
| SEQUENCE NUMBER | YEAR MONTH | FEEDER KEY | PLACEHOLD ENC CAMP LEJEUNE | COMBAT VETERAN INDICATOR | COMBAT VETERAN LOCATION | FORM REQUESTED ON | UNIT OF ISSUE | NEW COST OF TRANSACTION | NEW LAB LABOR COST | NEW LAB MATERIAL COST | NEW MPI | SELF IDENTIFIED GENDER | QUANTITY | PLACEHOLD PRIMARY CARE TEAM | PLACEHOLD PC PROVIDER | PCE CPT/HCPCS CODE & MODIFIERS | PLACEHOLDER | EXTRACT NUMBER | AGENT ORANGE STATUS | RADIATION EXPOSURE STATUS | SW ASIA CONDITIONS | PATIENT ELIGIBILITY | PLACEHOLD COST OF TRANSACTION | PLACEHOLD LAB LABOR COST | PLACEHOLD LAB MATERIAL COST | BILLING STATUS | VET/NON VET | TYPE OF TRANSACTION | FACILITY | REQUESTING STATION | RECEIVING STATION | PSAS HCPCS CODE | ZIP CODE | DATE OF BIRTH | SEX | AMIS GROUPER | PLACEHOLD MPI | PATIENT NO. DFN | PLACEHOLD PC PROV PERSON CLASS | PLACEHOLD RACE | POW STATUS | POW LOCATION | PLACEHOLD SHARE AGREEMNT PAYOR | PLACEHOLD SHARE AGREEMNT INSUR | MST STATUS | ENROLLMENT LOCATION | STATE | COUNTY | SSN | PLACEHOLD ASSOC PC PROVIDER | PLACEHOLD AS PC PROV PERSON CL | DOM,PRRTP AND SAARTP INDICATOR | ENROLLMENT CATEGORY | ENROLLMENT STATUS | PURPLE HEART INDICATOR | PERIOD OF SERVICE | OBSERVATION PATIENT INDICATOR | NAME | ENCOUNTER NUMBER | AGENT ORANGE LOCATION | CNH STATUS | PRODUCTION DIVISION CODE | HEAD & NECK CANCER INDICATOR | PLACEHOLD ETHNICITY | PLACEHOLD RACE 1 | PLACEHOLD DSS IP # | ENROLLMENT PRIORITY | USER ENROLLEE | IN OUTPATIENT INDICATOR | PATIENT TYPE | CV STATUS ELIGIBILITY | CV ELIGIBILITY END DATE | PLACEHOLD ENCOUNTER CV | NATIONAL PATIENT RECORD FLAG | ERI | PLACEHOLD AGENT ORANGE ENC | PLACEHOLD ENCOUNTER SWAC | PLACEHOLD ENC HEAD/NECK CA | PLACEHOLD ENCOUNTER MST | DATE OF SERVICE | PLACEHOLD RADIATION ENCOUNTER | OEF/OIF | OEF/OIF RETURN DATE | NPPD CODE | NPPD ENTRY DATE | PLACEHOLD ASSOC PC PROV NPI | PLACEHOLD PC PROVIDER NPI | COUNTRY CODE | SHAD STATUS | PLACEHOLD ENCOUNTER SHAD | FEEDER LOCATION | LABOR HOURS | PATCAT | PRIMARY ICD-10 CODE | SECONDARY ICD-10 CODE #1 | SECONDARY ICD-10 CODE #2 | SECONDARY ICD-10 CODE #3 | SECONDARY ICD-10 CODE #4 | PLACEHOLD ENCOUNTER SC | VIETNAM | CAMP LEJEUNE STATUS |
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