Position
Element
Name
Type
Requirement
Min
Max
Repeat
010Object identifier
String (AN)
Mandatory
1
35
4
Code specifying the unique identity of an object.
020
Date/time/period
Composite (composite)
Conditional
5
010Date or time or period function code qualifier
String (AN)
Mandatory
1
3
-
Code qualifying the function of a date, time or period.
020Date or time or period value
String (AN)
Conditional
1
35
-
The value of a date, a date and time, a time or of a period in a specified representation.
030Date or time or period format code
String (AN)
Conditional
1
3
-
Code specifying the representation of a date, time or period.
030
Service
Composite (composite)
Conditional
1
010Product identifier
String (AN)
Mandatory
1
35
-
To identify a product.
020Code list identification code
String (AN)
Conditional
1
17
-
Code identifying a code list.
030Procedure modification code
String (AN)
Conditional
1
3
-
Code specifying the procedure modification.
040Procedure modification code
String (AN)
Conditional
1
3
-
Code specifying the procedure modification.
050Procedure modification code
String (AN)
Conditional
1
3
-
Code specifying the procedure modification.
060Procedure modification code
String (AN)
Conditional
1
3
-
Code specifying the procedure modification.
040Quantity
String (AN)
Conditional
1
35
2
Alphanumeric representation of a quantity.
050Monetary amount
Numeric (N)
Conditional
1
35
5
To specify a monetary amount.
060Index value
String (AN)
Conditional
1
35
4
To specify the value of an index.
070Facility type description code
String (AN)
Conditional
1
3
1
Code specifying the facility type.
080Service type code
String (AN)
Conditional
1
3
1
Code specifying the type of service.
090Special condition code
String (AN)
Conditional
1
3
9
Code specifying a special condition.
100
Supporting evidence
Composite (composite)
Conditional
1
010Supporting evidence type code qualifier
String (AN)
Mandatory
1
3
-
Code qualifying the type of supporting evidence.
020Reference identifier
String (AN)
Mandatory
1
70
-
Identifies a reference.
030Communication medium type code
String (AN)
Conditional
1
3
-
Code specifying the type of communication medium.