 .. 1] No 11003 IN3 2.1 ID Number C ST 15 R R No [1 .. 1] [1 .. 1] No 11004 IN3 2.2 Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 11005 IN3 2.3 Check Digit Scheme C ID 3 CE CE No [0 .. 1] [0 .. 1] No 0061 11006 IN3 2.4 Assigning Authority C HD 227 R R No [1 .. 1] [1 .. 1] No 0363 11007 IN3 2.4.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11008 IN3 2.4.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11009 IN3 2.4.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11010 IN3 2.5 Identifier Type Code C ID 5 R R No [1 .. 1] [1 .. 1] No 0203 11011 IN3 2.6 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 11012 IN3 2.6.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11013 IN3 2.6.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11014 IN3 2.6.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11015 IN3 2.7 Effective Date C DT 8 O O No [0 .. 1] [0 .. 1] No 11016 IN3 2.8 Expiration Date C DT 8 O O No [0 .. 1] [0 .. 1] No 11017 IN3 2.9 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 11018 IN3 2.9.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11019 IN3 2.9.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11020 IN3 2.9.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11021 IN3 2.9.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11022 IN3 2.9.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11023 IN3 2.9.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11024 IN3 2.9.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11025 IN3 2.9.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11026 IN3 2.9.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11027 IN3 2.10 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 11028 IN3 2.10.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11029 IN3 2.10.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11030 IN3 2.10.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11031 IN3 2.10.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11032 IN3 2.10.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11033 IN3 2.10.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11034 IN3 2.10.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11035 IN3 2.10.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11036 IN3 2.10.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11037 IN3 3 Certified By F XCN 2945 O O No [0 .. *] [0 .. *] No 11038 IN3 3.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 11039 IN3 3.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 11040 IN3 3.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 11041 IN3 3.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 11042 IN3 3.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 11043 IN3 3.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 11044 IN3 3.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 11045 IN3 3.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11046 IN3 3.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11047 IN3 3.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 11048 IN3 3.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 11049 IN3 3.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 11050 IN3 3.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 11051 IN3 3.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 11052 IN3 3.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11053 IN3 3.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11054 IN3 3.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11055 IN3 3.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 11056 IN3 3.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 11057 IN3 3.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 11058 IN3 3.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 11059 IN3 3.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 11060 IN3 3.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11061 IN3 3.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11062 IN3 3.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11063 IN3 3.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 11064 IN3 3.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 11065 IN3 3.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11066 IN3 3.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11067 IN3 3.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11068 IN3 3.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11069 IN3 3.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11070 IN3 3.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11071 IN3 3.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 11072 IN3 3.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 11073 IN3 3.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11074 IN3 3.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11075 IN3 3.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11076 IN3 3.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11077 IN3 3.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11078 IN3 3.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11079 IN3 3.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 11080 IN3 3.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 11081 IN3 3.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11082 IN3 3.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11083 IN3 3.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11084 IN3 3.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11085 IN3 3.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11086 IN3 3.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11087 IN3 3.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11088 IN3 3.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11089 IN3 3.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11090 IN3 3.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 11091 IN3 3.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11092 IN3 3.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11093 IN3 3.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11094 IN3 3.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11095 IN3 3.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11096 IN3 3.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11097 IN3 3.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11098 IN3 3.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11099 IN3 3.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11100 IN3 4 Certification Required F ID 1 O O No [0 .. 1] [0 .. 1] No 0136 11101 IN3 5 Penalty F MOP 23 O O No [0 .. 1] [0 .. 1] No 11102 IN3 5.1 Money or Percentage Indicator C ID 2 R R No [1 .. 1] [1 .. 1] No 0148 11103 IN3 5.2 Money or Percentage Quantity C NM 16 R R No [1 .. 1] [1 .. 1] No 11104 IN3 5.3 Currency Denomination C ID 3 O O No [0 .. 1] [0 .. 1] No 11105 IN3 6 Certification Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 11106 IN3 6.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 11107 IN3 6.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11108 IN3 7 Certification Modify Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 11109 IN3 7.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 11110 IN3 7.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11111 IN3 8 Operator F XCN 2945 O O No [0 .. *] [0 .. *] No 11112 IN3 8.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 11113 IN3 8.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 11114 IN3 8.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 11115 IN3 8.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 11116 IN3 8.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 11117 IN3 8.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 11118 IN3 8.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 11119 IN3 8.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11120 IN3 8.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11121 IN3 8.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 11122 IN3 8.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 11123 IN3 8.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 11124 IN3 8.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 11125 IN3 8.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 11126 IN3 8.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11127 IN3 8.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11128 IN3 8.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11129 IN3 8.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 11130 IN3 8.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 11131 IN3 8.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 11132 IN3 8.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 11133 IN3 8.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 11134 IN3 8.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11135 IN3 8.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11136 IN3 8.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11137 IN3 8.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 11138 IN3 8.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 11139 IN3 8.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11140 IN3 8.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11141 IN3 8.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11142 IN3 8.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11143 IN3 8.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11144 IN3 8.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11145 IN3 8.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 11146 IN3 8.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 11147 IN3 8.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11148 IN3 8.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11149 IN3 8.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11150 IN3 8.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11151 IN3 8.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11152 IN3 8.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11153 IN3 8.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 11154 IN3 8.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 11155 IN3 8.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11156 IN3 8.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11157 IN3 8.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11158 IN3 8.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11159 IN3 8.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11160 IN3 8.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11161 IN3 8.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11162 IN3 8.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11163 IN3 8.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11164 IN3 8.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 11165 IN3 8.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11166 IN3 8.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11167 IN3 8.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11168 IN3 8.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11169 IN3 8.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11170 IN3 8.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11171 IN3 8.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11172 IN3 8.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11173 IN3 8.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11174 IN3 9 Certification Begin Date F DT 8 O O No [0 .. 1] [0 .. 1] No 11175 IN3 10 Certification End Date F DT 8 O O No [0 .. 1] [0 .. 1] No 11176 IN3 11 Days F DTN 6 O O No [0 .. 1] [0 .. 1] No 11177 IN3 11.1 Day Type C IS 2 R R No [1 .. 1] [1 .. 1] No 0149 11178 IN3 11.2 Number of Days C NM 3 R R No [1 .. 1] [1 .. 1] No 11179 IN3 12 Non-Concur Code/Description F CE 483 O O No [0 .. 1] [0 .. 1] No 0233 11180 IN3 12.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 11181 IN3 12.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11182 IN3 12.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11183 IN3 12.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 11184 IN3 12.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11185 IN3 12.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11186 IN3 13 Non-Concur Effective Date/Time F TS 26 O O No [0 .. 1] [0 .. 1] No 11187 IN3 13.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 11188 IN3 13.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11189 IN3 14 Physician Reviewer F XCN 2945 O O No [0 .. *] [0 .. *] No 0010 11190 IN3 14.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 11191 IN3 14.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 11192 IN3 14.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 11193 IN3 14.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 11194 IN3 14.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 11195 IN3 14.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 11196 IN3 14.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 11197 IN3 14.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11198 IN3 14.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11199 IN3 14.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 11200 IN3 14.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 11201 IN3 14.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 11202 IN3 14.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 11203 IN3 14.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 11204 IN3 14.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11205 IN3 14.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11206 IN3 14.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11207 IN3 14.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 11208 IN3 14.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 11209 IN3 14.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 11210 IN3 14.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 11211 IN3 14.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 11212 IN3 14.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11213 IN3 14.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11214 IN3 14.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11215 IN3 14.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 11216 IN3 14.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 11217 IN3 14.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11218 IN3 14.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11219 IN3 14.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11220 IN3 14.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11221 IN3 14.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11222 IN3 14.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11223 IN3 14.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 11224 IN3 14.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 11225 IN3 14.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11226 IN3 14.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11227 IN3 14.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11228 IN3 14.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11229 IN3 14.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11230 IN3 14.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11231 IN3 14.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 11232 IN3 14.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 11233 IN3 14.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11234 IN3 14.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11235 IN3 14.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11236 IN3 14.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11237 IN3 14.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11238 IN3 14.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11239 IN3 14.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11240 IN3 14.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11241 IN3 14.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11242 IN3 14.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 11243 IN3 14.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11244 IN3 14.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11245 IN3 14.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11246 IN3 14.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11247 IN3 14.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11248 IN3 14.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11249 IN3 14.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11250 IN3 14.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11251 IN3 14.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11252 IN3 15 Certification Contact F ST 48 O O No [0 .. 1] [0 .. 1] No 11253 IN3 16 Certification Contact Phone Number F XTN 850 O O No [0 .. *] [0 .. *] No 11254 IN3 16.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 11255 IN3 16.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 11256 IN3 16.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 11257 IN3 16.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11258 IN3 16.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 11259 IN3 16.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 11260 IN3 16.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 11261 IN3 16.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 11262 IN3 16.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 11263 IN3 16.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 11264 IN3 16.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 11265 IN3 16.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 11266 IN3 17 Appeal Reason F CE 483 O O No [0 .. 1] [0 .. 1] No 0345 11267 IN3 17.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 11268 IN3 17.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11269 IN3 17.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11270 IN3 17.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 11271 IN3 17.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11272 IN3 17.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11273 IN3 18 Certification Agency F CE 483 O O No [0 .. 1] [0 .. 1] No 0346 11274 IN3 18.1 Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 11275 IN3 18.2 Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11276 IN3 18.3 Name of Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11277 IN3 18.4 Alternate Identifier C ST 20 RE RE No [0 .. 1] [0 .. 1] No 11278 IN3 18.5 Alternate Text C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11279 IN3 18.6 Name of Alternate Coding System C ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11280 IN3 19 Certification Agency Phone Number F XTN 850 O O No [0 .. *] [0 .. *] No 11281 IN3 19.1 Telephone Number C ST 0 X X No [0 .. 0] [0 .. 0] No 11282 IN3 19.2 Telecommunication Use Code C ID 3 R R No [1 .. 1] [1 .. 1] No 0201 11283 IN3 19.3 Telecommunication Equipment Type C ID 8 RE RE No [0 .. 1] [0 .. 1] No 0202 11284 IN3 19.4 Email Address C ST 199 CE CE No [0 .. 1] [0 .. 1] No 11285 IN3 19.5 Country Code C NM 3 O O No [0 .. 1] [0 .. 1] No 11286 IN3 19.6 Area/City Code C NM 5 CE CE No [0 .. 1] [0 .. 1] No 11287 IN3 19.7 Local Number C NM 9 CE CE No [0 .. 1] [0 .. 1] No 11288 IN3 19.8 Extension C NM 5 O O No [0 .. 1] [0 .. 1] No 11289 IN3 19.9 Any Text C ST 199 O O No [0 .. 1] [0 .. 1] No 11290 IN3 19.10 Extension Prefix C ST 4 O O No [0 .. 1] [0 .. 1] No 11291 IN3 19.11 Speed Dial Code C ST 6 O O No [0 .. 1] [0 .. 1] No 11292 IN3 19.12 Unformatted Telephone number C ST 199 O O No [0 .. 1] [0 .. 1] No 11293 IN3 20 Pre-Certification Requirement F ICD 40 O O No [0 .. *] [0 .. *] No 11294 IN3 20.1 Certification Patient Type C IS 11 O O No [0 .. 1] [0 .. 1] No 0150 11295 IN3 20.2 Certification Required C ID 1 R R No [1 .. 1] [1 .. 1] No 0136 11296 IN3 20.3 Date/Time Certification Required C TS 26 O O No [0 .. 1] [0 .. 1] No 11297 IN3 20.3.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11298 IN3 20.3.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11299 IN3 21 Case Manager F ST 48 O O No [0 .. 1] [0 .. 1] No 11300 IN3 22 Second Opinion Date F DT 8 O O No [0 .. 1] [0 .. 1] No 11301 IN3 23 Second Opinion Status F IS 1 O O No [0 .. 1] [0 .. 1] No 0151 11302 IN3 24 Second Opinion Documentation Received F IS 1 O O No [0 .. *] [0 .. *] No 0152 11303 IN3 25 Second Opinion Physician F XCN 2945 O O No [0 .. *] [0 .. *] No 0010 11304 IN3 25.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No 11305 IN3 25.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 11306 IN3 25.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 11307 IN3 25.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 11308 IN3 25.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 11309 IN3 25.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 11310 IN3 25.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 11311 IN3 25.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11312 IN3 25.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 11313 IN3 25.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 11314 IN3 25.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 11315 IN3 25.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 11316 IN3 25.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 11317 IN3 25.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363 11318 IN3 25.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11319 IN3 25.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11320 IN3 25.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11321 IN3 25.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 11322 IN3 25.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 11323 IN3 25.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061 11324 IN3 25.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 11325 IN3 25.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 11326 IN3 25.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 11327 IN3 25.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11328 IN3 25.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 11329 IN3 25.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 11330 IN3 25.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 11331 IN3 25.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11332 IN3 25.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11333 IN3 25.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11334 IN3 25.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11335 IN3 25.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11336 IN3 25.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11337 IN3 25.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 11338 IN3 25.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 11339 IN3 25.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11340 IN3 25.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11341 IN3 25.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11342 IN3 25.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 11343 IN3 25.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 11344 IN3 25.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 11345 IN3 25.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 11346 IN3 25.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 11347 IN3 25.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11348 IN3 25.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11349 IN3 25.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11350 IN3 25.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11351 IN3 25.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11352 IN3 25.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11353 IN3 25.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11354 IN3 25.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11355 IN3 25.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 11356 IN3 25.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 11357 IN3 25.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11358 IN3 25.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11359 IN3 25.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11360 IN3 25.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 11361 IN3 25.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 11362 IN3 25.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 11363 IN3 25.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 11364 IN3 25.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 11365 IN3 25.23.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 12001 ORC 1 Order Control F ID 2 R R No [1 .. 1] [1 .. 1] No 0119 12002 ORC 2 Placer Order Number F EI 427 RE RE No [0 .. 1] [0 .. 1] No 12003 ORC 2.1 Entity Identifier C ST 199 RE RE No [0 .. 1] [0 .. 1] No 12004 ORC 2.2 Namespace ID C IS 20 C C No [0 .. 1] [0 .. 1] No 0363   If entity Id is populated this field shall be populated. 12005 ORC 2.3 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If entity id is not populated, then this should be populated with an OID. 12006 ORC 2.4 Universal ID Type C ID 6 C C No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 12007 ORC 3 Filler Order Number F EI 427 R R No [1 .. 1] [1 .. 1] No 12008 ORC 3.1 Entity Identifier C ST 199 RE RE No [0 .. 1] [0 .. 1] No 12009 ORC 3.2 Namespace ID C IS 20 C C No [0 .. 1] [0 .. 1] No 0363   If entity id is populated then this field shall be populated. 12010 ORC 3.3 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No   If entity id is not populated, then this field shall be populated with an OID. 12011 ORC 3.4 Universal ID Type C ID 6 C C No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 12012 ORC 4 Placer Group Number F EI 427 O O No [0 .. 1] [0 .. 1] No 12013 ORC 4.1 Entity Identifier C ST 199 RE RE No [0 .. 1] [0 .. 1] No 12014 ORC 4.2 Namespace ID C IS 20 C C No [0 .. 1] [0 .. 1] No 0363 12015 ORC 4.3 Universal ID C ST 199 CE CE No [0 .. 1] [0 .. 1] No 12016 ORC 4.4 Universal ID Type C ID 6 C C No [0 .. 1] [0 .. 1] No 0301 12017 ORC 5 Order Status F ID 2 O O No [0 .. 1] [0 .. 1] No 0038 12018 ORC 6 Response Flag F ID 1 O O No [0 .. 1] [0 .. 1] No 0121 12019 ORC 7 Quantity/Timing F TQ 1778 X X No [0 .. 0] [0 .. 0] No 12020 ORC 8 Parent F EIP 855 O O No [0 .. 1] [0 .. 1] No 12021 ORC 8.1 Placer Assigned Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No 12022 ORC 8.1.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No 12023 ORC 8.1.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363 12024 ORC 8.1.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12025 ORC 8.1.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301 12026 ORC 8.2 Filler Assigned Identifier C EI 427 O O No [0 .. 1] [0 .. 1] No 12027 ORC 8.2.1 Entity Identifier S ST 199 RE RE No [0 .. 1] [0 .. 1] No 12028 ORC 8.2.2 Namespace ID S IS 20 C C No [0 .. 1] [0 .. 1] No 0363 12029 ORC 8.2.3 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12030 ORC 8.2.4 Universal ID Type S ID 6 C C No [0 .. 1] [0 .. 1] No 0301 12031 ORC 9 Date/Time of Transaction F TS 26 O O No [0 .. 1] [0 .. 1] No 12032 ORC 9.1 Time C DTM 24 R R No [1 .. 1] [1 .. 1] No 12033 ORC 9.2 Degree of Precision C ID 0 X X No [0 .. 0] [0 .. 0] No 0529 12034 ORC 10 Entered By F XCN 2945 RE RE No [0 .. 1] [0 .. 1] No 12035 ORC 10.1 ID Number C ST 15 C C No [0 .. 1] [0 .. 1] No   if name fields are not populated then this field shall be populated. 12036 ORC 10.2 Family Name C FN 194 RE RE No [0 .. 1] [0 .. 1] No 12037 ORC 10.2.1 Surname S ST 50 R R No [1 .. 1] [1 .. 1] No 12038 ORC 10.2.2 Own Surname Prefix S ST 20 O O No [0 .. 1] [0 .. 1] No 12039 ORC 10.2.3 Own Surname S ST 50 O O No [0 .. 1] [0 .. 1] No 12040 ORC 10.2.4 Surname Prefix From Partner/Spouse S ST 20 O O No [0 .. 1] [0 .. 1] No 12041 ORC 10.2.5 Surname From Partner/Spouse S ST 50 O O No [0 .. 1] [0 .. 1] No 12042 ORC 10.3 Given Name C ST 30 RE RE No [0 .. 1] [0 .. 1] No 12043 ORC 10.4 Second and Further Given Names or Initials Thereof C ST 30 RE RE No [0 .. 1] [0 .. 1] No 12044 ORC 10.5 Suffix (e.g., JR or III) C ST 20 O O No [0 .. 1] [0 .. 1] No 12045 ORC 10.6 Prefix (e.g., DR) C ST 20 O O No [0 .. 1] [0 .. 1] No 12046 ORC 10.7 Degree (e.g., MD) C IS 0 X X No [0 .. 0] [0 .. 0] No 0360 12047 ORC 10.8 Source Table C IS 4 O O No [0 .. 1] [0 .. 1] No 0297 12048 ORC 10.9 Assigning Authority C HD 227 C C No [0 .. 1] [0 .. 1] No 0363   If Id number is populated, then this field must be populated. 12049 ORC 10.9.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 12050 ORC 10.9.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No   if namespace id is not populated, then this field shall be populated with an OID. 12051 ORC 10.9.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301   If universal id is populated, then this field shall be populated with ISO. 12052 ORC 10.10 Name Type Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0200 12053 ORC 10.11 Identifier Check Digit C ST 1 O O No [0 .. 1] [0 .. 1] No 12054 ORC 10.12 Check Digit Scheme C ID 3 C C No [0 .. 1] [0 .. 1] No 0061   if identifier check digit is populated, then this field shall be populated. 12055 ORC 10.13 Identifier Type Code C ID 5 O O No [0 .. 1] [0 .. 1] No 0203 12056 ORC 10.14 Assigning Facility C HD 227 O O No [0 .. 1] [0 .. 1] No 12057 ORC 10.14.1 Namespace ID S IS 20 CE CE No [0 .. 1] [0 .. 1] No 0300 12058 ORC 10.14.2 Universal ID S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12059 ORC 10.14.3 Universal ID Type S ID 6 CE CE No [0 .. 1] [0 .. 1] No 0301 12060 ORC 10.15 Name Representation Code C ID 1 O O No [0 .. 1] [0 .. 1] No 0465 12061 ORC 10.16 Name Context C CE 483 O O No [0 .. 1] [0 .. 1] No 0448 12062 ORC 10.16.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 12063 ORC 10.16.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12064 ORC 10.16.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 12065 ORC 10.16.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 12066 ORC 10.16.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12067 ORC 10.16.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 12068 ORC 10.17 Name Validity Range C DR 0 X X No [0 .. 0] [0 .. 0] No 12069 ORC 10.18 Name Assembly Order C ID 1 X X No [0 .. 0] [0 .. 0] No 0444 12070 ORC 10.19 Effective Date C TS 26 O O No [0 .. 1] [0 .. 1] No 12071 ORC 10.19.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 12072 ORC 10.19.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 12073 ORC 10.20 Expiration Date C TS 26 O O No [0 .. 1] [0 .. 1] No 12074 ORC 10.20.1 Time S DTM 24 R R No [1 .. 1] [1 .. 1] No 12075 ORC 10.20.2 Degree of Precision S ID 0 X X No [0 .. 0] [0 .. 0] No 0529 12076 ORC 10.21 Professional Suffix C ST 199 O O No [0 .. 1] [0 .. 1] No 12077 ORC 10.22 Assigning Jurisdiction C CWE 705 O O No [0 .. 1] [0 .. 1] No 12078 ORC 10.22.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 12079 ORC 10.22.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12080 ORC 10.22.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 12081 ORC 10.22.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 12082 ORC 10.22.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12083 ORC 10.22.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 12084 ORC 10.22.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 12085 ORC 10.22.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 12086 ORC 10.22.9 Original Text S ST 199 O O No [0 .. 1] [0 .. 1] No 12087 ORC 10.23 Assigning Agency or Department C CWE 705 O O No [0 .. 1] [0 .. 1] No 12088 ORC 10.23.1 Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 12089 ORC 10.23.2 Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12090 ORC 10.23.3 Name of Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 12091 ORC 10.23.4 Alternate Identifier S ST 20 RE RE No [0 .. 1] [0 .. 1] No 12092 ORC 10.23.5 Alternate Text S ST 199 CE CE No [0 .. 1] [0 .. 1] No 12093 ORC 10.23.6 Name of Alternate Coding System S ID 20 C C No [0 .. 1] [0 .. 1] No 0396 12094 ORC 10.23.7 Coding System Version ID S ST 10 C C No [0 .. 1] [0 .. 1] No 12095 ORC 10.23.8 Alternate Coding System Version ID S ST 10 O O No [0 .. 1] [0 .. 1] No 12096 ORC 10.23.9 Original Text S ST