hl7v2:FT1.1
  | 
                                 SI | 
                                 0 … 1 | 
                                  | 
                                   Set ID - FT1 Bevat 2.16.840.1.113883.3.1937.777.10.15.88 SI - Sequence ID (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.18 DR - Date/time range (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.64 TS - Time stamp (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.89 ST - String (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.86 NM - Numeric (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.44 PL - Person location (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.84 IS - Coded value for user-defined tables (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.8 CP - Composite price (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.21 EI - Entity identifier (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.74 XCN - Extended composite ID number and name for persons (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.5 CE - Coded element (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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. Bevat 2.16.840.1.113883.3.1937.777.10.15.11 CWE - Coded with exceptions (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.6 CNE - Coded with no exceptions (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.12 CX - Extended composite ID with check digit (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @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 Bevat 2.16.840.1.113883.3.1937.777.10.15.88 SI - Sequence ID (DYNAMISCH) | 
                                 (FT1 ent) | 
                              
                              
                                 @Item
  | 
                                  | 
                                 0 … 1 | 
                                 F | 
                                 1847 | 
                              
                              
                                 @Type
  | 
                                  | 
                                 0 … 1 | 
                                 F | 
                                 SI | 
                              
                              
                                 @LongName
  | 
                                  | 
                                 0 … 1 | 
                                 F | 
                                 Transaction Reference Key |