Health Level Seven (HL7) Admission Discharge Transfer (ADT)
The Health Level Seven (HL7) Admission Discharge Transfer (ADT) connection is used to import all detected fields from HL7 ADT formatted documents. The documents can stand alone or be contained within a valid HL7 formatted batch.
General Attributes
This connection extracts information and creates a General Line with certain common properties that may be used for mapping as detailed by the Copy macro command.
The attributes generated from an HL7 ADT formatted document are dependent upon the segments and fields included within the document. The attribute keys are comprised of the name of the segment, index of the field value, name of the field, and name of the sub-component (if applicable). When segments are repeated within a single document, attributes must be keyed differently to prevent attributes from being overridden. Where possible, attribute keys are suffixed with codes contained within the segment. If the attribute key is still not unique, an automatically incrementing numeric value is appending to each duplicated attribute key.
For Example:
The event header (EVN) is a segment that appears once time in the document. As a result, every field name is unique in relation to the segment. This will yield the following attribute values
EVN|A01-|198808181123
EVN1EventTypeCode - A01-
EVN2RecordedDateTime - 198808181123
EVN2RecordedDateTimeFormat - yyyyMMddHHmm
EVN2RecordedDateTimeDateFormatISO - 1988-08-18
EVN2RecordedDateTimeTimeFormatISO - 11-23-00
The TIM category (OBX) is a segment that can repeat multiple times in the document. As a result, the field names are no longer unique in relation to the segment if more than one segment exists. Fields are therefore further suffixed with the code and text when it exists.
OBX||NM|Sys|IBP1|120|mmHg||||F
OBX||NM|Dia|IBP1|80|mmHg||||F
OBX||NM|Map|IBP1|100|mmHg||||F
OBX||NM|Sys|IBP2|121|mmHg||||F
OBX||NM|Dia|IBP2|79|mmHg||||F
OBX||NM|Map|IBP2|98|mmHg||||F
OBX2ValueTypeSys_IBP1 - NM
OBX3ObservationIdentifierSys_IBP1Identifier - Sys
OBX4ObservationSubIDSys_IBP1OriginalSubIdentifier - IBP1
OBX5ObservationValueSys_IBP1 - 120
OBX6UnitsSys_IBP1Identifier - mmHg
OBX10NatureOfAbnormalTestSys_IBP1 - F
OBX2ValueTypeDia_IBP1 - NM
OBX3ObservationIdentifierDia_IBP1Identifier - Dia
OBX4ObservationSubIDDia_IBP1OriginalSubIdentifier - IBP1
OBX5ObservationValueDia_IBP1 - 80
OBX6UnitsDia_IBP1Identifier - mmHg
OBX10NatureOfAbnormalTestDia_IBP1 - F
OBX2ValueTypeMap_IBP1 - NM
OBX3ObservationIdentifierMap_IBP1Identifier - Map
OBX4ObservationSubIDMap_IBP1OriginalSubIdentifier - IBP1
OBX5ObservationValueMap_IBP1 - 100
OBX6UnitsMap_IBP1Identifier - mmHg
OBX10NatureOfAbnormalTestMap_IBP1 - F
OBX2ValueTypeSys_IBP2 - NM
OBX3ObservationIdentifierSys_IBP2Identifier - Sys
OBX4ObservationSubIDSys_IBP2OriginalSubIdentifier - IBP2
OBX5ObservationValueSys_IBP2 - 121
OBX6UnitsSys_IBP2Identifier - mmHg
OBX10NatureOfAbnormalTestSys_IBP2 - F
OBX2ValueTypeDia_IBP2 - NM
OBX3ObservationIdentifierDia_IBP2Identifier - Dia
OBX4ObservationSubIDDia_IBP2OriginalSubIdentifier - IBP2
OBX5ObservationValueDia_IBP2 - 79
OBX6UnitsDia_IBP2Identifier - mmHg
OBX10NatureOfAbnormalTestDia_IBP2 - F
OBX2ValueTypeMap_IBP2 - NM
OBX3ObservationIdentifierMap_IBP2Identifier - Map
OBX4ObservationSubIDMap_IBP2OriginalSubIdentifier - IBP2
OBX5ObservationValueMap_IBP2 - 98
OBX6UnitsMap_IBP2Identifier - mmHg
OBX10NatureOfAbnormalTestMap_IBP2 - F
All imported attributes contained within a single message header are turned into General Lines of data and may be consumed in mapping with the Attribute macro command. Below is a list of prefixes used to generate attributes:
ACC1AccidentDateTime
ACC2AccidentCode
ACC3AccidentLocation
ACC4AutoAccidentState
ACC5AccidentJobRelatedIndicator
ACC6AccidentDeathIndicator
ACC7EnteredBy
ACC8AccidentDescription
ACC9BroughtInBy
ACC10PoliceNotifiedIndicator
ACC11AccidentAddress
ACC12DegreeOfpatientliability
ACC13AccidentIdentifier
AL11SetID
AL12AllergenTypeCode
AL13AllergenCodeMnemonicDescription
AL14AllergySeverityCode
AL15AllergyReactionCode
AL16IdentificationDate
DB11SetID
DB12DisabledPersonCode
DB13DisabledPersonIdentifier
DB14DisabilityIndicator
DB15DisabilityStartDate
DB16DisabilityEndDate
DB17DisabilityReturnToWorkDate
DB18DisabilityUnableToWorkDate
DG11SetID
DG12DiagnosisCodingMethod
DG13DiagnosisCodeDG1
DG14DiagnosisDescription
DG15DiagnosisDateTime
DG16DiagnosisType
DG17MajorDiagnosticCategory
DG18DiagnosticRelatedGroup
DG19DRGApprovalIndicator
DG110DRGGrouperReviewCode
DG111OutlierType
DG112OutlierDays
DG113OutlierCost
DG114GrouperVersionAndType
DG115DiagnosisPriority
DG116DiagnosingClinician
DG117DiagnosisClassification
DG118ConfidentialIndicator
DG119AttestationDateTime
DG120DiagnosisIdentifier
DG121DiagnosisActionCode
DG122ParentDiagnosis
DG123DRGCCLValueCode
DG124DRGGroupingUsage
DG125DRGDiagnosisDeterminationStatus
DG126PresentOnAdmissionIndicator
DRG1DiagnosticRelatedGroup
DRG2DRGAssignedDateTime
DRG3DRGApprovalIndicator
DRG4DRGGrouperReviewCode
DRG5OutlierType
DRG6OutlierDays
DRG7OutlierCost
DRG8DRGPayor
DRG9OutlierReimbursement
DRG10ConfidentialIndicator
DRG11DRGTransferType
DRG12NameOfCoder
DRG13GrouperStatus
DRG14PCCLValueCode
DRG15EffectiveWeight
DRG16MonetaryAmount
DRG17StatusPatient
DRG18GrouperSoftwareName
DRG19GrouperSoftwareVersion
DRG20StatusFinancialCalculation
DRG21RelativeDiscountSurcharge
DRG22BasicCharge
DRG23TotalCharge
DRG24DiscountSurcharge
DRG25CalculatedDays
DRG26StatusGender
DRG27StatusAge
DRG28StatusLengthOfStay
DRG29StatusSameDayFlag
DRG30StatusSeparationMode
DRG31StatusWeightAtBirth
DRG32StatusRespirationMinutes
DRG33StatusAdmission
EVN1EventTypeCode
EVN2RecordedDateTime
EVN3DateTimePlannedEvent
EVN4EventReasonCode
EVN5OperatorID
EVN6EventOccurred
EVN7EventFacility
GT11SetID
GT12GuarantorNumber
GT13GuarantorName
GT14GuarantorSpouseName
GT15GuarantorAddress
GT16GuarantorPhNumHome
GT17GuarantorPhNumBusiness
GT18GuarantorDateTimeOfBirth
GT19GuarantorAdministrativeSex
GT110GuarantorType
GT111GuarantorRelationship
GT112GuarantorSSN
GT113GuarantorDateBegin
GT114GuarantorDateEnd
GT115GuarantorPriority
GT116GuarantorEmployerName
GT117GuarantorEmployerAddress
GT118GuarantorEmployerPhoneNumber
GT119GuarantorEmployeeIDNumber
GT120GuarantorEmploymentStatus
GT121GuarantorOrganizationName
GT122GuarantorBillingHoldFlag
GT123GuarantorCreditRatingCode
GT124GuarantorDeathDateAndTime
GT125GuarantorDeathFlag
GT126GuarantorChargeAdjustmentCode
GT127GuarantorHouseholdAnnualIncome
GT128GuarantorHouseholdSize
GT129GuarantorEmployerIDNumber
GT130GuarantorMaritalStatusCode
GT131GuarantorHireEffectiveDate
GT132EmploymentStopDate
GT133LivingDependency
GT134AmbulatoryStatus
GT135Citizenship
GT136PrimaryLanguage
GT137LivingArrangement
GT138PublicityCode
GT139ProtectionIndicator
GT140StudentIndicator
GT141Religion
GT142MothersMaidenName
GT143Nationality
GT144EthnicGroup
GT145ContactPersonsName
GT146ContactPersonsTelephoneNumber
GT147ContactReason
GT148ContactRelationship
GT149JobTitle
GT150JobCodeClass
GT151GuarantorEmployersOrganizationName
GT152Handicap
GT153JobStatus
GT154GuarantorFinancialClass
GT155GuarantorRace
GT156GuarantorBirthPlace
GT157VIPIndicator
IN11SetID
IN12HealthPlanID
IN13InsuranceCompanyID
IN14InsuranceCompanyName
IN15InsuranceCompanyAddress
IN16InsuranceCompanyContactPerson
IN17InsuranceCompanyPhoneNumber
IN18GroupNumber
IN19GroupName
IN110InsuredGroupEmployeeID
IN111InsuredGroupEmployeeName
IN112PlanEffectiveDate
IN113PlanExpirationDate
IN114AuthorizationInformation
IN115PlanType
IN116NameOfInsured
IN117InsuredRelationshipToPatient
IN118InsuredDateOfBirth
IN119InsuredAddress
IN120AssignmentOfBenefits
IN121CoordinationOfBenefits
IN122CoordinationOfBenefitsPriority
IN123NoticeOfAdmissionFlag
IN124NoticeOfAdmissionDate
IN125ReportOfEligibilityFlag
IN126ReportOfEligibilityDate
IN127ReleaseInformationCode
IN128PreAdmitCert
IN129VerificationDateTime
IN130VerificationBy
IN131TypeOfAgreementCode
IN132BillingStatus
IN133LifetimeReserveDays
IN134DelayBeforeLRDay
IN135CompanyPlanCode
IN136PolicyNumber
IN137PolicyDeductible
IN138PolicyLimitAmount
IN139PolicyLimitDays
IN140RoomRateSemiPrivate
IN141RoomRatePrivate
IN142InsuredEmploymentStatus
IN143InsuredAdministrativeSex
IN144InsuredEmployersAddress
IN145VerificationStatus
IN146PriorInsurancePlanID
IN147CoverageType
IN148Handicap
IN149InsuredIDNumber
IN150SignatureCode
IN151SignatureCodeDate
IN152InsuredBirthPlace
IN153VIPIndicator
IN154ExternalHealthPlanIdentifiers
IN155InsuranceActionCode
IN21InsuredsEmployeeID
IN22InsuredsSocialSecurityNumber
IN23InsuredsEmployersNameandID
IN24EmployerInformationData
IN25MailClaimParty
IN26MedicareHealthInsCardNumber
IN27MedicaidCaseName
IN28MedicaidCaseNumber
IN29MilitarySponsorName
IN210MilitaryIDNumber
IN211DependentOfMilitaryRecipient
IN212MilitaryOrganization
IN213MilitaryStation
IN214MilitaryService
IN215MilitaryRankGrade
IN216MilitaryStatus
IN217MilitaryRetireDate
IN218MilitaryNonAvailCertOnFile
IN219BabyCoverage
IN220CombineBabyBill
IN221BloodDeductible
IN222SpecialCoverageApprovalName
IN223SpecialCoverageApprovalTitle
IN224NonCoveredInsuranceCode
IN225PayorID
IN226PayorSubscriberID
IN227EligibilitySource
IN228RoomCoverageTypeAmount
IN229PolicyTypeAmount
IN230DailyDeductible
IN231LivingDependency
IN232AmbulatoryStatus
IN233Citizenship
IN234PrimaryLanguage
IN235LivingArrangement
IN236PublicityCode
IN237ProtectionIndicator
IN238StudentIndicator
IN239Religion
IN240MothersMaidenName
IN241Nationality
IN242EthnicGroup
IN243MaritalStatus
IN244InsuredsEmploymentStartDate
IN245EmploymentStopDate
IN246JobTitle
IN247JobCodeClass
IN248JobStatus
IN249EmployerContactPersonName
IN250EmployerContactPersonPhoneNumber
IN251EmployerContactReason
IN252InsuredsContactPersonsName
IN253InsuredsContactPersonPhoneNumber
IN254InsuredsContactPersonReason
IN255RelationshipToThePatientStartDate
IN256RelationshipToThePatientStopDate
IN257InsuranceCoContactReason
IN258InsuranceCoContactPhoneNumber
IN259PolicyScope
IN260PolicySource
IN261PatientMemberNumber
IN262GuarantorsRelationshiptoInsured
IN263InsuredsPhoneNumberHome
IN264InsuredsEmployerPhoneNumber
IN265MilitaryHandicappedProgram
IN266SuspendFlag
IN267CopayLimitFlag
IN268StoplossLimitFlag
IN269InsuredOrganizationNameandID
IN270InsuredEmployerOrganizationNameandID
IN271Race
IN272PatientsRelationshiptoInsured
IN31SetID
IN32CertificationNumber
IN33CertifiedBy
IN34CertificationRequired
IN35Penalty
IN36CertificationDateTime
IN37CertificationModifyDateTime
IN38Operator
IN39CertificationBeginDate
IN310CertificationEndDate
IN311Days
IN312NonConcurCodeDescription
IN313NonConcurEffectiveDateTime
IN314PhysicianReviewer
IN315CertificationContact
IN316CertificationContactPhoneNumber
IN317AppealReason
IN318CertificationAgency
IN319CertificationAgencyPhoneNumber
IN320PreCertificationRequirement
IN321CaseManager
IN322SecondOpinionDate
IN323SecondOpinionStatus
IN324SecondOpinionDocumentationReceived
IN325SecondOpinionPhysician
IN326CertificationType
IN327CertificationCategory
MSH1FieldSeparator
MSH2EncodingCharacters
MSH3SendingApplication
MSH4SendingFacility
MSH5ReceivingApplication
MSH6ReceivingFacility
MSH7DateTimeOfMessage
MSH8Security
MSH9MessageType
MSH10MessageControlID
MSH11ProcessingID
MSH12VersionID
MSH13SequenceNumber
MSH14ContinuationPointer
MSH15AcceptAcknowledgmentType
MSH16ApplicationAcknowledgmentType
MSH17CountryCode
MSH18CharacterSet
MSH19PrincipalLanguageOfMessage
MSH20AlternateCharacterSetHandlingScheme
MSH21MessageProfileIdentifier
MSH22SendingResponsibleOrganization
MSH23ReceivingResponsibleOrganization
MSH24SendingNetworkAddress
MSH25ReceivingNetworkAddress
NK11SetID
NK12Name
NK13Relationship
NK14Address
NK15PhoneNumber
NK16BusinessPhoneNumber
NK17ContactRole
NK18StartDate
NK19EndDate
NK110NextOfKinAssociatedPartiesJobTitle
NK111NextOfKinAssociatedPartiesJobCodeClass
NK112NextOfKinAssociatedPartiesEmployeeNumber
NK113OrganizationNameNK1
NK114MaritalStatus
NK115AdministrativeSex
NK116DateTimeOfBirth
NK117LivingDependency
NK118AmbulatoryStatus
NK119Citizenship
NK120PrimaryLanguage
NK121LivingArrangement
NK122PublicityCode
NK123ProtectionIndicator
NK124StudentIndicator
NK125Religion
NK126MothersMaidenName
NK127Nationality
NK128EthnicGroup
NK129ContactReason
NK130ContactPersonsName
NK131ContactPersonsTelephoneNumber
NK132ContactPersonsAddress
NK133NextOfKinAssociatedPartysIdentifiers
NK134JobStatus
NK135Race
NK136Handicap
NK137ContactPersonSocialSecurityNumber
NK138NextOfKinBirthPlace
NK139VIPIndicator
NK140NextOfKinTelecommunicationInformation
NK141ContactPersonsTelecommunicationInformation
OBX1SetID
OBX2ValueType
OBX3ObservationIdentifier
OBX4ObservationSubID
OBX5ObservationValue
OBX6Units
OBX7ReferencesRange
OBX8InterpretationCodes
OBX9Probability
OBX10NatureOfAbnormalTest
OBX11ObservationResultStatus
OBX12EffectiveDateOfReferenceRange
OBX13UserDefinedAccessChecks
OBX14DateTimeOftheObservation
OBX15ProducersID
OBX16ResponsibleObserver
OBX17ObservationMethod
OBX18EquipmentInstanceIdentifier
OBX19DateTimeOftheAnalysis
OBX20ObservationSite
OBX21ObservationInstanceIdentifier
OBX22MoodCode
OBX23PerformingOrganizationName
OBX24PerformingOrganizationAddress
OBX25PerformingOrganizationMedicalDirector
OBX26PatientResultsReleaseCategory
OBX27RootCause
OBX28LocalProcessControl
OBX29ObservationType
OBX30ObservationSubType
PD11LivingDependency
PD12LivingArrangement
PD13PatientPrimaryFacility
PD14PatientPrimaryCareProviderNameAndIDNumber
PD15StudentIndicator
PD16Handicap
PD17LivingWillCode
PD18OrganDonorCode
PD19SeparateBill
PD110DuplicatePatient
PD111PublicityCode
PD112ProtectionIndicator
PD113ProtectionIndicatorEffectiveDate
PD114PlaceOfWorship
PD115AdvanceDirectiveCode
PD116ImmunizationRegistryStatus
PD117ImmunizationRegistryStatusEffectiveDate
PD118PublicityCodeEffectiveDate
PD119MilitaryBranch
PD120MilitaryRankGrade
PD121MilitaryStatus
PD122AdvanceDirectiveLastVerifiedDate
PID1SetID
PID2PatientID
PID3PatientIdentifierList
PID4AlternatePatientID
PID5PatientName
PID6MothersMaidenName
PID7DateTimeOfBirth
PID8AdministrativeSex
PID9PatientAlias
PID10Race
PID11PatientAddress
PID12CountryCode
PID13PhoneNumberHome
PID14PhoneNumberBusiness
PID15PrimaryLanguage
PID16MaritalStatus
PID17Religion
PID18PatientAccountNumber
PID19PatientSSN
PID20PatientDriverLicenseNumber
PID21MothersIdentifier
PID22EthnicGroup
PID23BirthPlace
PID24MultipleBirthIndicator
PID25BirthOrder
PID26Citizenship
PID27VeteransMilitaryStatus
PID28Nationality
PID29PartientDeathDateAndTime
PID30PatientDeathIndicator
PID31IdentityUnknownIndicator
PID32IdentityReliabilityCode
PID33LastUpdatedDateTime
PID34LastUpdateFacility
PID35TaxonomicClassificationCode
PID36BreedCode
PID37Strain
PID38ProductionClassCode
PID39TribalCitizenship
PID40PatientTelecommunicationInformation
PR11SetID
PR12ProcedureCodingMethod
PR13ProcedureCode
PR14ProcedureDescription
PR15ProcedureDateTime
PR16ProcedureFunctionalType
PR17ProcedureMinutes
PR18Anesthesiologist
PR19AnesthesiaCode
PR110AnesthesiaMinutes
PR111Surgeon
PR112ProcedurePractitioner
PR113ConsentCode
PR114ProcedurePriority
PR115AssociatedDiagnosisCode
PR116ProcedureCodeModifier
PR117ProcedureDRGType
PR118TissueTypeCode
PR119ProcedureIdentifier
PR120ProcedureActionCode
PR121DRGProcedureDeterminationStatus
PR122DRGProcedureRelevance
PR123TreatingOrganizationalUnit
PR124RespiratoryWithinSurgery
PR125ParentProcedureID
PV11SetID
PV12PatientClass
PV13AssignedPatientLocation
PV14AdmissionType
PV15PreadmitNumber
PV16PriorPatientLocation
PV17AttendingDoctor
PV18ReferringDoctor
PV19ConsultingDoctor
PV110HospitalService
PV111TemporaryLocation
PV112PreadmitTestIndicator
PV113ReadmissionIndicator
PV114AdmitSource
PV115AmbulatoryStatus
PV116VIPIndicator
PV117AdmittingDoctor
PV118PatientType
PV119VisitNumber
PV120FinancialClass
PV121ChargePriceIndicator
PV122CourtesyCode
PV123CreditRating
PV124ContractCode
PV125ContractEffectiveDate
PV126ContractAmount
PV127ContractPeriod
PV128InterestCode
PV129TransferToBadDebtCode
PV130TransferToBadDebtDate
PV131BadDebtAgencyCode
PV132BadDebtTransferAmount
PV133BadDebtRecoveryAmount
PV134DeleteAccountIndicator
PV135DeleteAccountDate
PV136DischargeDisposition
PV137DischargedToLocation
PV138DietType
PV139ServicingFacility
PV140BedStatus
PV141AccountStatus
PV142PendingLocation
PV143PriorTemporaryLocation
PV144AdmitDateTime
PV145DischargeDateTime
PV146CurrentPatientBalance
PV147TotalCharges
PV148TotalAdjustments
PV149TotalPayments
PV150AlternateVisitID
PV151VisitIndicator
PV152OtherHealthcareProvider
PV153ServiceEpisodeDescription
PV154ServiceEpisodeIdentifier
PV21PriorPendingLocation
PV22AccommodationCode
PV23AdmitReason
PV24TransferReason
PV25PatientValuables
PV26PatientValuablesLocation
PV27VisitUserCode
PV28ExpectedAdmitDateTime
PV29ExpectedDischargeDateTime
PV210EstimatedLengthOfInpatientStay
PV211ActualLengthOfInpatientStay
PV212VisitDescription
PV213ReferralSourceCode
PV214PreviousServiceDate
PV215EmploymentIllnessRelatedIndicator
PV216PurgeStatusCode
PV217PurgeStatusDate
PV218SpecialProgramCode
PV219RetentionIndicator
PV220ExpectedNumberOfInsurancePlans
PV221VisitPublicityCode
PV222VisitProtectionIndicator
PV223ClinicOrganizationName
PV224PatientStatusCode
PV225VisitPriorityCode
PV226PreviousTreatmentDate
PV227ExpectedDischargeDisposition
PV228SignatureonFileDate
PV229FirstSimilarIllnessDate
PV230PatientChargeAdjustmentCode
PV231RecurringServiceCode
PV232BillingMediaCode
PV233ExpectedSurgeryDateandTime
PV234MilitaryPartnershipCode
PV235MilitaryNonAvailabilityCode
PV236NewbornBabyIndicator
PV237BabyDetainedIndicator
PV238ModeOfArrivalCode
PV239RecreationalDrugUseCode
PV240AdmissionLevelOfCareCode
PV241PrecautionCode
PV242PatientConditionCode
PV243LivingWillCode
PV244OrganDonorCode
PV245AdvanceDirectiveCode
PV246PatientStatusEffectiveDate
PV247ExpectedLOAReturnDateTime
PV248ExpectedPreadmissionTestingDateTime
PV249NotifyClergyCode
PV250AdvanceDirectiveLastVerifiedDate
ROL1RoleInstanceID
ROL2ActionCode
ROL3RoleROL
ROL4RolePerson
ROL5RoleBeginDateTime
ROL6RoleEndDateTime
ROL7RoleDuration
ROL8RoleActionReason
ROL9ProviderType
ROL10OrganizationUnitType
ROL11OfficeHomeAddressBirthplace
ROL12Phone
ROL13PersonsLocation
ROL14Organization
UB11SetID
UB12BloodDeductible
UB13BloodFurnishedPints
UB14BloodReplacedPints
UB15BloodNotReplacedPints
UB16CoInsuranceDays
UB17ConditionCode
UB18CoveredDays
UB19NonCoveredDays
UB110ValueAmountAndCode
UB111NumberOfGraceDays
UB112SpecialProgramIndicator
UB113PSROURApprovalIndicator
UB114PSROURApprovedStayFm
UB115PSROURApprovedStayTo
UB116Occurrence
UB117OccurrenceSpan
UB118OccurSpanStartDate
UB119OccurSpanEndDate
UB120UB82Locator2
UB121UB82Locator9
UB122UB82Locator27
UB123UB82Locator45
UB21SetID
UB22CoInsuranceDays9
UB23ConditionCode2430
UB24CoveredDays7
UB25NonCoveredDays8
UB26ValueAmountAndCode3941
UB27OccurrenceCodeAndDate3235
UB28OccurrenceSpanCodeDates36
UB29UniformBillingLocator2State
UB210UniformBillingLocator11State
UB211UniformBillingLocator31National
UB212DocumentControlNumber
UB213UniformBillingLocator49National
UB214UniformBillingLocator56State
UB215UniformBillingLocator57National
UB216UniformBillingLocator78State
UB217SpecialVisitCount
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