MSH|^~\&|REG||||202101042020||ADT^A01^ADT_A01|238888889|P|2.4|||AL|NE
EVN|A01|202101011544||ENADMNB|SWASHING^Washington^Shariss^L^^^^^^^^^XX|202101011537
PID|1||12131415^^^^MR^NA~E012131415^^^^PI^NA~12131415^^^^EMR^NA~12131415^^^^PT^NA||YALEZZZTESTPATIENT^YALECONNI E||19750501|F||W|1234 Main
St^^Hartford^CT^06118^USA^^^15||^PRN^C^ENG|S|NONE||||A087561984|NOT HISP
NK1|1|Peanut^Jelly^E|M^Mother|0000 Hollyholy Rd^^LAVIE^MD^29990|^PRN^C||NOK
PV1|1|I|NBN^1048^A^Hospital|NB||NBN|FAP1^Fainberg^Patrick^H^^^MD^^^^^^XX||DOP4^Dora^Pa ssale^Lufau^^^MD^^^^^^XX|NB||||NA|||FAP1^Fainberg^Patrick^H^^^MD^^^^^^XX|NB||BC|||||||| |||||||||||NA||ADM|||202101011537
PV2|1|NUR^Nursery^NUR|Birth/NVD||||||||1|||||||||||N|||NB|||||||||||Y
ROL|1|AD|PP|PCPUNKN^PCP Unknown^^^^^^^^^^^XX
ROL|2|AD|AD|FAP1^Fainberg^Patrick^H^^^MD^^^^^^XX
AL1|1|DA|F001900388^No Known Allergies^^No Known Allergies^^allergy.id|U||20210101
DRG|38^Version 38^ICD10
GT1|1||YALEZZZTESTPATIENT^YALECONNIE||1234 Main St^^Hartford^CT^06118^USA^^^15|^PRN^C|||||M|555-55-5555||||MCPS|1111 test DRIVE^^PAYSAGE^MD^20850|()309-6277^WPN^EMP
IN1|1|BCBLUCHOI||Carefirst BlueChoice product|PO BOX 14116^^LEXINGTON^KY^405124116||(800)842-5555|005801171DC10006|MONTGOMERY CO PUBLIC SCHOOLS||MCPS|20210101||||Peanut^Jelly^Erin|M|20210101|0000 Holsey Rd^^LAVIE^MD^20872||||||||||20210101|JALDANA||||||MKM832364627|||||||F|850 GRAYMARSH DRIVE^^PAYSAGE^MD^20850|Verified
IN2|1|555-55-5555||||||||||||||||||||||||||||||||||||||||W|U||||||||||||||||||||
IN1|2|SP||Self Pay Patient||||||||20202020