PER

Additional Patient Information Contact Information

Pos: 220

Max: 1

Detail - Optional

Loop: 2010CB

Elements: 8

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	PER01	366	Contact Function Code Description: Code identifying the major duty or responsibility of the person or group named	M	ID	2/2	Required

	Code	Name
	IC	Information Contact

	PER02	93	Name Description: Free-form name Industry: Response Contact Name Used only when response must be directed to a particular contact. Use this data element when the name of the individual to contact is not already defined or is different than the name within the prior name segment (e.g. N1 or NM1).	O	AN	1/60	Situational
	PER03	365	Communication Number Qualifier Description: Code identifying the type of communication number Required if PER02 is not valued and may be used if necessary to transmit a contact communication number.	X	ID	2/2	Situational

	Code	Name
	EM	Electronic Mail
	FX	Facsimile
	TE	Telephone

	PER04	364	Communication Number Description: Complete communications number including country or area code when applicable Industry: Response Contact Communication Number Required if PER02 is not valued and may be used if necessary to transmit a contact communication number.	X	AN	1/80	Situational
	PER05	365	Communication Number Qualifier Description: Code identifying the type of communication number Used only when the telephone extension or multiple communication types are available.	X	ID	2/2	Situational

	Code	Name
	EM	Electronic Mail
	EX	Telephone Extension
	FX	Facsimile
	TE	Telephone

	PER06	364	Communication Number Description: Complete communications number including country or area code when applicable Industry: Response Contact Communication Number Used only when the telephone extension or multiple communication types are available.	X	AN	1/80	Situational
	PER07	365	Communication Number Qualifier Description: Code identifying the type of communication number Used only when the telephone extension or multiple communication types are available.	X	ID	2/2	Situational

	Code	Name
	EM	Electronic Mail
	EX	Telephone Extension
	FX	Facsimile
	TE	Telephone

PER08

364

Communication Number
Description: Complete communications number including country or area code when applicable
Industry: Response Contact Communication Number
Used only when the telephone extension or multiple communication types are available.

1/80

Situational

1.	P0304 - If either PER03,PER04 is present, then all are required
2.	P0506 - If either PER05,PER06 is present, then all are required
3.	P0708 - If either PER07,PER08 is present, then all are required

Notes:

1. Required if the provider must direct the response to the request for additional patient information to a specific requester contact, electronic mail, facsimile, or phone number other than the contact provided in the PER segment in the UMO Name loop (Loop 2010A) PER segment of this 278 response.
2. Use this segment only if the subscriber is the patient.
3. Do not use if the request for additional patient information is in another X12 functional group.
4. When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc), the communication number should always include the area code and phone number using the format AAABBBCCCC. Where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g. (534)224-2525 would be represented as 5342242525). The extension, when applicable, should be included in the communication number immediately after the telephone number.
5. By definition of the standard, if PER03 is used, PER04 is required.

Example:

PER*IC*MARY*FX*3135554321~