| 45392-8 | Patient First name | |
| 45392-8 | Patient First name | |
| 52461-1 | Patient middle name | |
| 52461-1 | Patient middle name | |
| 45394-4 | Patient Last name | |
| 45394-4 | Patient Last name | |
| 52462-9 | Nickname | |
| 52462-9 | Nickname | |
| 45397-7 | Medicare or comparable # | |
| 45397-7 | Medicare or comparable # | |
| 45400-9 | Medicaid # | |
| 45400-9 | Medicaid # | |
| 52463-7 | Patient ID # or Provider Acct # | |
| 52463-7 | Patient ID # or Provider Acct # | |
| 52455-3 | Admission date | |
| 52455-3 | Admission date | |
| 21112-8 | Birth date | |
| 21112-8 | Birth date | |
| 45396-9 | Social Security # | |
| 45396-9 | Social Security # | |
| 46098-0 | Sex | |
| 46098-0 | Sex | |