| 76435-7 | Pt ID | |
| 76698-0 | Pt ID assign auth | |
| 76471-2 | Organization EOC unique ID | |
| 76470-4 | Federal employer tax ID Organization | |
| 76696-4 | Name Fclty | |
| 76427-4 | Visit date | |
| 76417-5 | Provider First name | |
| 76419-1 | Provider Last name | |
| 45952-9 | National provider ID:ID:Pt:Provider:Nom: | |
| 86637-6 | Provider role | |
| 18630-4 | Diagnosis.primary:Imp:Pt:^Patient:Nom: | |
| 81885-6 | Dx.secondary | |
| 89177-0 | Movement system dx | |
| 76442-3 | Primary health cond | |
| 76472-0 | Other health condition | |
| 76444-9 | Body function ICF code | |
| 76445-6 | Body structure ICF code | |
| 76446-4 | Activities and participation ICF code | |
| 89189-5 | Clinical presentation status | |
| 89188-7 | Medication documentation status | |
| 57828-6 | Prescriptions | |
| 92725-1 | Prognosis for rehabilitation | |
| 77574-2 | Glob meas of phys function Pnl APTA | |
| 77575-9 | Condition-spec function Pnl APTA | |
| 77576-7 | Self-care and mobility Pnl APTA | |
| 92562-8 | PT goals Pnl | |
| 92566-9 | Planned intervention or services Pnl | |
| 89176-2 | Intervention or services provided pnl | |
| 89175-4 | Billing info pnl | |