Name | Value |
---|---|
ENTITY | CLINICAL CASE REGISTRIES |
PARAMETER | ROR GUI PARAMETER |
INSTANCE | ICRCDCDEF |
VALUE | HIV CDC Form Template |
WORD PROCESSING TEXT | dtp2_1=^^161^567^30^MMDDYY^49^117^^^1^HDR^3^^6^^Date form was Completed chkb5_3_1=^^2228^1555^24^^49^^^^1^PH^5^1^20^^Injected Drug Yes chkb5_3_2=^^2316^1555^24^^49^^^^1^PH^5^0^20^^Injected Drug No chkb5_3_3=^^2398^1555^24^^49^^^^1^PH^5^9^20^^Injected Drug Unk chkb5_2_1=^^2228^1509^24^^49^^^^1^PH^4^1^20^^Sex With Female Yes chkb5_2_2=^^2316^1509^24^^49^^^^1^PH^4^0^20^^Sex With Female No chkb5_2_3=^^2398^1509^24^^49^^^^1^PH^4^9^20^^Sex With Female Unk chkb5_1_1=^^2228^1463^24^^49^^^^1^PH^3^1^20^^Sex With Male Yes chkb5_1_2=^^2316^1463^24^^49^^^^1^PH^3^0^20^^Sex With Male No chkb5_1_3=^^2399^1463^24^^49^^^^1^PH^3^9^20^^Sex With Male Unk chkb6_8_1=^^2228^2563^24^^49^^^^1^LD2^5^1^14^^HIV-1 Yes edt2_1=^^^^32^^49^^^^1^^^^^^ chkb6_8_2=^^2308^2563^24^^49^^^^1^LD2^5^0^14^^HIV-1 No chkb6_8_3=^^2387^2563^24^^49^^^^1^LD2^5^9^14^^HIV-1 Unk edt6_8_1=^^2230^2656^30^MMYY^50^170^^^1^LD2^6^^14^MM/YY^HIV Diagnosis by Physician Date edt6_7_1=^^2230^2448^30^MMYY^50^170^^^1^LD2^4^^14^MM/YY^Lst Documented negative HIV Date edt6_7_2=^^1557^2469^22^^49^^^^1^LD2^3^^14^^Lst Documented negative HIV Name edt6_4_1=^^1046^2664^30^MMYY^50^170^^^1^LD1^10^^18^MM/YY^VI. Other HIV Test Date chkb6_4_1=^^746^2671^27^^49^^^^1^LD1^9^1^18^^VI. Other HIV Test Pos chkb6_4_2=^^821^2671^27^^49^^^^1^LD1^9^0^18^^VI. Other HIV Test Neg chkb6_4_3=^^895^2671^27^^49^^^^1^LD1^9^8^18^^VI. Other HIV Test Ind chkb6_4_4=^^966^2671^27^^49^^^^1^LD1^9^9^18^^VI. Other HIV Not Done edt2_2=^^^^32^^49^^^^1^^^^^^ edt6_4_2=^^315^2718^22^^49^^^^1^LD1^11^^18^^VI. Other HIV Test Name edt6_3_1=^^1046^2598^30^MMYY^50^170^^^1^LD1^8^^18^MM/YY^VI. HIV-1 Western Date chkb6_3_1=^^746^2605^26^^49^^^^1^LD1^7^1^18^^VI. HIV-1 Western Yes chkb6_3_2=^^821^2605^26^^49^^^^1^LD1^7^0^18^^VI. HIV-1 Western No chkb6_3_3=^^896^2605^26^^49^^^^1^LD1^7^8^18^^VI. HIV-1 Western Ind chkb6_3_4=^^967^2605^26^^49^^^^1^LD1^7^9^18^^VI. HIV-1 Western Not Done edt6_2_1=^^1046^2531^30^MMYY^50^170^^^1^LD1^6^^18^MM/YY^VI. HIV-1/2 Date chkb6_2_1=^^746^2538^27^^49^^^^1^LD1^5^1^18^^VI. HIV 1/2 Pos chkb6_2_2=^^820^2538^27^^49^^^^1^LD1^5^0^18^^VI. HIV 1/2 Neg chkb6_2_3=^^967^2538^27^^49^^^^1^LD1^5^9^18^^VI. HIV 1/2 Not Done edt2_3=^^^^32^^49^^^^1^^^^^^ edt6_1_1=^^1046^2465^30^MMYY^50^170^^^1^LD1^4^^18^MM/YY^VI. HIV-1 EAI Date chkb6_1_1=^^746^2471^27^^49^^^^1^LD1^3^1^18^^VI. HIV-1 EAI Pos chkb6_1_2=^^821^2471^27^^49^^^^1^LD1^3^0^18^^VI. HIV-1 EAI Neg chkb6_1_3=^^966^2471^27^^49^^^^1^LD1^3^9^18^^VI. HIV-1 EAI Not Done edt6_5_1=^^1046^2836^30^MMYY^50^170^^^1^LD1^13^^18^MM/YY^VI. Positive HIV Detection Date edt6_5_2=^^399^2908^22^^49^^^^1^LD1^14^^18^^VI. Positive HIV Detection Other Test Type edt6_5_3=^^1046^2902^30^MMYY^50^170^^^1^LD1^15^^18^MM/YY^VI. Positive HIV Detection Other Date chkb6_5_1=^^162^2838^27^^49^^^^1^LD1^12^1^18^^VI. Positive HIV Detection Culture chkb6_5_2=^^337^2838^27^^49^^^^1^LD1^12^2^18^^VI. Positive HIV Detection Antigen chkb6_5_3=^^524^2838^27^^49^^^^1^LD1^12^3^18^^VI. Positive HIV Detection PCR, DNA or RNA Probe edt2_4=^^^^32^^49^^^^1^^^^^^ edt6_6_2=^^1046^3074^30^MMYY^50^170^^^1^LD1^18^^18^MM/YY^VI. VIRAL LOAD TEST DATE cmbb6_6_1=^^301^3073^30^BoxedLine^49^2^^^1^LD1^16^^18^^VI. VIRAL LOAD TEST TYPE edt6_6_1=^^517^3073^30^N7^50^29^125^^1^LD1^17^^18^^VI. VIRAL LOAD COPIES/ML edt6_9_2=^^2230^2877^30^MMYY^50^170^^^1^LD2^8^^14^MM/YY^VI. IMMUNOLOGY LAB CD4 Count Date edt6_9_4=^^2230^2944^30^MMYY^50^170^^^1^LD2^10^^14^MM/YY^VI. IMMUNOLOGY LAB CD4 Percent Date edt6_9_6=^^2230^3058^30^MMYY^50^170^^^1^LD2^12^^14^MM/YY^VI. IMMUNOLOGY LAB First <200ml CD4 Count Date edt6_9_8=^^2230^3123^30^MMYY^50^170^^^1^LD2^14^^14^MM/YY^VI. IMMUNOLOGY LAB First <200ml CD4 Percent Date edt6_9_3=^^1938^2944^30^BoxedLine^49^2^^^1^LD2^9^^14^^VI. IMMUNOLOGY LAB CD4 Percent edt6_9_1=^^1811^2877^30^N4^49^30^^^1^LD2^7^^14^^VI. IMMUNOLOGY LAB CD4 Count edt6_9_5=^^1810^3057^30^N4^49^30^^^1^LD2^11^^14^^VI. IMMUNOLOGY LAB First <200ml CD4 Count edt2_5=^^^^32^^49^^^^1^^^^^^ edt6_9_7=^^1939^3123^30^BoxedLine^49^2^^^1^LD2^13^^14^^VI. IMMUNOLOGY LAB First <200ml CD4 Percent edt7_1=^^380^111^22^^49^^^^2^^^^^^VII. Physician edt7_5=^^1320^184^22^PlainLine^49^^^^2^^^^^^VII. Person, compiling form edt7_3=^^1455^111^22^^49^^^^2^^^^^^VII. Physician Phone edt7_6=^^2005^184^22^^49^^^^2^^^^^^VII. Person compiling phone edt7_4=^^355^184^22^^49^^^^2^^^^^^VII. Hospital edt7_2=^^2140^111^22^^49^^^^2^^^^^^VII. Medical Record Num edt8_27_1=^^2185^1640^30^MMYY^50^158^^26^2^AID^4^^4^MM/YY^ chkb8_27_1=^^2016^1642^27^^49^^^26^2^AID^3^1^4^^ edt8_26_1=^^2185^1553^30^MMYY^50^158^^25^2^AID^4^^4^MM/YY^ edt2_6=^^^^32^^49^^^^1^^^^^^ chkb8_26_1=^^2017^1555^26^^49^^^25^2^AID^3^1^4^^ chkb8_26_2=^^2100^1555^26^^49^^^25^2^AID^3^2^4^^ edt8_25_1=^^2185^1464^30^MMYY^50^158^^24^2^AID^4^^4^MM/YY^ chkb8_25_1=^^2016^1467^27^PlainLine^49^1^^24^2^AID^3^1^4^^ edt8_24_1=^^2185^1378^30^MMYY^50^158^^23^2^AID^4^^4^MM/YY^ chkb8_24_1=^^2016^1380^26^^49^^^23^2^AID^3^1^26^^ edt8_23_1=^^2185^1290^30^MMYY^50^158^^22^2^AID^4^^4^MM/YY^ chkb8_23_1=^^2016^1292^27^^49^^^22^2^AID^3^1^4^^ chkb8_23_2=^^2104^1292^27^^49^^^22^2^AID^3^2^4^^ edt8_22_1=^^2185^1204^30^MMYY^50^158^^21^2^AID^4^^4^MM/YY^ chkb2_1=^^^^32^^49^^^^1^^^^^^ chkb8_22_1=^^2017^1205^26^^49^^^21^2^AID^3^1^4^^ chkb8_22_2=^^2104^1205^26^^49^^^21^2^AID^3^2^4^^ edt8_21_1=^^2185^1115^30^MMYY^50^158^^20^2^AID^4^^4^MM/YY^ chkb8_21_1=^^2016^1117^27^^49^^^20^2^AID^3^1^4^^ chkb8_21_2=^^2104^1117^27^^49^^^20^2^AID^3^2^4^^ edt8_20_1=^^2185^1028^30^MMYY^50^158^^19^2^AID^4^^4^MM/YY^ chkb8_20_1=^^2017^1034^26^^49^^^19^2^AID^3^1^4^^ chkb8_20_2=^^2104^1034^26^^49^^^19^2^AID^3^2^4^^ edt8_19_1=^^2185^941^30^MMYY^50^158^^18^2^AID^4^^4^MM/YY^ chkb8_19_1=^^2016^942^27^^49^^^18^2^AID^3^1^4^^ chkb2_2=^^^^32^^49^^^^1^^^^^^ chkb8_19_2=^^2104^942^27^^49^^^18^2^AID^3^2^4^^ edt8_18_1=^^2185^853^30^MMYY^50^158^^17^2^AID^4^^4^MM/YY^ chkb8_18_1=^^2017^855^26^^49^^^17^2^AID^3^1^4^^ chkb8_18_2=^^2104^855^26^PlainLine^49^^^17^2^AID^3^2^4^^ edt8_17_1=^^2185^765^30^MMYY^50^158^^16^2^AID^4^^4^MM/YY^ chkb8_17_1=^^2016^767^27^^49^^^16^2^AID^3^1^4^^ edt8_16_1=^^2185^676^30^MMYY^50^158^^15^2^AID^4^^4^MM/YY^ chkb8_16_1=^^2017^680^26^^49^^^15^2^AID^3^1^4^^ edt8_15_1=^^2185^590^30^MMYY^50^158^^14^2^AID^4^^4^MM/YY^ chkb8_15_1=^^2016^592^27^^49^^^14^2^AID^3^1^4^^ edt3_3_1=^^1985^871^22^^49^^^^1^CDM^6^^8^^Territory of death edt8_14_1=^^1019^1640^30^MMYY^50^158^^13^2^AID^4^^4^MM/YY^ chkb8_14_1=^^846^1642^27^^49^^^13^2^AID^3^1^4^^ chkb8_14_2=^^933^1642^27^^49^^^13^2^AID^3^2^4^^ edt8_13_1=^^1019^1552^30^MMYY^50^158^^12^2^AID^4^^4^MM/YY^ chkb8_13_1=^^846^1555^26^^49^^^12^2^AID^3^1^4^^ edt8_12_1=^^1019^1465^30^MMYY^50^158^^11^2^AID^4^^4^MM/YY^ chkb8_12_1=^^845^1467^27^^49^^^11^2^AID^3^1^4^^ edt8_11_1=^^1019^1376^30^MMYY^50^158^^10^2^AID^4^^4^MM/YY^ chkb8_11_1=^^846^1380^26^^49^^^10^2^AID^3^1^4^^ edt8_10_1=^^1019^1289^30^MMYY^50^158^^9^2^AID^4^^4^MM/YY^ edt1_1=^^548^87^32^^49^^^^1^^^^^^Name chkb3_3_1=^^1301^910^25^^49^^^^1^CDM^1^^14^^Current Status Alive chkb8_10_1=^^846^1292^27^^49^^^9^2^AID^3^1^4^^ edt8_9_1=^^1019^1202^30^MMYY^50^158^^8^2^AID^4^^4^MM/YY^ chkb8_9_1=^^846^1205^26^^49^^^8^2^AID^3^1^4^^ chkb8_9_2=^^934^1205^26^^49^^^8^2^AID^3^2^4^^ edt8_8_1=^^1019^1115^30^MMYY^50^158^^7^2^AID^4^^4^MM/YY^ chkb8_8_1=^^846^1117^27^^49^^^7^2^AID^3^1^4^^ edt8_7_1=^^1019^1029^30^MMYY^50^158^^6^2^AID^4^^4^MM/YY^ chkb8_7_1=^^846^1034^26^^49^^^6^2^AID^3^1^4^^ edt8_6_1=^^1019^941^30^MMYY^50^158^^5^2^AID^4^^4^MM/YY^ chkb8_6_1=^^846^946^27^^49^^^5^2^AID^3^1^4^^ chkb3_3_2=^^1393^910^25^^49^^^^1^CDM^2^^14^^Current Status Dead edt8_5_1=^^1019^853^30^MMYY^50^158^^4^2^AID^4^^4^MM/YY^ chkb8_5_1=^^846^855^26^^49^^^4^2^AID^3^1^4^^ edt8_4_1=^^1019^765^30^MMYY^50^158^^3^2^AID^4^^4^MM/YY^ chkb8_4_1=^^846^767^27^^49^^^3^2^AID^3^1^4^^ edt8_3_1=^^1019^678^30^MMYY^50^158^^2^2^AID^4^^4^MM/YY^VIII. Candidiasis, esophagel Date chkb8_3_1=^^846^684^26^^49^^^2^2^AID^3^1^4^^VIII. Candidiasis, esophagel Def chkb8_3_2=^^934^684^26^^49^^^2^2^AID^3^2^4^^VIII. Candidiasis, esophagel Pres edt8_2_1=^^1019^591^30^MMYY^50^158^^1^2^AID^4^^4^MM/YY^VIII. Candidiasis, Bronchi, trachea Date chkb8_2_1=^^846^596^27^^49^^^1^2^AID^3^1^4^^VIII. Candidiasis, Bronchi, trachea Def chkb8_1=^^471^417^27^^49^^^^2^CS^3^1^7^^VIII. Record Rewieved yes chkb3_3_3=^^1485^910^25^^49^^^^1^CDM^9^^14^^Current Status Unk chkb8_2=^^566^417^27^^49^^^^2^CS^3^0^7^^VIII. Record Rewieved No edt8_1_1=^^1667^420^30^MMYY^50^155^^^2^CS^4^^7^MM/YY^VIII Asymptomatic Date edt8_1_2=^^2188^419^30^MMYY^50^155^^^2^CS^5^^7^MM/YY^Symptomatic Date edt8_1=^^1622^1724^30^BoxedLine^46^9^^^2^CS^6^^7^^RVCT CASE NO chkb8_28_1=^^1396^1813^27^PlainLine^49^^^^2^CS^7^1^7^^VIII. Immunideficiency disqualifying from AIDS Yes chkb8_28_2=^^1563^1813^27^^49^^^^2^CS^7^0^7^^VIII. Immunideficiency disqualifying from AIDS No chkb8_28_3=^^1712^1813^27^^49^^^^2^CS^7^9^7^^VIII. Immunideficiency disqualifying from AIDS Unk chkb9_8_1=^^1142^2255^26^^49^^^^2^TS1^10^1^11^^Clinic (HRSA) chkb9_8_2=^^1142^2305^26^^49^^^^2^TS1^10^2^11^^Clinic (Other) chkb9_8_4=^^1142^2405^26^^49^^^^2^TS1^10^9^11^^Clinic (None) edt3_3_2=^^1607^902^30^MMDDYY^58^116^^^1^DEM^7^^14^^Date of Death chkb9_8_3=^^1142^2355^26^^49^^^^2^TS1^10^3^11^^Clinic (Unknown) chkb9_6_1=^^467^2392^27^^49^^^^2^TS1^8^1^11^^PCP prophylaxis Yes chkb9_6_2=^^550^2392^27^^49^^^^2^TS1^8^0^11^^PCP prophylaxis No chkb9_6_3=^^632^2392^27^^49^^^^2^TS1^8^9^11^^PCP prophylaxis Unk chkb9_12_1=^^1241^2588^27^^49^^^^2^TS2^5^1^9^^IX. Live Infant delivered Yes chkb9_12_2=^^2100^2588^27^^49^^^^2^TS2^5^0^9^^IX. Live Infant delivered No chkb9_12_3=^^2250^2588^27^^49^^^^2^TS2^5^3^9^^IX. Live Infant delivered Unk edt9_12_2=^^1417^2758^30^BoxedLine^49^4^^^2^TS2^^^9^^IX. Live Infant delivered Child SOUNDEX ???? edt9_12_5=^^1942^2751^30^BoxedLine^50^10^^^2^TS2^^^9^^IX. Live Infant delivered Child State Patient # dtp9_12_1=^^164^2761^30^MMDDYY^49^106^^^2^TS2^6^^9^^IX. Live Infant delivered Date of Birth edt3_2_1=^^885^902^30^MMDDYY^58^115^^^1^DEM^5^^8^^Date of Birth edt9_12_3=^^615^2772^22^^49^^^^2^TS2^8^^9^^IX. Live Infant delivered City edt9_12_1=^^769^2700^22^^49^^^^2^TS2^7^^9^^IX. Live Infant delivered Hospital cmbb9_12_1=^^1037^2772^22^^49^^^^2^TS2^9^^9^^IX. Live Infant delivered State chkb9_11_1=^^1934^2534^26^^49^^^^2^TS2^4^1^9^^IX. Is patient pregnant Yes chkb9_11_2=^^2101^2534^26^^49^^^^2^TS2^4^0^9^^IX. Is patient pregnant No chkb9_11_3=^^2251^2534^26^^49^^^^2^TS2^4^9^9^^IX. Is patient pregnant Unk chkb9_4_1=^^2146^2105^26^^49^^^^2^TS1^6^1^11^^Substance abuse Yes chkb9_4_2=^^2229^2105^26^^49^^^^2^TS1^6^0^11^^Substance abuse No chkb9_4_4=^^2392^2105^26^^49^^^^2^TS1^6^9^11^^Substance abuse Unk chkb9_4_3=^^2313^2105^26^^49^^^^2^TS1^6^8^11^^Substance abuse NA edt3_1_2=^^574^910^30^BoxedLine^54^2^^^1^CDM^4^^14^^AIDS age chkb9_3_1=^^2146^2050^27^^49^^^^2^TS1^5^1^11^^HIV med. services Yes chkb9_3_2=^^2229^2050^27^^49^^^^2^TS1^5^0^11^^HIV med. services No chkb9_3_3=^^2392^2050^27^^49^^^^2^TS1^5^9^11^^HIV med. services Unk chkb9_2_1=^^229^2109^26^^49^^^^2^TS1^4^1^11^^Notified Health department chkb9_2_3=^^625^2109^26^^49^^^^2^TS1^4^2^11^^Notified Physician/Provider chkb9_2_2=^^1030^2109^26^^49^^^^2^TS1^4^3^11^^Notified Patient chkb9_2_4=^^1263^2109^26^^49^^^^2^TS1^4^9^11^^Notified Unk chkb9_1_1=^^996^1992^27^^49^^^^2^TS1^3^1^11^^Informed of HIV Yes chkb9_1_2=^^1162^1992^27^^49^^^^2^TS1^3^0^11^^Informed of HIV No chkb9_1_3=^^1312^1992^27^^49^^^^2^TS1^3^9^11^^Informed of HIV Unk chkb3_1_1=^^126^868^25^^49^^^^1^CDM^3^1^14^^Diagnostic status HIV chkb9_5_1=^^468^2280^26^^49^^^^2^TS1^7^1^11^^ARV therapy Yes chkb9_5_2=^^550^2280^26^^49^^^^2^TS1^7^0^11^^ARV therapy No chkb9_5_3=^^634^2280^26^^49^^^^2^TS1^7^9^11^^ARV therapy Unk chkb9_7_1=^^784^2255^26^^49^^^^2^TS1^9^1^11^^Clinical Trial NIH chkb9_7_2=^^784^2305^26^^49^^^^2^TS1^9^2^11^^Clinical Trial Other chkb9_7_4=^^784^2405^26^^49^^^^2^TS1^9^9^11^^Clinical Trial Unkn chkb9_7_3=^^784^2355^26^^49^^^^2^TS1^9^3^11^^Clinical Trial None chkb9_9_1=^^1621^2255^26^^49^^^^2^TS1^11^1^11^^Reimburse Medicaid chkb9_9_3=^^1621^2309^26^^49^^^^2^TS1^11^3^11^^Reimbursed No coverage chkb9_9_2=^^2000^2255^26^^49^^^^2^TS1^11^2^11^^Reimbursed HMO chkb3_1_2=^^126^923^25^^49^^^^1^CDM^3^2^14^^Diagnostic status AIDS chkb9_9_4=^^2001^2309^26^^49^^^^2^TS1^11^4^11^^Reimbursed Other chkb9_9_5=^^1621^2363^27^^49^^^^2^TS1^11^7^11^^Reimbursed Trial chkb9_9_6=^^2000^2363^27^^49^^^^2^TS1^11^9^11^^Reimbursed Unk chkb9_10_1=^^1934^2480^26^^49^^^^2^TS2^3^1^9^^Gynecol. services Yes chkb9_10_2=^^2101^2480^26^^49^^^^2^TS2^3^0^9^^Gynecol. services No chkb9_10_3=^^2251^2480^26^^49^^^^2^TS2^3^9^9^^Gynecol. services Unk mmComments=^^420^2864^30^MEMO^65^^^^2^CMT^3^^3^^ edt3_1_1=^^574^848^30^BoxedLine^54^2^^^1^CDM^4^^14^^HIV Age chkb3_5_1=^^355^1040^25^^49^^^^1^ETN^3^2135-2^6^^Ethnicity Hispanic edt1_3=^^246^178^22^^49^^^^1^ADR^3^^13^^Address chkb3_5_2=^^543^1039^25^^49^^^^1^ETN^3^2186-5^6^^Ethnicity Unk chkb3_5_3=^^355^1101^25^^49^^^^1^ETN^3^9999-4^6^^Ethnicity Not Hispanic chkb3_4_1=^^127^1040^25^^49^^^^1^DEM^8^M^8^^Sex Male chkb3_4_2=^^126^1106^25^^49^^^^1^DEM^8^F^8^^Sex Female chkb3_6_1=^^730^1039^25^^49^^^^1^RCE^3^1002-5^6^^Race American chkb3_6_2=^^730^1118^25^^49^^^^1^RCE^3^2028-9^6^^Race Asian chkb3_6_4=^^864^1119^25^^49^^^^1^RCE^3^2054-5^6^^Race Hawaiian chkb3_6_3=^^1001^1039^25^^49^^^^1^RCE^3^2076-8^6^^Race Black Am chkb3_6_6=^^1334^1115^25^^49^^^^1^RCE^3^2106-3^6^^Race Unkn. chkb3_6_5=^^1189^1114^25^^49^^^^1^RCE^3^9999-4^6^^Race White edt1_4=^^1083^178^22^^49^^^^1^ADR^6^^13^^City chkb3_7_1=^^1501^1019^25^^49^^^^1^CDM^7^1^14^^Country of Birth USA chkb3_7_2=^^1643^1018^25^^49^^^^1^CDM^7^7^14^^Country of Birth US Depend chkb3_7_4=^^2339^1123^25^^49^^^^1^CDM^7^9^14^^Country of Birth Unk. edt3_7_1=^^1811^1065^22^^49^^^^1^CDM^8^^14^^Country of Birth USA Dep Name chkb3_7_3=^^1501^1119^25^^49^^^^1^CDM^7^8^14^^Country of Birth Other edt3_7_2=^^1765^1122^22^^49^^^^1^CDM^8^^14^^Country of Birth Other Name edt3_8_2=^^864^1234^22^^49^^^^1^CDM^10^^14^^Residence County edt3_8_1=^^214^1234^22^^49^^^^1^CDM^9^^14^^Residence City edt3_8_4=^^1974^1215^30^BoxedLine^49^9^^^1^CDM^14^^14^ZIP^Residence ZIP edt3_8_5=^^1383^1234^22^^49^^^^1^CDM^13^^14^^Residence Country edt1_5=^^1512^178^22^^49^^^^1^ADR^12^^13^^County cmbb3_8_1=^^1383^1234^22^^49^^^^1^CDM^11^^14^^Residence State chkb4_3_1=^^130^1806^25^^49^^^^1^FD^9^01^10^^Diagnostic Facility Type Physitcan, HMO chkb4_3_2=^^484^1806^25^^49^^^^1^FD^9^31^10^^Diagnostic Facility Type Inpatient chkb4_3_3=^^129^1865^25^^49^^^^1^FD^9^88^10^^Diagnostic Facility Type Other edt4_3_1=^^397^1859^22^^49^^^^1^FD^10^^10^^Diagnostic Facility Type Other Name chkb4_2_1=^^130^1694^25^^49^^^^1^FD^8^1^10^^Diagnostic Facility Setting Public chkb4_2_2=^^339^1694^25^^49^^^^1^FD^8^2^10^^Diagnostic Facility Setting Private chkb4_2_3=^^551^1694^25^^49^^^^1^FD^8^3^10^^Diagnostic Facility Setting Federal chkb4_2_4=^^772^1694^25^^49^^^^1^FD^8^9^10^^Diagnostic Facility Setting Unk edt4_1_1=^^125^1402^22^^49^^^^1^FD^3^^10^^Diagnostic Facility Name edt1_6=^^2205^178^22^^49^^^^1^ADR^9^^13^^ZIP edt4_1_2=^^125^1474^22^^49^^^^1^FD^4^^10^^Diagnostic Facility City edt4_1_4=^^125^1550^22^^49^^^^1^FD^7^^10^^Facility Country cmbb4_1_1=^^125^1550^22^^49^^^^1^FD^5^^10^^Diagnostic Facility Setting State chkb5_14_1=^^2228^2209^24^^49^^^^1^PH^19^1^20^^Work in Clinical Lab Yes chkb5_14_2=^^2316^2209^24^^49^^^^1^PH^19^0^20^^Work in Clinical Lab No chkb5_14_3=^^2399^2209^24^^49^^^^1^PH^19^9^20^^Work in Clinical Lab Unk. edt5_14_1=^^1420^2257^22^^49^^^^1^PH^20^^20^^Work in Clinical Lab Name chkb5_12_1=^^2228^2163^24^^49^^^^1^PH^18^1^20^^Received Transpalnt Yes chkb5_12_2=^^2316^2163^24^^49^^^^1^PH^18^0^20^^Received Transpalnt No chkb5_12_3=^^2398^2163^24^^49^^^^1^PH^18^9^20^^Received Transpalnt Unk cmbb1_1=^^1872^176^24^^49^^^^1^ADR^8^^13^^ chkb5_11_1=^^2228^2038^24^^49^^^^1^PH^15^1^20^^Received Transfusion Yes chkb5_11_2=^^2316^2038^24^^49^^^^1^PH^15^0^20^^Received Transfusion No chkb5_11_3=^^2399^2038^24^^49^^^^1^PH^15^9^20^^Received Transfusion Unk edV_FirstYear=^^1357^2107^30^MMYY^50^170^^^1^PH^16^^20^MM/YY^Received Transfusion First edV_LastYear=^^1766^2107^30^MMYY^50^170^^^1^PH^17^^20^MM/YY^Received Transfusion Last chkb5_10_1=^^2228^1992^24^^49^^^^1^PH^14^1^20^^Hetero SR with Person with AIDS Yes chkb5_10_2=^^2316^1992^24^^49^^^^1^PH^14^0^20^^Hetero SR with Person with AIDS No chkb5_10_3=^^2398^1992^24^^49^^^^1^PH^14^9^20^^Hetero SR with Person with AIDS Unk. chkb5_9_1=^^2228^1946^25^^49^^^^1^PH^13^1^20^^Hetero SR with Transplant recepient Yes chkb5_9_2=^^2315^1946^25^^49^^^^1^PH^13^0^20^^Hetero SR with Transplant recepient No edt1_2=^^2020^108^22^^49^^^^1^ADR^13^^13^^Phone chkb5_9_3=^^2398^1946^25^^49^^^^1^PH^13^9^20^^Hetero SR with Transplant recepient Unk chkb5_8_1=^^2228^1901^24^^49^^^^1^PH^12^1^20^^Hetero SR with Transfusion recepient Yes chkb5_8_2=^^2316^1901^24^^49^^^^1^PH^12^0^20^^Hetero SR with Transfusion recepient No chkb5_8_3=^^2399^1901^24^^49^^^^1^PH^12^9^20^^Hetero SR with Transfusion recepient Unk chkb5_7_1=^^2228^1855^24^^49^^^^1^PH^11^1^20^^Hetero SR with Hemofilia Yes chkb5_7_2=^^2316^1855^24^^49^^^^1^PH^11^0^20^^Hetero SR with Hemofilia No chkb5_7_3=^^2398^1855^24^^49^^^^1^PH^11^9^20^^Hetero SR with Hemofilia Unk chkb5_6_1=^^2228^1809^24^^49^^^^1^PH^9^1^20^^Hetero SR with Bisexual male Yes chkb5_6_2=^^2316^1809^24^^49^^^^1^PH^9^0^20^^Hetero SR with Bisexual male No chkb5_6_3=^^2398^1809^24^^49^^^^1^PH^9^9^20^^Hetero SR with Bisexual male Unk edt1_7=^^1872^178^22^^49^^^^1^ADR^^^^^State chkb5_5_1=^^2228^1763^24^^49^^^^1^PH^10^1^20^^Hetero SR with Intravenoue Yes chkb5_5_2=^^2316^1763^24^^49^^^^1^PH^10^0^20^^Hetero SR with Intravenoue No chkb5_5_3=^^2398^1763^24^^49^^^^1^PH^10^9^20^^Hetero SR with Intravenoue Unk chkb5_4_1=^^2228^1601^24^^49^^^^1^PH^6^1^20^^Receiving Clotting Factor Yes chkb5_4_2=^^2316^1601^24^^49^^^^1^PH^6^0^20^^Receiving Clotting Factor No chkb5_4_3=^^2399^1601^24^^49^^^^1^PH^6^9^20^^Receiving Clotting Factor Unk chkb5_4_4=^^1167^1642^27^^49^^^^1^PH^7^1^20^^Receiving Clotting Factor VIII chkb5_4_5=^^1429^1642^27^^49^^^^1^PH^7^2^20^^Receiving Clotting Factor IX chkb5_4_6=^^1708^1642^27^^49^^^^1^PH^7^8^20^^Receiving Clotting Factor Other edt5_4_1=^^1901^1672^22^^49^^^^1^PH^8^^20^^Receiving Clotting Factor Other Name |