| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | DX CODE | 0;1 | FREE TEXT | 
 | 
| .02 | DATE OF EVENT | 0;2 | DATE | 
 | 
| .03 | RECORD | 0;3 | FREE TEXT | 
 | 
| .04 | DFN | 0;4 | FREE TEXT | 
 | 
| .05 | RECORD FILE | 0;5 | POINTER TO FILE FILE (#1) | FILE(#1) 
 | 
| .06 | VISIT IEN | 0;6 | FREE TEXT | 
 | 
| 1 | SUPPORTING VALUES | 1;0 | Multiple #90507.61111 | 90507.61111 |