CR4 Enteral or Parenteral Therapy Certification

Opt

AtMax 3

To supply information regarding certification of medical necessity for enteral or parenteral nutrition therapy

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1073	Yes/No Condition or Response Code	Mandatory	ID	1/1	AtMax 1
2	1322	Certification Type Code	Opt	ID	1/1	AtMax 1
3	355	Unit or Basis for Measurement Code	Rel	ID	2/2	AtMax 1
4	380	Quantity	Rel	Decimal	1/15	AtMax 1
5	355	Unit or Basis for Measurement Code	Rel	ID	2/2	AtMax 1
6	380	Quantity	Rel	Decimal	1/15	AtMax 1
7	1344	Non-Visit Code	Opt	ID	1/1	AtMax 1
8	355	Unit or Basis for Measurement Code	Rel	ID	2/2	AtMax 1
9	380	Quantity	Rel	Decimal	1/15	AtMax 1
10	355	Unit or Basis for Measurement Code	Rel	ID	2/2	AtMax 1
11	65	Height	Rel	Decimal	1/8	AtMax 1
12	355	Unit or Basis for Measurement Code	Rel	ID	2/2	AtMax 1
13	81	Weight	Rel	Decimal	1/10	AtMax 1
14	380	Quantity	Opt	Decimal	1/15	AtMax 1
15	352	Description	Opt	Alphanumeric	1/80	AtMax 1
16	1346	Nutrient Administration Method Code	Opt	ID	1/1	AtMax 1
17	1347	Nutrient Administration Technique Code	Opt	ID	1/1	AtMax 1
18	380	Quantity	Opt	Decimal	1/15	AtMax 1
19	380	Quantity	Opt	Decimal	1/15	AtMax 1
20	352	Description	Opt	Alphanumeric	1/80	AtMax 1
21	380	Quantity	Opt	Decimal	1/15	AtMax 1
22	954	Percentage as Decimal	Opt	Decimal	1/10	AtMax 1
23	380	Quantity	Opt	Decimal	1/15	AtMax 1
24	380	Quantity	Opt	Decimal	1/15	AtMax 1
25	954	Percentage as Decimal	Opt	Decimal	1/10	AtMax 1
26	380	Quantity	Opt	Decimal	1/15	AtMax 1
27	954	Percentage as Decimal	Opt	Decimal	1/10	AtMax 1
28	380	Quantity	Opt	Decimal	1/15	AtMax 1
29	352	Description	Opt	Alphanumeric	1/80	AtMax 1

ID1073

NameYes/No Condition or Response Code

LengthMin 1 / Max 1

Position1

RequirementMandatory

Codes