RIC         1  3                                        C RECORD INDENTIFICATION CODE

FILEYR      4  2                                        C YY REFERENCE YEAR OF RECORD

BASEID      6  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                               4,529             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C UNIQUE EVENT IDENTIFIER

                               1,326            C000-C999 EVENT CREATED FROM CLAIM
                               3,203            0000-9999 SURVEY REPORTED EVENT

OREVTYPE   18  2  $EVNTTYP                              C ORIGINAL REPORTED EVENT TYPE

                               1,326
                                   0                   DU DENTAL
                                   0                   ER EMERGENCY ROOM
                               3,162                   IP INPATIENT
                                  41                   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?

                               4,190                    0 EVENT NOT PROV BY HMO
                                 339                    1 EVENT PROVIDED BY HMO

EVBEGYY    27  2  EVYY                                  N EVENT BEGIN YEAR

                                   2                   -8 DK
                               4,527                 1-99 YEAR

EVBEGMM    29  2  EVMM                                  N EVENT BEGIN MONTH

                                   3                   -8 DK
                               4,526                 1-12 MONTH
                                   0                   95 STILL IN PROGRESS

EVBEGDD    31  2  EVDD                                  N EVENT BEGIN YEAR

                                  29                   -8 DK
                                   0                   -5 MULTIPLE VISITS THIS MONTH
                               4,500                 1-31 DAY OF MONTH

EVENDYY    33  2  EVYY                                  N EVENT END YEAR

                                   1                   -9 NOT ASCERTAINED
                                   5                   -8 DK
                                   2                   -1 INAPPLICABLE
                               4,521                 1-99 YEAR

EVENDMM    35  2  EVMM                                  N EVENT END MONTH

                                   2                   -9 NOT ASCERTAINED
                                   6                   -8 DK
                               4,519                 1-12 MONTH
                                   2                   95 STILL IN PROGRESS

EVENDDD    37  2  EVDD                                  N EVENT END YEAR

                                   2                   -9 NOT ASCERTAINED
                                  28                   -8 DK
                                   0                   -5 MULTIPLE VISITS THIS MONTH
                                   2                   -1 INAPPLICABLE
                               4,497                 1-31 DAY OF MONTH

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

                                 359                    1 SURVEY ONLY
                               1,326                    2 CLAIMS ONLY
                               2,844                    3 BOTH SURVEY & CLAIMS

SITCODE    40  1  $SITCODE                              C COMMUNITY OR FACILITY SETTING?

                               3,680                    C COMMUNITY
                                 390                    D DEEMED COMMUNITY
                                 438                    F FACILITY
                                  21                    G DEEMED FACILITY

AMTTOT     41  9  MONYFMT                               N TOTAL PAYMENT

                               4,529                      AMOUNT AS $$$$$$.CC

IMPATOT    50  1  IMPFLAG                               N IMPUTATION FLAG:  TOTAL PAYMENT

                               3,574                    0 NOT IMPUTED
                                 955                    1 IMPUTED

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

                               4,529                      AMOUNT AS $$$$$$.CC

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

                               4,529                      AMOUNT AS $$$$$$.CC

AMTCARE    69  9  MONYFMT                               N AMOUNT PAID BY MEDICARE

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSCARE   78  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICARE

                               4,525                    0 NOT IMPUTED
                                   4                    1 IMPUTED

IMPACARE   79  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICARE

                               4,468                    0 NOT IMPUTED
                                  61                    1 IMPUTED

AMTCAID    80  9  MONYFMT                               N AMOUNT PAID BY MEDICAID

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSCAID   89  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICAID

                               4,231                    0 NOT IMPUTED
                                 298                    1 IMPUTED

IMPACAID   90  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICAID

                               3,735                    0 NOT IMPUTED
                                 794                    1 IMPUTED

AMTHMOM    91  9  MONYFMT                               N AMOUNT PAID BY MEDICARE HMO

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSHMOM  100  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICARE HMO

                               4,473                    0 NOT IMPUTED
                                  56                    1 IMPUTED

IMPAHMOM  101  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICARE HMO

                               4,381                    0 NOT IMPUTED
                                 148                    1 IMPUTED

AMTHMOP   102  9  MONYFMT                               N AMOUNT PAID BY PRIVATE HMO

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSHMOP  111  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIVATE HMO

                               4,498                    0 NOT IMPUTED
                                  31                    1 IMPUTED

IMPAHMOP  112  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIVATE HMO

                               4,468                    0 NOT IMPUTED
                                  61                    1 IMPUTED

AMTVA     113  9  MONYFMT                               N AMOUNT PAID BY VETERANS ADM

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSVA    122  1  IMPFLAG                               N IMPUTATION FLAG: SOP VETERANS ADM

                               4,523                    0 NOT IMPUTED
                                   6                    1 IMPUTED

IMPAVA    123  1  IMPFLAG                               N IMPUTATION FLAG: AMT VETERANS ADM

                               4,452                    0 NOT IMPUTED
                                  77                    1 IMPUTED

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

                               4,529                      AMOUNT AS $$$$$$.CC

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

                               4,150                    0 NOT IMPUTED
                                 379                    1 IMPUTED

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

                               4,052                    0 NOT IMPUTED
                                 477                    1 IMPUTED

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

                               4,529                      AMOUNT AS $$$$$$.CC

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

                               4,127                    0 NOT IMPUTED
                                 402                    1 IMPUTED

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

                               4,012                    0 NOT IMPUTED
                                 517                    1 IMPUTED

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

                               4,529                      AMOUNT AS $$$$$$.CC

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

                               4,490                    0 NOT IMPUTED
                                  39                    1 IMPUTED

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

                               4,490                    0 NOT IMPUTED
                                  39                    1 IMPUTED

AMTOOP    157  9  MONYFMT                               N AMOUNT PAID BY PERSON/FAMILY

                               4,529                      AMOUNT AS $$$$$$.CC

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

                               3,884                    0 NOT IMPUTED
                                 645                    1 IMPUTED

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

                               3,767                    0 NOT IMPUTED
                                 762                    1 IMPUTED

AMTDISC   168  9  MONYFMT                               N AMOUNT OF UNCOLLECTED LIABILITIES

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSDISC  177  1  IMPFLAG                               N IMPUTATION FLAG: SOP UNCOLL LIAB

                               4,362                    0 NOT IMPUTED
                                 167                    1 IMPUTED

IMPADISC  178  1  IMPFLAG                               N IMPUTATION FLAG: AMT UNCOLL LIAB

                               4,343                    0 NOT IMPUTED
                                 186                    1 IMPUTED

AMTOTH    179  9  MONYFMT                               N AMOUNT PAID BY OTHER SOURCES

                               4,529                      AMOUNT AS $$$$$$.CC

IMPSOTH   188  1  IMPFLAG                               N IMPUTATION FLAG: SOP OTHER SOURCES

                               4,475                    0 NOT IMPUTED
                                  54                    1 IMPUTED

IMPAOTH   189  1  IMPFLAG                               N IMPUTATION FLAG: AMT OTHER SOURCES

                               4,453                    0 NOT IMPUTED
                                  76                    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

DRG       207  3                                        C DIAGNOSIS RELATED GROUP FROM CLAIM

PROCCNT   210  2                                        N NUMBER OF PROCEDURE CODES ON CLAIM

PROC1     212  4                                        C FIRST PROCEDURE CODE FROM CLAIMS

PROV      216  5                                        C PROVIDER NUMBER FROM CLAIM

STATUS    221  2                                        C BENE STATUS AS OF THRU DATE ON CLAIM

UTLZNDAY  223  3                                        N NUMBER OF COVERED DAYS OF CARE

COINDAY   226  2                                        N TOTAL NUMBER OF COINSURANCE DAYS

LRDAYS    228  2                                        N NUMBER OF LIFETIME RESERVE DAYS USED

