| 76435-7 | Pt ID | |
| 76698-0 | Pt ID assign auth | |
| 45394-4 | Patient Last name | |
| 45392-8 | Patient First name | |
| 52461-1 | Patient middle name | |
| 21112-8 | Birth date | |
| 45396-9 | Social Security # | |
| 45401-7 | Postal code | |
| 72143-1 | Sex:Type:Pt:^Patient:Nom:HL7.v3 | |
| 72826-1 | Race OMB.1997 | |
| 69490-1 | Ethnicity OMB.1997 | |
| 11381-1 | Marital status+living arrang | |
| 76458-9 | Patient Email address | |