| Position | Line | Contents | Size | Code | Format |
| 1 | 1 | Transaction Code | 1 | ||
| 2 | 2 | Time Stamp | 16 | mm/dd/yyhh:mm xm | |
| 3 | 3 | Patient Type | 1 | AR | |
| 4 | 3 | Database Number | 2 | nn | |
| 5 | 3 | Pdf Number | 6 | AA# | nnnnnn |
| 6 | 3 | Episode Number | 4 | *EPEN# | nnnn |
| 7 | 4 | Medical Record # | 10 | AEA | nn-nn-nn-n |
| 8 | 5 | Name | 30 | AA& | last,_first_middle_title |
| 9 | 6 | Gender | 1 | AAB | |
| 10 | 7 | Ethnicity | 1 | AAM | |
| 11 | 8 | Date Of Birth | 8 | AAD | mm/dd/yy |
| 12 | 9 | Age | 3 | AAC | |
| 13 | 10 | Marital Status | 25 | AAE | |
| 14 | 11 | Institute And Branch | 5 | AUC | |
| 15 | 12 | Senior Authorizing MD | 18 | AB& | last,first_middle |
| 16 | 13 | MD's Initials | 4 | ABG | ABG |
| 17 | 14 | Nursing Unit or location from CAS | 6 | AC& | |
| 18 | 15 | Bed | 6 | AD& | |
| 19 | 16 | Protocol Number | 10 | ATG | nn-aa-nnnn |
| 20 | 17 | Patient's Street | 25 | AAH | |
| 21 | 18 | Patient's City, State | 23 | AAI | |
| 22 | 19 | Patient's Zip Code | 5 | AAL | nnnnn |
| 23 | 20 | Home Phone # | 12 | AAG | nnn-nnn-nnnn |
| 24 | 21 | Social Security Number | 11 | AAA | nnn-nn-nnnn |
| 25 | 22 | Religion | 20 | AAF | |
| 26 | 23 | Mother's Name | 21 | AEQ | |
| 27 | 24 | Admit Diagnosis | 52 | AED | |
| 28 | 25 | Referring MD | 30 | AGA | |
| 29 | 26 | rMD's Street#1 | 25 | AGD | |
| 30 | 27 | rMD's Street#2 | 25 | AGE | |
| 31 | 28 | rMD's city,state | 25 | AGF | |
| 32 | 29 | rMD's Zip Code | 5 | AGH | nnnnn |
| 33 | 30 | rMD's Telephone # | 12 | AGJ | nnn-nnn-nnnn |
| 34 | 31 | rMD's Fax # | 12 | AGC | nnn-nnn-nnnn |
| 35 | 32 | rMD's Speciality | 26 | AGK | |
| 36 | 33 | MD To Get Reports | 25 | AGI | |
| 37 | 34 | MD's Street#1 | 25 | AGL | |
| 38 | 35 | MD's Street#2 | 26 | AGM | |
| 39 | 36 | MD's city,state | 25 | AGN | |
| 40 | 37 | MD's Zip Code | 5 | AGP | nnnnn |
| 41 | 38 | MD's Telephone # | 12 | AGQ | nnn-nnn-nnnn |
| 42 | 39 | MD's Fax # | 12 | AGT | nnn-nnn-nnnn |
| 43 | 40 | MD's Speciality | 26 | AGR | |
| 44 | 41 | Admit Date | 8 | AEB | mm/dd/yy |
| 45 | 42 | Attending MD | 30 | AUD | |
| 46 | 43 | Primary MD | 30 | AUF | |
| 47 | 44 | Clinical Associate MD | 30 | AU& | |
| 48 | 45 | Clinical Associate MD | 30 | AU& | |
| 49 | 46 | Clinical Associate MD | 30 | AU& | |
| 50 | 47 | Clinical Associate MD | 30 | AU& |