MSH|^~\&|FLHIE|FL_ABCDEFG^ABCEDEFG HOSPITAL|FL_RECIPIENT^Name Org Receiving Notification||20261014145833689||ADT^A04|cb48a901-7122-4bac-b4b3-2d46f67d6c40|P|2.5|||||
EVN|A04|20261014105727
PID|1||123456^^^FL_BAPTISTSF^PI~5555555^^^FL_RECIPIENT^MR||PARKER^PETER^G||19400101|M||2106-3|123 SPIDER WAY^^FORT LAUDERDALE^FL^33308-2712||12341234~12341234|12341234|ENGLISH|||||||2186-5||||||||N|
NK1|1|PARKER^PETERA|Spouse|123 SPIDER WAY^^FORT LAUDERDALE^FL^^US|(555)444-3333^NH^H^^^234^45678~(123)555-6666^NM^M^^^123^1234567||1^Emergency Contact^EC|||||||||||||eng||||||||||||||||||||(111)222-3333^NM^M^^^111^222234~(234)234-2344^NH^H^^^123^1234567~^NET^Internet^spiders@gmail.com
PV1|1|O|HCFHDORTPT^^^HFPL^^^HCFHD^^^^DEPID|ELECTIVE|||RFXM1111^DOCTOR^ABBAS^A^^^^^PROVID^^^^PROVID~111111111^DOCTOR^ABBAS^A^^^^^NPI^^^^NPI~RFXM55555^DOCTOR^ABBAS^A^^^^^EMPID^^^^EMPID|111111^SMITH^JUSTIN^^^^^^PROVID^^^^PROVID~1386940450^SMITH^JUSTIN^^^^^^NPI^^^^NPI~brcd111^SMITH^JUSTIN^^^^^^EMPID^^^^EMPID||||||Phys/Clinic|||||1000690594175|CARE||||||||||||||||||||||||20261014105722|||625
PV2||||||||20261014111000||||50||||||||||N||||||||||N
OBX|1|NM|PrimaryCSN|1|100069212345||||||F
OBX|2|TX|PACE_DATES^PATIENT NAME|1
OBX|3|TX|HAR_ITEMS^VISIT HOSPITAL ACCOUNT|1|ACCT_CLASS_HAR^115~ACCT_BASECLS_HAR^2~SBO_HAR_TYPE^0~PATIENT_STATUS|||||||||20261014
OBX|4|TX|APPT_STATUS^APPT STATUS|1|6|||||||||20261014
OBX|5|NM|APPT_DEP_ITEMS^APPT DEPARTMENT|1|APPT_DEP_GROUPER_14~APPT_DEP_SPECIALTY^34|||||||||20261014
OBX|6|TX|APPT_TYPE_ITEMS^APPT PROCEDURES|1|10052^PT TREATMENT|||||||||20261014
AL1|1|DRUG INGREDI|16121^PENICILLIN^HIC|||20240101
AL1|2|DRUG|3364^SULFAMETHOXAZOLE-TRIMETHOPRIM^MEDNAMEID|||20230101|||Intolerance
DG1|1|I10|Z96.641^Presence of right artificial hip joint^I10|Presence of right artificial hip joint||^W
GT1|1|1112222222|SMITH^JOHN^G^^^^L||12345 15TH ST^^FORT LAUDERDALE^FL^33308-2712^US^^^BROWARD|(123)555-6666^P^H^^^234^2345678||19400101|M|P/F|SLF|560-50-5048|||||^^^^^US|||Retired||||||PENDING REVI|137000|2
IN1|1|400000000^MEDICARE PART A & B^PLANID||MEDICARE|PO BOX 7149^^INDIANAPOLIS^IN^46206-6474|||||||20060501|||Medicare|FINKLE^DAVID^G|Self|19410529|123 SPIDER WAY^^FORT LAUDERDALE^FL^33308-2712^US^^^BROWARD|||1*1|||YES|20261006131036|||||||||6611111|5ABCADEFG4|||||||M||||BOTH
IN1|2|10000000^BANKERS LIFE CASUALTY^PLANID|100000^^^^PAYORID|BANKERS LIFE CASUALTY|PO BOX 1935^^CARMEL^IN^46082|||||||20060501||||PARKER^PETER^G|Self|19410101|123 SPIDER WAY^^FORT LAUDERDALE^FL^33308-2712^US^^^BROWARD|||2*2|||YES|20230120160000|||||||||6634438|20601111111|||||||M||||BOTH
ZSH|0|2