thank you.
Sebastien William
MSH|^~&|||||200907291554||ADT^A08|8971|D|2.4|||AL|NE|
EVN||200907291554|||ZWILLIAMS^Williams^Zelda|200907290900|
PID|1||I000000703^^^^MR^IMC~042-45-9998^^^^SS^IMC~I753^^^^PI^IMC~HUBTVI0002392^^^^HUB^IMC||JOE^MIKEY^^^^^L||19660424|M||CA|24 CENTRAL AVE^^PAWTUCKET^RI^02860||401-555-1254|||S||V00000021750|042-45-9998|
NK1|1|SMOE^JOE|BR^BROTHER|700 EMPIRE BLVD^^BROOKLYN^NY^11213|333-456-5858|NONE|NOK|
NK1|2|JOE^MIKEY|SP^SELF|24 CENTRAL AVE^^PAWTUCKET^RI^02860|401-555-1254||NOT|
NK1|3|SELF|||||EMP|||TRUCK DRIVER|||SELF-EMPLOYED|||||||||||||||||||||RE|
PV1|1|P|AA.NUCMED|EL|||ADESMAN^ADESMAN^JEROME^^^^^^^^^^XX|||||||PHY||||RCR||BC|||||||||||||||||||IMC||PRE|||200907290900|
PV2|||||||||||||||||||||||||EL|||||||||||N|
ROL|1|AD|AT|ADESMAN^ADESMAN^JEROME^^^^^^^^^^XX|
ROL|2|AD|PP|DROBERTS^ROBERTS^DANIEL^D^^^^^^^^^XX|
OBX|1|CE|ADM.REG 18^Was the patient given a metrocard?^ADM||N^NO||||||F|
OBX|2|TX|ADM.REG 2^Proof of Identification:^ADM||Y||||||F|
OBX|3|TX|ADM.REG 20^Date Packet Given:^ADM||20090729||||||F|
OBX|4|TX|ADM.REG 21^Date Consent for Treatment Given:^ADM||20090729||||||F|
OBX|5|CE|ADM.REG 22^How did you hear about Interfaith Medical Center?^ADM||NEWS^NEWSPAPER||||||F|
OBX|6|CE|ADM.REG 23^What is the Patient’s Primary Language?^ADM||EN^ENGLISH||||||F|
OBX|7|TX|ADM.REG 3^Proof of Address:^ADM||Y||||||F|
OBX|8|TX|ADM.REG 4^Insurance Card:^ADM||Y||||||F|
OBX|9|TX|ADM.REG 7^Does this clinic encounter need to be authorized?^ADM||Y||||||F|
OBX|10|TX|ADM.REG 8^Was Consent for Treatment given to the patient?^ADM||Y||||||F|
OBX|11|TX|ADM.REG 9^Was Acknowledgement of Patient Packet given to the Patient?^ADM||Y||||||F|
OBX|12|TX|BAR.DEN12^Is this a Dental patient?^ADM||N||||||F|
GT1|1||JOE^MIKEY||24 CENTRAL AVE^^PAWTUCKET^RI^02860|401-555-1254|||||SP|042-45-9998||||SELF|
IN1|1|BCNY||BLUE CROSS OF NY|PO BOX 1407 CHURCH ST STA^^NEW YORK^NY^100081407||800-123-4567|||||||||JOE^MIKEY|SP|19660424|24 CENTRAL AVE^^PAWTUCKET^RI^02860||||||||||20090729|ZWILLIAMS||||||0125488896A|||||||M||VERIFIED|
IN2|1|042-45-9998||||||||||||||||||||||||||||||||||||||||CA|S||||||||||||||||||||401-555-1254|
The one on top: Version 2.4 — Should look like the bottom: Version 2.2
MSH|^~&|||||200906291124||ADT^A08|6884|D|2.2|||AL|NE|
EVN|A08|200906291123|||*ABS.IMC|200901010723|
PID|1|HUBTVI0002277|I000000603|I650|EDTEST^ONE||19840728|F|||113 HALSEY STREET^^BROOKLYN^NY^11216||718-444-1234|||S||V00000017485|051-60-1681|
NK1|1|EDTEST^LUEANDRINA|MO^MOTHER|113 HALSEY STREET^^BROOKLYN^NY^11216|718-444-1234||NOK|
NK1|2|EDTEST^LUEANDRINA|MO^MOTHER|113 HALSEY STREET^^BROOKLYN^NY^11216|718-444-1234||NOT|
NK1|3|UN||NONE^.^.^^.|||EMP||||||UNKNOWN|||||||||||||||||||||UN|
PV1|1|E|AA.EDFT|ER|||ROBISAN^ROBINSON^SANDRA^^^^MD^^^^^^XX|||||||EMR||||ER||MCDHMO|||||||||||||||||||IMC||REG|||200901010723|
PV2|||HEADACHE||||||||1||||||||||||||ER|||||||||||N|
OBX|1|TX|ADM.GUAR^What is the Guarantor’s Date of Birth:^ADM||19840728||||||F|
OBX|2|TX|ADM.REG 13^Financial Assistance Application:^ADM||Y||||||F|
OBX|3|TX|ADM.REG 15^Benefit Assignments:^ADM||Y||||||F|
OBX|4|TX|ADM.REG 2^Proof of Identification:^ADM||Y||||||F|
OBX|5|TX|ADM.REG 3^Proof of Address:^ADM||Y||||||F|
OBX|6|TX|ADM.REG 4^Insurance Card:^ADM||Y||||||F|
OBX|7|TX|ADM.REG 9^Was Acknowledgement of Patient Packet given to the Patient?^ADM||Y||||||F|
GT1|1||EDTEST^ONE||113 HALSEY STREET^^BROOKLYN^NY^11216|718-444-1234|||||SP|051-60-1681||||UN|NONE^.^.^.^.|
IN1|1|AFFINHP||AFFINITY HEALTH PLAN|2500 HALSEY ST^^BRONX^NY^10461||||||||||||||||||||||||20090610|PROBERTS||||||SY77194W|||||||||VERIFIED|