MSH|^~\&|ADM|SMH|||201912121249||ADT^A06|4128267|D|2.2|||AL|NE
EVN|A06|201912121249||||201912121245
PID|1|FHATVIG0012775|SM00047130|SM46908|CWSCLARK^MYSTIQUE^TRAIN|JANE|19850111|F|||8785 11 ST^^PITT MEADOWS^BC^V4R 0P5|||||||SM003775/19|9874779098
PV1|1|I|SM-S2FBU1^SMFBU1-202^A|UE||SM.TRAIN|SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^^^^^^XX|||OBS/AP||||||||IN|||||||||||||||||||||SMH|||||201912121245|
PV2||W^Ward|LABOUR
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||20181101||||||F
OBX|3|CE|ADM IDSOUR^SOURCE OF ID^ADM||OPID^Other Photo ID||||||F
OBX|4|CE|ADM MDRO2^Canada in the last 12 months?^ADM||N^NO||||||F
OBX|5|CE|ADM MDRO4^or Bangladesh in the last 12 months?^ADM||N^NO||||||F
OBX|6|CE|ADM MRSA2^correctional/shelter in the last 6 months?^ADM||N^NO||||||F
OBX|7|TX|ADM PRERE^Previous Address if less than 6 months at current^ADM||123 LIVEDHEREBEFORE ST, EDMONTON, AB, T0L 2T0||||||F
OBX|8|TX|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
OBX|9|TX|INS OPC^Other Province Health Care Number^INS||123450000||||||F
OBX|10|TX|INS OPCAD1^Address line 1^INS||123 LIVEDHEREBEFORE ST||||||F
OBX|11|TX|INS OPCAD3^City^INS||EDMONTON||||||F
OBX|12|TX|INS OPCAD4^Province^INS||AB||||||F
OBX|13|TX|INS OPCAD5^Postal Code^INS||TOL1TO||||||F
OBX|14|TX|INS OPCRBC^Reason patient in British Columbia^INS||4||||||F
GT1|1||CWSCLARK^MYSTIQUE^TRAIN||8785 11 ST^^PITT MEADOWS^BC^V4R 0P5||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|
ZFH|LUMED||||||

MSH|^~\&|ADM|SMH|||201912121249||ADT^A06|4128268|D|2.2|||AL|NE
EVN|A06|201912121249||||201912121245
PID|1|FHATVIG0012776|SM00047131|SM46909|CWSGARCIA^VIGOR^TRAIN|JANE|19940101|F|||2676 164 ST^^MAPLE RIDGE^BC^V1B 8H7|||||||SM003776/19|9874779073
PV1|1|I|SM-S2FBU1^SMFBU1-203^A|UE||SM.TRAIN|SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^^^^^^XX|||OBS/AP||||||||IN|||||||||||||||||||||SMH|||||201912121245|
PV2||W^Ward|LABOR
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||20181101||||||F
OBX|3|CE|ADM IDSOUR^SOURCE OF ID^ADM||OPID^Other Photo ID||||||F
OBX|4|CE|ADM MDRO2^Canada in the last 12 months?^ADM||N^NO||||||F
OBX|5|CE|ADM MDRO4^or Bangladesh in the last 12 months?^ADM||N^NO||||||F
OBX|6|CE|ADM MRSA2^correctional/shelter in the last 6 months?^ADM||N^NO||||||F
OBX|7|TX|ADM PRERE^Previous Address if less than 6 months at current^ADM||123 LIVEDHEREBEFORE ST, EDMONTON, AB, T0L 2T0||||||F
OBX|8|TX|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
OBX|9|TX|INS OPC^Other Province Health Care Number^INS||123450000||||||F
OBX|10|TX|INS OPCAD1^Address line 1^INS||123 LIVEDHEREBEFORE ST||||||F
OBX|11|TX|INS OPCAD3^City^INS||EDMONTON||||||F
OBX|12|TX|INS OPCAD4^Province^INS||AB||||||F
OBX|13|TX|INS OPCAD5^Postal Code^INS||T0L1TO||||||F
OBX|14|TX|INS OPCRBC^Reason patient in British Columbia^INS||4||||||F
GT1|1||CWSGARCIA^VIGOR^TRAIN||2676 164 ST^^MAPLE RIDGE^BC^V1B 8H7||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|
ZFH|LUMED||||||

