MSH|^~\&|ADM|SMH|||201911130954||ADT^A04|4104327|D|2.2|||AL|NE
EVN|A04|201911130954||||201911130954
PID|1|FHATVIG0011045|SM00045830|SM45628|ADMCARTER^FIREBIRD|NICKY|19850513|F|||9915 243 ST^^PORT COQUITLAM^BC^V7Y 6H8|||||||SM003477/19|9875047562
PV1|1|O|SM.TRAIN||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^^^^^^XX|||||||||||CLI|||||||||||||||||||||SMH|||||201911130954|
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||OPID^Other Photo ID||||||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||123 LIVEDHEREBEFORE ST||||||F
OBX|7|TX|INS OPCAD3^City^INS||EDMONTON||||||F
OBX|8|TX|INS OPCAD5^Postal Code^INS||T0L1T0||||||F
GT1|1||ADMCARTER^FIREBIRD^TRAIN||9915 243 ST^^PORT COQUITLAM^BC^V7Y 6H8||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|
ZFH|LUMED||||||

