| Element/Gruppe | No/Code | Beschreibung | Opt/Mand. |
|---|
| Element | 7402 | Code specifying the unique identity of an object. | Mandatory |
| Gruppe | E507 | Date and/or time, or period relevant to the specified date/time/period type. | Optional |
| Gruppe | E021 | To identify a service and any modifications. | Optional |
| Element | 6060 | Alphanumeric representation of a quantity. | Optional |
| Element | 5004 | To specify a monetary amount. | Optional |
| Element | 5030 | To specify the value of an index. | Optional |
| Element | 9039 | Code specifying the facility type. | Optional |
| Element | 5267 | Code specifying the type of service. | Optional |
| Element | 4183 | Code specifying a special condition. | Optional |
| Gruppe | E024 | To identify the type of evidence, a unique reference number and the communication method. | Optional |
