RIC         1  3                                        C RIC CODE FOR ADMIN IDENTIFICATION RECORD

FILEYR      4  2                                        C YY REFERENCE YEAR OF RECORD

BASEID      6  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                              42,323             LOW-HIGH BASEID Count

EVNTNUM    14  4                                        C UNIQUE EVENT IDENTIFIER

OREVTYPE   18  2  $EVNTTYP                              C ORIGINAL REPORTED EVENT TYPE

                              16,002
                                   0                   DU DENTAL
                               2,160                   ER EMERGENCY ROOM
                                 698                   IP INPATIENT
                                   0                   IU INSTITUTIONAL UTILIZATION
                               2,740                   MP MEDICAL PROVIDER
                                 615                   OM OTHER MEDICAL EXPENSE
                              19,238                   OP OUTPATIENT
                                   0                   PM PRESCRIBED MEDICINE
                                 150                   SD SEP BILLING DOCTOR
                                 720                   SL SEP BILLING LAB

CLAIMID    20  6                                        N CLAIM THIS SURVEY EVENT MATCHED TO

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

                              39,306                    0 EVENT NOT PROV BY HMO
                               3,017                    1 EVENT PROVIDED BY HMO

FROMDT     27  6                                        N FROM DATE ON CLAIM

THRUDT     33  6                                        N THRU DATE ON CLAIM

EVBEGYY    39  2  EVYY                                  N EVENT BEGIN YEAR

                               1,202                    . INAPPLICABLE
                                   6                   -9 NOT ASCERTAINED
                                  43                   -8 DK
                              41,072                 1-99 YEAR

EVBEGMM    41  2  EVMM                                  N EVENT BEGIN MONTH

                               1,202                    . INAPPLICABLE
                                   9                   -9 NOT ASCERTAINED
                                  91                   -8 DK
                              41,021                 1-12 MONTH
                                   0                   95 STILL IN PROGRESS

EVBEGDD    43  2  EVDD                                  N EVENT BEGIN YEAR

                               1,202                    . INAPPLICABLE
                                  11                   -9 NOT ASCERTAINED
                               1,317                   -8 DK
                                   3                   -7 REFUSED
                                  81                   -5 MULTIPLE VISITS THIS MONTH
                              39,709                 1-31 DAY OF MONTH

SOURCE     45  1  $SOURCE                               C SOURCE OF EVENT: SURVEY, CLAIM, OR BOTH?

                              10,042                    1 SURVEY ONLY
                              16,002                    2 CLAIMS ONLY
                              16,279                    3 BOTH SURVEY & CLAIMS

SITCODE    46  1  $SITCODE                              C COMMUNITY OR FACILITY SETTING?

                                  12                    B BOTH COMM & FACILITY
                              35,611                    C COMMUNITY
                               2,498                    D DEEMED COMMUNITY
                               4,138                    F FACILITY
                                  64                    G DEEMED FACILITY

AMTTOT     47  9                                        N TOTAL PAYMENT

IMPATOT    56  1  IMPFLAG                               N IMPUTATION FLAG: AMT TOTAL PAYMENT

                              28,877                    0 NOT IMPUTED
                              13,446                    1 IMPUTED

AMTCOV     57  9                                        N PORTION OF TOTAL PAY COV BY MEDICARE

AMTNCOV    66  9                                        N PORTION OF TOTAL PAY NOT COV BY MEDICARE

AMTCARE    75  9                                        N AMOUNT PAID BY MEDICARE

IMPSCARE   84  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICARE

                              42,194                    0 NOT IMPUTED
                                 129                    1 IMPUTED

IMPACARE   85  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICARE

                              40,353                    0 NOT IMPUTED
                               1,970                    1 IMPUTED

AMTCAID    86  9                                        N AMOUNT PAID BY MEDICAID

IMPSCAID   95  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICAID

                              38,747                    0 NOT IMPUTED
                               3,576                    1 IMPUTED

IMPACAID   96  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICAID

                              32,957                    0 NOT IMPUTED
                               9,366                    1 IMPUTED

AMTHMOM    97  9                                        N AMOUNT PAID BY MEDICARE HMO

IMPSHMOM  106  1  IMPFLAG                               N IMPUTATION FLAG: SOP MEDICARE HMO

                              41,976                    0 NOT IMPUTED
                                 347                    1 IMPUTED

IMPAHMOM  107  1  IMPFLAG                               N IMPUTATION FLAG: AMT MEDICARE HMO

                              41,379                    0 NOT IMPUTED
                                 944                    1 IMPUTED

AMTHMOP   108  9                                        N AMOUNT PAID BY PRIVATE HMO

IMPSHMOP  117  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIVATE HMO

                              42,071                    0 NOT IMPUTED
                                 252                    1 IMPUTED

IMPAHMOP  118  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIVATE HMO

                              41,820                    0 NOT IMPUTED
                                 503                    1 IMPUTED

AMTVA     119  9                                        N AMOUNT PAID BY VETERANS ADM

IMPSVA    128  1  IMPFLAG                               N IMPUTATION FLAG: SOP VETERANS ADM

                              42,208                    0 NOT IMPUTED
                                 115                    1 IMPUTED

IMPAVA    129  1  IMPFLAG                               N IMPUTATION FLAG: AMT VETERANS ADM

                              41,070                    0 NOT IMPUTED
                               1,253                    1 IMPUTED

AMTPRVE   130  9                                        N AMOUNT PAID BY PRIV INS (EMPLOYER SPONS)

IMPSPRVE  139  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIV INS-EMPLOYER

                              38,903                    0 NOT IMPUTED
                               3,420                    1 IMPUTED

IMPAPRVE  140  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIV INS-EMPLOYER

                              38,123                    0 NOT IMPUTED
                               4,200                    1 IMPUTED

AMTPRVI   141  9                                        N AMOUNT PAID BY PRIV INS (INDIV PURCH)

IMPSPRVI  150  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIV INS-INDIV PUR

                              39,374                    0 NOT IMPUTED
                               2,949                    1 IMPUTED

IMPAPRVI  151  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIV INS-INDIV PUR

                              38,424                    0 NOT IMPUTED
                               3,899                    1 IMPUTED

AMTPRVU   152  9                                        N AMOUNT PAID BY PRIV INS (UNKNOWN PURCH)

IMPSPRVU  161  1  IMPFLAG                               N IMPUTATION FLAG: SOP PRIV INS-UNKNOWN

                              42,000                    0 NOT IMPUTED
                                 323                    1 IMPUTED

IMPAPRVU  162  1  IMPFLAG                               N IMPUTATION FLAG: AMT PRIV INS-UNKNOWN

                              42,000                    0 NOT IMPUTED
                                 323                    1 IMPUTED

AMTOOP    163  9                                        N AMOUNT PAID BY PERSON/FAMILY

IMPSOOP   172  1  IMPFLAG                               N IMPUTATION FLAG: SOP PAID BY PERSON

                              35,891                    0 NOT IMPUTED
                               6,432                    1 IMPUTED

IMPAOOP   173  1  IMPFLAG                               N IMPUTATION FLAG: AMT PAID BY PERSON

                              34,666                    0 NOT IMPUTED
                               7,657                    1 IMPUTED

AMTDISC   174  9                                        N AMOUNT OF UNCOLLECTED LIABILITIES

IMPSDISC  183  1  IMPFLAG                               N IMPUTATION FLAG: SOP UNCOLL LIAB

                              40,922                    0 NOT IMPUTED
                               1,401                    1 IMPUTED

IMPADISC  184  1  IMPFLAG                               N IMPUTATION FLAG: AMT UNCOLL LIAB

                              40,572                    0 NOT IMPUTED
                               1,751                    1 IMPUTED

AMTOTH    185  9                                        N AMOUNT PAID BY OTHER SOURCES

IMPSOTH   194  1  IMPFLAG                               N IMPUTATION FLAG: SOP OTHER SOURCES

                              41,697                    0 NOT IMPUTED
                                 626                    1 IMPUTED

IMPAOTH   195  1  IMPFLAG                               N IMPUTATION FLAG: AMT OTHER SOURCES

                              41,003                    0 NOT IMPUTED
                               1,320                    1 IMPUTED

ODIAGCNT  196  2                                        N NUMBER OF DIAGNOSIS CODES ON CLAIM

ODIAG1    198  5                                        C FIRST ICD-9 DIAGNOSIS CODE FROM CLAIM

ODIAG2    203  5                                        C SECOND ICD-9 DIAGNOSIS CODE FROM CLAIM

ODIAG3    208  5                                        C THIRD ICD-9 DIAGNOSIS CODE FROM CLAIM

