MSH|^~\&|ADM|SMH|||202001280950||ADT^A01|4157273|D|2.2|||AL|NE
EVN|A01|202001280950||||202001280949
PID|1|FHATVIG0002190|SM00041948|SU3598|TESTVP^LADY^B||19900115|F|||123 4TH STREET^^SURREY^BC^V3R 5N7|||||||SM004042/19|9876212492
PV1|1|I|SM-5E^SM5E-501^B|EL|||ZTEST^Test Provider^IM/IT^Use Only^^^^^^^^^XX|||ACE||||||||IN|||||||||||||||||||||SMH|||||202001280949|
PV2||S^Semi-Private - Non-Solicited|
OBX|1|CE|ADM ACC VE^Requested Accommodation Verified?^ADM||N^NOT ASKED/NOTHING SIGNED||||||F
OBX|2|TX|ADM CURRES^Residing at current add. since (DD/MM/YY)^ADM||20010101||||||F
OBX|3|CE|ADM IDSOUR^SOURCE OF ID^ADM||BCSWP^BC Services With Photo||||||F
OBX|4|CE|ADM MDRO2^Canada in the last 12 months?^ADM||N^NO||||||F
OBX|5|CE|ADM MDRO4^Bangladesh or Vietnam in the last 12 months?^ADM||N^NO||||||F
OBX|6|TX|ADM MN^Enter Patient's Maiden Name:^ADM||REGBATEST||||||F
OBX|7|CE|ADM MRSA2^correctional/shelter in the last 12 months?^ADM||N^NO||||||F
OBX|8|CE|ADM RESQDA^CONSENT TO BEING CONTACTED FOR RESEARCH^ADM||Y^Yes||||||F
OBX|9|TX|ADM RESQDD^DATE ASKED^ADM||20010101||||||F
OBX|10|TX|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
GT1|1||TESTVP^LADY^B||123 4TH STREET^^SURREY^BC^V3R 5N7||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||ZTEST^Test Provider^IM/IT^Use Only^^^^500001^DOC|ZTEST^Test Provider^IM/IT^Use Only^^^^500001^DOC|
ZFH|LUMED|||||||||ENADMIN

