RIC         1  3                                        C RECORD IDENTIFICATION CODE

FILEYR      4  2                                        C YY REFERENCE YEAR OF RECORD

BASEID      6  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                                 664             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C UNIQUE EVENT IDENTIFIER

                                 480            C000-C999 EVENT CREATED FROM CLAIM
                                 184            0000-9999 SURVEY REPORTED EVENT

OREVTYPE   18  2  $EVNTTYP                              C ORIGINAL REPORTED EVENT TYPE

                                 480
                                   0                   DU DENTAL
                                   0                   ER EMERGENCY ROOM
                                  39                   IP INPATIENT
                                 145                   IU INSTITUTIONAL UTILIZATION
                                   0                   MP MEDICAL PROVIDER
                                   0                   OM OTHER MEDICAL EXPENSE
                                   0                   OP OUTPATIENT
                                   0                   PM PRESCRIBED MEDICINE
                                   0                   SD SEP BILLING DOCTOR
                                   0                   SL SEP BILLING LAB

CLAIMID    20  6                                        N CLAIM THIS SURVEY EVENT MATCHED TO

HMO        26  1  $HMO                                  C EVENT PROVIDED BY AN HMO?

                                 636                    0 EVENT NOT PROV BY HMO
                                  28                    1 EVENT PROVIDED BY HMO

EVBEGYY    27  2  EVYY                                  N EVENT BEGIN YEAR

                                   1                   -8 DK
                                 663                 1-99 YEAR

EVBEGMM    29  2  EVMM                                  N EVENT BEGIN MONTH

                                   2                   -8 DK
                                 662                 1-12 MONTH
                                   0                   95 STILL IN PROGRESS

EVBEGDD    31  2  EVDD                                  N EVENT BEGIN YEAR

                                   6                   -8 DK
                                   0                   -5 MULTIPLE VISITS THIS MONTH
                                 658                 1-31 DAY OF MONTH

EVENDYY    33  2  EVYY                                  N EVENT END YEAR

                                   7                   -8 DK
                                 657                 1-99 YEAR

EVENDMM    35  2  EVMM                                  N EVENT END MONTH

                                   7                   -8 DK
                                 657                 1-12 MONTH
                                   0                   95 STILL IN PROGRESS

EVENDDD    37  2  EVDD                                  N EVENT END YEAR

                                  13                   -8 DK
                                   0                   -5 MULTIPLE VISITS THIS MONTH
                                 651                 1-31 DAY OF MONTH

SOURCE     39  1  $SOURCE                               C SOURCE OF EVENT: SURVEY, CLAIM, OR BOTH?

                                  79                    1 SURVEY ONLY
                                 480                    2 CLAIMS ONLY
                                 105                    3 BOTH SURVEY & CLAIMS

SITCODE    40  1  $SITCODE                              C COMMUNITY OR FACILITY SETTING?

                                 268                    C COMMUNITY
                                  10                    D DEEMED COMMUNITY
                                 382                    F FACILITY
                                   4                    G DEEMED FACILITY

AMTTOT     41  9  MONYFMT                               N TOTAL PAYMENT

                                 664                      AMOUNT AS $$$$$$.CC

IMPATOT    50  1  IMPFLAG                               N IMPUTATION FLAG:  TOTAL PAYMENT

                                 570                    0 NOT IMPUTED
                                  94                    1 IMPUTED

AMTCOV     51  9  MONYFMT                               N PORTION OF TOTAL PAY COV BY MEDICARE

                                 664                      AMOUNT AS $$$$$$.CC

AMTNCOV    60  9  MONYFMT                               N PORTION OF TOTAL PAY NOT COV BY MEDICARE

                                 664                      AMOUNT AS $$$$$$.CC

AMTCARE    69  9  MONYFMT                               N AMOUNT PAID BY MEDICARE

                                 664                      AMOUNT AS $$$$$$.CC

IMPSCARE   78  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICARE

                                 663                    0 NOT IMPUTED
                                   1                    1 IMPUTED

IMPACARE   79  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICARE

                                 662                    0 NOT IMPUTED
                                   2                    1 IMPUTED

AMTCAID    80  9  MONYFMT                               N AMOUNT PAID BY MEDICAID

                                 664                      AMOUNT AS $$$$$$.CC

IMPSCAID   89  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICAID

                                 644                    0 NOT IMPUTED
                                  20                    1 IMPUTED

IMPACAID   90  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICAID

                                 499                    0 NOT IMPUTED
                                 165                    1 IMPUTED

AMTHMOM    91  9  MONYFMT                               N AMOUNT PAID BY MEDICARE HMO

                                 664                      AMOUNT AS $$$$$$.CC

IMPSHMOM  100  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICARE HMO

                                 657                    0 NOT IMPUTED
                                   7                    1 IMPUTED

IMPAHMOM  101  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICARE HMO

                                 655                    0 NOT IMPUTED
                                   9                    1 IMPUTED

AMTHMOP   102  9  MONYFMT                               N AMOUNT PAID BY PRIVATE HMO

                                 664                      AMOUNT AS $$$$$$.CC

IMPSHMOP  111  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIVATE HMO

                                 661                    0 NOT IMPUTED
                                   3                    1 IMPUTED

IMPAHMOP  112  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIVATE HMO

                                 659                    0 NOT IMPUTED
                                   5                    1 IMPUTED

AMTVA     113  9  MONYFMT                               N AMOUNT PAID BY VETERANS ADM

                                 664                      AMOUNT AS $$$$$$.CC

IMPSVA    122  1  IMPFLAG                               N IMPUTATION FLAG: SOP VETERANS ADM

                                 664                    0 NOT IMPUTED
                                   0                    1 IMPUTED

IMPAVA    123  1  IMPFLAG                               N IMPUTATION FLAG: AMT VETERANS ADM

                                 661                    0 NOT IMPUTED
                                   3                    1 IMPUTED

AMTPRVE   124  9  MONYFMT                               N AMOUNT PAID BY PRIV INS (EMPLOYER SPONS)

                                 664                      AMOUNT AS $$$$$$.CC

IMPSPRVE  133  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIV INS-EMPLOYER

                                 629                    0 NOT IMPUTED
                                  35                    1 IMPUTED

IMPAPRVE  134  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIV INS-EMPLOYER

                                 627                    0 NOT IMPUTED
                                  37                    1 IMPUTED

AMTPRVI   135  9  MONYFMT                               N AMOUNT PAID BY PRIV INS (INDIV PURCH)

                                 664                      AMOUNT AS $$$$$$.CC

IMPSPRVI  144  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIV INS-INDIV PUR

                                 625                    0 NOT IMPUTED
                                  39                    1 IMPUTED

IMPAPRVI  145  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIV INS-INDIV PUR

                                 624                    0 NOT IMPUTED
                                  40                    1 IMPUTED

AMTPRVU   146  9  MONYFMT                               N AMOUNT PAID BY PRIV INS (UNKNOWN PURCH)

                                 664                      AMOUNT AS $$$$$$.CC

IMPSPRVU  155  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIV INS-UNKNOWN

                                 569                    0 NOT IMPUTED
                                  95                    1 IMPUTED

IMPAPRVU  156  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIV INS-UNKNOWN

                                 569                    0 NOT IMPUTED
                                  95                    1 IMPUTED

AMTOOP    157  9  MONYFMT                               N AMOUNT PAID BY PERSON/FAMILY

                                 664                      AMOUNT AS $$$$$$.CC

IMPSOOP   166  1  IMPFLAG                               N IMPUTATION FLAG: SOP PAID BY PERSON

                                 619                    0 NOT IMPUTED
                                  45                    1 IMPUTED

IMPAOOP   167  1  IMPFLAG                               N IMPUTATION FLAG: AMT PAID BY PERSON

                                 598                    0 NOT IMPUTED
                                  66                    1 IMPUTED

AMTDISC   168  9  MONYFMT                               N AMOUNT OF UNCOLLECTED LIABILITIES

                                 664                      AMOUNT AS $$$$$$.CC

IMPSDISC  177  1  IMPFLAG                               N IMPUTATION FLAG: SOP UNCOLL LIAB

                                 661                    0 NOT IMPUTED
                                   3                    1 IMPUTED

IMPADISC  178  1  IMPFLAG                               N IMPUTATION FLAG: AMT UNCOLL LIAB

                                 639                    0 NOT IMPUTED
                                  25                    1 IMPUTED

AMTOTH    179  9  MONYFMT                               N AMOUNT PAID BY OTHER SOURCES

                                 664                      AMOUNT AS $$$$$$.CC

IMPSOTH   188  1  IMPFLAG                               N IMPUTATION FLAG: SOP OTHER SOURCES

                                 663                    0 NOT IMPUTED
                                   1                    1 IMPUTED

IMPAOTH   189  1  IMPFLAG                               N IMPUTATION FLAG: AMT OTHER SOURCES

                                 658                    0 NOT IMPUTED
                                   6                    1 IMPUTED

ODIAGCNT  190  2                                        N NUMBER OF DIAGNOSIS CODES ON CLAIM

PRINDIAG  192  5                                        C PRIMARY ICD-9 DIAGNOSIS CODE FROM CLAIM

ODIAG1    197  5                                        C SECOND ICD-9 DIAGNOSIS CODE FROM CLAIM

ODIAG2    202  5                                        C THIRD ICD-9 DIAGNOSIS CODE FROM CLAIM

PROV      207  5                                        C PROVIDER NUMBER FROM CLAIM

STATUS    212  2                                        C BENE STATUS AS OF THRU DATE ON CLAIM

UTLZNDAY  214  3                                        N NUMBER OF COVERED DAYS OF CARE

COINDAY   217  2                                        N TOTAL NUMBER OF COINSURANCE DAYS

