MSH|^~\&|ADM|BH|||201912090300||ADT^A04|4125580|D|2.2|||AL|NE
EVN|A04|201912090300||||201912080700
PID|1|FHATVIG0012627|BH00005210|SM46830|ADMRIVERA^PREVIA^TRAIN|ALYSSA|19840507|F|||9510 114 AVE^^MAPLE RIDGE^BC^V4A 2R6|||||||BH000419/19|9874809334
PV1|1|O|BH.ONC||||TELIOD^Telio^David^^^^^^^^^^XX|||||||||||RCR|||||||||||||||||||||BH|||||201912080700|
PV2|||ONCOLOGY
OBX|1|TX|ADM CURRES^Residing at current add. since (DD/MM/YY)^ADM||20191121||||||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|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
OBX|5|TX|INS OPCAD1^Address line 1^INS||123 LIVEDHEREBEFORE ST||||||F
OBX|6|TX|INS OPCAD3^City^INS||EDMONTON||||||F
OBX|7|TX|INS OPCAD5^Postal Code^INS||T0L1T0||||||F
GT1|1||ADMRIVERA^PREVIA^TRAIN||9510 114 AVE^^MAPLE RIDGE^BC^V4A 2R6||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||TELIOD^Telio^David^^^^^64416^DOC|
ZFH|LUMED||||||

