HL7 Lookup/Crosswalk Table

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Field Field Description
ABS-1 Discharge Care Provider
ABS-2 Transfer Medical Service Code
ABS-3 Severity of Illness Code
ABS-4 Date/Time of Attestation
ABS-5 Attested By
ABS-6 Triage Code
ABS-7 Abstract Completion Date/Time
ABS-8 Abstracted By
ABS-9 Case Category Code
ABS-10 Caesarian Section Indicator
ABS-11 Gestation Category Code
ABS-12 Gestation Period - Weeks
ABS-13 Newborn Code
ABS-14 Stillborn Indicator


Field Field Description
ACC-1 Accident Date/Time
ACC-2 Accident Code
ACC-3 Accident Location
ACC-4 Auto Accident State
ACC-5 Accident Job Related Indicator
ACC-6 Accident Death Indicator
ACC-7 Entered By
ACC-8 Accident Description
ACC-9 Brought In By
ACC-10 Police Notified Indicator
ACC-11 Accident Address
ACC-12 Degree of patient liability
ACC-13 Accident Identifier


Field Field Description
ADD-1 Addendum Continuation Pointer


Field Field Description
ADJ-1 Provider Adjustment Number
ADJ-2 Payer Adjustment Number
ADJ-3 Adjustment Sequence Number
ADJ-4 Adjustment Category
ADJ-5 Adjustment Amount
ADJ-6 Adjustment Quantity
ADJ-7 Adjustment Reason PA
ADJ-8 Adjustment Description
ADJ-9 Original Value
ADJ-10 Substitute Value
ADJ-11 Adjustment Action
ADJ-12 Provider Adjustment Number Cross Reference
ADJ-13 Provider Product/Service Line Item Number Cross Reference
ADJ-14 Adjustment Date
ADJ-15 Responsible Organization


Field Field Description
AFF-1 Set ID - AFF
AFF-2 Professional Organization
AFF-3 Professional Organization Address
AFF-4 Professional Organization Affiliation Date Range
AFF-5 Professional Affiliation Additional Information


Field Field Description
AIG-1 Set ID - AIG
AIG-2 Segment Action Code
AIG-3 Resource ID
AIG-4 Resource Type
AIG-5 Resource Group
AIG-6 Resource Quantity
AIG-7 Resource Quantity Units
AIG-8 Start Date/Time
AIG-9 Start Date/Time Offset
AIG-10 Start Date/Time Offset Units
AIG-11 Duration
AIG-12 Duration Units
AIG-13 Allow Substitution Code
AIG-14 Filler Status Code


Field Field Description
AIL-1 Set ID - AIL
AIL-2 Segment Action Code
AIL-3 Location Resource ID
AIL-4 Location Type - AIL
AIL-5 Location Group
AIL-6 Start Date/Time
AIL-7 Start Date/Time Offset
AIL-8 Start Date/Time Offset Units
AIL-9 Duration
AIL-10 Duration Units
AIL-11 Allow Substitution Code
AIL-12 Filler Status Code


Field Field Description
AIP-1 Set ID - AIP
AIP-2 Segment Action Code
AIP-3 Personnel Resource ID
AIP-4 Resource Type
AIP-5 Resource Group
AIP-6 Start Date/Time
AIP-7 Start Date/Time Offset
AIP-8 Start Date/Time Offset Units
AIP-9 Duration
AIP-10 Duration Units
AIP-11 Allow Substitution Code
AIP-12 Filler Status Code


Field Field Description
AIS-1 Set ID - AIS
AIS-2 Segment Action Code
AIS-3 Universal Service Identifier
AIS-4 Start Date/Time
AIS-5 Start Date/Time Offset
AIS-6 Start Date/Time Offset Units
AIS-7 Duration
AIS-8 Duration Units
AIS-9 Allow Substitution Code
AIS-10 Filler Status Code
AIS-11 Placer Supplemental Service Information
AIS-12 Filler Supplemental Service Information


Field Field Description
AL1-1 Set ID - AL1
AL1-2 Allergen Type Code
AL1-3 Allergen Code/Mnemonic/Description
AL1-4 Allergy Severity Code
AL1-5 Allergy Reaction Code
AL1-6 Identification Date


Field Field Description
APR-1 Time Selection Criteria
APR-2 Resource Selection Criteria
APR-3 Location Selection Criteria
APR-4 Slot Spacing Criteria
APR-5 Filler Override Criteria


Field Field Description
ARQ-1 Placer Appointment ID
ARQ-2 Filler Appointment ID
ARQ-3 Occurrence Number
ARQ-4 Placer Group Number
ARQ-5 Schedule ID
ARQ-6 Request Event Reason
ARQ-7 Appointment Reason
ARQ-8 Appointment Type
ARQ-9 Appointment Duration
ARQ-10 Appointment Duration Units
ARQ-11 Requested Start Date/Time Range
ARQ-12 Priority-ARQ
ARQ-13 Repeating Interval
ARQ-14 Repeating Interval Duration
ARQ-15 Placer Contact Person
ARQ-16 Placer Contact Phone Number
ARQ-17 Placer Contact Address
ARQ-18 Placer Contact Location
ARQ-19 Entered By Person
ARQ-20 Entered By Phone Number
ARQ-21 Entered By Location
ARQ-22 Parent Placer Appointment ID
ARQ-23 Parent Filler Appointment ID
ARQ-24 Placer Order Number
ARQ-25 Filler Order Number


Field Field Description
ARV-1 Set ID
ARV-2 Access Restriction Action Code
ARV-3 Access Restriction Value
ARV-4 Access Restriction Reason
ARV-5 Special Access Restriction Instructions
ARV-6 Access Restriction Date Range


Field Field Description
AUT-1 Authorizing Payor, Plan ID
AUT-2 Authorizing Payor, Company ID
AUT-3 Authorizing Payor, Company Name
AUT-4 Authorization Effective Date
AUT-5 Authorization Expiration Date
AUT-6 Authorization Identifier
AUT-7 Reimbursement Limit
AUT-8 Requested Number of Treatments
AUT-9 Authorized Number of Treatments
AUT-10 Process Date
AUT-11 Requested Discipline(s)
AUT-12 Authorized Discipline(s)
AUT-13 Authorization Referral Type
AUT-14 Approval Status
AUT-15 Planned Treatment Stop Date
AUT-16 Clinical Service
AUT-17 Reason Text
AUT-18 Number of Authorized Treatments/Units
AUT-19 Number of Used Treatments/Units
AUT-20 Number of Schedule Treatments/Units
AUT-21 Encounter Type
AUT-22 Remaining Benefit Amount
AUT-23 Authorized Provider
AUT-24 Authorized Health Professional
AUT-25 Source Text
AUT-26 Source Date
AUT-27 Source Phone
AUT-28 Comment
AUT-29 Action Code


Field Field Description
BHS-1 Batch Field Separator
BHS-2 Batch Encoding Characters
BHS-3 Batch Sending Application
BHS-4 Batch Sending Facility
BHS-5 Batch Receiving Application
BHS-6 Batch Receiving Facility
BHS-7 Batch Creation Date/Time
BHS-8 Batch Security
BHS-9 Batch Name/ID/Type
BHS-10 Batch Comment
BHS-11 Batch Control ID
BHS-12 Reference Batch Control ID
BHS-13 Batch Sending Network Address
BHS-14 Batch Receiving Network Address


Field Field Description
BLC-1 Blood Product Code
BLC-2 Blood Amount


Field Field Description
BLG-1 When to Charge
BLG-2 Charge Type
BLG-3 Account ID
BLG-4 Charge Type Reason


Field Field Description
BPO-1 Set ID - BPO
BPO-2 BP Universal Service Identifier
BPO-3 BP Processing Requirements
BPO-4 BP Quantity
BPO-5 BP Amount
BPO-6 BP Units
BPO-7 BP Intended Use Date/Time
BPO-8 BP Intended Dispense From Location
BPO-9 BP Intended Dispense From Address
BPO-10 BP Requested Dispense Date/Time
BPO-11 BP Requested Dispense To Location
BPO-12 BP Requested Dispense To Address
BPO-13 BP Indication for Use
BPO-14 BP Informed Consent Indicator


Field Field Description
BPX-1 Set ID - BPX
BPX-2 BP Dispense Status
BPX-3 BP Status
BPX-4 BP Date/Time of Status
BPX-5 BC Donation ID
BPX-6 BC Component
BPX-7 BC Donation Type / Intended Use
BPX-8 CP Commercial Product
BPX-9 CP Manufacturer
BPX-10 CP Lot Number
BPX-11 BP Blood Group
BPX-12 BC Special Testing
BPX-13 BP Expiration Date/Time
BPX-14 BP Quantity
BPX-15 BP Amount
BPX-16 BP Units
BPX-17 BP Unique ID
BPX-18 BP Actual Dispensed To Location
BPX-19 BP Actual Dispensed To Address
BPX-20 BP Dispensed to Receiver
BPX-21 BP Dispensing Individual


Field Field Description
BTS-1 Batch Message Count
BTS-2 Batch Comment
BTS-3 Batch Totals


Field Field Description
BTX-1 Set ID - BTX
BTX-2 BC Donation ID
BTX-3 BC Component
BTX-4 BC Blood Group
BTX-5 CP Commercial Product
BTX-6 CP Manufacturer
BTX-7 CP Lot Number
BTX-8 BP Quantity
BTX-9 BP Amount
BTX-10 BP Units
BTX-11 BP Transfusion/Disposition Status
BTX-12 BP Message Status
BTX-13 BP Date/Time of Status
BTX-14 BP Transfusion Administrator
BTX-15 BP Transfusion Verifier
BTX-16 BP Transfusion Start Date/Time of Status
BTX-17 BP Transfusion End Date/Time of Status
BTX-18 BP Adverse Reaction Type
BTX-19 BP Transfusion Interrupted Reason
BTX-20 BP Unique ID


Field Field Description
BUI-1 Set ID - BUI
BUI-2 Blood Unit Identifier
BUI-3 Blood Unit Type
BUI-4 Blood Unit Weight
BUI-5 Weight Units
BUI-6 Blood Unit Volume
BUI-7 Volume Units
BUI-8 Container Catalog Number
BUI-9 Container Lot Number
BUI-10 Container Manufacturer
BUI-11 Transport Temperature
BUI-12 Transport Temperature Units


Field Field Description
CDM-1 Primary Key Value - CDM
CDM-2 Charge Code Alias
CDM-3 Charge Description Short
CDM-4 Charge Description Long
CDM-5 Description Override Indicator
CDM-6 Exploding Charges
CDM-7 Procedure Code
CDM-8 Active/Inactive Flag
CDM-9 Inventory Number
CDM-10 Resource Load
CDM-11 Contract Number
CDM-12 Contract Organization
CDM-13 Room Fee Indicator


Field Field Description
CDO-1 Set ID - CDO
CDO-2 Action Code
CDO-3 Cumulative Dosage Limit
CDO-4 Cumulative Dosage Limit Time Interval


Field Field Description
CER-1 Set ID - CER
CER-2 Serial Number
CER-3 Version
CER-4 Granting Authority
CER-5 Issuing Authority
CER-6 Signature
CER-7 Granting Country
CER-8 Granting State/Province
CER-9 Granting County/Parish
CER-10 Certificate Type
CER-11 Certificate Domain
CER-12 Subject ID
CER-13 Subject Name
CER-14 Subject Directory Attribute Extension
CER-15 Subject Public Key Info
CER-16 Authority Key Identifier
CER-17 Basic Constraint
CER-18 CRL Distribution Point
CER-19 Jurisdiction Country
CER-20 Jurisdiction State/Province
CER-21 Jurisdiction County/Parish
CER-22 Jurisdiction Breadth
CER-23 Granting Date
CER-24 Issuing Date
CER-25 Activation Date
CER-26 Inactivation Date
CER-27 Expiration Date
CER-28 Renewal Date
CER-29 Revocation Date
CER-30 Revocation Reason Code
CER-31 Certificate Status Code


Field Field Description
CM0-1 Set ID - CM0
CM0-2 Sponsor Study ID
CM0-3 Alternate Study ID
CM0-4 Title of Study
CM0-5 Chairman of Study
CM0-6 Last IRB Approval Date
CM0-7 Total Accrual to Date
CM0-8 Last Accrual Date
CM0-9 Contact for Study
CM0-10 Contact's Telephone Number
CM0-11 Contact's Address


Field Field Description
CM1-1 Set ID - CM1
CM1-2 Study Phase Identifier
CM1-3 Description of Study Phase


Field Field Description
CM2-1 Set ID- CM2
CM2-2 Scheduled Time Point
CM2-3 Description of Time Point
CM2-4 Events Scheduled This Time Point


Field Field Description
CNS-1 Starting Notification Reference Number
CNS-2 Ending Notification Reference Number
CNS-3 Starting Notification Date/Time
CNS-4 Ending Notification Date/Time
CNS-5 Starting Notification Code
CNS-6 Ending Notification Code


Field Field Description
CON-1 Set ID - CON
CON-2 Consent Type
CON-3 Consent Form ID and Version
CON-4 Consent Form Number
CON-5 Consent Text
CON-6 Subject-specific Consent Text
CON-7 Consent Background Information
CON-8 Subject-specific Consent Background Text
CON-9 Consenter-imposed limitations
CON-10 Consent Mode
CON-11 Consent Status
CON-12 Consent Discussion Date/Time
CON-13 Consent Decision Date/Time
CON-14 Consent Effective Date/Time
CON-15 Consent End Date/Time
CON-16 Subject Competence Indicator
CON-17 Translator Assistance Indicator
CON-18 Language Translated To
CON-19 Informational Material Supplied Indicator
CON-20 Consent Bypass Reason
CON-21 Consent Disclosure Level
CON-22 Consent Non-disclosure Reason
CON-23 Non-subject Consenter Reason
CON-24 Consenter ID
CON-25 Relationship to Subject


Field Field Description
CSP-1 Study Phase Identifier
CSP-2 Date/time Study Phase Began
CSP-3 Date/time Study Phase Ended
CSP-4 Study Phase Evaluability


Field Field Description
CSR-1 Sponsor Study ID
CSR-2 Alternate Study ID
CSR-3 Institution Registering the Patient
CSR-4 Sponsor Patient ID
CSR-5 Alternate Patient ID - CSR
CSR-6 Date/Time of Patient Study Registration
CSR-7 Person Performing Study Registration
CSR-8 Study Authorizing Provider
CSR-9 Date/Time Patient Study Consent Signed
CSR-10 Patient Study Eligibility Status
CSR-11 Study Randomization Date/time
CSR-12 Randomized Study Arm
CSR-13 Stratum for Study Randomization
CSR-14 Patient Evaluability Status
CSR-15 Date/Time Ended Study
CSR-16 Reason Ended Study


Field Field Description
CSS-1 Study Scheduled Time Point
CSS-2 Study Scheduled Patient Time Point
CSS-3 Study Quality Control Codes


Field Field Description
CTD-1 Contact Role
CTD-2 Contact Name
CTD-3 Contact Address
CTD-4 Contact Location
CTD-5 Contact Communication Information
CTD-6 Preferred Method of Contact
CTD-7 Contact Identifiers


Field Field Description
CTI-1 Sponsor Study ID
CTI-2 Study Phase Identifier
CTI-3 Study Scheduled Time Point


Field Field Description
DB1-1 Set ID - DB1
DB1-2 Disabled Person Code
DB1-3 Disabled Person Identifier
DB1-4 Disability Indicator
DB1-5 Disability Start Date
DB1-6 Disability End Date
DB1-7 Disability Return to Work Date
DB1-8 Disability Unable to Work Date


Field Field Description
DG1-1 Set ID - DG1
DG1-2 Diagnosis Coding Method
DG1-3 Diagnosis Code - DG1
DG1-4 Diagnosis Description
DG1-5 Diagnosis Date/Time
DG1-6 Diagnosis Type
DG1-7 Major Diagnostic Category
DG1-8 Diagnostic Related Group
DG1-9 DRG Approval Indicator
DG1-10 DRG Grouper Review Code
DG1-11 Outlier Type
DG1-12 Outlier Days
DG1-13 Outlier Cost
DG1-14 Grouper Version And Type
DG1-15 Diagnosis Priority
DG1-16 Diagnosing Clinician
DG1-17 Diagnosis Classification
DG1-18 Confidential Indicator
DG1-19 Attestation Date/Time
DG1-20 Diagnosis Identifier
DG1-21 Diagnosis Action Code
DG1-22 Parent Diagnosis
DG1-23 DRG CCL Value Code
DG1-24 DRG Grouping Usage
DG1-25 DRG Diagnosis Determination Status
DG1-26 Present On Admission (POA) Indicator


Field Field Description
DMI-1 Diagnostic Related Group
DMI-2 Major Diagnostic Category
DMI-3 Lower and Upper Trim Points
DMI-4 Average Length of Stay
DMI-5 Relative Weight


Field Field Description
DON-1 Donation Identification Number - DIN
DON-2 Donation Type
DON-3 Phlebotomy Start Date/Time
DON-4 Phlebotomy End Date/Time
DON-5 Donation Duration
DON-6 Donation Duration Units
DON-7 Intended Procedure Type
DON-8 Actual Procedure Type
DON-9 Donor Eligibility Flag
DON-10 Donor Eligibility Procedure Type
DON-11 Donor Eligibility Date
DON-12 Process Interruption
DON-13 Process Interruption Reason
DON-14 Phlebotomy Issue
DON-15 Intended Recipient Blood Relative
DON-16 Intended Recipient Name
DON-17 Intended Recipient DOB
DON-18 Intended Recipient Facility
DON-19 Intended Recipient Procedure Date
DON-20 Intended Recipient Ordering Provider
DON-21 Phlebotomy Status
DON-22 Arm Stick
DON-23 Bleed Start Phlebotomist
DON-24 Bleed End Phlebotomist
DON-25 Aphaeresis Type Machine
DON-26 Aphaeresis Machine Serial Number
DON-27 Donor Reaction
DON-28 Final Review Staff ID
DON-29 Final Review Date/Time
DON-30 Number of Tubes Collected
DON-31 Donation Sample Identifier
DON-32 Donation Accept Staff
DON-33 Donation Material Review Staff


Field Field Description
DRG-1 Diagnostic Related Group
DRG-2 DRG Assigned Date/Time
DRG-3 DRG Approval Indicator
DRG-4 DRG Grouper Review Code
DRG-5 Outlier Type
DRG-6 Outlier Days
DRG-7 Outlier Cost
DRG-8 DRG Payor
DRG-9 Outlier Reimbursement
DRG-10 Confidential Indicator
DRG-11 DRG Transfer Type
DRG-12 Name of Coder
DRG-13 Grouper Status
DRG-14 PCCL Value Code
DRG-15 Effective Weight
DRG-16 Monetary Amount
DRG-17 Status Patient
DRG-18 Grouper Software Name
DRG-19 Grouper Software Version
DRG-20 Status Financial Calculation
DRG-21 Relative Discount/Surcharge
DRG-22 Basic Charge
DRG-23 Total Charge
DRG-24 Discount/Surcharge
DRG-25 Calculated Days
DRG-26 Status Gender
DRG-27 Status Age
DRG-28 Status Length of Stay
DRG-29 Status Same Day Flag
DRG-30 Status Separation Mode
DRG-31 Status Weight at Birth
DRG-32 Status Respiration Minutes
DRG-33 Status Admission


Field Field Description
DSC-1 Continuation Pointer
DSC-2 Continuation Style


Field Field Description
DSP-1 Set ID - DSP
DSP-2 Display Level
DSP-3 Data Line
DSP-4 Logical Break Point
DSP-5 Result ID


Field Field Description
ECD-1 Reference Command Number
ECD-2 Remote Control Command
ECD-3 Response Required
ECD-4 Requested Completion Time
ECD-5 Parameters


Field Field Description
ECR-1 Command Response
ECR-2 Date/Time Completed
ECR-3 Command Response Parameters


Field Field Description
EDU-1 Set ID - EDU
EDU-2 Academic Degree
EDU-3 Academic Degree Program Date Range
EDU-4 Academic Degree Program Participation Date Range
EDU-5 Academic Degree Granted Date
EDU-6 School
EDU-7 School Type Code
EDU-8 School Address
EDU-9 Major Field of Study


Field Field Description
EQP-1 Event type
EQP-2 File Name
EQP-3 Start Date/Time
EQP-4 End Date/Time
EQP-5 Transaction Data


Field Field Description
EQU-1 Equipment Instance Identifier
EQU-2 Event Date/Time
EQU-3 Equipment State
EQU-4 Local/Remote Control State
EQU-5 Alert Level


Field Field Description
ERR-1 Error Code and Location
ERR-2 Error Location
ERR-3 HL7 Error Code
ERR-4 Severity
ERR-5 Application Error Code
ERR-6 Application Error Parameter
ERR-7 Diagnostic Information
ERR-8 User Message
ERR-9 Inform Person Indicator
ERR-10 Override Type
ERR-11 Override Reason Code
ERR-12 Help Desk Contact Point


Field Field Description
EVN-1 Event Type Code
EVN-2 Recorded Date/Time
EVN-3 Date/Time Planned Event
EVN-4 Event Reason Code
EVN-5 Operator ID
EVN-6 Event Occurred
EVN-7 Event Facility


Field Field Description
FAC-1 Facility ID-FAC
FAC-2 Facility Type
FAC-3 Facility Address
FAC-4 Facility Telecommunication
FAC-5 Contact Person
FAC-6 Contact Title
FAC-7 Contact Address
FAC-8 Contact Telecommunication
FAC-9 Signature Authority
FAC-10 Signature Authority Title
FAC-11 Signature Authority Address
FAC-12 Signature Authority Telecommunication


Field Field Description
FHS-1 File Field Separator
FHS-2 File Encoding Characters
FHS-3 File Sending Application
FHS-4 File Sending Facility
FHS-5 File Receiving Application
FHS-6 File Receiving Facility
FHS-7 File Creation Date/Time
FHS-8 File Security
FHS-9 File Name/ID
FHS-10 File Header Comment
FHS-11 File Control ID
FHS-12 Reference File Control ID
FHS-13 File Sending Network Address
FHS-14 File Receiving Network Address


Field Field Description
FT1-1 Set ID - FT1
FT1-2 Transaction ID
FT1-3 Transaction Batch ID
FT1-4 Transaction Date
FT1-5 Transaction Posting Date
FT1-6 Transaction Type
FT1-7 Transaction Code
FT1-8 Transaction Description
FT1-9 Transaction Description - Alt
FT1-10 Transaction Quantity
FT1-11 Transaction Amount - Extended
FT1-12 Transaction amount - unit
FT1-13 Department Code
FT1-14 Health Plan ID
FT1-15 Insurance Amount
FT1-16 Assigned Patient Location
FT1-17 Fee Schedule
FT1-18 Patient Type
FT1-19 Diagnosis Code - FT1
FT1-20 Performed By Code
FT1-21 Ordered By Code
FT1-22 Unit Cost
FT1-23 Filler Order Number
FT1-24 Entered By Code
FT1-25 Procedure Code
FT1-26 Procedure Code Modifier
FT1-27 Advanced Beneficiary Notice Code
FT1-28 Medically Necessary Duplicate Procedure Reason
FT1-29 NDC Code
FT1-30 Payment Reference ID
FT1-31 Transaction Reference Key
FT1-32 Performing Facility
FT1-33 Ordering Facility
FT1-34 Item Number
FT1-35 Model Number
FT1-36 Special Processing Code
FT1-37 Clinic Code
FT1-38 Referral Number
FT1-39 Authorization Number
FT1-40 Service Provider Taxonomy Code
FT1-41 Revenue Code
FT1-42 Prescription Number
FT1-43 NDC Qty and UOM


Field Field Description
FTS-1 File Batch Count
FTS-2 File Trailer Comment


Field Field Description
GOL-1 Action Code
GOL-2 Action Date/Time
GOL-3 Goal ID
GOL-4 Goal Instance ID
GOL-5 Episode of Care ID
GOL-6 Goal List Priority
GOL-7 Goal Established Date/Time
GOL-8 Expected Goal Achieve Date/Time
GOL-9 Goal Classification
GOL-10 Goal Management Discipline
GOL-11 Current Goal Review Status
GOL-12 Current Goal Review Date/Time
GOL-13 Next Goal Review Date/Time
GOL-14 Previous Goal Review Date/Time
GOL-15 Goal Review Interval
GOL-16 Goal Evaluation
GOL-17 Goal Evaluation Comment
GOL-18 Goal Life Cycle Status
GOL-19 Goal Life Cycle Status Date/Time
GOL-20 Goal Target Type
GOL-21 Goal Target Name
GOL-22 Mood Code


Field Field Description
GP1-1 Type of Bill Code
GP1-2 Revenue Code
GP1-3 Overall Claim Disposition Code
GP1-4 OCE Edits per Visit Code
GP1-5 Outlier Cost


Field Field Description
GP2-1 Revenue Code
GP2-2 Number of Service Units
GP2-3 Charge
GP2-4 Reimbursement Action Code
GP2-5 Denial or Rejection Code
GP2-6 OCE Edit Code
GP2-7 Ambulatory Payment Classification Code
GP2-8 Modifier Edit Code
GP2-9 Payment Adjustment Code
GP2-10 Packaging Status Code
GP2-11 Expected CMS Payment Amount
GP2-12 Reimbursement Type Code
GP2-13 Co-Pay Amount
GP2-14 Pay Rate per Service Unit


Field Field Description
GT1-1 Set ID - GT1
GT1-2 Guarantor Number
GT1-3 Guarantor Name
GT1-4 Guarantor Spouse Name
GT1-5 Guarantor Address
GT1-6 Guarantor Ph Num - Home
GT1-7 Guarantor Ph Num - Business
GT1-8 Guarantor Date/Time Of Birth
GT1-9 Guarantor Administrative Sex
GT1-10 Guarantor Type
GT1-11 Guarantor Relationship
GT1-12 Guarantor SSN
GT1-13 Guarantor Date - Begin
GT1-14 Guarantor Date - End
GT1-15 Guarantor Priority
GT1-16 Guarantor Employer Name
GT1-17 Guarantor Employer Address
GT1-18 Guarantor Employer Phone Number
GT1-19 Guarantor Employee ID Number
GT1-20 Guarantor Employment Status
GT1-21 Guarantor Organization Name
GT1-22 Guarantor Billing Hold Flag
GT1-23 Guarantor Credit Rating Code
GT1-24 Guarantor Death Date And Time
GT1-25 Guarantor Death Flag
GT1-26 Guarantor Charge Adjustment Code
GT1-27 Guarantor Household Annual Income
GT1-28 Guarantor Household Size
GT1-29 Guarantor Employer ID Number
GT1-30 Guarantor Marital Status Code
GT1-31 Guarantor Hire Effective Date
GT1-32 Employment Stop Date
GT1-33 Living Dependency
GT1-34 Ambulatory Status
GT1-35 Citizenship
GT1-36 Primary Language
GT1-37 Living Arrangement
GT1-38 Publicity Code
GT1-39 Protection Indicator
GT1-40 Student Indicator
GT1-41 Religion
GT1-42 Mother's Maiden Name
GT1-43 Nationality
GT1-44 Ethnic Group
GT1-45 Contact Person's Name
GT1-46 Contact Person's Telephone Number
GT1-47 Contact Reason
GT1-48 Contact Relationship
GT1-49 Job Title
GT1-50 Job Code/Class
GT1-51 Guarantor Employer's Organization Name
GT1-52 Handicap
GT1-53 Job Status
GT1-54 Guarantor Financial Class
GT1-55 Guarantor Race
GT1-56 Guarantor Birth Place
GT1-57 VIP Indicator


Field Field Description
IAM-1 Set ID - IAM
IAM-2 Allergen Type Code
IAM-3 Allergen Code/Mnemonic/Description
IAM-4 Allergy Severity Code
IAM-5 Allergy Reaction Code
IAM-6 Allergy Action Code
IAM-7 Allergy Unique Identifier
IAM-8 Action Reason
IAM-9 Sensitivity to Causative Agent Code
IAM-10 Allergen Group Code/Mnemonic/Description
IAM-11 Onset Date
IAM-12 Onset Date Text
IAM-13 Reported Date/Time
IAM-14 Reported By
IAM-15 Relationship to Patient Code
IAM-16 Alert Device Code
IAM-17 Allergy Clinical Status Code
IAM-18 Statused by Person
IAM-19 Statused by Organization
IAM-20 Statused at Date/Time
IAM-21 Inactivated by Person
IAM-22 Inactivated Date/Time
IAM-23 Initially Recorded by Person
IAM-24 Initially Recorded Date/Time
IAM-25 Modified by Person
IAM-26 Modified Date/Time
IAM-27 Clinician Identified Code
IAM-28 Initially Recorded by Organization
IAM-29 Modified by Organization
IAM-30 Inactivated by Organization


Field Field Description
IAR-1 Allergy Reaction Code
IAR-2 Allergy Severity Code
IAR-3 Sensitivity to Causative Agent Code
IAR-4 Management


Field Field Description
IIM-1 Primary Key Value - IIM
IIM-2 Service Item Code
IIM-3 Inventory Lot Number
IIM-4 Inventory Expiration Date
IIM-5 Inventory Manufacturer Name
IIM-6 Inventory Location
IIM-7 Inventory Received Date
IIM-8 Inventory Received Quantity
IIM-9 Inventory Received Quantity Unit
IIM-10 Inventory Received Item Cost
IIM-11 Inventory On Hand Date
IIM-12 Inventory On Hand Quantity
IIM-13 Inventory On Hand Quantity Unit
IIM-14 Procedure Code
IIM-15 Procedure Code Modifier


Field Field Description
ILT-1 Set Id - ILT
ILT-2 Inventory Lot Number
ILT-3 Inventory Expiration Date
ILT-4 Inventory Received Date
ILT-5 Inventory Received Quantity
ILT-6 Inventory Received Quantity Unit
ILT-7 Inventory Received Item Cost
ILT-8 Inventory On Hand Date
ILT-9 Inventory On Hand Quantity
ILT-10 Inventory On Hand Quantity Unit


Field Field Description
IN1-1 Set ID - IN1
IN1-2 Health Plan ID
IN1-3 Insurance Company ID
IN1-4 Insurance Company Name
IN1-5 Insurance Company Address
IN1-6 Insurance Co Contact Person
IN1-7 Insurance Co Phone Number
IN1-8 Group Number
IN1-9 Group Name
IN1-10 Insured's Group Emp ID
IN1-11 Insured's Group Emp Name
IN1-12 Plan Effective Date
IN1-13 Plan Expiration Date
IN1-14 Authorization Information
IN1-15 Plan Type
IN1-16 Name Of Insured
IN1-17 Insured's Relationship To Patient
IN1-18 Insured's Date Of Birth
IN1-19 Insured's Address
IN1-20 Assignment Of Benefits
IN1-21 Coordination Of Benefits
IN1-22 Coord Of Ben. Priority
IN1-23 Notice Of Admission Flag
IN1-24 Notice Of Admission Date
IN1-25 Report Of Eligibility Flag
IN1-26 Report Of Eligibility Date
IN1-27 Release Information Code
IN1-28 Pre-Admit Cert (PAC)
IN1-29 Verification Date/Time
IN1-30 Verification By
IN1-31 Type Of Agreement Code
IN1-32 Billing Status
IN1-33 Lifetime Reserve Days
IN1-34 Delay Before L.R. Day
IN1-35 Company Plan Code
IN1-36 Policy Number
IN1-37 Policy Deductible
IN1-38 Policy Limit - Amount
IN1-39 Policy Limit - Days
IN1-40 Room Rate - Semi-Private
IN1-41 Room Rate - Private
IN1-42 Insured's Employment Status
IN1-43 Insured's Administrative Sex
IN1-44 Insured's Employer's Address
IN1-45 Verification Status
IN1-46 Prior Insurance Plan ID
IN1-47 Coverage Type
IN1-48 Handicap
IN1-49 Insured's ID Number
IN1-50 Signature Code
IN1-51 Signature Code Date
IN1-52 Insured's Birth Place
IN1-53 VIP Indicator
IN1-54 External Health Plan Identifiers
IN1-55 Insurance Action Code


Field Field Description
IN2-1 Insured's Employee ID
IN2-2 Insured's Social Security Number
IN2-3 Insured's Employer's Name and ID
IN2-4 Employer Information Data
IN2-5 Mail Claim Party
IN2-6 Medicare Health Ins Card Number
IN2-7 Medicaid Case Name
IN2-8 Medicaid Case Number
IN2-9 Military Sponsor Name
IN2-10 Military ID Number
IN2-11 Dependent Of Military Recipient
IN2-12 Military Organization
IN2-13 Military Station
IN2-14 Military Service
IN2-15 Military Rank/Grade
IN2-16 Military Status
IN2-17 Military Retire Date
IN2-18 Military Non-Avail Cert On File
IN2-19 Baby Coverage
IN2-20 Combine Baby Bill
IN2-21 Blood Deductible
IN2-22 Special Coverage Approval Name
IN2-23 Special Coverage Approval Title
IN2-24 Non-Covered Insurance Code
IN2-25 Payor ID
IN2-26 Payor Subscriber ID
IN2-27 Eligibility Source
IN2-28 Room Coverage Type/Amount
IN2-29 Policy Type/Amount
IN2-30 Daily Deductible
IN2-31 Living Dependency
IN2-32 Ambulatory Status
IN2-33 Citizenship
IN2-34 Primary Language
IN2-35 Living Arrangement
IN2-36 Publicity Code
IN2-37 Protection Indicator
IN2-38 Student Indicator
IN2-39 Religion
IN2-40 Mother's Maiden Name
IN2-41 Nationality
IN2-42 Ethnic Group
IN2-43 Marital Status
IN2-44 Insured's Employment Start Date
IN2-45 Employment Stop Date
IN2-46 Job Title
IN2-47 Job Code/Class
IN2-48 Job Status
IN2-49 Employer Contact Person Name
IN2-50 Employer Contact Person Phone Number
IN2-51 Employer Contact Reason
IN2-52 Insured's Contact Person's Name
IN2-53 Insured's Contact Person Phone Number
IN2-54 Insured's Contact Person Reason
IN2-55 Relationship to the Patient Start Date
IN2-56 Relationship to the Patient Stop Date
IN2-57 Insurance Co Contact Reason
IN2-58 Insurance Co Contact Phone Number
IN2-59 Policy Scope
IN2-60 Policy Source
IN2-61 Patient Member Number
IN2-62 Guarantor's Relationship to Insured
IN2-63 Insured's Phone Number - Home
IN2-64 Insured's Employer Phone Number
IN2-65 Military Handicapped Program
IN2-66 Suspend Flag
IN2-67 Copay Limit Flag
IN2-68 Stoploss Limit Flag
IN2-69 Insured Organization Name and ID
IN2-70 Insured Employer Organization Name and ID
IN2-71 Race
IN2-72 Patient's Relationship to Insured


Field Field Description
IN3-1 Set ID - IN3
IN3-2 Certification Number
IN3-3 Certified By
IN3-4 Certification Required
IN3-5 Penalty
IN3-6 Certification Date/Time
IN3-7 Certification Modify Date/Time
IN3-8 Operator
IN3-9 Certification Begin Date
IN3-10 Certification End Date
IN3-11 Days
IN3-12 Non-Concur Code/Description
IN3-13 Non-Concur Effective Date/Time
IN3-14 Physician Reviewer
IN3-15 Certification Contact
IN3-16 Certification Contact Phone Number
IN3-17 Appeal Reason
IN3-18 Certification Agency
IN3-19 Certification Agency Phone Number
IN3-20 Pre-Certification Requirement
IN3-21 Case Manager
IN3-22 Second Opinion Date
IN3-23 Second Opinion Status
IN3-24 Second Opinion Documentation Received
IN3-25 Second Opinion Physician
IN3-26 Certification Type
IN3-27 Certification Category


Field Field Description
INV-1 Substance Identifier
INV-2 Substance Status
INV-3 Substance Type
INV-4 Inventory Container Identifier
INV-5 Container Carrier Identifier
INV-6 Position on Carrier
INV-7 Initial Quantity
INV-8 Current Quantity
INV-9 Available Quantity
INV-10 Consumption Quantity
INV-11 Quantity Units
INV-12 Expiration Date/Time
INV-13 First Used Date/Time
INV-14 On Board Stability Duration
INV-15 Test/Fluid Identifier(s)
INV-16 Manufacturer Lot Number
INV-17 Manufacturer Identifier
INV-18 Supplier Identifier
INV-19 On Board Stability Time
INV-20 Target Value


Field Field Description
IPC-1 Accession Identifier
IPC-2 Requested Procedure ID
IPC-3 Study Instance UID
IPC-4 Scheduled Procedure Step ID
IPC-5 Modality
IPC-6 Protocol Code
IPC-7 Scheduled Station Name
IPC-8 Scheduled Procedure Step Location
IPC-9 Scheduled Station AE Title


Field Field Description
IPR-1 IPR Identifier
IPR-2 Provider Cross Reference Identifier
IPR-3 Payer Cross Reference Identifier
IPR-4 IPR Status
IPR-5 IPR Date/Time
IPR-6 Adjudicated/Paid Amount
IPR-7 Expected Payment Date/Time
IPR-8 IPR Checksum


Field Field Description
ISD-1 Reference Interaction Number
ISD-2 Interaction Type Identifier
ISD-3 Interaction Active State


Field Field Description
ITM-1 Item Identifier
ITM-2 Item Description
ITM-3 Item Status
ITM-4 Item Type
ITM-5 Item Category
ITM-6 Subject to Expiration Indicator
ITM-7 Manufacturer Identifier
ITM-8 Manufacturer Name
ITM-9 Manufacturer Catalog Number
ITM-10 Manufacturer Labeler Identification Code
ITM-11 Patient Chargeable Indicator
ITM-12 Transaction Code
ITM-13 Transaction amount - unit
ITM-14 Stocked Item Indicator
ITM-15 Supply Risk Codes
ITM-16 Approving Regulatory Agency
ITM-17 Latex Indicator
ITM-18 Ruling Act
ITM-19 Item Natural Account Code
ITM-20 Approved To Buy Quantity
ITM-21 Approved To Buy Price
ITM-22 Taxable Item Indicator
ITM-23 Freight Charge Indicator
ITM-24 Item Set Indicator
ITM-25 Item Set Identifier
ITM-26 Track Department Usage Indicator
ITM-27 Procedure Code
ITM-28 Procedure Code Modifier
ITM-29 Special Handling Code
ITM-30 Hazardous Indicator
ITM-31 Sterile Indicator
ITM-32 Material Data Safety Sheet Number
ITM-33 United Nations Standard Products and Services Code (UNSPSC)


Field Field Description
IVC-1 Provider Invoice Number
IVC-2 Payer Invoice Number
IVC-3 Contract/Agreement Number
IVC-4 Invoice Control
IVC-5 Invoice Reason
IVC-6 Invoice Type
IVC-7 Invoice Date/Time
IVC-8 Invoice Amount
IVC-9 Payment Terms
IVC-10 Provider Organization
IVC-11 Payer Organization
IVC-12 Attention
IVC-13 Last Invoice Indicator
IVC-14 Invoice Booking Period
IVC-15 Origin
IVC-16 Invoice Fixed Amount
IVC-17 Special Costs
IVC-18 Amount for Doctors Treatment
IVC-19 Responsible Physician
IVC-20 Cost Center
IVC-21 Invoice Prepaid Amount
IVC-22 Total Invoice Amount without Prepaid Amount
IVC-23 Total-Amount of VAT
IVC-24 VAT-Rates applied
IVC-25 Benefit Group
IVC-26 Provider Tax ID
IVC-27 Payer Tax ID
IVC-28 Provider Tax Status
IVC-29 Payer Tax Status
IVC-30 Sales Tax ID


Field Field Description
IVT-1 Set Id - IVT
IVT-2 Inventory Location Identifier
IVT-3 Inventory Location Name
IVT-4 Source Location Identifier
IVT-5 Source Location Name
IVT-6 Item Status
IVT-7 Bin Location Identifier
IVT-8 Order Packaging
IVT-9 Issue Packaging
IVT-10 Default Inventory Asset Account
IVT-11 Patient Chargeable Indicator
IVT-12 Transaction Code
IVT-13 Transaction amount - unit
IVT-14 Item Importance Code
IVT-15 Stocked Item Indicator
IVT-16 Consignment Item Indicator
IVT-17 Reusable Item Indicator
IVT-18 Reusable Cost
IVT-19 Substitute Item Identifier
IVT-20 Latex-Free Substitute Item Identifier
IVT-21 Recommended Reorder Theory
IVT-22 Recommended Safety Stock Days
IVT-23 Recommended Maximum Days Inventory
IVT-24 Recommended Order Point
IVT-25 Recommended Order Amount
IVT-26 Operating Room Par Level Indicator


Field Field Description
LAN-1 Set ID - LAN
LAN-2 Language Code
LAN-3 Language Ability Code
LAN-4 Language Proficiency Code


Field Field Description
LCC-1 Primary Key Value - LCC
LCC-2 Location Department
LCC-3 Accommodation Type
LCC-4 Charge Code


Field Field Description
LCH-1 Primary Key Value - LCH
LCH-2 Segment Action Code
LCH-3 Segment Unique Key
LCH-4 Location Characteristic ID
LCH-5 Location Characteristic Value - LCH


Field Field Description
LDP-1 Primary Key Value - LDP
LDP-2 Location Department
LDP-3 Location Service
LDP-4 Specialty Type
LDP-5 Valid Patient Classes
LDP-6 Active/Inactive Flag
LDP-7 Activation Date - LDP
LDP-8 Inactivation Date - LDP
LDP-9 Inactivated Reason
LDP-10 Visiting Hours
LDP-11 Contact Phone
LDP-12 Location Cost Center


Field Field Description
LOC-1 Primary Key Value - LOC
LOC-2 Location Description
LOC-3 Location Type - LOC
LOC-4 Organization Name - LOC
LOC-5 Location Address
LOC-6 Location Phone
LOC-7 License Number
LOC-8 Location Equipment
LOC-9 Location Service Code


Field Field Description
LRL-1 Primary Key Value - LRL
LRL-2 Segment Action Code
LRL-3 Segment Unique Key
LRL-4 Location Relationship ID
LRL-5 Organizational Location Relationship Value
LRL-6 Patient Location Relationship Value


Field Field Description
MFA-1 Record-Level Event Code
MFA-2 MFN Control ID
MFA-3 Event Completion Date/Time
MFA-4 MFN Record Level Error Return
MFA-5 Primary Key Value - MFA
MFA-6 Primary Key Value Type - MFA


Field Field Description
MFE-1 Record-Level Event Code
MFE-2 MFN Control ID
MFE-3 Effective Date/Time
MFE-4 Primary Key Value - MFE
MFE-5 Primary Key Value Type
MFE-6 Entered Date/Time
MFE-7 Entered By


Field Field Description
MFI-1 Master File Identifier
MFI-2 Master File Application Identifier
MFI-3 File-Level Event Code
MFI-4 Entered Date/Time
MFI-5 Effective Date/Time
MFI-6 Response Level Code


Field Field Description
MRG-1 Prior Patient Identifier List
MRG-2 Prior Alternate Patient ID
MRG-3 Prior Patient Account Number
MRG-4 Prior Patient ID
MRG-5 Prior Visit Number
MRG-6 Prior Alternate Visit ID
MRG-7 Prior Patient Name


Field Field Description
MSA-1 Acknowledgment Code
MSA-2 Message Control ID
MSA-3 Text Message
MSA-4 Expected Sequence Number
MSA-5 Delayed Acknowledgment Type
MSA-6 Error Condition
MSA-7 Message Waiting Number
MSA-8 Message Waiting Priority


Field Field Description
MSH-1 Field Separator
MSH-2 Encoding Characters
MSH-3 Sending Application
MSH-4 Sending Facility
MSH-5 Receiving Application
MSH-6 Receiving Facility
MSH-7 Date/Time of Message
MSH-8 Security
MSH-9 Message Type
MSH-10 Message Control ID
MSH-11 Processing ID
MSH-12 Version ID
MSH-13 Sequence Number
MSH-14 Continuation Pointer
MSH-15 Accept Acknowledgment Type
MSH-16 Application Acknowledgment Type
MSH-17 Country Code
MSH-18 Character Set
MSH-19 Principal Language Of Message
MSH-20 Alternate Character Set Handling Scheme
MSH-21 Message Profile Identifier
MSH-22 Sending Responsible Organization
MSH-23 Receiving Responsible Organization
MSH-24 Sending Network Address
MSH-25 Receiving Network Address


Field Field Description
NCK-1 System Date/Time


Field Field Description
NDS-1 Notification Reference Number
NDS-2 Notification Date/Time
NDS-3 Notification Alert Severity
NDS-4 Notification Code


Field Field Description
NK1-1 Set ID - NK1
NK1-2 Name
NK1-3 Relationship
NK1-4 Address
NK1-5 Phone Number
NK1-6 Business Phone Number
NK1-7 Contact Role
NK1-8 Start Date
NK1-9 End Date
NK1-10 Next of Kin / Associated Parties Job Title
NK1-11 Next of Kin / Associated Parties Job Code/Class
NK1-12 Next of Kin / Associated Parties Employee Number
NK1-13 Organization Name - NK1
NK1-14 Marital Status
NK1-15 Administrative Sex
NK1-16 Date/Time of Birth
NK1-17 Living Dependency
NK1-18 Ambulatory Status
NK1-19 Citizenship
NK1-20 Primary Language
NK1-21 Living Arrangement
NK1-22 Publicity Code
NK1-23 Protection Indicator
NK1-24 Student Indicator
NK1-25 Religion
NK1-26 Mother's Maiden Name
NK1-27 Nationality
NK1-28 Ethnic Group
NK1-29 Contact Reason
NK1-30 Contact Person's Name
NK1-31 Contact Person's Telephone Number
NK1-32 Contact Person's Address
NK1-33 Next of Kin/Associated Party's Identifiers
NK1-34 Job Status
NK1-35 Race
NK1-36 Handicap
NK1-37 Contact Person Social Security Number
NK1-38 Next of Kin Birth Place
NK1-39 VIP Indicator
NK1-40 Next of Kin Telecommunication Information
NK1-41 Contact Person's Telecommunication Information


Field Field Description
NPU-1 Bed Location
NPU-2 Bed Status


Field Field Description
NSC-1 Application Change Type
NSC-2 Current CPU
NSC-3 Current Fileserver
NSC-4 Current Application
NSC-5 Current Facility
NSC-7 New Fileserver
NSC-8 New Application
NSC-9 New Facility


Field Field Description
NST-1 Statistics Available
NST-2 Source Identifier
NST-3 Source Type
NST-4 Statistics Start
NST-5 Statistics End
NST-6 Receive Character Count
NST-7 Send Character Count
NST-8 Messages Received
NST-9 Messages Sent
NST-10 Checksum Errors Received
NST-11 Length Errors Received
NST-12 Other Errors Received
NST-13 Connect Timeouts
NST-14 Receive Timeouts
NST-15 Application control-level Errors


Field Field Description
NTE-1 Set ID - NTE
NTE-2 Source of Comment
NTE-3 Comment
NTE-4 Comment Type
NTE-5 Entered By
NTE-6 Entered Date/Time
NTE-7 Effective Start Date
NTE-8 Expiration Date


Field Field Description
OBR-1 Set ID - OBR
OBR-2 Placer Order Number
OBR-3 Filler Order Number
OBR-4 Universal Service Identifier
OBR-5 Priority
OBR-6 Requested Date/Time
OBR-7 Observation Date/Time #
OBR-8 Observation End Date/Time #
OBR-9 Collection Volume *
OBR-10 Collector Identifier *
OBR-11 Specimen Action Code *
OBR-12 Danger Code
OBR-13 Relevant Clinical Information
OBR-14 Specimen Received Date/Time
OBR-15 Specimen Source
OBR-16 Ordering Provider
OBR-17 Order Callback Phone Number
OBR-18 Placer Field 1
OBR-19 Placer Field 2
OBR-20 Filler Field 1 +
OBR-21 Filler Field 2 +
OBR-22 Results Rpt/Status Chng - Date/Time +
OBR-23 Charge to Practice +
OBR-24 Diagnostic Serv Sect ID
OBR-25 Result Status +
OBR-26 Parent Result +
OBR-27 Quantity/Timing
OBR-28 Result Copies To
OBR-29 Parent Results Observation Identifier
OBR-30 Transportation Mode
OBR-31 Reason for Study
OBR-32 Principal Result Interpreter +
OBR-33 Assistant Result Interpreter +
OBR-34 Technician +
OBR-35 Transcriptionist +
OBR-36 Scheduled Date/Time +
OBR-37 Number of Sample Containers *
OBR-38 Transport Logistics of Collected Sample *
OBR-39 Collector's Comment *
OBR-40 Transport Arrangement Responsibility
OBR-41 Transport Arranged
OBR-42 Escort Required
OBR-43 Planned Patient Transport Comment
OBR-44 Procedure Code
OBR-45 Procedure Code Modifier
OBR-46 Placer Supplemental Service Information
OBR-47 Filler Supplemental Service Information
OBR-48 Medically Necessary Duplicate Procedure Reason
OBR-49 Result Handling
OBR-50 Parent Universal Service Identifier
OBR-51 Observation Group ID
OBR-52 Parent Observation Group ID
OBR-53 Alternate Placer Order Number
OBR-54 Parent Order


Field Field Description
OBX-1 Set ID - OBX
OBX-2 Value Type
OBX-3 Observation Identifier
OBX-4 Observation Sub-ID
OBX-5 Observation Value
OBX-6 Units
OBX-7 References Range
OBX-8 Interpretation Codes
OBX-9 Probability
OBX-10 Nature of Abnormal Test
OBX-11 Observation Result Status
OBX-12 Effective Date of Reference Range
OBX-13 User Defined Access Checks
OBX-14 Date/Time of the Observation
OBX-15 Producer's ID
OBX-16 Responsible Observer
OBX-17 Observation Method
OBX-18 Equipment Instance Identifier
OBX-19 Date/Time of the Analysis
OBX-20 Observation Site
OBX-21 Observation Instance Identifier
OBX-22 Mood Code
OBX-23 Performing Organization Name
OBX-24 Performing Organization Address
OBX-25 Performing Organization Medical Director
OBX-26 Patient Results Release Category
OBX-27 Root Cause
OBX-28 Local Process Control


Field Field Description
ODS-1 Type
ODS-2 Service Period
ODS-3 Diet, Supplement, or Preference Code
ODS-4 Text Instruction


Field Field Description
ODT-1 Tray Type
ODT-2 Service Period
ODT-3 Text Instruction


Field Field Description
OM1-1 Sequence Number - Test/Observation Master File
OM1-2 Producer's Service/Test/Observation ID
OM1-3 Permitted Data Types
OM1-4 Specimen Required
OM1-5 Producer ID
OM1-6 Observation Description
OM1-7 Other Service/Test/Observation IDs for the Observation
OM1-8 Other Names
OM1-9 Preferred Report Name for the Observation
OM1-10 Preferred Short Name or Mnemonic for the Observation
OM1-11 Preferred Long Name for the Observation
OM1-12 Orderability
OM1-13 Identity of Instrument Used to Perform this Study
OM1-14 Coded Representation of Method
OM1-15 Portable Device Indicator
OM1-16 Observation Producing Department/Section
OM1-17 Telephone Number of Section
OM1-18 Nature of Service/Test/Observation
OM1-19 Report Subheader
OM1-20 Report Display Order
OM1-21 Date/Time Stamp for Any Change in Definition for the Observation
OM1-22 Effective Date/Time of Change
OM1-23 Typical Turn-Around Time
OM1-24 Processing Time
OM1-25 Processing Priority
OM1-26 Reporting Priority
OM1-27 Outside Site(s) Where Observation May Be Performed
OM1-28 Address of Outside Site(s)
OM1-29 Phone Number of Outside Site
OM1-30 Confidentiality Code
OM1-31 Observations Required to Interpret this Observation
OM1-32 Interpretation of Observations
OM1-33 Contraindications to Observations
OM1-34 Reflex Tests/Observations
OM1-35 Rules that Trigger Reflex Testing
OM1-36 Fixed Canned Message
OM1-37 Patient Preparation
OM1-38 Procedure Medication
OM1-39 Factors that may Affect the Observation
OM1-40 Service/Test/Observation Performance Schedule
OM1-41 Description of Test Methods
OM1-42 Kind of Quantity Observed
OM1-43 Point Versus Interval
OM1-44 Challenge Information
OM1-45 Relationship Modifier
OM1-46 Target Anatomic Site Of Test
OM1-47 Modality of Imaging Measurement
OM1-48 Exclusive Test
OM1-49 Diagnostic Serv Sect ID
OM1-50 Taxonomic Classification Code
OM1-51 Other Names


Field Field Description
OM2-1 Sequence Number - Test/Observation Master File
OM2-2 Units of Measure
OM2-3 Range of Decimal Precision
OM2-4 Corresponding SI Units of Measure
OM2-5 SI Conversion Factor
OM2-6 Reference (Normal) Range for Ordinal and Continuous Observations
OM2-7 Critical Range for Ordinal and Continuous Observations
OM2-8 Absolute Range for Ordinal and Continuous Observations
OM2-9 Delta Check Criteria
OM2-10 Minimum Meaningful Increments


Field Field Description
OM3-1 Sequence Number - Test/Observation Master File
OM3-2 Preferred Coding System
OM3-3 Valid Coded Answers
OM3-4 Normal Text/Codes for Categorical Observations
OM3-5 Abnormal Text/Codes for Categorical Observations
OM3-6 Critical Text/Codes for Categorical Observations
OM3-7 Value Type


Field Field Description
OM4-1 Sequence Number - Test/Observation Master File
OM4-2 Derived Specimen
OM4-3 Container Description
OM4-4 Container Volume
OM4-5 Container Units
OM4-6 Specimen
OM4-7 Additive
OM4-8 Preparation
OM4-9 Special Handling Requirements
OM4-10 Normal Collection Volume
OM4-11 Minimum Collection Volume
OM4-12 Specimen Requirements
OM4-13 Specimen Priorities
OM4-14 Specimen Retention Time
OM4-15 Specimen Handling Code
OM4-16 Specimen Preference
OM4-17 Preferred Specimen/Attribture Sequence ID
OM4-18 Taxonomic Classification Code


Field Field Description
OM5-1 Sequence Number - Test/Observation Master File
OM5-2 Test/Observations Included Within an Ordered Test Battery
OM5-3 Observation ID Suffixes


Field Field Description
OM6-1 Sequence Number - Test/Observation Master File
OM6-2 Derivation Rule


Field Field Description
OM7-1 Sequence Number - Test/Observation Master File
OM7-2 Universal Service Identifier
OM7-3 Category Identifier
OM7-4 Category Description
OM7-5 Category Synonym
OM7-6 Effective Test/Service Start Date/Time
OM7-7 Effective Test/Service End Date/Time
OM7-8 Test/Service Default Duration Quantity
OM7-9 Test/Service Default Duration Units
OM7-10 Test/Service Default Frequency
OM7-11 Consent Indicator
OM7-12 Consent Identifier
OM7-13 Consent Effective Start Date/Time
OM7-14 Consent Effective End Date/Time
OM7-15 Consent Interval Quantity
OM7-16 Consent Interval Units
OM7-17 Consent Waiting Period Quantity
OM7-18 Consent Waiting Period Units
OM7-19 Effective Date/Time of Change
OM7-20 Entered By
OM7-21 Orderable-at Location
OM7-22 Formulary Status
OM7-23 Special Order Indicator
OM7-24 Primary Key Value - CDM


Field Field Description
ORC-1 Order Control
ORC-2 Placer Order Number
ORC-3 Filler Order Number
ORC-4 Placer Group Number
ORC-5 Order Status
ORC-6 Response Flag
ORC-7 Quantity/Timing
ORC-8 Parent Order
ORC-9 Date/Time of Transaction
ORC-10 Entered By
ORC-11 Verified By
ORC-12 Ordering Provider
ORC-13 Enterer's Location
ORC-14 Call Back Phone Number
ORC-15 Order Effective Date/Time
ORC-16 Order Control Code Reason
ORC-17 Entering Organization
ORC-18 Entering Device
ORC-19 Action By
ORC-20 Advanced Beneficiary Notice Code
ORC-21 Ordering Facility Name
ORC-22 Ordering Facility Address
ORC-23 Ordering Facility Phone Number
ORC-24 Ordering Provider Address
ORC-25 Order Status Modifier
ORC-26 Advanced Beneficiary Notice Override Reason
ORC-27 Filler's Expected Availability Date/Time
ORC-28 Confidentiality Code
ORC-29 Order Type
ORC-30 Enterer Authorization Mode
ORC-31 Parent Universal Service Identifier
ORC-32 Advanced Beneficiary Notice Date
ORC-33 Alternate Placer Order Number
ORC-34 Order Workflow Profile


Field Field Description
ORG-1 Set ID - ORG
ORG-2 Organization Unit Code
ORG-3 Organization Unit Type Code
ORG-4 Primary Org Unit Indicator
ORG-5 Practitioner Org Unit Identifier
ORG-6 Health Care Provider Type Code
ORG-7 Health Care Provider Classification Code
ORG-8 Health Care Provider Area of Specialization Code
ORG-9 Effective Date Range
ORG-10 Employment Status Code
ORG-11 Board Approval Indicator
ORG-12 Primary Care Physician Indicator
ORG-13 Cost Center Code


Field Field Description
OVR-1 Business Rule Override Type
OVR-2 Business Rule Override Code
OVR-3 Override Comments
OVR-4 Override Entered By
OVR-5 Override Authorized By


Field Field Description
PAC-1 Set Id - PAC
PAC-2 Package ID
PAC-3 Parent Package ID
PAC-4 Position in Parent Package
PAC-5 Package Type
PAC-6 Package Condition
PAC-7 Package Handling Code
PAC-8 Package Risk Code


Field Field Description
PCE-1 Set ID - PCE
PCE-2 Cost Center Account Number
PCE-3 Transaction Code
PCE-4 Transaction amount - unit


Field Field Description
PCR-1 Implicated Product
PCR-2 Generic Product
PCR-3 Product Class
PCR-4 Total Duration Of Therapy
PCR-5 Product Manufacture Date
PCR-6 Product Expiration Date
PCR-7 Product Implantation Date
PCR-8 Product Explantation Date
PCR-9 Single Use Device
PCR-10 Indication For Product Use
PCR-11 Product Problem
PCR-12 Product Serial/Lot Number
PCR-13 Product Available For Inspection
PCR-14 Product Evaluation Performed
PCR-15 Product Evaluation Status
PCR-16 Product Evaluation Results
PCR-17 Evaluated Product Source
PCR-18 Date Product Returned To Manufacturer
PCR-19 Device Operator Qualifications
PCR-20 Relatedness Assessment
PCR-21 Action Taken In Response To The Event
PCR-22 Event Causality Observations
PCR-23 Indirect Exposure Mechanism


Field Field Description
PD1-1 Living Dependency
PD1-2 Living Arrangement
PD1-3 Patient Primary Facility
PD1-4 Patient Primary Care Provider Name & ID No.
PD1-5 Student Indicator
PD1-6 Handicap
PD1-7 Living Will Code
PD1-8 Organ Donor Code
PD1-9 Separate Bill
PD1-10 Duplicate Patient
PD1-11 Publicity Code
PD1-12 Protection Indicator
PD1-13 Protection Indicator Effective Date
PD1-14 Place of Worship
PD1-15 Advance Directive Code
PD1-16 Immunization Registry Status
PD1-17 Immunization Registry Status Effective Date
PD1-18 Publicity Code Effective Date
PD1-19 Military Branch
PD1-20 Military Rank/Grade
PD1-21 Military Status
PD1-22 Advance Directive Last Verified Date


Field Field Description
PDA-1 Death Cause Code
PDA-2 Death Location
PDA-3 Death Certified Indicator
PDA-4 Death Certificate Signed Date/Time
PDA-5 Death Certified By
PDA-6 Autopsy Indicator
PDA-7 Autopsy Start and End Date/Time
PDA-8 Autopsy Performed By
PDA-9 Coroner Indicator


Field Field Description
PDC-1 Manufacturer/Distributor
PDC-2 Country
PDC-3 Brand Name
PDC-4 Device Family Name
PDC-5 Generic Name
PDC-6 Model Identifier
PDC-7 Catalogue Identifier
PDC-8 Other Identifier
PDC-9 Product Code
PDC-10 Marketing Basis
PDC-11 Marketing Approval ID
PDC-12 Labeled Shelf Life
PDC-13 Expected Shelf Life
PDC-14 Date First Marketed
PDC-15 Date Last Marketed


Field Field Description
PEO-1 Event Identifiers Used
PEO-2 Event Symptom/Diagnosis Code
PEO-3 Event Onset Date/Time
PEO-4 Event Exacerbation Date/Time
PEO-5 Event Improved Date/Time
PEO-6 Event Ended Data/Time
PEO-7 Event Location Occurred Address
PEO-8 Event Qualification
PEO-9 Event Serious
PEO-10 Event Expected
PEO-11 Event Outcome
PEO-12 Patient Outcome
PEO-13 Event Description from Others
PEO-14 Event Description from Original Reporter
PEO-15 Event Description from Patient
PEO-16 Event Description from Practitioner
PEO-17 Event Description from Autopsy
PEO-18 Cause Of Death
PEO-19 Primary Observer Name
PEO-20 Primary Observer Address
PEO-21 Primary Observer Telephone
PEO-22 Primary Observer's Qualification
PEO-23 Confirmation Provided By
PEO-24 Primary Observer Aware Date/Time
PEO-25 Primary Observer's identity May Be Divulged


Field Field Description
PES-1 Sender Organization Name
PES-2 Sender Individual Name
PES-3 Sender Address
PES-4 Sender Telephone
PES-5 Sender Event Identifier
PES-6 Sender Sequence Number
PES-7 Sender Event Description
PES-8 Sender Comment
PES-9 Sender Aware Date/Time
PES-10 Event Report Date
PES-11 Event Report Timing/Type
PES-12 Event Report Source
PES-13 Event Reported To


Field Field Description
PID-1 Set ID - PID
PID-2 Patient ID
PID-3 Patient Identifier List
PID-4 Alternate Patient ID - PID
PID-5 Patient Name
PID-6 Mother's Maiden Name
PID-7 Date/Time of Birth
PID-8 Administrative Sex
PID-9 Patient Alias
PID-10 Race
PID-11 Patient Address
PID-12 County Code
PID-13 Phone Number - Home
PID-14 Phone Number - Business
PID-15 Primary Language
PID-16 Marital Status
PID-17 Religion
PID-18 Patient Account Number
PID-19 SSN Number - Patient
PID-20 Driver's License Number - Patient
PID-21 Mother's Identifier
PID-22 Ethnic Group
PID-23 Birth Place
PID-24 Multiple Birth Indicator
PID-25 Birth Order
PID-26 Citizenship
PID-27 Veterans Military Status
PID-28 Nationality
PID-29 Patient Death Date and Time
PID-30 Patient Death Indicator
PID-31 Identity Unknown Indicator
PID-32 Identity Reliability Code
PID-33 Last Update Date/Time
PID-34 Last Update Facility
PID-35 Taxonomic Classification Code
PID-36 Breed Code
PID-37 Strain
PID-38 Production Class Code
PID-39 Tribal Citizenship
PID-40 Patient Telecommunication Information


Field Field Description
PKG-1 Set Id - PKG
PKG-2 Packaging Units
PKG-3 Default Order Unit Of Measure Indicator
PKG-4 Package Quantity
PKG-5 Price
PKG-6 Future Item Price
PKG-7 Future Item Price Effective Date
PKG-8 Global Trade Item Number


Field Field Description
PMT-1 Payment/Remittance Advice Number
PMT-2 Payment/Remittance Effective Date/Time
PMT-3 Payment/Remittance Expiration Date/Time
PMT-4 Payment Method
PMT-5 Payment/Remittance Date/Time
PMT-6 Payment/Remittance Amount
PMT-7 Check Number
PMT-8 Payee Bank Identification
PMT-9 Payee Transit Number
PMT-10 Payee Bank Account ID
PMT-11 Payment Organization
PMT-12 ESR-Code-Line


Field Field Description
PR1-1 Set ID - PR1
PR1-2 Procedure Coding Method
PR1-3 Procedure Code
PR1-4 Procedure Description
PR1-5 Procedure Date/Time
PR1-6 Procedure Functional Type
PR1-7 Procedure Minutes
PR1-8 Anesthesiologist
PR1-9 Anesthesia Code
PR1-10 Anesthesia Minutes
PR1-11 Surgeon
PR1-12 Procedure Practitioner
PR1-13 Consent Code
PR1-14 Procedure Priority
PR1-15 Associated Diagnosis Code
PR1-16 Procedure Code Modifier
PR1-17 Procedure DRG Type
PR1-18 Tissue Type Code
PR1-19 Procedure Identifier
PR1-20 Procedure Action Code
PR1-21 DRG Procedure Determination Status
PR1-22 DRG Procedure Relevance
PR1-23 Treating Organizational Unit
PR1-24 Respiratory Within Surgery
PR1-25 Parent Procedure ID


Field Field Description
PRA-1 Primary Key Value - PRA
PRA-2 Practitioner Group
PRA-3 Practitioner Category
PRA-4 Provider Billing
PRA-5 Specialty
PRA-6 Practitioner ID Numbers
PRA-7 Privileges
PRA-8 Date Entered Practice
PRA-9 Institution
PRA-10 Date Left Practice
PRA-11 Government Reimbursement Billing Eligibility
PRA-12 Set ID - PRA


Field Field Description
PRB-1 Action Code
PRB-2 Action Date/Time
PRB-3 Problem ID
PRB-4 Problem Instance ID
PRB-5 Episode of Care ID
PRB-6 Problem List Priority
PRB-7 Problem Established Date/Time
PRB-8 Anticipated Problem Resolution Date/Time
PRB-9 Actual Problem Resolution Date/Time
PRB-10 Problem Classification
PRB-11 Problem Management Discipline
PRB-12 Problem Persistence
PRB-13 Problem Confirmation Status
PRB-14 Problem Life Cycle Status
PRB-15 Problem Life Cycle Status Date/Time
PRB-16 Problem Date of Onset
PRB-17 Problem Onset Text
PRB-18 Problem Ranking
PRB-19 Certainty of Problem
PRB-20 Probability of Problem (0-1)
PRB-21 Individual Awareness of Problem
PRB-22 Problem Prognosis
PRB-23 Individual Awareness of Prognosis
PRB-24 Family/Significant Other Awareness of Problem/Prognosis
PRB-25 Security/Sensitivity
PRB-26 Problem Severity
PRB-27 Problem Perspective
PRB-28 Mood Code


Field Field Description
PRC-1 Primary Key Value - PRC
PRC-2 Facility ID - PRC
PRC-3 Department
PRC-4 Valid Patient Classes
PRC-5 Price
PRC-6 Formula
PRC-7 Minimum Quantity
PRC-8 Maximum Quantity
PRC-9 Minimum Price
PRC-10 Maximum Price
PRC-11 Effective Start Date
PRC-12 Effective End Date
PRC-13 Price Override Flag
PRC-14 Billing Category
PRC-15 Chargeable Flag
PRC-16 Active/Inactive Flag
PRC-17 Cost
PRC-18 Charge on Indicator


Field Field Description
PRD-1 Provider Role
PRD-2 Provider Name
PRD-3 Provider Address
PRD-4 Provider Location
PRD-5 Provider Communication Information
PRD-6 Preferred Method of Contact
PRD-7 Provider Identifiers
PRD-8 Effective Start Date of Provider Role
PRD-9 Effective End Date of Provider Role
PRD-10 Provider Organization Name and Identifier
PRD-11 Provider Organization Address
PRD-12 Provider Organization Location Information
PRD-13 Provider Organization Communication Information
PRD-14 Provider Organization Method of Contact


Field Field Description
PRT-1 Participation Instance ID
PRT-2 Action Code
PRT-3 Action Reason
PRT-4 Participation
PRT-5 Participation Person
PRT-6 Participation Person Provider Type
PRT-7 Participant Organization Unit Type
PRT-8 Participation Organization
PRT-9 Participant Location
PRT-10 Participation Device
PRT-11 Participation Begin Date/Time (arrival time)
PRT-12 Participation End Date/Time (departure time)
PRT-13 Participation Qualitative Duration
PRT-14 Participation Address
PRT-15 Participant Telecommunication Address


Field Field Description
PSG-1 Provider Product/Service Group Number
PSG-2 Payer Product/Service Group Number
PSG-3 Product/Service Group Sequence Number
PSG-4 Adjudicate as Group
PSG-5 Product/Service Group Billed Amount
PSG-6 Product/Service Group Description


Field Field Description
PSH-1 Report Type
PSH-2 Report Form Identifier
PSH-3 Report Date
PSH-4 Report Interval Start Date
PSH-5 Report Interval End Date
PSH-6 Quantity Manufactured
PSH-7 Quantity Distributed
PSH-8 Quantity Distributed Method
PSH-9 Quantity Distributed Comment
PSH-10 Quantity in Use
PSH-11 Quantity in Use Method
PSH-12 Quantity in Use Comment
PSH-13 Number of Product Experience Reports Filed by Facility
PSH-14 Number of Product Experience Reports Filed by Distributor


Field Field Description
PSL-1 Provider Product/Service Line Item Number
PSL-2 Payer Product/Service Line Item Number
PSL-3 Product/Service Line Item Sequence Number
PSL-4 Provider Tracking ID
PSL-5 Payer Tracking ID
PSL-6 Product/Service Line Item Status
PSL-7 Product/Service Code
PSL-8 Product/Service Code Modifier
PSL-9 Product/Service Code Description
PSL-10 Product/Service Effective Date
PSL-11 Product/Service Expiration Date
PSL-12 Product/Service Quantity
PSL-13 Product/Service Unit Cost
PSL-14 Number of Items per Unit
PSL-15 Product/Service Gross Amount
PSL-16 Product/Service Billed Amount
PSL-17 Product/Service Clarification Code Type
PSL-18 Product/Service Clarification Code Value
PSL-19 Health Document Reference Identifier
PSL-20 Processing Consideration Code
PSL-21 Restricted Disclosure Indicator
PSL-22 Related Product/Service Code Indicator
PSL-23 Product/Service Amount for Physician
PSL-24 Product/Service Cost Factor
PSL-25 Cost Center
PSL-26 Billing Period
PSL-27 Days without Billing
PSL-28 Session-No
PSL-29 Executing Physician ID
PSL-30 Responsible Physician ID
PSL-31 Role Executing Physician
PSL-32 Medical Role Executing Physician
PSL-33 Side of body
PSL-34 Number of TP's PP
PSL-35 TP-Value PP
PSL-36 Internal Scaling Factor PP
PSL-37 External Scaling Factor PP
PSL-38 Amount PP
PSL-39 Number of TP's Technical Part
PSL-40 TP-Value Technical Part
PSL-41 Internal Scaling Factor Technical Part
PSL-42 External Scaling Factor Technical Part
PSL-43 Amount Technical Part
PSL-44 Total Amount Professional Part + Technical Part
PSL-45 VAT-Rate
PSL-46 Main-Service
PSL-47 Validation
PSL-48 Comment


Field Field Description
PSS-1 Provider Product/Service Section Number
PSS-2 Payer Product/Service Section Number
PSS-3 Product/Service Section Sequence Number
PSS-4 Billed Amount
PSS-5 Section Description or Heading


Field Field Description
PTH-1 Action Code
PTH-2 Pathway ID
PTH-3 Pathway Instance ID
PTH-4 Pathway Established Date/Time
PTH-5 Pathway Life Cycle Status
PTH-6 Change Pathway Life Cycle Status Date/Time
PTH-7 Mood Code


Field Field Description
PV1-1 Set ID - PV1
PV1-2 Patient Class
PV1-3 Assigned Patient Location
PV1-4 Admission Type
PV1-5 Preadmit Number
PV1-6 Prior Patient Location
PV1-7 Attending Doctor
PV1-8 Referring Doctor
PV1-9 Consulting Doctor
PV1-10 Hospital Service
PV1-11 Temporary Location
PV1-12 Preadmit Test Indicator
PV1-13 Re-admission Indicator
PV1-14 Admit Source
PV1-15 Ambulatory Status
PV1-16 VIP Indicator
PV1-17 Admitting Doctor
PV1-18 Patient Type
PV1-19 Visit Number
PV1-20 Financial Class
PV1-21 Charge Price Indicator
PV1-22 Courtesy Code
PV1-23 Credit Rating
PV1-24 Contract Code
PV1-25 Contract Effective Date
PV1-26 Contract Amount
PV1-27 Contract Period
PV1-28 Interest Code
PV1-29 Transfer to Bad Debt Code
PV1-30 Transfer to Bad Debt Date
PV1-31 Bad Debt Agency Code
PV1-32 Bad Debt Transfer Amount
PV1-33 Bad Debt Recovery Amount
PV1-34 Delete Account Indicator
PV1-35 Delete Account Date
PV1-36 Discharge Disposition
PV1-37 Discharged to Location
PV1-38 Diet Type
PV1-39 Servicing Facility
PV1-40 Bed Status
PV1-41 Account Status
PV1-42 Pending Location
PV1-43 Prior Temporary Location
PV1-44 Admit Date/Time
PV1-45 Discharge Date/Time
PV1-46 Current Patient Balance
PV1-47 Total Charges
PV1-48 Total Adjustments
PV1-49 Total Payments
PV1-50 Alternate Visit ID
PV1-51 Visit Indicator
PV1-52 Other Healthcare Provider
PV1-53 Service Episode Description
PV1-54 Service Episode Identifier


Field Field Description
PV2-1 Prior Pending Location
PV2-2 Accommodation Code
PV2-3 Admit Reason
PV2-4 Transfer Reason
PV2-5 Patient Valuables
PV2-6 Patient Valuables Location
PV2-7 Visit User Code
PV2-8 Expected Admit Date/Time
PV2-9 Expected Discharge Date/Time
PV2-10 Estimated Length of Inpatient Stay
PV2-11 Actual Length of Inpatient Stay
PV2-12 Visit Description
PV2-13 Referral Source Code
PV2-14 Previous Service Date
PV2-15 Employment Illness Related Indicator
PV2-16 Purge Status Code
PV2-17 Purge Status Date
PV2-18 Special Program Code
PV2-19 Retention Indicator
PV2-20 Expected Number of Insurance Plans
PV2-21 Visit Publicity Code
PV2-22 Visit Protection Indicator
PV2-23 Clinic Organization Name
PV2-24 Patient Status Code
PV2-25 Visit Priority Code
PV2-26 Previous Treatment Date
PV2-27 Expected Discharge Disposition
PV2-28 Signature on File Date
PV2-29 First Similar Illness Date
PV2-30 Patient Charge Adjustment Code
PV2-31 Recurring Service Code
PV2-32 Billing Media Code
PV2-33 Expected Surgery Date and Time
PV2-34 Military Partnership Code
PV2-35 Military Non-Availability Code
PV2-36 Newborn Baby Indicator
PV2-37 Baby Detained Indicator
PV2-38 Mode of Arrival Code
PV2-39 Recreational Drug Use Code
PV2-40 Admission Level of Care Code
PV2-41 Precaution Code
PV2-42 Patient Condition Code
PV2-43 Living Will Code
PV2-44 Organ Donor Code
PV2-45 Advance Directive Code
PV2-46 Patient Status Effective Date
PV2-47 Expected LOA Return Date/Time
PV2-48 Expected Pre-admission Testing Date/Time
PV2-49 Notify Clergy Code
PV2-50 Advance Directive Last Verified Date


Field Field Description
PYE-1 Set ID - PYE
PYE-2 Payee Type
PYE-3 Payee Relationship to Invoice (Patient)
PYE-4 Payee Identification List
PYE-5 Payee Person Name
PYE-6 Payee Address
PYE-7 Payment Method


Field Field Description
QAK-1 Query Tag
QAK-2 Query Response Status
QAK-3 Message Query Name
QAK-4 Hit Count Total
QAK-5 This payload
QAK-6 Hits remaining


Field Field Description
QID-1 Query Tag
QID-2 Message Query Name


Field Field Description
QPD-1 Message Query Name
QPD-2 Query Tag
QPD-3 User Parameters (in successive fields)


Field Field Description
QRI-1 Candidate Confidence
QRI-2 Match Reason Code
QRI-3 Algorithm Descriptor


Field Field Description
RCP-1 Query Priority
RCP-2 Quantity Limited Request
RCP-3 Response Modality
RCP-4 Execution and Delivery Time
RCP-5 Modify Indicator
RCP-6 Sort-by Field
RCP-7 Segment group inclusion


Field Field Description
RDF-1 Number of Columns per Row
RDF-2 Column Description


Field Field Description
RDT-1 Column Value


Field Field Description
REL-2 Relationship Type
REL-3 This Relationship Instance Identifier
REL-4 Source Information Instance Identifier
REL-5 Target Information Instance Identifier
REL-6 Asserting Entity Instance ID
REL-7 Asserting Person
REL-8 Asserting Organization
REL-9 Assertor Address
REL-10 Assertor Contact
REL-11 Assertion Date Range
REL-12 Negation Indicator
REL-13 Certainty of Relationship
REL-14 Priority No
REL-15 Priority Sequence No (rel preference for consideration)
REL-16 Separability Indicator


Field Field Description
RF1-1 Referral Status
RF1-2 Referral Priority
RF1-3 Referral Type
RF1-4 Referral Disposition
RF1-5 Referral Category
RF1-6 Originating Referral Identifier
RF1-7 Effective Date
RF1-8 Expiration Date
RF1-9 Process Date
RF1-10 Referral Reason
RF1-11 External Referral Identifier
RF1-12 Referral Documentation Completion Status
RF1-13 Planned Treatment Stop Date
RF1-14 Referral Reason Text
RF1-15 Number of Authorized Treatments/Units
RF1-16 Number of Used Treatments/Units
RF1-17 Number of Schedule Treatments/Units
RF1-18 Remaining Benefit Amount
RF1-19 Authorized Provider
RF1-20 Authorized Health Professional
RF1-21 Source Text
RF1-22 Source Date
RF1-23 Source Phone
RF1-24 Comment
RF1-25 Action Code


Field Field Description
RFI-1 Request Date
RFI-2 Response Due Date
RFI-3 Patient Consent
RFI-4 Date Additional Information Was Submitted


Field Field Description
RGS-1 Set ID - RGS
RGS-2 Segment Action Code
RGS-3 Resource Group ID


Field Field Description
RMI-1 Risk Management Incident Code
RMI-2 Date/Time Incident
RMI-3 Incident Type Code


Field Field Description
ROL-1 Role Instance ID
ROL-2 Action Code
ROL-3 Role-ROL
ROL-4 Role Person
ROL-5 Role Begin Date/Time
ROL-6 Role End Date/Time
ROL-7 Role Duration
ROL-8 Role Action Reason
ROL-9 Provider Type
ROL-10 Organization Unit Type
ROL-11 Office/Home Address/Birthplace
ROL-12 Phone
ROL-13 Person's Location
ROL-14 Organization


Field Field Description
RQ1-1 Anticipated Price
RQ1-2 Manufacturer Identifier
RQ1-3 Manufacturer's Catalog
RQ1-4 Vendor ID
RQ1-5 Vendor Catalog
RQ1-6 Taxable
RQ1-7 Substitute Allowed


Field Field Description
RQD-1 Requisition Line Number
RQD-2 Item Code - Internal
RQD-3 Item Code - External
RQD-4 Hospital Item Code
RQD-5 Requisition Quantity
RQD-6 Requisition Unit of Measure
RQD-7 Cost Center Account Number
RQD-8 Item Natural Account Code
RQD-9 Deliver To ID
RQD-10 Date Needed


Field Field Description
RXA-1 Give Sub-ID Counter
RXA-2 Administration Sub-ID Counter
RXA-3 Date/Time Start of Administration
RXA-4 Date/Time End of Administration
RXA-5 Administered Code
RXA-6 Administered Amount
RXA-7 Administered Units
RXA-8 Administered Dosage Form
RXA-9 Administration Notes
RXA-10 Administering Provider
RXA-11 Administered-at Location
RXA-12 Administered Per (Time Unit)
RXA-13 Administered Strength
RXA-14 Administered Strength Units
RXA-15 Substance Lot Number
RXA-16 Substance Expiration Date
RXA-17 Substance Manufacturer Name
RXA-18 Substance/Treatment Refusal Reason
RXA-19 Indication
RXA-20 Completion Status
RXA-21 Action Code - RXA
RXA-22 System Entry Date/Time
RXA-23 Administered Drug Strength Volume
RXA-24 Administered Drug Strength Volume Units
RXA-25 Administered Barcode Identifier
RXA-26 Pharmacy Order Type
RXA-27 Administer-at
RXA-28 Administered-at Address
RXA-29 Administered Tag Identifier


Field Field Description
RXC-1 RX Component Type
RXC-2 Component Code
RXC-3 Component Amount
RXC-4 Component Units
RXC-5 Component Strength
RXC-6 Component Strength Units
RXC-7 Supplementary Code
RXC-8 Component Drug Strength Volume
RXC-9 Component Drug Strength Volume Units
RXC-10 Dispense Amount
RXC-11 Dispense Units


Field Field Description
RXD-1 Dispense Sub-ID Counter
RXD-2 Dispense/Give Code
RXD-3 Date/Time Dispensed
RXD-4 Actual Dispense Amount
RXD-5 Actual Dispense Units
RXD-6 Actual Dosage Form
RXD-7 Prescription Number
RXD-8 Number of Refills Remaining
RXD-9 Dispense Notes
RXD-10 Dispensing Provider
RXD-11 Substitution Status
RXD-12 Total Daily Dose
RXD-13 Dispense-to Location
RXD-14 Needs Human Review
RXD-15 Special Dispensing Instructions
RXD-16 Actual Strength
RXD-17 Actual Strength Unit
RXD-18 Substance Lot Number
RXD-19 Substance Expiration Date
RXD-20 Substance Manufacturer Name
RXD-21 Indication
RXD-22 Dispense Package Size
RXD-23 Dispense Package Size Unit
RXD-24 Dispense Package Method
RXD-25 Supplementary Code
RXD-26 Initiating Location
RXD-27 Packaging/Assembly Location
RXD-28 Actual Drug Strength Volume
RXD-29 Actual Drug Strength Volume Units
RXD-30 Dispense to Pharmacy
RXD-31 Dispense to Pharmacy Address
RXD-32 Pharmacy Order Type
RXD-33 Dispense Type
RXD-34 Pharmacy Phone Number
RXD-35 Dispense Tag Identifier


Field Field Description
RXE-1 Quantity/Timing
RXE-2 Give Code
RXE-3 Give Amount - Minimum
RXE-4 Give Amount - Maximum
RXE-5 Give Units
RXE-6 Give Dosage Form
RXE-7 Provider's Administration Instructions
RXE-8 Deliver-To Location
RXE-9 Substitution Status
RXE-10 Dispense Amount
RXE-11 Dispense Units
RXE-12 Number Of Refills
RXE-13 Ordering Provider's DEA Number
RXE-14 Pharmacist/Treatment Supplier's Verifier ID
RXE-15 Prescription Number
RXE-16 Number of Refills Remaining
RXE-17 Number of Refills/Doses Dispensed
RXE-18 D/T of Most Recent Refill or Dose Dispensed
RXE-19 Total Daily Dose
RXE-20 Needs Human Review
RXE-21 Special Dispensing Instructions
RXE-22 Give Per (Time Unit)
RXE-23 Give Rate Amount
RXE-24 Give Rate Units
RXE-25 Give Strength
RXE-26 Give Strength Units
RXE-27 Give Indication
RXE-28 Dispense Package Size
RXE-29 Dispense Package Size Unit
RXE-30 Dispense Package Method
RXE-31 Supplementary Code
RXE-32 Original Order Date/Time
RXE-33 Give Drug Strength Volume
RXE-34 Give Drug Strength Volume Units
RXE-35 Controlled Substance Schedule
RXE-36 Formulary Status
RXE-37 Pharmaceutical Substance Alternative
RXE-38 Pharmacy of Most Recent Fill
RXE-39 Initial Dispense Amount
RXE-40 Dispensing Pharmacy
RXE-41 Dispensing Pharmacy Address
RXE-42 Deliver-to Patient Location
RXE-43 Deliver-to Address
RXE-44 Pharmacy Order Type
RXE-45 Pharmacy Phone Number


Field Field Description
RXG-1 Give Sub-ID Counter
RXG-2 Dispense Sub-ID Counter
RXG-3 Quantity/Timing
RXG-4 Give Code
RXG-5 Give Amount - Minimum
RXG-6 Give Amount - Maximum
RXG-7 Give Units
RXG-8 Give Dosage Form
RXG-9 Administration Notes
RXG-10 Substitution Status
RXG-11 Dispense-to Location
RXG-12 Needs Human Review
RXG-13 Special Administration Instructions
RXG-14 Give Per (Time Unit)
RXG-15 Give Rate Amount
RXG-16 Give Rate Units
RXG-17 Give Strength
RXG-18 Give Strength Units
RXG-19 Substance Lot Number
RXG-20 Substance Expiration Date
RXG-21 Substance Manufacturer Name
RXG-22 Indication
RXG-23 Give Drug Strength Volume
RXG-24 Give Drug Strength Volume Units
RXG-25 Give Barcode Identifier
RXG-26 Pharmacy Order Type
RXG-27 Dispense to Pharmacy
RXG-28 Dispense to Pharmacy Address
RXG-29 Deliver-to Patient Location
RXG-30 Deliver-to Address
RXG-31 Give Tag Identifier
RXG-32 Dispense Amount
RXG-33 Dispense Units


Field Field Description
RXO-1 Requested Give Code
RXO-2 Requested Give Amount - Minimum
RXO-3 Requested Give Amount - Maximum
RXO-4 Requested Give Units
RXO-5 Requested Dosage Form
RXO-6 Provider's Pharmacy/Treatment Instructions
RXO-7 Provider's Administration Instructions
RXO-8 Deliver-To Location
RXO-9 Allow Substitutions
RXO-10 Requested Dispense Code
RXO-11 Requested Dispense Amount
RXO-12 Requested Dispense Units
RXO-13 Number Of Refills
RXO-14 Ordering Provider's DEA Number
RXO-15 Pharmacist/Treatment Supplier's Verifier ID
RXO-16 Needs Human Review
RXO-17 Requested Give Per (Time Unit)
RXO-18 Requested Give Strength
RXO-19 Requested Give Strength Units
RXO-20 Indication
RXO-21 Requested Give Rate Amount
RXO-22 Requested Give Rate Units
RXO-23 Total Daily Dose
RXO-24 Supplementary Code
RXO-25 Requested Drug Strength Volume
RXO-26 Requested Drug Strength Volume Units
RXO-27 Pharmacy Order Type
RXO-28 Dispensing Interval
RXO-29 Medication Instance Identifier
RXO-30 Segment Instance Identifier
RXO-31 Mood Code
RXO-32 Dispensing Pharmacy
RXO-33 Dispensing Pharmacy Address
RXO-34 Deliver-to Patient Location
RXO-35 Deliver-to Address
RXO-36 Pharmacy Phone Number


Field Field Description
RXR-1 Route
RXR-2 Administration Site
RXR-3 Administration Device
RXR-4 Administration Method
RXR-5 Routing Instruction
RXR-6 Administration Site Modifier


Field Field Description
RXV-1 Set ID - RXV
RXV-2 Bolus Type
RXV-3 Bolus Dose Amount
RXV-4 Bolus Dose Amount Units
RXV-5 Bolus Dose Volume
RXV-6 Bolus Dose Volume Units
RXV-7 PCA Type
RXV-8 PCA Dose Amount
RXV-9 PCA Dose Amount Units
RXV-10 PCA Dose Amount Volume
RXV-11 PCA Dose Amount Volume Units
RXV-12 Max Dose Amount
RXV-13 Max Dose Amount Units
RXV-14 Max Dose Amount Volume
RXV-15 Max Dose Amount Volume Units
RXV-16 Max Dose per Time
RXV-17 Lockout Interval
RXV-18 Syringe Manufacturer
RXV-19 Syringe Model Number
RXV-20 Syringe Size
RXV-21 Syringe Size Units
RXV-22 Action Code


Field Field Description
SAC-1 External Accession Identifier
SAC-2 Accession Identifier
SAC-3 Container Identifier
SAC-4 Primary (Parent) Container Identifier
SAC-5 Equipment Container Identifier
SAC-6 Specimen Source
SAC-7 Registration Date/Time
SAC-8 Container Status
SAC-9 Carrier Type
SAC-10 Carrier Identifier
SAC-11 Position in Carrier
SAC-12 Tray Type - SAC
SAC-13 Tray Identifier
SAC-14 Position in Tray
SAC-15 Location
SAC-16 Container Height
SAC-17 Container Diameter
SAC-18 Barrier Delta
SAC-19 Bottom Delta
SAC-20 Container Height/Diameter/Delta Units
SAC-21 Container Volume
SAC-22 Available Specimen Volume
SAC-23 Initial Specimen Volume
SAC-24 Volume Units
SAC-25 Separator Type
SAC-26 Cap Type
SAC-27 Additive
SAC-28 Specimen Component
SAC-29 Dilution Factor
SAC-30 Treatment
SAC-31 Temperature
SAC-32 Hemolysis Index
SAC-33 Hemolysis Index Units
SAC-34 Lipemia Index
SAC-35 Lipemia Index Units
SAC-36 Icterus Index
SAC-37 Icterus Index Units
SAC-38 Fibrin Index
SAC-39 Fibrin Index Units
SAC-40 System Induced Contaminants
SAC-41 Drug Interference
SAC-42 Artificial Blood
SAC-43 Special Handling Code
SAC-44 Other Environmental Factors


Field Field Description
SCD-1 Cycle Start Time
SCD-2 Cycle Count
SCD-3 Temp Max
SCD-4 Temp Min
SCD-5 Load Number
SCD-6 Condition Time
SCD-7 Sterilize Time
SCD-8 Exhaust Time
SCD-9 Total Cycle Time
SCD-10 Device Status
SCD-11 Cycle Start Date/Time
SCD-12 Dry Time
SCD-13 Leak Rate
SCD-14 Control Temperature
SCD-15 Sterilizer Temperature
SCD-16 Cycle Complete Time
SCD-17 Under Temperature
SCD-18 Over Temperature
SCD-19 Abort Cycle
SCD-20 Alarm
SCD-21 Long in Charge Phase
SCD-22 Long in Exhaust Phase
SCD-23 Long in Fast Exhaust Phase
SCD-24 Reset
SCD-25 Operator - Unload
SCD-26 Door Open
SCD-27 Reading Failure
SCD-28 Cycle Type
SCD-29 Thermal Rinse Time
SCD-30 Wash Time
SCD-31 Injection Rate
SCD-32 Procedure Code
SCD-33 Patient Identifier List
SCD-34 Attending Doctor
SCD-35 Dilution Factor
SCD-36 Fill Time
SCD-37 Inlet Temperature


Field Field Description
SCH-1 Placer Appointment ID
SCH-2 Filler Appointment ID
SCH-3 Occurrence Number
SCH-4 Placer Group Number
SCH-5 Schedule ID
SCH-6 Event Reason
SCH-7 Appointment Reason
SCH-8 Appointment Type
SCH-9 Appointment Duration
SCH-10 Appointment Duration Units
SCH-11 Appointment Timing Quantity
SCH-12 Placer Contact Person
SCH-13 Placer Contact Phone Number
SCH-14 Placer Contact Address
SCH-15 Placer Contact Location
SCH-16 Filler Contact Person
SCH-17 Filler Contact Phone Number
SCH-18 Filler Contact Address
SCH-19 Filler Contact Location
SCH-20 Entered By Person
SCH-21 Entered By Phone Number
SCH-22 Entered By Location
SCH-23 Parent Placer Appointment ID
SCH-24 Parent Filler Appointment ID
SCH-25 Filler Status Code
SCH-26 Placer Order Number
SCH-27 Filler Order Number


Field Field Description
SCP-1 Number Of Decontamination/Sterilization Devices
SCP-2 Labor Calculation Type
SCP-3 Date Format
SCP-4 Device Number
SCP-5 Device Name
SCP-6 Device Model Name
SCP-7 Device Type
SCP-8 Lot Control


Field Field Description
SDD-1 Lot Number
SDD-2 Device Number
SDD-3 Device Name
SDD-4 Device Data State
SDD-5 Load Status
SDD-6 Control Code
SDD-7 Operator Name


Field Field Description
SFT-1 Software Vendor Organization
SFT-2 Software Certified Version or Release Number
SFT-3 Software Product Name
SFT-4 Software Binary ID
SFT-5 Software Product Information
SFT-6 Software Install Date


Field Field Description
SGH-1 Set ID - SGH
SGH-2 Segment Group Name


Field Field Description
SGT-1 Set ID - SGT
SGT-2 Segment Group Name


Field Field Description
SHP-1 Shipment ID
SHP-2 Internal Shipment ID
SHP-3 Shipment Status
SHP-4 Shipment Status Date/Time
SHP-5 Shipment Status Reason
SHP-6 Shipment Priority
SHP-7 Shipment Confidentiality
SHP-8 Number of Packages in Shipment
SHP-9 Shipment Condition
SHP-10 Shipment Handling Code
SHP-11 Shipment Risk Code


Field Field Description
SID-1 Application/Method Identifier
SID-2 Substance Lot Number
SID-3 Substance Container Identifier
SID-4 Substance Manufacturer Identifier


Field Field Description
SLT-1 Device Number
SLT-2 Device Name
SLT-3 Lot Number
SLT-4 Item Identifier
SLT-5 Bar Code


Field Field Description
SPM-1 Set ID - SPM
SPM-2 Specimen ID
SPM-3 Specimen Parent IDs
SPM-4 Specimen Type
SPM-5 Specimen Type Modifier
SPM-6 Specimen Additives
SPM-7 Specimen Collection Method
SPM-8 Specimen Source Site
SPM-9 Specimen Source Site Modifier
SPM-10 Specimen Collection Site
SPM-11 Specimen Role
SPM-12 Specimen Collection Amount
SPM-13 Grouped Specimen Count
SPM-14 Specimen Description
SPM-15 Specimen Handling Code
SPM-16 Specimen Risk Code
SPM-17 Specimen Collection Date/Time
SPM-18 Specimen Received Date/Time
SPM-19 Specimen Expiration Date/Time
SPM-20 Specimen Availability
SPM-21 Specimen Reject Reason
SPM-22 Specimen Quality
SPM-23 Specimen Appropriateness
SPM-24 Specimen Condition
SPM-25 Specimen Current Quantity
SPM-26 Number of Specimen Containers
SPM-27 Container Type
SPM-28 Container Condition
SPM-29 Specimen Child Role
SPM-30 Accession ID
SPM-31 Other Specimen ID
SPM-32 Shipment ID


Field Field Description
STF-1 Primary Key Value - STF
STF-2 Staff Identifier List
STF-3 Staff Name
STF-4 Staff Type
STF-5 Administrative Sex
STF-6 Date/Time of Birth
STF-7 Active/Inactive Flag
STF-8 Department
STF-9 Hospital Service - STF
STF-10 Phone
STF-11 Office/Home Address/Birthplace
STF-12 Institution Activation Date
STF-13 Institution Inactivation Date
STF-14 Backup Person ID
STF-15 E-Mail Address
STF-16 Preferred Method of Contact
STF-17 Marital Status
STF-18 Job Title
STF-19 Job Code/Class
STF-20 Employment Status Code
STF-21 Additional Insured on Auto
STF-22 Driver's License Number - Staff
STF-23 Copy Auto Ins
STF-24 Auto Ins Expires
STF-25 Date Last DMV Review
STF-26 Date Next DMV Review
STF-27 Race
STF-28 Ethnic Group
STF-29 Re-activation Approval Indicator
STF-30 Citizenship
STF-31 Date/Time of Death
STF-32 Death Indicator
STF-33 Institution Relationship Type Code
STF-34 Institution Relationship Period
STF-35 Expected Return Date
STF-36 Cost Center Code
STF-37 Generic Classification Indicator
STF-38 Inactive Reason Code
STF-39 Generic resource type or category
STF-40 Religion
STF-41 Signature


Field Field Description
STZ-1 Sterilization Type
STZ-2 Sterilization Cycle
STZ-3 Maintenance Cycle
STZ-4 Maintenance Type


Field Field Description
TCC-1 Universal Service Identifier
TCC-2 Equipment Test Application Identifier
TCC-3 Specimen Source
TCC-4 Auto-Dilution Factor Default
TCC-5 Rerun Dilution Factor Default
TCC-6 Pre-Dilution Factor Default
TCC-7 Endogenous Content of Pre-Dilution Diluent
TCC-8 Inventory Limits Warning Level
TCC-9 Automatic Rerun Allowed
TCC-10 Automatic Repeat Allowed
TCC-11 Automatic Reflex Allowed
TCC-12 Equipment Dynamic Range
TCC-13 Units
TCC-14 Processing Type
TCC-15 Test Criticality


Field Field Description
TCD-1 Universal Service Identifier
TCD-2 Auto-Dilution Factor
TCD-3 Rerun Dilution Factor
TCD-4 Pre-Dilution Factor
TCD-5 Endogenous Content of Pre-Dilution Diluent
TCD-6 Automatic Repeat Allowed
TCD-7 Reflex Allowed
TCD-8 Analyte Repeat Status


Field Field Description
TQ1-1 Set ID - TQ1
TQ1-2 Quantity
TQ1-3 Repeat Pattern
TQ1-4 Explicit Time
TQ1-5 Relative Time and Units
TQ1-6 Service Duration
TQ1-7 Start date/time
TQ1-8 End date/time
TQ1-9 Priority
TQ1-10 Condition text
TQ1-11 Text instruction
TQ1-12 Conjunction
TQ1-13 Occurrence duration
TQ1-14 Total occurrences


Field Field Description
TQ2-1 Set ID - TQ2
TQ2-2 Sequence/Results Flag
TQ2-3 Related Placer Number
TQ2-4 Related Filler Number
TQ2-5 Related Placer Group Number
TQ2-6 Sequence Condition Code
TQ2-7 Cyclic Entry/Exit Indicator
TQ2-8 Sequence Condition Time Interval
TQ2-9 Cyclic Group Maximum Number of Repeats
TQ2-10 Special Service Request Relationship


Field Field Description
TXA-2 Document Type
TXA-3 Document Content Presentation
TXA-4 Activity Date/Time
TXA-5 Primary Activity Provider Code/Name
TXA-6 Origination Date/Time
TXA-7 Transcription Date/Time
TXA-8 Edit Date/Time
TXA-9 Originator Code/Name
TXA-10 Assigned Document Authenticator
TXA-11 Transcriptionist Code/Name
TXA-12 Unique Document Number
TXA-13 Parent Document Number
TXA-14 Placer Order Number
TXA-15 Filler Order Number
TXA-16 Unique Document File Name
TXA-17 Document Completion Status
TXA-18 Document Confidentiality Status
TXA-19 Document Availability Status
TXA-20 Document Storage Status
TXA-21 Document Change Reason
TXA-22 Authentication Person, Time Stamp (set)
TXA-23 Distributed Copies (Code and Name of Recipient(s) )
TXA-24 Folder Assignment
TXA-25 Document Title
TXA-26 Agreed Due Date/Time


Field Field Description
UAC-1 User Authentication Credential Type Code
UAC-2 User Authentication Credential


Field Field Description
UB1-1 Set ID - UB1
UB1-2 Blood Deductible
UB1-3 Blood Furnished-Pints
UB1-4 Blood Replaced-Pints
UB1-5 Blood Not Replaced-Pints
UB1-6 Co-Insurance Days
UB1-7 Condition Code
UB1-8 Covered Days
UB1-9 Non Covered Days
UB1-10 Value Amount & Code
UB1-11 Number Of Grace Days
UB1-12 Special Program Indicator
UB1-13 PSRO/UR Approval Indicator
UB1-14 PSRO/UR Approved Stay-Fm
UB1-15 PSRO/UR Approved Stay-To
UB1-16 Occurrence
UB1-17 Occurrence Span
UB1-18 Occur Span Start Date
UB1-19 Occur Span End Date
UB1-20 UB-82 Locator 2
UB1-21 UB-82 Locator 9
UB1-22 UB-82 Locator 27
UB1-23 UB-82 Locator 45


Field Field Description
UB2-1 Set ID - UB2
UB2-2 Co-Insurance Days (9)
UB2-3 Condition Code (24-30)
UB2-4 Covered Days (7)
UB2-5 Non-Covered Days (8)
UB2-6 Value Amount & Code (39-41)
UB2-7 Occurrence Code & Date (32-35)
UB2-8 Occurrence Span Code/Dates (36)
UB2-9 Uniform Billing Locator 2 (state)
UB2-10 Uniform Billing Locator 11 (state)
UB2-11 Uniform Billing Locator 31 (national)
UB2-12 Document Control Number
UB2-13 Uniform Billing Locator 49 (national)
UB2-14 Uniform Billing Locator 56 (state)
UB2-15 Uniform Billing Locator 57 (sational)
UB2-16 Uniform Billing Locator 78 (state)
UB2-17 Special Visit Count


Field Field Description
VAR-1 Variance Instance ID
VAR-2 Documented Date/Time
VAR-3 Stated Variance Date/Time
VAR-4 Variance Originator
VAR-5 Variance Classification
VAR-6 Variance Description


Field Field Description
VND-1 Set Id - VND
VND-2 Vendor Identifier
VND-3 Vendor Name
VND-4 Vendor Catalog Number
VND-5 Primary Vendor Indicator