MSH|^~\&|ADM|SMH|||201910301049||ADT^A08|4093635|D|2.2|||AL|NE
EVN|A08|201910301049||||201910301042
PID|1|FHATVIG0012247|SM00046813|SM46604|ADMSTEN^TEST^ONE|SAM|19901010|M|||321 WINDY ST^^SURREY^BC^V2S 1P9|||||||SM003320/19|9874940566
PV1|1|I|SM-ERTAC1^SMERTAC1^AG|UE|||CHANA6^Chan^Albert^K^^^^^^^^^XX|||ORTH||||||||IN|||||||||||||||||||||SMH|||||201910301041|
PV2||W^Ward|BILATER LEG FRACTURES
OBX|1|CE|ADM ACC VE^Requested Accommodation Verified?^ADM||Y^YES VERIF PA NOT SIGNED||||||F
OBX|2|TX|ADM CURRES^Residing at current add. since (DD/MM/YY)^ADM||20151101||||||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||Y^YES||||||F
OBX|5|CE|ADM MDRO4^or Bangladesh in the last 12 months?^ADM||U^UNK||||||F
OBX|6|CE|ADM MRSA2^correctional/shelter in the last 6 months?^ADM||U^UNK||||||F
OBX|7|CE|ADM TPL^Third Party Liability?^ADM||N^No||||||F
OBX|8|TX|INS WCBAP^Anatomical Positions (Side of Body)^INS||B||||||F
OBX|9|TX|INS WCBBP^Body Part^INS||41000||||||F
OBX|10|TX|INS WCBDOI^Date of Injury^INS||20191030||||||F
OBX|11|TX|INS WCBNOI^Nature of Injury^INS||03400||||||F
OBX|12|CE|INS WSBC^Is this a WorkSafeBC claim?^INS||Y^Yes||||||F
GT1|1||ADMSTEN^TEST^ONE||321 WINDY ST^^SURREY^BC^V2S 1P9||||||SP
ZFD|WONGD^Wong^Daniel^K^^^^09200^DOC|110 - 20528 Lougheed Highway^Mageta Medical Clinic^Maple Ridge^BC^V2X 2P8|IPU^Ip^Y.B.^Urbain^^^^23128^DOC||CHANA6^Chan^Albert^K^^^^28346^DOC|IPU^Ip^Y.B.^Urbain^^^^23128^DOC|#WBC^BC^#Worksafe^^^^^^LOCATION|
ZFH|LUMED|201910300945|2||||

MSH|^~\&|ADM|SMH|||201910301050||ADT^A02|4093641|D|2.2|||AL|NE
EVN|A02|201910301050||||201910301042
PID|1|FHATVIG0012247|SM00046813|SM46604|ADMSTEN^TEST^ONE|SAM|19901010|M|||321 WINDY ST^^SURREY^BC^V2S 1P9|||||||SM003320/19|9874940566
PV1|1|I|SM-S3S3^SMS3S3-327^A|UE||SM-ERTAC1^SMERTAC1^AG|CHANA6^Chan^Albert^K^^^^^^^^^XX|||ORTH||||||||IN|||||||||||||||||||||SMH|||||201910301041|
PV2||S^Semi-Private - Non-Solicited|BILATER LEG FRACTURES
OBX|1|CE|ADM ACC VE^Requested Accommodation Verified?^ADM||Y^YES VERIF PA NOT SIGNED||||||F
OBX|2|TX|ADM CURRES^Residing at current add. since (DD/MM/YY)^ADM||20151101||||||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||Y^YES||||||F
OBX|5|CE|ADM MDRO4^or Bangladesh in the last 12 months?^ADM||U^UNK||||||F
OBX|6|CE|ADM MRSA2^correctional/shelter in the last 6 months?^ADM||U^UNK||||||F
OBX|7|CE|ADM TPL^Third Party Liability?^ADM||N^No||||||F
OBX|8|TX|INS WCBAP^Anatomical Positions (Side of Body)^INS||B||||||F
OBX|9|TX|INS WCBBP^Body Part^INS||41000||||||F
OBX|10|TX|INS WCBDOI^Date of Injury^INS||20191030||||||F
OBX|11|TX|INS WCBNOI^Nature of Injury^INS||03400||||||F
OBX|12|CE|INS WSBC^Is this a WorkSafeBC claim?^INS||Y^Yes||||||F
ZFD|WONGD^Wong^Daniel^K^^^^09200^DOC|110 - 20528 Lougheed Highway^Mageta Medical Clinic^Maple Ridge^BC^V2X 2P8|IPU^Ip^Y.B.^Urbain^^^^23128^DOC||CHANA6^Chan^Albert^K^^^^28346^DOC|IPU^Ip^Y.B.^Urbain^^^^23128^DOC|#WBC^BC^#Worksafe^^^^^^LOCATION|
ZFH|LUMED|201910300945|2||||

