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active Template  IN2 - Insurance Additional Information

Id 2.16.840.1.113883.3.1937.777.10.13.57
ref
ad4bbr-
 		Ingangsdatum 2013‑02‑10
Status active Actief Versielabel
Naam IN2_segment Weergavenaam IN2 - Insurance Additional Information
Classificatie HL7v2 segment level template
Open/gesloten Open (ook andere dan gedefinieerde elementen zijn toegestaan)
Gebruikt door / Gebruikt
Gebruikt door 0 transacties en 1 template, Gebruikt 14 templates
Gebruikt door als Naam Versie
2.16.840.1.113883.2.4.3.11.60.25.10.1 Containment draft Lab2Lab Aanvraagbericht (OML^O21) 2015‑07‑21 11:35:02
Gebruikt als Naam Versie
2.16.840.1.113883.3.1937.777.10.15.12 Containment active CX - Extended composite ID with check digit DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.89 Containment active ST - String DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.74 Containment active XCN - Extended composite ID number and name for persons DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.84 Containment active IS - Coded value for user-defined tables DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.76 Containment active XPN - Extended person name DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.5 Containment active CE - Coded element DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.80 Containment active DT - Date DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.83 Containment active ID - Coded value for HL7 defined tables DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.55 Containment active RMC - Room coverage DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.49 Containment active PTA - Policy type and amount DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.13 Containment active DDI - Daily deductible information DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.30 Containment active JCC - Job code/class DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.77 Containment active XTN - Extended telecommunications number DYNAMISCH
2.16.840.1.113883.3.1937.777.10.15.75 Containment active XON - Extended composite name and ID number for organizations DYNAMISCH
Item DT Card Conf Omschrijving Label
hl7v2:IN2.1
 CX 0 … * en-US Insured's Employee ID
Bevat 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 472
@Type
 0 … 1 F CX
@LongName
 0 … 1 F Insured's Employee ID
hl7v2:IN2.2
 ST 0 … 1 en-US Insured's Social Security Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 473
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Insured's Social Security Number
hl7v2:IN2.3
 XCN 0 … * en-US Insured's Employer's Name and ID
Bevat 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMISCH) 		(IN2dotsent)
@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 en-US Employer Information Data
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Mail Claim Party
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Medicare Health Ins Card Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 477
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Medicare Health Ins Card Number
hl7v2:IN2.7
 XPN 0 … * en-US Medicaid Case Name
Bevat 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 478
@Type
 0 … 1 F XPN
@LongName
 0 … 1 F Medicaid Case Name
hl7v2:IN2.8
 ST 0 … 1 en-US Medicaid Case Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 479
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Medicaid Case Number
hl7v2:IN2.9
 XPN 0 … * en-US Military Sponsor Name
Bevat 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 480
@Type
 0 … 1 F XPN
@LongName
 0 … 1 F Military Sponsor Name
hl7v2:IN2.10
 ST 0 … 1 en-US Military ID Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 481
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Military ID Number
hl7v2:IN2.11
 CE 0 … 1 en-US Dependent Of Military Recipient
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US Military Organization
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 483
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Military Organization
hl7v2:IN2.13
 ST 0 … 1 en-US Military Station
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 484
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Military Station
hl7v2:IN2.14
 IS 0 … 1 en-US Military Service
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Military Rank/Grade
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Military Status
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Military Retire Date
Bevat 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 488
@Type
 0 … 1 F DT
@LongName
 0 … 1 F Military Retire Date
hl7v2:IN2.18
 ID 0 … 1 en-US Military Non-Avail Cert On File
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Baby Coverage
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Combine Baby Bill
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Blood Deductible
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 492
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Blood Deductible
hl7v2:IN2.22
 XPN 0 … * en-US Special Coverage Approval Name
Bevat 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 493
@Type
 0 … 1 F XPN
@LongName
 0 … 1 F Special Coverage Approval Name
hl7v2:IN2.23
 ST 0 … 1 en-US Special Coverage Approval Title
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 494
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Special Coverage Approval Title
hl7v2:IN2.24
 IS 0 … * en-US Non-Covered Insurance Code
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Payor ID
Bevat 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 496
@Type
 0 … 1 F CX
@LongName
 0 … 1 F Payor ID
hl7v2:IN2.26
 CX 0 … * en-US Payor Subscriber ID
Bevat 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 497
@Type
 0 … 1 F CX
@LongName
 0 … 1 F Payor Subscriber ID
hl7v2:IN2.27
 IS 0 … 1 en-US Eligibility Source
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Room Coverage Type/Amount
Bevat 2.16.840.1.113883.3.1937.777.10.15.55 RMC - Room coverage (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 499
@Type
 0 … 1 F RMC
@LongName
 0 … 1 F Room Coverage Type/Amount
hl7v2:IN2.29
 PTA 0 … * en-US Policy Type/Amount
Bevat 2.16.840.1.113883.3.1937.777.10.15.49 PTA - Policy type and amount (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 500
@Type
 0 … 1 F PTA
@LongName
 0 … 1 F Policy Type/Amount
hl7v2:IN2.30
 DDI 0 … 1 en-US Daily Deductible
Bevat 2.16.840.1.113883.3.1937.777.10.15.13 DDI - Daily deductible information (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 501
@Type
 0 … 1 F DDI
@LongName
 0 … 1 F Daily Deductible
hl7v2:IN2.31
 IS 0 … 1 en-US Living Dependency
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Ambulatory Status
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Citizenship
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US Primary Language
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US Living Arrangement
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Publicity Code
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US Protection Indicator
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Student Indicator
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Religion
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Mother's Maiden Name
Bevat 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 109
@Type
 0 … 1 F XPN
@LongName
 0 … 1 F Mother's Maiden Name
hl7v2:IN2.41
 CE 0 … 1 en-US Nationality
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Ethnic Group
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Marital Status
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US Insured's Employment Start Date
Bevat 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMISCH) 		(IN2dotsent)
@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 en-US Employment Stop Date
Bevat 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 783
@Type
 0 … 1 F DT
@LongName
 0 … 1 F Employment Stop Date
hl7v2:IN2.46
 ST 0 … 1 en-US Job Title
Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 785
@Type
 0 … 1 F ST
@LongName
 0 … 1 F Job Title
hl7v2:IN2.47
 JCC 0 … 1 en-US Job Code/Class
Bevat 2.16.840.1.113883.3.1937.777.10.15.30 JCC - Job code/class (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 786
@Type
 0 … 1 F JCC
@LongName
 0 … 1 F Job Code/Class
hl7v2:IN2.48
 IS 0 … 1 en-US Job Status
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Employer Contact Person Name
Bevat 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 789
@Type
 0 … 1 F XPN
@LongName
 0 … 1 F Employer Contact Person Name
hl7v2:IN2.50
 XTN 0 … * en-US Employer Contact Person Phone Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMISCH) 		(IN2dotsent)
@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 en-US Employer Contact Reason
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Insured's Contact Person's Name
Bevat 2.16.840.1.113883.3.1937.777.10.15.76 XPN - Extended person name (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Insured's Contact Person Phone Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Insured's Contact Person Reason
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Relationship to the Patient Start Date
Bevat 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Relationship to the Patient Stop Date
Bevat 2.16.840.1.113883.3.1937.777.10.15.80 DT - Date (DYNAMISCH) 		(IN2dotsent)
@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 en-US Insurance Co. Contact Reason
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Insurance Co Contact Phone Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMISCH) 		(IN2dotsent)
@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 en-US Policy Scope
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Policy Source
Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Patient Member Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 801
@Type
 0 … 1 F CX
@LongName
 0 … 1 F Patient Member Number
hl7v2:IN2.62
 CE 0 … 1 en-US Guarantor's Relationship To Insured
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Insured's Phone Number - Home
Bevat 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 803
@Type
 0 … 1 F XTN
@LongName
 0 … 1 F Insured's Phone Number - Home
hl7v2:IN2.64
 XTN 0 … * en-US Insured's Employer Phone Number
Bevat 2.16.840.1.113883.3.1937.777.10.15.77 XTN - Extended telecommunications number (DYNAMISCH) 		(IN2dotsent)
@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 en-US Military Handicapped Program
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US Suspend Flag
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Copay Limit Flag
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 en-US Stoploss Limit Flag
Bevat 2.16.840.1.113883.3.1937.777.10.15.83 ID - Coded value for HL7 defined tables (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Insured Organization Name and ID
Bevat 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMISCH) 		(IN2dotsent)
@Item
 0 … 1 F 809
@Type
 0 … 1 F XON
@LongName
 0 … 1 F Insured Organization Name and ID
hl7v2:IN2.70
 XON 0 … * en-US Insured Employer Organization Name and ID
Bevat 2.16.840.1.113883.3.1937.777.10.15.75 XON - Extended composite name and ID number for organizations (DYNAMISCH) 		(IN2dotsent)
@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 … * en-US Race
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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 en-US CMS Patient_s Relationship to Insured
Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) 		(IN2dotsent)
@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