Active| Used by 0 transactions and 6 templates, Uses 8 templates | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Item | DT | Card | Conf | Description | Label |
|---|---|---|---|---|---|
| hl7v2:UB1.1 | SI | 0 … 1 | Set ID - UB1 Contains 2.16.840.1.113883.3.1937.777.10.15.88 SI - Sequence ID (DYNAMIC) | UB1_ ment | |
| @Item | 0 … 1 | F | 530 | ||
| @Type | 0 … 1 | F | SI | ||
| @LongName | 0 … 1 | F | Set ID - UB1 | ||
| hl7v2:UB1.2 | NM | 0 … 1 | Blood Deductible (43) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 531 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Blood Deductible (43) | ||
| hl7v2:UB1.3 | NM | 0 … 1 | Blood Furnished-Pints Of (40) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 532 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Blood Furnished-Pints Of (40) | ||
| hl7v2:UB1.4 | NM | 0 … 1 | Blood Replaced-Pints (41) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 533 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Blood Replaced-Pints (41) | ||
| hl7v2:UB1.5 | NM | 0 … 1 | Blood Not Replaced-Pints(42) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 534 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Blood Not Replaced-Pints(42) | ||
| hl7v2:UB1.6 | NM | 0 … 1 | Co-Insurance Days (25) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 535 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Co-Insurance Days (25) | ||
| hl7v2:UB1.7 | IS | 0 … * | Condition Code (35-39) Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 536 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70043 | ||
| @LongName | 0 … 1 | F | Condition Code (35-39) | ||
| hl7v2:UB1.8 | NM | 0 … 1 | Covered Days - (23) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 537 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Covered Days - (23) | ||
| hl7v2:UB1.9 | NM | 0 … 1 | Non Covered Days - (24) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 538 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Non Covered Days - (24) | ||
| hl7v2:UB1.10 | UVC | 0 … * | Value Amount & Code (46-49) Contains 2.16.840.1.113883.3.1937.777.10.15.66 UVC - UB value code and amount (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 539 | ||
| @Type | 0 … 1 | F | UVC | ||
| @LongName | 0 … 1 | F | Value Amount & Code (46-49) | ||
| hl7v2:UB1.11 | NM | 0 … 1 | Number Of Grace Days (90) Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 540 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Number Of Grace Days (90) | ||
| hl7v2:UB1.12 | CE | 0 … 1 | Special Program Indicator (44) Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 541 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70348 | ||
| @LongName | 0 … 1 | F | Special Program Indicator (44) | ||
| hl7v2:UB1.13 | CE | 0 … 1 | PSRO/UR Approval Indicator (87) Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 542 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70349 | ||
| @LongName | 0 … 1 | F | PSRO/UR Approval Indicator (87) | ||
| hl7v2:UB1.14 | DT | 0 … 1 | PSRO/UR Approved Stay-Fm (88) Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 543 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | PSRO/UR Approved Stay-Fm (88) | ||
| hl7v2:UB1.15 | DT | 0 … 1 | PSRO/UR Approved Stay-To (89) Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 544 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | PSRO/UR Approved Stay-To (89) | ||
| hl7v2:UB1.16 | OCD | 0 … * | Occurrence (28-32) Contains 2.16.840.1.113883.3.1937.777.10.15.40 OCD - Occurrence code and date (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 545 | ||
| @Type | 0 … 1 | F | OCD | ||
| @LongName | 0 … 1 | F | Occurrence (28-32) | ||
| hl7v2:UB1.17 | CE | 0 … 1 | Occurrence Span (33) Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 546 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70351 | ||
| @LongName | 0 … 1 | F | Occurrence Span (33) | ||
| hl7v2:UB1.18 | DT | 0 … 1 | Occur Span Start Date(33) Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 547 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Occur Span Start Date(33) | ||
| hl7v2:UB1.19 | DT | 0 … 1 | Occur Span End Date (33) Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 548 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Occur Span End Date (33) | ||
| hl7v2:UB1.20 | ST | 0 … 1 | UB-82 Locator 2 Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 549 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB-82 Locator 2 | ||
| hl7v2:UB1.21 | ST | 0 … 1 | UB-82 Locator 9 Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 550 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB-82 Locator 9 | ||
| hl7v2:UB1.22 | ST | 0 … 1 | UB-82 Locator 27 Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 551 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB-82 Locator 27 | ||
| hl7v2:UB1.23 | ST | 0 … 1 | UB-82 Locator 45 Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | UB1_ment | |
| @Item | 0 … 1 | F | 552 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | UB-82 Locator 45 | ||