RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             344,779             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,154                      Missing
                             181,264            C000-C999 Event created from claim
                             162,361            0000-9999 Survey-reported event

EVNTTYPE   18  2  $EVNTTYP                              C Event type

                                   0                   DU Dental
                                   0                   ER Emergency Room
                                   0                   IP Inpatient
                                   0                   IU Institutional utilization
                             175,167                   MP Medical provider
                              46,031                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              68,498                   SD Separately billing physician
                              55,083                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             182,418                      Missing
                                   0                   DU Dental
                                 827                   ER Emergency Room
                                 364                   IP Inpatient
                                   0                   IU Institutional utilization
                             113,123                   MP Medical provider
                              22,511                   OM Other medical expense
                               2,913                   OP Outpatient
                                   0                   PM Prescribed medicine
                              18,777                   SD Separately billing physician
                               3,846                   SL Separately billing lab

CLAIMID    22  7                                        N Claim this survey event matched to

CLAIMTYP   29  1  $CLAIMTP                              C Claim type that event matched to

                              66,954
                              23,155                    D DME claim
                             253,516                    P Physician claim
                               1,154                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                  92                   -8 Don't know
                                   9                   -9 Not ascertained
                             344,678                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                               1,091                   -8 Don't know
                                  24                   -9 Not ascertained
                                   0                   95 Still in progress
                             343,664                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  10                   -7 Refused
                              15,733                   -8 Don't know
                                  24                   -9 Not ascertained
                             329,012                      Day of month

SOURCE     36  1  $SOURCE                               C Source of event: survey, claim, or both?

                              66,954                    1 Survey only
                             182,418                    2 Claims only
                              95,407                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 296                    B Both community & facility
                             295,142                    C Community
                               9,183                    D Deemed community
                              31,403                    F Facility
                               1,465                    G Deemed facility
                               7,290                    S SNF

AMTTOT     38  9                                        N Total payment

IMPATOT    47  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                             239,328                    0 Not imputed
                             105,451                    1 Imputed

AMTCOV     48  9                                        N Medicare program liability, incl. copays

AMTNCOV    57  9                                        N Total payment not covered by Medicare

AMTCARE    66  9                                        N Amount paid by Medicare

IMPSCARE   75  1  IMPFLAG                               N AMTCARE payment source imputed?

                             344,180                    0 Not imputed
                                 599                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             331,762                    0 Not imputed
                              13,017                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             310,096                    0 Not imputed
                              34,683                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             282,931                    0 Not imputed
                              61,848                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             335,763                    0 Not imputed
                               9,016                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             331,564                    0 Not imputed
                              13,215                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             337,609                    0 Not imputed
                               7,170                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             335,472                    0 Not imputed
                               9,307                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             344,653                    0 Not imputed
                                 126                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             343,535                    0 Not imputed
                               1,244                    1 Imputed

AMTPRVE   121  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             306,453                    0 Not imputed
                              38,326                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             296,862                    0 Not imputed
                              47,917                    1 Imputed

AMTPRVI   132  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             310,591                    0 Not imputed
                              34,188                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             303,980                    0 Not imputed
                              40,799                    1 Imputed

AMTPRVU   143  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             338,532                    0 Not imputed
                               6,247                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             338,532                    0 Not imputed
                               6,247                    1 Imputed

AMTOOP    154  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             288,783                    0 Not imputed
                              55,996                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             265,524                    0 Not imputed
                              79,255                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             335,959                    0 Not imputed
                               8,820                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             334,125                    0 Not imputed
                              10,654                    1 Imputed

AMTOTH    176  9                                        N Amount paid by other payor(s)

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             344,396                    0 Not imputed
                                 383                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             343,246                    0 Not imputed
                               1,533                    1 Imputed

PAMTMED   187  9                                        N Total amount paid for medical services

PAMTSURG  196  9                                        N Total amount paid for surgical services

PAMTLABX  205  9                                        N Total amount paid for lab/X-Ray

PAMTOM    214  9                                        N Total payment for other medical services

PAMTPM    223  9                                        N Total payment for prescribed medicines

PROVSPEC  232  2  PROVSPEC                              N Medical provider specialty

                             182,531                    . Missing
                                  14                   -9 Not ascertained
                                 330                   -8 Don't know
                              41,262                   -1 Inapplicable
                                  44                    1 Dentist or dental provider
                              89,587                    2 Medical doctor
                                 429                    3 Audiologist
                               6,520                    4 Chiropractor
                                 189                    5 Clinical Social Worker
                                  59                    6 Dietician or nutritionist
                                  19                    7 Hearing therapist
                                 148                    8 Home health/health aide
                                  18                    9 Homemaker
                                  89                   10 Hospice worker
                                 147                   11 I.V. Therapist
                               1,427                   12 Nurse (RN)
                                 405                   13 Nurse Practitioner
                                  16                   14 Nurse's aide
                                 383                   15 Occupational Therapist (OT)
                               2,736                   16 Optometrist
                                 158                   17 Osteopath (DO)
                                  78                   18 Paramedic
                               6,423                   19 Physical Therapist (PT)
                                 263                   20 Physician's Assistant
                               2,914                   21 Podiatrist (foot doctor)
                               1,587                   22 Psychologist
                                 149                   23 Respiratory Therapist
                                 435                   24 Social/case worker
                                 153                   25 Speech Therapist
                                 521                   26 Therapist (mental health)
                               1,111                   27 X-Ray Technician
                                  81                   28 Licensed Practical Nurse (LPN)
                                 310                   29 Acupuncturist
                                  11                   30 Homeopath
                                 656                   31 Massage therapist
                                  44                   32 Naturopath
                                 375                   33 Licensed Professional Counselor (LPC)
                                 189                   34 Lab Technician
                               2,968                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             164,134                    . Missing
                             139,850                   -1 Inapplicable
                               2,697                    1 Eyeglasses
                                 872                    2 Hearing or speech device
                               2,568                    3 Orthopedic
                               8,102                    4 Diabetic
                               5,065                    5 Ambulance
                                 178                    6 Prosthesis
                                 384                    7 Alteration
                               7,410                    8 Oxygen
                                  73                    9 Kidney dialysis
                              13,446                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             181,748                    . Missing
                             160,463                   -1 Inapplicable
                                 658                    1 Braces or supports
                                 237                    2 Cane
                                 389                    3 Corrective shoes or inserts
                                  43                    4 Crutches
                                 539                    5 Walker
                                 463                    6 Wheelchair
                                 188                    7 Stockings
                                  51                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             182,405                    . Missing
                             161,990                   -1 Inapplicable
                                  21                    1 Elevator or incline chair
                                  86                    2 Handrails (other than tub)
                                  50                    3 Ramps
                                  50                    4 Tub handrails
                                  14                    5 Tub seat
                                   5                    6 Any car alteration
                                 158                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of other medical event

                             178,186                    . Missing
                             153,149                   -1 Inapplicable
                                 313                    1 Portable or raised toilet
                                  97                    2 Portable tub seat
                                 116                    3 Special chair or cushion
                               1,089                    4 Hospital bed
                               1,654                    5 Ostomy supplies
                               6,005                    6 Depends (diapers)
                                 601                    7 Bandages, dressings, tape supplies
                                 359                    8 Pulmonary equipment
                                 145                    9 Blood pressure equipment
                               3,065                   91 Other

HMO       242  1  $HMO                                  C Event provided by an HMO?

                             296,936                    0 Event not provided by HMO
                              46,689                    1 Event provided by HMO
                               1,154                    3 Event provided by PDP/MAPD

