MSH|^~\&|ADM|SMH|||201911250905||ADT^A08|4112203|D|2.2|||AL|NE
EVN|A08|201911250905||||201911120910
PID|1|FHATVIG0009963|SM00045206|SM45004|CWSBUTLER^COUGAR^TRAIN|ANNABELLE|19920502|F|||3376 97 AVE^^PORT COQUITLAM^BC^V5Z 7W4|||||||SM002468/19|9875246214
PV1|1|O|SM.DIAB||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^^^^^^XX|||||||||||RCR|||||||||||||||||||||SMH|||||201911120910|
PV2|||DIABETES
OBX|1|TX|ADM CURRES^Residing at current add. since (DD/MM/YY)^ADM||20181101||||||F
OBX|2|CE|ADM IDSOUR^SOURCE OF ID^ADM||OPID^Other Photo ID||||||F
OBX|3|TX|ADM PRERE^Previous Address if less than 6 months at current^ADM||123 LIVEDHEREALBERTA||||||F
OBX|4|TX|ADM WCB^IS THIS VISIT RELATED TO A WCB CLAIM?^INS||N||||||F
OBX|5|TX|INS OPCAD1^Address line 1^INS||123 LIVEDHERBEFORE ST||||||F
OBX|6|TX|INS OPCAD3^City^INS||EDMONTON||||||F
OBX|7|TX|INS OPCAD5^Postal Code^INS||T0L1T0||||||F
GT1|1||CWSBUTLER^COUGAR^TRAIN||3376 97 AVE^^PORT COQUITLAM^BC^V5Z 7W4||||||SP
ZFD|.UNATTACH^Unattach^^^^^^^OTH||||SEUSST^SEUSS *TEST^THEODORE^*TEST* G^^^^12^DOC|
ZFH|LUMED||||||