148 Report of Injury, Illness or Incident
148 Report of Injury, Illness or Incident
Function Group IJ
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.
Position
Segment
Name
Max Use
0100
Transaction Set HeaderMandatory
Max 1
To indicate the start of a transaction set and to assign a control number
0200
Beginning of Hierarchical TransactionMandatory
Max 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
0220
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
0240
QuantityOptional
Max 1
To specify quantity information
0260
Reference IdentificationOptional
Max 9
To specify identifying information
NM1Loop
Optional
Repeat >1
0300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
0400
Additional Name InformationOptional
Max 1
To specify additional names
0500
Address InformationOptional
Max 2
To specify the location of the named party
0600
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
0700
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
0800
Account IdentificationOptional
Max 9
To specify account information
0900
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
1000
Demographic InformationOptional
Max 1
To supply demographic information
1100
Reference IdentificationOptional
Max 9
To specify identifying information
1200
QuantityOptional
Max >1
To specify quantity information
1300
Conditions IndicatorOptional
Max >1
To supply information on conditions
Position
Segment
Name
Max Use
HLLoop
Mandatory
Repeat 999999
0100
Hierarchical LevelMandatory
Max 1
To identify dependencies among and the content of hierarchically related groups of data segments
0150
Claim Report InformationOptional
Max >1
To specify information about the claim being reported
0200
Account IdentificationOptional
Max 2
To specify account information
0300
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
0400
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
0500
Monetary AmountOptional
Max >1
To indicate the total monetary amount
0600
Financial ContributionOptional
Max 2
To specify the financial contribution information
0700
Reference IdentificationOptional
Max >1
To specify identifying information
0800
Demographic InformationOptional
Max 1
To supply demographic information
0900
QuantityOptional
Max >1
To specify quantity information
1200
Conditions IndicatorOptional
Max >1
To supply information on conditions
1250
Vehicle InformationOptional
Max >1
To provide descriptions that identify a specific vehicle
NM1Loop
Optional
Repeat 999
1300
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
1400
Additional Name InformationOptional
Max 1
To specify additional names
1500
Address InformationOptional
Max 2
To specify the location of the named party
1600
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
1700
Administrative Communications ContactOptional
Max 3
To identify a person or office to whom administrative communications should be directed
1720
Account IdentificationOptional
Max 9
To specify account information
1740
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
1760
Demographic InformationOptional
Max 1
To supply demographic information
1780
Reference IdentificationOptional
Max >1
To specify identifying information
1790
QuantityOptional
Max >1
To specify quantity information
1800
Conditions IndicatorOptional
Max >1
To supply information on conditions
ESILoop
Optional
Repeat 99
1830
Employment Status InformationMandatory
Max 1
To specify status of employment
1850
EmploymentOptional
Max 1
To specify employment information
1870
Business Professional TitleOptional
Max 1
To identify title of an individual within a company
1900
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
1930
Reference IdentificationOptional
Max >1
To specify identifying information
1950
QuantityOptional
Max >1
To specify quantity information
2000
Individual or Organizational NameOptional
Max 1
To supply the full name of an individual or organizational entity
2010
Administrative Communications ContactOptional
Max >1
To identify a person or office to whom administrative communications should be directed
2020
Conditions IndicatorOptional
Max 9
To supply information on conditions
LXLoop
Optional
Repeat 99
2050
Assigned NumberMandatory
Max 1
To reference a line number in a transaction set
2100
IncomeOptional
Max 1
To provide type and amount of income obtained
2200
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
2300
Tax InformationOptional
Max 9
To specify tax information
2400
Work ScheduleOptional
Max 99
To specify an individual's work schedule
2500
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
2600
QuantityOptional
Max 9
To specify quantity information
2650
Reference IdentificationOptional
Max >1
To specify identifying information
LNLoop
Optional
Repeat 999
2700
Loan InformationMandatory
Max 1
To specify information about the loan
2800
Reference IdentificationOptional
Max >1
To specify identifying information
VEHLoop
Optional
Repeat >1
2820
Vehicle InformationMandatory
Max 1
To provide descriptions that identify a specific vehicle
2840
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
2860
Product/Item DescriptionOptional
Max >1
To describe a product or process in coded or free-form format
AMTLoop
Optional
Repeat 99
2900
Monetary AmountMandatory
Max 1
To indicate the total monetary amount
2950
Percent AmountsOptional
Max 1
To qualify percent amounts and supply percent amounts
3000
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
NM1Loop
Optional
Repeat >1
3050
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
3070
Demographic InformationOptional
Max 1
To supply demographic information
3090
Address InformationOptional
Max 1
To specify the location of the named party
3120
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
3140
Administrative Communications ContactOptional
Max 1
To identify a person or office to whom administrative communications should be directed
3160
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
3180
Reference IdentificationOptional
Max >1
To specify identifying information
3190
Loop HeaderOptional
Max 1
To indicate that the next segment begins a loop
LXLoop
Optional
Repeat >1
3200
Assigned NumberMandatory
Max 1
To reference a line number in a transaction set
IIILoop
Optional
Repeat >1
3250
InformationMandatory
Max 1
To report information
3300
Impairment DetailOptional
Max 6
To specify impairment to a body part
3400
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
3420
Conditions IndicatorOptional
Max 9
To supply information on conditions
3430
QuantityOptional
Max >1
To specify quantity information
3440
Reference IdentificationOptional
Max >1
To specify identifying information
LMLoop
Optional
Repeat >1
3450
Code Source InformationMandatory
Max 1
To transmit standard code list identification information
3460
Industry CodeMandatory
Max >1
Code to transmit standard industry codes
NM1Loop
Optional
Repeat 999
3500
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
3600
Additional Name InformationOptional
Max 1
To specify additional names
3700
Address InformationOptional
Max 2
To specify the location of the named party
3800
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
3900
Administrative Communications ContactOptional
Max 2
To identify a person or office to whom administrative communications should be directed
3920
Account IdentificationOptional
Max 9
To specify account information
3940
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
3960
Demographic InformationOptional
Max 1
To supply demographic information
3970
Reference IdentificationOptional
Max >1
To specify identifying information
3980
Conditions IndicatorOptional
Max >1
To supply information on conditions
3990
Loop TrailerOptional
Max 1
To indicate that the loop immediately preceding this segment is complete
CFILoop
Optional
Repeat 999
4000
Compensation Financial InformationMandatory
Max 1
To report compensation and or claim financial information
4100
CurrencyOptional
Max 1
To specify the currency (dollars, pounds, francs, etc.) used in a transaction
4150
Monetary AmountOptional
Max 9
To indicate the total monetary amount
4200
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
4300
QuantityOptional
Max >1
To specify quantity information
4400
RelationshipOptional
Max 30
To specify relationship and birth order of entity
4420
Reference IdentificationOptional
Max 9
To specify identifying information
4440
Conditions IndicatorOptional
Max >1
To supply information on conditions
AD1Loop
Optional
Repeat 999
4460
Adjustment AmountMandatory
Max 1
To specify the characteristics of an adjustment
4480
Date or Time or PeriodOptional
Max >1
To specify any or all of a date, a time, or a time period
4490
Reference IdentificationOptional
Max >1
To specify identifying information
NM1Loop
Optional
Repeat 999
4500
Individual or Organizational NameMandatory
Max 1
To supply the full name of an individual or organizational entity
4600
Additional Name InformationOptional
Max 1
To specify additional names
4700
Address InformationOptional
Max 2
To specify the location of the named party
4800
Geographic LocationOptional
Max 1
To specify the geographic place of the named party
4900
Administrative Communications ContactOptional
Max 2
To identify a person or office to whom administrative communications should be directed
4920
Account IdentificationOptional
Max 9
To specify account information
4940
Date or Time or PeriodOptional
Max 9
To specify any or all of a date, a time, or a time period
4960
Demographic InformationOptional
Max 1
To supply demographic information
4980
Reference IdentificationOptional
Max 9
To specify identifying information
Position
Segment
Name
Max Use
0100
Statistical Government InformationOptional
Max 99
To respond to a specific government reporting requirement
0300
Transaction Set TrailerMandatory
Max 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)