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| Item | DT | Card | Conf | Description | Label |
|---|---|---|---|---|---|
| hl7v2:IN1.1 | SI | 1 … 1 | Set ID - IN1 Contains 2.16.840.1.113883.3.1937.777.10.15.88 SI - Sequence ID (DYNAMIC) | IN1_ ment | |
| @Item | 0 … 1 | F | 426 | ||
| @Type | 0 … 1 | F | SI | ||
| @LongName | 0 … 1 | F | Set ID - IN1 | ||
| hl7v2:IN1.2 | CE | 1 … 1 | Insurance Plan ID Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 368 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70072 | ||
| @LongName | 0 … 1 | F | Insurance Plan ID | ||
| hl7v2:IN1.3 | CX | 1 … * | Insurance Company ID Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 428 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Insurance Company ID | ||
| hl7v2:IN1.4 | XON | 0 … * | Insurance Company Name Contains 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 429 | ||
| @Type | 0 … 1 | F | XON | ||
| @LongName | 0 … 1 | F | Insurance Company Name | ||
| hl7v2:IN1.5 | XAD | 0 … * | Insurance Company Address Contains 2.16.840.1.113883.3.1937.777.10.15.73 XAD - Extended address (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 430 | ||
| @Type | 0 … 1 | F | XAD | ||
| @LongName | 0 … 1 | F | Insurance Company Address | ||
| hl7v2:IN1.6 | XPN | 0 … * | Insurance Co Contact Person Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 431 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Insurance Co Contact Person | ||
| hl7v2:IN1.7 | XTN | 0 … * | Insurance Co Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 432 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Insurance Co Phone Number | ||
| hl7v2:IN1.8 | ST | 0 … 1 | Group Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 433 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Group Number | ||
| hl7v2:IN1.9 | XON | 0 … * | Group Name Contains 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 434 | ||
| @Type | 0 … 1 | F | XON | ||
| @LongName | 0 … 1 | F | Group Name | ||
| hl7v2:IN1.10 | CX | 0 … * | Insured's Group Emp ID Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 435 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Insured's Group Emp ID | ||
| hl7v2:IN1.11 | XON | 0 … * | Insured's Group Emp Name Contains 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 436 | ||
| @Type | 0 … 1 | F | XON | ||
| @LongName | 0 … 1 | F | Insured's Group Emp Name | ||
| hl7v2:IN1.12 | DT | 0 … 1 | Plan Effective Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 437 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Plan Effective Date | ||
| hl7v2:IN1.13 | DT | 0 … 1 | Plan Expiration Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 438 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Plan Expiration Date | ||
| hl7v2:IN1.14 | AUI | 0 … 1 | Authorization Information Contains 2.16.840.1.113883.3.1937.777.10.15.2 AUI - Authorization information (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 439 | ||
| @Type | 0 … 1 | F | AUI | ||
| @LongName | 0 … 1 | F | Authorization Information | ||
| hl7v2:IN1.15 | IS | 0 … 1 | Plan Type Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 440 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70086 | ||
| @LongName | 0 … 1 | F | Plan Type | ||
| hl7v2:IN1.16 | XPN | 0 … * | Name Of Insured Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 441 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Name Of Insured | ||
| hl7v2:IN1.17 | CE | 0 … 1 | Insured's Relationship To Patient Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 442 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70063 | ||
| @LongName | 0 … 1 | F | Insured's Relationship To Patient | ||
| hl7v2:IN1.18 | TS | 0 … 1 | Insured's Date Of Birth Contains 2.16.840.1.113883.3.1937.777.10.15.64 TS - Time stamp (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 443 | ||
| @Type | 0 … 1 | F | TS | ||
| @LongName | 0 … 1 | F | Insured's Date Of Birth | ||
| hl7v2:IN1.19 | XAD | 0 … * | Insured's Address Contains 2.16.840.1.113883.3.1937.777.10.15.73 XAD - Extended address (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 444 | ||
| @Type | 0 … 1 | F | XAD | ||
| @LongName | 0 … 1 | F | Insured's Address | ||
| hl7v2:IN1.20 | IS | 0 … 1 | Assignment Of Benefits Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 445 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70135 | ||
| @LongName | 0 … 1 | F | Assignment Of Benefits | ||
| hl7v2:IN1.21 | IS | 0 … 1 | Coordination Of Benefits Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 446 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70173 | ||
| @LongName | 0 … 1 | F | Coordination Of Benefits | ||
| hl7v2:IN1.22 | ST | 0 … 1 | Coord Of Ben. Priority Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 447 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Coord Of Ben. Priority | ||
| hl7v2:IN1.23 | ID | 0 … 1 | Notice Of Admission Flag Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 448 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Notice Of Admission Flag | ||
| hl7v2:IN1.24 | DT | 0 … 1 | Notice Of Admission Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 449 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Notice Of Admission Date | ||
| hl7v2:IN1.25 | ID | 0 … 1 | Report Of Eligibility Flag Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 450 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Report Of Eligibility Flag | ||
| hl7v2:IN1.26 | DT | 0 … 1 | Report Of Eligibility Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 451 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Report Of Eligibility Date | ||
| hl7v2:IN1.27 | IS | 0 … 1 | Release Information Code Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 452 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70093 | ||
| @LongName | 0 … 1 | F | Release Information Code | ||
| hl7v2:IN1.28 | ST | 0 … 1 | Pre-Admit Cert (PAC) Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 453 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Pre-Admit Cert (PAC) | ||
| hl7v2:IN1.29 | TS | 0 … 1 | Verification Date/Time Contains 2.16.840.1.113883.3.1937.777.10.15.64 TS - Time stamp (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 454 | ||
| @Type | 0 … 1 | F | TS | ||
| @LongName | 0 … 1 | F | Verification Date/Time | ||
| hl7v2:IN1.30 | XCN | 0 … * | Verification By Contains 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 455 | ||
| @Type | 0 … 1 | F | XCN | ||
| @LongName | 0 … 1 | F | Verification By | ||
| hl7v2:IN1.31 | IS | 0 … 1 | Type Of Agreement Code Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 456 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70098 | ||
| @LongName | 0 … 1 | F | Type Of Agreement Code | ||
| hl7v2:IN1.32 | IS | 0 … 1 | Billing Status Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 457 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70022 | ||
| @LongName | 0 … 1 | F | Billing Status | ||
| hl7v2:IN1.33 | NM | 0 … 1 | Lifetime Reserve Days Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 458 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Lifetime Reserve Days | ||
| hl7v2:IN1.34 | NM | 0 … 1 | Delay Before L.R. Day Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 459 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Delay Before L.R. Day | ||
| hl7v2:IN1.35 | IS | 0 … 1 | Company Plan Code Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 460 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70042 | ||
| @LongName | 0 … 1 | F | Company Plan Code | ||
| hl7v2:IN1.36 | ST | 0 … 1 | Policy Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 461 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Policy Number | ||
| hl7v2:IN1.37 | CP | 0 … 1 | Policy Deductible Contains 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 462 | ||
| @Type | 0 … 1 | F | CP | ||
| @LongName | 0 … 1 | F | Policy Deductible | ||
| hl7v2:IN1.38 | CP | 0 … 1 | Policy Limit - Amount Contains 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 463 | ||
| @Type | 0 … 1 | F | CP | ||
| @LongName | 0 … 1 | F | Policy Limit - Amount | ||
| hl7v2:IN1.39 | NM | 0 … 1 | Policy Limit - Days Contains 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 464 | ||
| @Type | 0 … 1 | F | NM | ||
| @LongName | 0 … 1 | F | Policy Limit - Days | ||
| hl7v2:IN1.40 | CP | 0 … 1 | Room Rate - Semi-Private Contains 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 465 | ||
| @Type | 0 … 1 | F | CP | ||
| @LongName | 0 … 1 | F | Room Rate - Semi-Private | ||
| hl7v2:IN1.41 | CP | 0 … 1 | Room Rate - Private Contains 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 466 | ||
| @Type | 0 … 1 | F | CP | ||
| @LongName | 0 … 1 | F | Room Rate - Private | ||
| hl7v2:IN1.42 | CE | 0 … 1 | Insured's Employment Status Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 467 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70066 | ||
| @LongName | 0 … 1 | F | Insured's Employment Status | ||
| hl7v2:IN1.43 | IS | 0 … 1 | Insured's Administrative Sex Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 468 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70001 | ||
| @LongName | 0 … 1 | F | Insured's Administrative Sex | ||
| hl7v2:IN1.44 | XAD | 0 … * | Insured's Employer's Address Contains 2.16.840.1.113883.3.1937.777.10.15.73 XAD - Extended address (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 469 | ||
| @Type | 0 … 1 | F | XAD | ||
| @LongName | 0 … 1 | F | Insured's Employer's Address | ||
| hl7v2:IN1.45 | ST | 0 … 1 | Verification Status Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 470 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Verification Status | ||
| hl7v2:IN1.46 | IS | 0 … 1 | Prior Insurance Plan ID Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 471 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70072 | ||
| @LongName | 0 … 1 | F | Prior Insurance Plan ID | ||
| hl7v2:IN1.47 | IS | 0 … 1 | Coverage Type Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 1227 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70309 | ||
| @LongName | 0 … 1 | F | Coverage Type | ||
| hl7v2:IN1.48 | IS | 0 … 1 | Handicap Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 753 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70295 | ||
| @LongName | 0 … 1 | F | Handicap | ||
| hl7v2:IN1.49 | CX | 0 … * | Insured's ID Number Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 1230 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Insured's ID Number | ||
| hl7v2:IN1.50 | IS | 0 … 1 | Signature Code Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 1854 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70535 | ||
| @LongName | 0 … 1 | F | Signature Code | ||
| hl7v2:IN1.51 | DT | 0 … 1 | Signature Code Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 1855 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Signature Code Date | ||
| hl7v2:IN1.52 | ST | 0 … 1 | Insured_s Birth Place Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 1899 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Insured_s Birth Place | ||
| hl7v2:IN1.53 | IS | 0 … 1 | VIP Indicator Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN1_ment | |
| @Item | 0 … 1 | F | 1852 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70099 | ||
| @LongName | 0 … 1 | F | VIP Indicator | ||