Additional Patient Information Contact City/State/Zip Code

Pos: 210

Max: 1

Detail - Optional

Loop: 2010DB

Elements: 6

Ref	Id	Element Name	Req	Type	Min/Max	Usage
N401	19	City Name Description: Free-form text for city name Industry: Response Contact City Name Use when necessary to provide this data as part of the response contact location identification.	O	AN	2/30	Situational
N402	156	State or Province Code Description: Code (Standard State/Province) as defined by appropriate government agency Industry: Response Contact State or Province Code CODE SOURCE: 22: States and Outlying Areas of the U.S. Use when necessary to provide this data as part of the response contact location identification.	O	ID	2/2	Situational

	ExternalCodeList
	Name: 22
	Description: States and Outlying Areas of the U.S.

N403

116

Postal Code
Description: Code defining international postal zone code excluding punctuation and blanks (zip code for United States)
Industry: Response Contact Postal Zone or ZIP Code
CODE SOURCE: 51: ZIP Code
Use when necessary to provide this data as part of the response contact location identification.

3/15

Situational

N404

Country Code
Description: Code identifying the country
Industry: Response Contact Country Code
CODE SOURCE: 5: Countries, Currencies and Funds
Use only if the address is out of the U.S.

2/3

Situational

	ExternalCodeList
	Name: 5
	Description: Countries, Currencies and Funds

N405

309

Location Qualifier
Description: Code identifying type of location
Required if N406 is valued.

1/2

Situational

	Code	Name
	B1	Branch
	DP	Department

N406

310

Location Identifier
Description: Code which identifies a specific location
Industry: Response Contact Specific Information
Required if N405 is valued.
Value this field if the response to the request for additional information must be directed to a particular domain.

1/30

Situational

Notes:

1. This segment identifies the office location to route the response to the request for additional patient information.
2. Use this segment only if the subscriber is the patient and the response to the request for additional patient information must be routed to a specific office location.
3. Do not use if the request for additional patient information is in another X12 functional group.

Example:

N4*MIAMI*FL*33131**DP*UTILIZATION REVIEW DEPT~

1.	A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location.
2.	N402 is required only if city name (N401) is in the U.S. or Canada.