x12 112 Property Damage Report

112 Example

 ISA*00* *00* *01*1234567890 *01*999999999 *120126*1211*U*00401*000000010*0*P~
GS*NL*1234567890 *999999999 *20120126*1211*1*T*004010~
ST*112*0001~
BGN*00*Reference Identification*20120127*09075500*01*Reference Identification*01*1*00~
DTP*001*CC*Date Time Period~
C3*CUR*57122*CUR*CUR~
SUP*BLC*01*Free Form Message*CN~
MSG*Free-Form Message Text*AA*81232307~
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01~
N2*Name*Name~
N3*Address Information*Address Information~
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number~
HL*1**1*0~
N9*01*Reference Identification*Free-form Description*20120127*0907*01*01\Reference Identification\01\Reference Identification~
K2*Description~
QTY*01*41264775236*01\130352591328509\1764\01\71661012\86712558\01\311201107747\12089173\01\1994421\3432485\01\43390676\1106281~
DTP*001*CC*Date Time Period~
TXI*AA*143352671*283163435*CD*Tax Jurisd*0*A*298*Tax Identification~
LM*10*Source~
SLN*Assigned Identificat*Assigned Identificat*A*36*01\183701950912919\7\01\28\2120616\01\28051547\286362802\01\174511\~
AMT*1*14*C~
III*0*Industry Code*01*Free-Form Message~
Text*31153*01\26093173682\7773\01\19293571\14106\01\2\261102\01\327463436502919\191622983\01\2279149\36*1S*1S*1S~
AMT*1*183719056*C~
PCT*1*271223588~
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01~
N2*Name*Name~
N3*Address Information*Address Information~
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier~
MS1*City Name*ST*COU~
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number~
CID*1*01*10*Product Desc*Description*Source Subquali*N~
MEA*9L*1*2044*01\29\535129\01\3\77402\01\23695184811\1819\01\3206318\114451\01\24895699369\114543*24*24766468*01**1S*BM~
SE*32*0001~
GE*1*1~
IEA*1*000000010~