NameDescriptionTypeAdditional 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.