| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | REFERRING PHYSICIAN | 0;1 | FREE TEXT | 
 | 
| 1 | STREET ADDRESS | 0;2 | FREE TEXT | 
 | 
| 2 | CITY | 0;3 | FREE TEXT | 
 | 
| 3 | STATE | 0;4 | POINTER TO STATE FILE (#5) | STATE(#5) 
 | 
| 4 | ZIP CODE | 0;5 | FREE TEXT | 
 | 
| 5 | PHONE NUMBER | 0;6 | FREE TEXT | 
 | 
| 6 | REF PHY 200 LINK | 0;7 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200) 
 |