| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | sequence number(+) | 0;1 | NUMERIC | The Record Number for this extract entry. | ||
| 1 | year month(+) | 0;2 | FREE TEXT | A six character string representing the year and the month for which this extract was performed. | ||
| 2 | extract number(+) | 0;3 | POINTER | 727 | AC | The corresponding entry in the DSS EXTRACT LOG file (#727) for this extract. |
| 3 | facility | 0;4 | POINTER | 40.8 | This is the medical center division where the extract was performed. | |
| 4 | patient no. - dfn(+) | 0;5 | POINTER | 2 | This is the patient to whom this extract record pertains. | |
| 5 | ssn | 0;6 | FREE TEXT | The patient's social security number. | ||
| 6 | name | 0;7 | FREE TEXT | The first four characters of the patient's last name. | ||
| 7 | in/out patient indicator | 0;8 | SET OF CODES | I:INPATIENT O:OUTPATIENT | Indicates whether the patient was an inpatient or an outpatient for this extract. | |
| 8 | day | 0;9 | FREE TEXT | Date on which the clinic visit occurred. | ||
| 9 | feeder key | 0;10 | FREE TEXT | Code that uniquely identifies a DSS product. | ||
| 10 | overbooked indicator | 0;11 | SET OF CODES | O:OVERBOOKED | Indicates if this was an overbook appointment for this visit. | |
| 11 | *placeholder | 0;12 | POINTER | 44 | This field is no longer used. | |
| 12 | treating speciality | 0;13 | FREE TEXT | The PTF CODE of the treating specialty associated with this extract record. | ||
| 13 | time | 0;14 | FREE TEXT | Time for this clinic visit (6-digit military time). | ||
| 14 | primary care team | 0;15 | POINTER | 404.51 | The primary care team assigned to this patient in the PCMM module. | |
| 15 | primary care provider | 0;16 | FREE TEXT | The primary care provider assigned to this patient through the PCMM module. | ||
| 16 | primary care prv person class | 0;17 | FREE TEXT | The VA code of the Person Class of the Primary Care Provider as of the date of this extract record. | ||
| 17 | provider | 0;18 | FREE TEXT | The provider associated with the patient encounter. | ||
| 18 | provider person class | 0;19 | FREE TEXT | The VA Code of the Person Class of the Provider for this record. | ||
| 19 | cpt code qty & modifiers #1 | 0;20 | FREE TEXT | The first 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 20 | cpt code qty & modifiers #2 | 0;21 | FREE TEXT | The second 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 21 | cpt code qty & modifiers #3 | 0;22 | FREE TEXT | The third 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 22 | cpt code qty & modifiers #4 | 0;23 | FREE TEXT | The fourth 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 23 | cpt code qty and modifers #5 | 0;24 | FREE TEXT | The fifth 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 24 | cpt code qty and modifiers #6 | 1;1 | FREE TEXT | The sixth 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 25 | cpt code qty and modifers #7 | 1;2 | FREE TEXT | The seventh 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 26 | cpt code qty and modifiers #8 | 1;3 | FREE TEXT | The eighth 5-character CPT Code for the procedure performed, the Quantity, or how many times the unique code appears in the record, and up to 5 two-character CPT modifiers. | ||
| 27 | primary icd9 code | 1;4 | FREE TEXT | The Primary ICD-9 code for this clinic visit. | ||
| 28 | secondary icd9 1 | 1;5 | FREE TEXT | Secondary ICD9 code #1 for this clinic visit. | ||
| 29 | secondary icd9 2 | 1;6 | FREE TEXT | Secondary ICD9 code #2 for this clinic visit. | ||
| 30 | secondary icd9 3 | 1;7 | FREE TEXT | Secondary ICD9 code #3 for this clinic visit. | ||
| 31 | secondary icd9 4 | 1;8 | FREE TEXT | Secondary ICD9 code #4 for this clinic visit. | ||
| 32 | date of birth | 1;9 | FREE TEXT | Patient's date of birth. | ||
| 33 | eligibility | 1;10 | FREE TEXT | Appropriate eligibility code based on veteran or non-veteran status. | ||
| 34 | veteran | 1;11 | BOOLEAN | N:NO Y:YES | Patient's veteran status. | |
| 35 | race | 1;12 | FREE TEXT | Race abbreviation for this patient. | ||
| 36 | pow status | 1;13 | SET OF CODES | N:NO Y:YES U:UNKNOWN | Indicates if patient was confined as a Prisoner of War. | |
| 37 | pow location | 1;14 | FREE TEXT | If POW Status is indicated, this is the POW confinement location/period. | ||
| 38 | radiation status | 1;15 | SET OF CODES | N:NO Y:YES U:UNKNOWN | Indicates if patient claims exposure to ionizing radiation. | |
| 39 | radiation encounter indicator | 1;16 | BOOLEAN | N:NO Y:YES | Indicates whether service provided during this patient encounter is related to exposure to ionizing radiation. | |
| 40 | agent orange status | 1;17 | SET OF CODES | N:NO Y:YES U:UNKNOWN | Indicates whether patient was exposed to Agent Orange. | |
| 41 | agent orange enc indicator | 1;18 | BOOLEAN | N:NO Y:YES | Indicates whether service provided during this patient encounter is related to exposure to Agent Orange. | |
| 42 | master patient index | 1;19 | FREE TEXT | Unique national VA patient identifier | ||
| 43 | dss product department | 1;20 | FREE TEXT | The nationally defined DSS Intermediate Department Number designated to the patient care product being provided. | ||
| 44 | sex | 1;21 | SET OF CODES | M:MALE F:FEMALE | Patient's gender. | |
| 45 | zip+4 | 1;22 | FREE TEXT | The ZIP code for where the patient resides. The 5-character ZIP code is provided if ZIP+4 is not available. | ||
| 46 | placeholder | 1;23 | FREE TEXT | Currently NULL. | ||
| 47 | placeholder | 1;24 | FREE TEXT | Currently NULL. | ||
| 48 | encounter eligibility | 1;25 | NUMERIC | Eligibility code for the encounter based on the purpose of the encounter and the patient's eligibility. | ||
| 49 | mst status | 1;26 | SET OF CODES | N:NO Y:YES U:UNKNOWN D:DENIED | Military Sexual Trauma (MST) status of a patient on the date of the encounter. | |
| 50 | mst encounter indicator | 1;27 | BOOLEAN | N:NO Y:YES | Indicates if treatment is related to Military Sexual Trauma. | |
| 51 | sharing agreement payor | 1;28 | FREE TEXT | An indicator used for patients participating in sharing agreements. | ||
| 52 | sharing agreement insurance co | 1;29 | FREE TEXT | Indicates the first insurer for patients who participate in sharing agreements. | ||
| 53 | enrollment location | 1;30 | FREE TEXT | The facility that the patient chooses to designate as his preferred location for care. | ||
| 54 | state code | 1;31 | FREE TEXT | The state in which the patient resides. | ||
| 55 | county code | 1;32 | FREE TEXT | County in which the patient resides. | ||
| 56 | associate pc provider | 1;33 | FREE TEXT | The associate primary care provider assigned to this patient through the PCMM module. | ||
| 57 | associate pc prov person class | 1;34 | FREE TEXT | The VA code of the Person Class of the Associate Primary Care Provider as of the date of this extract record. | ||
| 58 | placeholder | 1;35 | FREE TEXT | Currently NULL. | ||
| 59 | dom,prrtp and saartp indicator | 1;36 | SET OF CODES | P:GEN. PRRTP T:PTSD PRRTP S:DOM. PRRTP H:HOMELESS CWT/TR A:SA CWT/TR D:DOMICILIARY B:PTSD CWT/TR C:GEN. CET/TR | Indicates if the patient is admitted to either a RRTP, PRRTP, or SARRTP at the time care is provided. | |
| 60 | enrollment category | 1;37 | FREE TEXT | Patient's enrollment category. | ||
| 61 | enrollment status | 2;1 | POINTER | 27.15 | Patient's enrollment status. | |
| 62 | shad status | 2;2 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates whether patient meets requirements for Shipboard Hazard and Defense (SHAD). | |
| 63 | purple heart indicator | 2;3 | BOOLEAN | Y:YES N:NO | Indicates whether or not a patient is a Purple Heart recipient. | |
| 64 | period of service | 2;4 | FREE TEXT | The period of service which best classifies this patient based on eligibility code. | ||
| 65 | observation patient indicator | 2;5 | SET OF CODES | NO:NO YES:YES | Indicates if patient is considered to be an observation patient. | |
| 66 | encounter number | 2;6 | FREE TEXT | The unique number assigned for DSS. | ||
| 67 | agent orange location | 2;7 | SET OF CODES | K:KOREAN DMZ V:VIETNAM O:OTHER | Indicates the location where the patient was exposed to Agent Orange. | |
| 68 | production division code | 2;8 | FREE TEXT | Identifies the division/facility where the work was performed. | ||
| 69 | appointment type | 2;9 | SET OF CODES | 1:COMPENSATION & PENSION 2:CLASS II DENTAL 3:ORGAN DONORS 4:EMPLOYEE 5:PRIMA FACIA 6:RESEARCH 7:COLLATERAL OF VET. 8:SHARING AGREEMENT 9:REGULAR 10:COMPUTER GENERATED | Indicates the type of appointment the patient is scheduled for. | |
| 70 | purpose of visit | 2;10 | SET OF CODES | 1:C&P Exam 2:10-10 3:Scheduled Appointment 4:Unscheduled Visit | Indicates the reason the patient has an appointment. Choices are: '1' FOR C&P; '2' FOR 10-10; '3' FOR SCHEDULED VISIT; '4' FOR UNSCHED. VISIT; | |
| 71 | means test | 2;11 | SET OF CODES | A:CATEGORY A B:CATEGORY B C:CATEGORY C P:PENDING ADJUDICATION R:REQUIRES MEANS TEST N:MEANS TEST NOT REQUIRED E:EXEMPT I:INCOMPLETE L:NO LONGER APPLICABLE M:NON-EXEMPT | The current means test category for this patient. | |
| 72 | head & neck cancer indicator | 2;12 | BOOLEAN | Y:YES N:NO | Identifies whether patient has head and/or neck cancer. | |
| 73 | ethnicity | 2;13 | FREE TEXT | The patient's PTF ethnicity code. | ||
| 74 | race 1 | 2;14 | FREE TEXT | Self-reported by patient as recorded in VistA patient file. | ||
| 75 | cboc status indicator | 2;15 | BOOLEAN | Y:YES | Indicates if the patient was seen at a Community Based Outpatient Clinic (CBOC). | |
| 76 | dss ip # | 2;16 | NUMERIC | The nationally defined DSS Intermediate Product Number designated to the patient care product being provided. | ||
| 77 | enrollment priority | 2;17 | FREE TEXT | This field contains the enrollment priority group and the enrollment priority subgroup. | ||
| 78 | user enrollee | 2;18 | SET OF CODES | U:USER ENROLLED | Indicates whether a Veteran has User Enrollee status for the current or future fiscal year. | |
| 79 | patient type | 2;19 | SET OF CODES | AC:ACTIVE DUTY AL:ALLIED VETERAN CO:COLLATERAL EM:EMPLOYEE IN:INELIGIBLE MI:MILITARY RETIREE NO:NON-VETERAN (OTHER) NS:NSC VETERAN SC:SC VETERAN TR:TRICARE | Refers to the various types of patient which may be seen at a VA facility. Every patient in the system must have a TYPE specified. | |
| 80 | cv status eligibility | 2;20 | SET OF CODES | Y:YES E:ELIGIBILITY EXPIRED | Records if veteran served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998. | |
| 81 | cv eligibility end date | 2;21 | FREE TEXT | Records the Combat Veteran eligibility expiration date of veteran who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998. | ||
| 82 | encounter cv | 2;22 | BOOLEAN | Y:YES | Records if a veteran served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998. | |
| 83 | national patient record flag | 2;23 | BOOLEAN | Y:YES | This field records whether the patient's record contains 1 or more active category 1 (National) Patient Record Flags. | |
| 84 | sw asia conditions | 2;24 | SET OF CODES | Y:YES N:NO U:UNKNOWN | This field is used to indicate if patient claims exposure to Southwest Asia Conditions. | |
| 85 | encounter swac | 2;25 | BOOLEAN | Y:YES | This field indicates whether treatment provided during this patient encounter is related to exposure to Southwest Asia conditions while serving in the Southwest Asia Theater of operations. | |
| 86 | eri | 2;26 | FREE TEXT | This field identifies patients from impacted zip code areas designated by the Federal Emergency Management Agency (FEMA). | ||
| 87 | enc head/neck ca | 2;27 | BOOLEAN | Y:YES N:NO | Indicates whether service provided during this patient encounter is related to head/neck Cancer. | |
| 88 | oef/oif | 2;28 | FREE TEXT | The Military Operation in which the patient was in combat during the specified time period. This field is a length of nine characters and reflects the OEF or OIF where this patient was in combat. | ||
| 89 | oef/oif return date | 2;29 | FREE TEXT | The date the patient left the OEF/OIF area, if known. Otherwise, it is the end date of military pay for this OEF/OIF deployment. | ||
| 90 | associate pc provider npi | 2;30 | FREE TEXT | A standard unique life-long identifier of the associate primary care provider. This field has a length of fifteen characters. | ||
| 91 | primary care provider npi | 2;31 | FREE TEXT | A standard unique life-long identifier of the primary care provider. This field has a length of fifteen characters. | ||
| 92 | provider npi | 2;32 | FREE TEXT | A standard unique life-long identifier of the individuals providing health care services. This field has a length of fifteen characters. | ||
| 93 | country code | 3;1 | FREE TEXT | The code for the country associated with the address. | ||
| 94 | encounter shad | 3;2 | BOOLEAN | Y:YES N:NO | Indicates if treatment provided during the patient's encounter is related to the Shipboard Hazard And Defense (SHAD) condition. | |
| 95 | patcat | 3;3 | SET OF CODES | AD:Active Duty ADD:Active Duty Dependent FNRS:Former Non-Remarried Spouse RET:Retired RETD:Retiree Dependent RES:Reservist REC:Recruit TDRL:Temporary Disability TFL:TRICARE for Life | This is the Patient's category which will be used for FHCC (Federal Health Care Center) Reconciliation. DSS must capture and report DoD patients so that the FHCC reconciliation process can function as designed. "Reconciliation" is the process used within the new FHCC to determine which patients DoD pays for and which VA pays for. | |
| 96 | secondary provider #1 | 3;4 | FREE TEXT | This character string is an IEN for the NEW PERSON file (#200); a '2' has been appended to the beginning of the character string. It represents the first assisting provider associated with this clinic visit. | ||
| 97 | secondary provider #1 pc | 3;5 | FREE TEXT | The VA code of the Person Class of the first assisting provider as of the date of this record. | ||
| 98 | secondary provider #1 npi | 3;6 | FREE TEXT | A standard unique life-long identifier of the first assisting provider associated with this clinic visit. | ||
| 99 | secondary provider #2 | 3;7 | FREE TEXT | This character string is an IEN for the NEW PERSON file (#200); a '2' has been appended to the beginning of the character string. It represents the second assisting provider associated with this clinic visit. | ||
| 100 | secondary provider #2 pc | 3;8 | FREE TEXT | The VA code of the Person Class of the second assisting provider as of the date of this record. | ||
| 101 | secondary provider #2 npi | 3;9 | FREE TEXT | A standard unique life-long identifier of the second assisting provider associated with this clinic visit. | ||
| 102 | secondary provider #3 | 3;10 | FREE TEXT | This character string is an IEN for the NEW PERSON file (#200); a '2' has been appended to the beginning of the character string. It represents the third assisting provider associated with this clinic visit. | ||
| 103 | secondary provider #3 pc | 3;11 | FREE TEXT | The VA code of the Person Class of the third assisting provider as of the date of this record. | ||
| 104 | secondary provider #3 npi | 3;12 | FREE TEXT | A standard unique life-long identifier of the third assisting provider associated with this clinic visit. | ||
| 105 | secondary provider #4 | 3;13 | FREE TEXT | This character string is an IEN for the NEW PERSON file (#200); a '2' has been appended to the beginning of the character string. It represents the fourth assisting provider associated with this clinic visit. | ||
| 106 | secondary provider #4 pc | 3;14 | FREE TEXT | The VA code of the Person Class of the fourth assisting provider as of the date of this record. | ||
| 107 | secondary provider #4 npi | 3;15 | FREE TEXT | A standard unique life-long identifier of the fourth assisting provider associated with this clinic visit. | ||
| 108 | secondary provider #5 | 3;16 | FREE TEXT | This character string is an IEN for the NEW PERSON file (#200); a '2' has been appended to the beginning of the character string. It represents the fifth assisting provider associated with this clinic visit. | ||
| 109 | secondary provider #5 pc | 3;17 | FREE TEXT | The VA code of the Person Class of the fifth assisting provider as of the date of this record. | ||
| 110 | secondary provider #5 npi | 3;18 | FREE TEXT | A standard unique life-long identifier of the fifth assisting provider associated with this clinic visit. | ||
| 111 | ed disposition code | 3;19 | SET OF CODES | A:ADMIT D:DECEASED E:ERROR L:LEFT R:REFERRED T:TRANSFERRED U:UNKNOWN N:NONE | Disposition code associated with the patient's emergency room visit. | |
| 112 | primary icd-10 code | 3;20 | FREE TEXT | The primary ICD-10 code for this clinic visit. | ||
| 113 | secondary icd-10 code #1 | 3;21 | FREE TEXT | The first secondary ICD-10 code for this clinic visit. | ||
| 114 | secondary icd-10 code #2 | 3;22 | FREE TEXT | The second secondary ICD-10 code for this clinic visit. | ||
| 115 | secondary icd-10 code #3 | 3;23 | FREE TEXT | The third secondary ICD-10 code for this clinic visit. | ||
| 116 | secondary icd-10 code #4 | 3;24 | FREE TEXT | The fourth secondary ICD-10 code for this clinic visit. | ||
| 117 | encounter sc | 3;25 | BOOLEAN | Y:YES N:NO | Indicates if treatment provided during this patient encounter is Service Connected. | |
| 118 | vietnam | 3;26 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates if patient is a Vietnam era veteran. | |
| 119 | secondary provider #6 | 3;27 | FREE TEXT | This is the sixth assisting provider associated with this clinic visit. | ||
| 120 | secondary provider #6 pc | 3;28 | FREE TEXT | The VA code of the Person Class of the sixth assisting provider as of the date of this record. | ||
| 121 | secondary provider #6 npi | 3;29 | FREE TEXT | A standard unique life-long identifier of the sixth assisting provider associated with this clinic visit. | ||
| 122 | secondary provider #7 | 4;1 | FREE TEXT | This is the seventh assisting provider associated with this clinic visit. | ||
| 123 | secondary provider #7 pc | 4;2 | FREE TEXT | The VA code of the Person Class of the seventh assisting provider as of the date of this record. | ||
| 124 | secondary provider #7 npi | 4;3 | FREE TEXT | A standard unique life-long identifier of the seventh assisting provider associated with this clinic visit. | ||
| 125 | camp lejeune status | 4;4 | BOOLEAN | Y:YES N:NO | Indicates if patient was exposed to contaminated water while stationed at Camp Lejeune, NC between January 1, 1957 and December 31, 1987. | |
| 126 | encounter camp lejeune | 4;5 | BOOLEAN | Y:YES N:NO | Indicates if episode of care is related to exposure to contaminated water while stationed at Camp Lejeune, NC between January 1, 1957 and December 31, 1987. | |
| 127 | primary procedure | 4;6 | FREE TEXT | Identifies the CPT code used during the visit that is considered to be the primary procedure. This entry will include the CPT code as well as any modifiers associated with the code. | ||
| 128 | combat veteran indicator | 4;7 | BOOLEAN | Y:YES N:NO | Identifies if the patient served in a combat zone. | |
| 129 | combat veteran location | 4;8 | FREE TEXT | Identifies the war in which the combat service was incurred. | ||
| 130 | clinic ien | 4;9 | POINTER | 44 | The specific clinic associated with the patient encounter. |
Not Referenced