552^FACILITY ID^DAYTON^552
552^INTEGRATION CONTROL NUMBER^[ien]
552^DFN^152825
552^SOURCE ID TYPE^Patient internal identifier^PI
552^ASSIGNING AUTHORITY^1^USVHA^2.16.840.1.113883.4.349
552^SURNAME^[lastname]
552^FIRST NAME^[firstname]
552^MIDDLE NAME^[middleinitial]
552^NAME PREFIX^
552^NAME SUFFIX^
552^MOTHERS MAIDEN NAME^
552^DATE OF BIRTH^[dob]
552^PLACE OF BIRTH CITY^
552^PLACE OF BIRTH STATE^^
552^DATE OF DEATH^
552^GENDER^[gender]^M
552^SOCIAL SECURITY NUMBER^[ssn]
552^SSN VERIFICATION STATUS^^
552^PSEUDO SSN REASON^^
552^CLAIM NUMBER^
552^DATE LAST TREATED^
552^ADT/HL7 EVENT REASON^^
552^DATE OF LAST UPDATE MESSAGE^JUN 01, 2007@10:40:01
552^POTENTIAL CAT EDIT STATUS^^
552^CORRELATION DATE LAST UPDATED^APR 11, 2011@17:10:59
552^IDENTIFIER STATUS^^
552^MARITAL STATUS^MARRIED^M
552^STREET ADDRESS [LINE 1]^123 Main St.
552^STREET ADDRESS [LINE 2]^
552^STREET ADDRESS [LINE 3]^
552^CITY [RESIDENCE]^Pleasantville
552^STATE [RESIDENCE]^Florida^FL
552^ZIP+4 [RESIDENCE]^34522
552^PHONE NUMBER [RESIDENCE]^(760)555-2121
552^POW STATUS INDICATED?^^
552^MULTIPLE BIRTH INDICATOR^NO^N
552^ALIAS^1^~~~~~
552^RACE INFORMATION^1^^~
552^ETHNICITY INFORMATION^1^^~
552^SITE ASSOCIATION^1^^~~~~