RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             353,191             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,569                      Missing
                             180,155            C000-C999 Event created from claim
                             171,467            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
                             181,387                   MP Medical provider
                              45,376                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              70,344                   SD Separately billing physician
                              56,084                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             181,724                      Missing
                                   0                   DU Dental
                                 819                   ER Emergency Room
                                 451                   IP Inpatient
                                   0                   IU Institutional utilization
                             119,724                   MP Medical provider
                              22,281                   OM Other medical expense
                               3,889                   OP Outpatient
                                   0                   PM Prescribed medicine
                              20,199                   SD Separately billing physician
                               4,104                   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

                              75,405
                              23,016                    D DME claim
                             253,201                    P Physician claim
                               1,569                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                  73                   -8 Don't know
                                  12                   -9 Not ascertained
                             353,106                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                                   1                   -7 Refused
                                 976                   -8 Don't know
                                  58                   -9 Not ascertained
                                   0                   95 Still in progress
                             352,156                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  28                   -7 Refused
                              27,352                   -8 Don't know
                                  58                   -9 Not ascertained
                             325,753                      Day of month

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

                              75,405                    1 Survey only
                             181,724                    2 Claims only
                              96,062                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 200                    B Both community & facility
                             294,955                    C Community
                              14,133                    D Deemed community
                              37,115                    F Facility
                                 752                    G Deemed facility
                               6,036                    S SNF

AMTTOT     38  9                                        N Total payment

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

                             243,954                    0 Not imputed
                             109,237                    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?

                             352,364                    0 Not imputed
                                 827                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             338,008                    0 Not imputed
                              15,183                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             319,282                    0 Not imputed
                              33,909                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             291,691                    0 Not imputed
                              61,500                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             343,462                    0 Not imputed
                               9,729                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             338,759                    0 Not imputed
                              14,432                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             343,235                    0 Not imputed
                               9,956                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             340,232                    0 Not imputed
                              12,959                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             353,008                    0 Not imputed
                                 183                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             351,897                    0 Not imputed
                               1,294                    1 Imputed

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

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             313,966                    0 Not imputed
                              39,225                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             303,659                    0 Not imputed
                              49,532                    1 Imputed

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

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             320,255                    0 Not imputed
                              32,936                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             313,275                    0 Not imputed
                              39,916                    1 Imputed

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

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             348,020                    0 Not imputed
                               5,171                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             348,020                    0 Not imputed
                               5,171                    1 Imputed

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

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             299,744                    0 Not imputed
                              53,447                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             277,148                    0 Not imputed
                              76,043                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             342,479                    0 Not imputed
                              10,712                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             340,372                    0 Not imputed
                              12,819                    1 Imputed

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

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             352,679                    0 Not imputed
                                 512                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             350,992                    0 Not imputed
                               2,199                    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

                             181,867                    . Missing
                                  17                   -9 Not ascertained
                                 193                   -8 Don't know
                              43,712                   -1 Inapplicable
                                  27                    1 Dentist or dental provider
                              93,951                    2 Medical doctor
                                 441                    3 Audiologist
                               6,663                    4 Chiropractor
                                 239                    5 Clinical Social Worker
                                  62                    6 Dietician or nutritionist
                                  10                    7 Hearing therapist
                                  75                    8 Home health/health aide
                                  19                    9 Homemaker
                                 112                   10 Hospice worker
                                 183                   11 I.V. Therapist
                               1,131                   12 Nurse (RN)
                                 432                   13 Nurse Practitioner
                                  33                   14 Nurse's aide
                                 324                   15 Occupational Therapist (OT)
                               2,832                   16 Optometrist
                                 216                   17 Osteopath (DO)
                                 116                   18 Paramedic
                               8,348                   19 Physical Therapist (PT)
                                 338                   20 Physician's Assistant
                               2,908                   21 Podiatrist (foot doctor)
                               1,654                   22 Psychologist
                                 208                   23 Respiratory Therapist
                                 616                   24 Social/case worker
                                 196                   25 Speech Therapist
                                 541                   26 Therapist (mental health)
                               1,092                   27 X-Ray Technician
                                  26                   28 Licensed Practical Nurse (LPN)
                                 356                   29 Acupuncturist
                                   6                   30 Homeopath
                                 695                   31 Massage therapist
                                   9                   32 Naturopath
                                 435                   33 Licensed Professional Counselor (LPC)
                                 818                   34 Lab Technician
                               2,290                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             163,744                    . Missing
                             149,186                   -1 Inapplicable
                               2,702                    1 Eyeglasses
                                 869                    2 Hearing or speech device
                               2,674                    3 Orthopedic
                               9,121                    4 Diabetic
                               4,620                    5 Ambulance
                                 166                    6 Prosthesis
                                 367                    7 Alteration
                               7,249                    8 Oxygen
                                  76                    9 Kidney dialysis
                              12,417                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             181,083                    . Missing
                             169,434                   -1 Inapplicable
                                 678                    1 Braces or supports
                                 271                    2 Cane
                                 388                    3 Corrective shoes or inserts
                                  36                    4 Crutches
                                 555                    5 Walker
                                 474                    6 Wheelchair
                                 211                    7 Stockings
                                  61                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             181,784                    . Missing
                             171,040                   -1 Inapplicable
                                  22                    1 Elevator or incline chair
                                  84                    2 Handrails (other than tub)
                                  53                    3 Ramps
                                  68                    4 Tub handrails
                                  13                    5 Tub seat
                                   5                    6 Any car alteration
                                 122                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of other medical event

                             177,894                    . Missing
                             162,880                   -1 Inapplicable
                                 346                    1 Portable or raised toilet
                                  95                    2 Portable tub seat
                                 139                    3 Special chair or cushion
                                 900                    4 Hospital bed
                                 747                    5 Ostomy supplies
                               6,035                    6 Depends (diapers)
                                 455                    7 Bandages, dressings, tape supplies
                                 464                    8 Pulmonary equipment
                                 179                    9 Blood pressure equipment
                               3,057                   91 Other

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

                             293,712                    0 Event not provided by HMO
                              57,910                    1 Event provided by HMO
                               1,569                    3 Event provided by PDP/MAPD

