MSH|^~\&|EYE CARE|RADIOLOGY|1^Recv App|2^Rev Facility|20140514024725.

244+0530|SE
CURITY NUM|ADT^A01^ADT_A01|301|P|2.6|9890|34|Continuation Pointer|ACK|AKA|US|ENG
LISH|CHR SET|6|NNEACC|BANGALORE^DIH TEAM^^23|8788|1117799
EVN|1|20140514114702.679+0530||02|opID
PID|2|12102^^^MTH^MR^PI|12101^^^VMTH^MR^PI|12103^^^ALT^PT^ID|WOUGH^MARK^Initial^
^^^^S|Mothers&Maiden&Name|19971001|M|SAM ALIAS|AFRICAN|16341 J St^Apt214^Davis^C
A^32342^USA^^^ZULU|US|^HPN^CP^^^622^6656^1234^222|^WPN^CP^^^622^2222^333^222|FRE
NCH|MARRIED|12102|PT ACC^406-03-1234|PT SSN^406-03-1234|DRV LSC|MOTHER IDENTIFIE
R|pegan|Birth Place|Y|3|Indian^East Side^H^Assam|Veterans Military Status|Nation
ality^Indian|20140511024725.244+0530|death|Unknown|Reliability Code|201405120247
25.244+0530|Good Health Hospital|L-80700^Canine|Breed Code|Strain|Production Cla
ss Code|Tribal Citizenship
NK1|33|ROE^MARIE|SPO||^WPN^PH^^^626^5551234^1234^333||EC
PV1|4|R|X RAY ROOM|R|Preadmit Number^8987|Prior Patient Location|SHEPARD^DEREK^A
ttending&Doctor|GREY judith^Referring&Doctor|Wilson Jr^Consulting&Doctor|MED|TEM
P LOCATION|PREADMIT-INDICATOR|R|2|A2|VIP|SHEPARD^DEREK^Attending&Doctor|PT TYPE|
|||||||||||||||||||||||||20110221
PV2||||||||199901101400||||||||||||||||||||||||||199901101401
AL1|1||ALPHA DRUGS||Produces PAIN
OBX|1|CE|1082^REVIEW OF SYSTEMS, CENTRAL NERVOUS SYSTEM^DCT|100mm/h^millimeter p
er hour^UCUM|||||||W||20050217204000
DG1|1||212.9^Upper respiratory tract NOS^ICD9||20091125224900|B
DRG|FEVER|20140513114701
PR1|1|^Prinivil 10mg oral CAPSULE^NDC|3427||20110106095819-0800
GT1|1|Guarantor Number|MASSIE^JAMES^""^""^""^""|Guarantor Spouse|12 NELSON^^MAND
ELA^STREET^49849^""|^PRN^FX^^^669^5551233^1234^989|^WPN^CP^^^622^9871234^1234^22
2|19950111|M|GT|SE^SELF|SSN-371-66-925|19950111|19950111|1|Guarantor Employer Na
me|171ZOBERLEIN^^ISHPEMING^MI^49849^""|^NET^INTERNET^^^10^118^254^14|Guarantor E
mployee ID Number|ES|Guarantor Organization Name|199401101400|Guarantor Credit R
ating Code|199401101400|D|G Charge Adjustment Code|10000|9|Guarantor Employer ID
Number|G Marital Status|19981007|19981208|LD|AS|MEXICAN|SPANISH|LA|Publicity Co
de|P|St|CHRISTIAN|Mother s Maiden Name SARA|BRAZILLIAN|Ethnic Group|Contact Person s
Name|^WPH^7682^1231^56|Contact Reason|CRe|JOB TITTLE|JOB CODE|SUNRISE DENTAL CL
INIC|HN|JS|Guarantor Financial Class|Guarantor RACE|G BIRTH PLACE|VIP
IN1|1|0|BC1|BLUE CROSS|171 ZOBERLEIN^^ISHPEMING^M1^49849||^PRN^bp^^^777^5551244^
4321^111|90||||||50
IN1|2