Name | Description | Type | Additional information |
---|---|---|---|
Exam_ID | globally unique identifier |
None. |
|
Patient_ID | globally unique identifier |
None. |
|
PICALEFT | string |
None. |
|
PICARIGHT | string |
None. |
|
MEDICARE | boolean |
None. |
|
MEDICAID | boolean |
None. |
|
TRICARECHAMPUS | boolean |
None. |
|
CHAMPVA | boolean |
None. |
|
HEALTHPLAN | boolean |
None. |
|
FECABLCLUNG | boolean |
None. |
|
OTHER | boolean |
None. |
|
INSUREDNUMBER | string |
None. |
|
PATIENTNAME | string |
None. |
|
PATIENTBIRTHDATE | date |
None. |
|
SEXM | boolean |
None. |
|
SEXF | boolean |
None. |
|
INSUREDNAME | string |
None. |
|
PATIENTADDRESS | string |
None. |
|
RELATIONSHIPSELF | boolean |
None. |
|
RELATIONSHIPSPOUSE | boolean |
None. |
|
RELATIONSHIPCHILD | boolean |
None. |
|
RELATIONSHIPOTHER | boolean |
None. |
|
INSUREDADDRESS | string |
None. |
|
CITY | string |
None. |
|
STATE | string |
None. |
|
ZIP | string |
None. |
|
TELEPHONE | string |
None. |
|
STATUSSINGLE | boolean |
None. |
|
STATUSMARRIED | boolean |
None. |
|
STATUSOTHER | boolean |
None. |
|
STATUSEMPLOYED | boolean |
None. |
|
STATUSFULLSTUDENT | boolean |
None. |
|
STATUSPARTSTUDENT | boolean |
None. |
|
CITY2 | string |
None. |
|
STATE2 | string |
None. |
|
ZIP2 | string |
None. |
|
TELEPHONE2 | string |
None. |
|
OTHERINSUREDNAME | string |
None. |
|
CONDITIONRELATED | string |
None. |
|
INSUREDPOLICYGROUP | string |
None. |
|
OTHERINSUREDGROUP | string |
None. |
|
OTHERINSUREDDATEOFBIRTH | date |
None. |
|
OTHERSEXM | boolean |
None. |
|
OTHERSEXF | boolean |
None. |
|
EMPLNAMEORSCHOOLNAME | string |
None. |
|
PROGRAMNAME | string |
None. |
|
EMPLOYMENTYES | boolean |
None. |
|
EMPLOYMENTNO | boolean |
None. |
|
AUTOACCIDENTYES | boolean |
None. |
|
AUTOACCIDENTNOT | boolean |
None. |
|
PLACESTATE | string |
None. |
|
OTHERACCIDENTYES | boolean |
None. |
|
OTHERACCIDENTNOT | boolean |
None. |
|
OTHERINSUREDDATEOFBIRTH2 | string |
None. |
|
OTHERSEXM2 | boolean |
None. |
|
OTHERSEXF2 | boolean |
None. |
|
EMPLNAMEORSCHOOLNAME2 | string |
None. |
|
PROGRAMNAME2 | string |
None. |
|
ISBENEFITPLANYES | boolean |
None. |
|
ISBENEFITPLANNO | boolean |
None. |
|
RESERVEDLOCAL | string |
None. |
|
SIGNED1 | string |
None. |
|
DATESIGNED1 | string |
None. |
|
SIGNED2 | string |
None. |
|
DATEOFCURRENT | date |
None. |
|
FIRSTDATE | string |
None. |
|
WORKDATEFROM | date |
None. |
|
WORKDATETO | date |
None. |
|
NAMEOFREFERRING | string |
None. |
|
FIELD17ASHOT | string |
None. |
|
FIELD17ALONG | string |
None. |
|
FIELD17BNPI | string |
None. |
|
WORKDATEFROM2 | date |
None. |
|
WORKDATETO2 | date |
None. |
|
RESERVEDLOCAL2 | string |
None. |
|
OUTSIDELABYES | boolean |
None. |
|
OUTSIDELABNO | boolean |
None. |
|
CHARGESFIRST | decimal number |
None. |
|
CHARGESSECOND | decimal number |
None. |
|
MEDICAIDCODE | string |
None. |
|
MEDICAIDOROGINALNO | string |
None. |
|
PRIORNUMBER | string |
None. |
|
RELATE1 | string |
None. |
|
RELATE2 | string |
None. |
|
RELATE3 | string |
None. |
|
RELATE4 | string |
None. |
|
RELATE5 | string |
None. |
|
DATEOFSERVICEFROM1 | string |
None. |
|
DATEOFSERVICETO1 | string |
None. |
|
PLACESERVICE1 | string |
None. |
|
EMG1 | string |
None. |
|
CPTHCPCS1 | string |
None. |
|
MODIFIER1 | string |
None. |
|
DIAGNOSISPOINTER1 | string |
None. |
|
CHARGESFIRST1 | decimal number |
None. |
|
CHARGESSECOND1 | decimal number |
None. |
|
UNITS1 | string |
None. |
|
EPSDT1 | string |
None. |
|
QUAL1 | string |
None. |
|
RENDERING1 | string |
None. |
|
RENDERINGNPI1 | string |
None. |
|
DATEOFSERVICEFROM2 | string |
None. |
|
DATEOFSERVICETO2 | string |
None. |
|
PLACESERVICE2 | string |
None. |
|
EMG2 | string |
None. |
|
CPTHCPCS2 | string |
None. |
|
MODIFIER2 | string |
None. |
|
DIAGNOSISPOINTER2 | string |
None. |
|
CHARGESFIRST2 | decimal number |
None. |
|
CHARGESSECOND2 | decimal number |
None. |
|
UNITS2 | string |
None. |
|
EPSDT2 | string |
None. |
|
QUAL2 | string |
None. |
|
RENDERING2 | string |
None. |
|
RENDERINGNPI2 | string |
None. |
|
DATEOFSERVICEFROM3 | string |
None. |
|
DATEOFSERVICETO3 | string |
None. |
|
PLACESERVICE3 | string |
None. |
|
EMG3 | string |
None. |
|
CPTHCPCS3 | string |
None. |
|
MODIFIER3 | string |
None. |
|
DIAGNOSISPOINTER3 | string |
None. |
|
CHARGESFIRST3 | decimal number |
None. |
|
CHARGESSECOND3 | decimal number |
None. |
|
UNITS3 | string |
None. |
|
EPSDT3 | string |
None. |
|
QUAL3 | string |
None. |
|
RENDERING3 | string |
None. |
|
RENDERINGNPI3 | string |
None. |
|
DATEOFSERVICEFROM4 | string |
None. |
|
DATEOFSERVICETO4 | string |
None. |
|
PLACESERVICE4 | string |
None. |
|
EMG4 | string |
None. |
|
CPTHCPCS4 | string |
None. |
|
MODIFIER4 | string |
None. |
|
DIAGNOSISPOINTER4 | string |
None. |
|
CHARGESFIRST4 | decimal number |
None. |
|
CHARGESSECOND4 | decimal number |
None. |
|
UNITS4 | string |
None. |
|
EPSDT4 | string |
None. |
|
QUAL4 | string |
None. |
|
RENDERING4 | string |
None. |
|
RENDERINGNPI4 | string |
None. |
|
DATEOFSERVICEFROM5 | string |
None. |
|
DATEOFSERVICETO5 | string |
None. |
|
PLACESERVICE5 | string |
None. |
|
EMG5 | string |
None. |
|
CPTHCPCS5 | string |
None. |
|
MODIFIER5 | string |
None. |
|
DIAGNOSISPOINTER5 | string |
None. |
|
CHARGESFIRST5 | decimal number |
None. |
|
CHARGESSECOND5 | decimal number |
None. |
|
UNITS5 | string |
None. |
|
EPSDT5 | string |
None. |
|
QUAL5 | string |
None. |
|
RENDERING5 | string |
None. |
|
RENDERINGNPI5 | string |
None. |
|
DATEOFSERVICEFROM6 | string |
None. |
|
DATEOFSERVICETO6 | string |
None. |
|
PLACESERVICE6 | string |
None. |
|
EMG6 | string |
None. |
|
CPTHCPCS6 | string |
None. |
|
MODIFIER6 | string |
None. |
|
DIAGNOSISPOINTER6 | string |
None. |
|
CHARGESFIRST6 | decimal number |
None. |
|
CHARGESSECOND6 | decimal number |
None. |
|
UNITS6 | string |
None. |
|
EPSDT6 | string |
None. |
|
QUAL6 | string |
None. |
|
RENDERING6 | string |
None. |
|
RENDERINGNPI6 | string |
None. |
|
FEDERALTAXNUMBER | string |
None. |
|
SSNCHECK | boolean |
None. |
|
EINCHECK | boolean |
None. |
|
PATIENTACCOUNTNO | string |
None. |
|
ACCEPTASSIGNMENTYES | boolean |
None. |
|
ACCEPTASSIGNMENTNO | boolean |
None. |
|
TOTALCHARGEFIRST | decimal number |
None. |
|
TOTALCHARGESECOND | decimal number |
None. |
|
AMOUNTPAIDFIRST | decimal number |
None. |
|
AMOUNTPAIDSECOND | decimal number |
None. |
|
BALANCEDUEFIRST | decimal number |
None. |
|
BALANCEDUESECOND | decimal number |
None. |
|
SIGNED3 | string |
None. |
|
DATESIGNED3 | string |
None. |
|
SERVICEINFO | string |
None. |
|
SERVICEINFOA | string |
None. |
|
SERVICEINFOB | string |
None. |
|
PHONENO | string |
None. |
|
PROVIDERINFO | string |
None. |
|
PROVIDERINFOA | string |
None. |
|
PROVIDERINFOB | string |
None. |
|
CREATEDDATE | date |
None. |
|
LASTUPDATEDATE | date |
None. |
|
ElectronicSubmission | string |
None. |
|
ElectronicSubmissionStatus | string |
None. |
|
RELATE6 | string |
None. |
|
RELATE7 | string |
None. |
|
RELATE8 | string |
None. |
|
RELATE9 | string |
None. |
|
RELATE10 | string |
None. |
|
RELATE11 | string |
None. |
|
RELATE12 | string |
None. |
|
NAMEOFREFERRING2 | string |
None. |
|
IQUAL1 | string |
None. |
|
IQUAL2 | string |
None. |
|
IQUAL3 | string |
None. |
|
ICD1 | string |
None. |
|
ICD2 | string |
None. |
|
InsuranceDate | date |
None. |