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1UOWa1lEWNqb3lpaVgtPcU0rmNo5O_v_2udjcqVgZt80
HL7 Segment Definitions
2024-06-13T23:33:25.168Z
481
anichols
text/x-markdown
sending-hl7-messages-to-system.md
receiving-hl7-messages-from-system.md
outbound-interface-install-instructions.md
sample-hl7-messages.md
0008bcbb1563384efe0a28ada6f97e9432e65f10
{{% anchor sys="msh" %}}
This documentation is for HL7 Segments related to:
Outbound Interface Install Instructions
Message Header (MSH)
Sequence
Length
Data Type
Required
Repetition
Name
1
1
ST
REQ
NO_RPT
Field Separator
2
4
ST
REQ
NO_RPT
Encoding Characters
3
15
ST
OPT
NO_RPT
Sending Application
4
20
ST
OPT
NO_RPT
Sending Facility
5
15
ST
OPT
NO_RPT
Receiving Application
6
30
ST
OPT
NO_RPT
Receiving Facility
7
19
TS
OPT
NO_RPT
Date/Time of Message
8
40
ST
OPT
NO_RPT
Security
9
7
ID
REQ
NO_RPT
Message Type
10
20
ST
REQ
NO_RPT
Message Control ID
11
1
ID
REQ
NO_RPT
Processing ID
12
8
NM
REQ
NO_RPT
Version ID
13
15
NM
OPT
NO_RPT
Sequence Number
14
180
ST
OPT
NO_RPT
Continuation Pointer
15
2
ID
OPT
NO_RPT
Accept Acknowledgment Type
16
2
ID
OPT
NO_RPT
Application Acknowledgment Type
17
2
ID
OPT
NO_RPT
Country Code
18
2
ID
OPT
NO_RPT
Character Set
Master File Identification (MFI)
Sequence
Length
Data Type
Required
Repetition
Name
1
60
CE
REQ
NO_RPT
Master File Identifier
2
180
HD
OPT
NO_RPT
Master File Application Identifier
3
3
ID
REQ
NO_RPT
File-Level Event Code
4
26
TS
OPT
NO_RPT
Entered Date/Time
5
26
TS
OPT
NO_RPT
Effective Date/Time
6
2
ID
REQ
NO_RPT
Response Level Code
Sequence
Length
Data Type
Required
Repetition
Name
1
3
ID
REQ
NO_RPT
Record-Level Event Code
2
20
ST
REQ
NO_RPT
MFN Control ID
3
26
TS
OPT
NO_RPT
Effective Date/Time
4
200
FT
REQ
NO_MAX
Primary Key Value - MFE
5
3
ID
REQ
NO_MAX
Primary Key Value Type
{{% anchor sys="msa" %}}
Message Acknowledgement (MSA)
Sequence
Length
Data Type
Required
Repetition
Name
1
2
ID
REQ
NO_RPT
Acknowledgement Code
2
20
ST
REQ
NO_RPT
Message Control ID
3
80
ST
OPT
NO_RPT
Text Message
4
15
NM
OPT
NO_RPT
Expected Sequence Number
5
1
ID
OPT
NO_RPT
Delayed Ack Type
{{% anchor sys="evn" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
3
ID
REQ
NO_RPT
Event Type Code
2
19
TS
REQ
NO_RPT
Date/Time of Event
3
19
TS
OPT
NO_RPT
Date/Time Planned Event
4
3
ID
OPT
NO_RPT
Event Reason Code
{{% anchor sys="mrg" %}}
Merge Patient Information (MRG)
Sequence
Length
Data Type
Required
Repetition
Name
1
250
CX
REQ
NO_RPT
Prior Patient Identifier List
2
250
CX
OPT
NO_RPT
Prior Alternate Patient ID
3
250
CX
OPT
NO_RPT
Prior Patient Account Number
4
250
CX
OPT
NO_RPT
Prior Patient ID
5
250
CX
OPT
NO_RPT
Prior Visit Number
6
250
CX
OPT
NO_RPT
Prior Alternate Visit ID
7
250
XPN
OPT
NO_RPT
Prior Patient Name
{{% anchor sys="pid" %}}
Patient Identification (PID)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID - PID
2
20
CX
OPT
NO_RPT
Patient ID
3
250
CX
REQ
NO_MAX
Patient Identifier List
4
20
CX
OPT
NO_MAX
Alternate Patient ID - PID
5
250
XPN
REQ
NO_MAX
Patient Name
6
250
XPN
OPT
NO_MAX
Mother's Maiden Name
7
26
TS
OPT
NO_RPT
Date/Time of Birth
8
1
IS
OPT
NO_RPT
Sex
9
250
XPN
OPT
NO_MAX
Patient Alias
10
250
CE
OPT
NO_MAX
Race
11
250
XAD
OPT
NO_MAX
Patient Address
12
4
IS
OPT
NO_RPT
County Code
13
250
XTN
OPT
NO_MAX
Phone Number - Home
14
250
XTN
OPT
NO_MAX
Phone Number - Business
15
250
CE
OPT
NO_RPT
Primary Language
16
250
CE
OPT
NO_RPT
Marital Status
17
250
CE
OPT
NO_RPT
Religion
18
250
CX
OPT
NO_RPT
Patient Account Number
19
16
ST
OPT
NO_RPT
SSN Number - Patient (not used)
20
25
DLN
OPT
NO_RPT
Driver's License Number - Patient (not used)
21
250
CX
OPT
NO_MAX
Mother's Identifier
22
250
CE
OPT
NO_MAX
Ethnic Group
23
250
ST
OPT
NO_RPT
Birth Place
24
1
ID
OPT
NO_RPT
Multiple Birth Indicator
25
2
NM
OPT
NO_RPT
Birth Order
26
250
CE
OPT
NO_MAX
Citizenship
27
250
CE
OPT
NO_RPT
Veterans Military Status
28
250
CE
OPT
NO_RPT
Nationality
29
26
TS
OPT
NO_RPT
Patient Death Date and Time
30
1
ID
OPT
NO_RPT
Patient Death Indicator
31
1
ID
OPT
NO_RPT
Identity Unknown Indicator
32
20
IS
OPT
NO_MAX
Identity Reliability Code
33
26
TS
OPT
NO_RPT
Last Update Date/Time
34
241
HD
OPT
NO_RPT
Last Update Facility
35
250
CE
OPT
NO_RPT
Species Code
36
250
CE
OPT
NO_RPT
Breed Code
37
80
ST
OPT
NO_RPT
Strain
38
250
CE
OPT
NO_MAX
Production Class Code
39
250
CWE
OPT
NO_MAX
Tribal Citizenship
{{% anchor sys="pd1" %}}
Patient Additional Demographics (PD1)
Sequence
Length
Data Type
Required
Repetition
Name
1
2
IS
OPT
NO_RPT
Living Dependency
2
2
IS
OPT
NO_RPT
Living Arrangement
3
90
XON
OPT
NO_RPT
Patient Primary Facility
4
90
XCN
OPT
NO_RPT
Patient Primary Care Provider Name & ID No.
5
2
IS
OPT
NO_RPT
Student Indicator
6
2
IS
0PT
NO_RPT
Handicap
7
2
IS
OPT
NO_RPT
Living Will
8
2
IS
OPT
NO_RPT
Organ Donor
9
1
ID
OPT
NO_RPT
Separate Bill
10
20
CX
OPT
NO_MAX
Duplicate Patient
11
80
CE
OPT
NO_RPT
Publicity Code
12
1
ID
OPT
NO_RPT
Protection Indicator
{{% anchor sys="pv1" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set Id
2
1
ID
REQ
NO_RPT
Patient Class
3
80
PL
OPT
NO_RPT
Assigned Patient Location
4
2
IS
OPT
NO_RPT
Admission Type
5
250
CX
OPT
NO_RPT
Pre-Admit Number
6
80
PL
OPT
NO_RPT
Prior Patient Location
7
250
XCN
OPT
NO_MAX
Attending Doctor
8
250
XCN
OPT
NO_MAX
Referring Doctor
9
250
XCN
OPT
NO_MAX
Consulting Doctor (use ROL segment)
10
3
IS
OPT
NO_RPT
Hospital Service
11
80
PL
OPT
NO_RPT
Temporary Location
12
2
IS
OPT
NO_RPT
Pre-Admit Test Indicator
13
2
IS
OPT
NO_RPT
Re-Admission Indicator
14
6
IS
OPT
NO_RPT
Admit Source
15
2
IS
OPT
NO_MAX
Ambulatory Status
16
2
IS
OPT
NO_RPT
VIP Indicators
17
250
XCN
OPT
NO_MAX
Admitting Doctor
18
2
IS
OPT
NO_RPT
Patient Type
19
250
CX
OPT
NO_RPT
Visit Number
20
50
FC
OPT
NO_MAX
Financial Class
21
2
IS
OPT
NO_RPT
Charge Price Indicator
22
2
IS
OPT
NO_RPT
Courtesy Code
23
2
IS
OPT
NO_RPT
Credit Rating
24
2
IS
OPT
NO_MAX
Contract Code
25
8
DT
OPT
NO_MAX
Contract Effective Date
26
12
NM
OPT
NO_MAX
Contract Amount
27
3
NM
OPT
NO_MAX
Contract Period
28
2
IS
OPT
NO_RPT
Interest Code
29
4
IS
OPT
NO_RPT
Transfer to Bad Debt Code
30
8
DT
OPT
NO_RPT
Transfer to Bad Debt Date
31
10
IS
OPT
NO_RPT
Bad Debt Agency Code
32
12
NM
OPT
NO_RPT
Bad Debt Transfer Amount
33
12
NM
OPT
NO_RPT
Bad Debt Recovery Amount
34
1
IS
OPT
NO_RPT
Delete Account Indicator
35
8
DT
OPT
NO_RPT
Delete Account Date
36
3
IS
OPT
NO_RPT
Discharge Disposition
37
47
DLD
OPT
NO_RPT
Discharged to Location
38
250
CE
OPT
NO_RPT
Diet Type
39
2
IS
OPT
NO_RPT
Servicing Facility
40
1
IS
OPT
NO_RPT
Bed Status (not used)
41
2
IS
OPT
NO_RPT
Account Status
42
80
PL
OPT
NO_RPT
Pending Location
43
80
PL
OPT
NO_RPT
Prior Temporary Location
44
26
TS
OPT
NO_RPT
Admit Date/Time
45
26
TS
OPT
NO_MAX
Discharge Date/Time
46
12
NM
OPT
NO_RPT
Current Patient Balance
47
12
NM
OPT
NO_RPT
Total Charges
48
12
NM
OPT
NO_RPT
Total Adjustments
49
12
NM
OPT
NO_RPT
Total Payments
50
250
CX
OPT
NO_RPT
Alternate Visit ID
51
1
IS
OPT
NO_RPT
Visit Indicator
52
250
XCN
OPT
NO_MAX
Other Healthcare Provider
{{% anchor sys="pv1_dft" %}}
Patient Visit (PV1) for DFT
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set Id
2
1
ID
REQ
NO_RPT
Patient Class
3
80
PL
OPT
NO_RPT
Assigned Patient Location
4
2
IS
OPT
NO_RPT
Admission Type
5
250
CX
OPT
NO_RPT
Pre-Admit Number
6
80
PL
OPT
NO_RPT
Prior Patient Location
7
250
XCN
OPT
NO_MAX
Encounter Performing Provider
8
250
XCN
OPT
NO_MAX
Billing Provider
9
250
XCN
OPT
NO_MAX
Rendering Provider
10
3
IS
OPT
NO_RPT
Supervising Provider
11
80
PL
OPT
NO_RPT
Temporary Location
12
2
IS
OPT
NO_RPT
Pre-Admit Test Indicator
13
2
IS
OPT
NO_RPT
Re-Admission Indicator
14
6
IS
OPT
NO_RPT
Admit Source
15
2
IS
OPT
NO_MAX
Ambulatory Status
16
2
IS
OPT
NO_RPT
VIP Indicators
17
250
XCN
OPT
NO_MAX
Admitting Doctor
18
2
IS
OPT
NO_RPT
Patient Type
19
250
CX
OPT
NO_RPT
Visit Number
20
50
FC
OPT
NO_MAX
Financial Class
21
2
IS
OPT
NO_RPT
Charge Price Indicator
22
2
IS
OPT
NO_RPT
Courtesy Code
23
2
IS
OPT
NO_RPT
Credit Rating
24
2
IS
OPT
NO_MAX
Contract Code
25
8
DT
OPT
NO_MAX
Contract Effective Date
26
12
NM
OPT
NO_MAX
Contract Amount
27
3
NM
OPT
NO_MAX
Contract Period
28
2
IS
OPT
NO_RPT
Interest Code
29
4
IS
OPT
NO_RPT
Transfer to Bad Debt Code
30
8
DT
OPT
NO_RPT
Transfer to Bad Debt Date
31
10
IS
OPT
NO_RPT
Bad Debt Agency Code
32
12
NM
OPT
NO_RPT
Bad Debt Transfer Amount
33
12
NM
OPT
NO_RPT
Bad Debt Recovery Amount
34
1
IS
OPT
NO_RPT
Delete Account Indicator
35
8
DT
OPT
NO_RPT
Delete Account Date
36
3
IS
OPT
NO_RPT
Discharge Disposition
37
47
DLD
OPT
NO_RPT
Discharged to Location
38
250
CE
OPT
NO_RPT
Diet Type
39
2
IS
OPT
NO_RPT
Servicing Facility
40
1
IS
OPT
NO_RPT
Bed Status (not used)
41
2
IS
OPT
NO_RPT
Account Status
42
80
PL
OPT
NO_RPT
Pending Location
43
80
PL
OPT
NO_RPT
Prior Temporary Location
44
26
TS
OPT
NO_RPT
Admit Date/Time
45
26
TS
OPT
NO_MAX
Discharge Date/Time
46
12
NM
OPT
NO_RPT
Current Patient Balance
47
12
NM
OPT
NO_RPT
Total Charges
48
12
NM
OPT
NO_RPT
Total Adjustments
49
12
NM
OPT
NO_RPT
Total Payments
50
250
CX
OPT
NO_RPT
Alternate Visit ID
51
1
IS
OPT
NO_RPT
Visit Indicator
52
250
XCN
OPT
NO_MAX
Other Healthcare Provider
{{% anchor sys="pv2" %}}
Patient Visit - Additional Information (PV2)
Sequence
Length
Data Type
Required
Repetition
Name
1
80
PL
REQ
NO_RPT
Prior Pending Location
2
60
CE
OPT
NO_RPT
Accommodation Code
3
60
CE
OPT
NO_RPT
Admit Reason
4
60
CE
OPT
NO_RPT
Transfer Reason
5
25
ST
OPT
NO_MAX
Patient Valuables
6
25
ST
OPT
NO_RPT
Patient Valuables Location
7
2
IS
OPT
NO_RPT
Visit User Code
8
26
TS
OPT
NO_RPT
Expected Admit Date/Time
9
26
TS
OPT
NO_RPT
Expected Discharge Date/Time
10
3
NM
OPT
NO_RPT
Estimated Length of Inpatient Stay
11
3
NM
OPT
NO_RPT
Actual Length of Inpatient Stay
12
50
ST
OPT
NO_RPT
Visit Description
13
90
XCN
OPT
NO_MAX
Referral Source Code
14
8
DT
OPT
NO_RPT
Previous Service Date
15
1
ID
OPT
NO_RPT
Employment Illness Related Indicator
16
1
IS
OPT
NO_RPT
Purge Status Code
17
8
DT
OPT
NO_RPT
Purge Status Date
18
2
IS
OPT
NO_RPT
Special Program Code
19
1
ID
OPT
NO_RPT
Retention Indicator
20
1
NM
OPT
NO_RPT
Expected Number of Insurance Plans
21
1
IS
OPT
NO_RPT
Visit Publicity Code
22
1
ID
OPT
NO_RPT
Visit Protection Indicator
23
90
XON
OPT
NO_MAX
Clinic Organization Name
24
2
IS
OPT
NO_RPT
Patient Status Code
25
1
IS
OPT
NO_RPT
Visit Priority Code
26
8
DT
OPT
NO_RPT
Previous Treatment Date
27
2
IS
OPT
NO_RPT
Expected Discharge Disposition
28
8
DT
OPT
NO_RPT
Signature on File Date
29
8
DT
OPT
NO_RPT
First Similar Illness Date
30
80
CE
OPT
NO_RPT
Patient Charge Adjustment Code
31
2
IS
OPT
NO_RPT
Recurring Service Code
32
1
ID
OPT
NO_RPT
Billing Media Code
33
26
TS
OPT
NO_RPT
Expected Surgery Date & Time
34
1
ID
OPT
NO_RPT
Military Partnership Code
35
1
ID
OPT
NO_RPT
Military Non-Availability Code
36
1
ID
OPT
NO_RPT
Newborn Baby Indicator
37
1
ID
OPT
NO_RPT
Baby Detained Indicator
{{% anchor sys="dg1" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID - Diagnosis
2
2
ID
REQ
NO_RPT
Diagnosis Coding Method
3
10
ID
OPT
NO_RPT
Diagnosis Code
4
40
ST
OPT
NO_RPT
Diagnosis Description
5
19
TS
OPT
NO_RPT
Diagnosis Date/Time
6
2
ID
REQ
NO_RPT
Diagnosis/DRG Type
7
4
ST
OPT
NO_RPT
Major Diagnostic Category
8
4
ID
OPT
NO_RPT
Diagnostic Related Group
9
2
ID
OPT
NO_RPT
DRG Approval Indicator
10
2
ID
OPT
NO_RPT
DRG Grouper Review Code
11
2
ID
OPT
NO_RPT
Outlier Type
12
3
NM
OPT
NO_RPT
Outlier Days
13
12
NM
OPT
NO_RPT
Outlier Cost
14
4
ST
OPT
NO_RPT
Grouper Version and Type
15
2
NM
OPT
NO_RPT
Diagnosis/DRG priority
16
36
TX
OPT
NO_RPT
Diagnosing clinician
{{% anchor sys="ft1" %}}
Financial Transaction (FT1)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
1 Set ID - Financial Trans
2
12
ST
OPT
NO_RPT
2 Transaction ID
3
5
ST
OPT
NO_RPT
3 Transaction Batch ID
4
8
DT
REQ
NO_RPT
4 Transaction Date
5
8
DT
OPT
NO_RPT
5 Transaction Posting Date
6
8
ID
REQ
NO_RPT
6 Transaction Type
7
20
ID
REQ
NO_RPT
7 Transaction Code
8
40
ST
OPT
NO_RPT
8 Transaction Description
9
40
ST
OPT
NO_RPT
9 Transaction Desc. - Alt
10
4
NM
OPT
NO_RPT
10 Transaction Quantity
11
12
NM
OPT
NO_RPT
11 Transaction Amount - Ext.
12
12
NM
OPT
NO_RPT
12 Transaction Amount - Unit
13
16
ST
OPT
NO_RPT
13 Department Code
14
8
ID
OPT
NO_RPT
14 Insurance Plan ID
15
12
NM
OPT
NO_RPT
15 Insurance Amount
16
12
ST
OPT
NO_RPT
16 Patient Location
17
1
ID
OPT
NO_RPT
17 Fee Schedule
18
2
ID
OPT
NO_RPT
18 Patient Type
19
8
ID
OPT
NO_RPT
19 Diagnosis Code
20
60
CN
OPT
NO_RPT
20 Performed by Code
21
60
CN
OPT
NO_RPT
21 Ordered by Code
22
12
NM
OPT
NO_RPT
22 Unit Cost
23
22
EI
OPT
NO_RPT
23 Filler Order Number
24
120
XCN
OPT
NO_RPT
24 Entered By Code
25
80
CE
OPT
NO_RPT
25 Procedure Code
26
80
CE
OPT
NO_RPT
26 Procedure Code Modifier
{{% anchor sys="gt1" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID - Guarantor
2
20
ID
OPT
NO_MAX
Guarantor Number
3
48
PN
REQ
NO_MAX
Guarantor Name
4
48
PN
OPT
NO_MAX
Guarantor Spouse Name
5
106
AD
OPT
NO_MAX
Guarantor Address
6
40
TN
OPT
NO_MAX
Guarantor Phone - Home
7
40
TN
OPT
NO_MAX
Guarantor Phone - Bus
8
8
DT
OPT
NO_RPT
Guarantor Date of Birth
9
1
ID
OPT
NO_RPT
Guarantor Sex
10
2
ID
OPT
NO_RPT
Guarantor Type
11
2
ID
OPT
NO_RPT
Guarantor Relationship
12
11
ST
OPT
NO_RPT
Guarantor SSN
13
8
DT
OPT
NO_RPT
Guarantor Date - Begin
14
8
DT
OPT
NO_RPT
Guarantor Date - End
15
2
NM
OPT
NO_RPT
Guarantor Priority
16
45
ST
OPT
NO_MAX
Guarantor Employer Name
17
106
AD
OPT
NO_MAX
Guarantor Employer Addr
18
40
TN
OPT
NO_MAX
Guarantor Employer Phone
19
20
ST
OPT
NO_MAX
Guarantor Employee ID #
20
2
ID
OPT
NO_RPT
Guarantor Employmt Status
21
130
XON
OPT
NO_MAX
Guarantor Organization Name
22
1
ID
OPT
NO_RPT
Guarantor Billing Hold Flag
23
80
CE
OPT
NO_RPT
Guarantor Credit Rating Code
24
26
TS
OPT
NO_RPT
Guarantor Death Date And Time
25
1
ID
OPT
NO_RPT
Guarantor Death Flag
26
80
CE
OPT
NO_RPT
Guarantor Charge Adjustment Code
27
10
CP
OPT
NO_RPT
Guarantor Household Annual Income
28
3
NM
OPT
NO_RPT
Guarantor Household Size
29
20
CX
OPT
NO_MAX
Guarantor Employer ID Number
30
80
CE
OPT
NO_RPT
Guarantor Marital Status Code
31
8
DT
OPT
NO_RPT
Guarantor Hire Effective Date
32
8
DT
OPT
NO_RPT
Employment Stop Date
33
2
IS
OPT
NO_RPT
Living Dependency
34
2
IS
OPT
NO_MAX
Ambulatory Status
35
80
CE
OPT
NO_MAX
Citizenship
36
60
CE
OPT
NO_RPT
Primary Language
37
2
IS
OPT
NO_RPT
Living Arrangement
38
80
CE
OPT
NO_RPT
Publicity Code
39
1
ID
OPT
NO_RPT
Protection Indicator
40
2
IS
OPT
NO_RPT
Student Indicator
41
80
CE
OPT
NO_RPT
Religion
42
48
XPN
OPT
NO_MAX
Mother's Maiden Name
43
80
CE
OPT
NO_RPT
Nationality
44
80
CE
OPT
NO_MAX
Ethnic Group
45
48
XPN
OPT
NO_MAX
Contact Person's Name
46
40
XTN
OPT
NO_MAX
Contact Person's Telephone Number
47
80
CE
OPT
NO_RPT
Contact Reason
48
2
IS
OPT
NO_RPT
Contact Relationship
49
20
ST
OPT
NO_RPT
Job Title
50
20
JCC
OPT
NO_RPT
Job Code/Class
51
130
XON
OPT
NO_MAX
Guarantor Employer's Organization Name
52
2
IS
OPT
NO_RPT
Handicap
53
2
IS
OPT
NO_RPT
Job Status
54
50
FC
OPT
NO_RPT
Guarantor Financial Class
55
80
CE
OPT
NO_MAX
Guarantor Race
{{% anchor sys="in1" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID - Insurance
2
8
ID
REQ
NO_RPT
Insurance Plan ID
3
8
ST
REQ
NO_RPT
Insurance Company ID
4
45
ST
OPT
NO_RPT
Insurance Company Name
5
106
AD
OPT
NO_RPT
Insurance Company Address
6
48
PN
OPT
NO_RPT
Insurance Co Contact Pers
7
40
TN
OPT
NO_RPT
Insurance Co Phone Number
8
12
ST
OPT
NO_RPT
Group Number
9
35
ST
OPT
NO_RPT
Group Name
10
12
ST
OPT
NO_RPT
Insured's Group Emp. ID
11
45
ST
OPT
NO_RPT
Insured's Group Emp. Name
12
8
DT
OPT
NO_RPT
Plan Effective Date
13
8
DT
OPT
NO_RPT
Plan Expiration Date
14
55
ST
OPT
NO_RPT
Authorization Information
15
2
ID
OPT
NO_RPT
Plan Type
16
48
PN
OPT
NO_RPT
Name of Insured
17
10
ID
OPT
NO_RPT
Insured's Relation to Pat
18
8
DT
OPT
NO_RPT
Insured's Date of Birth
19
106
AD
OPT
NO_RPT
Insured's Address
20
2
ID
OPT
NO_RPT
Assignment of Benefits
21
2
ID
OPT
NO_RPT
Coordination of Benefits
22
2
ST
OPT
NO_RPT
Coord. of Ben. Priority
23
2
ID
OPT
NO_RPT
Notice of Admission Code
24
8
DT
OPT
NO_RPT
Notice of Admission Date
25
2
ID
OPT
NO_RPT
Rpt of Eligibility Code
26
8
DT
OPT
NO_RPT
Rpt of Eligibility Date
27
2
ID
OPT
NO_RPT
Release Information Code
28
15
ST
OPT
NO_RPT
Pre-Admit Cert. (PAC)
29
8
DT
OPT
NO_RPT
Verification Date
30
60
CM
OPT
NO_RPT
Verification By
31
2
ID
OPT
NO_RPT
Type of Agreement Code
32
2
ID
OPT
NO_RPT
Billing Status
33
4
NM
OPT
NO_RPT
Lifetime Reserve Days
34
4
NM
OPT
NO_RPT
Delay Before L. R. Day
35
8
ST
OPT
NO_RPT
Company Plan Code
36
80
ST
OPT
NO_RPT
Policy Number
37
12
NM
OPT
NO_RPT
Policy Deductible
38
12
NM
OPT
NO_RPT
Policy Limit - Amount
39
4
NM
OPT
NO_RPT
Policy Limit - Days
40
12
NM
OPT
NO_RPT
Room Rate - Semi-Private
41
12
NM
OPT
NO_RPT
Room Rate - Private
42
1
ID
OPT
NO_RPT
Insured's Employ Status
43
1
ID
OPT
NO_RPT
Insured's Sex
44
106
XAD
OPT
NO_RPT
Insured's Employer Addr
45
2
ST
OPT
NO_RPT
Verification Status
46
8
IS
OPT
NO_RPT
Prior Insurance Plan ID
47
3
IS
OPT
NO_RPT
Coverage Type
48
2
IS
OPT
NO_RPT
Handicap
49
12
CX
OPT
NO_RPT
Insured<92>s ID Number
{{% anchor sys="in2" %}}
Insurance - Additional Information (IN2)
Sequence
Length
Data Type
Required
Repetition
Name
1
59
CX
OPT
NO_MAX
Insured's Employee ID
2
11
ST
OPT
NO_RPT
Insured's Social Security Number
3
130
XCN
OPT
NO_MAX
Insured's Employer's Name and ID
4
1
IS
OPT
NO_RPT
Employer Information Data
5
1
IS
OPT
NO_MAX
Mail Claim Party
6
15
ST
OPT
NO_RPT
Medicare Health Ins Card Number
7
48
XPN
OPT
NO_MAX
Medicaid Case Name
8
15
ST
OPT
NO_RPT
Medicaid Case Number
9
48
XPN
OPT
NO_MAX
Military Sponsor Name
10
20
ST
OPT
NO_RPT
Military ID Number
11
80
CE
OPT
NO_RPT
Dependent Of Military Recipient
12
25
ST
OPT
NO_RPT
Military Organization
13
25
ST
OPT
NO_RPT
Military Station
14
14
IS
OPT
NO_RPT
Military Service
15
2
IS
OPT
NO_RPT
Military Rank/Grade
16
3
IS
OPT
NO_RPT
Military Status
17
8
DT
OPT
NO_RPT
Military Retire Date
18
1
ID
OPT
NO_RPT
Military Non-Avail Cert On File
19
1
ID
OPT
NO_RPT
Baby Coverage
20
1
ID
OPT
NO_RPT
Combine Baby Bill
21
1
ST
OPT
NO_RPT
Blood Deductible
22
48
XPN
OPT
NO_MAX
Special Coverage Approval Name
23
30
ST
OPT
NO_RPT
Special Coverage Approval Title
24
8
IS
OPT
NO_MAX
Non-Covered Insurance Code
25
59
CX
OPT
NO_MAX
Payor ID
26
59
CX
OPT
NO_MAX
Payor Subscriber ID
27
1
IS
OPT
NO_RPT
Eligibility Source
28
25
CM
OPT
NO_MAX
Room Coverage Type/Amount
29
25
CM
OPT
NO_MAX
Policy Type/Amount
30
25
CM
OPT
NO_RPT
Daily Deductible
31
2
IS
OPT
NO_RPT
Living Dependency
32
2
IS
OPT
NO_MAX
Ambulatory Status
33
80
CE
OPT
NO_MAX
Citizenship
34
60
CE
OPT
NO_RPT
Primary Language
35
2
IS
OPT
NO_RPT
Living Arrangement
36
80
CE
OPT
NO_RPT
Publicity Code
37
1
ID
OPT
NO_RPT
Protection Indicator
38
2
IS
OPT
NO_RPT
Student Indicator
39
80
CE
OPT
NO_RPT
Religion
40
48
XPN
OPT
NO_MAX
Mother's Maiden Name
41
80
CE
OPT
NO_RPT
Nationality
42
80
CE
OPT
NO_MAX
Ethnic Group
43
80
CE
OPT
NO_MAX
Marital Status
44
8
DT
OPT
NO_RPT
Insured's Employment Start Date
45
8
DT
OPT
NO_RPT
Employment Stop Date
46
20
ST
OPT
NO_RPT
Job Title
47
20
JCC
OPT
NO_RPT
Job Code/Class
48
2
IS
OPT
NO_RPT
Job Status
49
48
XPN
OPT
NO_MAX
Employer Contact Person Name
50
40
XTN
OPT
NO_MAX
Employer Contact Person Phone Number
51
2
IS
OPT
NO_RPT
Employer Contact Reason
52
48
XPN
OPT
NO_MAX
Insured's Contact Person's Name
53
40
XTN
OPT
NO_MAX
Insured's Contact Person Phone Number
54
2
IS
OPT
NO_MAX
Insured's Contact Person Reason
55
8
DT
OPT
NO_RPT
Relationship To The Patient Start Date
56
8
DT
OPT
NO_MAX
Relationship To The Patient Stop Date
57
2
IS
OPT
NO_RPT
Insurance Co. Contact Reason
58
40
XTN
OPT
NO_RPT
Insurance Co Contact Phone Number
59
2
IS
OPT
NO_RPT
Policy Scope
60
2
IS
OPT
NO_RPT
Policy Source
61
60
CX
OPT
NO_RPT
Patient Member Number
62
80
CE
OPT
NO_RPT
Guarantor's Relationship To Insured
63
40
XTN
OPT
NO_MAX
Insured's Phone Number - Home
64
40
XTN
OPT
NO_MAX
Insured's Employer Phone Number
65
60
CE
OPT
NO_RPT
Military Handicapped Program
66
1
ID
OPT
NO_RPT
Suspend Flag
67
1
ID
OPT
NO_RPT
Copay Limit Flag
68
1
ID
OPT
NO_RPT
Stoploss Limit Flag
69
130
XON
OPT
NO_MAX
Insured Organization Name And ID
70
130
XON
OPT
NO_MAX
Insured Employer Organization Name And ID
71
80
CE
OPT
NO_MAX
Race
72
60
CE
OPT
NO_RPT
HCFA Patient's Relationship to Insured
Insurance - Additional Information, Certification (IN3)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID - IN3
2
59
CX
OPT
NO_RPT
Certification Number
3
60
XCN
OPT
NO_MAX
Certified By
4
1
ID
OPT
NO_RPT
Certification Required
5
10
CM
OPT
NO_RPT
Penalty
6
26
TS
OPT
NO_RPT
Certification Date/Time
7
26
TS
OPT
NO_RPT
Certification Modify Date/Time
8
60
XCN
OPT
NO_MAX
Operator
9
8
DT
OPT
NO_RPT
Certification Begin Date
10
8
DT
OPT
NO_RPT
Certification End Date
11
3
CM
OPT
NO_RPT
Days
12
60
CE
OPT
NO_RPT
Non-Concur Code/Description
13
26
TS
OPT
NO_RPT
Non-Concur Effective Date/Time
14
60
XCN
OPT
NO_MAX
Physician Reviewer
15
48
ST
OPT
NO_RPT
Certification Contact
16
40
XTN
OPT
NO_MAX
Certification Contact Phone Number
17
60
CE
OPT
NO_RPT
Appeal Reason
18
60
CE
OPT
NO_RPT
Certification Agency
19
40
XTN
OPT
NO_MAX
Certification Agency Phone Number
20
40
CM
OPT
NO_MAX
Pre-Certification Req/Window
21
48
ST
OPT
NO_RPT
Case Manager
22
8
DT
OPT
NO_RPT
Second Opinion Date
23
1
IS
OPT
NO_RPT
Second Opinion Status
24
1
IS
OPT
NO_MAX
Second Opinion Documentation Received
25
60
XCN
OPT
NO_MAX
Second Opinion Physician
{{% anchor sys="pr1" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_MAX
Set ID - Procedure
2
2
ID
REQ
NO_MAX
Procedure Coding Method
3
10
ID
REQ
NO_MAX
Procedure Code
4
40
ST
OPT
NO_MAX
Procedure Description
5
19
TS
REQ
NO_RPT
Procedure Date/Time
6
2
ID
REQ
NO_RPT
Procedure Type
7
4
NM
OPT
NO_RPT
Procedure Minutes
8
60
CN
OPT
NO_RPT
Anesthesiologist
9
2
ID
OPT
NO_RPT
Anesthesia Code
10
4
NM
OPT
NO_RPT
Anesthesia Minutes
11
60
CN
OPT
NO_RPT
Surgeon
12
60
CN
OPT
NO_RPT
Resident Code
13
2
ID
OPT
NO_RPT
Consent Code
{{% anchor sys="err" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
80
ID
REQ
NO_MAX
Error Code and Location
{{% anchor sys="zil" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
64
ID
OPT
NO_MAX
Dicom Study Ins UID
{{% anchor sys="ztn" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
100
ST
REQ
NO_RPT
System Handle
2
100
ST
REQ
NO_RPT
System OID
3
300
TN
OPT
NO_MAX
Translations used
{{% anchor sys="zdg" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
20
ST
REQ
NO_RPT
Debug Message Type
2
500
ST
OPT
NO_RPT
Debug Message
{{% anchor sys="nte" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID
2
8
ID
OPT
NO_RPT
Source of Comment
3
64000
TX
REQ
NO_MAX
Comment
4
60
CE
OPT
NO_RPT
Comment Type
{{% anchor sys="sch" %}}
Scheduling Activity Information (SCH)
Sequence
Length
Data Type
Required
Repetition
Name
1
75
EI
OPT
NO_RPT
Placer Appointment ID
2
75
EI
REQ
NO_RPT
Filler Appointment ID
3
5
NM
OPT
NO_RPT
Occurrence Number
4
22
EI
OPT
NO_RPT
Placer Group Number
5
200
CE
OPT
NO_RPT
Schedule ID
6
200
CE
OPT
NO_RPT
Event Reason
7
200
CE
OPT
NO_RPT
Appointment Reason
8
200
CE
OPT
NO_RPT
Appointment Type
9
20
NM
OPT
NO_RPT
Appointment Duration
10
200
CE
OPT
NO_RPT
Appointment Duration Units
11
200
TQ
REQ
NO_RPT
Appointment Timing Quantity
12
48
XCN
OPT
NO_RPT
Placer Contact Person
13
40
XTN
OPT
NO_RPT
Placer Contact Phone Number
14
106
XAD
OPT
NO_RPT
Placer Contact Address
15
80
PL
OPT
NO_RPT
Placer Contact Location
16
38
XCN
OPT
NO_RPT
Filler Contact Person
17
40
XTN
OPT
NO_RPT
Filler Contact Phone Number
18
106
XAD
OPT
NO_RPT
Filler Contact Address
19
80
PL
OPT
NO_RPT
Filler Contact Location
20
48
XCN
OPT
NO_RPT
Entered by Person
21
40
XTN
OPT
NO_RPT
Entered by Phone Number
22
80
PL
OPT
NO_RPT
Entered by Location
23
75
EI
OPT
NO_RPT
Parent Placer Appointment ID
24
75
EI
OPT
NO_RPT
Parent Filler Appointment ID
25
200
CE
OPT
NO_RPT
Filler Status Code
{{% anchor sys="rgs" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID
2
3
ID
OPT
NO_RPT
Segment Action Code
3
200
CE
OPT
NO_RPT
Resource Group ID
{{% anchor sys="ail" %}}
Appointment Information - Location resource (AIL)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID
2
1
ID
OPT
NO_RPT
Segment Action Code
3
80
PL
OPT
NO_RPT
Location Resource ID
4
200
CE
REQ
NO_RPT
Location Type
5
200
CE
OPT
NO_RPT
Location Group
6
26
TS
OPT
NO_RPT
Start Date/Time
7
20
NM
OPT
NO_RPT
Start Date/Time Offset
8
200
CE
OPT
NO_RPT
Start Date/Time Offset Units
9
20
NM
OPT
NO_RPT
Duration
10
200
CE
OPT
NO_RPT
Duration Units
11
10
IS
OPT
NO_RPT
Allow Substitution Code
12
200
CE
OPT
NO_RPT
Filler Status Code
{{% anchor sys="aip" %}}
Appointment Information - Personnel Resource (AIP)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID
2
3
ID
OPT
NO_RPT
Segment Action code
3
200
XCN
REQ
NO_RPT
Personnel Resource ID
4
200
CE
OPT
NO_RPT
Resource Role
5
200
CE
OPT
NO_RPT
Resource Group
6
26
TS
OPT
NO_RPT
Start Date/Time
7
20
NM
OPT
NO_RPT
Start Date/Time Offset
8
200
CE
OPT
NO_RPT
Start Date/Time Offset Units
9
20
NM
OPT
NO_RPT
Duration
10
200
CE
OPT
NO_RPT
Duration Units
11
10
IS
OPT
NO_RPT
Allow Substitution Code
12
200
CE
OPT
NO_RPT
Filler Status Code
{{% anchor sys="aig" %}}
Appointment Information - General Resource (AIG)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID - AIG
2
3
ID
OPT
NO_RPT
Segment Action Code
3
200
CE
REQ
NO_RPT
Resource ID
4
200
CE
REQ
NO_RPT
Resource Type
5
200
CE
OPT
NO_MAX
Resource Group
6
5
NM
OPT
NO_RPT
Resource Quantity
7
200
CE
OPT
NO_RPT
Resource Quantity Units
8
26
TS
OPT
NO_RPT
Start Date/Time
9
20
NM
OPT
NO_RPT
Start Date/Time Offset
10
200
CE
OPT
NO_RPT
Start Date/Time Offset Units
11
20
NM
OPT
NO_RPT
Duration
12
200
CE
OPT
NO_RPT
Duration Units
13
10
IS
OPT
NO_RPT
Allow Substitution Code
14
200
CE
OPT
NO_RPT
Filler Status Code
Sequence
Length
Data Type
Required
Repetition
Name
1
26
TS
OPT
NO_RPT
Accident Date/Time
2
60
CE
OPT
NO_RPT
Accident Code
3
25
ST
OPT
NO_RPT
Accident Location
4
60
CE
OPT
NO_RPT
Auto Accident State
5
1
ID
OPT
NO_RPT
Accident Job Related Indicator
6
12
ID
OPT
NO_RPT
Accident Death Indicator
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID - UB1
2
1
NM
OPT
NO_RPT
Blood Deductible
3
2
NM
OPT
NO_RPT
Blood Furnished-Pints Of
4
2
NM
OPT
NO_RPT
Blood Replaced-Pints
5
2
NM
OPT
NO_RPT
Blood Not Replaced-Pints
6
2
NM
OPT
NO_RPT
Co-Insurance Days
7
14
IS
OPT
NO_MAX
Condition Code
8
3
NM
OPT
NO_RPT
Covered Days -
9
3
NM
OPT
NO_RPT
Non Covered Days
10
12
CM
OPT
NO_MAX
Value Amount & Code
11
2
NM
OPT
NO_RPT
Number Of Grace Days
12
60
CE
OPT
NO_RPT
Special Program Indicator
13
60
CE
OPT
NO_RPT
PSRO/UR Approval Indicator
14
8
DT
OPT
NO_RPT
PSRO/UR Approved Stay-Fm
15
8
DT
OPT
NO_RPT
PSRO/UR Approved Stay-To
16
20
CM
OPT
NO_MAX
Occurrence
17
60
CE
OPT
NO_RPT
Occurrence Span
18
8
DT
OPT
NO_RPT
Span Start Date
19
8
DT
OPT
NO_RPT
Span End Date
20
30
ST
OPT
NO_RPT
UB-82 Locator
21
7
ST
OPT
NO_RPT
UB-82 Locator
22
8
ST
OPT
NO_RPT
UB-82 Locator
23
17
ST
OPT
NO_RPT
UB-82 Locator
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID - UB2
2
3
ST
OPT
NO_MAX
Co-Insurance Days
3
2
IS
OPT
NO_RPT
Condition Code
4
3
ST
OPT
NO_RPT
Covered Days
5
4
ST
OPT
NO_RPT
Non-Covered Days
6
11
CM
OPT
NO_MAX
Value Amount & Code
7
11
CM
OPT
NO_MAX
Occurrence Code & Date
8
28
CM
OPT
NO_MAX
Occurrence Span Code/Dates
9
29
ST
OPT
NO_MAX
UB92 Locator 2 (State)
10
12
ST
OPT
NO_MAX
UB92 Locator 11 (State)
11
5
ST
OPT
NO_RPT
UB92 Locator 31 (National)
12
23
ST
OPT
NO_MAX
Document Control Number
13
4
ST
OPT
NO_MAX
UB92 Locator 49 (National)
14
14
ST
OPT
NO_MAX
UB92 Locator 56 (State)
15
27
ST
OPT
NO_RPT
UB92 Locator 57 (National)
16
2
ST
OPT
NO_MAX
UB92 Locator 78 (State)
17
3
NM
OPT
NO_RPT
Special Visit Count
Next of Kin/Associated Parties (NK1)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID - NK1
2
48
XPN
OPT
NO_MAX
Name
3
60
CE
OPT
NO_RPT
Relationship
4
106
XAD
OPT
NO_MAX
Address
5
40
XTN
OPT
NO_MAX
Phone Number
6
40
XTN
OPT
NO_MAX
Business Phone Number
7
60
CE
OPT
NO_RPT
Contact Role
8
8
DT
OPT
NO_RPT
Start Date
9
8
DT
OPT
NO_RPT
End Date
10
60
ST
OPT
NO_RPT
Next of Kin / Associated Parties Job Title
11
20
JCC
OPT
NO_RPT
Next of Kin / Associated Parties JobCode/Class
12
20
CX
OPT
NO_RPT
Next of Kin / Associated Parties EmployeeNumber
13
90
XON
OPT
NO_MAX
Organization Name - NK1
14
80
CE
OPT
NO_RPT
Marital Status
15
1
IS
OPT
NO_RPT
Sex
16
26
TS
OPT
NO_RPT
Date/Time of Birth
17
2
IS
OPT
NO_MAX
Living Dependency
18
2
IS
OPT
NO_MAX
Ambulatory Status
19
80
CE
OPT
NO_MAX
Citizenship
20
60
CE
OPT
NO_RPT
Primary Language
21
2
IS
OPT
NO_RPT
Living Arrangement
22
80
CE
OPT
NO_RPT
Publicity Code
23
1
ID
OPT
NO_RPT
Protection Indicator
24
2
IS
OPT
NO_RPT
Student Indicator
24
80
CE
OPT
NO_RPT
Religion
25
48
XPN
OPT
NO_MAX
Mother's Maiden Name
26
80
CE
OPT
NO_RPT
Nationality
27
80
CE
OPT
NO_MAX
Ethnic Group
28
80
CE
OPT
NO_MAX
Contact Reason
29
48
XPN
OPT
NO_MAX
Contact Person's Name
30
40
XTN
OPT
NO_MAX
Contact Person's Telephone Number
31
106
XAD
OPT
NO_MAX
Contact Person's Address
32
32
CX
OPT
NO_MAX
Next of Kin/Associated Party's Identifiers
33
2
IS
OPT
NO_RPT
Job Status
34
80
CE
OPT
NO_MAX
Race
35
2
IS
OPT
NO_RPT
Handicap
36
16
ST
OPT
NO_RPT
Contact Person Social Security Number
Sequence
Length
Data Type
Required
Repetition
Name
1
30
ST
OPT
NO_RPT
Account Balance
2
30
ST
OPT
NO_RPT
Account Balance Forward
3
30
ST
OPT
NO_RPT
Account Unapplied Credit
4
30
ST
OPT
NO_RPT
Account Creation Date
5
30
ST
OPT
NO_RPT
Account Bill Type
6
30
ST
OPT
NO_RPT
Account Monthly Payment Amount
7
30
ST
OPT
NO_RPT
Account Date Last Payment
8
30
ST
OPT
NO_RPT
Account Amount Last Payment
10
30
ST
OPT
NO_RPT
Account Date Last Bill
11
30
ST
OPT
NO_RPT
Account Amount Last Statement
12
30
ST
OPT
NO_RPT
Account YTD Charges
13
30
ST
OPT
NO_RPT
Account Patient Due AR
14
30
ST
OPT
NO_RPT
Account Account Status
15
30
ST
OPT
NO_RPT
Account Discount Percent
16
30
ST
OPT
NO_RPT
Account Date Last Procedure Posting
17
30
ST
OPT
NO_RPT
Account Patient Class
18
30
ST
OPT
NO_RPT
Account Patient Hist Balance
19
30
ST
OPT
NO_RPT
Account Days before Enter Call
20
30
ST
OPT
NO_RPT
Account Collection Priority
{{% anchor sys="orc" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
2
ID
REQ
NO_RPT
Order Control Code
2
22
EI
OPT
NO_RPT
Placer Order Number
3
22
EI
OPT
NO_RPT
Filler Order Number
4
22
EI
OPT
NO_RPT
Placer Group Number
5
2
ID
OPT
NO_RPT
Order Status
6
1
ID
OPT
NO_RPT
Response Flag
7
200
TQ
OPT
NO_RPT
Quantity/Timing
8
200
CM
REQ
NO_RPT
Parent
9
26
TS
OPT
NO_RPT
Transaction Date/Time
10
120
XCN
OPT
NO_MAX
Entered By
11
120
XCN
OPT
NO_MAX
Verified By
12
120
XCN
OPT
NO_MAX
Ordering Provider
13
80
PL
OPT
NO_RPT
Enterer's Location
14
40
XTN
OPT
NO_RPT
Call Back Phone Number
15
26
TS
OPT
NO_RPT
Order Effective Date/Time
16
200
CE
OPT
NO_RPT
Order Control Code Reason
17
60
CE
OPT
NO_RPT
Entering Organization
18
60
CE
OPT
NO_RPT
Entering Device
19
120
XCN
OPT
NO_MAX
Action By
20
40
CE
OPT
NO_RPT
Advanced Beneficiary Notice Code
21
60
XON
OPT
NO_MAX
Ordering Facility Name
22
106
XAD
OPT
NO_MAX
Ordering Facility Address
23
48
XTN
OPT
NO_MAX
Ordering Facility Phone Number
24
106
XAD
OPT
NO_MAX
Ordering Provider Address
{{% anchor sys="obr" %}}
Observation request (OBR)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID
2
22
EI
OPT
NO_RPT
Placer Order Number
3
22
EI
REQ
NO_RPT
Filler Order Number
4
200
CE
REQ
NO_RPT
Universal Service ID
5
2
ID
OPT
NO_RPT
Priority
6
26
TS
REQ
NO_RPT
Requested Date/Time
7
26
TS
REQ
NO_RPT
Observation Date/Time
8
26
TS
OPT
NO_RPT
Observation End Date/Time
9
20
CQ
OPT
NO_RPT
Collection Volume
10
60
XCN
OPT
NO_MAX
Collector Identifier
11
1
ID
OPT
NO_RPT
Specimen Action Code
12
60
CE
OPT
NO_RPT
Danger Code
13
300
ST
OPT
NO_RPT
Relevant Clinical Info
14
26
TS
REQ
NO_RPT
Specimen Received Date/Time
15
300
CM
OPT
NO_RPT
Specimen Source
16
120
XCN
OPT
NO_MAX
Ordering Provider
17
40
XTN
OPT
NO_RPT
Order Callback Phone Number
18
60
ST
OPT
NO_RPT
Placer Field 1
19
60
ST
OPT
NO_RPT
Placer Field 2
20
60
ST
OPT
NO_RPT
Filler Field 1
21
60
ST
OPT
NO_RPT
Filler Field 2
22
26
TS
OPT
NO_RPT
Results Rpt/Change Date/Time
23
40
CM
OPT
NO_RPT
Charge to Practice
24
10
ID
OPT
NO_RPT
Diagnostic Serv Sect ID
25
1
ID
OPT
NO_RPT
Result Status
26
200
CM
OPT
NO_RPT
Parent Result
27
200
TQ
OPT
NO_MAX
Quantity/Timing
28
150
XCN
OPT
NO_RPT
Result Copies To
29
200
CM
OPT
NO_RPT
Parent
30
20
ID
OPT
NO_RPT
Transportation Mode
31
300
CE
OPT
NO_MAX
Reason for Study
32
200
CM
OPT
NO_RPT
Principal Result Interpreter
33
200
CM
OPT
NO_RPT
Assistant Result Interpreter
34
200
CM
OPT
NO_RPT
Technician
35
200
CM
OPT
NO_MAX
Transcriptionist
36
26
TS
OPT
NO_RPT
Scheduled Date/Time
37
4
NM
OPT
NO_RPT
Number of Sample Containers
38
60
CE
OPT
NO_MAX
Transport Logistics of Collected Samples
39
200
CE
OPT
NO_MAX
Collector's Comment
40
60
CE
OPT
NO_RPT
Transport Arrangement Responsibility
41
30
ID
OPT
NO_RPT
Transport Arranged
42
1
ID
OPT
NO_RPT
Escort Required
43
200
CE
OPT
NO_MAX
Planned Patient Transport Comment
44
80
CE
OPT
NO_RPT
Procedure Code
45
80
CE
OPT
NO_MAX
Procedure Code Modifier
{{% anchor sys="obx" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
OPT
NO_RPT
Set ID
2
3
ID
OPT
NO_RPT
Value Type
3
80
CE
REQ
NO_RPT
Observation Identifier
4
20
ST
OPT
NO_RPT
Observation Sub-Id
5
65536
FT
OPT
NO_RPT
Observation Value
6
60
CE
OPT
NO_RPT
Units
7
60
ST
OPT
NO_RPT
Reference Range
8
5
ID
OPT
NO_RPT
Abnormal Flags
9
5
NM
OPT
NO_RPT
Probability
10
2
ID
OPT
NO_RPT
Nature of Abnormal Test
11
1
ID
REQ
NO_RPT
Observation Result Status
12
26
TS
OPT
NO_RPT
Date Last Obs Normal Value
13
20
ST
OPT
NO_RPT
User Defined Access Checks
14
26
TS
OPT
NO_RPT
Date/Time of the Observation
15
60
CE
OPT
NO_RPT
Producer's ID
16
80
XCN
OPT
NO_RPT
Responsible Observer
17
60
CE
OPT
NO_RPT
Observation Method
Pharmacy/Treatment Administration (RXA)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
NM
REQ
NO_RPT
Give Sub-ID Counter
2
4
NM
REQ
NO_RPT
Administration Sub-ID Counter
3
26
TS
REQ
NO_RPT
Date/Time Start of Administration
4
26
TS
REQ
NO_RPT
Date/Time End of Administration
5
100
CE
REQ
NO_RPT
Administered Code ^CVX (CDC DB)
6
20
NM
REQ
NO_RPT
Administered Amount
7
60
CE
OPT
NO_RPT
Administered Units
8
60
CE
OPT
NO_RPT
Administered Dosage Form
9
200
CE
OPT
NO_MAX
Administration Notes
10
200
XCN
OPT
NO_MAX
Administering Provider
11
200
CM
OPT
NO_RPT
Administered-at Location
12
20
ST
OPT
NO_RPT
Administered Per (Time Unit)
13
20
NM
OPT
NO_RPT
Administered Strength
14
60
CE
OPT
NO_RPT
Administered Strength Units
15
20
ST
OPT
NO_MAX
Substance Lot Number
16
27
TS
OPT
NO_MAX
Substance Expiration Date
17
60
CE
OPT
NO_MAX
Substance Manufacturer Name ^MVX
18
200
CE
OPT
NO_MAX
Substance Refusal Reason
19
200
CE
OPT
NO_MAX
Indication
20
2
ID
OPT
NO_RPT
Completion Status
21
2
ID
OPT
NO_RPT
Action Code-RXA
22
26
TS
OPT
NO_RPT
System Entry Date/Time
Pharmacy/Treatment Route (RXR)
Sequence
Length
Data Type
Required
Repetition
Name
1
60
CE
REQ
NO_RPT
Route (p351 in pdf)
2
60
CE
OPT
NO_RPT
Site (possibly SNOMED)
3
60
CE
OPT
NO_RPT
Administration Device (p352 in pdf)
4
60
CE
OPT
NO_RPT
Administration Method
5
60
CE
OPT
NO_RPT
Routing Instruction
{{% anchor sys="txa" %}}
Transcription Document Header (TXA)
Sequence
Length
Data Type
Required
Repetition
Name
1
4
SI
REQ
NO_RPT
Set ID- TXA
2
30
IS
REQ
NO_RPT
Document Type
3
2
ID
OPT
NO_RPT
Document Content Presentation
4
26
TS
OPT
NO_RPT
Activity Date/Time
5
60
XCN
OPT
NO_MAX
Primary Activity Provider Code/Name
6
26
TS
OPT
NO_RPT
Origination Date/Time
7
26
TS
OPT
NO_RPT
Transcription Date/Time
8
26
TS
OPT
NO_MAX
Edit Date/Time
9
60
XCN
OPT
NO_MAX
Originator Code/Name
10
60
XCN
OPT
NO_MAX
Assigned Document Authenticator
11
48
XCN
OPT
NO_MAX
Transcriptionist Code/Name
12
30
EI
REQ
NO_RPT
Unique Document Number
13
30
EI
OPT
NO_RPT
Parent Document Number
14
22
EI
OPT
NO_MAX
Placer Order Number
15
22
EI
OPT
NO_RPT
Filler Order Number
16
30
ST
OPT
NO_RPT
Unique Document File Name
17
2
ID
REQ
NO_RPT
Document Completion Status
18
2
ID
OPT
NO_RPT
Document Confidentiality Status
19
2
ID
OPT
NO_RPT
Document Availability Status
20
2
ID
OPT
NO_RPT
Document Storage Status
21
30
ST
OPT
NO_RPT
Document Change Reason
22
60
PPN
OPT
NO_MAX
Authentication Person, Time Stamp
23
60
XCN
OPT
NO_MAX
Distributed Copies (Code and Name of Recipients)
Query Acknowledgement (QAK)
Sequence
Length
Data Type
Required
Repetition
Name
1
32
ST
OPT
NO_RPT
Query Tag
2
60
CE
REQ
NO_RPT
Event Identifier
3
256
QIP
OPT
NO_MAX
Input Parameter List
Original Style Query Definition (QRD)
Sequence
Length
Data Type
Required
Repetition
Name
1
26
TS
REQ
NO_RPT
Query Date/Time
2
1
ID
REQ
NO_RPT
Query Format Code - usually: R
3
1
ID
REQ
NO_RPT
Query Priority - usually: I
4
10
ST
REQ
NO_RPT
Query ID (unique ID assigned by querying app)
5
1
ID
OPT
NO_RPT
Deferred Response Type (not used w/ .3 == I)
6
26
TS
OPT
NO_RPT
Deferred Response Date/Time (not used w/ .3 == I)
7
10
CQ
REQ
NO_RPT
Quantity Limited Request (not used)
8
60
XCN
REQ
NO_MAX
Who Subject Filter (Queried Patient information)
9
60
CE
REQ
NO_MAX
What Subject Filter - usually: VXI
10
60
CE
REQ
NO_MAX
What Department Data Code (specific for VXI)
11
20
CM
OPT
NO_MAX
What Data Code Value Qual (result range criteria)
12
1
ID
OPT
NO_RPT
Query Results Level
Original Style Query Filter (QRF)
Sequence
Length
Data Type
Required
Repetition
Name
1
20
ST
REQ
NO_MAX
Where Subject Filter (department,system,etc: LAB~HEMO)
2
26
TS
OPT
NO_RPT
When Data Start Date/Time - Backwards only
3
26
TS
OPT
NO_RPT
When Data End Date/Time - Backwards only
4
60
ST
OPT
NO_MAX
What User Qualifier (extra limitation)
5
60
ST
OPT
NO_MAX
Other QRY Subject Filter (limit of 10 repeats for VXQ) see hl7_notes.txt
6
12
ID
OPT
NO_MAX
Which Date/Time Qualifier (range of .2/.3) - usually: ANY
7
12
ID
OPT
NO_MAX
Which Date/Time Status Qualifier - usually: CFN or FIN (current final value, final only)
8
12
ID
OPT
NO_MAX
Date/Time Selection Qualifier (value ordering (1ST,LST,ALL,REV) - usually:REV (reverse cronological)
9
60
TQ
OPT
NO_RPT
When Quantity/Timing Qualifier (replaces .2/.3)
Sequence
Length
Data Type
Required
Repetition
Name
1
255
ST
OPT
NO_RPT
Height
2
255
ST
OPT
NO_RPT
Weight
3
255
ST
OPT
NO_RPT
Urine Collection
4
255
ST
OPT
NO_RPT
Fasting
Sequence
Length
Data Type
Required
Repetition
Name
1
255
ST
REQ
NO_RPT
Patient Race
2
255
ST
REQ
NO_RPT
Hispanic
3
255
ST
REQ
NO_RPT
Blood Lead Type
4
255
ST
OPT
NO_RPT
Blood Lead Purpose
5
255
ST
OPT
NO_RPT
Blood Lead County
Sequence
Length
Data Type
Required
Repetition
Name
1
255
ST
REQ
NO_RPT
Cervical
2
255
ST
REQ
NO_RPT
Endocervical
3
255
ST
REQ
NO_RPT
Labia-Vulva
4
255
ST
REQ
NO_RPT
Vaginal
5
255
ST
REQ
NO_RPT
Endometrial
6
255
ST
REQ
NO_RPT
Swab-Spatula
7
255
ST
REQ
NO_RPT
Brush-Spatula
8
255
ST
REQ
NO_RPT
Spatula-Alone
9
255
ST
REQ
NO_RPT
Brush-Alone
10
255
ST
REQ
NO_RPT
Broom-Alone
11
255
ST
REQ
NO_RPT
Other Collection Technique
12
255
ST
REQ
NO_RPT
LMP-Meno Date
13
255
ST
REQ
NO_RPT
Prev Treatment
14
255
ST
REQ
NO_RPT
Hyst-Prev Treatment
15
255
ST
REQ
NO_RPT
Coniza-Prev Treatment
16
255
ST
REQ
NO_RPT
Colp-BX-Prev Treatment
17
255
ST
REQ
NO_RPT
Laser Vap-Prev Treatment
18
255
ST
REQ
NO_RPT
Cyro-Prev Treatment
19
255
ST
REQ
NO_RPT
Radiation-Prev Treatment
20
255
ST
REQ
NO_RPT
Dates Results-prev cyto inf
21
255
ST
REQ
NO_RPT
Pregnant
22
255
ST
REQ
NO_RPT
Lactating
23
255
ST
REQ
NO_RPT
Oral Contraceptive
24
255
ST
REQ
NO_RPT
Menopausal
25
255
ST
REQ
NO_RPT
Estro-RX
26
255
ST
REQ
NO_RPT
PMP-Bleeding
27
255
ST
REQ
NO_RPT
Post-Part
28
255
ST
REQ
NO_RPT
IUD
29
255
ST
REQ
NO_RPT
All Other Pat Info
30
255
ST
REQ
NO_RPT
Negative prev cyto info
31
255
ST
REQ
NO_RPT
Atypical prev cyto info
32
255
ST
REQ
NO_RPT
Dysplasia prev cyto info
33
255
ST
REQ
NO_RPT
Ca-In-Situ prev cyto info
34
255
ST
REQ
NO_RPT
Invasive prev cyto info
35
255
ST
REQ
NO_RPT
Other prev cyto info
Sequence
Length
Data Type
Required
Repetition
Name
1
255
ST
REQ
NO_RPT
Insulin Dependent
2
255
ST
REQ
NO_RPT
Gestational Age
3
255
ST
REQ
NO_RPT
Gest Age by LMP
4
255
ST
REQ
NO_RPT
Gest Age by Ultrasound
5
255
ST
REQ
NO_RPT
Gest Age by Est Date of Delivery
6
255
ST
REQ
NO_RPT
Type of Pregnancy
7
255
ST
REQ
NO_RPT
Routine Screening
8
255
ST
REQ
NO_RPT
Prev Neural Tube Defects
9
255
ST
REQ
NO_RPT
Advanced Maternal Age
10
255
ST
REQ
NO_RPT
History of Down Syndrome
11
255
ST
REQ
NO_RPT
Hist of Cystic Fibrosis
12
255
ST
REQ
NO_RPT
Other Indications
13
255
ST
REQ
NO_RPT
Hand Written AFP Info
14
255
ST
REQ
NO_RPT
Reason for Repeat: Elevated
15
255
ST
REQ
NO_RPT
Early GA
16
255
ST
REQ
NO_RPT
Hemolyzed
Sequence
Length
Data Type
Required
Repetition
Name
1
255
ST
REQ
NO_RPT
Sequence Number
2
255
ST
REQ
NO_RPT
Facility Mnemonic
3
255
ST
REQ
NO_RPT
Facility Name
4
255
ST
REQ
NO_RPT
Facility Address Info
5
255
ST
REQ
NO_RPT
Facility Phone num
6
255
ST
REQ
NO_RPT
Facility Contact
7
255
ST
REQ
NO_RPT
Facility Director
Sequence
Length
Data Type
Required
Repetition
Name
1
60
CE
OPT
NO_RPT
Unused
2
60
CE
OPT
NO_RPT
Unused
3
60
CE
OPT
NO_RPT
Unused
4
60
CE
OPT
NO_RPT
Unused
5
60
CE
OPT
NO_RPT
Unused
6
60
CE
OPT
NO_RPT
Unused
7
60
CE
OPT
NO_RPT
VFC Code
{{% anchor sys="zpa" %}}
Sequence
Length
Data Type
Required
Repetition
Name
1
10
CE
OPT
NO_RPT
employee_group
2
10
CE
OPT
NO_RPT
employee_class
3
10
CE
OPT
NO_RPT
job_code
4
10
CE
OPT
NO_RPT
company_code
5
10
CE
OPT
NO_RPT
cost_center_code
6
10
CE
OPT
NO_RPT
facility_code
7
10
CE
OPT
NO_RPT
building_code
8
10
CE
OPT
NO_RPT
floor_code
9
26
TS
OPT
NO_RPT
hire_datetime
10
26
TS
OPT
NO_RPT
rehire_datetime
11
26
TS
OPT
NO_RPT
retirement_datetime
12
26
TS
OPT
NO_RPT
termination_datetime
13
8
CE
OPT
NO_RPT
work_schedule_code
14
26
TS
OPT
NO_RPT
onboard_datetime
15
30
ST
OPT
NO_RPT
supervisor_mrn
16
10
ST
OPT
NO_RPT
supervisor_id
17
30
ST
OPT
NO_RPT
admin_assist_mrn
18
10
ST
OPT
NO_RPT
admin_assist_id
19
100
ST
OPT
NO_RPT
hr_rsn_typ_nm
20
2
ST
OPT
NO_RPT
hr_actn_typ_cd
21
100
ST
OPT
NO_RPT
hr_actn_typ_nm
22
26
TS
OPT
NO_RPT
actn_begin_dt
23
26
TS
OPT
NO_RPT
actn_end_dt
24
10
ST
OPT
NO_RPT
clinic_location
25
10
CE
OPT
NO_RPT
capacity_utilization_level
26
5
ST
OPT
NO_RPT
hours_worked_per_day
27
5
ST
OPT
NO_RPT
days_worked_per_week
28
4
CE
OPT
NO_RPT
status_code
29
26
TS
OPT
NO_RPT
edl_start_datetime
30
26
TS
OPT
NO_RPT
edl_end_datetime
31
5
ST
OPT
NO_RPT
personnel_area_code
32
5
ST
OPT
NO_RPT
personnel_area_text
33
10
ST
OPT
NO_RPT
location
34
50
CE
OPT
NO_RPT
employee_union
35
20
ST
OPT
NO_RPT
hourlyrate
36
26
TS
OPT
NO_RPT
seniority_date
{{% anchor sys="tn" %}}
The TN Data Type is an MIE Extension designed for notifying a sending system of translations used in the processing of the message. This can be thought of as an incremental approach to maintaining a MFN interface.
Name
Data Type
Required
Use
From ID
ID
REQ
the requesting system's local identifier (external vendor)
To ID
ID
REQ
the creating system's local identifier (webchart)
Type
ST
REQ
indication of type of translation created: user, or one of the WCMAP_ family of #defines
Context
ST
OPT
optional indication of the context of the translation created. for users, an indication of originating, authenticating, etc.
Sending HL7 Messages to System
Sample HL7 Messages