148Report of Injury, Illness or Incident

This Draft Standard for Trial Use contains the format and establishes the data contents of the Report of Injury, Illness or Incident Transaction Set (148) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set can be used to report information pertaining to an injury, illness or incident to entities interested in the information for statistical, legal, and claims and risk management processing requirements.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

    To indicate the start of a transaction set and to assign a control number

  • BGN
    Beginning Segment
    M必须(Mandatory)
    Repeat 1

    To indicate the beginning of a transaction set

  • CUR
    Currency
    O可选(Optional)
    Repeat 1

    To specify the currency (dollars, pounds, francs, etc.) used in a transaction

  • QTY
    Quantity
    O可选(Optional)
    Repeat 1

    To specify quantity information

  • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
    NM1N2N3N4PERACTDTPDMGREF
    • NM1
      Individual or Organizational Name
      M必须(Mandatory)
      Repeat 1

      To supply the full name of an individual or organizational entity

    • N2
      Additional Name Information
      O可选(Optional)
      Repeat 1

      To specify additional names or those longer than 35 characters in length

    • N3
      Address Information
      O可选(Optional)
      Repeat 2

      To specify the location of the named party

    • N4
      Geographic Location
      O可选(Optional)
      Repeat 1

      To specify the geographic place of the named party

    • PER
      Administrative Communications Contact
      O可选(Optional)
      Repeat 3

      To identify a person or office to whom administrative communications should be directed

    • ACT
      Account Identification
      O可选(Optional)
      Repeat 9

      To specify account information

    • DTP
      Date or Time or Period
      O可选(Optional)
      Repeat 9

      To specify any or all of a date, a time, or a time period

    • DMG
      Demographic Information
      O可选(Optional)
      Repeat 1

      To supply demographic information

    • REF
      Reference Identification
      O可选(Optional)
      Repeat 9

      To specify identifying information

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat 999999
    HLACTDTPCURAMTFCREFDMGQTYCRIEMTCRCVEHNM1Loop2ESILoop1LNLoop1IIILoop1AD1Loop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

      To identify dependencies among and the content of hierarchically related groups of data segments

    • ACT
      Account Identification
      O可选(Optional)
      Repeat 2

      To specify account information

    • DTP
      Date or Time or Period
      O可选(Optional)
      Repeat > 1

      To specify any or all of a date, a time, or a time period

    • CUR
      Currency
      O可选(Optional)
      Repeat 1

      To specify the currency (dollars, pounds, francs, etc.) used in a transaction

    • AMT
      Monetary Amount
      O可选(Optional)
      Repeat > 1

      To indicate the total monetary amount

    • FC
      Financial Contribution
      O可选(Optional)
      Repeat 2

      To specify the financial contribution information

    • REF
      Reference Identification
      O可选(Optional)
      Repeat > 1

      To specify identifying information

    • DMG
      Demographic Information
      O可选(Optional)
      Repeat 1

      To supply demographic information

    • QTY
      Quantity
      O可选(Optional)
      Repeat > 1

      To specify quantity information

    • CRI
      Claim Report Information
      O可选(Optional)
      Repeat > 1

      To specify information about the claim being reported

    • EMT
      Employment
      O可选(Optional)
      Repeat 1

      To specify employment information

    • CRC
      Conditions Indicator
      O可选(Optional)
      Repeat > 1

      To supply information on conditions

    • VEH
      Vehicle Information
      O可选(Optional)
      Repeat > 1

      To provide descriptions that identify a specific vehicle

    • NM1Loop2Individual or Organizational Name LOOPM必须(Mandatory)Repeat 999
      NM1N2N3N4PERACTDTPDMGREF
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • N2
        Additional Name Information
        O可选(Optional)
        Repeat 1

        To specify additional names or those longer than 35 characters in length

      • N3
        Address Information
        O可选(Optional)
        Repeat 2

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 3

        To identify a person or office to whom administrative communications should be directed

      • ACT
        Account Identification
        O可选(Optional)
        Repeat 9

        To specify account information

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 9

        To specify any or all of a date, a time, or a time period

      • DMG
        Demographic Information
        O可选(Optional)
        Repeat 1

        To supply demographic information

      • REF
        Reference Identification
        O可选(Optional)
        Repeat > 1

        To specify identifying information

    • ESILoop1Employment Status Information LOOPO可选(Optional)Repeat 99
      ESIDTPQTYCRCAINLoop1
      • ESI
        Employment Status Information
        M必须(Mandatory)
        Repeat 1

        To specify status of employment

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat > 1

        To specify any or all of a date, a time, or a time period

      • QTY
        Quantity
        O可选(Optional)
        Repeat > 1

        To specify quantity information

      • CRC
        Conditions Indicator
        O可选(Optional)
        Repeat 9

        To supply information on conditions

      • AINLoop1Income LOOPO可选(Optional)Repeat 99
        AINCURTXIWSDTPQTY
        • AIN
          Income
          M必须(Mandatory)
          Repeat 1

          To provide type and amount of income obtained

        • CUR
          Currency
          O可选(Optional)
          Repeat 1

          To specify the currency (dollars, pounds, francs, etc.) used in a transaction

        • TXI
          Tax Information
          O可选(Optional)
          Repeat 9

          To specify tax information

        • WS
          Work Schedule
          O可选(Optional)
          Repeat 99

          To specify an individual's work schedule

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat > 1

          To specify any or all of a date, a time, or a time period

        • QTY
          Quantity
          O可选(Optional)
          Repeat 9

          To specify quantity information

    • LNLoop1Loan Information LOOPO可选(Optional)Repeat 999
      LNREFAMTLoop1
      • LN
        Loan Information
        M必须(Mandatory)
        Repeat 1

        To specify information about the loan

      • REF
        Reference Identification
        O可选(Optional)
        Repeat 2

        To specify identifying information

      • AMTLoop1Monetary Amount LOOPO可选(Optional)Repeat 99
        AMTDTP
        • AMT
          Monetary Amount
          M必须(Mandatory)
          Repeat 1

          To indicate the total monetary amount

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat > 1

          To specify any or all of a date, a time, or a time period

    • IIILoop1Information LOOPO可选(Optional)Repeat > 1
      IIIIMPDTPCRCLMLoop1NM1Loop3
      • III
        Information
        M必须(Mandatory)
        Repeat > 1

        To report information

      • IMP
        Impairment Detail
        O可选(Optional)
        Repeat 6

        To specify impairment to a body part

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat > 1

        To specify any or all of a date, a time, or a time period

      • CRC
        Conditions Indicator
        O可选(Optional)
        Repeat 9

        To supply information on conditions

      • LMLoop1Code Source Information LOOPO可选(Optional)Repeat > 1
        LMLQ
        • LM
          Code Source Information
          M必须(Mandatory)
          Repeat 1

          To transmit standard code list identification information

        • LQ
          Industry Code
          M必须(Mandatory)
          Repeat > 1

          Code to transmit standard industry codes

      • NM1Loop3Individual or Organizational Name LOOPO可选(Optional)Repeat 999
        NM1N2N3N4PERACTDTPDMGREF
        • NM1
          Individual or Organizational Name
          M必须(Mandatory)
          Repeat 1

          To supply the full name of an individual or organizational entity

        • N2
          Additional Name Information
          O可选(Optional)
          Repeat 1

          To specify additional names or those longer than 35 characters in length

        • N3
          Address Information
          O可选(Optional)
          Repeat 2

          To specify the location of the named party

        • N4
          Geographic Location
          O可选(Optional)
          Repeat 1

          To specify the geographic place of the named party

        • PER
          Administrative Communications Contact
          O可选(Optional)
          Repeat 2

          To identify a person or office to whom administrative communications should be directed

        • ACT
          Account Identification
          O可选(Optional)
          Repeat 9

          To specify account information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat > 1

          To specify any or all of a date, a time, or a time period

        • DMG
          Demographic Information
          O可选(Optional)
          Repeat 1

          To supply demographic information

        • REF
          Reference Identification
          O可选(Optional)
          Repeat > 1

          To specify identifying information

    • AD1Loop1Adjustment Amount LOOPO可选(Optional)Repeat 999
      AD1CURDTPQTYRELNM1Loop4
      • AD1
        Adjustment Amount
        M必须(Mandatory)
        Repeat 1

        To specify the characteristics of an adjustment

      • CUR
        Currency
        O可选(Optional)
        Repeat 1

        To specify the currency (dollars, pounds, francs, etc.) used in a transaction

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat > 1

        To specify any or all of a date, a time, or a time period

      • QTY
        Quantity
        O可选(Optional)
        Repeat > 1

        To specify quantity information

      • REL
        Relationship
        O可选(Optional)
        Repeat 30

        To specify relationship and birth order of entity

      • NM1Loop4Individual or Organizational Name LOOPO可选(Optional)Repeat 999
        NM1N2N3N4PERACTDTPDMGREF
        • NM1
          Individual or Organizational Name
          M必须(Mandatory)
          Repeat 1

          To supply the full name of an individual or organizational entity

        • N2
          Additional Name Information
          O可选(Optional)
          Repeat 1

          To specify additional names or those longer than 35 characters in length

        • N3
          Address Information
          O可选(Optional)
          Repeat 2

          To specify the location of the named party

        • N4
          Geographic Location
          O可选(Optional)
          Repeat 1

          To specify the geographic place of the named party

        • PER
          Administrative Communications Contact
          O可选(Optional)
          Repeat 2

          To identify a person or office to whom administrative communications should be directed

        • ACT
          Account Identification
          O可选(Optional)
          Repeat 9

          To specify account information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 9

          To specify any or all of a date, a time, or a time period

        • DMG
          Demographic Information
          O可选(Optional)
          Repeat 1

          To supply demographic information

        • REF
          Reference Identification
          O可选(Optional)
          Repeat 9

          To specify identifying information

  • LXLoop1Assigned Number LOOPO可选(Optional)Repeat 1
    LXQTY
    • LX
      Assigned Number
      M必须(Mandatory)
      Repeat 1

      To reference a line number in a transaction set

    • QTY
      Quantity
      O可选(Optional)
      Repeat 99

      To specify quantity information

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 1

    To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Segment
X12 EDI Release 00306
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9