RIC         1  1  $RICFMT                               C RIC CODE FOR ADMIN IDENTIFICATION RECORD

                              13,039                    A RIC A - HCFA RECORD SUMMARY

FILEYR      2  2                                        C YY REFERENCE YEAR OF RECORD

BASEID      4  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                              13,039             LOW-HIGH BASEID Count

H_DOB      12  8  $DTE8FMT                              C DATE OF BIRTH

                              13,039                      DATE AS YYYYMMDD

H_DOD      20  6  $DTE6FMT                              C DATE OF DEATH

                              12,367                      MISSING
                                 672        000000-999999 DATE AS YYMMDD

H_DODSRC   26  2  $SRCFMT                               C SOURCE OF DEATH INFORMATION

                              12,368                      NO DATE OF DEATH
                                   0                   01 FROM MEDICARE BILL
                                   0                   03 CLERICAL ENTRY
                                   0                   05 BILL AND CLERICAL
                                 254                   10 PROVEN MBR
                                  46                   11 PROVEN MBR AND BILL
                                 315                   20 UNPROVEN MBR
                                  55                   21 UNPROVEN MBR AND BILL
                                   0                   23 UNPROVEN MBR AND CLERICAL
                                   1                   25 UNPROVEN MBR, BILL AND CLERICAL

H_SEX      28  1  $SEXFMT                               C SEX CODE

                               5,739                    1 MALE
                               7,300                    2 FEMALE

H_RACE     29  1  $RACEFMT                              C RACE CODE

                                 128                      UNKNOWN
                                   0                    0 UNKNOWN
                              11,060                    1 WHITE
                               1,477                    2 BLACK
                                 160                    3 OTHER
                                  48                    4 ASIAN
                                 156                    5 HISPANIC
                                  10                    6 N AMERICAN NATIVE

H_AGE      30  3  AGEFMT                                N AGE

                              13,039                0-999 AGE IN YEARS

D_STRAT    33  1  $AGEFMT                               C MCBS SAMPLE STRATUM

                               1,162                    1  0-44
                               1,246                    2 45-64
                               3,059                    3 65-69
                               1,872                    4 70-74
                               1,859                    5 75-79
                               1,872                    6 80-84
                               1,969                    7 85 +

H_ENT01    34  1  $ENTFMT                               C JAN MEDICARE ENTITLEMENT

                                 362                    A PART A MEDICARE ONLY
                                 119                    B PART B MEDICARE ONLY
                              11,258                    C PART A AND B MEDICARE
                               1,300                    N NO MEDICARE ENTITLEMENT

H_ENT02    35  1  $ENTFMT                               C FEB MEDICARE ENTITLEMENT

                                 358                    A PART A MEDICARE ONLY
                                 119                    B PART B MEDICARE ONLY
                              11,303                    C PART A AND B MEDICARE
                               1,259                    N NO MEDICARE ENTITLEMENT

H_ENT03    36  1  $ENTFMT                               C MAR MEDICARE ENTITLEMENT

                                 371                    A PART A MEDICARE ONLY
                                 121                    B PART B MEDICARE ONLY
                              11,359                    C PART A AND B MEDICARE
                               1,188                    N NO MEDICARE ENTITLEMENT

H_ENT04    37  1  $ENTFMT                               C APR MEDICARE ENTITLEMENT

                                 381                    A PART A MEDICARE ONLY
                                 122                    B PART B MEDICARE ONLY
                              11,414                    C PART A AND B MEDICARE
                               1,122                    N NO MEDICARE ENTITLEMENT

H_ENT05    38  1  $ENTFMT                               C MAY MEDICARE ENTITLEMENT

                                 390                    A PART A MEDICARE ONLY
                                 123                    B PART B MEDICARE ONLY
                              11,482                    C PART A AND B MEDICARE
                               1,044                    N NO MEDICARE ENTITLEMENT

H_ENT06    39  1  $ENTFMT                               C JUN MEDICARE ENTITLEMENT

                                 399                    A PART A MEDICARE ONLY
                                 125                    B PART B MEDICARE ONLY
                              11,554                    C PART A AND B MEDICARE
                                 961                    N NO MEDICARE ENTITLEMENT

H_ENT07    40  1  $ENTFMT                               C JUL MEDICARE ENTITLEMENT

                                 372                    A PART A MEDICARE ONLY
                                 127                    B PART B MEDICARE ONLY
                              11,698                    C PART A AND B MEDICARE
                                 842                    N NO MEDICARE ENTITLEMENT

H_ENT08    41  1  $ENTFMT                               C AUG MEDICARE ENTITLEMENT

                                 378                    A PART A MEDICARE ONLY
                                 123                    B PART B MEDICARE ONLY
                              11,756                    C PART A AND B MEDICARE
                                 782                    N NO MEDICARE ENTITLEMENT

H_ENT09    42  1  $ENTFMT                               C SEP MEDICARE ENTITLEMENT

                                 372                    A PART A MEDICARE ONLY
                                 123                    B PART B MEDICARE ONLY
                              11,794                    C PART A AND B MEDICARE
                                 750                    N NO MEDICARE ENTITLEMENT

H_ENT10    43  1  $ENTFMT                               C OCT MEDICARE ENTITLEMENT

                                 383                    A PART A MEDICARE ONLY
                                 124                    B PART B MEDICARE ONLY
                              11,824                    C PART A AND B MEDICARE
                                 708                    N NO MEDICARE ENTITLEMENT

H_ENT11    44  1  $ENTFMT                               C NOV MEDICARE ENTITLEMENT

                                 388                    A PART A MEDICARE ONLY
                                 124                    B PART B MEDICARE ONLY
                              11,854                    C PART A AND B MEDICARE
                                 673                    N NO MEDICARE ENTITLEMENT

H_ENT12    45  1  $ENTFMT                               C DEC MEDICARE ENTITLEMENT

                                 399                    A PART A MEDICARE ONLY
                                 121                    B PART B MEDICARE ONLY
                              11,888                    C PART A AND B MEDICARE
                                 631                    N NO MEDICARE ENTITLEMENT

H_DOE      46  6  $DTE6FMT                              C ENTITLEMENT START DATE

                                   2                      MISSING
                              13,037        000000-999999 DATE AS YYMMDD

H_DOT      52  6  $DTE6FMT                              C ENTITLEMENT END DATE

                              12,999                      MISSING
                                  40        000000-999999 DATE AS YYMMDD

H_MEDSTA   58  2  $MSCFMT                               C MEDICARE STATUS CODE AS OF DEC 31

                                   1                      UNKNOWN
                              10,611                   10 AGED, NO ESRD
                                  25                   11 AGED, ESRD
                               2,324                   20 DISABLED, NO ESRD
                                  25                   21 DISABLED, ESRD
                                  53                   31 ESRD ONLY

H_LAF      60  2  $LAFFMT                               C STATUS OF SSA BENEFIT CHECK (LAF) DEC 31

                                  32                      UNKNOWN
                                   0                   AD CUR PAY-ADJ FOR DUAL ENTITLEMENT
                                   0                   AF TRANSFER TO ANOTHER PC OR DIO
                                   0                   A9 CUR PAY-MISCELLANEOUS ADJUSTMENT
                              11,893                    C CURRENT PAYMENT STATUS
                                   1                   DW DEFERRED-WORKERS COMP
                                  35                   D2 DEF-RETIREMENT TEST
                                   3                   D3 DEF-D2 FOR PRIMARY
                                   4                   D6 DEF-RECOVER OVERPAYMENT
                                   2                   D9 DEF-MISCELLANEOUS REASON
                                   2                    J ADVANCE FILING-CURRENT PAY
                                   0                   L2 ADVANCED FILING-WORKED INSIDE U S
                                   0                   L3 ADVANCED FILING-INSURED WORKED IN U S
                                   0                    N NOT IN PAY STATUS
                                   0                   RN CUR PAY-PART B REINSTATED
                                   0                    S SUSP-DEFERRED RETIREMENT
                                   3                   SD SUSP-OTHER
                                   0                   SF SUSP-FAILS TO MEET RESIDENCE REQUIRMNT
                                  17                   SH SUSP-GOVERNMENT PENSION
                                   3                   SP SUSP-PUBLIC ASSISTANCE
                                   5                   S0 SUSP-CONTINUING DISABILITY INVESTIG
                                  47                   S2 SUSP-FAILS RETIREMENT TEST
                                   3                   S3 SUSP-PRIMARY ACCOUNT S2
                                   3                   S6 SUSP-CHECK RETURNED FOR ADDRESS
                                  15                   S7 SUSP-VOCATIONAL REHAB REFUSAL
                                   1                   S8 SUSP-PAYEE NOT DETERMINED
                                   2                   S9 SUSP-MISCELLANEOUS REASON
                                   1                   TR TERM-CLAIM WITHDRAWN
                                   0                   T0 TERM-BENEFITS PAID BY ANOTHER AGENCY
                                 631                   T1 TERM-DEATH OF BENEFICIARY
                                   0                   T2 TERM-DEATH OF PRIMARY
                                   1                   T3 TERM-DIVORCE, MARRIAGE, REMARRIAGE
                                   2                   T5 TERM-ENTITLED ON ANOTHER ACCT
                                   5                   T8 TERM-RECOVERY FROM DISABILITY
                                   1                   T9 TERM-MISCELLANEOUS
                                 304                    U ACTIVE UNINSURED STATUS (NO SSA CHECK)
                                   0                   XR TERMINATED -
                                  15                   X1 TERM-DEATH OF INSURED
                                   0                   X5 TERM-ENTITLED TO ANOTHER BENEFIT
                                   8                   X7 TERM OF UNINSURED
                                   0                   X9 TERM MISCELLANEOUS
                                   0                   ZZ ERRONEOUS ENTITLEMENT

H_CENSUS   72  2  $CENFMT                               C CENSUS REGION OF RESIDENCE AS OF DEC 31

                                  25                      UNKNOWN
                                   0                   ** UNKNOWN
                                 409                   01 NEW ENGLAND
                               2,290                   02 MIDDLE ATLANTIC
                               2,169                   03 EAST NORTH CENTRAL
                                 837                   04 WEST NORTH CENTRAL
                               2,681                   05 SOUTH ATLANTIC
                                 762                   06 EAST SOUTH CENTRAL
                               1,321                   07 WEST SOUTH CENTRAL
                                 737                   08 MOUNTAIN
                               1,613                   09 PACIFIC
                                 195                   10 PUERTO RICO

H_METRO    74  1  $METFMT                               C METRO STATUS

                               3,495                    N NON-METRO AREA
                                  25                    U UNKNOWN
                               9,519                    Y METRO AREA

H_HSBEG1   75  6  $DTE6FMT                              C BEGINNING DATE OF LATEST HOSPICE PERIOD

                              12,818                      MISSING
                                 221        000000-999999 DATE AS YYMMDD

H_HSEND1   81  6  $DTE6FMT                              C ENDING DATE OF LATEST HOSPICE PERIOD

                              12,818                      MISSING
                                 221        000000-999999 DATE AS YYMMDD

H_HSBEG2   87  6  $DTE6FMT                              C BEGINNING DATE OF 2ND HOSPICE PERIOD

                              12,993                      MISSING
                                  46        000000-999999 DATE AS YYMMDD

H_HSEND2   93  6  $DTE6FMT                              C ENDING DATE OF 2ND HOSPICE PERIOD

                              12,993                      MISSING
                                  46        000000-999999 DATE AS YYMMDD

H_HSBEG3   99  6  $DTE6FMT                              C BEGINNING DATE OF 3RD HOSPICE PERIOD

                              13,017                      MISSING
                                  22        000000-999999 DATE AS YYMMDD

H_HSEND3  105  6  $DTE6FMT                              C ENDING DATE OF 3RD HOSPICE PERIOD

                              13,017                      MISSING
                                  22        000000-999999 DATE AS YYMMDD

H_HSBEG4  111  6  $DTE6FMT                              C BEGINNING DATE OF 4TH HOSPICE PERIOD

                              13,018                      MISSING
                                  21        000000-999999 DATE AS YYMMDD

H_HSEND4  117  6  $DTE6FMT                              C ENDING DATE OF 4TH HOSPICE PERIOD

                              13,018                      MISSING
                                  21        000000-999999 DATE AS YYMMDD

H_ESRBEG  123  6  $DTE6FMT                              C BEGINNING DATE OF ESRD PERIOD

                              13,039                      MISSING
                                   0        000000-999999 DATE AS YYMMDD

H_ESREND  129  6  $DTE6FMT                              C ENDING DATE OF ESRD PERIOD

                              13,039                      MISSING
                                   0        000000-999999 DATE AS YYMMDD

H_GHPSW   135  1  $GHPSW                                C 1= SOME GROUP HEALTH PARTICIPATION

                              12,321                    0 NO ENROLLMENT
                                 718                    1 SOME ENROLLMENT

H_PLTP01  136  2  $PLNFMT                               C GHP PLAN TYPE JAN

                              12,393                      NO ENROLLMENT FOR MONTH
                                 207                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 398                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY01  138  4                                        N MEDICARE PERCAP PAYMENT JAN

H_PLTP02  142  2  $PLNFMT                               C GHP PLAN TYPE FEB

                              12,387                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 403                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY02  144  4                                        N MEDICARE PERCAP PAYMENT FEB

H_PLTP03  148  2  $PLNFMT                               C GHP PLAN TYPE MAR

                              12,390                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 400                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY03  150  4                                        N MEDICARE PERCAP PAYMENT MAR

H_PLTP04  154  2  $PLNFMT                               C GHP PLAN TYPE APR

                              12,386                      NO ENROLLMENT FOR MONTH
                                 206                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 406                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY04  156  4                                        N MEDICARE PERCAP PAYMENT APR

H_PLTP05  160  2  $PLNFMT                               C GHP PLAN TYPE MAY

                              12,381                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 409                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY05  162  4                                        N MEDICARE PERCAP PAYMENT MAY

H_PLTP06  166  2  $PLNFMT                               C GHP PLAN TYPE JUN

                              12,380                      NO ENROLLMENT FOR MONTH
                                 209                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 410                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY06  168  4                                        N MEDICARE PERCAP PAYMENT JUN

H_PLTP07  172  2  $PLNFMT                               C GHP PLAN TYPE JUL

                              12,373                      NO ENROLLMENT FOR MONTH
                                 209                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 417                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY07  174  4                                        N MEDICARE PERCAP PAYMENT JUL

H_PLTP08  178  2  $PLNFMT                               C GHP PLAN TYPE AUG

                              12,369                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 422                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY08  180  4                                        N MEDICARE PERCAP PAYMENT AUG

H_PLTP09  184  2  $PLNFMT                               C GHP PLAN TYPE SEP

                              12,369                      NO ENROLLMENT FOR MONTH
                                 206                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 425                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY09  186  4                                        N MEDICARE PERCAP PAYMENT SEP

H_PLTP10  190  2  $PLNFMT                               C GHP PLAN TYPE OCT

                              12,366                      NO ENROLLMENT FOR MONTH
                                 207                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 427                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY10  192  4                                        N MEDICARE PERCAP PAYMENT OCT

H_PLTP11  196  2  $PLNFMT                               C GHP PLAN TYPE NOV

                              12,369                      NO ENROLLMENT FOR MONTH
                                 209                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 422                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY11  198  4                                        N MEDICARE PERCAP PAYMENT NOV

H_PLTP12  202  2  $PLNFMT                               C GHP PLAN TYPE DEC

                              12,371                      NO ENROLLMENT FOR MONTH
                                 211                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 418                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLPY12  204  4                                        N MEDICARE PERCAP PAYMENT DEC

H_MCSW    208  1  $SWFMT                                C Y=SOME MEDICAID ELIGIBILITY FOR CY

                              10,810                    N NO PARTICIPATION
                               2,229                    Y SOME PARTICIPATION

H_MCDE01  209  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR JAN

                                   0                    A STATE PART A BUY-IN
                               1,856                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,121                    N NO BUY-IN THIS MONTH

H_MCDE02  210  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR FEB

                                   0                    A STATE PART A BUY-IN
                               1,862                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,115                    N NO BUY-IN THIS MONTH

H_MCDE03  211  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR MAR

                                   0                    A STATE PART A BUY-IN
                               1,866                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,111                    N NO BUY-IN THIS MONTH

H_MCDE04  212  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR APR

                                   0                    A STATE PART A BUY-IN
                               1,880                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,097                    N NO BUY-IN THIS MONTH

H_MCDE05  213  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR MAY

                                   0                    A STATE PART A BUY-IN
                               1,892                    B STATE PART B BUY-IN
                                  61                    C STATE PART A AND B BUY-IN
                              11,086                    N NO BUY-IN THIS MONTH

H_MCDE06  214  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR JUN

                                   0                    A STATE PART A BUY-IN
                               1,910                    B STATE PART B BUY-IN
                                  64                    C STATE PART A AND B BUY-IN
                              11,065                    N NO BUY-IN THIS MONTH

H_MCDE07  215  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR JUL

                                   0                    A STATE PART A BUY-IN
                               1,931                    B STATE PART B BUY-IN
                                  65                    C STATE PART A AND B BUY-IN
                              11,043                    N NO BUY-IN THIS MONTH

H_MCDE08  216  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR AUG

                                   0                    A STATE PART A BUY-IN
                               1,950                    B STATE PART B BUY-IN
                                  66                    C STATE PART A AND B BUY-IN
                              11,023                    N NO BUY-IN THIS MONTH

H_MCDE09  217  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR SEP

                                   0                    A STATE PART A BUY-IN
                               1,966                    B STATE PART B BUY-IN
                                  67                    C STATE PART A AND B BUY-IN
                              11,006                    N NO BUY-IN THIS MONTH

H_MCDE10  218  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR OCT

                                   0                    A STATE PART A BUY-IN
                               1,954                    B STATE PART B BUY-IN
                                  67                    C STATE PART A AND B BUY-IN
                              11,018                    N NO BUY-IN THIS MONTH

H_MCDE11  219  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR NOV

                                   0                    A STATE PART A BUY-IN
                               1,950                    B STATE PART B BUY-IN
                                  69                    C STATE PART A AND B BUY-IN
                              11,020                    N NO BUY-IN THIS MONTH

H_MCDE12  220  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR DEC

                                   0                    A STATE PART A BUY-IN
                               1,916                    B STATE PART B BUY-IN
                                  69                    C STATE PART A AND B BUY-IN
                              11,054                    N NO BUY-IN THIS MONTH

H_HOSSW   221  1  $UTLFMT                               C 1 = ONE OR MORE HOSPICE BILLS IN CY

                              12,964                    0 NO UTILIZATION THIS TYPE
                                  75                    1 SOME UTILIZATION THIS TYPE

H_INPSW   222  1  $UTLFMT                               C 1 = ONE OR MORE INP DISCHARGES IN CY

                              10,560                    0 NO UTILIZATION THIS TYPE
                               2,479                    1 SOME UTILIZATION THIS TYPE

H_SNFSW   223  1  $UTLFMT                               C 1 = ONE OR MORE SNF ADMISSIONS IN CY

                              12,783                    0 NO UTILIZATION THIS TYPE
                                 256                    1 SOME UTILIZATION THIS TYPE

H_HHASW   224  1  $UTLFMT                               C 1 = ONE OR MORE HHA VISITS IN CY

                              12,096                    0 NO UTILIZATION THIS TYPE
                                 943                    1 SOME UTILIZATION THIS TYPE

H_OUTSW   225  1  $UTLFMT                               C 1 = ONE OR MORE OUTPT VISITS IN CY

                               6,601                    0 NO UTILIZATION THIS TYPE
                               6,438                    1 SOME UTILIZATION THIS TYPE

H_PBSW    226  1  $UTLFMT                               C 1 = ONE OR MORE PART B CLAIMS IN CY

                               2,236                    0 NO UTILIZATION THIS TYPE
                              10,803                    1 SOME UTILIZATION THIS TYPE

H_PTARMB  227  6                                        N $$$$$$$ TOTAL PART A REIMB CY

H_PTBRMB  233  6                                        N $$$$$$$ TOTAL PART B REIMB CY

H_LATDCH  239  6  $DTE6FMT                              C DISCHARGE DATE OF LATEST INP STAY

                              10,643                      MISSING
                               2,396        000000-999999 DATE AS YYMMDD

H_LATDRG  245  3  $DRGFMT                               C DRG CODE FOR LATEST INP STAY

                              10,643                      UNKNOWN, OR NO DISCHARGE
                               2,396              000-999 DRG

H_DISDES  248  2  $DSTFMT                               C DISCHARGE DESTINATION FOR LAST STAY

                              10,643                      NO DISCHARGE
                               1,504                   01 DISCHARGE TO HOME
                                  23                   02 TRANSFER-TO HOSP
                                 258                   03 TRANSFER-TO SNF
                                  76                   04 TRANSFER-TO ICF
                                  60                   05 TRANSFER-OTHER
                                 202                   06 TRANSFER TO HHA
                                   8                   07 LEFT AGAINS MEDICAL ADVICE
                                   1                   08 HOME IV DRUG
                                   0                   09 ADMIT/READMIT
                                   0                10-19 TRANSFER-ST CODES
                                 264                   20 EXPIRED
                                   0                21-29 EXPIRED-ST CODES
                                   0                   30 STILL PATIENT
                                   0                31-39 STILL PATIENT, ST
                                   0                   40 EXPIRED AT HOME
                                   0                   41 DIED IN FACILITY
                                   0                   42 DIED, PLACE UNK
                                   0                43-99 NOT USED

H_LATLOS  250  3                                        C NOT USED

H_INPSTY  253  2                                        N NO. OF INPAT STAYS FOR CY

H_INPDAY  255  3                                        N NO. OF INPAT COVRD DAYS FOR CY

H_INPCHG  258  6                                        N $$$$$$$ INPAT CHARGES FOR CY

H_INPCCH  264  6                                        N $$$$$$$ INPAT COVRD CHGS FOR CY

H_INPRMB  270  6                                        N $$$$$$$ INPAT REIMB FOR CY

H_INPCDY  280  2                                        N INPAT COINSURANCE DAYS USED IN CY

H_INPCAM  282  5                                        N $$$$$$ TOTAL INP COINS AMT CY

H_SNFSTY  295  2                                        N TOTAL SNF STAYS IN CY

H_SNFDAY  297  3                                        N TOTAL SNF COVERED DAYS IN CY

H_SNFCHG  300  6                                        N $$$$$$$ TOTAL SNF CHRGS IN CY

H_SNFCCH  306  6                                        N $$$$$$$ TOTAL SNF COV CHRGS CY

H_SNFRMB  312  6                                        N $$$$$$$ TOTAL SNF REIMB IN CY

H_SNFCDY  318  3                                        N TOTAL SNF COINS DAYS IN CY

H_SNFCAM  321  6                                        N $$$$$$ TOTAL SNF COINS AMT CY

H_HHAVST  327  3                                        N TOTAL HHA VISITS IN CY

H_HHACCH  330  6                                        N $$$$$$$ TOTAL HHA COV CHGS CY

H_HHACHO  336  6                                        N $$$$$$ TOT HHA OTHER COV CHGS CY

H_HHARMB  342  6                                        N $$$$$$ TOT HHA REIMB IN CY

H_HSDAYS  348  3                                        N TOTAL COVRD HOSPICE DAYS CY

H_HSTCHG  351  6                                        N $$$$$$$ TOT HOSPICE CHGS CY

H_HSREIM  357  6                                        N $$$$$$$ TOT HOSPICE REIMB CY

H_OUTBIL  363  3                                        N TOTAL OUTPT BILLS IN CY

H_OUTCHG  366  6                                        N $$$$$$$ TOTAL OUTPT COV CHG CY

H_OUTRMB  372  6                                        N $$$$$$$ TOTAL OUTPT REIMB CY

H_PMTCLM  378  4                                        N TOTAL PHYSICIAN/SUPPLIER CLAIMS IN CY

H_PMTLIN  382  4                                        N TOTAL PHYSICIAN/SUPPLIER LINE ITEMS CY

H_PMTSCH  386  6                                        N $$$$$$$ TOT SUBMITTED CHGS CY

H_PMTACH  392  6                                        N $$$$$$$ TOT ALLOWED CHGS CY

H_PMTRMB  398  6                                        N $$$$$$$ TOT PHYS REIMB CY

H_PMTVST  404  3                                        N TOTAL OFFICE VISITS IN CY

H_PMTCHO  407  6                                        N TOTAL OFFICE VISIT CHARGES IN CY

H_PTBDED  413  4                                        C NOT USED

