<?xml version=“1.0” encoding=“UTF-8”?> <HL7v2xConformanceProfile HL7Version=“2.4” ProfileType=“Implementation”> <MetaData Name=“MHVSM_Patient Eligibility_Response” OrgName=“MHVSM” Version=“3” Status=“” Topics=“confsig-MHVSM-2.4-profile-accNE_accAL-Deferred” /> <Encodings> <Encoding>ER7</Encoding> </Encodings> <DynamicDef AccAck=“NE” AppAck=“AL” MsgAckMode=“Deferred” /> <HL7v2xStaticDef MsgType=“RSP” EventType=“K11” MsgStructID=“RSP_K11” EventDesc=“” Role=“Receiver”> <MetaData Name=“MHVSM_Patient Eligibility_Response” OrgName=“MHVSM” Version=“3” Status=“” Topics=“confsig-MHVSM-2.4-static-RSP-K11-null-RSP_K11-3–Receiver” /> <Segment Name=“MSH” LongName=“Message Header” Usage=“R” Min=“1” Max=“1”> <Field Name=“Field Separator” Usage=“R” Min=“1” Max=“1” Datatype=“ST” Length=“1” ItemNo=“00001”> <Reference>2.16.9.1</Reference> <DataValues ExValue=“|” /> </Field> <Field Name=“Encoding Characters” Usage=“R” Min=“1” Max=“1” Datatype=“ST” Length=“4” ItemNo=“00002”> <Reference>2.16.9.2</Reference> </Field> <Field Name=“Sending Application” Usage=“R” Min=“1” Max=“1” Datatype=“HD” Length=“10” Table=“0361” ItemNo=“00003”> <Reference>2.16.9.3</Reference> <Component Name=“namespace ID” Usage=“R” Datatype=“IS” Length=“10” Table=“0363”> <DataValues ExValue=“MHV VISTA” /> </Component> <Component Name=“universal ID” Usage=“X” Datatype=“ST”> </Component> <Component Name=“universal ID type” Usage=“X” Datatype=“ID” Table=“0301”> </Component> </Field> <Field Name=“Sending Facility” Usage=“R” Min=“1” Max=“1” Datatype=“HD” Length=“180” Table=“0362” ItemNo=“00004”> <Reference>2.16.9.4</Reference> <Component Name=“namespace ID” Usage=“R” Datatype=“IS” Length=“3” Table=“0363”> <DataValues ExValue=“991” /> </Component> <Component Name=“universal ID” Usage=“R” Datatype=“ST” Length=“30”> <DataValues ExValue=“SLC4.FO-BAYPINES.MED.VA.GOV” /> </Component> <Component Name=“universal ID type” Usage=“R” Datatype=“ID” Length=“3” Table=“0301”> <DataValues ExValue=“DNS” /> </Component> </Field> <Field Name=“Receiving Application” Usage=“R” Min=“1” Max=“1” Datatype=“HD” Length=“10” Table=“0361” ItemNo=“00005”> <Reference>2.16.9.5</Reference> <Component Name=“namespace ID” Usage=“R” Datatype=“IS” Length=“10” Table=“0363”> <DataValues ExValue=“MHV SM” /> </Component> <Component Name=“universal ID” Usage=“X” Datatype=“ST”> </Component> <Component Name=“universal ID type” Usage=“X” Datatype=“ID” Table=“0301”> </Component> </Field> <Field Name=“Receiving Facility” Usage=“R” Min=“1” Max=“1” Datatype=“HD” Length=“180” Table=“0362” ItemNo=“00006”> <Reference>2.16.9.6</Reference> <Component Name=“namespace ID” Usage=“R” Datatype=“IS” Length=“10” Table=“0363”> <DataValues ExValue=“200MHS” /> </Component> <Component Name=“universal ID” Usage=“R” Datatype=“ST” Length=“20”> <DataValues ExValue=“SYS.MHV.MED.VA.GOV” /> </Component> <Component Name=“universal ID type” Usage=“R” Datatype=“ID” Length=“3” Table=“0301”> <DataValues ExValue=“DNS” /> </Component> </Field> <Field Name=“Date/Time Of Message” Usage=“R” Min=“1” Max=“1” Datatype=“TS” Length=“26” ItemNo=“00007”> <Reference>2.16.9.7</Reference> <Component Name=“Date/Time” Usage=“R” Datatype=“NM” Length=“20”> <ImpNote>YYYYMMDD[HHHMM][+-ZZZZ] </ImpNote> <DataValues ExValue=“20040328134602+0600” /> </Component> <Component Name=“degree of precision” Usage=“X” Datatype=“ST”> <ImpNote>Retained for backward compatibility only </ImpNote> <DataValues ExValue=“D” /> </Component> </Field> <Field Name=“Security” Usage=“X” Min=“0” Max=“*” Datatype=“ST” Length=“40” ItemNo=“00008”> <Reference>2.16.9.8</Reference> </Field> <Field Name=“Message Type” Usage=“R” Min=“1” Max=“1” Datatype=“CM_MSG” Length=“15” Table=“0076” ItemNo=“00009”> <Reference>2.16.9.9</Reference> <Component Name=“message type” Usage=“R” Datatype=“ID” Length=“3” Table=“0076”> <DataValues ExValue=“RSP” /> </Component> <Component Name=“trigger event” Usage=“R” Datatype=“ID” Length=“3” Table=“0003”> <DataValues ExValue=“K11” /> </Component> <Component Name=“message structure” Usage=“X” Datatype=“ID” Table=“0354”> <DataValues ExValue=“RSP_K11” /> </Component> </Field> <Field Name=“Message Control ID” Usage=“R” Min=“1” Max=“1” Datatype=“ST” Length=“20” ItemNo=“00010”> <Reference>2.16.9.10</Reference> <DataValues ExValue=“99146086193” /> </Field> <Field Name=“Processing ID” Usage=“R” Min=“1” Max=“1” Datatype=“PT” Length=“7” ItemNo=“00011”> <Reference>2.16.9.11</Reference> <Component Name=“processing ID” Usage=“R” Datatype=“ID” Length=“3” Table=“0103”> <DataValues ExValue=“T” /> </Component> <Component Name=“processing mode” Usage=“X” Datatype=“ID” Table=“0207”> </Component> </Field> <Field Name=“Version ID” Usage=“R” Min=“1” Max=“1” Datatype=“VID” Length=“60” Table=“0104” ItemNo=“00012”> <Reference>2.16.9.12</Reference> <Component Name=“version ID” Usage=“R” Datatype=“ID” Length=“3” Table=“0104”> <DataValues ExValue=“2.4” /> </Component> <Component Name=“internationalization code” Usage=“X” Datatype=“CE” Table=“0399”> <SubComponent Name=“identifier” Usage=“O” Datatype=“ST” Table=“0399”> </SubComponent> <SubComponent Name=“text” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“name of coding system” Usage=“O” Datatype=“IS” Length=“3” Table=“0396”> </SubComponent> <SubComponent Name=“alternate identifier” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“alternate text” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“name of alternate coding system” Usage=“O” Datatype=“IS” Length=“3” Table=“0396”> </SubComponent> </Component> <Component Name=“international version ID” Usage=“X” Datatype=“CE”> <SubComponent Name=“identifier” Usage=“O” Datatype=“ST”> </SubComponent> <SubComponent Name=“text” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“name of coding system” Usage=“O” Datatype=“IS” Length=“3” Table=“0396”> </SubComponent> <SubComponent Name=“alternate identifier” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“alternate text” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“name of alternate coding system” Usage=“O” Datatype=“IS” Length=“3” Table=“0396”> </SubComponent> </Component> </Field> <Field Name=“Sequence Number” Usage=“X” Min=“0” Max=“*” Datatype=“NM” Length=“15” ItemNo=“00013”> <Reference>2.16.9.13</Reference> </Field> <Field Name=“Continuation Pointer” Usage=“X” Min=“0” Max=“*” Datatype=“ST” Length=“180” ItemNo=“00014”> <Reference>2.16.9.14</Reference> </Field> <Field Name=“Accept Acknowledgment Type” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“2” Table=“0155” ItemNo=“00015”> <Reference>2.16.9.15</Reference> </Field> <Field Name=“Application Acknowledgment Type” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“2” Table=“0155” ItemNo=“00016”> <Reference>2.16.9.16</Reference> </Field> <Field Name=“Country Code” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“3” Table=“0399” ItemNo=“00017”> <Reference>2.16.9.17</Reference> </Field> <Field Name=“Character Set” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“16” Table=“0211” ItemNo=“00692”> <Reference>2.16.9.18</Reference> </Field> <Field Name=“Principal Language Of Message” Usage=“X” Min=“0” Max=“*” Datatype=“CE” Length=“250” Table=“0301” ItemNo=“00693”> <Reference>2.16.9.19</Reference> <Component Name=“identifier” Usage=“X” Datatype=“ST” Table=“0301”> </Component> <Component Name=“text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of coding system” Usage=“X” Datatype=“IS” Table=“0396”> </Component> <Component Name=“alternate identifier” Usage=“X” Datatype=“ST”> </Component> <Component Name=“alternate text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of alternate coding system” Usage=“X” Datatype=“IS” Table=“0396”> </Component> </Field> <Field Name=“Alternate Character Set Handling Scheme” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“20” Table=“0356” ItemNo=“01317”> <Reference>2.16.9.20</Reference> </Field> <Field Name=“Conformance Statement ID” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“10” Table=“0449” ItemNo=“01598”> <Reference>2.16.9.21</Reference> </Field> </Segment> <Segment Name=“MSA” LongName=“Message Acknowledgment” Usage=“R” Min=“1” Max=“1”> <Field Name=“Acknowledgment Code” Usage=“R” Min=“1” Max=“1” Datatype=“ID” Length=“2” Table=“0008” ItemNo=“00018”> <Reference>2.16.8.1</Reference> <DataValues ExValue=“AA” /> </Field> <Field Name=“Message Control ID” Usage=“R” Min=“1” Max=“1” Datatype=“ST” Length=“20” ItemNo=“00010”> <Reference>2.16.9.10</Reference> <DataValues ExValue=“500000000000011830” /> </Field> <Field Name=“Text Message” Usage=“RE” Min=“0” Max=“1” Datatype=“ST” Length=“80” ItemNo=“00020”> <ImpNote>- only if error (the Ack Code = AE, AR) </ImpNote> <Reference>2.16.8.3</Reference> <DataValues ExValue=“INVALID DATA LINK” /> </Field> <Field Name=“Expected Sequence Number” Usage=“X” Min=“0” Max=“*” Datatype=“NM” Length=“15” ItemNo=“00021”> <Reference>2.16.8.4</Reference> </Field> <Field Name=“Delayed Acknowledgment Type” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“1” Table=“0102” ItemNo=“00022”> <Reference>2.16.8.5</Reference> </Field> <Field Name=“Error Condition” Usage=“X” Min=“0” Max=“*” Datatype=“CE” Length=“250” Table=“0357” ItemNo=“00023”> <Reference>2.16.8.6</Reference> <Component Name=“identifier” Usage=“X” Datatype=“ST” Table=“0357”> </Component> <Component Name=“text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of coding system” Usage=“X” Datatype=“IS” Table=“0396”> </Component> <Component Name=“alternate identifier” Usage=“X” Datatype=“ST”> </Component> <Component Name=“alternate text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of alternate coding system” Usage=“X” Datatype=“IS” Table=“0396”> </Component> </Field> </Segment> <Segment Name=“QAK” LongName=“Query Acknowledgment” Usage=“R” Min=“1” Max=“1”> <Field Name=“Query Tag” Usage=“R” Min=“1” Max=“1” Datatype=“ST” Length=“36” ItemNo=“00696”> <ImpNote>VistA - SM interface supports 36 characters for this field. </ImpNote> <Reference>5.10.5.8.1</Reference> <DataValues ExValue=“B81548A4-B069-11E3-9CA9-50569E013100” /> </Field> <Field Name=“Query Response Status” Usage=“R” Min=“1” Max=“1” Datatype=“ID” Length=“2” Table=“0208” ItemNo=“00708”> <Reference>5.5.2.2</Reference> <DataValues ExValue=“OK” /> </Field> <Field Name=“Message Query Name” Usage=“R” Min=“1” Max=“1” Datatype=“CE” Length=“250” Table=“0471” ItemNo=“01375”> <Reference>5.5.3.1</Reference> <Component Name=“identifier” Usage=“R” Datatype=“ST” Length=“3” Table=“0471”> <DataValues ExValue=“Q11” /> </Component> <Component Name=“text” Usage=“R” Datatype=“ST” Length=“20”> <DataValues ExValue=“SMPATIENTECLASS” /> </Component> <Component Name=“name of coding system” Usage=“R” Datatype=“IS” Length=“10” Table=“0396”> <DataValues ExValue=“HL70471” /> </Component> <Component Name=“alternate identifier” Usage=“X” Datatype=“ST”> </Component> <Component Name=“alternate text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of alternate coding system” Usage=“X” Datatype=“IS” Table=“0396”> </Component> </Field> <Field Name=“Hit Count” Usage=“R” Min=“1” Max=“1” Datatype=“NM” Length=“10” ItemNo=“01434”> <Reference>5.5.2.4</Reference> <DataValues ExValue=“4” /> </Field> <Field Name=“This payload” Usage=“R” Min=“1” Max=“1” Datatype=“NM” Length=“10” ItemNo=“01622”> <Reference>5.5.2.5</Reference> <DataValues ExValue=“4” /> </Field> <Field Name=“Hits remaining” Usage=“R” Min=“1” Max=“1” Datatype=“NM” Length=“10” ItemNo=“01623”> <Reference>5.5.2.6</Reference> <DataValues ExValue=“0” /> </Field> </Segment> <Segment Name=“ZEL” LongName=“Patient Eligibility Segment” Usage=“R” Min=“1” Max=“*”> <ImpNote>MHV SM Implementation:

there is more than one eligibility code available for the patient;

Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present.

Eligibilities; Fields 5 thru 44 are null. </ImpNote> <Field Name=“SET ID - ZEL” Usage=“R” Min=“1” Max=“1” Datatype=“SI” Length=“4” ConstantValue=“0001”> <ImpNote>SEQUENTIAL NUMBER primary eligibility is always 0001; additional segments are secondary eligibilities </ImpNote> <Reference>SEQUENTIAL NUMBER (1 is always primary eligibility)</Reference> <DataValues ExValue=“0001” /> </Field> <Field Name=“ELIGIBILITY CODE” Usage=“R” Min=“1” Max=“1” Datatype=“IS” Length=“2” Table=“VA004”> <ImpNote>- first for Primary Eligibilitiesand Aditional ZEL segments for Secondary Eligibilities </ImpNote> <Reference>2.361</Reference> <DataValues ExValue=“1” /> </Field> <Field Name=“LONG ID” Usage=“X” Min=“0” Max=“*” Datatype=“CK” Length=“25”> <ImpNote>For backward compatability only </ImpNote> <Reference>2.363</Reference> <Component Name=“ID number (NM)” Usage=“X” Datatype=“NM”> <DataValues ExValue=“567889098” /> </Component> <Component Name=“check digit” Usage=“X” Datatype=“NM”> </Component> <Component Name=“code identifying the check digit scheme employed” Usage=“X” Datatype=“ID”> </Component> <Component Name=“assigning authority” Usage=“X” Datatype=“HD”> <SubComponent Name=“namespace ID” Usage=“X” Datatype=“IS” Length=“3” Table=“0300”> </SubComponent> <SubComponent Name=“universal ID” Usage=“X” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“universal ID type” Usage=“X” Datatype=“ID” Length=“3” Table=“0301”> </SubComponent> </Component> </Field> <Field Name=“SHORT ID” Usage=“X” Min=“0” Max=“*” Datatype=“ST” Length=“12”> <ImpNote>For backward compatability only </ImpNote> <Reference>2.364</Reference> <DataValues ExValue=“9098” /> </Field> <Field Name=“DISABILITY RETIREMENT FROM MIL” Usage=“X” Min=“0” Max=“*” Datatype=“IS” Length=“1” Table=“VA005”> <Reference>2.362</Reference> </Field> <Field Name=“CLAIM FOLDER NUMBER” Usage=“X” Min=“0” Max=“*” Datatype=“NM” Length=“8”> <Reference>2.313</Reference> <DataValues ExValue=“1212134” /> </Field> <Field Name=“CLAIM FOLDER LOCATION” Usage=“X” Min=“0” Max=“*” Datatype=“ST” Length=“40”> <Reference>2.314</Reference> <DataValues ExValue=“541CLEVELAND-RO” /> </Field> <Field Name=“VETERAN?” Usage=“X” Min=“0” Max=“*” Datatype=“IS” Length=“1” Table=“VA001”> <ImpNote>- first for Primary Eligibilitiesand Aditional ZEL segments for Secondary Eligibilities </ImpNote> <Reference>2.1901</Reference> <DataValues ExValue=“0” /> </Field> <Field Name=“TYPE OF PATIENT” Usage=“RE” Min=“0” Max=“1” Datatype=“ST” Length=“30”> <ImpNote>Inpatient Outpatient Status:

</ImpNote> <Reference>2.391</Reference> <DataValues ExValue=“O” /> </Field> <Field Name=“ELIGIBLITY STATUS” Usage=“RE” Min=“0” Max=“1” Datatype=“IS” Length=“1” Table=“VA006”> <Reference>2.3611</Reference> <DataValues ExValue=“P” /> </Field> <Field Name=“ELIGIBILITY STATUS DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.3612</Reference> <DataValues ExValue=“20041203” /> </Field> <Field Name=“ELIGIBLILITY INTERIM RESPONSE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.3614</Reference> <DataValues ExValue=“20041103” /> </Field> <Field Name=“ELIGIBILITY VERIFICATION METHOD” Usage=“X” Min=“0” Max=“*” Datatype=“ST” Length=“50”> <Reference>2.3615</Reference> <DataValues ExValue=“Interview” /> </Field> <Field Name=“RECEIVING A&amp;A BENEFITS?” Usage=“X” Min=“0” Max=“*” Datatype=“IS” Length=“1” Table=“VA001”> <Reference>2.36205</Reference> <DataValues ExValue=“0” /> </Field> <Field Name=“RECEIVING HOUSEBOUND BENEFITS?” Usage=“X” Min=“0” Max=“*” Datatype=“IS” Length=“1” Table=“VA001”> <Reference>2.36215</Reference> <DataValues ExValue=“0” /> </Field> <Field Name=“RECEIVING A VA PENSION?” Usage=“X” Min=“0” Max=“*” Datatype=“IS” Length=“1” Table=“VA001”> <Reference>2.36235</Reference> <DataValues ExValue=“0” /> </Field> <Field Name=“RECEIVING A VA DISABILITY?” Usage=“X” Min=“0” Max=“*” Datatype=“IS” Length=“1” Table=“VA001”> <Reference>2.3025</Reference> <DataValues ExValue=“1” /> </Field> <Field Name=“EXPOSED TO AGENT ORANGE” Usage=“RE” Min=“0” Max=“1” Datatype=“IS” Length=“1” Table=“VA001”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <Reference>2.32102</Reference> <DataValues ExValue=“E” /> </Field> <Field Name=“RADIATION EXPOSURE INDICATED” Usage=“RE” Min=“0” Max=“1” Datatype=“IS” Length=“1” Table=“VA001”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <Reference>2.32103</Reference> <DataValues ExValue=“E” /> </Field> <Field Name=“ENVIRONMENTAL CONTAMINANTS” Usage=“RE” Min=“0” Max=“1” Datatype=“IS” Length=“1” Table=“VA001”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <Reference>2.322013</Reference> <DataValues ExValue=“E” /> </Field> <Field Name=“TOTAL ANNUAL VA CHECK AMOUNT” Usage=“X” Min=“0” Max=“*” Datatype=“NM” Length=“8”> <Reference>2.36295</Reference> <DataValues ExValue=“1000.00” /> </Field> <Field Name=“RADIATION EXPOSURE METHOD” Usage=“X” Min=“0” Max=“*” Datatype=“CE” Length=“22” Table=“VA022”> <Reference>2.3212</Reference> <Component Name=“identifier” Usage=“X” Datatype=“ST” Table=“VA022”> <Reference>2.3212</Reference> <DataValues ExValue=“3” /> </Component> <Component Name=“text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of coding system” Usage=“X” Datatype=“ST”> </Component> <Component Name=“alternate identifier” Usage=“X” Datatype=“ST”> </Component> <Component Name=“alternate text” Usage=“X” Datatype=“ST”> </Component> <Component Name=“name of alternate coding system” Usage=“X” Datatype=“ST”> </Component> </Field> <Field Name=“MST STATUS” Usage=“RE” Min=“0” Max=“1” Datatype=“IS” Length=“1” Table=“VA036”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <Reference>29.11.3</Reference> <DataValues ExValue=“N” /> </Field> <Field Name=“MST STATUS CHANGE DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>29.11.01</Reference> <DataValues ExValue=“20030101” /> </Field> <Field Name=“SITE DETERMINING MST STATUS” Usage=“X” Min=“0” Max=“*” Datatype=“NM” Length=“10” Table=“0115”> <Reference>29.11.6</Reference> <DataValues ExValue=“402” /> </Field> <Field Name=“AGENT ORANGE REGISTRATION DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.32107</Reference> <DataValues ExValue=“19890908” /> </Field> <Field Name=“AGENT ORANGE EXAM DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.32109</Reference> <DataValues ExValue=“19890908” /> </Field> <Field Name=“AGENT ORANGE REGISTRATION NUMBER” Usage=“X” Min=“0” Max=“*” Datatype=“NM” Length=“6”> <Reference>2.3211</Reference> <DataValues ExValue=“12345” /> </Field> <Field Name=“AGENT ORANGE EXPOSURE LOCATION” Usage=“X” Min=“0” Max=“*” Datatype=“ST” Length=“1”> <Reference>2.3213</Reference> <DataValues ExValue=“V” /> </Field> <Field Name=“RADIATION REGISTRATION DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.32111</Reference> <DataValues ExValue=“19780405” /> </Field> <Field Name=“ENVIRONMENTAL CONTAMINANTS EXAM DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.322015</Reference> <DataValues ExValue=“19780405” /> </Field> <Field Name=“ENVIRONMENTAL CONTAMINANTS REGISTRATION DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.322014</Reference> <DataValues ExValue=“19780405” /> </Field> <Field Name=“MONETARY BENEFITS DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.306</Reference> <DataValues ExValue=“20041203” /> </Field> <Field Name=“USER ENROLLEE VALID THROUGH” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.3617</Reference> <DataValues ExValue=“20061203” /> </Field> <Field Name=“USER ENROLLEE SITE” Usage=“RE” Min=“0” Max=“1” Datatype=“NM” Length=“3”> <Reference>2.3618</Reference> <DataValues ExValue=“500” /> </Field> <Field Name=“ELIGIBILITY VERIFICATION SITE/SOURCE” Usage=“X” Min=“0” Max=“*” Datatype=“XON” Length=“200”> <Component Name=“organization name” Usage=“X” Datatype=“ST”> <Reference>2.3613</Reference> <DataValues ExValue=“V” /> </Component> <Component Name=“organization name type code” Usage=“X” Datatype=“IS”> </Component> <Component Name=“ID number (NM)” Usage=“X” Datatype=“NM”> <Reference>2.3613</Reference> <DataValues ExValue=“541” /> </Component> <Component Name=“check digit” Usage=“X” Datatype=“NM”> </Component> <Component Name=“code identifying the check digit scheme employed” Usage=“X” Datatype=“ID”> </Component> <Component Name=“assigning authority” Usage=“X” Datatype=“HD”> <SubComponent Name=“namespace ID” Usage=“X” Datatype=“IS” Length=“3” Table=“0300”> </SubComponent> <SubComponent Name=“universal ID” Usage=“X” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“universal ID type” Usage=“X” Datatype=“ID” Length=“3” Table=“0301”> </SubComponent> </Component> <Component Name=“identifier type code” Usage=“X” Datatype=“IS”> </Component> <Component Name=“assigning facility ID” Usage=“X” Datatype=“HD”> <SubComponent Name=“namespace ID” Usage=“X” Datatype=“IS” Length=“3” Table=“0300”> </SubComponent> <SubComponent Name=“universal ID” Usage=“X” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“universal ID type” Usage=“X” Datatype=“ID” Length=“3” Table=“0301”> </SubComponent> </Component> <Component Name=“Name Representation code” Usage=“X” Datatype=“ID”> </Component> </Field> <Field Name=“COMBAT VETERAN” Usage=“X” Min=“0” Max=“*” Datatype=“ID” Length=“1” Table=“VA001”> <Reference>2.5292</Reference> <DataValues ExValue=“1” /> </Field> <Field Name=“COMBAT VETERAN STATUS END DATE” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>2.5295</Reference> <DataValues ExValue=“20011023” /> </Field> <Field Name=“ELIGIBILITY STATUS ENTERED BY” Usage=“X” Min=“0” Max=“*” Datatype=“XCN” Length=“250”> <Reference>2.3616</Reference> <Component Name=“ID number (ST)” Usage=“X” Datatype=“ST”> <Reference>2.3616</Reference> <DataValues ExValue=“541732145” /> </Component> <Component Name=“family name” Usage=“X” Datatype=“FN”> <SubComponent Name=“surname” Usage=“X” Datatype=“ST”> <Reference>2.3616</Reference> <DataValues ExValue=“HL7PFSSZELSURNAME” /> </SubComponent> <SubComponent Name=“own surname prefix” Usage=“X” Datatype=“ST”> </SubComponent> <SubComponent Name=“own surname” Usage=“X” Datatype=“ST”> </SubComponent> <SubComponent Name=“surname prefix from partner/spouse” Usage=“X” Datatype=“ST”> </SubComponent> <SubComponent Name=“surname from partner/spouse” Usage=“X” Datatype=“ST”> </SubComponent> </Component> <Component Name=“given name” Usage=“X” Datatype=“ST”> <Reference>2.3616</Reference> <DataValues ExValue=“HL7PFSSZELGVNNAME” /> </Component> <Component Name=“second and further given names or initials thereof” Usage=“X” Datatype=“ST”> </Component> <Component Name=“suffix (e.g., JR or III)” Usage=“X” Datatype=“ST”> </Component> <Component Name=“prefix (e.g., DR)” Usage=“X” Datatype=“ST”> </Component> <Component Name=“degree (e.g., MD)” Usage=“X” Datatype=“IS” Table=“0360”> </Component> <Component Name=“source table” Usage=“X” Datatype=“IS” Table=“0297”> </Component> <Component Name=“assigning authority” Usage=“X” Datatype=“HD”> <SubComponent Name=“namespace ID” Usage=“O” Datatype=“IS” Length=“3” Table=“0363”> </SubComponent> <SubComponent Name=“universal ID” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“universal ID type” Usage=“O” Datatype=“ID” Length=“3” Table=“0301”> </SubComponent> </Component> <Component Name=“name type code” Usage=“X” Datatype=“ID” Table=“0200”> </Component> <Component Name=“identifier check digit” Usage=“X” Datatype=“ST”> </Component> <Component Name=“code identifying the check digit scheme employed” Usage=“X” Datatype=“ID” Table=“0061”> </Component> <Component Name=“identifier type code (IS)” Usage=“X” Datatype=“IS”> </Component> <Component Name=“assigning facility” Usage=“X” Datatype=“HD”> <SubComponent Name=“namespace ID” Usage=“O” Datatype=“IS” Length=“3” Table=“0363”> </SubComponent> <SubComponent Name=“universal ID” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“universal ID type” Usage=“O” Datatype=“ID” Length=“3” Table=“0301”> </SubComponent> </Component> <Component Name=“Name Representation code” Usage=“X” Datatype=“ID” Table=“0465”> </Component> <Component Name=“name context” Usage=“X” Datatype=“CE” Table=“0448”> <SubComponent Name=“identifier” Usage=“U” Datatype=“ST” Table=“0448”> </SubComponent> <SubComponent Name=“text” Usage=“U” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“name of coding system” Usage=“U” Datatype=“IS” Length=“3” Table=“0396”> </SubComponent> <SubComponent Name=“alternate identifier” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“alternate text” Usage=“O” Datatype=“ST” Length=“3”> </SubComponent> <SubComponent Name=“name of alternate coding system” Usage=“O” Datatype=“IS” Length=“3” Table=“0396”> </SubComponent> </Component> <Component Name=“name validity range” Usage=“X” Datatype=“DR”> <SubComponent Name=“range start date/time” Usage=“U” Datatype=“TS” Length=“3”> </SubComponent> <SubComponent Name=“range end date/time” Usage=“U” Datatype=“TS” Length=“3”> </SubComponent> </Component> <Component Name=“name assembly order” Usage=“X” Datatype=“ID” Table=“0444”> </Component> </Field> <Field Name=“NOSE/THROAT RADIATION” Usage=“RE” Min=“0” Max=“1” Datatype=“ID” Length=“1” Table=“VA001”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <Reference>28.11.02</Reference> <DataValues ExValue=“E” /> </Field> <Field Name=“NOSE/THROAT RADIATION DATE VERIFIED” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>28.11.1.02</Reference> <DataValues ExValue=“19901231” /> </Field> <Field Name=“HEAD/NECK CANCER” Usage=“RE” Min=“0” Max=“1” Datatype=“ID” Length=“1” Table=“VA001”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <Reference>28.11.2.01</Reference> <DataValues ExValue=“E” /> </Field> <Field Name=“HEAD/NECK CANCER DATE VERIFIED” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <Reference>28.11.2.02</Reference> <DataValues ExValue=“19960325” /> </Field> <Field Name=“SHAD (Shipboard Hazard And Defense)” Usage=“RE” Min=“0” Max=“1” Datatype=“ST” Length=“1”> <ImpNote>- 1st ZEL segment is always for Primary Eligibility; and for Data Classification: Fields 2,8,9,10,18,19,20,23,35,40,42 and 44 are required if data present. </ImpNote> <DataValues ExValue=“Y” /> </Field> <Field Name=“SHAD DATE VERIFIED” Usage=“X” Min=“0” Max=“*” Datatype=“DT” Length=“8”> <DataValues ExValue=“20050302” /> </Field> </Segment> </HL7v2xStaticDef> </HL7v2xConformanceProfile>