RF1
Referral Information
This segment represents information that may be useful when sending referrals from the referring provider to the referred-to provider.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
25
| C.Len | Element | v2.8.1 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | - | - | CWE | O | 1 | 0283 | 01137 | RF1-1 | Referral Status | |
| 2 | - | - | CWE | O | 1 | 0280 | 01138 | RF1-2 | Referral Priority | |
| 3 | - | - | CWE | O | 1 | 0281 | 01139 | RF1-3 | Referral Type | |
| 4 | - | - | CWE | O | * | 0282 | 01140 | RF1-4 | Referral Disposition | |
| 5 | - | - | CWE | O | 1 | 0284 | 01141 | RF1-5 | Referral Category | |
| 6 | - | - | EI | R | 1 | - | 01142 | RF1-6 | Originating Referral Identifier | |
| 7 | - | - | DTM | O | 1 | - | 01143 | RF1-7 | Effective Date | |
| 8 | - | - | DTM | O | 1 | - | 01144 | RF1-8 | Expiration Date | |
| 9 | - | - | DTM | O | 1 | - | 01145 | RF1-9 | Process Date | |
| 10 | - | - | CWE | O | * | 0336 | 01228 | RF1-10 | Referral Reason | |
| 11 | - | - | EI | O | * | - | 01300 | RF1-11 | External Referral Identifier | |
| 12 | - | - | CWE | O | 1 | 0865 | 02262 | RF1-12 | Referral Documentation Completion Status | |
| 13 | ..24 | - | DTM | O | 1 | - | 03400 | RF1-13 | Planned Treatment Stop Date | |
| 14 | ..60 | - | ST | O | 1 | - | 03401 | RF1-14 | Referral Reason Text | |
| 15 | ..721 | - | CQ | O | 1 | - | 03402 | RF1-15 | Number of Authorized Treatments/Units | |
| 16 | ..721 | - | CQ | O | 1 | - | 03403 | RF1-16 | Number of Used Treatments/Units | |
| 17 | ..721 | - | CQ | O | 1 | - | 03404 | RF1-17 | Number of Schedule Treatments/Units | |
| 18 | ..20 | - | MO | O | 1 | - | 03405 | RF1-18 | Remaining Benefit Amount | Length |
| 19 | ..250 | - | XON | O | 1 | - | 03406 | RF1-19 | Authorized Provider | |
| 20 | ..250 | - | XCN | O | 1 | - | 03407 | RF1-20 | Authorized Health Professional | |
| 21 | ..60 | - | ST | O | 1 | - | 03408 | RF1-21 | Source Text | |
| 22 | ..24 | - | DTM | O | 1 | - | 03409 | RF1-22 | Source Date | |
| 23 | ..250 | - | XTN | O | 1 | - | 03410 | RF1-23 | Source Phone | |
| 24 | ..250 | - | ST | O | 1 | - | 03411 | RF1-24 | Comment | |
| 25 | ..1 | - | ID | O | 1 | 0206 | 03412 | RF1-25 | Action Code |
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