Loop 2010DA

Pos: 170	Repeat: 1
Optional
Loop: 2010DA	Elements: N/A

Pos

Id

Segment Name

Req

Max Use

Repeat

Usage

170

NM1

Dependent Name

O

1

Required

180

REF

Dependent Supplemental Identification

O

3

Situational

250

DMG

Dependent Demographic Information

O

1

Situational

260

INS

Dependent Relationship

O

1

Situational

1.

NM102 qualifies NM103.

1.

NM110 and NM111 further define the type of entity in NM101.

Notes:

1. Use this segment to convey the name of the dependent who is the patient.
2. The maximum data elements in Loop 2010D that can be required by a UMO to identify a dependent are as follows:
Dependent Last Name (NM103)
Dependent First Name (NM104)
Dependent Birth Date (DMG01 and DMG02)
3. Refer to Section 2.2.2.1 Identifying the Patient for specific information on how to identify an individual to a UMO.

Example:

NM1*QC*1*SMITH*MARY~