| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | institution | 0;1 | FREE TEXT | B | This field contains the Institution where the Internship or Residency was conducted. | |
| 1 | address | 0;2 | FREE TEXT | Indicates the Address of the institution. | ||
| 1.1 | address 2 | 0;7 | FREE TEXT | Indicates the address of the institution. | ||
| 1.2 | city | 0;8 | FREE TEXT | Indicate the city of the institution. | ||
| 1.3 | state | 0;9 | POINTER | 5 | Indicate the state where the institution is located. | |
| 1.4 | zip | 0;10 | FREE TEXT | Enter the zip code for the institution. | ||
| 2 | specialty | 0;3 | POINTER | 747.9 | Indicates the Specialties covered in Internship/Residency. | |
| 3 | completion date | 0;4 | DATE-TIME | Indicates the Completion Date for training. | ||
| 4 | # of months | 0;5 | NUMERIC | Number of Months of doing internship or residency at this institution. | ||
| 5 | verification | 0;6 | SET OF CODES | 1:LETTER FROM TRAINING INSTITUTE 2:ROC 3:AMA PHYSICIAN VERIF. SVC. | #3 AMA Physician Verification Service should only be used if Primary Source Institution has been CLOSED and no longer in operation. |
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