RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                             316,541             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,367                      Missing
                             163,859            C000-C999 Event created from claim
                             151,315            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
                             163,669                   MP Medical provider
                              37,054                   OM Other medical expense
                                   0                   OP Outpatient
                                   0                   PM Prescribed medicine
                              67,060                   SD Separately billing physician
                              48,758                   SL Separately billing lab

OREVTYPE   20  2  $EVNTTYP                              C Original reported event type

                             165,226                      Missing
                                   0                   DU Dental
                                 762                   ER Emergency Room
                                 410                   IP Inpatient
                                   0                   IU Institutional utilization
                             107,604                   MP Medical provider
                              18,583                   OM Other medical expense
                               3,078                   OP Outpatient
                                   0                   PM Prescribed medicine
                              17,004                   SD Separately billing physician
                               3,874                   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

                              75,980
                              17,922                    D DME claim
                             221,272                    P Physician claim
                               1,367                    R PDE claim

EVBEGYY    30  2  $EVENTYY                              C Event begin year

                                 134                   -8 Don't know
                                   5                   -9 Not ascertained
                             316,402                      Year

EVBEGMM    32  2  $EVENTMM                              C Event begin month

                                  30                   -7 Refused
                               2,391                   -8 Don't know
                                  15                   -9 Not ascertained
                                   0                   95 Still in progress
                             314,105                      Month

EVBEGDD    34  2  $EVENTDD                              C Event begin day

                                  16                   -7 Refused
                              38,788                   -8 Don't know
                                  15                   -9 Not ascertained
                             277,722                      Day of month

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

                              75,980                    1 Survey only
                             165,226                    2 Claims only
                              75,335                    3 Both survey & claims

SITCODE    37  1  $SITCODE                              C Community or facility setting?

                                 243                    B Both community & facility
                             260,083                    C Community
                              13,877                    D Deemed community
                              33,222                    F Facility
                               1,494                    G Deemed facility
                               7,622                    S SNF

AMTTOT     38  9                                        N Total payment

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

                             213,262                    0 Not imputed
                             103,279                    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?

                             315,252                    0 Not imputed
                               1,289                    1 Imputed

IMPACARE   76  1  IMPFLAG                               N AMTCARE payment amount imputed?

                             299,476                    0 Not imputed
                              17,065                    1 Imputed

AMTCAID    77  9                                        N Amount paid by Medicaid

IMPSCAID   86  1  IMPFLAG                               N AMTCAID payment source imputed?

                             288,458                    0 Not imputed
                              28,083                    1 Imputed

IMPACAID   87  1  IMPFLAG                               N AMTCAID payment amount imputed?

                             264,414                    0 Not imputed
                              52,127                    1 Imputed

AMTHMOM    88  9                                        N Amount paid by Medicare HMO

IMPSHMOM   97  1  IMPFLAG                               N AMTHMOM payment source imputed?

                             301,034                    0 Not imputed
                              15,507                    1 Imputed

IMPAHMOM   98  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                             292,398                    0 Not imputed
                              24,143                    1 Imputed

AMTHMOP    99  9                                        N Amount paid by private HMO

IMPSHMOP  108  1  IMPFLAG                               N AMTHMOP payment source imputed?

                             306,574                    0 Not imputed
                               9,967                    1 Imputed

IMPAHMOP  109  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                             304,145                    0 Not imputed
                              12,396                    1 Imputed

AMTVA     110  9                                        N Amount paid by Veterans Administration

IMPSVA    119  1  IMPFLAG                               N AMTVA payment source imputed?

                             316,485                    0 Not imputed
                                  56                    1 Imputed

IMPAVA    120  1  IMPFLAG                               N AMTVA payment amount imputed?

                             315,522                    0 Not imputed
                               1,019                    1 Imputed

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

IMPSPRVE  130  1  IMPFLAG                               N AMTPRVE payment source imputed?

                             281,795                    0 Not imputed
                              34,746                    1 Imputed

IMPAPRVE  131  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                             273,448                    0 Not imputed
                              43,093                    1 Imputed

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

IMPSPRVI  141  1  IMPFLAG                               N AMTPRVI payment source imputed?

                             284,519                    0 Not imputed
                              32,022                    1 Imputed

IMPAPRVI  142  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                             278,261                    0 Not imputed
                              38,280                    1 Imputed

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

IMPSPRVU  152  1  IMPFLAG                               N AMTPRVU payment source imputed?

                             311,692                    0 Not imputed
                               4,849                    1 Imputed

IMPAPRVU  153  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                             311,692                    0 Not imputed
                               4,849                    1 Imputed

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

IMPSOOP   163  1  IMPFLAG                               N AMTOOP payment source imputed?

                             254,457                    0 Not imputed
                              62,084                    1 Imputed

IMPAOOP   164  1  IMPFLAG                               N AMTOOP payment amount imputed?

                             231,658                    0 Not imputed
                              84,883                    1 Imputed

AMTDISC   165  9                                        N Amount of uncollected SP liability

IMPSDISC  174  1  IMPFLAG                               N AMTDISC payment source imputed?

                             299,318                    0 Not imputed
                              17,223                    1 Imputed

IMPADISC  175  1  IMPFLAG                               N AMTDISC payment amount imputed?

                             297,083                    0 Not imputed
                              19,458                    1 Imputed

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

IMPSOTH   185  1  IMPFLAG                               N AMTOTH payment source imputed?

                             315,840                    0 Not imputed
                                 701                    1 Imputed

IMPAOTH   186  1  IMPFLAG                               N AMTOTH payment amount imputed?

                             314,236                    0 Not imputed
                               2,305                    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

                             165,571                    . Missing
                                 348                   -9 Not ascertained
                                 464                   -8 Don't know
                              37,624                   -1 Inapplicable
                                  36                    1 Dentist or dental provider
                              82,053                    2 Medical doctor
                                 436                    3 Audiologist
                               5,301                    4 Chiropractor
                                 274                    5 Clinical Social Worker
                                  86                    6 Dietician or nutritionist
                                  15                    7 Hearing therapist
                                 263                    8 Home health/health aide
                                  19                    9 Homemaker
                                  46                   10 Hospice worker
                                  73                   11 I.V. Therapist
                               1,177                   12 Nurse (RN)
                                 564                   13 Nurse Practitioner
                                  80                   14 Nurse's aide
                                 153                   15 Occupational Therapist (OT)
                               2,366                   16 Optometrist
                                 190                   17 Osteopath (DO)
                                  94                   18 Paramedic
                               8,317                   19 Physical Therapist (PT)
                                 334                   20 Physician's Assistant
                               2,445                   21 Podiatrist (foot doctor)
                               1,185                   22 Psychologist
                                 228                   23 Respiratory Therapist
                                 443                   24 Social/case worker
                                  98                   25 Speech Therapist
                                 673                   26 Therapist (mental health)
                                 927                   27 X-Ray Technician
                                  22                   28 Licensed Practical Nurse (LPN)
                                 215                   29 Acupuncturist
                                  38                   30 Homeopath
                                 745                   31 Massage therapist
                                  65                   32 Naturopath
                                 411                   33 Licensed Professional Counselor (LPC)
                               1,342                   34 Lab Technician
                               1,820                   91 Other medical provider

OMETYPE   234  2  OMETYPE                               N Type of other medical event

                             150,611                    . Missing
                             132,732                   -1 Inapplicable
                               2,222                    1 Eyeglasses
                                 537                    2 Hearing or speech device
                               2,243                    3 Orthopedic
                               7,995                    4 Diabetic
                               4,294                    5 Ambulance
                                 141                    6 Prosthesis
                                 313                    7 Alteration
                               5,843                    8 Oxygen
                                  66                    9 Kidney dialysis
                               9,544                   10 Other

ORTHTYPE  236  2  ORTHTYPE                              N Type of orthopedic item

                             164,917                    . Missing
                             149,381                   -1 Inapplicable
                                 577                    1 Braces or supports
                                 181                    2 Cane
                                 371                    3 Corrective shoes or inserts
                                  47                    4 Crutches
                                 424                    5 Walker
                                 416                    6 Wheelchair
                                 164                    7 Stockings
                                  63                   91 Other

ALTRTYPE  238  2  ALTRTYPE                              N Type of alteration

                             165,508                    . Missing
                             150,720                   -1 Inapplicable
                                  16                    1 Elevator or incline chair
                                  71                    2 Handrails (other than tub)
                                  40                    3 Ramps
                                  68                    4 Tub handrails
                                  27                    5 Tub seat
                                   1                    6 Any car alteration
                                  90                   91 Other

OTHRTYPE  240  2  OTHRTYPE                              N Type of other medical event

                             162,657                    . Missing
                             144,340                   -1 Inapplicable
                                 252                    1 Portable or raised toilet
                                  77                    2 Portable tub seat
                                  77                    3 Special chair or cushion
                                 647                    4 Hospital bed
                                 509                    5 Ostomy supplies
                               4,619                    6 Depends (diapers)
                                 497                    7 Bandages, dressings, tape supplies
                                 438                    8 Pulmonary equipment
                                 108                    9 Blood pressure equipment
                               2,320                   91 Other

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

                             243,973                    0 Event not provided by HMO
                              71,201                    1 Event provided by HMO
                               1,367                    3 Event provided by PDP/MAPD

