INTEGRATION CONTROL NUMBER^[ien]
SURNAME^[lastname]
FIRST NAME^[firstname]
MIDDLE NAME^[middleinitial]
NAME PREFIX^
NAME SUFFIX^
MOTHERS MAIDEN NAME^
DATE OF BIRTH^[dob]
PLACE OF BIRTH CITY^
PLACE OF BIRTH STATE^^
GENDER^[gender]^M
SOCIAL SECURITY NUMBER^[ssn]
SSN VERIFICATION STATUS^^
PSEUDO SSN REASON^^
PRIMARY ICN^
DATE/TIME OF ORIGINAL CREATION^DEC 18, 2009@19:55:12
FACILITY OF ORIGINAL CREATION^CHYSHR^983
CREATED BY^,
RESOLUTION JOURNAL CASE NUMBER^^
PRIMARY VIEW DATE LAST UPDATED^JAN 11, 2011@14:52:39
IDENTITY THEFT^^
MULTIPLE BIRTH INDICATOR^NO^N
ID STATE^PERMANENT^P
DATE OF ID STATE^DEC 18, 2009@19:55:12
ALIAS^1^~~~~~
RACE INFORMATION^1^^~
ETHNICITY INFORMATION^1^NOT HISPANIC OR LATINO^N