RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             342,414             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,603                      Missing
                             180,238            C000-C999 Event created from claim
                             160,573            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
                             178,587                   MP Medical provider
                              40,934                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              68,169                   SD Separately billing physician
                              54,724                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             181,841                      Missing
                                   0                   DU Dental
                                 779                   ER Emergency Room
                                 416                   IP Inpatient
                                   0                   IU Institutional utilization
                             115,386                   MP Medical provider
                              19,152                   OM Other medical expense
                               2,931                   OP Outpatient
                                   0                   PM Prescribed medicine
                              17,914                   SD Separately billing physician
                               3,995                   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

                              77,153
                              21,131                    D DME claim
                             242,527                    P Physician claim
                               1,603                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                 166                   -8 Don't know
                                  14                   -9 Not ascertained
                             342,234                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                                   4                   -7 Refused
                               1,550                   -8 Don't know
                                  19                   -9 Not ascertained
                                   0                   95 Still in progress
                             340,841                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  28                   -7 Refused
                              37,871                   -8 Don't know
                                  19                   -9 Not ascertained
                             304,496                      Day of month

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

                              77,153                    1 Survey only
                             181,841                    2 Claims only
                              83,420                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 330                    B Both community & facility
                             290,359                    C Community
                              13,247                    D Deemed community
                              32,613                    F Facility
                                 636                    G Deemed facility
                               5,229                    S SNF

AMTTOT     38  9                                        N Total payment

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

                             236,832                    0 Not imputed
                             105,582                    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?

                             341,360                    0 Not imputed
                               1,054                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             326,316                    0 Not imputed
                              16,098                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             313,260                    0 Not imputed
                              29,154                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             289,504                    0 Not imputed
                              52,910                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             326,201                    0 Not imputed
                              16,213                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             318,990                    0 Not imputed
                              23,424                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             332,573                    0 Not imputed
                               9,841                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             329,608                    0 Not imputed
                              12,806                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             342,232                    0 Not imputed
                                 182                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             341,000                    0 Not imputed
                               1,414                    1 Imputed

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

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             303,707                    0 Not imputed
                              38,707                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             294,180                    0 Not imputed
                              48,234                    1 Imputed

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

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             308,524                    0 Not imputed
                              33,890                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             300,893                    0 Not imputed
                              41,521                    1 Imputed

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

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             336,942                    0 Not imputed
                               5,472                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             336,942                    0 Not imputed
                               5,472                    1 Imputed

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

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             288,766                    0 Not imputed
                              53,648                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             265,613                    0 Not imputed
                              76,801                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             332,726                    0 Not imputed
                               9,688                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             331,113                    0 Not imputed
                              11,301                    1 Imputed

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

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             342,075                    0 Not imputed
                                 339                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             340,503                    0 Not imputed
                               1,911                    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

                             182,196                    . Missing
                                   7                   -9 Not ascertained
                                 338                   -8 Don't know
                              39,462                   -1 Inapplicable
                                  22                    1 Dentist or dental provider
                              88,817                    2 Medical doctor
                                 443                    3 Audiologist
                               6,443                    4 Chiropractor
                                 190                    5 Clinical Social Worker
                                  55                    6 Dietician or nutritionist
                                  14                    7 Hearing therapist
                                 134                    8 Home health/health aide
                                   1                    9 Homemaker
                                  76                   10 Hospice worker
                                 155                   11 I.V. Therapist
                               1,181                   12 Nurse (RN)
                                 422                   13 Nurse Practitioner
                                  20                   14 Nurse's aide
                                 196                   15 Occupational Therapist (OT)
                               2,368                   16 Optometrist
                                 150                   17 Osteopath (DO)
                                 117                   18 Paramedic
                               8,340                   19 Physical Therapist (PT)
                                 298                   20 Physician's Assistant
                               2,820                   21 Podiatrist (foot doctor)
                               1,333                   22 Psychologist
                                 237                   23 Respiratory Therapist
                                 512                   24 Social/case worker
                                  40                   25 Speech Therapist
                                 386                   26 Therapist (mental health)
                                 986                   27 X-Ray Technician
                                  28                   28 Licensed Practical Nurse (LPN)
                                 231                   29 Acupuncturist
                                   7                   30 Homeopath
                                 777                   31 Massage therapist
                                  46                   32 Naturopath
                                 119                   33 Licensed Professional Counselor (LPC)
                               1,273                   34 Lab Technician
                               2,174                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             164,471                    . Missing
                             141,421                   -1 Inapplicable
                               2,326                    1 Eyeglasses
                                 650                    2 Hearing or speech device
                               2,397                    3 Orthopedic
                               8,834                    4 Diabetic
                               4,210                    5 Ambulance
                                 187                    6 Prosthesis
                                 238                    7 Alteration
                               6,813                    8 Oxygen
                                  51                    9 Kidney dialysis
                              10,816                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             181,462                    . Missing
                             158,556                   -1 Inapplicable
                                 615                    1 Braces or supports
                                 212                    2 Cane
                                 334                    3 Corrective shoes or inserts
                                  38                    4 Crutches
                                 577                    5 Walker
                                 381                    6 Wheelchair
                                 172                    7 Stockings
                                  67                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             182,133                    . Missing
                             160,043                   -1 Inapplicable
                                  13                    1 Elevator or incline chair
                                  44                    2 Handrails (other than tub)
                                  38                    3 Ramps
                                  46                    4 Tub handrails
                                  16                    5 Tub seat
                                   3                    6 Any car alteration
                                  78                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of other medical event

                             178,465                    . Missing
                             153,142                   -1 Inapplicable
                                 246                    1 Portable or raised toilet
                                  91                    2 Portable tub seat
                                 101                    3 Special chair or cushion
                                 674                    4 Hospital bed
                                 592                    5 Ostomy supplies
                               5,132                    6 Depends (diapers)
                                 385                    7 Bandages, dressings, tape supplies
                                 451                    8 Pulmonary equipment
                                 127                    9 Blood pressure equipment
                               3,008                   91 Other

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

                             271,954                    0 Event not provided by HMO
                              68,857                    1 Event provided by HMO
                               1,603                    3 Event provided by PDP/MAPD

