| 1 | ▶authorizing_payor_plan_id | CWE | Optional | No | HL70072 |
| 1.1 | ├.identifier | ST | Optional | No | - |
| 1.2 | ├.text | ST | Optional | No | - |
| 1.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 1.4 | ├.alternate_identifier | ST | Optional | No | - |
| 1.5 | ├.alternate_text | ST | Optional | No | - |
| 1.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 1.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 1.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 1.9 | ├.original_text | ST | Optional | No | - |
| 1.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 1.11 | ├.second_alternate_text | ST | Optional | No | - |
| 1.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 1.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 1.14 | ├.coding_system_oid | ST | Optional | No | - |
| 1.15 | ├.value_set_oid | ST | Optional | No | - |
| 1.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 1.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 1.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 1.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 1.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 1.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 1.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 2 | ▶authorizing_payor_company_id | CWE | Required | No | HL70285 |
| 2.1 | ├.identifier | ST | Optional | No | - |
| 2.2 | ├.text | ST | Optional | No | - |
| 2.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 2.4 | ├.alternate_identifier | ST | Optional | No | - |
| 2.5 | ├.alternate_text | ST | Optional | No | - |
| 2.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 2.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 2.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 2.9 | ├.original_text | ST | Optional | No | - |
| 2.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 2.11 | ├.second_alternate_text | ST | Optional | No | - |
| 2.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 2.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 2.14 | ├.coding_system_oid | ST | Optional | No | - |
| 2.15 | ├.value_set_oid | ST | Optional | No | - |
| 2.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 2.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 2.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 2.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 2.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 2.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 2.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 3 | authorizing_payor_company_name | ST | Optional | No | - |
| 4 | authorization_effective_date | DTM | Optional | No | - |
| 5 | authorization_expiration_date | DTM | Optional | No | - |
| 6 | ▶authorization_identifier | EI | Optional | No | - |
| 6.1 | ├.entity_identifier | ST | Optional | No | - |
| 6.2 | ├.namespace_id | IS | Optional | No | - |
| 6.3 | ├.universal_id | ST | Optional | No | - |
| 6.4 | └.universal_id_type | ID | Optional | No | - |
| 7 | ▶reimbursement_limit | CP | Optional | No | - |
| 7.1 | ├.price | MO | Optional | No | - |
| 7.2 | ├.price_type | ID | Optional | No | - |
| 7.3 | ├.from_value | NM | Optional | No | - |
| 7.4 | ├.to_value | NM | Optional | No | - |
| 7.5 | ├.range_units | CWE | Optional | No | - |
| 7.6 | └.range_type | ID | Optional | No | - |
| 8 | ▶requested_number_of_treatments | CQ | Optional | No | - |
| 8.1 | ├.quantity | NM | Optional | No | - |
| 8.2 | └.units | CWE | Optional | No | - |
| 9 | ▶authorized_number_of_treatments | CQ | Optional | No | - |
| 9.1 | ├.quantity | NM | Optional | No | - |
| 9.2 | └.units | CWE | Optional | No | - |
| 10 | process_date | DTM | Optional | No | - |
| 11 | ▶requested_disciplines | CWE | Optional | Yes | HL70522 |
| 11.1 | ├.identifier | ST | Optional | No | - |
| 11.2 | ├.text | ST | Optional | No | - |
| 11.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 11.4 | ├.alternate_identifier | ST | Optional | No | - |
| 11.5 | ├.alternate_text | ST | Optional | No | - |
| 11.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 11.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 11.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 11.9 | ├.original_text | ST | Optional | No | - |
| 11.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 11.11 | ├.second_alternate_text | ST | Optional | No | - |
| 11.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 11.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 11.14 | ├.coding_system_oid | ST | Optional | No | - |
| 11.15 | ├.value_set_oid | ST | Optional | No | - |
| 11.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 11.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 11.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 11.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 11.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 11.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 11.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 12 | ▶authorized_disciplines | CWE | Optional | Yes | HL70546 |
| 12.1 | ├.identifier | ST | Optional | No | - |
| 12.2 | ├.text | ST | Optional | No | - |
| 12.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 12.4 | ├.alternate_identifier | ST | Optional | No | - |
| 12.5 | ├.alternate_text | ST | Optional | No | - |
| 12.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 12.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 12.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 12.9 | ├.original_text | ST | Optional | No | - |
| 12.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 12.11 | ├.second_alternate_text | ST | Optional | No | - |
| 12.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 12.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 12.14 | ├.coding_system_oid | ST | Optional | No | - |
| 12.15 | ├.value_set_oid | ST | Optional | No | - |
| 12.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 12.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 12.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 12.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 12.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 12.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 12.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 13 | ▶authorization_referral_type | CWE | Required | No | HL70551 |
| 13.1 | ├.identifier | ST | Optional | No | - |
| 13.2 | ├.text | ST | Optional | No | - |
| 13.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 13.4 | ├.alternate_identifier | ST | Optional | No | - |
| 13.5 | ├.alternate_text | ST | Optional | No | - |
| 13.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 13.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 13.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 13.9 | ├.original_text | ST | Optional | No | - |
| 13.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 13.11 | ├.second_alternate_text | ST | Optional | No | - |
| 13.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 13.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 13.14 | ├.coding_system_oid | ST | Optional | No | - |
| 13.15 | ├.value_set_oid | ST | Optional | No | - |
| 13.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 13.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 13.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 13.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 13.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 13.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 13.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 14 | ▶approval_status | CWE | Optional | No | HL70563 |
| 14.1 | ├.identifier | ST | Optional | No | - |
| 14.2 | ├.text | ST | Optional | No | - |
| 14.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 14.4 | ├.alternate_identifier | ST | Optional | No | - |
| 14.5 | ├.alternate_text | ST | Optional | No | - |
| 14.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 14.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 14.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 14.9 | ├.original_text | ST | Optional | No | - |
| 14.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 14.11 | ├.second_alternate_text | ST | Optional | No | - |
| 14.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 14.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 14.14 | ├.coding_system_oid | ST | Optional | No | - |
| 14.15 | ├.value_set_oid | ST | Optional | No | - |
| 14.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 14.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 14.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 14.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 14.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 14.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 14.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 15 | planned_treatment_stop_date | DTM | Optional | No | - |
| 16 | ▶clinical_service | CWE | Optional | No | HL70573 |
| 16.1 | ├.identifier | ST | Optional | No | - |
| 16.2 | ├.text | ST | Optional | No | - |
| 16.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 16.4 | ├.alternate_identifier | ST | Optional | No | - |
| 16.5 | ├.alternate_text | ST | Optional | No | - |
| 16.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 16.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 16.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 16.9 | ├.original_text | ST | Optional | No | - |
| 16.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 16.11 | ├.second_alternate_text | ST | Optional | No | - |
| 16.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 16.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 16.14 | ├.coding_system_oid | ST | Optional | No | - |
| 16.15 | ├.value_set_oid | ST | Optional | No | - |
| 16.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 16.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 16.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 16.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 16.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 16.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 16.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 17 | reason_text | ST | Optional | No | - |
| 18 | ▶number_of_authorized_treatments_units | CQ | Optional | No | - |
| 18.1 | ├.quantity | NM | Optional | No | - |
| 18.2 | └.units | CWE | Optional | No | - |
| 19 | ▶number_of_used_treatments_units | CQ | Optional | No | - |
| 19.1 | ├.quantity | NM | Optional | No | - |
| 19.2 | └.units | CWE | Optional | No | - |
| 20 | ▶number_of_schedule_treatments_units | CQ | Optional | No | - |
| 20.1 | ├.quantity | NM | Optional | No | - |
| 20.2 | └.units | CWE | Optional | No | - |
| 21 | ▶encounter_type | CWE | Optional | No | HL70574 |
| 21.1 | ├.identifier | ST | Optional | No | - |
| 21.2 | ├.text | ST | Optional | No | - |
| 21.3 | ├.name_of_coding_system | ID | Optional | No | - |
| 21.4 | ├.alternate_identifier | ST | Optional | No | - |
| 21.5 | ├.alternate_text | ST | Optional | No | - |
| 21.6 | ├.name_of_alternate_coding_system | ID | Optional | No | - |
| 21.7 | ├.coding_system_version_id | ST | Optional | No | - |
| 21.8 | ├.alternate_coding_system_version_id | ST | Optional | No | - |
| 21.9 | ├.original_text | ST | Optional | No | - |
| 21.10 | ├.second_alternate_identifier | ST | Optional | No | - |
| 21.11 | ├.second_alternate_text | ST | Optional | No | - |
| 21.12 | ├.name_of_second_alternate_coding_system | ID | Optional | No | - |
| 21.13 | ├.second_alternate_coding_system_version_id | ST | Optional | No | - |
| 21.14 | ├.coding_system_oid | ST | Optional | No | - |
| 21.15 | ├.value_set_oid | ST | Optional | No | - |
| 21.16 | ├.value_set_version_id | DTM | Optional | No | - |
| 21.17 | ├.alternate_coding_system_oid | ST | Optional | No | - |
| 21.18 | ├.alternate_value_set_oid | ST | Optional | No | - |
| 21.19 | ├.alternate_value_set_version_id | DTM | Optional | No | - |
| 21.20 | ├.second_alternate_coding_system_oid | ST | Optional | No | - |
| 21.21 | ├.second_alternate_value_set_oid | ST | Optional | No | - |
| 21.22 | └.second_alternate_value_set_version_id | DTM | Optional | No | - |
| 22 | ▶remaining_benefit_amount | MO | Optional | No | - |
| 22.1 | ├.quantity | NM | Optional | No | - |
| 22.2 | └.denomination | ID | Optional | No | - |
| 23 | ▶authorized_provider | XON | Optional | No | - |
| 23.1 | ├.organization_name | ST | Optional | No | - |
| 23.2 | ├.organization_name_type_code | CWE | Optional | No | - |
| 23.3 | ├.id_number | NM | Optional | No | - |
| 23.4 | ├.identifier_check_digit | ST | Optional | No | - |
| 23.5 | ├.check_digit_scheme | ID | Optional | No | - |
| 23.6 | ├.assigning_authority | HD | Optional | No | - |
| 23.7 | ├.identifier_type_code | ID | Optional | No | - |
| 23.8 | ├.assigning_facility | HD | Optional | No | - |
| 23.9 | ├.name_representation_code | ID | Optional | No | - |
| 23.10 | └.organization_identifier | ST | Optional | No | - |
| 24 | ▶authorized_health_professional | XCN | Optional | No | - |
| 24.1 | ├.person_identifier | ST | Optional | No | - |
| 24.2 | ├.family_name | FN | Optional | No | - |
| 24.3 | ├.given_name | ST | Optional | No | - |
| 24.4 | ├.second_and_further_given_names_or_initials_thereof | ST | Optional | No | - |
| 24.5 | ├.suffix | ST | Optional | No | - |
| 24.6 | ├.prefix | ST | Optional | No | - |
| 24.7 | ├.degree | ST | Optional | No | - |
| 24.8 | ├.source_table | CWE | Optional | No | - |
| 24.9 | ├.assigning_authority | HD | Optional | No | - |
| 24.10 | ├.name_type_code | ID | Optional | No | - |
| 24.11 | ├.identifier_check_digit | ST | Optional | No | - |
| 24.12 | ├.check_digit_scheme | ID | Optional | No | - |
| 24.13 | ├.identifier_type_code | ID | Optional | No | - |
| 24.14 | ├.assigning_facility | HD | Optional | No | - |
| 24.15 | ├.name_representation_code | ID | Optional | No | - |
| 24.16 | ├.name_context | CWE | Optional | No | - |
| 24.17 | ├.name_validity_range | DR | Optional | No | - |
| 24.18 | ├.name_assembly_order | ID | Optional | No | - |
| 24.19 | ├.effective_date | DTM | Optional | No | - |
| 24.20 | ├.expiration_date | DTM | Optional | No | - |
| 24.21 | ├.professional_suffix | ST | Optional | No | - |
| 24.22 | ├.assigning_jurisdiction | CWE | Optional | No | - |
| 24.23 | ├.assigning_agency_or_department | CWE | Optional | No | - |
| 24.24 | ├.security_check | ST | Optional | No | - |
| 24.25 | └.security_check_scheme | ID | Optional | No | - |
| 25 | source_text | ST | Optional | No | - |
| 26 | source_date | DTM | Optional | No | - |
| 27 | ▶source_phone | XTN | Optional | No | - |
| 27.1 | ├.telephone_number | ST | Optional | No | - |
| 27.2 | ├.telecommunication_use_code | ID | Optional | No | - |
| 27.3 | ├.telecommunication_equipment_type | ID | Optional | No | - |
| 27.4 | ├.communication_address | ST | Optional | No | - |
| 27.5 | ├.country_code | SNM | Optional | No | - |
| 27.6 | ├.area_city_code | SNM | Optional | No | - |
| 27.7 | ├.local_number | SNM | Optional | No | - |
| 27.8 | ├.extension | SNM | Optional | No | - |
| 27.9 | ├.any_text | ST | Optional | No | - |
| 27.10 | ├.extension_prefix | ST | Optional | No | - |
| 27.11 | ├.speed_dial_code | ST | Optional | No | - |
| 27.12 | ├.unformatted_telephone_number | ST | Optional | No | - |
| 27.13 | ├.effective_start_date | DTM | Optional | No | - |
| 27.14 | ├.expiration_date | DTM | Optional | No | - |
| 27.15 | ├.expiration_reason | CWE | Optional | No | - |
| 27.16 | ├.protection_code | CWE | Optional | No | - |
| 27.17 | ├.shared_telecommunication_identifier | EI | Optional | No | - |
| 27.18 | └.preference_order | NM | Optional | No | - |
| 28 | comment | ST | Optional | No | - |
| 29 | action_code | ID | Optional | No | HL70206 |