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'15H%-BDATE#+1**2"22%5H%-BHOSPI3+1A#%-(#1!) 2'2#L2--4@ASPHYXIADI#1 VIT K +#7-D!HVITKBCARE1BCARE2BCARE3NOT NULLBPLACELMPEDC!'1A#-2#!5#03@7-#1II2"'15H3+%- ID%2##'  VDRL_RSVDRL_RS%2##'  HB_RSHB_RS%2##'  HIV_RSHIV_RS'15H#' HCT.DATEHCT%2##'  HCTHCT_RS%2##' THALASSAEMIATHALASS#'*8 21A%0A03(+#7-D!H)DENTAL18(3')TCARIESGUMINF@+7--1@*(!5+#7-D!H)TARTAR '1%- / '1*4I*82#1I## LBTYPE#0@ -9I3%-BDOCTOR!'452#%- / *4I*82#1I## L3'@4!5
5LBORN3'2"%-SBORN'15H9A%A!H#1I5H 2'15H9A%A!H#1I5H 1PPCARE1PPCARE2'15H9A%A!H#1I5H 3PPCARE3%*4I*82#1I## LHOME-@G#2"%0@-5"I-!9%+%12@#7-C@#14
--#+1*I25H3+B"B#A#!@#5"%31D!HI31
I2@%5H+!9H5H3%-3@ -1+'1
(I2!5)ROAD
3'#-#1'NFAMILY5H1ILOCATYPE"1 = C@@(2% , 2 = -@@(2%	#+1* -*!.VHVID
#+1* @I2I2HEADID	2#!5*I'!TOILETI3*0-2@5"-WATER'4531"0GARBAGE2#1I29+%1HCARE'2!DURABLE	'2!*0-2CLEAN
2##02"-22(VENTILAA**'H2LIGHT2#31I3@*5"WATERTM*2##8AHC#1'MFOOD2#'8!A!%3B#BCTRL2#'8!*1'L3B#ACTRLHOUSE_ID2@%#03I2 2!#!2##-3+@G#+1*#03I2#+1*I22!#!2##-(2*2RELIGIONBGROUPODISEASE
*25H2"PDEATH1=C*2"22%, 2=-*2"22%DATEDISTYPEDIS'15H!2C
I#42#)#+1*B#5HI-@I2#0'12*31#02'4"2ANCRES1 = 4, 2 = 44BCRES'15H9A%%9#1I5H 1'15H9A%%9#1I5H 2'15H9A%%9#1I5H 3%2##'2#+%1%-PPRES#01.5!2B#4%2##'!2#2+%1%-#0@ A+%HI37H!*0-2WATTYPE#+1*'452#8!3@418191=B#"22%, 2=*25-2!1", 3=I2, 4=#0+'H22, 5=-7HF'452#%-Y@G#2"%0@-5"2#!2#1#42#-8%81I5H-2(1"-"9HC@ A%05H!22-@#14
-7@G#2"%0@-5"2#'44	1"B#-8%5H!2#1#42#8Y2#!2#1#42#AH%0#1I0!5@5" 1 record AHF+6H*2!2#!2C
I#42#DI!2'H2 1 #1IC2#!2#1#42#AH%0#1I*2!2#!52#1DI!2'H2 1 4##! (record)F2#!2#1#42#AH%0#1I*2!2#DI#1@'
 1LDI!2'H2 1 
4 (record)Y2#!2#1#42#AH%0#1I*2!2#DI#12#3+12#+#7-#42# DI!2'H2 1 +12#+#7-#42#C+
4'1"@#4
18L 1 0!5-"9H@5" 1 record 5H@GI-!9%181-1. +
41I## L85H-2(1"CC@#14
-92. +
41I## L5H-2(1"-"9H-@#14
-AH!2C
I#42#I2#1I## L 1 #1I*2!2#DI#1#42#2## LDI!2'H2 1 #1I (record)A@G#2"%0@-5"#0'142#1I## L 2#%- A%02#9A%!2#2+%1%-$+%12@#7- 1 +%10!5@5" 1 recordBRESULT'1 = C@#14
-, 2 = -@#14
-#1 = C@'%2#2
2#, 2 = -@'%2#2
2#4#0@ 2#3+H2" +#7-*20-9IH'"5H#2%+%1*8LNAME	DATE_SERV#0@ 9I#1#42#
DATE_DEATH NULLD_UPDATEdrugcode 2 "drug" C HCISCODING (TABLES)	hospitalsdiseasevaccine	tambolallprovince+4I3%2" (!5+#7-D!H)I-#'ckpiorityamper##+1*!2#2*31B"2"A%0"8(2*#L#+1*+!9HI2VHID+#+1*+!9HI2-+%12@#7-5H8%-2(1"-"9H
*208%TYPEAREA#+1*1##0
2
-!2#2#+1*1##0
2
-9H*!#*#+1*1##0
2
-42#'*- (AI)BWEIGHTAPDIAG #+1*5H1!2#'< 	 NOT NULLGRAVIDA PID PID  
DATE_SERV #+1*!2#22!#!2##-
#+1* CID 42#+1* CID !2#2#+1* CID 9H*!#*
2B#A#!THO+!2"@+82#-#1 #-#1#+1*"25H3+@G 24 +%1PKYPCUCODE 	PCUCODE  CHRONIC DIDSTD#+1*"2 24 +%1SEQ  
DIAGCODE  =9I!2#1#42# 1 *2!2#C
I#42#DI!2'H2 1 #1I (record)	#1WIDTH80 = 9IH'"@H2  , 1 =  9IH'"C+!H, 2= 9I#1#42#-7H$-I2-42!@%1#*445H!2#1#42##22H2+12#3'452##-I-!9%#-@G1'@% @
H ## L5H 1,2,3#+1*+12#5#+1*4##!2#1 2!5H*31B"2"A%0"8(2*#L3+(#+1*!2#22 *31B"2"A%0"8(2*#L 
7H-"2-#+1*@H2DNAME
+H'"1-"22##8H-+H'"1*25H#1'15#+1**2#42#5H*H9IH'"!2  #+1**2#42#5H*H9IH'"D 3#+1**2#42#+%12!@%5H1#*445H!2#1#42# @G@%3'@G! +2D!H!5C*H 0
D!H!5C+IC*H 0*3'@G@4!5
522#%- D!H!5C+IC*H 0+3'@G@4D#I
522#%- D!H!5C+IC*H 0+@G1'@% @
H 1,2,3 @GI +2D!H!5C*H 0E#+1*"2@H2+#7-#+1*"2 24 +%1 2!!2#2#+1*"2*31B"2"A%0"8(2*#L*20/*2@+82#3+H2"+H'"1@G#1!#+1*I25H3+B"B#A#!2AI! HOME A%0#+1*5I0I31DI+28%-2(1"-"9HC+%12@#7-@5"'1 -I2-4@7H-I+2I2CAI! HOME (2!0@5"I2)0I2@%5H A%0 +#7--"  2!0@5"I20H'"4@%+!9H  2!0@5"I2 (C
I  0  A
H-'H2)0H'"6#+1*3%2!#!2##-  (C
I  0  A
H-'H2) 0H'"6#+1*-3@ -2!#!2##- (C
I  0  A
H-'H2) 0H'"8#+1*1+'12!#!2##- (C
I  0  A
H-'H2) 0H'"I3+1(.)SEQ APTYPE PCUCODE	DIAGCODE DID  FPTYPE 	VCCTYPE  SEQ   	GRAVIDA  HID  o'15H@4H!A%0#1#8I-!9%  3+#9A@G 5@7-'1
1H'B!25'425 (YYYYMMDDHHMMSS) A%0@G5#4*(1#2
T
7H-"25HC
I-"9H181*1!1L1 DID (3+@4H!@7H-I+2
7H-"25HC
IC181)%-2"8## L ( *12+L) @G@%3'@G!@'1@7-55H%9DI#12#9A%#1I5H 1 3+@G .(.(YYYYMMDD)@'1@7-55H%9DI#12#9A%#1I5H 2 3+@G .(.(YYYYMMDD)@'1@7-55H%9DI#12#9A%#1I5H 3 3+@G .(.(YYYYMMDD).'1@7-55H"I2"@I2 3+@G .(.(YYYYMMDD).'1@7-55H3+H2" 3+@G .(. (YYYYMMDD)*'1@7-55H2" 3+@G .(.(YYYYMMDD) -'1@7-55H3+H2" 3+@G .(.(YYYYMMDD).'1@7-55H--1# 3+@G .(. (YYYYMMDD)2'1@7-55H1#+!-2"8 3+@G .(. (YYYYMMDD)1'1@7-55H!2#1#42# 3+@G .(.(YYYYMMDD)3'1@7-55H1#1IH-D 3+@G .(.(YYYYMMDD)/'1@7-55H@#4H!H'" 3+@G .(.(YYYYMMDD)/'1@7-55H@*5"
5'4 3+@G .(.(YYYYMMDD)*'1@7-55H%- 3+@G .(.(YYYYMMDD)='1A#-2#!5#03@7-#1I*8I2" 3+@G .(.(YYYYMMDD)2'1@7-5  5H3+%- 3+@G .(. (YYYYMMDD)C'1@7-55H%- / '1*4I*82#1I## L 3+@G .(.(YYYYMMDD)I'1@7-55HDI#12#9A%A!H+%1%-#1I5H 1 3+@G .(. (YYYYMMDD)I'1@7-55HDI#12#9A%A!H+%1%-#1I5H 2 3+@G .(. (YYYYMMDD)I'1@7-55HDI#12#9A%A!H+%1%-#1I5H 3 3+@G .(. (YYYYMMDD)&#+1*!2#2*31B"2"A%0"8(2*#L   %1 = PRINCIPLE DX (2#'44	1"B#+%1)$2 = CO-MORBIDITY(2#'44	1"B##H'!) 5= EXTERNAL CAUSE(*2@+8 2"-)  #+1*"2@H22!#05H@GD'I@4! 5	
H'5H 1 -2"8## L 1-27 *12+L ('#H- 12 *12+L)	4 = OTHER (-7H F)#@G+%1%- 1 0!5@5" 1 recordG#+1**2#42#5HC+I#42#'15 #+1*!2#2B"*31B"2"A%0"8(2*#L!*H'*9 (!.) 8(4"! 2 3A+H11'@% (D!HC*H 0 3+I2) @
H 1, 2, 10,12 @GIV'452##-I-!9%#-@G1'@% @
H ## L5H 1,2,10 @GI 16@G1'@% (number)$3 = COMPLICATION(2#'44	1"B#A#)2##8H-+H'"15HA*C Field UNIT C
I*3+#1"25H!52#AH##8@7H-2#H2""25H@+!20*! @
H "2I3 +#7- "2%8H!5H!50@5""2@5"'1AH!52##8H21-2#4)1 A%0-2@GH2 NULL DI*
7H- 2!0@5"I2 (C
I 0 A
H-'H2)	#1 TYPE
#1 WIDTHUNIT_PACKINGUNIT#+1*B# ICD - 10 TM
%1)0AI!2. #55H!59I!2#1#42##2"C+!H5H"1D!H@"6I0@5" +#7-!52##1AII-!9%7I2-9I#1#42##2"@4! C+I#1#8I-!9%@4H!@4!A%0*H*H'%2 2"C#--@7-1I F@GAI!*0*!  1. @GI-!9%B"2#*3#'  3+C+I32#*3#'5%0 1  #1I  2"C@7-*4+2!  A%0#12I-!9%C+IA%I'@*#G 2"C'15H  1 8%2! -85S2!+<  1*7-#1#-2#2" +#7-C!#1# #+1* ICD - 10 - TM 3+@G 6 +%1(D!H#'!8)##+1*B# ICD - 10 - TM (B#@#7I-#1)@GAI!#42##+1*B# ICD - 10 - TM=#+1*B# ICD - 10 - TM (#+1* Z 6H@G#+1*2##1#42#*8 2)4#+1*B# ICD - 10 - TM (B#5H@I2#0'12#02'4"2)DRUGWOMENPP MCH/1. +
41I## L85H-2(1"-"9HC@#14
-W2. +
41I## L5H-2(1"-"9H-@#14
-AH!2C
I#42#2## L %- +#7-#'+%1%-[3. 2#1I## LAH%0#1I0!5@5" 1 record AH+
4AH%0*2!2#1I## LDI!2'H2 1 #1I@GAI!#42#6H*3#'/1 = 2" , 2 = "I2"  , 3 = *2*9
 ,9 =D!H3+H2"j2. #55H!59I@*5"
5'4+%1@7-*4+2! C+I#1#8I-!9%@4H!@4!A%0*HC+I*H'%2 2"C#--@7-1I F2. #55H!59I!2#1#42##2"C+!H5H"1D!H@"6I0@5" +#7-!52##1AII-!9%7I2-9I#1#42##2"@4! C+I#1#8I-!9%@4H!@4!A%0*HC+I*H'%2 2"C#--@7-1I FY1@G/16I-!9%8#1I5H!2#1#42#  A%0*HI-!9%C+I*H'%2 2"C#--@7-1I FZ 1@G/16I-!9%8#1I5H!2#1#42#  A%0*HI-!9%C+I*H'%2 2"C#--@7-1I Ft0 = D!HDI8! , 1 = "2@!G , 2 = "2	5 ,    3 = +H'-2!1" , 4= "21,   
5= 8"2-2!1",  6= +!1
2", 7= +!1+
4 !	
H'5H 2 -2"8## L 28-31 *12+L	!	
H'5H 3 -2"8## L 32-35 *12+L	$	
H'5H 4  -2"8## L  36-39 *12+L 
.1 = 4, 2 = 44  8= D!H#'  9 =#-%#'#1TYPE{0@5"-8%5H!26I0@5"C*2#42#1IF C
I*3+#1@
7H-!B"+21'8%CAI!-7H F (*2!2#3+DI1IAH 1-15 +%1)0@5"8%P%315H2##42#5H3+B"B#A#!@#5"%31D!HI31 !5'2!+!2"@H21 1 visitCLINICA5H#1#42#H2#42#1I+! #222"COST-I2-42!#+1* *".#+1*"25H3+@G 24 +%1   @G@%3'@G! $1 = C*2#42# , 2 = -*2#42#SERVICE_TYPEF2#DI#1'15AH%0#1I*2!2#DI#1'15DI!2'H2 1 
4 (record) _#+1*!2#2*31B"2"A%0"8(2*#L (2##1'15AH%0#1I D!H'#	5
4@5"'1@4+6H@G!)_@G#2"%0@-5" 2'0B 
22#-#0
2#5H-2(1"-"9HC@#14
- (2#C+I#42#I2*H@*#4!*8 2)0@5"8%(@G)0@5"8%(A!H)0@5"8%5H3+B"B#A#!2AI! PERSON  A%00@5"5I0I31DI+28%1I!5!2#2@G8%@5"'1 C
I-I2-4CAI! Person (FK)0@5"-8%5H!26I0@5"C*2#42#1IF C
I*3+#1@
7H-!B"+21'8%CAI!-7H F (*2!2#3+DI1IAH 1-15 +%1)(program generate)9@%0@5"2#!2#1#42#(*2!2#3+DI1IAH 1-15 +%1)@GAI!#42# %1)0AI! 	+!2"@+8 @AI! APPOINT C+I1@GD'I5H*2#42#D!HI-1*H@I2*H'%2Y1@G/16I-!9%8#1I5H!2C+I#42#  A%0*HI-!9%C+I*H'%2 2"C#--@7-1I Ft4. -2"8 18 56ID @GI-!9%5%0#1I  2"C@7-*4+2! A%0#12I-!9%C+IA%I'@*#G 2"C'15H  1 8%2! -85NUTRI1!220@5"8%5H3+B"B#A#!2AI! PERSONZ'1@7-55H#'#1IA# +#7-'15H9IH'"C7I5H#14
-3+@G .(. (YYYYMMDD) 1 visit +!2"62#!2#1#42##1ICF A!I'H20!2#1#42#+%2"%44G2! (8%445H!2#1#42#C#1I1IF C
I seq @5"'1)1#+1*!2#2 ICD-9-CM +#7- ICD-10-TM (#+1*+12#)#+1*4##!'15@GAI!#42#A%0*0*!+'1@7-55H*3#' 3+@G .(.(YYYYMMDD)*202#1I## L	PREGNANCY\#+1*A5H#1#42#!51I+! 5 +%1 6H-I2-42!!2#2 *". 3+C+I16#1I 5 +%1@GAI!2#*3#'  NULL
o%315H2##42#5H3+B"B#A#!@#5"%31D!HI31 !5'2!+!2"@H21 1 visit  A%0C+I*1!1L1AI! serviceM%315H2##42#5H3+B"B#A#!@#5"%31D!HI31 A%0D!HH2AI! Service#+1*2#C+I#42#5H3+B"B#A#!@#5"%31D!HI31(@H21 1 visit) #55HC+I#42#I-!5'2!*1!1L1AI! service #55H32#*3#'+#7-16'2!#-%8!0I-D!H!5 seq CAI! service2. #55H!59I!2#1#42##2"C+!H5H"1D!H@"6I0@5" +#7-!52##1#8AIDI-!9%7I2-9I#1#42##2"@4! C+I#1#8I-!9%@4H!@4!A%0*HC+I*H'%2 2"C#--@7-1I FY2#1*HI-!9%C+I*H'%2  C+I*H#1I@5"'@!7H-!52#1@GI-!9%#84##!CAI! PP)@G#2"%0@-5"2#@*5"
5'4-8%       l@G#0'142#@GH'"I'"B#@#7I-#1-8% (B#@#7I-#1 +!2"6 B#4H-@#7I-#1A%0B#D!H4H-@#7I-#1)'15H#'#1IA#01 = +2" , 02 = 2" , 03 = "1#1)2-"9H , 04 =  <  D!H#2(D!H!5I-!9%)
05 = #-3+H2"/@I2#0'1, 06=22##1)2D!H!24H--5 (#2'H222##1)2), 07=#2##1)2, 08=B#-"9HC 2'0* (inactive)D!H!5'2!3@GI-#1)2, 09=4@*2##1)2, 10 = --27I5Hf#222"6H#'!H2"2A%0@'
 1L1I+!#'!1IH2#42#22#A"L (#'!8(4"!A%0@%+%18 2 3A+H)p3'@45H@#5"@G(H2"#4) #'!8(4"!A%0@%+%18 2 3A+H B"I2D!H!52#@#5"@GC+IC*H@%(9"L (0.00)'#222"C+I19I#1#42# D!H!5C*H 0.00?#227I-+#7-#22"25HDI#12B#"22%(A!HH2")  D!H!5C*H 0.00J	I-!9%+
4'1"@#4
18L5HAH2A%I'-"9H41*2!5 -2"8#0+'H2 15-49 5 AFk	@G#2"%0@-5"2#C+I#42#*#I2@*#4! 9!48I!1B# 1I9I!2#1#42#C*2#42# A%02#C+I#42#-*25H3#+1*2##42#5H3+B"B#A#!@#5"%31D!HI31 (@H21 1 visit) #55HC+I#42#I-!5'2!*1!1L1AI! service #55H32#*3#'+#7-16'2!#-%8!0I-D!H!5 seq CAI! service *1. #0
2#85H-2(1"-"9HC@#14
- @@G#2"%0@-5"-I-!9%B#5HI-@I2#0'128%5H!2#1#42#= 1@G/16I-!9%8#1I5H!52#1!2#1#42##1IH-D2. @G 0-5 5 @GI-!9%5%0 4 #1I #1I5H 1 @7-8%2! ,#1I5H 2 @7-!#2! ,#1I5H 3 @7-@!)2",#1I5H 4 @7-#2!  B"C+I1*HI-!9%C+I*H'%2 2"C#--@7-1I F 3. -2"8 6 -18 5 @GI-!9%5%0 2 #1I #1I5H 1 @-!5H 1 A%0#1I5H 2 @-!5H 2   B"C+I1*HI-!9%C+I*H'%2 2"C#--@7-1I F \  2#1*HI-!9%C+I*H'%2  C+I*H#1I@5"'@!7H-!52#1@GI-!9%#84##!CAI! MCH7'1@7-55HDI#12##' HCT 3+@G .(.(YYYYMMDD)'1@7-5@4 3+@G .(. (YYYYMMDD) (+2D!H#2'1 @7-5H@4 AH#2 .(. @4 C+I3+'1@4@G'15H 1 !#2!-5 .(.1IF)++%12@#7-8+%15H1I-"9HC@#14
-M5. @G1@#5"
1I#0!(6)25H 1 8CB#@#5"5H#14
-5HDI#1'15M6. @G1@#5"
1I#0!(6)25H 2 8CB#@#5"5H#14
-5HDI#1'15M7. @G1@#5"
1I#0!(6)25H 6 8CB#@#5"5H#14
-5HDI#1'15F1. @G-2"8H3'H2 7  5 85H-2(1"-"9HC@#14
-5H!2#1'15G2. @G-2"8H3'H2 7  5 85H-2(1"-"9H-@#14
-AH!2#1'15=3. +
41I## L85H-2(1"-"9HC@#14
-5H!2#1'15>4. +
41I## L85H-2(1"-"9H-@#14
-AH!2#1'15"8. #0
2
%8H!-7HF5H!2#1'15#+1*9IC+I#42#SERV_PER+!2"@%9IC+I#42#SEQ
'15H#'I3+1*H'*9@*I#-@-' (.!.)1#+1**2"22% 2!!2#2*31B"2"A%0"8(2*#L6,2WAIST_CMBPH_1BPL_1BPH_2BPL_2#01I32%C@%7-BSLEVEL'452##'I32%C@%7-BSTEST'2!1B%+4 4*B%4SBP'2!1B%+4 DA-*B%4DBP#+1*2##'2+I-4142#LABTEST%-2##'2+I-4142#	LABRESULT~12  =  H2I2'5H6I0@5"1#0#'A#2@7H--32 5H!5#+1*5H6III'"@% 0 A%0DI Work permitted (C--8
232)p13  =  H2I2'5H6I0@5"1#0#'!+2D" A%05H!5#+1*5H6III'"@% 0 AHD!H#'!-"9HC#+1* 01 ,02 A%0 03l14  =  H2I2'5H--8
2329I-2!+!2"1#0#'A#2 B"!5 Passport/Visa @G+%12C2#--8
2/21  =  H2I2'5H-"A%0-"9HCH2"/(9"L14\22  =  H2I2'5H@G9I42!-#+1* 11 ,12 ,15,16,17 I2I  DIAH *2!5/ ##"2/8#/
2423  =  +!2"6%8H!-7HF*20 2-2#-"9H-2(1"-8%	DATE_EXAM	SERVPLACEF1 = B* , 2 = 9H , 3 = +!I2" ,4 = +"H2 , 5 = A", 6 = *!0, 9=D!H#2P1  = NORMAL , 2 = CESAREAN , 3 = VACUUM , 4 = FORCEPS , 5 = H2I, 6 = ABORTION01 = H2I2'(8%5H!51
+2*20A%0*44)5H6I0@5"1#0#'!+2D" C%8H!1@#5"C*2(6)25H#1*'1*42#2#12%I22#(6)2 #0@ 0@5"#2)#L .#.38      A%0!5@%#031'#0
2
5H6III'"@% 002 = H2I2'(8%5H!51
+2*20A%0*44)5H6I0@5"1#0#'!+2D" C%8H!D#I#2@+I2  (%8H!8%5H282#5+#7-82#5-4I6H-"9H-*2#1@%5I"-#1)  A%0!5@-*2#A4!L#0'14 5HD!H!5*2020@5"#2)#L ( .#.38 .)  !5@%#031'#0
2
5H6III'"@% 003 = H2I2'(8%5H!51
+2*20A%0*44)5H6I0@5"1#0#'!+2D" C%8H!5H!58#0B"
LAH#0@( #0@ 0@5"#2)#L .#.38   A%0!5@%#031'#0
2
5H6III'"@% 0(11 = H2I2'(8%5H!51
+2*20A%0*44)5H@I2@!7-B"
-I'"+!2"C%1)0
1<  H'#2'(!.12,13,34,35 .#..@I2@!7- .(. 2522) A%0H2I2'5H@I2@!7-B"D!H
-I'"+!2"(!.17 .#..@I2@!7- .(. 2522)  #0@ 0@5"#2)#L .#. 13  !5@% 13 +%1 A%0!5@%#031'#0
2
5H6III'"@% 615  =  H2I2'(8%5H!51
+2*20A%0*44)5H@I2@!7-
-I'"+!2" DI*44-2(1"2'# (.#.. @I2@!7- .(. 2552)  #0@ 0@5"#2)#L.#.14   !5@%#031'#0
2
5H6III'"@%  3  A%0  4   A%0D!HC
H*1

24D"16  =  H2I2'(8%5H!51
+2*20A%0*44)5H@I2@!7-B"
-I'"+!2" !5*44-2(1"2'#@4H!
7H-C0@5"  H- 22 !52!  2535  !5@%#031'#0
2
5H6III'"@%  5  A%0D!HC
H*1

24D"17  =  H2I2'(8%5H!51
+2*20A%0*44)5H@I2@!7-B"
-I'"+!2" !5*44-2(1"2'#@4H!
7H-C0@5"  +%1 22 !52!  2535 !5@%#031'#0
2
5H6III'"@%  8   A%0D!HC
H*1

24D"W18  =  8#H2I2'(8%5H!51
+2*20A%0*44)5H@I2@!7-B"
-I'"+!2"C%1)0
1H'#2'5H@4C#0@(D"(!.12,13,34,35 .#..@I2@!7- .(. 2522) A%08#H2I2'5H@I2@!7-B"D!H
-I'"+!2"5H@4C#0@(D"(!.17 .#..@I2@!7- .(. 2522) #0@ 0@5"#2)#L .#. 13 !5@% 13 +%1 A%0!5@%#031'#0
2
5H6III'"@%  7PID#0'14*98+#5HSMOKE#0'147H!@#7H-7H!A-%-.-%L#0'14@2+'2C
24*2"##0'14'2!1*9C
24*2"#ALCOHOLDMFAMILYHTFAMILY*25H#1#42#1#-SCRPLACE0#+1**2"22%5HC+I#42#  2!#+1*!2#2  *".*'1@7-55H#' 3+@G .(.(YYYYMMDD)#42#C--*2#42#!I3+1 (.) 8(4"! 2 3A+H '2!1B%+4 4*B%4 #1I5H 10'2!1B%+4 4*B%4 2#'1#1I5H 1 (!!.#-)"'2!1B%+4 DA-*B%4 #1I5H 12'2!1B%+4 DA-*B%4 2#'1#1I5H 1 (!!.#-) '2!1B%+4 4*B%4 #1I5H 20'2!1B%+4 4*B%4 2#'1#1I5H 2 (!!.#-)"'2!1B%+4 DA-*B%4 #1I5H 22'2!1B%+4 DA-*B%4 2#'1#1I5H 2 (!!.#-)1%2##'I32%C@%7- (!./%.) 8(4"! 2 +%10%-2##'2+I-4142# (8(4"! 2 +%1)T1 = H3'H2@L, 2 = H-I2H3,       3 = 4, 4 = H-I2*9, 5 = *9@4@LR1 =  A"L , 2 = "22% , 3 =  **. , 4 = .B#2 , 5 = %-@- (2!C*941#)@%5H9IC+I#42#PROVIDER>@%5H9IC+I#42# --B"B#A#! D!HI31C*2"22%@5"'1<'2!1B%+4 4*B%4 (!!.#-) *3+#19IH'"'2!1B%+4*9>'2!1B%+4 DA-*B%4 (!!.#-) *3+#19IH'"'2!1B%+4*9	NCDSCREEN+!2"6 I-!9%2#C+I#42#1#-B#@2+'2A%0'2!1B%+4*9*3+#19I5H!2#1#42# A%0#0'142#DI#1#42#1#-B#@2+'2w1)#0
2
%8H!@I2+!2" (-2"8 15 56ID) 5HDI#1#42#1#-B#@2+'2A%0'2!1B%+4*9 CB#"22%A%0*2#42#-#01! 9!4 1IC*2"22%A%0-*2"22%  2.  I-!9%2#C+I#42#5H*2"22%-7HC+I1%8H!@I2+!2"5H-2(1"C@#14
- @G2#@GI-!9%@7H-#0@!4'2!#-%8!-#42#y  3.  2#C+I#42#1#-B#@2+'2A%0'2!1B%+4*9 1 #1I 0!5 1 record B"2#1#-@2+'2A%0'2!1B%+4*95H3Cw2#1#-#1I@5"'1 0-"9HC record @5"'1 A%02#42!9I5H'2!@*5H" ("1D!H@GB#) G016CAI!5II'"	CHRONICFU  2.  2##'42!9IH'" 1 #1I 0!5 1 record 6A!I9IH'"0!51IB#@2+'2 A%0'2!1B%+4*9 AH+2@G2##'#1I@5"'1 G0!5@5" 1 recordLABFU  2.  2##'2+I-4142#9IH'" 1 #2"2# 0!5 1 record +2!52##'2+I-4142#!2'H2 1 #2"2# G0!5!2'H2 1 recordB1 =  A"L , 2 = "22% , 3 =  **. , 4 = .B#2 , 5 = %-@-C2#9A%A!H#1I5H 1  +!2"6 2#9A%A!H1IAH 1 - 15 '1+%1%- D2#9A%A!H#1I5H 2  +!2"6 2#9A%A!H1IAH 16 - 42 '1+%1%- ?2#9A%A!H#1I5H 3  +!2"6 2#9A%A!H1IAH 43 '1+%1%- C2#9A%%9#1I5H 1  +!2"6 2#9A%%91IAH 1 - 15 '1+%1%- D2#9A%%9#1I5H 2  +!2"6 2#9A%%91IAH 16 - 42 '1+%1%- ?2#9A%%9#1I5H 3  +!2"6 2#9A%%91IAH 43 '1+%1%- Y	+!2"@+8  2#9A%%9+%1%-@I2#9A%#1I5H 1 A%0#1I5H 2 2!@L!2#22#!-2!1"-B#*#I2@'-#L
1H  4.0  '15H 1 8%2! 2554x1.  @GI-!9%B"2#1#- 3+C+I32#1#-5%0 1 #1I A%01*HI-!9%C+I1+'1A%0*H'%28#1I5H!52#1#-1 visit  +!2"6  2#!2#1#42##1IC F  A!I'H20!2#1#42#+%2"%44G2!  (8%445H!2#1#<  42#C#1I1I F  C
I seq @5"'1)1 visit  +!2"6  2#!2#1#42##1IC F  A!I'H20!2#1#42#+%2"%44G2!  (8%445H!2#1#42#C#1I1I F  C
I  seq @5"'1)Z	+!2"@+8   2#9A%A!H+%1%-@I2#9A%#1I5H 1 A%0#1I5H 2 2!@L!2#22#!-2!1""#228+!2"6#22#'!-2#C+I#42#CAH%0#1I DIAH H2"2, H2@'
 1L, H2#42#22#A"L /%/ #228!5(4"! 2 3A+H B"I2D!H#2#228C+IC*H 0.00F#22H2#42#+12# !5(4"! 2 3A+H I2D!H#2H2#42#C+IC*H 0.00#55H!52#!2#1#42#!2'H2 1 #1ICAH%0
H'@'%2 (#1I5H 1, #1I5H 2, #1I5H 3) C+I1*HI-!9%2#C+I#42##1I*8I2"CAH%0
H'@'%2*202#1I## L  1 = @*5"
5'4#0+'H21I## L 2 = @*5"
5'4#0+'H2%-+#7-+%1%- 2"C 42 '1  9 = D!H#2 (B"I29I
2"0C*H@GH2 null)6= ADDITIONAL CODE (#+1*@*#4!)*7= MORHDOLOGY CODE (#+1*@5H"'1@7I--)p+!2"@%#031'9IC+I#42#*3+#18%2#5HC+I#42#I22#A"LAD" 5H6I0@5"1#!122#A"LAD"  1. @GI-!9%B"2#*3#'  3+C+I32#*3#'5%0 1  #1I  2"C@7-*4+2!  A%0#12I-!9%C+IA%I'@*#G 2"C'15H  1  8%2! -8581 = !5#0'14@2+'2C
24*2"#, 2 = D!H!5, 9 = D!H#2@1 = !5#0'14'2!1B%+4*9C
24*2"#, 2 = D!H!5, 9 = D!H#2#-#6)2+!-44#12!#02(#+1*C+!H5 2555,-#1@4H!B#*#I2@4H!@4!5#0!2 2555>-#1@4H!B#*#I25#0!2 2555  -#!122#A"LAD"m1 = "2@!G , 2 = "2	5 , 3 = +H'-2!1" , 4= "21,  5 = 8"2-2!1"                6= +!1
2", 7= +!1+
4 #1#+1*C+!H  5 25557-#1B#*#I2@4H!@4!5#0!2 2555 A%0#1#+1*C+!H	+!2"@%#031'9IC+I#42#*3+#18%2#5HC+I#42#I22#A"LAD" 5H6I0@5"1#!122#A"LAD" I-@G-A"L5H32##1)2  n#	+!2"@%#031'9IC+I#42#*3+#18%2#5HC+I#42#I22#A"LAD" 5H6I0@5"1#!2#A"LAD" A"L9I32#'44	1"j# I3+1(.) 8(4"! 2 3A+HX1 = D!H7H!, 2 = 7H!2 F #1I, 3 = 7H!@G#1I#2', 4 = 7H!@G#03, 9 = D!H#2
B1  = NORMAL , 2 = CESAREAN , 3 = VACUUM , 4 = FORCEPS , 5 = H2Iq'15H@4H!A%0#1#8I-!9%  3+#9A@G 5 @7- '1
1H'B!25'425 (YYYYMMDDHHMMSS) A%0@G5#4*(1#2
;@4H!#+1*C+!H#55H@G'15-A2*#I2@*#4!8I!1B#@4H!#+1*C+I
1@  5 2555>#1#2"%0@-5"@4H!@4!C+I*-%I-12#B#*#I2-*2#42#@*I#-@-' (!.)#+1*2##'2+I-4142#
1=#'I32%C@%7- 2+%-@%7-3 +%1--2+2#
2=#'I32%C@%7- 2+%-@%7-3 B"D!H--2+2#
3=#'I32%C@%7- 2@*I@%7--" +%1--2+2#
4=#'I32%C@%7- 2@*I@%7--" B"D!H--2+2#1.  @GI-!9%2#C+I#42#9IH'"B#@#7I-#18#1I@7H-42!%2##1)2 A%0*HI-!9%C+I1+'1A%0*H'%2 2"C#--@7-1I Fp1.  @GI-!9%2##'2+I-4142#9IH'"B#@#7I-#1 A%0*HI-!9%C+I1+'1A%0*H'%2 2"C#--@7-1I F9I3+1C'15H!2#1#42# (4B%#1!) 8(4"! 2 3A+H4*H'*9C'15H!2#1#42# (!.) 8(4"! 2 3A+H#'@I2FOOT#'-#0*22RETINAP#'@I2 (#'A% 4'+1 #9@I2 2##1'2!#9I*6 
5#)
1 = #', 2 = D!H#' 6#'-#0*22I'" opthalmoscope
1 = #', 2 = D!H#'#+1*2##'2+I-4142#
01=#'I32%C@%7- 2+%-@%7-3 +%1--2+2#
02=#'I32%C@%7- 2+%-@%7-3 B"D!H--2+2#
03=#'I32%C@%7- 2@*I@%7--" +%1--2+2#
04=#'I32%C@%7- 2@*I@%7--" B"D!H--2+2#
05=#' HbA1C
06=#' Triglyceride
07=#' Total Cholesterol
08=#' HDL Cholesterol
09=#' LDL Cholesterol
10=#' BUN C@%7-
11=#' Creatinine C@%7-
12=#'B#5 albumin C1**2'0
13=#' Creatinine C1**2'02#+1**44!2#2 +H'"25H@5H"'I-#H'!13+01 = A , 02 = B , 03 = AB , 04 = O, 05 = A-negative , 06 = B-negative , 07 = AB-negative , 08 = O-negative , 09= A-positive , 10= B-positive , 11= AB-positive 12= 0-positive, 99 = D!H#2+!9H@%7-A#1@4H!#+1*4##! #55H!5'15-A2*#I2@*#4!8I!1B#"0 = D!H2 , 1 = 2 , 9 = D!H#2)0 = D!HDI#1 , 1 = DI#1 , 9 =  D!H#21=4, 2=44 , 9 = D!H#2$0 = D!H#' , 1 = #' , 9 = D!H#2+0 = D!H!5 , 1 = !5  8=D!H#' , 9 = D!H#2!0 = D!H!5 , 1 = !5  , 9 = D!H#2*0 = D!H@5"- , 1 = @5"- , 9 <= D!H#2e1=I3, 2=I3#02, 3=I322%, 4=H-I37I, 5=*#0I3 A!HI3,         6=I3##8@*#G , 9 = D!H#2J1 = 1 ,  2 = @2 ,  3 = +!138K" , 4 = *HD315H-7H , 9 = D!H#2"0 = D!H9 , 1 = 9 , 9 = D!H#2%0 = D!H , 1 =   , 9 = D!H#2&0 = D!H*0-2 , 1 = *0-2 , 9 = D!H#2&0 = D!H#02" , 1 = #02" , 9 = D!H#2&0 = D!H31 , 1 = 31 , 9 = D!H#2"0 = D!HC
I , 1 = C
I , 9 = D!H#2(0 = D!H'8! , 1 = '8! , 9 = D!H#2 B#*#I22I-!9%2#C+I#42#9IH'"- 2#*#I2@*#4!*8 2A%0I-1B#  C#9A 21 AI!!2#2  (2!!2#2 18 AI!)  5#0!2 2555S	1 = D!H*9, 2 = *92 F #1I, 3 = *9@G#1I#2', 4 = *9@G#03, 9 =D!H#2
GRIB#*#I22I-!9%2#C+I#42#9IH'"- 2#*#I2@*#4!*8 2A%0I-1B#>C#9A 21 AI!!2#2  (2!!2#2 18 AI!)  5#0!2 2555#@'-#L
1H 4.0 '15H 1 8%2!  2554-.............................................+I2m   #5B#"22% @#14
- +!2"6 3%5H1I-B#"22% +#7-7I5H#14
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- +!2"6 3%5H1I-B#"22% +#7-7I5H#14
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