Sample NSF

  Note:

 AA0043901                   ASY024000293JOHN DOE CLINIC                  12 MAIN STREET STE 101                                      CITY                ST55555         JOHN DOE     8885555555          888555555520070803160720                G     00400PROD00001                                                          3
 BA0444600051002   1000001      999999999      E               A12345                                    123456789001                                                JOHN DOE CLINIC                  DOE                 JOHN        R                  22354                                                       1501112222  3
 BA1444600051002   1000001         12 MAIN STREET                SUITE 101                     CITY                ST555559999888555555512 MAIN STREET                SUITE 101                     CITY                ST5555599998885555555                                                                                    3
 CA0  12345 A00056789  DOE                 ERIN        J   19990101F 123 MAY                                                     CITY                OK55555    8885555555MN9N        3C  N                          123456789002                                                                                                3
 CA1  37635                                                                         1301112222          1501112222                                                                                                                                                                                                               3
 DA00112345 A00056789  PG  SB840NONEBLUE CROSS OF OKLAHOMA           009907                                               N                              YB01EGIW12345678             DOE                 ERIN        J   F199901019                                                                                             3
 DA10112345 A00056789  P O BOX 3283                  CLAIMS DEPT                   TULSA               OK74102                                       0000000                                                                                                                                                                     3
 EA0  12345 A00056789  NN0                   Y        N                                                                                                                    N00000003730037515          AY20070803DOCTOR OFFICE                    9      N                                                             1G        3
 EA1  12345 A00056789  999999999                     123 MAIN STREET   SUITE 101                                 CITY                ST55555                                                                                                                                                                                     3
 FA00112345 A00056789  57355301         2007080320070803111 92012      000700012  00100000N  444600051002                    N                                                                                                                                                                                                   3
 FA10137635                             1301112222          1501112222          1301112222                                                                                                                                                                                                                                       3
 FB10112345 A00056789  57355301         DOCTOR OFFICE                                                                                                                    DOE                 JOHN        RA12345                                                                                                                 3
 XA0  12345 A00056789  020202030000009                                        000700000000000000000000000000000000000000000000000000000000000                                                                                                                                                                                    3
 YA0444600051002   1000001      999999999      000000200000230000002000014000                                                                                                                                                                                                                                                    3
 BA0444600051P     1000008      999999999      E999999999      A12345                                                                                                JOHN DOE CLINIC                  DOE                 JOHN        R                  22354                                                       1501112222  3
 BA1444600051P     1000008         12 MAIN STREET                SUITE 101                     CITY                ST555559999888555555512 MAIN STREET                SUITE 101                     CITY                ST5555599998885555555                                                                                    3
 CA0  54321 A00098765  DOE                 JESE        B   19990101M 415 E MAPLE                                                 CITY                OK55555    8885555555UN9N        1C  N                          444600051P                                                                                                  3
 CA1  37644                                                                         1301112222          1501112222                                                                                                                                                                                                               3
 DA00154321 A00098765  PCMP     NONEMEDICARE OKLAHOMA                NONE                                                 N                              YB01123456789A               DOE                 JESE        B   M199901019S                                                                                            3
 DA10154321 A00098765  P O BOX 8018                                                LITTLE ROCK         AR72203                                       0000000                                                                                                                                                                     3
 DA00254321 A00098765  IFSP     NONECONTINENTAL LIFE INS CO          NONE                                                 N                              YB01012345678S               DOE                 JESE        B   M199901019S                                                                                            3
 DA10254321 A00098765  P O BOX 1188                                                BRENTWOOD           TN370241188                                   0000000                                                                                                                                                                     3
 EA0  54321 A00098765  NN0                   Y        N                                                                                                                    N00000003651136250          AY20070803DOCTOR OFFICE                    9      N                                                             1G        3
 EA1  54321 A00098765  999999999                     123 MAIN STREET   SUITE 101                                 CITY                ST55555                                                                                                                                                                                     3
 FA00154321 A00098765  57358601         2007080320070803111 92012      000700012  00100000N  444600051P                      N                                                                                                                                                                                                   3
 FA10137644                             1301112222          1501112222          1301112222                                                                                                                                                                                                                                       3
 FB10154321 A00098765  57358601         DOCTOR OFFICE                                                                                                                    DOE                 JOHN        RA12345                                                                                                                 3
 XA0  54321 A00098765  020402030000011                                        000700000000000000000000000000000000000000000000000000000000000                                                                                                                                                                                    3
 YA0442745318P     1000012      999999999      000000500000540000004000027300                                                                                                                                                                                                                                                    3
 ZA0043901                                   000008600009310000071002000002398321                                                                                                                                                                                                                                                3