IN1.1_Set_ID_-_IN1Sequential Number: 1
Description: Set ID - IN1
Data Type: SI
Item ID: 426
IN1.2_Health_Plan_IDSequential Number: 2
Description: Health Plan ID
Data Type: CWE
Item ID: 368
Table: 0072
IN1.3_Insurance_Company_IDSequential Number: 3
Description: Insurance Company ID
Data Type: CX
Item ID: 428
IN1.4_Insurance_Company_NameSequential Number: 4
Description: Insurance Company Name
Data Type: XON
Item ID: 429
IN1.5_Insurance_Company_AddressSequential Number: 5
Description: Insurance Company Address
Data Type: XAD
Item ID: 430
IN1.6_Insurance_Co_Contact_PersonSequential Number: 6
Description: Insurance Co Contact Person
Data Type: XPN
Item ID: 431
IN1.7_Insurance_Co_Phone_NumberSequential Number: 7
Description: Insurance Co Phone Number
Data Type: XTN
Item ID: 432
Sequential Number: 8
Description: Group Number
Data Type: ST
Item ID: 433
IN1.9_Group_NameSequential Number: 9
Description: Group Name
Data Type: XON
Item ID: 434
IN1.10_Insured_s_Group_Emp_IDSequential Number: 10
Description: Insured's Group Emp ID
Data Type: CX
Item ID: 435
IN1.11_Insured_s_Group_Emp_NameSequential Number: 11
Description: Insured's Group Emp Name
Data Type: XON
Item ID: 436
Sequential Number: 12
Description: Plan Effective Date
Data Type: DT
Item ID: 437
Sequential Number: 13
Description: Plan Expiration Date
Data Type: DT
Item ID: 438
Sequential Number: 14
Description: Authorization Information
Data Type: AUI
Item ID: 439
Sequential Number: 15
Description: Plan Type
Data Type: CWE
Item ID: 440
Table: 0086
IN1.16_Name_Of_InsuredSequential Number: 16
Description: Name Of Insured
Data Type: XPN
Item ID: 441
Sequential Number: 17
Description: Insured's Relationship To Patient
Data Type: CWE
Item ID: 442
Table: 0063
Sequential Number: 18
Description: Insured's Date Of Birth
Data Type: DTM
Item ID: 443
IN1.19_Insured_s_AddressSequential Number: 19
Description: Insured's Address
Data Type: XAD
Item ID: 444
Sequential Number: 20
Description: Assignment Of Benefits
Data Type: CWE
Item ID: 445
Table: 0135
Sequential Number: 21
Description: Coordination Of Benefits
Data Type: CWE
Item ID: 446
Table: 0173
Sequential Number: 22
Description: Coord Of Ben. Priority
Data Type: ST
Item ID: 447
Sequential Number: 23
Description: Notice Of Admission Flag
Data Type: ID
Item ID: 448
Table: 0136
Sequential Number: 24
Description: Notice Of Admission Date
Data Type: DT
Item ID: 449
Sequential Number: 25
Description: Report Of Eligibility Flag
Data Type: ID
Item ID: 450
Table: 0136
Sequential Number: 26
Description: Report Of Eligibility Date
Data Type: DT
Item ID: 451
Sequential Number: 27
Description: Release Information Code
Data Type: CWE
Item ID: 452
Table: 0093
Sequential Number: 28
Description: Pre-Admit Cert (PAC)
Data Type: ST
Item ID: 453
Sequential Number: 29
Description: Verification Date/Time
Data Type: DTM
Item ID: 454
IN1.30_Verification_BySequential Number: 30
Description: Verification By
Data Type: XCN
Item ID: 455
Sequential Number: 31
Description: Type Of Agreement Code
Data Type: CWE
Item ID: 456
Table: 0098
Sequential Number: 32
Description: Billing Status
Data Type: CWE
Item ID: 457
Table: 0022
Sequential Number: 33
Description: Lifetime Reserve Days
Data Type: NM
Item ID: 458
Sequential Number: 34
Description: Delay Before L.R. Day
Data Type: NM
Item ID: 459
Sequential Number: 35
Description: Company Plan Code
Data Type: CWE
Item ID: 460
Table: 0042
Sequential Number: 36
Description: Policy Number
Data Type: ST
Item ID: 461
Sequential Number: 37
Description: Policy Deductible
Data Type: CP
Item ID: 462
Sequential Number: 39
Description: Policy Limit - Days
Data Type: NM
Item ID: 464
Sequential Number: 42
Description: Insured's Employment Status
Data Type: CWE
Item ID: 467
Table: 0066
Sequential Number: 43
Description: Insured's Administrative Sex
Data Type: CWE
Item ID: 468
Table: 0001
IN1.44_Insured_s_Employer_s_AddressSequential Number: 44
Description: Insured's Employer's Address
Data Type: XAD
Item ID: 469
Sequential Number: 45
Description: Verification Status
Data Type: ST
Item ID: 470
Sequential Number: 46
Description: Prior Insurance Plan ID
Data Type: CWE
Item ID: 471
Table: 0072
Sequential Number: 47
Description: Coverage Type
Data Type: CWE
Item ID: 1227
Table: 0309
Sequential Number: 48
Description: Handicap
Data Type: CWE
Item ID: 753
Table: 0295
IN1.49_Insured_s_ID_NumberSequential Number: 49
Description: Insured's ID Number
Data Type: CX
Item ID: 1230
Sequential Number: 50
Description: Signature Code
Data Type: CWE
Item ID: 1854
Table: 0535
Sequential Number: 51
Description: Signature Code Date
Data Type: DT
Item ID: 1855
Sequential Number: 52
Description: Insured's Birth Place
Data Type: ST
Item ID: 1899
Sequential Number: 53
Description: VIP Indicator
Data Type: CWE
Item ID: 1852
Table: 0099
IN1.54_External_Health_Plan_IdentifiersSequential Number: 54
Description: External Health Plan Identifiers
Data Type: CX
Item ID: 3292
Sequential Number: 55
Description: Insurance Action Code
Data Type: ID
Item ID: 3335
Table: 0206
any