MSH|^~\&|ADM|SMH|||201911221419||ADT^A04|4111724|D|2.2|||AL|NE
EVN|A04|201911221419||||201911221408
PID|1|FHATVIG0012561|SM00047026|SM46809|ADMKING^LIBERTE^TRAIN|PARMJIT|19920115|F|||7-7447 AVE^^PORT COQUITLAM^BC^V1V 1V1|||||||SM003616/19|9874856319
PV1|1|O|SM.TRAIN||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^^^^^^XX|||||||||||CLI|||||||||||||||||||||SMH|||||201911221408|
PV2|||
OBX|1|TX|ADM CURRES^Residing at current add. since (DD/MM/YY)^ADM||20181101||||||F
OBX|2|CE|ADM IDSOUR^SOURCE OF ID^ADM||NONE^None||||||F
OBX|3|TX|ADM PRERE^Previous Address if less than 6 months at current^ADM||123 LIVEDHEREBEFORE ST, EDMONTON,AB,T0L 2T0||||||F
OBX|4|TX|UPI ISO^^ADM||CAN||||||F
OBX|5|TX|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
OBX|6|TX|INS OPCAD1^Address line 1^INS||12 LIVEDHEREBEFORE ST||||||F
OBX|7|TX|INS OPCAD3^City^INS||EDMONTON||||||F
OBX|8|TX|INS OPCAD5^Postal Code^INS||TO1LIT||||||F
GT1|1||ADMKING^LIBERTE^TRAIN||7-7447 AVE^^PORT COQUITLAM^BC^V4K 7F2||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|
ZFH|LUMED||||||

