CR1

Ambulance Transport Information

Pos: 120	Max: 1
Detail - Optional
Loop: 2000F	Elements: 10

Ref

Id

Element Name

Req

Type

Min/Max

Usage

CR101

355

Unit or Basis for Measurement Code
Description: Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
Required if CR102 is present.

C

ID

2/2

Situational

Code

Name

KG

Kilogram

LB

Pound

CR102

81

Weight
Description: Numeric value of weight
Industry: Patient Weight
Required if patient weight information is needed to justify the medical necessity of the level of ambulance services.

C

R

1/10

Situational

CR103

1316

Ambulance Transport Code
Description: Code indicating the type of ambulance transport
All valid standard codes are used.

O

ID

1/1

Required

CR104

1317

Ambulance Transport Reason Code
Description: Code indicating the reason for ambulance transport

O

ID

1/1

Required

Code

Name

A

Patient was transported to nearest facility for care of symptoms, complaints, or both

Can be used to indicate that the patient was transferred to a residential facility.

B

Patient was transported for the benefit of a preferred physician

C

Patient was transported for the nearness of family members

D

Patient was transported for the care of a specialist or for availability of specialized equipment

E

Patient Transferred to Rehabilitation Facility

CR105

355

Unit or Basis for Measurement Code
Description: Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
Required if CR106 is present.

C

ID

2/2

Situational

Code

Name

DH

Miles

DK

Kilometers

CR106

380

Quantity
Description: Numeric value of quantity
Industry: Transport Distance
Required if known.

C

R

1/15

Situational

CR107

166

Address Information
Description: Address information
Industry: Ambulance Trip Origin Address
Required if CR106 is not present.

O

AN

1/55

Situational

CR108

166

Address Information
Description: Address information
Industry: Ambulance Trip Destination Address
Required if CR106 is not present.

O

AN

1/55

Situational

CR109

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Round Trip Purpose Description
Required if needed when CR103 (Ambulance Transport Code) = “X Round Trip”to justify the round trip. Otherwise Not Used.

O

AN

1/80

Situational

CR110

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Stretcher Purpose Description
Required if needed to justify usage of stretcher.

O

AN

1/80

Situational

1.

P0102 - If either CR101,CR102 is present, then all are required

2.

P0506 - If either CR105,CR106 is present, then all are required

1.

CR102 is the weight of the patient at time of transport.

2.

CR106 is the distance traveled during transport.

3.

CR107 is the address of origin.

4.

CR108 is the address of destination.

5.

CR109 is the purpose for the round trip ambulance service.

6.

CR110 is the purpose for the usage of a stretcher during ambulance service.

Notes:

1. Required for certifications involving non-emergency ambulance transport of a patient.

Example:

CR1*LB*155*T*A~