CR6 Home Health Care Certification

Opt

AtMax 1

To supply information related to the certification of a home health care patient

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	923	Prognosis Code	Mandatory	ID	1/1	AtMax 1
2	373	Date	Mandatory	Date	8/8	AtMax 1
3	1250	Date Time Period Format Qualifier	Rel	ID	2/3	AtMax 1
4	1251	Date Time Period	Rel	Alphanumeric	1/35	AtMax 1
5	373	Date	Opt	Date	8/8	AtMax 1
6	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
7	1073	Yes/No Condition or Response Code	Mandatory	ID	1/1	AtMax 1
8	1322	Certification Type Code	Mandatory	ID	1/1	AtMax 1
9	373	Date	Rel	Date	8/8	AtMax 1
10	235	Product/Service ID Qualifier	Rel	ID	2/2	AtMax 1
11	1137	Medical Code Value	Rel	Alphanumeric	1/15	AtMax 1
12	373	Date	Opt	Date	8/8	AtMax 1
13	373	Date	Opt	Date	8/8	AtMax 1
14	373	Date	Opt	Date	8/8	AtMax 1
15	1250	Date Time Period Format Qualifier	Rel	ID	2/3	AtMax 1
16	1251	Date Time Period	Rel	Alphanumeric	1/35	AtMax 1
17	1384	Patient Location Code	Rel	ID	1/1	AtMax 1
18	373	Date	Opt	Date	8/8	AtMax 1
19	373	Date	Opt	Date	8/8	AtMax 1
20	373	Date	Opt	Date	8/8	AtMax 1
21	373	Date	Opt	Date	8/8	AtMax 1

ID923

NamePrognosis Code

LengthMin 1 / Max 1

Position1

RequirementMandatory

Codes