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

  • BHT
    Beginning of Hierarchical Transaction
    M必须(Mandatory)
    Repeat 1

    To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time

  • 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

  • REF
    Reference Identification
    O可选(Optional)
    Repeat 9

    To specify identifying information

  • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
    NM1N2N3N4PERACTDTPDMGREFQTYCRC
    • 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

    • 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

    • QTY
      Quantity
      O可选(Optional)
      Repeat > 1

      To specify quantity information

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

      To supply information on conditions

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat 999999
    HLCRIACTDTPCURAMTFCREFDMGQTYCRCVEHNM1Loop2ESILoop1LNLoop1LSLoop1CFILoop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

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

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

      To specify information about the claim being reported

    • 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

    • 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 LOOPO可选(Optional)Repeat 999
      NM1N2N3N4PERACTDTPDMGREFQTYCRC
      • 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

      • 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

      • QTY
        Quantity
        O可选(Optional)
        Repeat > 1

        To specify quantity information

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

        To supply information on conditions

    • ESILoop1Employment Status Information LOOPO可选(Optional)Repeat 99
      ESIEMTTPBDTPREFQTYNM1PERCRCLXLoop1
      • ESI
        Employment Status Information
        M必须(Mandatory)
        Repeat 1

        To specify status of employment

      • EMT
        Employment
        O可选(Optional)
        Repeat 1

        To specify employment information

      • TPB
        Business Professional Title
        O可选(Optional)
        Repeat 1

        To identify title of an individual within a company

      • 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

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

        To specify identifying information

      • QTY
        Quantity
        O可选(Optional)
        Repeat > 1

        To specify quantity information

      • NM1
        Individual or Organizational Name
        O可选(Optional)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat > 1

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

      • CRC
        Conditions Indicator
        O可选(Optional)
        Repeat 9

        To supply information on conditions

      • LXLoop1Assigned Number LOOPO可选(Optional)Repeat 99
        LXAINCURTXIWSDTPQTYREF
        • LX
          Assigned Number
          M必须(Mandatory)
          Repeat 1

          To reference a line number in a transaction set

        • AIN
          Income
          O可选(Optional)
          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

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

          To specify identifying information

    • LNLoop1Loan Information LOOPO可选(Optional)Repeat 999
      LNREFVEHLoop1AMTLoop1NM1Loop3
      • LN
        Loan Information
        M必须(Mandatory)
        Repeat 1

        To specify information about the loan

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

        To specify identifying information

      • VEHLoop1Vehicle Information LOOPO可选(Optional)Repeat > 1
        VEHN4PID
        • VEH
          Vehicle Information
          M必须(Mandatory)
          Repeat 1

          To provide descriptions that identify a specific vehicle

        • N4
          Geographic Location
          O可选(Optional)
          Repeat 1

          To specify the geographic place of the named party

        • PID
          Product/Item Description
          O可选(Optional)
          Repeat > 1

          To describe a product or process in coded or free-form format

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

          To indicate the total monetary amount

        • PCT
          Percent Amounts
          O可选(Optional)
          Repeat 1

          To qualify percent amounts and supply percent amounts

        • 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

      • NM1Loop3Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
        NM1DMGN3N4PERDTPREF
        • NM1
          Individual or Organizational Name
          M必须(Mandatory)
          Repeat 1

          To supply the full name of an individual or organizational entity

        • DMG
          Demographic Information
          O可选(Optional)
          Repeat 1

          To supply demographic information

        • N3
          Address Information
          O可选(Optional)
          Repeat 1

          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 1

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

        • 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

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

          To specify identifying information

    • LSLoop1Loop Header LOOPO可选(Optional)Repeat 1
      LSLXLoop2LE
      • LS
        Loop Header
        M必须(Mandatory)
        Repeat 1

        To indicate that the next segment begins a loop

      • LXLoop2Assigned Number LOOPO可选(Optional)Repeat > 1
        LXIIILoop1NM1Loop4
        • LX
          Assigned Number
          M必须(Mandatory)
          Repeat 1

          To reference a line number in a transaction set

        • IIILoop1Information LOOPO可选(Optional)Repeat > 1
          IIIIMPDTPCRCQTYREFLMLoop1
          • 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

          • QTY
            Quantity
            O可选(Optional)
            Repeat > 1

            To specify quantity information

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

            To specify identifying information

          • 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

        • NM1Loop4Individual or Organizational Name LOOPO可选(Optional)Repeat 999
          NM1N2N3N4PERACTDTPDMGREFCRC
          • 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

          • 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

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

            To supply information on conditions

      • LE
        Loop Trailer
        M必须(Mandatory)
        Repeat 1

        To indicate that the loop immediately preceding this segment is complete

    • CFILoop1Compensation Financial Information LOOPO可选(Optional)Repeat 999
      CFICURAMTDTPQTYRELREFCRCAD1Loop1NM1Loop5
      • CFI
        Compensation Financial Information
        M必须(Mandatory)
        Repeat 1

        To report compensation and or claim financial information

      • 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 9

        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

      • 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

      • REF
        Reference Identification
        O可选(Optional)
        Repeat 9

        To specify identifying information

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

        To supply information on conditions

      • AD1Loop1Adjustment Amount LOOPO可选(Optional)Repeat 999
        AD1DTPREF
        • AD1
          Adjustment Amount
          M必须(Mandatory)
          Repeat 1

          To specify the characteristics of an adjustment

        • 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

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

          To specify identifying information

      • NM1Loop5Individual 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

        • 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

  • GRI
    Statistical Government Information
    O可选(Optional)
    Repeat 99

    To respond to a specific government reporting requirement

  • 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 00402
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

    Reference assigned to identify Implementation Convention