BHS^~|\&^VAMC 552^552^ESR^200ESR^20040810^^~T~ORU|Z07~2.3.1~AL~AL^^54364365^ 
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|100913~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|102330~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|99316~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|97135~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|99545~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|90322~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|64956~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|15849~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|59089~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|95195~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|94856~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|52310~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|71807~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|78730~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|100822~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|91760~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|9712~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|102958~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|88175~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|29260~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|59130~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|89808~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|90839~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|93333~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|106135~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|102533~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|27726~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|99143~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|91630~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|33371~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|925~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|69069~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|61992~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|21381~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|48935~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|79896~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105604~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|78765~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|101119~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|82123~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|100691~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|71649~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|86502~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|36081~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|70679~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|2974~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|101944~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|91292~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|57381~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|26172~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|25761~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|89785~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|24792~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|59217~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|106264~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|95610~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|97760~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|85729~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|82596~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|54723~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|103595~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|10103~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
MSH^~|\&^VAMC 552^552^ESR^200ESR^20030904121212-0500^^ORU~Z07^88864365-1^T^2.1^^^AL^AL^USA
PID^1^1000913833V082573^1000913833V082573~~~USVHA&&0363~NI~VA FACILITY ID&200M&L|105101~~~
USVHA&&0363~PI~VA FACILITY ID&500&L|000004834~~~USSSA&&0363~SS~VA FACILITY ID&500&L|666123456~~~USSSA&&0363~SS~VA FA
CILITY ID&500&L~~20060127|000123456~~~USSSA&&0363~SS~VA FACILITY ID&500&L~~20060127^^ESRPATIENT~FNAME~X~~~^^19270101^M^^^557 OREGONS~""~LITTLE FALLS~NY~13333-1633~USA~VACAE~STE 322~~~~20020125&20060125|3400 EDS DRIVE~""~HERNDON~VA~20171-1633~USA~P~STE 322~~~~20020125&20060125^^
(999)123-0001~PRN~PH|(999)123-0002~WPN~PH|(999)123-0003~ORN~CP|(999)123-0004~BPN~BP|~NET~INTERNET~EMAIL@FOO.COM^(999)123-0005X3464
^^^^^134673732
PD1^^^DAYTON~~552
ZPD^1^^^^^^^0^""^^0^0^199109030832-0500^^^^U^^0^^^^^^^^^^^^""^""^""^^CIV SER^^^^^""
ZTA^1^1^20050321^20050416^64 NEW ENGLAND~""~BIG FALLS~NY~13333-1633~USA~~STE 153^043^(800)934-7534^20041019164937-0400^552
ZIE^1^""^""^^
ZEL^1^3^^^""^10000007^442^1^^V^20000129^^VIVA^0^0^0^1^0^1^0^3876^2^N^20030422151958-0400^442^^^^""^^^^^20050000^554^^0^""^""^""
ZEN^1^19981029^1^1^""^""^552^552^""^20060308^19981029^""^""
ZCD^1^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^369.4~Blindness~ICD DIAGNOSIS^""^""^""^""^Y^""^20040920^20041020^20041120
ZCD^2^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^780.03~Persistent Vegetative State~ICD DIAGNOSIS^""^""^""^""^Y^""
ZCD^3^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^2~RLE~VA0042^""^""^Y^""
ZCD^4^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^2123~Above Knee Amputation~ICD OPERATION/PROCEDURE^4~LLE~VA0042^""^""^Y^""
ZCD^5^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^2~FOLS~VA0043^10^Y^1~PERMANENT~VA0045
ZCD^6^20041109^DR SMITH^552^20041109^3~PHYSICAL EXAMINATION~VA0041^""^""^""^1~KATZ~VA0043^4^Y^2~NOT PERMANENT~VA0045
ZMH^1^SL^ARMY~00552455~HONORABLE^19620216~19720131^R
ZMH^2^SNL^ARMY~17235361~HONORABLE^19440316~19460826^R
ZMH^2^POW^Y~""^""~""^""
ZMH^3^COMB^Y~WORLD WAR II - EUROPE^""
ZMH^4^LEBA^Y^19831010~19831110^""
ZMH^5^GREN^N^""~""^""
ZMH^6^PANA^N^""~""^""
ZMH^7^GULF^Y^""
ZMH^8^SOMA^N^""~""^""
ZMH^9^PH^N~1~1^""^""
ZRD^1^7913~DIABETES MELLITUS^40^1
ZRD^2^7017~CORONARY ARTERY BYPASS^30^1
ZRD^3^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^4^8520~PARALYSIS OF SCIATIC NERVE^20^1
ZRD^5^5284~RESIDUALS OF FOOT INJURY^20^1
ZRD^6^6079~IMPAIRED VISION^0^1
ZCT^1^1^ESRWIFE~FNAME~~~~~L^WIFE^PO BOX 1534~112 ELM STREET~HEBRON~OH~430251534^(666)666-5296^""^^^20060823132750-0400
ZEM^1^1^5^^^^^
ZEM^2^2^3^^^^^
ZGD^1^1^PVA^""^""^133 HOLLAND~~ALBANY~NY~12208^(518)225-2210^20051010
ZGD^2^2^""^""^""^""^""^""
ZIC^1^20050000^""^^^^^^""^^^""^""^""^""^""^^""^""^
ZIR^
ZDP^1^MARTINEZ~SUZIE^F^19500815^189440133^2^76035^JONES,SUZIE^19831215^""
ZIC^1^20050000^""^^^^^^""^^^""^^^^""^^""^""^
ZIR^1^""^""^^^^^^^^^^^
ZDP^1^MARTINEZ~JOE^M^19910915^388104010^3^76036^^19910915^""
ZIC^1^20050000^""^^^^^^""^^^""^^^""^""^^""^""^
ZIR^1^""^1^^^0^""^0^""^^^^^N
ZDP^1^MARTINEZ~FRED^M^19840915^380114910^3^76037^^19840923^""^19840923
ZIO^1^0^0^20000403^""^""
NTE^1^^:A MEANS TEST was edited on Oct 19, 2004 4:49:37 pm with data inconsistencies.
NTE^2^^: MT Copay Exempt veteran-Agree to Pay Deductible should be null
IN1^1^^^ALLMERICAN FINANCIALs^334 PIERCE ROAD SUITE 310~~ITASCA~IL~60150~USA^^(800)431-5197^25186-012^BENGA INDUSTRY^^^19951119^""^^40^FOOTE,RONALD A^v^^^^^^^^^^^1^^^^^^^^370585261
IN1^1^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART A^^^20010501^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846A
IN1^2^^^MEDICARE (WNR)^""^^(877)591-1587^""^PART B^^^20011201^""^^33^INSURANCE,JOE^v^^^^^^^^^^^0^^^^^^^^368739846B
ZMT^1^20060101^C^31800^0^""^1^23688^0^20060101000001-0400^""^0^0^""^""^""^1^1^^^""^552^^^20030124071207-0400^C^^0^^0
ZMT^2^20060831^E^469^""^""^""^^0^200608311351-0400^^1^^^""^""^2^1^^^""^987^^^20060831135159-0400^E
ZMT^4^^^^^^^^^^^^^^^^^^^^^
ZBT^1
ZSP^1^1^80^0^Y^0^1^""^^""
OBX^1^CE^38.1~SECURITY LOG^^Y~YES~HL70136^^^^^^R^^^200606031704-0400^^""^
OBX^2^CE^VISTA~28.11^^5~No NTR Trmt~VA0053^^^^^^F^""^^20040510120149-0400^554^""^""
RF1^^^SAD^^^552~USVAMC^20060309101714-0500^^^
RF1^^^CPH^^^552~USVAMC^20060627111830-0400^^^
RF1^^^PNO^^^552~USVAMC^20060627111845-0400^^^
RF1^^^EAD^^^552~USVAMC^20060627111952-0400^^^
BTS^100