<?xml version="1.0"?> <RegisterPatient> <MSH> <MSH.1.FieldSeparator>|</MSH.1.FieldSeparator> <MSH.2.EncodingCharacters>^~\&</MSH.2.EncodingCharacters> <MSH.4.SendingFacility> <HD> <HD.1.NamespaceID>.</HD.1.NamespaceID> </HD> </MSH.4.SendingFacility> <MSH.7.DatetimeOfMessage> <TS> <TS.1.Time>199908180016</TS.1.Time> </TS> </MSH.7.DatetimeOfMessage> <MSH.9.MessageType> <MSG> <MSG.1.MessageCode>ADT</MSG.1.MessageCode> <MSG.2.TriggerEvent>A04</MSG.2.TriggerEvent> </MSG> </MSH.9.MessageType> <MSH.10.MessageControlID>ADT.1.1698593</MSH.10.MessageControlID> <MSH.11.ProcessingID> <PT> <PT.1.ProcessingID>P</PT.1.ProcessingID> </PT> </MSH.11.ProcessingID> <MSH.12.VersionID> <VID> <VID.1.VersionID>2.1</VID.1.VersionID> </VID> </MSH.12.VersionID> </MSH> <PID> <PID.1.SetIDPid>1</PID.1.SetIDPid> <PID.3.PatientIdentifierList> <CX> <CX.1.IDNumber>000395122</CX.1.IDNumber> </CX> </PID.3.PatientIdentifierList> <PID.5.PatientName> <XPN> <XPN.1.FamilyName> <FN> <FN.1.Surname>LEVERKUHN</FN.1.Surname> </FN> </XPN.1.FamilyName> <XPN.2.GivenName>ADRIAN</XPN.2.GivenName> <XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof>C</XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof> </XPN> </PID.5.PatientName> <PID.7.DatetimeOfBirth> <TS> <TS.1.Time>19880517180606</TS.1.Time> </TS> </PID.7.DatetimeOfBirth> <PID.8.AdministrativeSex>M</PID.8.AdministrativeSex> <PID.11.PatientAddress> <XAD> <XAD.1.StreetAddress> <SAD> <SAD.1.StreetOrMailingAddress>6 66TH AVE NE</SAD.1.StreetOrMailingAddress> </SAD> </XAD.1.StreetAddress> <XAD.3.City>WEIMAR</XAD.3.City> <XAD.4.StateOrProvince>DL</XAD.4.StateOrProvince> <XAD.5.ZipOrPostalCode>98052</XAD.5.ZipOrPostalCode> </XAD> </PID.11.PatientAddress> <PID.13.PhoneNumberHome> <XTN> <XTN.1.TelephoneNumber>(157)983-3296</XTN.1.TelephoneNumber> </XTN> </PID.13.PhoneNumberHome> <PID.16.MaritalStatus> <CE> <CE.1.Identifier>S</CE.1.Identifier> </CE> </PID.16.MaritalStatus> <PID.18.PatientAccountNumber> <CX> <CX.1.IDNumber>12354768</CX.1.IDNumber> </CX> </PID.18.PatientAccountNumber> <PID.19.SsnNumberPatient>87654321</PID.19.SsnNumberPatient> </PID> <NK1> <NK1.1.SetIDNk1>1</NK1.1.SetIDNk1> <NK1.2.Name> <XPN> <XPN.1.FamilyName> <FN> <FN.1.Surname>TALLIS</FN.1.Surname> </FN> </XPN.1.FamilyName> <XPN.2.GivenName>THOMAS</XPN.2.GivenName> <XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof>C</XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof> </XPN> </NK1.2.Name> <NK1.3.Relationship> <CE> <CE.1.Identifier>GRANDFATHER</CE.1.Identifier> </CE> </NK1.3.Relationship> <NK1.4.Address> <XAD> <XAD.1.StreetAddress> <SAD> <SAD.1.StreetOrMailingAddress>12914 SPEM ST</SAD.1.StreetOrMailingAddress> </SAD> </XAD.1.StreetAddress> <XAD.3.City>ALIUM</XAD.3.City> <XAD.4.StateOrProvince>IN</XAD.4.StateOrProvince> <XAD.5.ZipOrPostalCode>98052</XAD.5.ZipOrPostalCode> </XAD> </NK1.4.Address> <NK1.5.PhoneNumber> <XTN> <XTN.1.TelephoneNumber>(157)883-6176</XTN.1.TelephoneNumber> </XTN> </NK1.5.PhoneNumber> </NK1> <NK1> <NK1.1.SetIDNk1>2</NK1.1.SetIDNk1> <NK1.2.Name> <XPN> <XPN.1.FamilyName> <FN> <FN.1.Surname>WEBERN</FN.1.Surname> </FN> </XPN.1.FamilyName> <XPN.2.GivenName>ANTON</XPN.2.GivenName> </XPN> </NK1.2.Name> <NK1.3.Relationship> <CE> <CE.1.Identifier>SON</CE.1.Identifier> </CE> </NK1.3.Relationship> <NK1.4.Address> <XAD> <XAD.1.StreetAddress> <SAD> <SAD.1.StreetOrMailingAddress>12 STRASSE MUSIK</SAD.1.StreetOrMailingAddress> </SAD> </XAD.1.StreetAddress> <XAD.3.City>VIENNA</XAD.3.City> <XAD.4.StateOrProvince>AUS</XAD.4.StateOrProvince> <XAD.5.ZipOrPostalCode>11212</XAD.5.ZipOrPostalCode> </XAD> </NK1.4.Address> <NK1.5.PhoneNumber> <XTN> <XTN.1.TelephoneNumber>(123)456-7890</XTN.1.TelephoneNumber> </XTN> </NK1.5.PhoneNumber> </NK1> <PV1> <PV1.1.SetIDPv1>1</PV1.1.SetIDPv1> <PV1.2.PatientClass>E</PV1.2.PatientClass> <PV1.3.AssignedPatientLocation> <PL> <PL.1.PointOfCare>EMG-W</PL.1.PointOfCare> </PL> </PV1.3.AssignedPatientLocation> <PV1.4.AdmissionType>1</PV1.4.AdmissionType> <PV1.14.AdmitSource>ER</PV1.14.AdmitSource> <PV1.18.PatientType>ER</PV1.18.PatientType> <PV1.20.FinancialClass> <FC> <FC.1.FinancialClassCode>H</FC.1.FinancialClassCode> </FC> </PV1.20.FinancialClass> <PV1.39.ServicingFacility>OVL</PV1.39.ServicingFacility> <PV1.41.AccountStatus>REG</PV1.41.AccountStatus> <PV1.44.AdmitDatetime> <TS> <TS.1.Time>199908180015</TS.1.Time> </TS> </PV1.44.AdmitDatetime> </PV1> <GT1> <GT1.1.SetIDGt1>1</GT1.1.SetIDGt1> <GT1.3.GuarantorName> <XPN> <XPN.1.FamilyName> <FN> <FN.1.Surname>SMITH</FN.1.Surname> </FN> </XPN.1.FamilyName> <XPN.2.GivenName>JAMES</XPN.2.GivenName> <XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof>M</XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof> </XPN> </GT1.3.GuarantorName> <GT1.5.GuarantorAddress> <XAD> <XAD.1.StreetAddress> <SAD> <SAD.1.StreetOrMailingAddress>12914 164TH AVE NE</SAD.1.StreetOrMailingAddress> </SAD> </XAD.1.StreetAddress> <XAD.3.City>RICHMOND</XAD.3.City> <XAD.4.StateOrProvince>ON</XAD.4.StateOrProvince> <XAD.5.ZipOrPostalCode>98052</XAD.5.ZipOrPostalCode> </XAD> </GT1.5.GuarantorAddress> <GT1.6.GuarantorPhNumHome> <XTN> <XTN.1.TelephoneNumber>(157)883-6176</XTN.1.TelephoneNumber> </XTN> </GT1.6.GuarantorPhNumHome> <GT1.11.GuarantorRelationship> <CE> <CE.1.Identifier>F</CE.1.Identifier> </CE> </GT1.11.GuarantorRelationship> <GT1.12.GuarantorSsn>535-52-9776</GT1.12.GuarantorSsn> <GT1.16.GuarantorEmployerName> <XPN> <XPN.1.FamilyName> <FN> <FN.1.Surname>WEISS JENSON</FN.1.Surname> </FN> </XPN.1.FamilyName> </XPN> </GT1.16.GuarantorEmployerName> <GT1.17.GuarantorEmployerAddress> <XAD> <XAD.1.StreetAddress> <SAD> <SAD.1.StreetOrMailingAddress>.</SAD.1.StreetOrMailingAddress> </SAD> </XAD.1.StreetAddress> <XAD.3.City>WELLINGTON</XAD.3.City> <XAD.4.StateOrProvince>ON</XAD.4.StateOrProvince> <XAD.5.ZipOrPostalCode>.</XAD.5.ZipOrPostalCode> </XAD> </GT1.17.GuarantorEmployerAddress> <GT1.18.GuarantorEmployerPhoneNumber> <XTN> <XTN.1.TelephoneNumber>(206)340-9577 </XTN.1.TelephoneNumber> </XTN> </GT1.18.GuarantorEmployerPhoneNumber> </GT1> <IN1> <IN1.1.SetIDIn1>1</IN1.1.SetIDIn1> <IN1.2.InsurancePlanID> <CE> <CE.1.Identifier>PRE2</CE.1.Identifier> </CE> </IN1.2.InsurancePlanID> <IN1.3.InsuranceCompanyID> <CX> <CX.1.IDNumber>001</CX.1.IDNumber> </CX> </IN1.3.InsuranceCompanyID> <IN1.4.InsuranceCompanyName> <XON> <XON.1.OrganizationName>LIFE PRUDENT BUYER</XON.1.OrganizationName> </XON> </IN1.4.InsuranceCompanyName> <IN1.5.InsuranceCompanyAddress> <XAD> <XAD.1.StreetAddress> <SAD> <SAD.1.StreetOrMailingAddress>PO BOX 23523</SAD.1.StreetOrMailingAddress> </SAD> </XAD.1.StreetAddress> <XAD.2.OtherDesignation>WELLINGTON</XAD.2.OtherDesignation> <XAD.3.City>ON</XAD.3.City> <XAD.4.StateOrProvince>98111</XAD.4.StateOrProvince> </XAD> </IN1.5.InsuranceCompanyAddress> <IN1.8.GroupNumber>19601</IN1.8.GroupNumber> <IN1.16.NameOfInsured> <XPN> <XPN.1.FamilyName> <FN> <FN.1.Surname>THOMAS</FN.1.Surname> </FN> </XPN.1.FamilyName> <XPN.2.GivenName>JAMES</XPN.2.GivenName> <XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof>M</XPN.3.SecondAndFurtherGivenNamesOrInitialsThereof> </XPN> </IN1.16.NameOfInsured> <IN1.17.InsuredsRelationshipToPatient> <CE> <CE.1.Identifier>F</CE.1.Identifier> </CE> </IN1.17.InsuredsRelationshipToPatient> <IN1.36.PolicyNumber>ZKA535529776</IN1.36.PolicyNumber> </IN1> </RegisterPatient>