Segment
X12 EDI Release 00401
To provide the receiving school district or postsecondary institution with a notice of the immunization status of the student
Elements
Code indicating the date format, time format, or date and time format
Codes (39)- CCFirst Two Digits of Year Expressed in Format CCYY
- CDMonth and Year Expressed in Format MMMYYYY
- CMDate in Format CCYYMM
- CQDate in Format CCYYQ
- CYYear Expressed in Format CCYY
- D6Date Expressed in Format YYMMDD
- D8Date Expression in Format CCYYMMDD
- DARange of Dates within a Single Month Expressed in Format DD-DD
- DBDate Expressed in Format MMDDCCYY
- DDDay of Month in Numeric Format
- DTDate and Time Expressed in Format CCYYMMDDHHMM
- EHLast Digit of Year and Julian Date Expressed in Format YDDD
- KADate Expressed in Format YYMMMDD
- MDMonth of Year and Day of Month Expressed in Format MMDD
- MMMonth of Year in Numeric Format
- RDRange of Dates Expressed in Format MMDDCCYY-MMDDCCYY
- TCJulian Date Expressed in Format DDD
- TMTime Expressed in Format HHMM
- TQDate Expressed in Format MMYY
- TRDate and Time Expressed in Format DDMMYYHHMM
- TSTime Expressed in Format HHMMSS
- TTDate Expressed in Format MMDDYY
- TUDate Expressed in Format YYDDD
- UNUnstructured
- YMYear and Month Expressed in Format YYMM
- YYLast Two Digits of Year Expressed in Format CCYY
- DTSRange of Date and Time Expressed in Format CCYYMMDDHHMMSS-CCYYMMDDHHMMSS
- RD2Range of Years Expressed in Format YY-YY
- RD4Range of Years Expressed in Format CCYY-CCYY
- RD5Range of Years and Months Expressed in Format CCYYMM-CCYYMM
- RD6Range of Dates Expressed in Format YYMMDD-YYMMDD
- RD8Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD
- RDMRange of Dates Expressed in Format YYMMDD-MMDD
- RDTRange of Date and Time, Expressed in Format CCYYMMDDHHMM-CCYYMMDDHHMM
- RMDRange of Months and Days Expressed in Format MMDD-MMDD
- RMYRange of Years and Months Expressed in Format YYMM-YYMM
- RTMRange of Time Expressed in Format HHMM-HHMM
- RTSDate and Time Expressed in Format CCYYMMDDHHMMSS
- YMMRange of Year and Months, Expressed in CCYYMMM-MMM Format
Code indicating the status of an immunization conducted on a person
Codes (14)- 1First Inoculation
- 2Second Inoculation
- 3Third Inoculation
- 4Fourth Inoculation
- 5Fifth Inoculation
- 6Sixth Inoculation
- 7Seventh Inoculation
- 8Eighth Inoculation
- 9Ninth Inoculation
- 10Medical Exemption
- 11Personal Exemption
- 12Religious Exemption
- 13Had the Disease
- 14Has Not Had the Disease
Code indicating the title or contents of a document, report or supporting item
Codes (522)- 10Continued Treatment
- 11Chemical Analysis
- 12Mechanical Properties
- 13Certified Test Report
- 14Core Loss Test Report
- 15Justification for Admission
- 16Western Region 01 (Internal Revenue Service Summary of line 31 on 1040)
- 17Return From Tax Payer Report (Internal Revenue Service Summary)
- 18Note Receivable
- 19Credit Report
- 20Process Plan
- 21Recovery Plan
- 22Functional Plan
- 23Contractual Plan
- 24Non-Contractual Plan
- 25Purchase Plan
- 26Production Plan
- 27Contract Delivery Schedule
- 28Master Delivery Schedule
- 29Assembly Plan
- 30Lead Time Chart
- 31Master Schedule
- 32Master Production Schedule
- 33Manufacturing Flow Diagram
- 34Lot Release Plan
- 35Subcontractor Plan
- 36Development Plan
- 37Lease Agreement
- 38Court Judgment
- 39Lottery Winning Letter
- 40Curb Side Inspection
- 41Statistical Model
- 42Interior and Exterior Inspection
- 43Non-Inspection Report
- 44Review Appraisal
- 45Investor Guidelines
- 46Sole Discretion Inspection
- 47Brokers Price Opinion
- 48Social Security Benefit Letter
- 49Divorce Decree
- 50Contract
- 51Gift Letter
- 52Will
- 53Trust Agreement
- 54Award Letter
- 55Rental Agreement
- 56Preliminary Real Estate Settlement Statement
- 57Income Statement (Internal Revenue Service Form 1099)
- 58Utility Bill
- 59Benefit Letter
- 60Canceled Check
- 61Individual Tax Return (Internal Revenue Service Form 1040)
- 62Asset Account Statement
- 63Statement of Profit and Loss
- 64Partner Share of Income, Credit, Deductions, (Internal Revenue Service Form K1)
- 65Partnership Tax Return (Internal Revenue Service Form 1120)
- 66Pay Stub
- 67Wage and Tax Statement (Internal Revenue Service Form W2)
- 68Year End Statement
- 69Bank Statement
- 70Verification of Loan/Installment Debt Form
- 71Verification of Deposit Form
- 72Verification of Mortgage/Rent Form
- 73Verification of Employment Form
- 74Corporation Tax Return (Internal Revenue Service Form 1065)
- 75Title Certificates
- 76Real Estate Settlement Statement (Housing and Urban Development Form - 1 "HUD1")
- 77Support Data for Verification
- 78Visa/Export License
- 79Multi-Country Textile Declaration
- 80Single Country Textile Declaration
- 81Negative Textile Declaration
- 82Endangered Species Convention on International Trade in Endangered Species (CITES)
- 83Trademark Release
- 84Water Resistance Statement
- 85Certificate of Ceramicware Ceramics Commodities Inspection Bureau (CCIB)
- 86Wearing Apparel Detail Sheet (WADS)
- 87Interim Footwear Invoice
- 88Impact Resistance Statement
- 89Toxic Substance Compliance Statement
- 90Foreign Shippers Declaration
- 91Veterinarian Certificate
- 92Child Labor Certificate
- 93Prison Labor Certificate
- 94Purchase Order Copy
- 95Product Analysis
- 96American Automotive Labeling Act Certificate
- 97Broker Market Analysis
- 01Product Transfer
- 02Resale
- 03Report Justifying Treatment Beyond Utilization Guidelines
- 04Drugs Administered
- 05Treatment Diagnosis
- 06Initial Assessment
- 07Functional Goals
- 08Plan of Treatment
- 09Progress Report
- A1Air Emissions Statements
- A2Anti-Dumping Gasoline Program Report
- A3Allergies/Sensitivities Document
- A4Autopsy Report
- AAAgent Inventory Report
- ABAssembly Drawing
- ACAssay Certificate
- ADAgent/Distributor Inventory Report
- AEAttachment
- AFAid Form
- AGActual
- AHEasement Report
- AIConditions, Covenant, and Restrictions Report
- AJImpound Account Escrow Analysis Report
- AKClosing Escrow Analysis Report
- ALReserved Escrow Analysis Report
- AMAmbulance Certification
- ANTitle Policy
- AOAverage Outgoing Quality Report
- APAdvanced Problem Notification
- AQHousing and Urban Development (HUD) 1 Report
- ARAsset Reclassification Extension Request
- ASAdmission Summary
- ATPurchase Order Attachment
- AUAutomobile Claim Report
- AVAveraging Areas Report
- AWAir Waybill
- AXAsset Reclassification Extension Response
- AYTax Certificate
- AZHome Owner Authorization
- B1Batch Report
- B2Prescription
- B3Physician Order
- B4Referral Form
- BABudget
- BBBuy or Sell Exchange Contract Status Statement
- BCBill of Lading Copy
- BEBenzene Content Averaging Report
- BFBailment Warehouse Withdrawal Request
- BLBill of Lading
- BMBill of Material
- BNBeneficiary Certificate
- BOBill of Lading Original
- BRBenchmark Testing Results
- BSBaseline
- BTBlanket Test Results
- BWBill of Sale
- BYBiennial Report
- C1Cost Data Summary
- C2Functional Cost and Hour
- C3Progress Curve
- C4Plant-Wide Data
- C5Certified Cost and Price Data
- C6Wage Determination
- C7Credit Transfer Summary Report
- C8Chemical/Radiological Report
- C9Certification/Authorization Document
- CACertificate of Analysis
- CBChiropractic Justification
- CCC.A.A. Certificate of Conformance (British CAA)
- CDCustomer/Distributor Inventory Report
- CEConstable Report
- CFCapability
- CGCertificate of Origin
- CHCertificate of Weight
- CICertificate of Inspection Report
- CJComplications Document
- CKConsent Form(s)
- CLCable
- CMCustomer/Manufacturer Inventory Report
- CNCustomer's Report of Nonconformance
- COConsignment Order
- CPCertificate of Compliance (Material Certification)
- CQCounty Record
- CRLetter of Credit
- CSConsigned Inventory Sales Report
- CTCertification
- CUCustomer Notification Letter
- CWCorrective Work Order
- CXCost/Schedule Status Report (C/SSR)
- CYContract Funds Status Report (CFSR)
- CZCampus Police Report
- D2Drug Profile Document
- DADental Models
- DBDurable Medical Equipment Prescription
- DCDistributor/Customer Inventory Report
- DDDistributor Inventory Report
- DECertificate of Quality
- DFDA59 Special Customs Invoice for South Africa
- DGDiagnostic Report
- DHNitrogen Certificate
- DIDirectory
- DJDischarge Monitoring Report
- DKDrawback Affidavit
- DLDraft and Transmittal Letter
- DMDistributor/Manufacturer Inventory Report
- DNDeviation/Nonconformance Test Results and Request for Action
- DQDelinquency
- DRDatalog Report
- DSDischarge Summary
- DTDepartment of Transportation
- DUCommercial
- DVCondominium
- DWDrawing(s)
- E1Exporter's Certificate and Agreement
- EAElectrical Average Outgoing Quality Report
- EBExplanation of Benefits (Coordination of Benefits or Medicare Secondary Payor)
- ECEngineering Change Order
- EDEnvironmental Exposure Document
- ELEligibility
- EPExperimental Material Purchase Order
- EREngineering Change Request
- EXShippers Export Declaration
- EYBarrel for Barrel Exchange Contract Status Statement
- F1Cost Performance Report (CPR) Format 1
- F2Cost Performance Report (CPR) Format 2
- F3Cost Performance Report (CPR) Format 3
- F4Cost Performance Report (CPR) Format 4
- F5Cost Performance Report (CPR) Format 5
- F6Transportation Carrier Inspection Report
- F7Government Inspection Report
- F8Inspection Waiver (Written)
- F9Inspection Waiver (Oral)
- FBFederal Bureau of Investigation
- FCFumigation Certificate
- FDFederal Specification Compliance
- FEFederal Emergency Management Agency
- FHLimitation of Heavy Elements
- FIFire Report
- FMFamily Medical History Document
- FSCertificate of Free Sale
- GPGas Processor's Report
- GTGas Transporter's Report
- HCHealth Certificate
- HRHealth Clinic Records
- HWHazardous Waste Manifest
- I2Consular Invoice
- I3Customs Invoice
- I4Forwarder's Invoice
- I5Immunization Record
- I6Carrier's Invoice
- IAInsurance Attachment
- ICInsurance Certificate
- IMImport License
- INInspection Request
- IPInventory Parameter Report
- IRState School Immunization Records
- ISIndex System
- ITCertified Inspection and Test Results
- IUInspection Result
- IVInvoice
- JACertificate of Good Standing
- JBTax Status Clearance
- JCConsent to Use Name
- JDCertificate of Registration
- JECertificate of Existence
- JFCertificate of Status
- JGCertificate of Name Change
- JHCertificate of Merger
- JICertificate of Significant Change
- JKBalance Sheet
- JLApplication of Name Reservation
- JMSchedule of Capital
- JNForeign Tax Return
- JOPermit Application
- JPAdmission Tax Return
- JQAddendum to Articles
- JRArticles and Amendments
- JSAppointment of Commissioner as Registered Agent
- JTCertificate of Disclosure
- JVNotice of Registered Office
- JWNotice of Directors
- JXOrganization and First Biennial Report
- JYAgreement of Statutory Agent
- JZConsent to Act
- KAContract Data Requirements List (CDRL)
- KCKosher Certificate
- KDEngineering Drawing List
- KEPurchased Engineering Data List
- KFSupport Documents
- KGPurchased Documents
- KHProposal Support Data
- KIPurchased Drawings
- KJChange Proposal Data
- KYReport of Assignment or Modification of Key Events
- KZRequest for Assignment or Modification of Key Events
- LALaboratory Results
- LBLegalized Bill of Lading
- LCLocation Inventory Report
- LDLaboratory Quality Review Variation, Deviation
- LELatest Revised Estimate
- LGLegalized Certificate of Origin
- LILegalized Invoice
- LOLaboratory Quality Review Order, Waiver
- LPLabor Plan
- LRLaboratory Quality Review Order, Deviation
- LSLease Settlement Statement
- LTLicense Application Attachment
- LWLaboratory Quality Review Variation, Waiver
- M1Medical Record Attachment
- MAManufacturer/Agent Inventory Report
- MBManufacturer/Distributor Inventory Report
- MCManufacturer/Customer Inventory Report
- MDMaterial Data Sheets
- MEMajor Deviation Request
- MFManufacturing Specification
- MGMigrant Student Records Transfer System (MSRTS) Record
- MHReport of Full Maintenance Period Detail
- MIMortgage Insurance Certification
- MJRequest for Maintenance Period Status
- MKReport of Maintenance Period Status
- MLRequest for Full Maintenance Period Detail
- MMManufacturer Inventory Report
- MNMinor Deviation Request
- MOManufacturer's Statement of Origin
- MPRequest for Establishment, Modification, or Cancellation of Maintenance Period
- MQReport of Establishment, Modification, or Cancellation of Maintenance Period
- MRMaterial Inspection and Receiving Report
- MSMaterial Safety Data Sheet
- MTModels
- MVMetered Volumes
- MZMotor Vehicle Report
- NANational Insurance Crime Bureau Assignment
- NCCertificate of Quantity
- NDCommercial Invoice
- NINational Insurance Crime Bureau
- NLNational Insurance Crime Bureau Total Loss
- NMMonthly Contractor Financial Management Report
- NNNursing Notes
- NONational Insurance Crime Bureau Other than Theft
- NQQuarterly Contractor Financial Management Report
- NRNOx Emissions Averaging Report
- NTNational Insurance Crime Bureau Total Theft
- OBOperative Note
- OCOxygen Content Averaging Report
- ODOrders and Treatments Document
- OEObjective Physical Examination (including vital signs) Document
- OLOcean Bill of Lading
- OPOutside Production Operation Sheet
- OROil Storer's Report
- OSOrganization Breakdown Structure
- OTOil Transporter's Report
- OXOxygen Therapy Certification
- OZSupport Data for Claim
- P1Packing List
- P2Protest
- P3Receipt
- P4Pathology Report
- P5Patient Medical History Document
- P6Periodontal Charts
- P7Periodontal Reports
- P8Property Claim Report
- PAPart Drawing
- PBProduct Catalog
- PCProcess Change Notice
- PDProof of Delivery
- PEParenteral or Enteral Certification
- PFProduct Specification
- PGPackaging Specification
- PHProduction History - Property Level
- PIProduct Availability Inquiry
- PJPurchasing Specification
- PKStorage Information Inquiry
- PLProperty Insurance Loss Register
- PMProof of Insurance
- PNPhysical Therapy Notes
- POProsthetics or Orthotic Certification
- PPProposal
- PQParamedical Results
- PRPurchase Report
- PSPipeline/Shipper Inventory Report
- PTInter-Plant Inventory Report
- PVPolice Report
- PWProduction History - Well Level
- PXProduction, Injection and Disposition Report
- PYPhysician's Report
- PZPhysical Therapy Certification
- QCCause and Corrective Action Report
- QDQuality Review Order, Purchasing
- QEQuality Detail
- QMQuality Review Order, Manufacturing
- QRQuality Report
- QSQuality Review Order Supplement
- QTQuality Summary
- R1Reformulated Gasoline/Anti-Dumping Company Registration
- R2Reformulated Gasoline/Anti-Dumping Facility Registration
- R3Technical Information Package
- R4Purchased Technical Information Package
- R5Technical Information
- R6Miscellaneous Information
- RARevision Announcement
- RBRadiology Films
- RCRequest for Cause and Corrective Action Report
- RDPayment Bond
- REPerformance Bond
- RFReliability Fail Rate Report
- RGResidential
- RMRequest for Manufacturing Engineer Appraisal
- RNSupplier's Report of Nonconformance
- RORegular Order
- RRRadiology Reports
- RTReport of Tests and Analysis Report
- RVReid Vapor Pressure (RVP) Averaging Report
- RXRenewable Oxygen Content Averaging Report
- S1Supply and Shipment Status Report
- S2Supply Status Report
- S3Exception Supply Status Report
- S4Exception Supply and Shipment Status Report
- S5Product Quality Deficiency Report Category I
- S6Product Quality Deficiency Report Category II
- S7"Walsh-Healey Act"Manufacturer or Regular Dealer
- S8Report of Findings
- S9Representation
- SAState Police Report
- SBSample Approval and Rejection List
- SCSanitary Certificate
- SDSupport Data for a Request for Quote
- SESecurity Police Report
- SFContract Security Classification Specification
- SGSymptoms Document
- SHSheriff Report
- SISeller Inventory Report
- SLSample Bale List
- SMShipping Manifests
- SNShipping Notice
- SOSecretary Certificate
- SPSpecification
- SQStatistical Quality Documents
- SRStatistical Report
- SSSeller Sales Report
- STStudent Educational Record (Transcript)
- SUSupplier's Certificate
- SVSurvey
- SWSea Waybill
- SXSteamship Due Bill
- SYTrain Sheet
- T1Title Bill
- T2Preliminary Title Work
- T3Loan Documents
- T4Tax Information
- T5Toxics Emissions Performance Averaging Report
- T6Toxics Release Inventory
- TAAsset Support Inquiry
- TBAsset Support Advice
- TCPhysical Inventory Request
- TDAsset Reclassification Response
- TEAsset Reclassification Request
- TFTransaction History Request
- TGTwo to Four Family
- THTotal Theft Claim Report
- TIAsset Status Inquiry
- TJAsset Status Advice
- TKLogistics Transfer Inquiry
- TLLogistics Transfer Advice
- TMStock Sale Report
- TNDelayed Sale Report
- TODemand Report
- TPTreatments Certificate
- TQStorage Information Advice
- TRTransmittal Letter
- TSSulfur, Olefins, and T90 Averaging Report
- TTTitle Transfer
- TXTax-exempt Certificate
- U1Survey Report
- UAUnion Agreement
- UBCertificate of Designation of Registered Agent
- UDList of Officers and Directors
- UEResolution and Consent Form
- UFDomestic Business Corporation Initial Report
- UGRegistered Agent Application
- UHArticles of Incorporation
- UICertificate of Compliance
- UJCertificate of Authorization
- UKCharter
- ULOther Type of Report
- UMAffidavit of Acceptance
- UNResolution Adopting Fictitious Name
- UOTrade Name Application
- UPDeclaration of Solicitor
- UQMemorandum of Association
- URNotice of Registered Agent
- US"BUY AMERICA"Certification of Compliance
- UT
- UUDissolution of Existing Registration
- UVAppointment of Statutory Agent
- UXRegulatory Approval for Professional Association
- UYInitial Annual Report
- UZCertificate of Fact
- V1Voter Registration Application
- V2Voter Registration Application Disposition
- V3Voter Information Record
- V4Change of Name and/or Address
- V5Death Notification
- V6Felony Conviction Notification
- V7Incompetency Notification
- VAVariance Analysis
- VCVolatile Organic Compounds (VOC) Emissions Averaging Report
- VDData Request for Vendor's Specifications or Drawings.
- VMVisual/Mechanical Average Outgoing Quality Report
- W1Safe Drinking Water Bacteriological Report
- W2Safe Drinking Water Report
- WAFictitious Name Statement
- WBWork Breakdown Structure
- WCRequest for Assignment or Deletion of Work Candidate
- WDReport of Assignment or Deletion of Work Candidate
- WEBusiness Conducted Prior to Qualification Form
- WFBy-Laws
- WGAppointment of Agent for Service and Consent to Act
- WHCertificate of Name Clearance
- WIWell Information
- WPWork Progress
- WTWell Test Information
- X1Complete Appraisal
- X2Limited Appraisal
- X3Self-contained Report
- X4Summary Report
- X5Restricted Report
- XEEquipment Test Results
- XPPhotographs
- Y1Appraisal
- Y2Broker Price Opinion
- Y3Real Estate Property Information
- ZAFlood Determination Report
- ZBConventional Ammunition Suspension Report
- ZZMutually Defined
