MSH|^~\&||CONNIE|CRISP||202101041609||ADT^A03|322503368|P|2.3|||AL|NE
EVN|A03|202101041609||ENDEPER||
PID|1|1|10111213|SA991111|YALEZZZTESTPATIENT^YALECONNIE||19750501|F||W|1234 Main St^^Hartford^MD^21754^USA^^^15||^^^|||S|NSP|10111213|999-99-9999|||N^
NK1|1|YALEZZZTESTPATIENT^Jeff^^^^|OA^OTHER ADULT|1235 Main St^^Hartford^MD^21754|555555-5555||NOK
NK1|2|YALEZZZTESTPATIENT^Jeff^^^^|OA^OTHER ADULT|1235 W LANVALLE ST^^Limaaaa^MD^21997|5555555555||NOK
NK1|3|UNEMP||^^^^|||EMP|||X|||UNEMPLOYED|||||||||||||||||||||
PV1|1|I|ED^^^^^^^^^|ER3|||FALLSJON^FALLS^JON^D^^^MD||NONE^NONE^^^^^|||||HOME||||ER ||MAHMO||||||||||||||||HOME|||SAH||DEP|||208101011232|202101041609|||
PV2|||TBE||||||||||||||||||||||||||||||||||
ROL|2|UP|Referring|1226225024^BOBATH^JOANN^NORNO^^^^^^^^^NPI~00137773^BOBATH^JOANN ^NORNO^^^^^^^^^CPDPROV~038218^BOBATH^JOANN^NORNO^^^^^^^^^BMCPROV~BOBAJOA^BOBA TH^JOANN^NORNO^^^^^^^^^BMCALPHA~211941^BOBATH^JOANN^NORNO^^^^^^^^^IDXPROV~8248 95^BOBATH^JOANN^NORNO^^^^^^^^^SMHPROV~T7778^BOBATH^JOANN^NORNO^^^^^^^^^JHHPRO V~100686^BOBATH^JOANN^NORNO^^^^^^^^^ENTPROV~1226225024^BOBATH^JOANN^NORNO^^^^^ ^^^^HCGHPROV~SH119930^BOBATH^JOANN^NORNO^^^^^^^^^SHPROV~JBOBAT^BOBATH^JOANN^NO RNO^^^^^^^^^JHEDPROV|||||||500 S Wolfe Street^Blalock 1012 D Medical Genetics^BALTIMORE^MD^21287^^S^^^^^^^^^^^^^1398-1^^^|(210)955-1899^^PH^^^210^9771699
ROL|3|UP|Unknown|1487781563^MATHIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^NPI~00242403^MA THIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^CPDPROV~034861^MATHIOUDAKIS^NESTORAS^NICOLAS^ ^^^^^^^^BMCPROV~MATHINES^MATHIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^BMCALPHA~66216^M ATHIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^IDXPROV~17557^MATHIOUDAKIS^NESTORAS^NICOLAS^^ ^^^^^^^SMHPROV~T4691^MATHIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^JHHPROV~106617^MATHIO UDAKIS^NESTORAS^NICOLAS^^^^^^^^^ENTPROV~1487781563^MATHIOUDAKIS^NESTORAS^NICOLAS^ ^^^^^^^^HCGHPROV~SH101686^MATHIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^SHPROV~NMATHIO1^ MATHIOUDAKIS^NESTORAS^NICOLAS^^^^^^^^^JHEDPROV|20230405154930||||||1830 BUILDING ROOM 333 ENDO^600 NORTH WOLFE STREET^BALTIMORE^MD^21287^|(410)5020993^^PH^^^410^5020993
DG1|1|I10|E11.9^Type 2 diabetes mellitus without complications^I10|Type 2 diabetes mellitus without complications|20211118081933|^19450;EPT||||||||||||||||||||
DG1|2|I10|Z79.4^Long term (current) use of insulin^I10|Long term (current) use of insulin|20211118081933|^19450;EPT||||||||||||||||||||
GT1|1||PEANUT^BUTTER^^^^||1111 W LANVALDEN STREET^^Liaaaam^MD^21997||||||SE|999-999999||||UNEMP|||||||||||||||||||||||||||||||||
IN1|1|AMERICAD|^^^^^^^|AMERICAID MCO^^^^^^|P.O.BOX 61010^^VIRGINIA BEACH^VA^234661010^^^^^^^^^^^^^^^^||1-800-4443000^^^^^^^^^^^^^||^^^^^^||UNEMP^^^^^^|||||PEANUT^BUTTER^^^^^^|SE||||||||||||2021010 4|NWILL106^^^^^^^^^^^^^^^^^^^^||||||45001008000||||||^|||PENDING