DHS 120.12(5m)(a) (a) Data to be collected. Hospitals shall submit to the department all of the following data for each patient:

DHS 120.12(5m)(a)1. 1. Federal tax identification number of the hospital.

DHS 120.12(5m)(a)2. 2. Discharge diagnosis.

DHS 120.12(5m)(a)3. 3. Referral source.

DHS 120.12(5m)(a)4. 4. Discharge date.

DHS 120.12(5m)(a)5. 5. Patient zip code.

DHS 120.12(5m)(a)6. 6. Patient birth date.

DHS 120.12(5m)(a)7. 7. Patient gender.

DHS 120.12(5m)(a)8. 8. Arrival date.

DHS 120.12(5m)(a)9. 9. Disposition.

DHS 120.12(5m)(a)10. 10. Source of admission.

DHS 120.12(5m)(a)11. 11. Patient discharge status.

DHS 120.12(5m)(a)12. 12. Attending emergency provider specialty.

DHS 120.12(5m)(a)13. 13. Total charges.

DHS 120.12(5m)(a)14. 14. Patient county of residence.

DHS 120.12(5m)(a)15. 15. Primary payer identifier and type.

DHS 120.12(5m)(a)16. 16. Secondary payer identifier and type.

DHS 120.12(5m)(a)17. 17. Principal and other diagnosis codes.

DHS 120.12(5m)(a)18. 18. External cause of injury codes.

DHS 120.12(5m)(a)19. 19. Principal and other procedure codes.

DHS 120.12(5m)(a)20. 20. Date of service.

DHS 120.12(5m)(a)21. 21. Attending emergency provider ID.

DHS 120.12(5m)(a)22. 22. Consulting provider ID.

DHS 120.12(5m)(a)23. 23. Consulting provider specialty.

DHS 120.12(5m)(a)24. 24. Performing provider ID.

DHS 120.12(5m)(a)25. 25. Performing provider type/specialty.

DHS 120.12(5m)(a)26. 26. Encrypted case identifier.

DHS 120.12(5m)(a)27. 27. Insured’s policy number.

DHS 120.12(5m)(a)28. 28. Diagnosis present at arrival.