{"aaData": [["CLINIC", "
APPOINTMENT (V2.1)
\n", "
SD CLINIC NAME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 1", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
1
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 5", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "
YES
\n", "
5
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC TREATMENT QUESTIONS", "
HIDDEN CLASSIFICATN (V2.1 MST)
\n", "
DPT SC TREATMENT QUESTIONS (MST)
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC TREATMENT QUESTIONS", "
HIDDEN SC TREATMNT QUEST (MST)
\n", "
DPT SC TREATMENT QUESTIONS (MST)
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC/MST CLASSIFICATION DISPLAY", "
HIDDEN SC/MST CLASSIFICATIONS
\n", "
DPT SC TREATMENT QUESTIONS (MST)
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MST STATUS DISPLAY", "
MST STATUS DISPLAY
\n", "
DGMST STATUS
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["INDICATORS", "
SC CONDITIONS (V2.1 MST)
\n", "
DPT SERVICE HISTORY RELATED DATA (MST)
\n", "", "", "", "", "
1
\n", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE CONNECTED PERCENTAGE", "
SC CONDITIONS (V2.1 MST)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 2", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
2
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 1", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "", "
1
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 2", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "", "
2
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 3", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "", "
3
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 4", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "
YES
\n", "
4
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE HISTORY DATA", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT SERVICE HISTORY RELATED DATA (MST)
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC %", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 5", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "
YES
\n", "
5
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ENROLLMENT PRIORITY", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DG ENROLLMENT PRIORITY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 3", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
3
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["CO-PAY", "
BASIC DEMOGRAPHICS (V3.0)
\n", "
DG ENROLLMENT PRIORITY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 1", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
1
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 2", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
2
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 3", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
3
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 4", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
YES
\n", "
4
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 4", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
YES
\n", "
4
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["TELEPHONE", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S TELEPHONE NUMBER
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MARITAL STATUS", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S MARITAL STATUS
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["EMPLOYER", "
PATIENT INFORMATION (V3.0)
\n", "
DPT PATIENT'S EMPLOYER NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SPOUSE'S EMPLOYER", "
PATIENT INFORMATION (V3.0)
\n", "
DPT SPOUSE'S EMPLOYER NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ENROLLMENT PRIORITY", "
PATIENT INFORMATION (V3.0)
\n", "
DG ENROLLMENT PRIORITY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["CO-PAY", "
PATIENT INFORMATION (V3.0)
\n", "
DG ENROLLMENT PRIORITY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Previous GAF Score Label", "
GAF HAND PRINT V3.0
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF DATE", "
GAF HAND PRINT V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF SCORE", "
GAF HAND PRINT V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF PROVIDER", "
GAF HAND PRINT V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["TELEPHONE", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S TELEPHONE NUMBER
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF SCORE REQUIRED", "
GAF HAND PRINT V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Previous GAF Score Label", "
GAF DISPLAY V3.0
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF DATE", "
GAF DISPLAY V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF SCORE", "
GAF DISPLAY V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF PROVIDER", "
GAF DISPLAY V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF SCORE REQUIRED", "
GAF DISPLAY V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Previous GAF Score Label", "
GAF SCORE MULT CHOICE V3.0
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["New GAF Score Label", "
GAF SCORE MULT CHOICE V3.0
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF DATE", "
GAF SCORE MULT CHOICE V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF SCORE", "
GAF SCORE MULT CHOICE V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MARITAL STATUS", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MARITAL STATUS
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF PROVIDER", "
GAF SCORE MULT CHOICE V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["GAF SCORE REQUIRED", "
GAF SCORE MULT CHOICE V3.0
\n", "
PREVIOUS GAF SCORE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSISLW (V2.1)
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S EMPLOYER NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SPOUSE'S EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT SPOUSE'S EMPLOYER NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ORDERS", "
PHYSICIAN ORDERS (V2.1)
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["CONSULTS", "
PHYSICIAN ORDERS (V2.1)
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["APPT. DT/TIME", "
APPOINTMENT (V2.1)
\n", "
SD APPOINTMENT DATE/TIME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["DISPOSITION", "
PHYSICIAN ORDERS (V2.1)
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["COMMENTS", "
PHYSICIAN ORDERS (V2.1)
\n", "
IBDF UTILITY FOR BLANK LINES
\n", "", "", "", "", "
0
\n", "
8
\n", "
4
\n", "
DOUBLE SPACED
\n", "
132
\n", ""], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Subjective:", "
PROGRESS NOTES (SOAP) V2.1
\n", "
IBDF UTILITY FOR BLANK LINES
\n", "", "", "
Subjective:
\n", "", "
0
\n", "
1
\n", "
8
\n", "
DOUBLE SPACED
\n", "
132
\n", ""], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["OBJECTIVE", "
PROGRESS NOTES (SOAP) V2.1
\n", "
IBDF UTILITY FOR BLANK LINES
\n", "", "", "
Objective:
\n", "", "
0
\n", "
9
\n", "
8
\n", "
DOUBLE SPACED
\n", "
132
\n", ""], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ASSESSMENT/DIAGNOSIS", "
PROGRESS NOTES (SOAP) V2.1
\n", "
IBDF UTILITY FOR BLANK LINES
\n", "", "", "
Assessment/Diagnosis:
\n", "", "
0
\n", "
17
\n", "
8
\n", "
DOUBLE SPACED
\n", "
132
\n", ""], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PLAN", "
PROGRESS NOTES (SOAP) V2.1
\n", "
IBDF UTILITY FOR BLANK LINES
\n", "", "", "
Plan:
\n", "", "
0
\n", "
25
\n", "
4
\n", "
DOUBLE SPACED
\n", "
132
\n", ""], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SIGNATURE", "
PROGRESS NOTES (SOAP) V2.1
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PROGRESS NOTES", "
PROGRESS NOTES (V2.1)
\n", "
IBDF UTILITY FOR BLANK LINES
\n", "", "", "
Progress Notes: ( ) Attached ( ) See Chart
\n", "", "
0
\n", "
0
\n", "
9
\n", "
DOUBLE SPACED
\n", "
132
\n", ""], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SIGNATURE", "
PROGRESS NOTES (V2.1)
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["INDICATORS", "
SC CONDITIONS (V2.1)
\n", "
DPT SERVICE HISTORY RELATED DATA
\n", "", "", "", "", "
1
\n", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC TREATMENT QUESTIONS", "
HIDDEN CLASSICATIONS (V2.1)
\n", "
DPT SC TREATMENT QUESTIONS
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE CONNECTED PERCENTAGE", "
SC CONDITIONS (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["INDICATORS", "
SC CONDITIONS (V2.1)
\n", "
DPT SERVICE HISTORY RELATED DATA
\n", "", "", "", "", "
1
\n", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE CONNECTED PERCENTAGE", "
SC CONDITIONS (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["CLINIC", "
APPOINTMENT
\n", "
SD CLINIC NAME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["APPT. DT/TIME", "
APPOINTMENT
\n", "
SD APPOINTMENT DATE/TIME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MEANS TEST CATEGORY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MEANS TEST DATA
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 1", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
1
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 2", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
2
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 3", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
3
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 4", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
YES
\n", "
4
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["TELEPHONE", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S TELEPHONE NUMBER
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MARITAL STATUS", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MARITAL STATUS
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S EMPLOYER NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SPOUSE'S EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT SPOUSE'S EMPLOYER NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["CLINIC", "
APPOINTMENT
\n", "
SD CLINIC NAME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["APPT. DT/TIME", "
APPOINTMENT
\n", "
SD APPOINTMENT DATE/TIME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MEANS TEST CATEGORY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MEANS TEST DATA
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 1", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
1
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 2", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
2
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 3", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
3
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 4", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
YES
\n", "
4
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["TELEPHONE", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S TELEPHONE NUMBER
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MARITAL STATUS", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MARITAL STATUS
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S EMPLOYER NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SPOUSE'S EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT SPOUSE'S EMPLOYER NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["INDICATORS", "
SC CONDITIONS (V2.1)
\n", "
DPT SERVICE HISTORY RELATED DATA
\n", "", "", "", "", "
1
\n", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE CONNECTED PERCENTAGE", "
SC CONDITIONS (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["CLINIC", "
APPOINTMENT
\n", "
SD CLINIC NAME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["APPT. DT/TIME", "
APPOINTMENT
\n", "
SD APPOINTMENT DATE/TIME
\n", "", "", "", "", "
1
\n", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MEANS TEST CATEGORY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MEANS TEST DATA
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 1", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
1
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 2", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
2
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["IF DIAGNOSIS", "
DIAGNOSES
\n", "
IBDF UTILITY FOR LABELS ONLY
\n", "", "", "", "", "", "
0
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 3", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
NO
\n", "
3
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ADDRESS LINE 4", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT ADDRESS LINES
\n", "
YES
\n", "
4
\n", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["TELEPHONE", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S TELEPHONE NUMBER
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MARITAL STATUS", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MARITAL STATUS
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S EMPLOYER NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SPOUSE'S EMPLOYER", "
PATIENT INFORMATION (V2.1)
\n", "
DPT SPOUSE'S EMPLOYER NAME
\n", "", "", "", "", "", "
2
\n", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["INDICATORS", "
SC CONDITIONS (V2.1)
\n", "
DPT SERVICE HISTORY RELATED DATA
\n", "", "", "", "", "
1
\n", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE CONNECTED PERCENTAGE", "
SC CONDITIONS (V2.1)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT NAME", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PATIENT DOB", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MEANS TEST CATEGORY", "
PATIENT INFORMATION (V2.1)
\n", "
DPT PATIENT'S MEANS TEST DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["PID", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 1", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "", "
1
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 2", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "", "
2
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 3", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "", "
3
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC CONDITION 4", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S SC CONDITIONS
\n", "
YES
\n", "
4
\n", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SEX", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S SEX
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["ELIGIBILITY", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["MEANS TEST CATEGORY", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT'S MEANS TEST DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SERVICE HISTORY DATA", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT SERVICE HISTORY RELATED DATA (MST)
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SC %", "
BASIC DEMOGRAPHICS (MST)
\n", "
DPT PATIENT ELIGIBILITY DATA
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["SSN", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S PID
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Age", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S DOB/AGE
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["HEADER", "
HEADER
\n", "", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"], ["Patient name", "
PATIENT INFORMATION
\n", "
DPT PATIENT'S NAME
\n", "", "", "", "", "", "", "", "", "", "
\n
\n\n
\n"]]}