1 Additional history notes
10 Allow SMS (text messages)?
11 Allow telephone messages?
17 Billing Code for Requested Service
26 Burning With Urination
32 Chart Storage Locations
36 Cirrhosis Of The Liver
40 Contraceptive Complication (specify)
46 Date contraceptive services initially provided
52 Did you receive a copy of the HIPAA Notice?
56 Do Not Resuscitate Order
60 Drivers License or State ID
75 Durable Power of Attorney
76 Emergency Contact Person
77 Emergency Contact Phone Number
89 Exposure To Foreign Countries
100 Final diagnosis by specialist
101 Findings by specialist
102 Gall Bladder Condition
104 Glaucoma Family History
119 HIPAA Notice Received
142 Layout-Based Visit Forms
159 Migrant or seasonal worker?
162 Misc Billing Options HCFA
183 Noninsulin Dependent Diabetes
197 PID (Pelvic Inflammatory Disease)
198 Pneumococcal Conjugate 1
199 Pneumococcal Conjugate 2
200 Pneumococcal Conjugate 3
201 Pneumococcal Conjugate 4
204 Prescriptions and/or referrals by specialist
205 Prescriptions/Referrals
207 Presumed diagnosis by specialist
209 Prior Authorization Form
215 Recommendations by specialist
227 Reserved for use to define Scheduled Vacation Time
228 Reserved to define when a provider may not have available appointments after.
229 Reserved to define when an event did not occur as specified.
230 Reserved todefine when a provider may haveavailable appointments after.
243 Service provided by specialist
247 Shortness Of Breath 2
254 Social Security Number
257 Start Date at This Clinic
262 Subscriber Relationship
305 Where may related scanned or paper documents be found?
309 With whom may we leave a message?