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
3
-
 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
35
-
 Identifies a reference.
030Communication medium type code
String (AN)
Conditional
1
3
-
 Code specifying the type of communication medium.