Item | DT | Card | Conf | Description | Label |
---|
hl7v2:FT1.1
| SI | 0 … 1 | | Set ID - FT1 | FT1_ment |
@Item
| | 0 … 1 | F | 355 |
@Type
| | 0 … 1 | F | SI |
@LongName
| | 0 … 1 | F | Set ID - FT1 |
hl7v2:FT1.2
| ST | 0 … 1 | | Transaction ID | FT1_ment |
@Item
| | 0 … 1 | F | 356 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Transaction ID |
hl7v2:FT1.3
| ST | 0 … 1 | | Transaction Batch ID | FT1_ment |
@Item
| | 0 … 1 | F | 357 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Transaction Batch ID |
hl7v2:FT1.4
| DR | 1 … 1 | | Transaction Date Contains 2.16.840.1.113883.3.1937.99.60.4.15.18 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 358 |
@Type
| | 0 … 1 | F | DR |
@LongName
| | 0 … 1 | F | Transaction Date |
hl7v2:FT1.5
| TS | 0 … 1 | | Transaction Posting Date Contains 2.16.840.1.113883.3.1937.99.60.4.15.64 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 359 |
@Type
| | 0 … 1 | F | TS |
@LongName
| | 0 … 1 | F | Transaction Posting Date |
hl7v2:FT1.6
| IS | 1 … 1 | | Transaction Type | FT1_ment |
@Item
| | 0 … 1 | F | 360 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70017 |
@LongName
| | 0 … 1 | F | Transaction Type |
hl7v2:FT1.7
| CE | 1 … 1 | | Transaction Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 361 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70132 |
@LongName
| | 0 … 1 | F | Transaction Code |
hl7v2:FT1.8
| ST | 0 … 1 | | Transaction Description | FT1_ment |
@Item
| | 0 … 1 | F | 362 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Transaction Description |
hl7v2:FT1.9
| ST | 0 … 1 | | Transaction Description - Alt | FT1_ment |
@Item
| | 0 … 1 | F | 363 |
@Type
| | 0 … 1 | F | ST |
@LongName
| | 0 … 1 | F | Transaction Description - Alt |
hl7v2:FT1.10
| NM | 0 … 1 | | Transaction Quantity | FT1_ment |
@Item
| | 0 … 1 | F | 364 |
@Type
| | 0 … 1 | F | NM |
@LongName
| | 0 … 1 | F | Transaction Quantity |
hl7v2:FT1.11
| CP | 0 … 1 | | Transaction Amount - Extended Contains 2.16.840.1.113883.3.1937.99.60.4.15.8 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 365 |
@Type
| | 0 … 1 | F | CP |
@LongName
| | 0 … 1 | F | Transaction Amount - Extended |
hl7v2:FT1.12
| CP | 0 … 1 | | Transaction Amount - Unit Contains 2.16.840.1.113883.3.1937.99.60.4.15.8 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 366 |
@Type
| | 0 … 1 | F | CP |
@LongName
| | 0 … 1 | F | Transaction Amount - Unit |
hl7v2:FT1.13
| CE | 0 … 1 | | Department Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 367 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70049 |
@LongName
| | 0 … 1 | F | Department Code |
hl7v2:FT1.14
| CE | 0 … 1 | | Insurance Plan ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 368 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70072 |
@LongName
| | 0 … 1 | F | Insurance Plan ID |
hl7v2:FT1.15
| CP | 0 … 1 | | Insurance Amount Contains 2.16.840.1.113883.3.1937.99.60.4.15.8 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 369 |
@Type
| | 0 … 1 | F | CP |
@LongName
| | 0 … 1 | F | Insurance Amount |
hl7v2:FT1.16
| PL | 0 … 1 | | Assigned Patient Location Contains 2.16.840.1.113883.3.1937.99.60.4.15.44 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 133 |
@Type
| | 0 … 1 | F | PL |
@LongName
| | 0 … 1 | F | Assigned Patient Location |
hl7v2:FT1.17
| IS | 0 … 1 | | Fee Schedule | FT1_ment |
@Item
| | 0 … 1 | F | 370 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70024 |
@LongName
| | 0 … 1 | F | Fee Schedule |
hl7v2:FT1.18
| IS | 0 … 1 | | Patient Type | FT1_ment |
@Item
| | 0 … 1 | F | 148 |
@Type
| | 0 … 1 | F | IS |
@Table
| | 0 … 1 | F | HL70018 |
@LongName
| | 0 … 1 | F | Patient Type |
hl7v2:FT1.19
| CE | 0 … * | | Diagnosis Code - FT1 Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 371 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70051 |
@LongName
| | 0 … 1 | F | Diagnosis Code - FT1 |
hl7v2:FT1.20
| XCN | 0 … * | | Performed By Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.74 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 372 |
@Type
| | 0 … 1 | F | XCN |
@Table
| | 0 … 1 | F | HL70084 |
@LongName
| | 0 … 1 | F | Performed By Code |
hl7v2:FT1.21
| XCN | 0 … * | | Ordered By Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.74 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 373 |
@Type
| | 0 … 1 | F | XCN |
@LongName
| | 0 … 1 | F | Ordered By Code |
hl7v2:FT1.22
| CP | 0 … 1 | | Unit Cost Contains 2.16.840.1.113883.3.1937.99.60.4.15.8 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 374 |
@Type
| | 0 … 1 | F | CP |
@LongName
| | 0 … 1 | F | Unit Cost |
hl7v2:FT1.23
| EI | 0 … 1 | | Filler Order Number Contains 2.16.840.1.113883.3.1937.99.60.4.15.21 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 217 |
@Type
| | 0 … 1 | F | EI |
@LongName
| | 0 … 1 | F | Filler Order Number |
hl7v2:FT1.24
| XCN | 0 … * | | Entered By Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.74 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 765 |
@Type
| | 0 … 1 | F | XCN |
@LongName
| | 0 … 1 | F | Entered By Code |
hl7v2:FT1.25
| CE | 0 … 1 | | Procedure Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 393 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70088 |
@LongName
| | 0 … 1 | F | Procedure Code |
hl7v2:FT1.26
| CE | 0 … * | | Procedure Code Modifier Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 1316 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70340 |
@LongName
| | 0 … 1 | F | Procedure Code Modifier |
hl7v2:FT1.27
| CE | 0 … 1 | | Advanced Beneficiary Notice Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.5 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 1310 |
@Type
| | 0 … 1 | F | CE |
@Table
| | 0 … 1 | F | HL70339 |
@LongName
| | 0 … 1 | F | Advanced Beneficiary Notice Code |
hl7v2:FT1.28
| CWE | 0 … 1 | | Medically Necessary Duplicate Procedure Reason. Contains 2.16.840.1.113883.3.1937.99.60.4.15.11 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 1646 |
@Type
| | 0 … 1 | F | CWE |
@Table
| | 0 … 1 | F | HL70476 |
@LongName
| | 0 … 1 | F | Medically Necessary Duplicate Procedure Reason. |
hl7v2:FT1.29
| CNE | 0 … 1 | | NDC Code Contains 2.16.840.1.113883.3.1937.99.60.4.15.6 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 1845 |
@Type
| | 0 … 1 | F | CNE |
@Table
| | 0 … 1 | F | HL70549 |
@LongName
| | 0 … 1 | F | NDC Code |
hl7v2:FT1.30
| CX | 0 … 1 | | Payment Reference ID Contains 2.16.840.1.113883.3.1937.99.60.4.15.12 (DYNAMIC) | FT1_ment |
@Item
| | 0 … 1 | F | 1846 |
@Type
| | 0 … 1 | F | CX |
@LongName
| | 0 … 1 | F | Payment Reference ID |
hl7v2:FT1.31
| SI | 0 … * | | Transaction Reference Key | FT1_ment |
@Item
| | 0 … 1 | F | 1847 |
@Type
| | 0 … 1 | F | SI |
@LongName
| | 0 … 1 | F | Transaction Reference Key |