Phone RE Number PID.13 RE Email Address PID.15 Patient Street R Address (Street & No) PID.11 Patient R Address City PID.11 Patient R Address State PID.11 Patient R Address Zip (Postal) Code PID.11 Social Security RE Number PID.19 Medical Record R Number - MRN PID.3 Patient R Race Demographics PID.10 R Ethnicity PID.22 RE Marital Status PID.16 RE Religion PID.17 Date Last RE Contact/Death PID.29 Name (Last, RE Next of Kin First, MI) NK.2 RE Relationship NK.3 RE Address NK.4, NK.32 Phone RE Number NK.5, NK.31 1R = Required, RE = required if available
RE Phone Number PID.13 RE Email Address PID.15 R Patient Street Address (Street & No) PID.11 R Patient Address City PID.11 R Patient Address State PID.11 R Patient Address Zip (Postal) Code PID.11 RE Social Security Number PID.19 R Medical Record Number - MRN PID.3 Patient Demographics R Race PID.10 R Ethnicity PID.22 RE Marital Status PID.16 RE Religion PID.17 RE Date Last Contact/Death PID.29 Next of Kin RE Name (Last, First, MI) NK.2 RE Relationship NK.3 RE Address NK.4, NK.32 RE Phone Number NK.5, NK.31 1R = Required, RE = required if available
CPDRImplementationGuide_v2.0_Final.docx