HL7 Segment Definitions

Covered by this topic

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

Master File Entry (MFE)

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

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

Event Type (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

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

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

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

Patient Visit (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

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

Diagnosis (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

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

Guarantor (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

Insurance (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

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

Procedures (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

Error (ERR)

Sequence	Length	Data Type	Required	Repetition	Name
1	80	ID	REQ	NO_MAX	Error Code and Location

ZIL

Sequence	Length	Data Type	Required	Repetition	Name
1	64	ID	OPT	NO_MAX	Dicom Study Ins UID

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

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

Notes and Comments (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

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

Resource Group (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

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

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

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

Accident (ACC)

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

UB82 (UB1)

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

UB92 Data (UB2)

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

ZMF

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

Common Order (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

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

Observation/Result (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

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)

ZCL

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

ZBL

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

ZCY

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

ZSA

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

ZPS

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

ZSV

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

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

Data Types

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

Enterprise Health Documentation

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