RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             311,083             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,385                      Missing
                             163,272            C000-C999 Event created from claim
                             146,426            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
                             164,666                   MP Medical provider
                              37,458                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              60,169                   SD Separately billing physician
                              48,790                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             164,657                      Missing
                                   0                   DU Dental
                                 764                   ER Emergency Room
                                 438                   IP Inpatient
                                   0                   IU Institutional utilization
                             105,538                   MP Medical provider
                              18,224                   OM Other medical expense
                               2,718                   OP Outpatient
                                   0                   PM Prescribed medicine
                              15,029                   SD Separately billing physician
                               3,715                   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

                              72,971
                              18,789                    D DME claim
                             217,938                    P Physician claim
                               1,385                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                 108                   -8 Don't know
                                   8                   -9 Not ascertained
                             310,967                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                                   7                   -7 Refused
                               2,063                   -8 Don't know
                                  12                   -9 Not ascertained
                                   0                   95 Still in progress
                             309,001                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  24                   -7 Refused
                              35,796                   -8 Don't know
                                  12                   -9 Not ascertained
                             275,251                      Day of month

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

                              72,971                    1 Survey only
                             164,657                    2 Claims only
                              73,455                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 237                    B Both community & facility
                             262,869                    C Community
                              14,251                    D Deemed community
                              26,666                    F Facility
                               1,562                    G Deemed facility
                               5,498                    S SNF

AMTTOT     38  9                                        N Total payment

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

                             210,837                    0 Not imputed
                             100,246                    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?

                             310,052                    0 Not imputed
                               1,031                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             296,138                    0 Not imputed
                              14,945                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             282,536                    0 Not imputed
                              28,547                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             260,640                    0 Not imputed
                              50,443                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             296,049                    0 Not imputed
                              15,034                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             287,669                    0 Not imputed
                              23,414                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             301,140                    0 Not imputed
                               9,943                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             298,744                    0 Not imputed
                              12,339                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             310,989                    0 Not imputed
                                  94                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             309,896                    0 Not imputed
                               1,187                    1 Imputed

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

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             275,842                    0 Not imputed
                              35,241                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             266,778                    0 Not imputed
                              44,305                    1 Imputed

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

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             282,562                    0 Not imputed
                              28,521                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             276,750                    0 Not imputed
                              34,333                    1 Imputed

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

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             306,614                    0 Not imputed
                               4,469                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             306,614                    0 Not imputed
                               4,469                    1 Imputed

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

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             261,270                    0 Not imputed
                              49,813                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             241,071                    0 Not imputed
                              70,012                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             302,379                    0 Not imputed
                               8,704                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             300,858                    0 Not imputed
                              10,225                    1 Imputed

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

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             310,803                    0 Not imputed
                                 280                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             309,708                    0 Not imputed
                               1,375                    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

                             164,870                    . Missing
                                 118                   -9 Not ascertained
                                 270                   -8 Don't know
                              35,183                   -1 Inapplicable
                                  22                    1 Dentist or dental provider
                              81,698                    2 Medical doctor
                                 366                    3 Audiologist
                               5,547                    4 Chiropractor
                                 171                    5 Clinical Social Worker
                                  36                    6 Dietician or nutritionist
                                   8                    7 Hearing therapist
                                 224                    8 Home health/health aide
                                   3                    9 Homemaker
                                  16                   10 Hospice worker
                                 283                   11 I.V. Therapist
                               1,028                   12 Nurse (RN)
                                 409                   13 Nurse Practitioner
                                  30                   14 Nurse's aide
                                 260                   15 Occupational Therapist (OT)
                               2,283                   16 Optometrist
                                 165                   17 Osteopath (DO)
                                 103                   18 Paramedic
                               8,117                   19 Physical Therapist (PT)
                                 288                   20 Physician's Assistant
                               2,382                   21 Podiatrist (foot doctor)
                               1,226                   22 Psychologist
                                 116                   23 Respiratory Therapist
                                 335                   24 Social/case worker
                                  54                   25 Speech Therapist
                                 337                   26 Therapist (mental health)
                                 835                   27 X-Ray Technician
                                  14                   28 Licensed Practical Nurse (LPN)
                                 268                   29 Acupuncturist
                                  32                   30 Homeopath
                                 475                   31 Massage therapist
                                  56                   32 Naturopath
                                 292                   33 Licensed Professional Counselor (LPC)
                               1,329                   34 Lab Technician
                               1,834                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             149,365                    . Missing
                             128,202                   -1 Inapplicable
                               2,321                    1 Eyeglasses
                                 576                    2 Hearing or speech device
                               2,243                    3 Orthopedic
                               7,932                    4 Diabetic
                               3,713                    5 Ambulance
                                 187                    6 Prosthesis
                                 295                    7 Alteration
                               6,539                    8 Oxygen
                                  75                    9 Kidney dialysis
                               9,635                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             164,187                    . Missing
                             144,653                   -1 Inapplicable
                                 594                    1 Braces or supports
                                 192                    2 Cane
                                 308                    3 Corrective shoes or inserts
                                  33                    4 Crutches
                                 526                    5 Walker
                                 361                    6 Wheelchair
                                 175                    7 Stockings
                                  54                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             164,804                    . Missing
                             145,984                   -1 Inapplicable
                                  20                    1 Elevator or incline chair
                                  47                    2 Handrails (other than tub)
                                  41                    3 Ramps
                                  59                    4 Tub handrails
                                  22                    5 Tub seat
                                   9                    6 Any car alteration
                                  97                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of other medical event

                             161,890                    . Missing
                             139,558                   -1 Inapplicable
                                 225                    1 Portable or raised toilet
                                  63                    2 Portable tub seat
                                  84                    3 Special chair or cushion
                                 578                    4 Hospital bed
                                 470                    5 Ostomy supplies
                               4,849                    6 Depends (diapers)
                                 398                    7 Bandages, dressings, tape supplies
                                 391                    8 Pulmonary equipment
                                 107                    9 Blood pressure equipment
                               2,470                   91 Other

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

                             242,451                    0 Event not provided by HMO
                              67,247                    1 Event provided by HMO
                               1,385                    3 Event provided by PDP/MAPD

