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Field Separator | Encoding Characters ^~\& Sending Application HL7Bridge Sending Facility HL7BridgeParser Receiving Application RECEIVING_APPLICATION Receiving Facility RECEIVING_FACILITY Date/Time of Message 20110613072049 Security Message Type ADT^A08 Message Control ID 934579920110613000000 Processing ID P Version ID 2.3 Sequence Number Continuation Pointer Accept Acknowledgment Type Application Acknowledgment Type
Event Type Code A08 Recorded Date/Time 20110613072049 Date/Time Planned Event Event Reason Code Operator ID
Set ID - PID 1 Patient ID Patient Identifier List 135769 Alternate Patient ID - PID Patient Name MOUSE^MICKEY Mother's Maiden Name Date/Time of Birth 19281118 Administrative Sex M Patient Alias Race Patient Address 123 Main St.^^Lake Buena vista^fl^32830 County Code Phone Number - Home (407)939-1289^^^themainmouse@disney.com Phone Number - Business Primary Language Marital Status Religion Patient Account Number 1719 SSN Number - Patient 99999999 Driver's License Number - Patient Mother's Identifier Ethnic Group Birth Place Multiple Birth Indicator Birth Order Citizenship Veterans Military Status Nationality Patient Death Date and Time Patient Death Indicator Identity Unknown Indicator Identity Reliability Code Last Update Date/Time Last Update Facility Taxonomic Classification Code Breed Code Strain Production Class Code Tribal Citizenship
Set ID - PV1 1 Patient Class O Assigned Patient Location Admission Type Preadmit Number Prior Patient Location Attending Doctor 7^Disney^Walt^^MD Referring Doctor Consulting Doctor Hospital Service Temporary Location Preadmit Test Indicator Re-admission Indicator Admit Source Ambulatory Status VIP Indicator Admitting Doctor Patient Type Visit Number Financial Class Charge Price Indicator Courtesy Code Credit Rating Contract Code Contract Effective Date Contract Amount Contract Period Interest Code Transfer to Bad Debt Code Transfer to Bad Debt Date Bad Debt Agency Code Bad Debt Transfer Amount Bad Debt Recovery Amount Delete Account Indicator Delete Account Date Discharge Disposition Discharged to Location Diet Type Servicing Facility Bed Status Account Status Pending Location Prior Temporary Location Admit Date/Time Discharge Date/Time Current Patient Balance Total Charges Total Adjustments Total Payments Alternate Visit ID Visit Indicator Other Healthcare Provider
Set ID - GT1 1 Guarantor Number 78 Guarantor Name MOUSE^MARSHALL Guarantor Spouse Name Guarantor Address 123 Main St.^^Lake Buena Vista^FL^32830 Guarantor Ph Num - Home (407)939-1289 Guarantor Ph Num - Business Guarantor Date/Time Of Birth 19190101 Guarantor Administrative Sex M Guarantor Type Guarantor Relationship Guarantor SSN Guarantor Date - Begin Guarantor Date - End Guarantor Priority Guarantor Employer Name Guarantor Employer Address Guarantor Employer Phone Number Guarantor Employee ID Number Guarantor Employment Status Guarantor Organization Name Guarantor Billing Hold Flag Guarantor Credit Rating Code Guarantor Death Date And Time Guarantor Death Flag Guarantor Charge Adjustment Code Guarantor Household Annual Income Guarantor Household Size Guarantor Employer ID Number Guarantor Marital Status Code Guarantor Hire Effective Date Employment Stop Date Living Dependency Ambulatory Status Citizenship Primary Language Living Arrangement Publicity Code Protection Indicator Student Indicator Religion Mother's Maiden Name Nationality Ethnic Group Contact Person's Name Contact Person's Telephone Number Contact Reason Contact Relationship Job Title Job Code/Class Guarantor Employer's Organization Name Handicap Job Status Guarantor Financial Class Guarantor Race
Set ID - IN1 1 Health Plan ID Insurance Company ID 1 Insurance Company Name ABC Insurance Medicaid Insurance Company Address P O Box 12345^^Atlanta^GA^30348 Insurance Co Contact Person Claims^Florida Insurance Co Phone Number (555)555-1234 Group Number G1234 Group Name Insured's Group Emp ID Insured's Group Emp Name Plan Effective Date Plan Expiration Date Authorization Information Plan Type G Name Of Insured Mouse^Mickey Insured's Relationship To Patient SELF Insured's Date Of Birth 19281118 Insured's Address 123 Main St.^^Lake Buena Vista^FL^32830 Assignment Of Benefits Y Coordination Of Benefits Coord Of Ben. Priority Notice Of Admission Flag Notice Of Admission Date Report Of Eligibility Flag Report Of Eligibility Date Release Information Code Pre-Admit Cert (PAC) Verification Date/Time Verification By Type Of Agreement Code Billing Status P Lifetime Reserve Days Delay Before L.R. Day Company Plan Code Policy Number ZYX1234589-1 Policy Deductible Policy Limit - Amount Policy Limit - Days Room Rate - Semi-Private Room Rate - Private Insured's Employment Status Insured's Administrative Sex M Insured's Employer's Address Verification Status Prior Insurance Plan ID Coverage Type M Handicap Insured's ID Number
Insured's Employee ID Insured's Social Security Number Insured's Employer's Name and ID Employer Information Data Mail Claim Party Medicare Health Ins Card Number ZYX1234589-1 Medicaid Case Name Medicaid Case Number Military Sponsor Name Military ID Number ZYX1234589-1 Dependent Of Military Recipient Military Organization Military Station Military Service Military Rank/Grade Military Status Military Retire Date Military Non-Avail Cert On File Baby Coverage Combine Baby Bill Blood Deductible Special Coverage Approval Name Special Coverage Approval Title Non-Covered Insurance Code Payor ID 000079 Payor Subscriber ID Eligibility Source Room Coverage Type/Amount Policy Type/Amount Daily Deductible Living Dependency Ambulatory Status Citizenship Primary Language Living Arrangement Publicity Code Protection Indicator Student Indicator Religion Mother's Maiden Name Nationality Ethnic Group Marital Status Insured's Employment Start Date Employment Stop Date Job Title Job Code/Class Job Status Employer Contact Person Name Employer Contact Person Phone Number Employer Contact Reason Insured's Contact Person's Name Insured's Contact Person Phone Number Insured's Contact Person Reason Relationship to the Patient Start Date Relationship to the Patient Stop Date Insurance Co Contact Reason Insurance Co Contact Phone Number Policy Scope Policy Source Patient Member Number Guarantor's Relationship to Insured Insured's Phone Number - Home (206)446-5080^^^^^260^4465080 Insured's Employer Phone Number Military Handicapped Program Suspend Flag Copay Limit Flag Stoploss Limit Flag Insured Organization Name and ID Insured Employer Organization Name and ID Race Patient's Relationship to Insured SELF
Message Summary Copy This HL7 ADT^A08 message (Admit/Visit Notification - Update) concerns Mickey Mouse. Key details include patient information, specifically that Mickey Mouse, born on November 18, 1928, resides at 123 Main St., Lake Buena Vista, FL 32830. The message also identifies Marshall Mouse as the guarantor and indicates that Mickey Mouse is insured by ABC Insurance Medicaid, with policy number ZYX1234589-1. The message was generated by HL7Bridge on June 13, 2011, at 07:20:49. 
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