<?xml version="1.0"?>
<HC_DATA>
	<HEADER>
		<TRANS_CODE>Q</TRANS_CODE>
		<RPT_YEAR>2006</RPT_YEAR>
		<RPT_QTR>1</RPT_QTR>
		<DATA_TYPE>PD10</DATA_TYPE>
		<SUBMISSION_TYPE>I</SUBMISSION_TYPE>
		<PROCESS_DATE>2005-09-20</PROCESS_DATE>
		<AHCA_NUM>00100088</AHCA_NUM>
		<ORG_NAME>BAPTIST MEDICAL CENTER</ORG_NAME>
		<NAME>HAMANN, CAROL</NAME>
		<PHONE>(904)202-2779</PHONE>
		<EMAIL>CHAMANN@BMCJAX.COM</EMAIL>
		<STREET>800 PRUDENTIAL DRIVE</STREET>
		<CITY>JACKSONVILLE</CITY>
		<STATE>FL</STATE>
		<ZIP>32207</ZIP>
	</HEADER>
	<RECORD>
		<AHCA_NUM>0000101188</AHCA_NUM>
		<RECORD_ID>00100005396</RECORD_ID>
		<PATIENT_SSN>555467122</PATIENT_SSN>
		<PATIENT_RACE>4</PATIENT_RACE>
		<PATIENT_BIRTHDATE>1980-07-02</PATIENT_BIRTHDATE>
		<PATIENT_SEX>2</PATIENT_SEX>
		<PATIENT_ZIP>32216</PATIENT_ZIP>
		<ADMIT_TYPE>3</ADMIT_TYPE>
		<ADMIT_SOURCE>1</ADMIT_SOURCE>
		<ADMIT_DATE>2005-08-16</ADMIT_DATE>
		<DISCH_DATE>2005-08-16</DISCH_DATE>
		<DISCH_STATUS>01</DISCH_STATUS>
		<PRINC_PAYER_CODE>F</PRINC_PAYER_CODE>
		<PRINC_DIAG_CODE>659.71</PRINC_DIAG_CODE>
		<OTHER_CODE>665.51</OTHER_CODE>
		<PRESENT_AT_ADMIT>3</PRESENT_AT_ADMIT>
		<OTHER_CODE>648.91</OTHER_CODE>
		<PRESENT_AT_ADMIT>3</PRESENT_AT_ADMIT>
		<OTHER_CODE>V25.2</OTHER_CODE>
		<PRESENT_AT_ADMIT>3</PRESENT_AT_ADMIT>
		<OTHER_CODE>V27.0</OTHER_CODE>
		<PRESENT_AT_ADMIT>3</PRESENT_AT_ADMIT>
		<OTHER_CODE>V02.51</OTHER_CODE>
		<PRESENT_AT_ADMIT>3</PRESENT_AT_ADMIT>
		<PRIN_PROC_CODE>66.32</PRIN_PROC_CODE>
		<PROC_DATE>2005-08-14</PROC_DATE>
		<PROC_CODE>72.79</PROC_CODE>
		<PROC_DATE>2005-08-14</PROC_DATE>
		<PROC_CODE>75.69</PROC_CODE>
		<PROC_DATE>2005-08-14</PROC_DATE>
		<ATTENDING_PHYS_ID>ME79231</ATTENDING_PHYS_ID>
		<OPERATING_PHYS_ID>ME79231</OPERATING_PHYS_ID>
		<ROOM_BOARD_CHARGES>972</ROOM_BOARD_CHARGES>
		<NURSERY_CHARGES>0</NURSERY_CHARGES>
		<L3_NURSERY_CHARGES>0</L3_NURSERY_CHARGES>
		<INTENSIVE_CARE_CHARGES>0</INTENSIVE_CARE_CHARGES>
		<CORONY_CARE_CHARGES>0</CORONY_CARE_CHARGES>
		<PHARMACY_CHARGES>1213</PHARMACY_CHARGES>
		<MED_SURG_SUPPLY_CHARGES>1222</MED_SURG_SUPPLY_CHARGES>
		<LAB_CHARGES>1224</LAB_CHARGES>
		<RADIOLOGY_IMAGING_CHARGES>0</RADIOLOGY_IMAGING_CHARGES>
		<CARDIOLOGY_CHARGES>0</CARDIOLOGY_CHARGES>
		<RESPIRATORY_PULMONARY_CHARGES>134</RESPIRATORY_PULMONARY_CHARGES>
		<OPER_ROOM_CHARGES>1264</OPER_ROOM_CHARGES>
		<ANESTHESIA_CHARGES>0</ANESTHESIA_CHARGES>
		<RECOVERY_ROOM_CHARGES>972</RECOVERY_ROOM_CHARGES>
		<LABOR_ROOM_CHARGES>4506</LABOR_ROOM_CHARGES>
		<ER_ROOM_CHARGES>0</ER_ROOM_CHARGES>
		<TRAUMA_RESPONSE_CHARGES>0</TRAUMA_RESPONSE_CHARGES>
		<TREATMENT_OBSERVATION_ROOM_CHARGES>161</TREATMENT_OBSERVATION_ROOM_CHARGES>
		<BEHAVIORAL_HEALTH_CHARGES>0</BEHAVIORAL_HEALTH_CHARGES>
		<ONCOLOGY_CHARGES>0</ONCOLOGY_CHARGES>
		<PHYS_OCC_THERAPY_CHARGES>0</PHYS_OCC_THERAPY_CHARGES>
		<OTHER_CHARGES>36</OTHER_CHARGES>
		<TOTAL_CHARGES>1</TOTAL_CHARGES>
	</RECORD>
</HC_DATA>
