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| Item | DT | Card | Conf | Description | Label |
|---|---|---|---|---|---|
| hl7v2:IN2.1 | CX | 0 … * | Insured's Employee ID Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN2_ ment | |
| @Item | 0 … 1 | F | 472 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Insured's Employee ID | ||
| hl7v2:IN2.2 | ST | 0 … 1 | Insured's Social Security Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 473 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Insured's Social Security Number | ||
| hl7v2:IN2.3 | XCN | 0 … * | Insured's Employer's Name and ID Contains 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 474 | ||
| @Type | 0 … 1 | F | XCN | ||
| @LongName | 0 … 1 | F | Insured's Employer's Name and ID | ||
| hl7v2:IN2.4 | IS | 0 … 1 | Employer Information Data Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 475 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70139 | ||
| @LongName | 0 … 1 | F | Employer Information Data | ||
| hl7v2:IN2.5 | IS | 0 … * | Mail Claim Party Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 476 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70137 | ||
| @LongName | 0 … 1 | F | Mail Claim Party | ||
| hl7v2:IN2.6 | ST | 0 … 1 | Medicare Health Ins Card Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 477 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Medicare Health Ins Card Number | ||
| hl7v2:IN2.7 | XPN | 0 … * | Medicaid Case Name Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 478 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Medicaid Case Name | ||
| hl7v2:IN2.8 | ST | 0 … 1 | Medicaid Case Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 479 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Medicaid Case Number | ||
| hl7v2:IN2.9 | XPN | 0 … * | Military Sponsor Name Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 480 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Military Sponsor Name | ||
| hl7v2:IN2.10 | ST | 0 … 1 | Military ID Number Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 481 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Military ID Number | ||
| hl7v2:IN2.11 | CE | 0 … 1 | Dependent Of Military Recipient Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 482 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70342 | ||
| @LongName | 0 … 1 | F | Dependent Of Military Recipient | ||
| hl7v2:IN2.12 | ST | 0 … 1 | Military Organization Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 483 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Military Organization | ||
| hl7v2:IN2.13 | ST | 0 … 1 | Military Station Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 484 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Military Station | ||
| hl7v2:IN2.14 | IS | 0 … 1 | Military Service Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 485 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70140 | ||
| @LongName | 0 … 1 | F | Military Service | ||
| hl7v2:IN2.15 | IS | 0 … 1 | Military Rank/Grade Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 486 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70141 | ||
| @LongName | 0 … 1 | F | Military Rank/Grade | ||
| hl7v2:IN2.16 | IS | 0 … 1 | Military Status Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 487 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70142 | ||
| @LongName | 0 … 1 | F | Military Status | ||
| hl7v2:IN2.17 | DT | 0 … 1 | Military Retire Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 488 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Military Retire Date | ||
| hl7v2:IN2.18 | ID | 0 … 1 | Military Non-Avail Cert On File Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 489 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Military Non-Avail Cert On File | ||
| hl7v2:IN2.19 | ID | 0 … 1 | Baby Coverage Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 490 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Baby Coverage | ||
| hl7v2:IN2.20 | ID | 0 … 1 | Combine Baby Bill Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 491 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Combine Baby Bill | ||
| hl7v2:IN2.21 | ST | 0 … 1 | Blood Deductible Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 492 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Blood Deductible | ||
| hl7v2:IN2.22 | XPN | 0 … * | Special Coverage Approval Name Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 493 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Special Coverage Approval Name | ||
| hl7v2:IN2.23 | ST | 0 … 1 | Special Coverage Approval Title Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 494 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Special Coverage Approval Title | ||
| hl7v2:IN2.24 | IS | 0 … * | Non-Covered Insurance Code Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 495 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70143 | ||
| @LongName | 0 … 1 | F | Non-Covered Insurance Code | ||
| hl7v2:IN2.25 | CX | 0 … * | Payor ID Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 496 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Payor ID | ||
| hl7v2:IN2.26 | CX | 0 … * | Payor Subscriber ID Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 497 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Payor Subscriber ID | ||
| hl7v2:IN2.27 | IS | 0 … 1 | Eligibility Source Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 498 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70144 | ||
| @LongName | 0 … 1 | F | Eligibility Source | ||
| hl7v2:IN2.28 | RMC | 0 … * | Room Coverage Type/Amount Contains 2.16.840.1.113883.3.1937.777.10.15.55 RMC - Room coverage (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 499 | ||
| @Type | 0 … 1 | F | RMC | ||
| @LongName | 0 … 1 | F | Room Coverage Type/Amount | ||
| hl7v2:IN2.29 | PTA | 0 … * | Policy Type/Amount Contains 2.16.840.1.113883.3.1937.777.10.15.49 PTA - Policy type and amount (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 500 | ||
| @Type | 0 … 1 | F | PTA | ||
| @LongName | 0 … 1 | F | Policy Type/Amount | ||
| hl7v2:IN2.30 | DDI | 0 … 1 | Daily Deductible Contains 2.16.840.1.113883.3.1937.777.10.15.13 DDI - Daily deductible information (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 501 | ||
| @Type | 0 … 1 | F | DDI | ||
| @LongName | 0 … 1 | F | Daily Deductible | ||
| hl7v2:IN2.31 | IS | 0 … 1 | Living Dependency Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 755 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70223 | ||
| @LongName | 0 … 1 | F | Living Dependency | ||
| hl7v2:IN2.32 | IS | 0 … * | Ambulatory Status Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 145 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70009 | ||
| @LongName | 0 … 1 | F | Ambulatory Status | ||
| hl7v2:IN2.33 | CE | 0 … * | Citizenship Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 129 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70171 | ||
| @LongName | 0 … 1 | F | Citizenship | ||
| hl7v2:IN2.34 | CE | 0 … 1 | Primary Language Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 118 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70296 | ||
| @LongName | 0 … 1 | F | Primary Language | ||
| hl7v2:IN2.35 | IS | 0 … 1 | Living Arrangement Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 742 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70220 | ||
| @LongName | 0 … 1 | F | Living Arrangement | ||
| hl7v2:IN2.36 | CE | 0 … 1 | Publicity Code Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 743 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70215 | ||
| @LongName | 0 … 1 | F | Publicity Code | ||
| hl7v2:IN2.37 | ID | 0 … 1 | Protection Indicator Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 744 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Protection Indicator | ||
| hl7v2:IN2.38 | IS | 0 … 1 | Student Indicator Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 745 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70231 | ||
| @LongName | 0 … 1 | F | Student Indicator | ||
| hl7v2:IN2.39 | CE | 0 … 1 | Religion Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 120 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70006 | ||
| @LongName | 0 … 1 | F | Religion | ||
| hl7v2:IN2.40 | XPN | 0 … * | Mother's Maiden Name Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 109 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Mother's Maiden Name | ||
| hl7v2:IN2.41 | CE | 0 … 1 | Nationality Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 739 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70212 | ||
| @LongName | 0 … 1 | F | Nationality | ||
| hl7v2:IN2.42 | CE | 0 … * | Ethnic Group Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 125 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70189 | ||
| @LongName | 0 … 1 | F | Ethnic Group | ||
| hl7v2:IN2.43 | CE | 0 … * | Marital Status Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 119 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70002 | ||
| @LongName | 0 … 1 | F | Marital Status | ||
| hl7v2:IN2.44 | DT | 0 … 1 | Insured's Employment Start Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 787 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Insured's Employment Start Date | ||
| hl7v2:IN2.45 | DT | 0 … 1 | Employment Stop Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 783 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Employment Stop Date | ||
| hl7v2:IN2.46 | ST | 0 … 1 | Job Title Contains 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 785 | ||
| @Type | 0 … 1 | F | ST | ||
| @LongName | 0 … 1 | F | Job Title | ||
| hl7v2:IN2.47 | JCC | 0 … 1 | Job Code/Class Contains 2.16.840.1.113883.3.1937.777.10.15.30 JCC - Job code/class (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 786 | ||
| @Type | 0 … 1 | F | JCC | ||
| @LongName | 0 … 1 | F | Job Code/Class | ||
| hl7v2:IN2.48 | IS | 0 … 1 | Job Status Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 752 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70311 | ||
| @LongName | 0 … 1 | F | Job Status | ||
| hl7v2:IN2.49 | XPN | 0 … * | Employer Contact Person Name Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 789 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Employer Contact Person Name | ||
| hl7v2:IN2.50 | XTN | 0 … * | Employer Contact Person Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 790 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Employer Contact Person Phone Number | ||
| hl7v2:IN2.51 | IS | 0 … 1 | Employer Contact Reason Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 791 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70222 | ||
| @LongName | 0 … 1 | F | Employer Contact Reason | ||
| hl7v2:IN2.52 | XPN | 0 … * | Insured's Contact Person's Name Contains 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 792 | ||
| @Type | 0 … 1 | F | XPN | ||
| @LongName | 0 … 1 | F | Insured's Contact Person's Name | ||
| hl7v2:IN2.53 | XTN | 0 … * | Insured's Contact Person Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 793 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Insured's Contact Person Phone Number | ||
| hl7v2:IN2.54 | IS | 0 … * | Insured's Contact Person Reason Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 794 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70222 | ||
| @LongName | 0 … 1 | F | Insured's Contact Person Reason | ||
| hl7v2:IN2.55 | DT | 0 … 1 | Relationship to the Patient Start Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 795 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Relationship to the Patient Start Date | ||
| hl7v2:IN2.56 | DT | 0 … * | Relationship to the Patient Stop Date Contains 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 796 | ||
| @Type | 0 … 1 | F | DT | ||
| @LongName | 0 … 1 | F | Relationship to the Patient Stop Date | ||
| hl7v2:IN2.57 | IS | 0 … 1 | Insurance Co. Contact Reason Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 797 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70232 | ||
| @LongName | 0 … 1 | F | Insurance Co. Contact Reason | ||
| hl7v2:IN2.58 | XTN | 0 … 1 | Insurance Co Contact Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 798 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Insurance Co Contact Phone Number | ||
| hl7v2:IN2.59 | IS | 0 … 1 | Policy Scope Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 799 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70312 | ||
| @LongName | 0 … 1 | F | Policy Scope | ||
| hl7v2:IN2.60 | IS | 0 … 1 | Policy Source Contains 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 800 | ||
| @Type | 0 … 1 | F | IS | ||
| @Table | 0 … 1 | F | HL70313 | ||
| @LongName | 0 … 1 | F | Policy Source | ||
| hl7v2:IN2.61 | CX | 0 … 1 | Patient Member Number Contains 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 801 | ||
| @Type | 0 … 1 | F | CX | ||
| @LongName | 0 … 1 | F | Patient Member Number | ||
| hl7v2:IN2.62 | CE | 0 … 1 | Guarantor's Relationship To Insured Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 802 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70063 | ||
| @LongName | 0 … 1 | F | Guarantor's Relationship To Insured | ||
| hl7v2:IN2.63 | XTN | 0 … * | Insured's Phone Number - Home Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 803 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Insured's Phone Number - Home | ||
| hl7v2:IN2.64 | XTN | 0 … * | Insured's Employer Phone Number Contains 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 804 | ||
| @Type | 0 … 1 | F | XTN | ||
| @LongName | 0 … 1 | F | Insured's Employer Phone Number | ||
| hl7v2:IN2.65 | CE | 0 … 1 | Military Handicapped Program Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 805 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70343 | ||
| @LongName | 0 … 1 | F | Military Handicapped Program | ||
| hl7v2:IN2.66 | ID | 0 … 1 | Suspend Flag Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 806 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Suspend Flag | ||
| hl7v2:IN2.67 | ID | 0 … 1 | Copay Limit Flag Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 807 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Copay Limit Flag | ||
| hl7v2:IN2.68 | ID | 0 … 1 | Stoploss Limit Flag Contains 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 808 | ||
| @Type | 0 … 1 | F | ID | ||
| @Table | 0 … 1 | F | HL70136 | ||
| @LongName | 0 … 1 | F | Stoploss Limit Flag | ||
| hl7v2:IN2.69 | XON | 0 … * | Insured Organization Name and ID Contains 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 809 | ||
| @Type | 0 … 1 | F | XON | ||
| @LongName | 0 … 1 | F | Insured Organization Name and ID | ||
| hl7v2:IN2.70 | XON | 0 … * | Insured Employer Organization Name and ID Contains 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 810 | ||
| @Type | 0 … 1 | F | XON | ||
| @LongName | 0 … 1 | F | Insured Employer Organization Name and ID | ||
| hl7v2:IN2.71 | CE | 0 … * | Race Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 113 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70005 | ||
| @LongName | 0 … 1 | F | Race | ||
| hl7v2:IN2.72 | CE | 0 … 1 | CMS Patient_s Relationship to Insured Contains 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMIC) | IN2_ment | |
| @Item | 0 … 1 | F | 811 | ||
| @Type | 0 … 1 | F | CE | ||
| @Table | 0 … 1 | F | HL70344 | ||
| @LongName | 0 … 1 | F | CMS Patient_s Relationship to Insured | ||