AOL File Library: 4,101 to 4,200

home *** CD-ROM | disk | FTP | other *** search

/ AOL File Library: 4,101 to 4,200 / aol-file-protocol-4400-4101-to-4200.zip / AOLDLs / Business Management / MEDISOFT_ V4.14a Medical Patient / MEDI414A.exe / MAETS6.FMT < prev next >

Wrap

Text File | 1996-02-05 | 213KB | 832 lines

830 0 25611 1000 0 00 0 00 0 00 0 00000000000ETS V6.0 NSF ETS 001030010302/05/969999001301.14 0A00000000010320 013 013 0000010090060010010000000 0C000000011BA0 PROVIDER DATA 1 BA0 01.0BA0 02.0BA0 03.0BA0 04.0BA0 05.0BA0 06.0BA0 07.0 0D000000011CA0 PATIENT DATA 1 CA0 01.0CA0 02.0CA0 03.0CA0 04.0CA0 05.0CA0 06.0CA0 07.0CA0 08.0CA0 09.0CA0 10.0CA0 11.0CA0 12.0CA0 13.0CA0 14.0CA0 15.0CA0 16.0CA0 17.0CA0 18.0CA0 19.0CA0 20.0CA0 21.0CA0 22.0CA0 23.0CA0 24.0 0D000000021DA0 PRIMARY INSURANCE INFO 1 DA0 01.0DA0 02.0DA0 03.0DA0 04.0DA0 05.0DA0 06.0DA0 07.0DA0 08.0DA0 09.0DA0 10.0DA0 11.0DA0 12.0DA0 13.0DA0 14.0DA0 15.0DA0 16.0DA0 17.0DA0 18.0DA0 19.0DA0 20.0DA0 21.0DA0 22.0DA0 23.0DA0 24.0 0D000000031DA1 PRIMARY INSURANCE INFO 2 DA1 01.0DA1 02.0DA1 03.0DA1 04.0DA1 05.0DA1 06.0DA1 07.0DA1 08.0DA1 09.0DA1 10.0DA1 11.0DA1 12.0DA1 13.0DA1 14.0DA1 15.0 0D000000041DA2 PRIMARY INSURANCE INFO 3 DA2 01.0DA2 02.0DA2 03.0DA2 04.0DA2 05.0DA2 06.0DA2 07.0DA2 08.0DA2 09.0DA2 10.0DA2 11.0DA2 12.0 0D000000051DA3 SECONDARY INSURANCE 1 010DA0 01.0DA0 02.1DA0 03.0DA0 04.0DA0 05.1DA0 06.1DA0 07.1DA0 08.1DA0 09.1DA0 10.1DA0 11.0DA0 12.0DA0 13.0DA0 14.0DA0 15.0DA0 16.1DA0 17.0DA0 18.0DA0 19.0DA0 20.0DA0 21.0DA0 22.0DA0 23.0DA0 24.0 0D000000061DA4 SECONDARY INSURANCE 2 010DA1 01.0DA1 02.1DA1 03.0DA1 04.1DA1 05.1DA1 06.1DA1 07.1DA1 08.1DA1 09.0DA1 10.0DA1 11.0DA1 12.0DA1 13.0DA1 14.0DA1 15.0 0D000000071DA5 SECONDARY INSURANCE 3 011DA2 01.0DA2 02.0DA2 03.0DA2 04.0DA2 05.0DA2 06.0DA2 07.0DA2 08.0DA2 09.0DA2 10.0DA2 11.0DA2 12.0 0D000000081EA0 CLAIM DATA 1 EA0 01.0EA0 02.0EA0 03.0EA0 04.0EA0 05.0EA0 06.0EA0 07.0EA0 08.0EA0 09.0EA0 10.0EA0 11.0EA0 12.0EA0 13.0EA0 14.0EA0 15.0EA0 16.0EA0 17.0EA0 18.0EA0 19.0EA0 20.0EA0 21.0EA0 22.0EA0 23.0EA0 24.0EA0 25.0EA0 26.0 0D000000082EA0 CLAIM DATA 1 EA0 27.0EA0 28.0EA0 29.0EA0 30.0EA0 31.0EA0 32.0EA0 33.0EA0 34.0EA0 35.0EA0 36.0EA0 37.0EA0 38.0EA0 39.0EA0 40.0EA0 41.0 0D000000091EA1 CLAIM DATA 2 002EA1 01.0EA1 02.0EA1 03.0EA1 04.0EA1 05.0EA1 06.0EA1 07.0EA1 08.0EA1 09.0EA1 10.0EA1 11.0EA1 12.0EA1 13.0EA1 14.0 0E000000011FA0 CLAIM - ROOT SEGMENT FA0 01.0FA0 02.0FA0 03.0FA0 04.0FA0 04.1FA0 05.0FA0 06.0FA0 07.0FA0 08.0FA0 09.0FA0 10.0FA0 11.0FA0 12.0FA0 13.0FA0 14.0FA0 15.0FA0 16.0FA0 17.0FA0 18.0FA0 19.0FA0 20.0FA0 21.0FA0 22.0FA0 23.0FA0 24.0FA0 25.0 0E000000012FA0 CLAIM - ROOT SEGMENT FA0 26.0FA0 27.0FA0 28.0FA0 29.0FA0 30.0 0E000000021FB0 MEDICAL SEGMENT 1 133FB0 01.0FB0 02.0FB0 03.0FB0 04.0FB0 04.1FB0 05.0FB0 06.0FB0 07.0 0E000000031GA0 AMBULANCE RECORD 141GA0 01.0GA0 02.0GA0 03.0GA0 04.0GA0 04.1GA0 05.0GA0 06.0GA0 07.0GA0 08.0GA0 09.0GA0 10.0 0E000000041GC0 CHIROPRACTIC CERT 004GC0 01.0GC0 02.0GC0 03.0GC0 04.0GC0 04.1GC0 05.0GC0 06.0GC0 07.0GC0 07.1GC0 07.2GC0 08.0GC0 09.0GC0 10.0GC0 11.0GC0 12.0GC0 13.0GC0 14.0GC0 15.0 0E000000051HA0 NARRATIVE RECORD-ECS 006HA0 01.0HA0 02.0HA0 03.0HA0 04.0HA0 05.0 0E000000061HA0 NARRATIVE RECORD-ECS 001HA0 01.0HA0 02.0HA0 03.0HA0 04.0HA0 05.1 0F000000011XA0 CLAIM TRAILER RECORD XA0 01.0XA0 02.0XA0 03.0XA0 04.0XA0 05.0XA0 06.0XA0 07.0XA0 08.0XA0 09.0XA0 10.0XA0 11.0XA0 12.0XA0 13.0 0G000000011YA0 BATCH TRAILER RECORD YA0 01.0YA0 02.0YA0 03.0YA0 04.0YA0 05.0YA0 06.0YA0 07.0YA0 08.0YA0 09.0YA0 10.0YA0 11.0YA0 12.0 0U000000010[DELKEY] 2 [KEY] 2 10 12 [BLANK]{0} 0U000000020[CPOS] 1 1 8 [APOS] 1 1 8 [BLANK]{0} 0U000000030[CPOS] 2 9 4 [APOS] 2 15 4 [BLANK]{0} 0U000000040[CPOS] 3 0 0 [APOS] 3 0 0 [BLANK]{0} 0U000000050[CPOS] 4 0 0 [APOS] 4 0 0 [BLANK]{0} 0U000000060[CPOS] 5 0 0 [APOS] 5 0 0 [BLANK]{0} 0U000000070[APOS] 6 80 1 [BLANK]{0} [BLANK]{0} 0U000000080SET [CONDVAR1] = 'R' SET [CONDVAR2] = 'T' SET [CONDVAR3] = 'P' 0U000000090[PROCESS] [DELKEY] 2 [BLANK]{0} 0VACCEPTA1 ACCEPT ASSIGNMENT OF BENEFITS 1 011 266 001 0VACCSTATE ACCIDENT STATE 011 596 002 0VATTEMPTS CONNECTION ATTEMPTS 002 209 003 0VAUTHVIS AUTHORIZED NUMBER OF VISITS 011 864 002 0VBAUDRATE EMC TRANSMISSION BAUD RATE 002 067 001 0VBDAY PATIENT BIRTHDAY 011 222 -9 0VCHART PATIENT CHART NUMBER 011 002 008 0VCHBRANCH CHAMPUS BRANCH OF SERVICE 011 837 001 0VCHCEFF CHAMPUS CARD EFFECTIVE DATE 011 844 -4 0VCHCTERM CHAMPUS CARD TERMINATION DATE 011 850 -4 0VCHNONA CHAMPUS NON AVAILABILITY INDICATOR 011 836 001 0VCHPHAN CHAMPUS PROGRAM FOR HANDICAPPED 011 841 002 0VCHSGRD CHAMPUS SPONSOR GRADE 011 838 002 0VCHSSTAT CHAMPUS SPONSOR STATUS 011 840 001 0VCITY PATIENT CITY 011 070 020 0VCOCI CROSSOVER CLAIM INDICATOR 019 043 001 0VCODEB ENTRY PROCEDURE CODE 2 016 042 -3 0VCODEC ENTRY PROCEDURE CODE 3 016 052 -3 0VCONTACT SUBMITTER CONTACT NAME 002 175 030 0VCSINO SECONDARY INSURANCE NUMBER 019 035 004 0VCSTATE INSURANCE STATE 020 081 002 0VCURSVT CURRENT SERIES VISIT TOTAL 011 862 002 0VDATECON DATE PHYSICIAN NFRST CONSULTED 011 365 -4 0VDATEINJ DATE OF INJURY/ILLNESS/LMP 011 359 -4 0VDATESYMP DATE OF SIMILAR SYMPTOMS 011 598 -4 0VDATEWORK DATE UNABLE TO WORK TO 011 371 -4 0VDCPHONE EMC PHONE NUMBER 002 069 015 0VDEATH PATIENT DEATH INDICATOR 011 450 001 0VDESTIN DESTINATION INFORMATION 010 124 040 0VEMCIND EMC DOCUMENTATION INDICATOR 010 001 003 0VEMCJC1 (JC) LAST XRAY TRIGGER 010 042 003 0VEMCJC10 (JC) NATURE OF CONDITION IND 010 069 001 0VEMCJC11 (JC) DATE OF ACUTE MANIFESTATION 010 071 006 0VEMCJC12 (JC) SYMPTOMS DESCRIPTION TRIGGER 010 083 003 0VEMCJC13 (JC) SYMPTOMS DESCRIPTION 010 086 037 0VEMCJC14 (JC) XRAY STATEMENT IND TRIGGER 010 078 003 0VEMCJC15 (JC) X-RAY STATEMENT INDICATOR 010 081 001 0VEMCJC16 (JC) ADDITIONAL NOTES FOR HA0 010 124 122 0VEMCJC2 (JC) LAST X-RAY DATE MUST BE MMDDYY 010 045 006 0VEMCJC3 (JC) CURRENT VISIT NUMBER TRIGGER 010 052 003 0VEMCJC4 (JC) CURRENT VISIT NUMBER 010 055 003 0VEMCJC5 (JC) AUTH # OF VISITS TRIGGER 010 059 003 0VEMCJC6 (JC) AUTH # OF VISITS 010 062 003 0VEMCJC7 (JC) LEVEL OF SUBLUX TRIGGER 010 001 003 0VEMCJC8 (JC) LEVEL OF SUBLUXATION 010 004 037 0VEMCJC9 (JC) NATURE COND TRIGGER 010 066 003 0VEMCNT1 EMC NOTE TEXT: FULL 010 001 239 0VEMCNT2 EMC NOTE TEXT: PARTIAL 010 004 236 0VEMCNT3 EMC NOTE TEXT: STRIP REPEATER/PARTIAL 010 004 233 0VEMCNT4 EMC NOTE TEXT: STRIP REPEATER/FULL 010 001 236 0VEMCRIND EMC NOTE REPEATER INDICATOR 010 237 003 0VEMERG EMERGENCY TREATMENT INDICATOR 011 348 001 0VEMPLSTS EMPLOYMENT STATUS 011 448 001 0VEPSDT EPSDT INDICATOR 011 349 001 0VFACILITY FACILITY ADDRESS CODE 011 339 005 0VFAMPLAN FAMILY PLANNING INDICATOR 011 350 001 0VFCITY FACILITY CITY 003 067 020 0VFCONTACT FACILITY CONTACT 003 109 020 0VFDIAG1 FORM DIAGNOSES NUMBER 1 019 044 005 0VFDIAG2 FORM DIAGNOSES NUMBER 2 019 049 005 0VFDIAG3 FORM DIAGNOSES NUMBER 3 019 054 005 0VFDIAG4 FORM DIAGNOSES NUMBER 4 019 059 005 0VFINDINGS AMBULANCE PRELIMINARY FINDINGS 010 042 018 0VFNAME FACILITY NAME 003 007 030 0VFSTATE FACILITY STATE 003 087 002 0VFSTREET FACILITY STREET 003 037 030 0VFUPIN FACILITY ID NUMBER 003 130 020 0VFZIP FACILITY ZIP CODE 003 089 010 0VGA0NOTES RECORD ID NOTES TEST 010 001 003 0VHOSPFROM HOSPITALIZATION FROM DATE 011 401 -4 0VHOSPTO HOSPITALIZATION TO DATE 011 407 -4 0VICITY INSURANCE CITY 008 061 020 0VICODETYPEPROCEDURE CODE TYPE SET 008 123 001 0VIEMC INSURANCE EMC CODE 008 121 002 0VIEMCID INSURANCE PRACTICE ID NUMBER 008 125 015 0VIEMCPN EMC PAYOR NUMBER 008 173 005 0VIEMCSID EMC SUBMITTER ID 008 178 015 0VIENAME INSURED EMPLOYER NAME 006 007 030 0VINAME INSURANCE COMPANY NAME 008 001 030 0VINJURY PATIENT INJURY/ILLNESS/LMP INDICATOR 011 451 001 0VINS1REL PATIENT RELATION TO INSURED 1 011 140 001 0VIPLAN INSURANCE PLAN NAME 008 142 030 0VISTATE INSURANCE STATE 008 081 002 0VISTREET INSURANCE STREET ADDRESS 008 031 030 0VISTREET2 INSURANCE STREET ADDRESS 2 008 234 030 0VITYPE INSURANCE COMPANMY TYPE 008 172 001 0VIZIP INSURANCE ZIP CODE 008 083 010 0VLABCHARGELAB WORK CHARGES 011 352 007 0VLABWORK LAB WORK INDICATOR 011 351 001 0VLAST PATIENT LAST NAME 011 010 -2 0VLASTXRAY DATE OF LAST XRAY 011 951 -4 0VLOCALA1 LOCAL USE (A): POS 1-3 011 640 003 0VLOCALA2 LOCAL USE (A): POS 4-1 011 643 001 0VLOCALA3 LOCAL USE (A): POS 4-10 011 643 010 0VLOCALB1 LOCAL USE (B): POS 1-3 011 660 003 0VLOCALB2 LOCAL USE (B): POS 4-1 011 663 001 0VMAIDCODE MEDICAID RESUBMISSION NUMBER 011 610 012 0VMAIDORG MEDICAID ORIGINAL REFERENCE NUMBER 011 622 018 0VMARITAL PATIENT MARITAL STATUS 011 447 001 0VMIDDLE PATIENT MIDDLE NAME 011 010 -2 0VMODA DEFAULT MOD CODE SET 1 016 002 -3 0VMODB DEFAULT MOD CODE SET 2 016 042 -3 0VMODC DEFAULT MOD CODE SET 3 016 052 -3 0VMPREFIX MODEM DIALING PREFIX 002 104 035 0VMSUFFIX MODEM DIALING SUFFIX 002 139 030 0VNAME PATIENT NAME 011 010 030 0VNATURE NATURE OF ACCIDENT CODE 011 428 001 0VNFRST PATIENT NFRST NAME 011 010 -2 0VOCITY INSURANCE CITY 009 061 020 0VOEMC INSURANCE EMC CODE 009 121 002 0VOEMCPN EMC PAYOR NUMBER 009 173 005 0VOEMCSID EMC SUBMITTER ID 009 178 015 0VONAME INSURANCE COMPANY NAME 009 001 030 0VOPLAN INSURANCE PLAN NAME 009 142 030 0VORIGIN ORIGIN INFORMATION 010 083 040 0VOSTATE INSURANCE STATE 009 081 002 0VOSTREET INSURANCE STREET ADDRESS 009 031 030 0VOSTREET2 INSURANCE STREET ADDRESS 2 009 234 030 0VOTYPE INSURANCE COMPANMY TYPE 009 172 001 0VOZIP INSURANCE ZIP CODE 009 083 010 0VPASSWORD EMC PASSWORD 002 046 020 0VPCOPIN PROVIDER COMMERCIAL PIN 014 208 020 0VPDATESS DATE OF SIMILAR SYMPTOMS: PRACTISOFT 011 835 -4 0VPDISFROM PATIENT DISABILITY FROM DATE 011 389 -4 0VPDISTO PATIENT DISABILITY TO DATE 011 395 -4 0VPHONE PATIENT PHONE NUMBER 011 102 010 0VPHOSPF HOSPITALIZATION FROM DATE: PRACTISOFT 011 672 -4 0VPHOSPT HOSPITALIZATION TO DATE: PRACTISOFT 011 678 -4 0VPIBDAY PATIENT BIRTHDAY 012 222 -9 0VPICITY PATIENT CITY 012 070 020 0VPIEMPLSTSEMPLOYMENT STATUS 012 448 001 0VPILAST PATIENT LAST NAME 012 010 -2 0VPIMIDDLE PATIENT MIDDLE NAME 012 010 -2 0VPINFRST PATIENT NFRST NAME 012 010 -2 0VPIPHONE PATIENT PHONE NUMBER 012 102 010 0VPIPRIGRP PATIENT PRIMARY GROUP NUMBER 012 289 020 0VPIPRIPOL PATIENT PRIMARY POLICY 012 269 020 0VPISECGRP PATIENT SECONDARY GROUP NUMBER 012 576 020 0VPISECPOL PATIENT SECONDARY POLICY NAME 012 315 020 0VPISEX PATIENT GENDER 012 221 001 0VPISTATE PATIENT STATE 012 090 002 0VPISTREET PATIENT STREET ADDRESS 012 040 030 0VPIZIP PATIENT ZIP CODE 012 092 010 0VPLAB LAB WORK INDICATOR: PRACTISOFT 011 358 001 0VPLABC LAB WORK CHARGES: PRACTISOFT 011 684 007 0VPMAIDO MEDICAID ORIGINAL REF #: PRACTISOFT 011 691 018 0VPMAIDR MEDICAID RESUBMISSION #: PRACTISOFT 011 971 012 0VPRETW DATE UNABLE TO WORK TO: PRACTISOFT 011 666 -4 0VPRIGRP PATIENT PRIMARY GROUP NUMBER 011 289 020 0VPRIORAUTHPATIENT PRIOR AUTORIZATION NUMBER 011 413 012 0VPRIPOL PATIENT PRIMARY POLICY 011 269 020 0VPRTYPE PRACTICE TYPE INDICATOR 017 125 001 0VPSSN PROVIDER SOCIAL SECURITY NUMBER 014 103 009 0VPSYMP SAME OR SIMILAR SYMPTOMS: PRACTISOFT 011 349 001 0VPURPOSE PURPOSE OF ROUND TRIP 010 165 040 0VRCVTYP EMC DIRECT CARRIER TYPE 020 172 001 0VREGION SUBMITTER REGION CODE 002 170 005 0VRELTOACC RELATED TO ACCIDENT INDICATOR 011 346 001 0VRELTOEMPLRELATED TO EMPLOYMENT INDICATOR 011 345 001 0VRLAST REFERRING PROVIDER LAST NAME 004 007 -2 0VRMIDDLE REFERRING PROVIDER MIDDLE INITIAL 004 007 -2 0VRNFRST REFERRING PROVIDER NFRST NAME 004 007 -2 0VRSTATE REFERRING PROVIDER STATE 004 087 002 0VRUPIN REFERRING PROVIDER ID NUMBER 004 130 020 0VSCLAIM CLAIM NUMBER 019 018 004 0VSCODE ENTRY PROCEDURE CODE 018 045 -3 0VSDIAGP1 DIAGNOSES POINTER 1 018 055 001 0VSDIAGP2 DIAGNOSES POINTER 2 018 056 001 0VSDIAGP3 DIAGNOSES POINTER 3 018 057 001 0VSDIAGP4 DIAGNOSES POINTER 4 018 058 001 0VSECGRP PATIENT SECONDARY GROUP NUMBER 011 576 020 0VSECPOL PATIENT SECONDARY POLICY NAME 011 315 020 0VSERPORT COMMUNICATIONS SERIAL PORT ID 002 066 001 0VSEX PATIENT GENDER 011 221 001 0VSEXTAMT ENTRY PROCEDURE EXTENDED AMOUNT 018 070 910 0VSFROMDT DATE - FROM 018 031 -4 0VSIG PATIENT SIGNATURE ON FILE 011 456 001 0VSMINUTES MINUTES TO PERFORM SERVICE 018 160 510 0VSMODFYA PROCEDURE CODE MODFYIER 1 018 176 002 0VSMODFYB PROCEDURE CODE MODFYIER 2 018 178 002 0VSMODFYC PROCEDURE CODE MODFYIER 3 018 180 002 0VSMODS SERVICE TRX MODS 018 176 006 0VSNOTE SERVICE LINE NOTE INFORMATION-FULL 018 182 088 0VSPOS LOCATION 018 043 002 0VSSN PATIENT SOCIAL SECURITY NUMBER 011 122 010 0VSTATE PATIENT STATE 011 090 002 0VSTODT DATE - TO 018 037 -4 0VSTREET PATIENT STREET ADDRESS 011 040 030 0VSTRETCHERPURPOSE OF STRETCHER 010 206 040 0VSTUDENT PATIENT STUDENT STATUS 011 449 001 0VSUBLUX LEVEL OF SUBLUXATION 011 936 015 0VSUNITS ENTRY UNITS 018 080 510 0VSYMPTOMS SAME OR SIMILAR SYMPTOMS 011 347 001 0VTCLAIM TOTAL AMOUNT CLAIMED 019 064 910 0VTDISFROM PATIENT TOTAL DISABILITY FROM DATE 011 377 -4 0VTDISTO PATIENT TOTAL DISABILITY TO DATE 011 383 -4 0VTIPAID TOTAL AMOUNT INSURANCE PAID 019 084 910 0VTOS TYPE OF SERVICE CODE 016 062 003 0VTPOS PLACE OF SERVICE 011 350 001 0VUSERID COMMUNICATIONS USER ID NUMBER 002 026 020 0VZIP PATIENT ZIP CODE 011 092 010 0W000000010SET [PASS] = '1' [PASSMAX] = ATTEMPTS + '1' SET [PASSWAIT] = '30' 0W000000020SET [RVWAIT] = '0' SET [LASTCHAR] = '_' SET [LASTBLOCK] = '_' 0W000000030[EMC] = \[EMCPATH] + [EMCNAME] + '.' + [EMCEXT] [ERN] = \[EMCPATH] + [EMCNAME] + 'A.' + [EMCEXT] [EMCM] = \[EMCPATH] + [EMCNAME] + '.$$$' 0W000000040IF REGION ? 'BILL' THEN '600' ELSE '0' [ERNM] = \[EMCPATH] + [EMCNAME] + 'A.$$$' MESSAGE: COMPRESSING_EMC_BATCH_FILE {0} 0W000000050ETSCOMPRESS [EMC] {0} SET [ERROR] = [RESULT] IF [ERROR] = 'E5' THEN '895' ELSE '0' 0W000000060IF [ERROR] = 'E4' THEN '896' ELSE '0' IF [ERROR] <> '0' THEN '897' ELSE '0' [BLANK] {0} 0W000000070MESSAGE: RESET_THE_MODEM_INTERFACE {0} [ERNM] = \[EMCPATH] + [EMCNAME] + 'A.$$$' SET [ERROR] = 'E-1' {0} 0W000000080IF BAUDRATE = '1' THEN '0' ELSE '9' GLF1 PortOpen SERPORT '300' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000090IF BAUDRATE = '2' THEN '0' ELSE '10' GLF1 PortOpen SERPORT '1200' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000100IF BAUDRATE = '3' THEN '0' ELSE '11' GLF1 PortOpen SERPORT '2400' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000110IF BAUDRATE = '4' THEN '0' ELSE '12' GLF1 PortOpen SERPORT '9600' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000120IF BAUDRATE = '5' THEN '0' ELSE '13' GLF1 PortOpen SERPORT '19200' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000130IF BAUDRATE = '6' THEN '0' ELSE '14' GLF1 PortOpen SERPORT '38400' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000140IF BAUDRATE = '7' THEN '0' ELSE '15' GLF1 PortOpen SERPORT '57600' 'N' '8' '1' SET [ERROR] = [RESULT] 0W000000150IF [ERROR] <> '0' THEN '900' ELSE '0' GLF1 HMReset {0} SLEEP 2 {0} 0W000000160GLF1 HMSetHookSwitchOn {0} SLEEP 2 {0} GLF1 WriteString 'ATE0V1X4' '-2' {0} 0W000000170MESSAGE: DIALING_EQUIFAX:_ATTEMPT_#<PASS> {0} SLEEP 2 {0} [CONDVAR3] = '1' {0} 0W000000180GLF1 WriteString MPREFIX SET [ERROR] = [RESULT] IF [ERROR] <> '0' THEN '900' ELSE '0' 0W000000190GLF1 WriteString DCPHONE SET [ERROR] = [RESULT] IF [ERROR] <> '0' THEN '900' ELSE '0' 0W000000200GLF1 WriteString MSUFFIX SET [ERROR] = [RESULT] IF [ERROR] <> '0' THEN '900' ELSE '0' 0W000000210GLF1 WriteChar [013] SET [ERROR] = [RESULT] IF [ERROR] <> '0' THEN '900' ELSE '0' 0W000000220GLF1 ClearRXBuffer GLF1 ClearTXBuffer SET [ERROR] = [RESULT] 0W000000230IF [ERROR] <> '0' THEN '900' ELSE '0' SET [ERROR] = '0' [BLANK] {0} 0W000000240SET [LASTCHAR] = '_' SET [LASTBLOCK] = '_' SLEEP 7 0W000000250GLF1 ReadChar {0} BUILD [LASTBLOCK] 20 {0} IF [LASTBLOCK] ? 'NO CARRIER' THEN '991' ELSE '0' 0W000000260IF [LASTBLOCK] ? 'NO DIAL' THEN '991' ELSE '0' IF [LASTBLOCK] ? 'ERROR' THEN '991' ELSE '0' IF [LASTBLOCK] ? 'BUSY' THEN '991' ELSE '0' 0W000000270IF [LASTBLOCK] ? 'CONNECT' THEN '28' ELSE '0' IF [LASTBLOCK] ? 'CARRIER' THEN '28' ELSE '25' [BLANK] {0} 0W000000280MESSAGE: SIGNON_TO_EQUIFAX:_ATTEMPT_#<PASS> {0} SET [LASTBLOCK] = '_' SET [RVWAIT] = '0' 0W000000290SET [LASTCHAR] = '_' {0} [CONDVAR1] = [TIME] + '30' {0} [BLANK] {0} 0W000000300GLF1 ReadChar {0} BUILD [LASTBLOCK] 20 {0} IF [TIME] > [CONDVAR1] THEN '991' ELSE '0' 0W000000310IF [LASTBLOCK] ? 'NO CARRIER' THEN '991' ELSE '0' IF [LASTBLOCK] ? 'for' THEN '32' ELSE '0' IF [LASTBLOCK] ? 'FOR' THEN '32' ELSE '30' 0W000000320GLF1 WriteString USERID {0} GLF1 WriteChar [032] {0} GLF1 HMSendString PASSWORD {0} 0W000000330GLF1 ClearRXBuffer {0} GLF1 ClearTXBuffer {0} MESSAGE: SENDING_EMC_BATCH_FILE:_ATTEMPT_#<PASS> {0} 0W000000340GLF1 XmodemSendWithOptions [EMCM] {0} SET [ERROR] = [RESULT] IF [ERROR] <> '0' THEN '900' ELSE '0' 0W000000350SLEEP 45 {0} MESSAGE: RECEIVING_EQUIFAX_ACKNOWLEDGEMENT_REPORT:_ATTEMPT_#<PASS> {0} GLF1 XmodemReceiveWithOptions [ERNM] {0} 0W000000360SET [ERROR] = [RESULT] IF [ERROR] <> '0' THEN '900' ELSE '0' [BLANK] {0} 0W000000370MESSAGE: DECOMPRESS_ACKNOWLEDGEMENT_REPORT:_ATTEMPT_#<PASS> {0} ETSDECOMPRESS [ERNM] [ERN] SET [ERROR] = [RESULT] 0W000000380IF [ERROR] <> '0' THEN '870' ELSE '0' REMOVE [ERNM] {0} REMOVE [EMCM] {45} 0W000000390SETNEXTFILE {0} IF [ERROR] <> '0' THEN '44' ELSE '0' [SUBFILE] = \[EMCPATH] + [EMCNAME] + [ADDFILE] 0W000000400MESSAGE: Search/Receive_Additional_File_ID:_<ADDFILE> {0} [BLANK] {0} SET [ERROR] = '0' {0} 0W000000410GLF1 XmodemReceiveWithOptions [SUBFILE] {0} SET [ERROR] = [RESULT] IF [ERROR] = '0' THEN '39' ELSE '0' 0W000000420REMOVE [SUBFILE] {0} SET [ERROR] = '0' {0} [BLANK] {0} 0W000000430[BLANK] {0} [BLANK] {0} [BLANK] {0} 0W000000440[BLANK] {0} MESSAGE: DISCONNECTING_FROM_EQUIFAX:_ATTEMPT_#<PASS> {0} SET [XRESULT] = '0' {0} 0W000000450SET [ERROR] = '600' {500} [BLANK] {0} [BLANK] {0} 0W000005000MESSAGE: RESET_THE_MODEM_INTERFACE {0} GLF1 WriteString '+++' {0} SLEEP 2 {0} 0W000005010GLF1 HMReset {0} SLEEP 2 GLF1 HMSetHookSwitchOn {0} 0W000005020SLEEP 2 {0} GLF1 PortClose {0} SET [RESULT] = [ERROR] 0W000006000REMOVE [EMCM] {0} REMOVE [ERNM] [BLANK] {0} 0W000006010SET [RESULT] = '-1' [BLANK] {0} [BLANK] {0} 0W000008700SET [XRESULT] = '2' {0} [BLANK] {0} [BLANK] {0} 0W000008710IF [ERROR] = 'E1' THEN '0' ELSE '872' ERROR: Decompress_Acknowledgement:_Bad_File_Name_! {0} SET [ERROR] = '600' {500} 0W000008720IF [ERROR] = 'E2' THEN '0' ELSE '873' ERROR: Decompress_Acknowledgement:_Out_of_Disk_Space_! {0} SET [ERROR] = '600' {500} 0W000008730IF [ERROR] = 'E3' THEN '0' ELSE '874' ERROR: Decompress_Acknowledgement:_Memory_Error_! {0} SET [ERROR] = '600' {500} 0W000008740IF [ERROR] = 'E4' THEN '0' ELSE '875' ERROR: Decompress_Acknowledgement:_Resubmit_Error_!? {0} SET [ERROR] = '600' {500} 0W000008750ERROR: DECOMPRESS_ACKNOWLEDGEMENT:_CORRUPT_FILE_! {0} SET [XRESULT] = '1' SET [ERROR] = '600' {500} 0W000008950ERROR: UNABLE_TO_COMPRESS_CORRUPTED_FILE_! {0} SET [XRESULT] = '2' [BLANK] {-1} 0W000008960ERROR: UNABLE_TO_FIND/OPEN_EMC_TRANSACTION_! {0} SET [XRESULT] = '2' [BLANK] {-1} 0W000008970ERROR: UNABLE_TO_COMPRESS_EMC_TRANSACTION_FILE_! {0} SET [XRESULT] = '2' [BLANK] {-1} 0W000009000IF [ERROR] = 'E-1' THEN '930' ELSE '0' IF [ERROR] = 'E-2' THEN '931' IF [ERROR] = 'E-3' THEN '932' 0W000009010IF [ERROR] = 'E-4' THEN '933' ELSE '0' IF [ERROR] = 'E-5' THEN '934' IF [ERROR] = 'E-6' THEN '935' 0W000009020IF [ERROR] = 'E-7' THEN '936' ELSE '0' IF [ERROR] = 'E-8' THEN '937' IF [ERROR] = 'E-9' THEN '938' 0W000009030IF [ERROR] = 'E-10' THEN '939' ELSE '0' IF [ERROR] = 'E-11' THEN '940' IF [ERROR] = 'E-12' THEN '941' 0W000009040IF [ERROR] = 'E-13' THEN '942' ELSE '0' IF [ERROR] = 'E-14' THEN '943' IF [ERROR] = 'E-15' THEN '944' 0W000009050IF [ERROR] = 'E-16' THEN '945' ELSE '0' IF [ERROR] = 'E-17' THEN '946' IF [ERROR] = 'E-18' THEN '947' 0W000009060IF [ERROR] = 'E-19' THEN '948' ELSE '0' IF [ERROR] = 'E-20' THEN '949' IF [ERROR] = 'E-21' THEN '950' 0W000009070IF [ERROR] = 'E-22' THEN '951' ELSE '0' IF [ERROR] = 'E-23' THEN '952' IF [ERROR] = 'E-24' THEN '953' 0W000009080IF [ERROR] = 'E-25' THEN '954' ELSE '0' IF [ERROR] = 'E-26' THEN '955' IF [ERROR] = 'E-27' THEN '956' 0W000009090IF [ERROR] = 'E-28' THEN '957' ELSE '0' IF [ERROR] = 'E-29' THEN '958' IF [ERROR] = 'E-30' THEN '959' 0W000009100IF [ERROR] = 'E-31' THEN '960' ELSE '0' IF [ERROR] = 'E-32' THEN '961' IF [ERROR] = 'E-33' THEN '962' 0W000009110IF [ERROR] = 'E-34' THEN '963' ELSE '0' IF [ERROR] = 'E-35' THEN '964' IF [ERROR] = 'E-36' THEN '965' 0W000009120IF [ERROR] = 'E-37' THEN '966' ELSE '0' IF [ERROR] = 'E-38' THEN '967' IF [ERROR] = 'E-39' THEN '968' 0W000009130IF [ERROR] = 'E-40' THEN '969' ELSE '0' IF [ERROR] = 'E-601' THEN '970' IF [ERROR] = 'E-602' THEN'971' 0W000009140IF [ERROR] = 'E-603' THEN '972' ELSE '0' IF [ERROR] = 'E-604' THEN '973' IF [ERROR] = 'E-605' THEN '974' 0W000009150IF [ERROR] = 'E-606' THEN '975' ELSE '0' IF [ERROR] = 'E-607' THEN '976' IF [ERROR] = 'E-608' THEN '977' 0W000009160IF [ERROR] = 'E-609' THEN '978' ELSE '0' IF [ERROR] = 'E-610' THEN '979' IF [ERROR] = 'E-611' THEN '980' 0W000009170IF [ERROR] = 'E-612' THEN '981' ELSE '0' IF [ERROR] = 'E-613' THEN '982' IF [ERROR] = 'E-614' THEN '983' 0W000009180IF [ERROR] = 'E-615' THEN '984' ELSE '0' IF [ERROR] = 'E-616' THEN '985' IF [ERROR] = 'E-617' THEN '986' 0W000009190IF [ERROR] = 'E-618' THEN '987' ELSE '0' IF [ERROR] = 'E-619' THEN '988' SET [RESULT] = '969' 0W000009300ERROR: Cannot_Access_Modem:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009310ERROR: Cannot_Access_COM_Port:_<SERPORT> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009320ERROR: COM_Port_In_Use:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009330ERROR: Invalid_TX/RV_Buffer_Size:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009340ERROR: Not_Enough_Memory_To_Continue:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009350ERROR: Modem_Interface_Not_Setup:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009360ERROR: Invalid_Comm_Parity:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009370ERROR: TX/RV_Buffer_Empty_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009380ERROR: TX/RV_Buffer_Full_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009390ERROR: Time_Out_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009400ERROR: RTS/CTS_Handshaking_Not_Available:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009410ERROR: RD/CD_Handshaking_Not_Available:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009420ERROR: DSR/CSR_Handshaking_Not_Available:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009430ERROR: No_8250_Available_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009440ERROR: XM_Status_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009450ERROR: User_Abandoned_Communication:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009460ERROR: File_Access_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009470ERROR: XM_General_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009480ERROR: No_Wide_Track_TX/RV_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009490ERROR: Modem_Conflict_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009500ERROR: Not_Able_to_Establish_CRC_Mode:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009510ERROR: Cannot_Initialize_Modem:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009520ERROR: Modem_Not_Responding:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009530ERROR: Modem_Not_Supported:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009540ERROR: Invalid_Baud_Rate:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009550ERROR: Invalid_Parity:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009560ERROR: Invalid_Word_Length:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009570ERROR: Invalid_Stop_Bits:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009580ERROR: No_Copy_Right_Notice:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009590ERROR: Driver_Not_Installed:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009600ERROR: Memory_Overflow:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009610ERROR: Connection_Failed:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009620ERROR: DOS_Extender_Error:_<ERROR>{0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009630ERROR: Illegal_Board_Number:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009640ERROR: Multiport_Board_In_Use:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009650ERROR: Handshake_Is_Blocked:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009660ERROR: Invalid_Comm_Port:_<SERPORT> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009670ERROR: Illegal_IRQ_Established:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009680ERROR: Required_IRQ_Under_Exclusive_Use:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009690ERROR: Unable_to_access_Modem:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009700ERROR: Failed_To_Alocate_Comm_Buffer:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009710ERROR: Couldn't_Open_Transfer_File:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009720ERROR: Buffer_Full,_Can't_Send_NAK:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009730ERROR: Buffer_Full,_Can't_Send_ACK:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009740ERROR: User_Hit_The_Abort_Key:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009750ERROR: Remote_End_Hit_The_Abort_Key:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009760ERROR: Failure_During_File_I/O:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009770ERROR: Timed_Out_Waiting_For_Packet:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009780ERROR: Got_An_Invalid_Packet_Size:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009790ERROR: Got_Too_Many_Errors_To_Go_On:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009800ERROR: Internal_Logic_Failure:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009810ERROR: Error_Transmitting_Buffer:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009820ERROR: Buffer_Full,_Can't_Send_EOT:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009830ERROR: Protocol_Transmit_Error:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009840ERROR: Error_Transmitting_A_Character:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009850ERROR: Error_Receiving_A_Character:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009860ERROR: ASCII_Transfer_Time_Out:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009870ERROR: Carrier_Lost_During_Transfer:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009880ERROR: No_Files_Sent:_<ERROR> {0} SET [XRESULT] = '2' SET [ERROR] = '600'{500} 0W000009910SET [RVWAIT] = '0' {0} [PASS] = [PASS] + '1' IF [PASS] = [PASSMAX] THEN '998' 0W000009920SET [ERROR] = '4' {500} [BLANK] {0} [BLANK] {0} 0W000009980ERROR: Unable_to_establish_connection_with_carrier_! {0} SET [XRESULT] = '2' SET [ERROR] = '600' {500} 0Y000000010OK FOR REPEATING NOTES \EMCRIND ? '>>>' AND !EMCNT4 <> '0' AND \REGION <> 'CHIRO' 0Y000000020FACILITY EXISTS !FACILITY <> '0' OR DATECON <> '0' OR DATEWORK <> '0' 0Y000000030INSURED IS NOT PATIENT INS1REL <> '1' 0Y000000040CHIRO CERT RECORD REQUIRED \PRTYPE ? 'C' OR REGION ? 'CHIRO' 0Y000000050SERVICE LINE HAS A NOTE !SNOTE <> '0' 0Y000000060OK FOR ETS NOTES IF EXIST @0404100 = '0' AND !EMCNT1 <> '0' AND \EMCRIND <> '>>>' AND \REGION <> 'CHIRO' OR @0404100 = '0' AND !EMCJC15 <> '0' AND \EMCRIND <> '>>>' AND \REGION ? 'CHIRO' 0Y000000070RECORD NOT USED IN NSF '1' = '0' 0Y000000080BATCH TYPE INDICATOR IF \PRTYPE ? 'C' OR \REGION ? 'CHIRO' THEN 'CH1' 0Y000000090DATE OF DEATH IF \DEATH ? 'D' AND \REGION <> 'DENT ' THEN TDISFROM 0Y000000100SECONDARY INSURANCE EXISTS CSINO <> '0' 0Y000000110SEC. INS. EXISTS/PAT NOT INSD CSINO <> '0' AND INS1REL <> '1' 0Y000000120DOCUMENTATION INDICATOR IF \EMCIND ? '@A' THEN 'A' 0Y000000130DOCUMENTATION INDICATOR IF \EMCIND ? '@B' THEN 'B' 0Y000000140DOCUMENTATION INDICATOR IF \EMCIND ? '@D' THEN 'D' 0Y000000150DOCUMENTATION INDICATOR IF \EMCIND ? '@P' THEN 'P' 0Y000000160DOCUMENTATION INDICATOR IF \EMCIND ? '@R' THEN 'R' 0Y000000170NARRATIVE INFORMATION IF \EMCIND ? '@' THEN EMCNT2 0Y000000180EMPLOYMENT STATUS 1 IF \PIEMPLSTS = 'R' THEN 'N' 0Y000000190EMPLOYMENT STATUS 2 IF \PIEMPLSTS = 'U' THEN ' ' 0Y000000200PATIENT RELATION TO INSURED 2 IF INS1REL = '2' THEN '02' 0Y000000210PATIENT RELATION TO INSURED 3 IF INS1REL = '3' THEN '03' 0Y000000220PATIENT RELATION TO INSURED 4 IF INS1REL = '4' THEN '09' 0Y000000230STUDENT STATUS IF \STUDENT = 'U' THEN ' ' 0Y000000240EMPLOYMENT STATUS 1 IF \EMPLSTS = 'R' THEN 'N' 0Y000000250EMPLOYMENT STATUS 2 IF \EMPLSTS = 'U' THEN ' ' 0Y000000260HMO/PPO/CHAMPUS INDICATOR IF \ITYPE = 'H' THEN 'H' 0Y000000270HMO/PPO/CHAMPUS INDICATOR IF \ITYPE = 'P' THEN 'P' 0Y000000280HMO/PPO/CHAMPUS INDICATOR IF \ITYPE = 'C' THEN 'E' 0Y000000290DEATH INDICATOR IF \DEATH ? 'D' THEN 'D' 0Y000000300LEGAL REPRESENTATIVE IND. IF INS1REL = '3' THEN 'Y' 0Y000000310STUDENT STATUS IF \STUDENT = 'N' THEN ' ' 0Y000000320HMO/PPO/CHAMPUS INDICATOR IF \OTYPE = 'H' THEN 'H' 0Y000000330HMO/PPO/CHAMPUS INDICATOR IF \OTYPE = 'P' THEN 'P' 0Y000000340HMO/PPO/CHAMPUS INDICATOR IF \OTYPE = 'C' THEN 'E' 0Y000000350GC0: LAST X-RAY (JC) IF \REGION ? 'CHIRO' AND \EMCJC1 ? 'LX:' THEN EMCJC2 0Y000000360ACCIDENT INDICATOR IF \RELTOACC = 'Y' THEN 'O' 0Y000000370SYMPTOM INDICATOR IF \INJURY = 'A' THEN ' ' 0Y000000380SYMPTOM INDICATOR IF \INJURY = 'I' AND DATEINJ <> '0' THEN '1' 0Y000000390SYMPTOM INDICATOR IF \INJURY = 'L' AND DATEINJ <> '0' THEN '2' 0Y000000400DISABILITY TYPE - PERMANANT IF TDISFROM <> '0' AND \REGION <> 'DENT ' THEN 'T' 0Y000000410DISABILITY TYPE - SHORT TERM IF PDISFROM <> '0' AND \REGION <> 'DENT ' THEN 'P' 0Y000000420DISABILITY FROM DATE IF PDISFROM <> '0' AND \REGION <> 'DENT ' THEN PDISFROM 0Y000000430DISABILITY TO DATE IF PDISFROM <> '0' AND \REGION <> 'DENT ' THEN PDISTO 0Y000000440GC0: CURRENT VISIT (JC) IF \REGION ? 'CHIRO' AND \EMCJC3 ? 'CV:' THEN EMCJC4 0Y000000450OTHER INSURANCE INDICATOR IF CSINO <> '0' THEN '1' 0Y000000460CLAIM EDITING INDICATOR 1 IF \RCVTYP = 'M' THEN 'C' 0Y000000470CLAIM EDITING INDICATOR 2 IF \RCVTYP = 'A' THEN 'D' 0Y000000480CLAIM EDITING INDICATOR 3 IF \RCVTYP = 'C' THEN 'H' 0Y000000490CLAIM EDITING INDICATOR 4 IF \RCVTYP = 'V' THEN 'H' 0Y000000500CLAIM EDITING INDICATOR 5 IF \RCVTYP = 'G' THEN 'F' 0Y000000510CLAIM EDITING INDICATOR 6 IF \RCVTYP = 'F' THEN 'E' 0Y000000520CLAIM EDITING INDICATOR 7 IF \RCVTYP = 'O' THEN 'Z' 0Y000000530CLAIM EDITING INDICATOR 8 IF \RCVTYP = 'B' THEN 'G' 0Y000000540TYPE OF CLAIM INDICATOR IF PRTYPE = '2' THEN 'C' 0Y000000550INSURANCE TYPE CODE SUPPLE IF CSINO <> '0' THEN 'SP' 0Y000000560INSURANCE TYPE CODE MEDIGAP IF \COCI = 'Y' THEN 'MG' 0Y000000570PATIENT ID/MEDICARE NUMBER IF \ITYPE = 'M' THEN PRIPOL 0Y000000580GC0: AUTHORIZED VISITS (JC) IF \REGION ? 'CHIRO' AND \EMCJC5 ? 'AV:' THEN EMCJC6 0Y000000590GC0: SUBLUXATION (JC) IF \REGION ? 'CHIRO' AND \EMCJC7 ? 'LS:' THEN EMCJC8 0Y000000600GC0: NATURE OF CONDITION (JC) IF \REGION ? 'CHIRO' AND \EMCJC9 ? 'NC:' THEN EMCJC10 0Y000000610GC0: DATE OF ACUTE MNFST (JC) IF \REGION ? 'CHIRO' AND \EMCJC9 ? 'NC:' THEN EMCJC11 0Y000000620ZERO PAYMENT INDICATOR IF TIPAID > '0' THEN 'N' 0Y000000630ACCIDENT INDICATOR IF \RELTOACC = ' ' THEN 'N' 0Y000000640SIMILAR SYMPTOMS INDICATOR IF \REGION <> 'DENT ' AND !SYMPTOMS > '0' THEN SYMPTOMS 0Y000000650PAYOR OFFICE NUMBER IF !IEMCSID = '0' THEN IEMCPN 0Y000000660PAYOR OFFICE NUMBER IF !OEMCSID = '0' THEN OEMCPN 0Y000000670NARRATIVE INFORMATION IF \EMCIND ? '@' THEN EMCNT3 0Y000000680NARRATIVE INFORMATION IF \EMCIND <> '@' AND \EMCRIND ? '>>>' THEN EMCNT4 0Y000000690NARRATIVE INFORMATION IF \EMCIND ? '@' AND \EMCRIND ? '>>>' THEN EMCNT3 0Y000000700GC0: SYMPTOMS DESC (JC) IF \REGION ? 'CHIRO' AND \EMCJC12 ? 'SD:' THEN EMCJC13 0Y000000710GC0: X-RAY STMNT IND (JC) IF \REGION ? 'CHIRO' AND \EMCJC14 ? 'SI:' THEN EMCJC15 0Y000000720GC0 15.0: X-RAY STMNT IND IF \LOCALA1 ? 'SI:' AND \REGION <> 'DENT ' THEN LOCALA2 0Y000000730TOS OF SERVICE CODE IF \TOS <> [BLANK1] THEN TOS 0Y000000740ASSIGMENT INDICATOR IF !ACCEPTA1 <> '0' THEN ACCEPTA1 0Y000000750MEDICAID NUMBER: PRIMARY IF !PRIGRP = '0' THEN PIPRIGRP 0Y000000760MEDICAID NUMBER:SECONDARY IF !SECGRP = '0' THEN PISECGRP 0Y000000770MEDICAID NUMBER: PRIMARY IF !PRIPOL = '0' THEN PIPRIPOL 0Y000000780MEDICAID NUMBER:SECONDARY IF !SECPOL = '0' THEN PISECPOL 0Y000000790PROCEDURE CODE SET 2 IF ICODETYPE = '2' THEN CODEB 0Y000000800PROCEDURE CODE SET 3 IF ICODETYPE = '3' THEN CODEC 0Y000000810FA0 04.0: TYPE OF SERVICE IF !TOS = '1' THEN TOS 0Y000000820FA0 04.0: TYPE OF SERVICE IF !TOS <> '1' THEN 'U' 0Y000000830FA0 29.0: UNIQUE TOS E IF !TOS <> '1' THEN TOS 0Y000000840DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'M' THEN '04' 0Y000000850DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'A' THEN '02' 0Y000000860DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'C' THEN '08' 0Y000000870DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'V' THEN '08' 0Y000000880DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'G' THEN '01' 0Y000000890DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'F' THEN '01' 0Y000000900DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'O' THEN '01' 0Y000000910DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'B' THEN '16' 0Y000000920DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'W' THEN '09' 0Y000000930DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'H' THEN '01' 0Y000000940DA0 05.0: DEF. ETS REC CODE IF !IEMC = '0' AND \ITYPE ? 'P' THEN '01' 0Y000000950DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'M' THEN '04' 0Y000000960DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'A' THEN '02' 0Y000000970DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'C' THEN '08' 0Y000000980DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'V' THEN '08' 0Y000000990DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'G' THEN '01' 0Y000001000DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'F' THEN '01' 0Y000001010DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'O' THEN '01' 0Y000001020DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'B' THEN '16' 0Y000001030DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'W' THEN '09' 0Y000001040DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'H' THEN '01' 0Y000001050DA0 05.1: DEF. ETS REC CODE IF !OEMC = '0' AND \OTYPE ? 'P' THEN '01' 0Y000001060FA0 27.0: ADMIT PHY IND. IF HOSPFROM <> '0' AND \REGION <> 'DENT ' THEN 'Y' 0Y000001070HA0: ADD CHIRO NARR (JC) IF \REGION ? 'CHIRO' AND \EMCJC12 ? 'SD:' THEN EMCJC16 0Y000001080DA1 10.0: CHAMPUS BRANCH IF \REGION <> 'DENT ' THEN CHBRANCH 0Y000001090DA1 11.0: CHAMPUS GRADE IF \REGION <> 'DENT ' THEN CHSGRD 0Y000001100DA1 12.0: CHAMPUS STATUS IF \REGION <> 'DENT ' THEN CHSSTAT 0Y000001110DA1 13.0: CHAMPUS EFFECTIVE IF \REGION <> 'DENT ' THEN CHCEFF 0Y000001120DA1 14.0: CHAMPUS TERMINATION IF \REGION <> 'DENT ' THEN CHCTERM 0Y000001130EA0 13.0: SAME/SIMILAR IND IF \REGION ? 'DENT' AND !PSYMP > '0' THEN PSYMP 0Y000001140EA0 14.0: SYMPTOM DATE IF \REGION <> 'DENT ' AND DATESYMP > '0' THEN DATESYMP 0Y000001150EA0 14.0: SYMPTOM DATE IF \REGION ? 'DENT' AND PDATESS > '0' THEN PDATESS 0Y000001160EA0 08.0: EXT CAUSE OF ACC IF \REGION <> 'DENT ' THEN NATURE 0Y000001170EA0 24.0: HOSP ADMIT IF \REGION ? 'DENT' THEN PHOSPF 0Y000001180EA0 24.0: HOSP ADMIT IF \REGION <> 'DENT ' THEN HOSPFROM 0Y000001190EA0 25.0: HOSP DISCHARGE IF \REGION ? 'DENT' THEN PHOSPT 0Y000001200EA0 25.0: HOSP DISCHARGE IF \REGION <> 'DENT ' THEN HOSPTO 0Y000001210EA0 26.0: LAB WORK IND IF \REGION ? 'DENT' AND !PLAB > '0' THEN PLAB 0Y000001220EA0 26.0: LAB WORK IND IF \REGION <> 'DENT ' AND !LABWORK > '0' THEN LABWORK 0Y000001230EA0 27.0: LAB CHARGES IF \REGION ? 'DENT' THEN PLABC 0Y000001240EA0 27.0: LAB CHARGES IF \REGION <> 'DENT ' THEN LABCHARGE 0Y000001250EA0 36.0: SPECIAL PROGRAM IF \REGION <> 'DENT ' THEN CHPHAN 0Y000001260EA0 37.0: NON AVAILABILITY IF \REGION <> 'DENT ' THEN CHNONA 0Y000001270EA0 39.0: RESUB CODE IF \REGION ? 'DENT' THEN PMAIDR 0Y000001280EA0 39.0: RESUB CODE IF \REGION <> 'DENT ' THEN MAIDCODE 0Y000001290EA0 40.0: RESUB REF IF \REGION ? 'DENT' THEN PMAIDO 0Y000001300EA0 40.0: RESUB REF IF \REGION <> 'DENT ' THEN MAIDORG 0Y000001310EA0 41.0: RETURN TO WORK IF \REGION ? 'DENT' THEN PRETW 0Y000001320EA0 41.0: RETURN TO WORK IF \REGION <> 'DENT ' THEN DATEWORK 0Y000001330FB0 REC REQ \REGION <> 'DENT ' 0Y000001340FA0 07.0: PLACE OF SERVICE IF \REGION ? 'DENT ' AND \TPOS ? 'H' THEN '22' 0Y000001350FA0 10.0: MOD 1 IF !SMODS = '0' AND ICODETYPE = '1' AND !MODA > '0' THEN MODA 0Y000001360FA0 10.0: MOD 1 IF !SMODS = '0' AND ICODETYPE = '2' AND !MODB > '0' THEN MODB 0Y000001370FA0 10.0: MOD 1 IF !SMODS = '0' AND ICODETYPE = '3' AND !MODC > '0' THEN MODC 0Y000001380FA0 11.0: MOD 2 IF !SMODS = '0' AND ICODETYPE = '1' AND !MODA > '2' THEN MODA 0Y000001390FA0 11.0: MOD 2 IF !SMODS = '0' AND ICODETYPE = '2' AND !MODB > '2' THEN MODB 0Y000001400FA0 11.0: MOD 2 IF !SMODS = '0' AND ICODETYPE = '3' AND !MODC > '2' THEN MODC 0Y000001410GA0 REC REQ \GA0NOTES ? 'GA0' 0Y000001420FA0 07.0: PLACE OF SERVICE IF \REGION ? 'DENT ' AND \TPOS ? 'E' THEN '24' 0Y000001430FA0 07.0: PLACE OF SERVICE IF \REGION ? 'DENT ' AND \TPOS ? 'O' THEN '11' 0Y000001440FA0 07.0: PLACE OF SERVICE IF \REGION ? 'DENT ' AND \TPOS ? 'T' THEN '99' 0Y000001450FA0 07.0: PLACE OF SERVICE IF \REGION ? 'DENT ' AND !TPOS = '0' THEN '11' 0Y000001460GC0 11.0: NATURE OF CONDITION IF \LOCALB1 ? 'CH:' THEN LOCALB2 0Y000001470FA0 22.0: MAMMOGRAPHY CERT NO IF \LOCALA1 ? 'MC:' THEN LOCALA3 0ZBA0 01.00RECORD ID "BA0" 1003 0[FIXED] 'BA0' 0ZBA0 02.00FILLER 1015 0[FIXED] [BLANK15] 0ZBA0 03.00BATCH TYPE 1003 0 '100' 0ZBA0 03.01008 0ZBA0 04.00FILLER 1006 9[FIXED] [BLANK4] '1' '1' '1' 0ZBA0 05.00BATCH IDENTIFICATION 1004 9 [PROV] 0ZBA0 06.00PROVIDER TAX ID 1009 0PSSN 0ZBA0 07.00FILLER 1280 0[FIXED] [BLANK280] 0ZCA0 01.00RECORD ID "CA0" 1003 0[FIXED] 'CA0' 0ZCA0 02.00FILLER 1002 0[FIXED] [BLANK2] 0ZCA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZCA0 04.00PATIENT LAST NAME 1020 0LAST 0ZCA0 05.00PATIENT NFRST NAME 1012 0NFRST 0ZCA0 06.00PATIENT MIDDLE INITIAL 1001 0MIDDLE 0ZCA0 07.00FILLER 1003 [FIXED] [BLANK3] 0ZCA0 08.00PATIENT DATE OF BIRTH 1008 6BDAY 0ZCA0 09.00PATIENT SEX CODE 1001 0SEX 0ZCA0 10.00FILLER 1001 0[FIXED] [BLANK1] 0ZCA0 11.00PATIENT ADDRESS 1 1030 0STREET 0ZCA0 12.00FILLER 1030 0[FIXED] [BLANK30] 0ZCA0 13.00PATIENT CITY 1020 0CITY 0ZCA0 14.00PATIENT STATE 1002 0STATE 0ZCA0 15.00PATIENT ZIP CODE 1009 0ZIP 0ZCA0 16.00PATIENT TELEPHONE NUMBER 1010 0PHONE 0ZCA0 17.00PATIENT MARITAL STATUS 1001 0MARITAL 0ZCA0 18.00PATIENT STUDENT STATUS 1001 0STUDENT 0ZCA0 18.01023031 0ZCA0 19.00PATIENT EMPLOYMENT STATUS 1001 0EMPLSTS 0ZCA0 19.01024025 0ZCA0 20.00PATIENT DEATH INDICATOR 1001 'N' 0ZCA0 20.01029 0ZCA0 21.00PATIENT DATE OF DEATH 1008 6 [BLANK8] 0ZCA0 21.01009 0ZCA0 22.00FILLER 1125 0[FIXED] [BLANK125] 0ZCA0 23.00CLAIM NUMBER FOR ETS 1005 DSCLAIM 0ZCA0 24.00FILLER-ETS 1009 0[FIXED] [BLANK9] 0ZDA0 01.00RECORD ID "DA0" 1003 0[FIXED] 'DA0' 0ZDA0 02.00SEQUENCE NUMBER 1002 0[FIXED] '01' 0ZDA0 02.10SEQUENCE NUMBER -SECONDARY 1002 0[FIXED] '02' 0ZDA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZDA0 04.00FILLER 1002 0[FIXED] [BLANK2] 0ZDA0 05.00ETS RECORD CODE 1002 0IEMC 0ZDA0 05.01084085086087088089090091092093 0ZDA0 05.10ETS RECORD CODE -SECONDARY 1002 0OEMC 0ZDA0 05.11094095096097098099100101102103 0ZDA0 06.00PAYOR CLAIM OFFICE NUMBER -P 1009 0IEMCSID 0ZDA0 06.01065 0ZDA0 06.10PAYOR CLAIM OFFICE NUMBER -S 1009 0OEMCSID 0ZDA0 06.11066 0ZDA0 07.00PAYOR NAME 1033 0INAME 0ZDA0 07.10PAYOR NAME -SECONDARY 1033 0ONAME 0ZDA0 08.00GROUP NUMBER 1020 0PRIGRP 0ZDA0 08.01075 0ZDA0 08.10GROUP NUMBER -SECONDARY 1020 0SECGRP 0ZDA0 08.11076 0ZDA0 09.00GROUP NAME 1033 0IPLAN 0ZDA0 09.10GROUP NAME -SECONDARY 1033 0OPLAN 0ZDA0 10.00HMO/PPO/PARTNERSHIP INDICATOR 1001 0 [BLANK1] 0ZDA0 10.01026027028 0ZDA0 10.10HMO/PPO/PARTNERSHIP INDICATOR 1001 0 [BLANK1] 0ZDA0 10.11032033034 0ZDA0 11.00PPO IDENTIFICATION 1015 0IEMCID 0ZDA0 12.00PRIOR AUTHORIZATION NUMBER 1015 0PRIORAUTH 0ZDA0 13.00PATIENT SIGNATURE INDICATOR 1001 0SIG 0ZDA0 14.00FILLER 1001 0[FIXED] [BLANK1] 0ZDA0 15.00PATIENT RELATION TO INSURED 1002 0 '01' 0ZDA0 15.01020021022 0ZDA0 16.00PRIMARY INSURANCE POLICY NO. 1025 0PRIPOL 0ZDA0 16.01077 0ZDA0 16.10SECONDARY INS. POLICY NUMBER 1025 0SECPOL 0ZDA0 16.11078 0ZDA0 17.00INSURED LAST NAME 1020 0PILAST 0ZDA0 18.00INSURED NFRST NAME 1012 0PINFRST 0ZDA0 19.00INSURED MIDDLE INITIAL 1001 0PIMIDDLE 0ZDA0 20.00FILLER 1003 0[FIXED] [BLANK3] 0ZDA0 21.00INSURED SEX 1001 0PISEX 0ZDA0 22.00INSURED DATE OF BIRTH 1008 6PIBDAY 0ZDA0 23.00INSURED EMPLOYMENT STATUS CODE1001 0PIEMPLSTS 0ZDA0 23.01018019 0ZDA0 24.00FILLER 1093 0[FIXED] [BLANK93] 0ZDA1 01.00RECORD ID "DA1" 1003 0[FIXED] 'DA1' 0ZDA1 02.00SEQUENCE NUMBER -PRIMARY 1002 0[FIXED] '01' 0ZDA1 02.10SEQUENCE NUMBER -SECONDARY 1002 0[FIXED] '02' 0ZDA1 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZDA1 04.00PAYOR STREET ADDRESS 1 1030 0ISTREET 0ZDA1 04.10PAYOR STREET ADDRESS 1 -SEC 1030 0OSTREET 0ZDA1 05.00PAYOR STREET ADDRESS 2 1030 0ISTREET2 0ZDA1 05.10PAYOR STREET ADDRESS 2 -SEC 1030 0OSTREET2 0ZDA1 06.00PAYOR CITY 1020 0ICITY 0ZDA1 06.10PAYOR CITY -SEC 1020 0OCITY 0ZDA1 07.00PAYOR STATE 1002 0ISTATE 0ZDA1 07.10PAYOR STATE -SEC 1002 0OSTATE 0ZDA1 08.00PAYOR ZIP CODE 1009 0IZIP 0ZDA1 08.10PAYOR ZIP CODE -SEC 1009 0OZIP 0ZDA1 09.00FILLER 1049 0[FIXED] [BLANK49] '0' '0' '9999999' '0' '9999999' 0ZDA1 10.00CHAMPUS SPONSOR BRANCH 1001 0 [BLANK1] 0ZDA1 10.01108 0ZDA1 11.00CHAMPUS SPONSOR GRADE 1002 0 [BLANK2] 0ZDA1 11.01109 0ZDA1 12.00CHAMPUS SPONSOR STATUS 1001 0 [BLANK1] 0ZDA1 12.01110 0ZDA1 13.00INSURANCE CARD EFFECTIVE DATE 1008 6 [BLANK6] 0ZDA1 13.01111 0ZDA1 14.00INSURANCE CARD TERMINATE DATE 1008 6 [CHCTERM] 0ZDA1 14.01112 0ZDA1 15.00FILLER 1138 0[FIXED] [BLANK138] 0ZDA2 01.00RECORD ID "DA2" 1003 0[FIXED] 'DA2' 0ZDA2 02.00SEQUENCE NUMBER 1002 0[FIXED] '01' 0ZDA2 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZDA2 04.00INSURED ADDRESS LINE 1 1030 0PISTREET 0ZDA2 05.00FILLER 1030 0[FIXED] [BLANK30] 0ZDA2 06.00INSURED ADDRESS CITY 1020 0PICITY 0ZDA2 07.00INSURED ADDRESS STATE 1002 0PISTATE 0ZDA2 08.00INSURED ZIP 1009 0PIZIP 0ZDA2 09.00INSURED'S TELEPHONE NUMBER 1010 0PIPHONE 0ZDA2 10.00FILLER 1016 0[FIXED] [BLANK16] 0ZDA2 11.00INSURED EMPLOYER NAME 1033 0IENAME 0ZDA2 12.00FILLER 1148 0[FIXED] [BLANK148] 0ZEA0 01.00RECORD ID "EA0" 1003 0[FIXED] 'EA0' 0ZEA0 02.00FILLER 1002 0[FIXED] [BLANK2] 0ZEA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZEA0 04.00EMPLOYMENT RELATED INDICATOR 1001 0RELTOEMPL 0ZEA0 05.00ACCIDENT INDICATOR 1001 0RELTOACC 0ZEA0 05.01036063 0ZEA0 06.00SYMPTOM INDICATOR 1001 0 [BLANK1] 0ZEA0 06.01037038039 0ZEA0 07.00ACCIDENT/SYMPTOM DATE 1008 6DATEINJ 0ZEA0 08.00EXTERNAL CAUSE OF ACCIDENT 1006 0 [BLANK6] 0ZEA0 08.01116 0ZEA0 09.00ACCIDENT STATE 1002 0ACCSTATE 0ZEA0 10.00FILLER 1003 0[FIXED] [BLANK3] 0ZEA0 11.00RELEASE OF INFORMATION IND. 1001 0SIG 0ZEA0 12.00RELEASE OF INFORMATION DATE 1008 0[FIXED] [BLANK8] 0ZEA0 13.00SAME/SIMILAR SYMPTOM INDICATOR1001 0 'N' 0ZEA0 13.01064113 0ZEA0 14.00SAME/SIMILAR SYMPTOM DATE 1008 6DATESYMP 0ZEA0 14.01114115 0ZEA0 15.00DISABILITY TYPE 1001 0 [BLANK1] 0ZEA0 15.01040041 0ZEA0 16.00DISABILITY FROM DATE 1008 6TDISFROM 0ZEA0 16.01042 0ZEA0 17.00DISABILITY TO DATE 1008 6TDISTO 0ZEA0 17.01043 0ZEA0 18.00REFERING PROVIDER ID NUMBER 1015 0RUPIN 0ZEA0 19.00FILLER 1025 0[FIXED] [BLANK25] 0ZEA0 20.00REFERRING PROVIDER LAST NAME 1020 0RLAST 0ZEA0 21.00REFERRING PROVIDER NFRST NAME 1012 0RNFRST 0ZEA0 22.00REFERRING PROVIDER MIDDLE INIT1001 0RMIDDLE 0ZEA0 23.00REFERRING PROVIDER STATE 1002 0RSTATE 0ZEA0 24.00ADMISSION DATE-1 1008 6 [BLANK6] 0ZEA0 24.01117118 0ZEA0 25.00DISCHARGE DATE-1 1008 6 [BLANK6] 0ZEA0 25.01119120 0ZEA0 26.00LABORATORY INDICATOR 1001 0 'N' 0ZEA0 26.01121122 0ZEA0 27.00LABORATORY CHARGES 1007 D [BLANK7] '0' '0' '9999999' '0' '9999999' 0ZEA0 27.01123124 '0' '0' '9999999' '0' '9999999' 0ZEA0 28.00DIAGNOSIS CODE-1 1005 0FDIAG1 0ZEA0 29.00DIAGNOSIS CODE-2 1005 0FDIAG2 0ZEA0 30.00DIAGNOSIS CODE-3 1005 0FDIAG3 0ZEA0 31.00DIAGNOSIS CODE-4 1005 0FDIAG4 0ZEA0 32.00PROVIDER ASSIGNMENT INDICATOR 1001 0 'N' 0ZEA0 32.01074 0ZEA0 33.00FILLER 1009 0[FIXED] [BLANK9] 0ZEA0 34.00FACILITY/LABORATORY NAME 1033 0FNAME 0ZEA0 35.00FILLER 1004 0[FIXED] [BLANK4] 0ZEA0 36.00SPECIAL PROGRAM INDICATOR 1002 0 [BLANK2] 0ZEA0 36.01125 0ZEA0 37.00CHAMPUS NON-AVAILABILITY IND. 1001 0 [BLANK1] 0ZEA0 37.01126 0ZEA0 38.00SUPERVISING PROVIDER INDICATOR1001 0[FIXED] [BLANK1] 0ZEA0 39.00RESUBMISSION CODE 1002 0 [BLANK2] 0ZEA0 39.01127128 0ZEA0 40.00RESUBMISSION REFERENCE NUMBER 1015 0 [BLANK15] 0ZEA0 40.01129130 0ZEA0 41.00FILLER 1054 0[FIXED] [BLANK54] 0ZEA1 01.00RECORD ID "EA1" 1003 0[FIXED] 'EA1' 0ZEA1 02.00FILLER 1002 0[FIXED] [BLANK2] 0ZEA1 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZEA1 04.00FACILITY/LABORATORY ID NUMEBR 1015 0FUPIN 0ZEA1 05.00FILLER 1015 0[FIXED] [BLANK15] 0ZEA1 06.00FACILITY/LAB STREET ADDRESS 1 1030 0FSTREET 0ZEA1 07.00FACILITY/LAB CONTACT 1030 0FCONTACT 0ZEA1 08.00FACILITY/LAB CITY 1020 0FCITY 0ZEA1 09.00FACILITY/LAB STATE 1002 0FSTATE 0ZEA1 10.00FACILITY/LAB ZIP CODE 1009 0FZIP 0ZEA1 11.00FILLER 1017 0[FIXED] [BLANK17] 0ZEA1 12.00RETURN TO WORK DATE 1008 6 [BLANK8] 0ZEA1 12.01131132 0ZEA1 13.00NFRST CONSULTED DATE 1008 6DATECON 0ZEA1 14.00FILLER 1144 0[FIXED] [BLANK144] 0ZFA0 01.00RECORD ID "FA0" 1003 0[FIXED] 'FA0' 0ZFA0 02.00SEQUENCE NUMBER 1002 9 @0401100 + '1' '1' '1' '1' 0ZFA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZFA0 04.00LINE ITEM CONTROL NUMBER 1003 9 @0401100 + '1' 0ZFA0 04.10FILLER 1014 0[FIXED] [BLANK14] 0ZFA0 05.00SERVICE FROM DATE 1008 6SFROMDT 0ZFA0 06.00SERVICE TO DATE 1008 6STODT 0ZFA0 07.00SERVICE LINE DETAIL 1002 0SPOS 0ZFA0 07.01134142143144145 0ZFA0 08.00TYPE OF SERVICE CODE 1002 0TOS 0ZFA0 08.01081082 0ZFA0 09.00HCPCS PROCEDURE CODE 1005 0SCODE 0ZFA0 09.01079080 0ZFA0 10.00HCPCS MODFYIER-1 1002 0SMODFYA 0ZFA0 10.01135136137 0ZFA0 11.00HCPCS MODFYIER-2 1002 1SMODFYB 0ZFA0 11.01138139140 0ZFA0 12.00HCPCS MODFYIER-3 1002 0SMODFYC 0ZFA0 13.00LINE CHARGES 1007 DSEXTAMT '0' '0' '9999999' '0' '9999999' 0ZFA0 14.00DIAGNOSIS CODE POINTER 1 1001 0SDIAGP1 0ZFA0 15.00DIAGNOSIS CODE POINTER 2 1001 0SDIAGP2 0ZFA0 16.00DIAGNOSIS CODE POINTER 3 1001 0SDIAGP3 0ZFA0 17.00DIAGNOSIS CODE POINTER 4 1001 0SDIAGP4 0ZFA0 18.00UNITS OF SERVICE 1004 DSUNITS '0' '0' '9999' '0' '9999' 0ZFA0 19.00ANESTHESIA/OXYGEN MINUTES 1004 DSMINUTES '0' '0' '9999' '0' '9999' 0ZFA0 20.00EMERGENCY INDICATOR 1001 0EMERG 0ZFA0 21.00FILLER 1051 0[FIXED] [BLANK51] 0ZFA0 22.00MAMMOGRAPHY CERT NO 1010 0[BLANK10] 0ZFA0 22.01147 0ZFA0 23.00FILLER 1136 0[FIXED] [BLANK136] 0ZFA0 24.00FIRST CLAIM INDICATOR 1001 0[FIXED] 'N' 0ZFA0 25.00CMN START DATE 1008 6[FIXED] [BLANK8] 0ZFA0 26.00CMN EXPIRATION DATE 1008 6[FIXED] [BLANK8] 0ZFA0 27.00ADMITTING PHYSICIAN IND. 1001 0 'N' 0ZFA0 27.01106 0ZFA0 28.00MEDICALLY UNNECESSARY TAG 1001 0[FIXED] 'N' 0ZFA0 29.00UNIQUE TYPE OF SERVICE CODE 1003 0 0ZFA0 29.01083 0ZFA0 30.00FILLER-ETS 1011 0[FIXED] [BLANK11] 0ZFB0 01.00RECORD ID "FB0" 1003 0[FIXED] 'FB0' 0ZFB0 02.00SEQUENCE NUMBER 1002 9 @0401100 '1' '1' '1' 0ZFB0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZFB0 04.00LINE ITEM CONTROL NUMBER 1003 9 @0401100 0ZFB0 04.10LINE ITEM CONTROL FILLER 1129 0[FIXED] [BLANK129] 0ZFB0 05.00EPSDT INDICATOR 1001 0EPSDT 0ZFB0 06.00FAMILY PLANNING INDICATOR 1001 0FAMPLAN 0ZFB0 07.00FILLER 1164 0[FIXED] [BLANK164] 0ZGA0 01.00RECORD ID "GA0" 1003 0[FIXED] 'GA0' 0ZGA0 02.00SEQUENCE NUMBER 1002 9 @0401100 0ZGA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0 0ZGA0 04.00LINE ITEM CONTROL NUMBER 1017 0 @0401100 0ZGA0 06.00AMBULANCE PRELIMINARY FINDINGS1018 0FINDINGS 0ZGA0 07.00ORIGIN INFORMATION 1040 0ORIGIN 0ZGA0 08.00DESTINATION INFORMATION 1040 0DESTIN 0ZGA0 09.00PURPOSE OF ROUND TRIP 1080 6PURPOSE 0ZGA0 10.00PURPOSE OF STRETCHER 1103 6STRETCHER 0ZGC0 01.00RECORD ID "GC0" 1003 0[FIXED] 'GC0' 0ZGC0 02.00SEQUENCE NUMBER 1002 9 @0401100 '1' '1' '1' 0ZGC0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZGC0 04.00LINE ITEM CONTROL NUMBER 1003 9 @0401100 0ZGC0 04.10FILLER 1014 0[FIXED] [BLANK14] 0ZGC0 05.00INITIAL TREATMENT DATE 1008 6DATECON 0ZGC0 06.00DATE OF LAST X-RAY 1008 6LASTXRAY 0ZGC0 06.01035 0ZGC0 07.00NUMBER IN SERIES 1003 9CURSVT 0ZGC0 07.01044 0ZGC0 07.10FILLER 1001 0[FIXED] [BLANK1] 0ZGC0 07.20LAST NUMBER IN SERIES 1003 9AUTHVIS 0ZGC0 07.21058 0ZGC0 08.00LEVEL OF SUBLUXATION 1007 0SUBLUX 0ZGC0 08.01059 0ZGC0 09.00TREATMENT MOS./YEARS IN SERIES1003 9AUTHVIS 0ZGC0 09.01058 0ZGC0 10.00NO. OF TREATMENTS THIS MONTH 1002 9CURSVT 0ZGC0 10.01044 0ZGC0 11.00NATURE OF CONDITION 1001 0 'A' 0ZGC0 11.01060146 0ZGC0 12.00DATE OF ACUTE MANIFESTATION 1008 6DATECON 0ZGC0 12.01061 0ZGC0 13.00COMPLICATION INDICATOR 1001 0[FIXED] [BLANK1] 0ZGC0 14.00SYMPTOMS DESCRIPTION 1235 0SUBLUX 0ZGC0 14.01070 0ZGC0 15.00X-RAY STATEMENT IND 1001 0 [BLANK1] 0ZGC0 15.01072071 0ZHA0 01.00RECORD ID "HA0" 1003 0[FIXED] 'HA0' 0ZHA0 02.00SEQUENCE NUMBER 1002 9 @0401100 '1' '1' '1' 0ZHA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZHA0 04.00DOCUMENTATION INDICATOR 1017 0 'Z' 0ZHA0 04.01012013014015016 0ZHA0 05.00EXTRA NARRATIVE DATA 1281 2EMCNT1 0ZHA0 05.01017068069107 0ZHA0 05.10EXTRA NARRATIVE DATA 1281 2EMCNT4 0ZHA0 05.11067 0ZXA0 01.00RECORD ID "XA0" 1003 0[FIXED] 'XA0' 0ZXA0 02.00RESERVED (XA0-02.0) 1002 0[FIXED] [BLANK2] 0ZXA0 03.00PATIENT CONTROL NUMBER 1017 0CHART 0ZXA0 04.00RECORD TYPE 'C??' COUNT 1002 D @0301100 '0' '0' '0' 0ZXA0 05.00RECORD TYPE 'D??' COUNT 1002 D @0302100+@0303100+@0304100+@0305100+@0306100+@0307100 '0' '0' '0' 0ZXA0 06.00RECORD TYPE 'E??' COUNT 1002 D @0308100+@0309100 '0' '0' '0' 0ZXA0 07.00RECORD TYPE 'F??' COUNT 1002 D @0401100+@0402100 '0' '0' '0' 0ZXA0 08.00RECORD TYPE 'G??' COUNT 1002 D @0403100+@0404100 '0' '0' '0' 0ZXA0 09.00RECORD TYPE 'H??' COUNT 1002 D @0405100 '0' '0' '0' 0ZXA0 10.00CLAIM RECORD COUNT 1003 D @0501104 + '1' '1' '1' '1' 0ZXA0 11.00RESERVED (XA0-11.0) 1040 0[FIXED] [BLANK40] 0ZXA0 12.00TOTAL CLAIM CHARGES 1007 DTCLAIM '0' '0' '0' 0ZXA0 13.00FILLER 1236 0[FIXED] [BLANK236] 0ZYA0 01.00RECORD ID "YA0" 1003 0[FIXED] 'YA0' 0ZYA0 02.00FILLER 1015 0[FIXED] [BLANK15] 0ZYA0 03.00BATCH TYPE 1003 0 '100' 0ZYA0 03.01008 0ZYA0 04.00FILLER 1004 9[FIXED] [BLANK4] 0ZYA0 05.00BATCH IDENTIFICATION 1006 9 [PROV] 0ZYA0 06.00PROVIDER TAX ID 1009 0PSSN 0ZYA0 07.00FILLER 1006 0[FIXED] [BLANK6] 0ZYA0 08.00BATCH SERVICE LINE COUNT 1007 D @0601103 '0' '0' '0' 0ZYA0 09.00BATCH RECORD COUNT 1007 D @0601104 + '1' '1' '1' '1' 0ZYA0 10.00BATCH CLAIM COUNT 1007 D @0601102 '0' '0' '0' 0ZYA0 11.00BATCH TOTAL CHARGES 1009 D @0501012 '0' '0' '0' 0ZYA0 12.00FILLER 1244 0[FIXED] [BLANK244]