The following is a sample output validation report in XML format containing the XML-formatted HIPAA document, resulting HIPAA formatted data, as well as the validation status.
<?xml version="1.0" encoding="ISO-8859-1" ?> <documents> <ValidationReport> <Report> <Success/> </Report> </ValidationReport> <input> <HIPAA270> <ISA> <_01_Authorization_Information_Qualifier_>00</_01_Authorization_Information_Qualifier_> <_02_Authorization_Information_>1234567890</_02_Authorization_Information_> <_03_Security_Information_Qualifier_>00</_03_Security_Information_Qualifier_> <_04_Security_Information_>1234567890</_04_Security_Information_> <_05_Interchange_ID_Qualifier_>ZZ</_05_Interchange_ID_Qualifier_> <_06_Interchange_Sender_ID_>SUBMITTERS ID12</_06_Interchange_Sender_ID_>
<_07_Interchange_ID_Qualifier_>ZZ</_07_Interchange_ID_Qualifier_> <_08_Interchange_Receiver_ID_>RECEIVERS ID123</_08_Interchange_Receiver_ID_> <_09_Interchange_Date_>010122</_09_Interchange_Date_> <_10_Interchange_Time_>1253</_10_Interchange_Time_> <_11_Repetition_Separator_>U</_11_Repetition_Separator_> <_12_Interchange_Control_Version_Number_>00401</_12_Interchange_Control_Version_Number_> <_13_Interchange_Control_Number_>000000905</_13_Interchange_Control_Number_> <_14_Acknowledgement_Requested_>1</_14_Acknowledgement_Requested_> <_15_Usage_Indicator_>T</_15_Usage_Indicator_> <_16_Component_Element_Separator_>:</_16_Component_Element_Separator_> </ISA> <GS> <_01_Functional_Identifier_Code_>HS</_01_Functional_Identifier_Code_> <_02_Application_Senders_Code_>SenderID</_02_Application_Senders_Code_> <_03_Application_Receivers_Code_>ReceiverID</_03_Application_Receivers_Code_> <_04_Date_>20010122</_04_Date_> <_05_Time_>1310</_05_Time_> <_06_Group_Control_Number_>1</_06_Group_Control_Number_> <_07_Responsible_Agency_Code_>X</_07_Responsible_Agency_Code_> <_08_Version__Release__Industry_Identifier_Code_>004010X092A1</_08_Version__Release__ Industry_Identifier_Code_> </GS> <_270> <ST> <_01_Transaction_Set_Identifier_Code_>270</_01_Transaction_Set_Identifier_Code_> <_02_Transaction_Set_Control_Number_>1234</_02_Transaction_Set_Control_Number_> </ST> <BHT> <_01_Hierarchical_Structure_Code_>0022</_01_Hierarchical_Structure_Code_> <_02_Transaction_Set_Purpose_Code_>13</_02_Transaction_Set_Purpose_Code_> <_03_Reference_Identification_>10001234</_03_Reference_Identification_> <_04_Date_>19990501</_04_Date_> <_05_Time_>1319</_05_Time_> </BHT> <_2000A> <HL> <_01_Hierarchical_ID_Number_>1</_01_Hierarchical_ID_Number_> <_03_Hierarchical_Level_Code_>20</_03_Hierarchical_Level_Code_> <_04_Hierarchical_Child_Code_>1</_04_Hierarchical_Child_Code_> </HL> <_2100A> <NM1> <_01_Entity_Identifier_Code_>PR</_01_Entity_Identifier_Code_> <_02_Entity_Type_Qualifier_>2</_02_Entity_Type_Qualifier_> <_03_Name_Last_or_Organization_Name_>ABCCOMPANY</_03_Name_Last_or_Organization_Name_> <_08_Identification_Code_Qualifier_>PI</_08_Identification_Code_Qualifier_> <_09_Identification_Code_>842610001</_09_Identification_Code_> </NM1> </_2100A> <_2000B> <HL> <_01_Hierarchical_ID_Number_>2</_01_Hierarchical_ID_Number_> <_02_Hierarchical_Parent_ID_Number_>1</_02_Hierarchical_Parent_ID_Number_> <_03_Hierarchical_Level_Code_>21</_03_Hierarchical_Level_Code_> <_04_Hierarchical_Child_Code_>1</_04_Hierarchical_Child_Code_> </HL> <_2100B> <NM1> <_01_Entity_Identifier_Code_>1P</_01_Entity_Identifier_Code_> <_02_Entity_Type_Qualifier_>1</_02_Entity_Type_Qualifier_> <_03_Name_Last_or_Organization_Name_>JONES</_03_Name_Last_or_Organization_Name_> <_04_Name_First_>MARCUS</_04_Name_First_> <_08_Identification_Code_Qualifier_>SV</_08_Identification_Code_Qualifier_> <_09_Identification_Code_>0202034</_09_Identification_Code_> </NM1> <REF> <_01_Reference_Identification_Qualifier_>N5</_01_Reference_Identification_Qualifier_> <_02_Reference_Identification_>129</_02_Reference_Identification_> </REF> <N3> <_01_Address_Information_>55 HIGH STREET</_01_Address_Information_> </N3> <N4> <_01_City_Name_>SEATTLE</_01_City_Name_> <_02_State_or_Province_Code_>NY</_02_State_or_Province_Code_> <_03_Postal_Code_>10121</_03_Postal_Code_> </N4> <PER> <_01_Contact_Function_Code_>IC</_01_Contact_Function_Code_> <_02_Name_>MARYMURPHY</_02_Name_> <_03_Communication_Number_Qualifier_>TE</_03_Communication_Number_Qualifier_> <_04_Communication_Number_>2065551212</_04_Communication_Number_> <_05_Communication_Number_Qualifier_>EX</_05_Communication_Number_Qualifier_> <_06_Communication_Number_>3694</_06_Communication_Number_> <_07_Communication_Number_Qualifier_>FX</_07_Communication_Number_Qualifier_> <_08_Communication_Number_>2065551214</_08_Communication_Number_> </PER> </_2100B> <_2000C> <HL> <_01_Hierarchical_ID_Number_>3</_01_Hierarchical_ID_Number_> <_02_Hierarchical_Parent_ID_Number_>2</_02_Hierarchical_Parent_ID_Number_> <_03_Hierarchical_Level_Code_>22</_03_Hierarchical_Level_Code_> <_04_Hierarchical_Child_Code_>1</_04_Hierarchical_Child_Code_> </HL> <_2100C> <NM1> <_01_Entity_Identifier_Code_>IL</_01_Entity_Identifier_Code_> <_02_Entity_Type_Qualifier_>1</_02_Entity_Type_Qualifier_> <_03_Name_Last_or_Organization_Name_>SMITH</_03_Name_Last_or_Organization_Name_> <_04_Name_First_>ROBERT</_04_Name_First_> <_05_Name_Middle_>B</_05_Name_Middle_> <_08_Identification_Code_Qualifier_>MI</_08_Identification_Code_Qualifier_> <_09_Identification_Code_>11122333301</_09_Identification_Code_> </NM1> <REF> <_01_Reference_Identification_Qualifier_>1L</_01_Reference_Identification_Qualifier_> <_02_Reference_Identification_>599119</_02_Reference_Identification_> </REF> <N3> <_01_Address_Information_>29 FREMONT ST</_01_Address_Information_> <_02_Address_Information_>APT# 1</_02_Address_Information_> </N3> <N4> <_01_City_Name_>PEACE</_01_City_Name_> <_02_State_or_Province_Code_>NY</_02_State_or_Province_Code_> <_03_Postal_Code_>10023</_03_Postal_Code_> </N4> <DMG> <_01_Date_Time_Period_Format_Qualifier_>D8</_01_Date_Time_Period_Format_Qualifier_> <_02_Date_Time_Period_>19430519</_02_Date_Time_Period_> <_03_Gender_Code_>M</_03_Gender_Code_> </DMG> </_2100C> <_2000D> <HL> <_01_Hierarchical_ID_Number_>4</_01_Hierarchical_ID_Number_> <_02_Hierarchical_Parent_ID_Number_>3</_02_Hierarchical_Parent_ID_Number_> <_03_Hierarchical_Level_Code_>23</_03_Hierarchical_Level_Code_> <_04_Hierarchical_Child_Code_>0</_04_Hierarchical_Child_Code_> </HL> <TRN> <_01_Trace_Type_Code_>1</_01_Trace_Type_Code_> <_02_Reference_Identification_>93175-012547</_02_Reference_Identification_> <_03_Originating_Company_Identifier_>9877281234</_03_Originating_Company_Identifier_> <_04_Reference_Identification_>RADIOLOGY</_04_Reference_Identification_> </TRN> <_2100D> <NM1> <_01_Entity_Identifier_Code_>03</_01_Entity_Identifier_Code_> <_02_Entity_Type_Qualifier_>1</_02_Entity_Type_Qualifier_> <_03_Name_Last_or_Organization_Name_>SMITH</_03_Name_Last_or_Organization_Name_> <_04_Name_First_>MARYLOU</_04_Name_First_> </NM1> <REF> <_01_Reference_Identification_Qualifier_>SY</_01_Reference_Identification_Qualifier_> <_02_Reference_Identification_>003221234</_02_Reference_Identification_> </REF> <N3> <_01_Address_Information_>29 FREMONT ST</_01_Address_Information_> <_02_Address_Information_>APT# 1</_02_Address_Information_> </N3> <N4> <_01_City_Name_>PEACE</_01_City_Name_> <_02_State_or_Province_Code_>NY</_02_State_or_Province_Code_> <_03_Postal_Code_>10023</_03_Postal_Code_> </N4> <DMG> <_01_Date_Time_Period_Format_Qualifier_>D8</_01_Date_Time_Period_Format_Qualifier_> <_02_Date_Time_Period_>19781014</_02_Date_Time_Period_> <_03_Gender_Code_>F</_03_Gender_Code_> </DMG> <DTP> <_01_Date_Time_Qualifier_>472</_01_Date_Time_Qualifier_> <_02_Date_Time_Period_Format_Qualifier_>D8</_02_Date_Time_Period_Format_Qualifier_> <_03_Date_Time_Period_>19990501</_03_Date_Time_Period_> </DTP> <_2110D> <EQ> <_01_Service_Type_Code_>81</_01_Service_Type_Code_> <_03_Coverage_Level_Code_>FAM</_03_Coverage_Level_Code_> </EQ> </_2110D> </_2100D> </_2000D> </_2000C> </_2000B> </_2000A> <SE> <_01_Number_of_Included_Segments_>26</_01_Number_of_Included_Segments_> <_02_Transaction_Set_Control_Number_>1234</_02_Transaction_Set_Control_Number_> </SE> </_270> <GE> <_01_Number_of_Transaction_Sets_Included_>1</_01_Number_of_Transaction_Sets_Included_> <_02_Group_Control_Number_>1</_02_Group_Control_Number_> </GE> <IEA> <_01_Number_of_Included_Functional_Groups_>1</_01_Number_of_Included_Functional_Groups_> <_02_Interchange_Control_Number_>000000905</_02_Interchange_Control_Number_> </IEA> </HIPAA270> </input> <output><![CDATA[ISA*00*1234567890*00*1234567890*ZZ*SUBMITTERS ID12*ZZ*RECEIVERS ID123*010122*1253*U*00401*000000905*1*T*:~GS*HS* SenderID*ReceiverID*20010122*1310*1*X*004010X092A1~ST*270*1234~BHT*0022*13*10001234*19990501 *1319~HL*1**20*1~NM1*PR*2*ABCCOMPANY*****PI*842610001~HL*2*1*21*1~NM1*1P*1*JONES* MARCUS****SV*0202034~REF*N5*129~N3*55 HIGH STREET~N4*SEATTLE*NY*10121~PER*IC*MARYMURPHY *TE*2065551212*EX*3694*FX*2065551214~HL*3*2*22*1~NM1*IL*1*SMITH*ROBERT*B ***MI*11122333301~REF*1L*599119~N3*29 FREMONT ST*APT# 1~N4*PEACE*NY*10023 ~DMG*D8*19430519*M~HL*4*3*23*0~TRN*1*93175-012547*9877281234 *RADIOLOGY~NM1*03*1*SMITH*MARYLOU~REF*SY*003221234~N3*29 FREMONT ST*APT# 1~N4*PEACE* NY*10023~DMG*D8*19781014*F~DTP*472*D8*19990501~EQ*81**FAM~SE*26*1234~GE*1*1~IEA*1*000000905~]]></output> </documents>
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