MSH|^~\&|ADM|RCH|||201911191037||ADT^A05|4107450|D|2.2|||AL|NE
EVN|A05|201911191037||||201911190830
PID|1|FHATVIG0006962|RC00007928|SM43384|CPATEST^BLUEJAY^TEST||19830303|M||||||||||RC000741/19|
PV1|1|P|RC.OR||||ORMDOC^ORMDOC^TESTSURG^^^^^^^^^^XX|||||||||||SDC|||||||||||||||||||||RCH|||||201911190830|
PV2|||
OBX|1|TX|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
ZFD|||||ORMDOC^ORMDOC^TESTSURG^^^^^123456^DOC|
ZFH|LUMED||||||

