Templates

SEGMENT / ISA INTERCHANGE CONTROL HEADER

ISA01 = Authorization Information Qualifier

Usage = Must use

^00^ = No Authorization information present

Description = Code 00 is to identify that there is no Authorization information is present

ISA02 = Authorisation information

Usage = Must Use

^^ = No Authorisation

Description = Information used for additional identification or authorization of the

interchange sender or the data in the interchange; the type of information is set by the Authorization
Information Qualifier (ISA01)

ISA03 = security information qualifier

Usage = Must Use

^00^ = No Security Information Present

Description = Code to identify the type of information in the Security Information but code
00 denotes that there is no security information is present

ISA04 = Security Information

Usage = Must Use

^^ = No Security Information

Description = This is used for identifying the security information about the interchange
sender or the data in the interchange; the type of information is set by the Security Information
Qualifier (ISA03)

ISA05 = Interchange ID Qualifier

Usage = Must Use

^01^ = Duns (Dun & Bradstreet)

Description = Qualifier to designate the system/method of code structure used to

designate the sender or receiver ID element being qualified.

ISA06 = Interchange Sender ID

Usage = Must Use

^0382206625066^ = Interchange Sender ID

Description: Identification code “FIRSTSOURCE “is published by the sender for other parties to use as
the receiver ID to route data to them; the sender always codes this value in the sender ID element

ISA07 = Interchange ID Qualifier

Usage = Must Use

^ZZ^ = Mutually Defined

Description = Qualifier to designate the system/method of code structure used to

designate the sender or receiver ID element being qualified and the value “ZZ” denotes “Mutually
Defined”

ISA08 = Interchange Receiver ID

Usage = Must Use

^GHX-EU^ = Interchange Receiver ID

Description = Identification code GHXFAX is published by the receiver of the data; When
sending, it is used by the sender as their sending ID, thus other parties sending to them will use this
as are receiving ID to route data to them

ISA09 = Interchange Date

Usage = Must Use

^201012^ = Interchanger Date

Description = Date of the interchange is 201012

ISA10 = Interchange Time

Usage = Must Use

^1039^ = Interchange Time

Description = The Interchange Time is 1039

ISA11 = Interchange Control Standard Identifier

Usage = Must Use

^U^ = U.S. EDI Community of ASC X12, TDCC, and UCS

Description = Code U is to identify the agency responsible for the control standard used by
the message that is enclosed by the interchange header and trailer, ie U.S. EDI Community of ASC
X12, TDCC, and UCS

ISA12 = Interchange Control Version Number

^00401^ = Draft Standards for Trial Use Approved for Publication by ASC X12
Procedures Review Board through October 1997

Description = Code 00401 is specifying the version number of the interchange control
segments by Draft Standards for Trial Use Approved for Publication by ASC X12 Procedures Review
Board through October 1997

ISA13 = interchange Control Number

Usage = Must Use

^13868^ = Interchange Control Number

Description = 500202236 is the control number assigned by the interchange sender

ISA14 = Acknowledgment Requested

Usage = Must Use

^0^ = No Acknowledgment Requested

Description = the code 0 means no acknowledgement is requested

ISA15 = Usage Indicator

Usage = Must Use

^P^ = Production Data

Description = P is to indicate that this is a production data

ISA16 = Component Element Separator

Usage = Must use

^|^ = Sub Field Delimiter

Description = The Sub field Delimiter | is the component element separator is a delimiter
and not a data element; this field provides the delimiter used to separate component data elements
within a composite data structure; this value must be different than the data element separator and
the segment terminator

=======================================

SEGMENT 1/ GS FUNCTION GROUP HEADER

GS01 = Functional Identifier Code

Usage = Must Use

^PR^ = purchase order Acknowledgement

Description = Code identifying a group of application related transaction sets

GS02 = Application Sender Code

Usage = Must Use

^0382206625066^= Application Sender Code

Description = Code FIRSTSOURCE is identifying party sending transmission; codes agreed

to by trading partners

GS03 = Application Receivers Code

Usage = Must use

^GHX-EU^ = Application receivers code

Description = Code identifying party receiving transmission; codes agreed to by trading

partners
GS04 = Date

Usage = Must Use

^20201012^ = Date

Description = Date 20201012 is expressed as CCYYMMDD

GS05 = Time

Usage = Must Use

^1039^ = Time

Description = Time iis expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or
HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-59), S = integer seconds (00-
59) and DD = decimal seconds; decimal seconds are expressed as follows: D= tenths (0-9) and DD =
hundredths (00-99)

GS06 = Group Control Number

Usage = Must use

^13868^ = Group Control Number

Description = Assigned number 1 originated and maintained by the sender

GS07 = Responsible Agency Code

Usage = Must Use

^x^ = Accredited Standards Committee X12

Description = Code identifying the issuer of the standard; this code is used in
conjunction with Data Element 480

GS08 = Version / Release / Industry Identifier code

Usage = Must Use

^004010^ = 004010 Draft Standards Approved for Publication by ASC X12 Procedures
Review Board through October 1997
Description = Code 004010 indicating the version, release, sub release, and industry
identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS
segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and
sub release, level of the version; and positions 7-12 are the industry or trade association identifiers
(optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed

==============================================

SEGMENT 2 / ST TRANSACTION SET HEADER

Purpose = To indicate the start of a transaction set and to assign a control number

ST01 = Transaction Set Identifier Code

Usage = Must Use

^855^ = PURCHASE ORDER ACKNOWLEDGEMENT

Description = Code uniquely identifying a Transaction Set

ST02 = Transaction set Control Number

Usage = Must use

^0001^ = Transaction Set Control Number

Description = Identifying control number 0001 that must be unique within the transaction
set functional group assigned by the originator for a transaction set

====================================

SEGMENT 3 / BAK BEGINNING SEGMENT FOR PURCHASE ORDER ACKNOWLEDGMENT

Purpose: To indicate the beginning of the Purchase Order Acknowledgment Transaction Set
and transmit identifying numbers and dates

BAK01 = Transaction Set Purpose Code

^00^ = Original

Description = Code identifying purpose of transaction set

BAK02 = Purchase order Type Code

Usage = Must use

^AT^ = Accepted

Description = Code specifying the type of Purchase Order

BAK03 = Purchase Order Number

Usage = Must Use

^2020/Z/67111^= purchase order Number

Description = Identifying number for Purchase Order assigned by the orderer/purchaser

BAK04 = Date

Usage = Must Use

^20201012^ = date

Description = Date expressed as CCYYMMDD

BAK05 = Release Number

USAGE = MUST USE

^^ = not defined

Description = Number identifying a release against a Purchase Order previously placed by

the parties involved in the transaction

BAK06 = Request Reference Number

USAGE = MUST USE

^^ = not defined

Description = Reference number or RFQ number to use to identify a particular transaction

set and query (additional reference number or description which can be used with contract number)

BAK07 = Contract Number

USAGE = MUST USE

^^ = not defined

Description = Contact Number

==============================================

SEGMENET 4/ CUR CURRENCY

Purpose: To specify the currency (dollars, pounds, francs, etc.) used in a transaction

CUR01 = Entity Identifier Code

Usage = Must use

^ZZ^ = Mutually Defined

Description = Code identifying an organizational entity, a physical location, property or an

individual

CUR02 = currency Code

Usage = Must Use

^EUR^ = European currency

Description = Code (Standard ISO) for country in whose currency the charges are specified

=======================================================

SEGMENT 5/ REF REFERENCE IDENTIFICATION

Purpose: To specify identifying information

REF01 = Reference Identifier Qualifier

Usage = Must Use

^^ = Not specified

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ EDIFACTHeaderStatus^29^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

==============================

SEGMENT 6/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^PO^ = Purchase Order

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ 2020/Z/67111^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

===========================

SEGMENT 7/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^ZZ^ = Mutually Defined

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ SellerOrderResponseNumber^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

REF03 = Description

Usage = used

^ 3834324^ = free form

Description = A free-form description to clarify the related data elements and their
content

===========================================

SEGMENT 8/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^CO^ = Customer Order Number

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ 2020/Z/67111#2020-10-12#^ = identification
Description = Reference information as defined for a particular Transaction Set or as
specified by the Reference Identification Qualifier

========================================

SEGMENT 9/ DTM DATE/TIME REFERENCE

DTM01 = Date /Time Qualifier

Usage = Must Use

^069^ = Promised for Delivery

Description = Code specifying type of date or time, or both date and time

==========================================================

SEGMENT 10/ N1 NAME

Purpose: To identify a party by type of organization, name, and code

N101 = Entity Identification Code

Usage = Must Use

^BY^ = Buying Party [purchaser]

Description = Code identifying an organizational entity, a physical location, property or an

individual

N102 = Name

Usage = Must Use

^ CHU DE LIMOGES ^ = freeform name

Description = Free-form name

N103 = Identification Code Qualifier

Usage = Must Use

^8^ = UCC/EAN Global Product Identification Prefix

Description = Code designating the system/method of code structure used for Identification
Code (67)

N104 = Identification Code

Usage = Situational (At least one of N102 or N103 is required)

^320^ = identification code

Description = Code identifying a party or other code

=========================================

SEGMENT 11 / N1 NAME

N101 = Name

Usage = Must Use

^SE^ = selling party

Description = Code identifying an organizational entity, a physical location, property or an

individual

N102 = Name

Usage = Must use

^ Integra Lifesciences Services (Fran^8^32S^ = free form name

Description = free form name

============================================

SEGMENT 12/ N2 ADDITIONAL NAME INFORMATION

N201 = Name

Usage = must use

^ ce) SAS ^ = free form name

Description = Free-form name

========================================

SEGMENT 13 / N3 = ADDRESS INFORMATION

N301 = Address information

Usage = Must use

^ Immeuble Sequoia 2,97 allée Alexand^re Borodine,Parc Tech Porte des Alp^ = address information
of the party

Description = Address information

===============================================

SEGMENT 14/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^VX^ = Mutually Defined

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ FR82492534466^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

===============================================

SEGMENT 15 / N1 NAME

Purpose: To identify a party by type of organization, name, and code

N101 = Entity Identification Code

Usage = Must Use

^ST^ = Shipping to

Description = Code identifying an organizational entity, a physical location, property or an

individual

N102 = Name

Usage = Must Use

^^ = freeform name

Description = Free-form name

N103 = Identification Code Qualifier

Usage = Must Use

^8^ = UCC/EAN Global Product Identification Prefix

Description = Code designating the system/method of code structure used for Identification
Code (67)

N104 = Identification Code

Usage = Situational (At least one of N102 or N103 is required)

^ 870004^ = identification code

Description = Code identifying a party or other code

======================================

SEGMENT 16 / PO1 / BASELINE ITEM DATA

PO101 = Assigned identification

Usage = Must Use

^1^ = assigned number

Description = Alphanumeric characters assigned for differentiation within a transaction set

PO102 = Quantity ordered

Usage = Must Use

^^ = not defined

Description = Quantity ordered

PO103 = Unit or Basis of Measurement Code

Usage = Must Use

^^ = Not defined

Description = Code specifying the units in which a value is being expressed, or manner in
which a measurement has been taken

PO104 = Unit Price

Usage = Must Use

^730.6^ = unit price

Description = Price per unit of product, service, commodity, etc.

PO105 = Unit Price code

Usage = Optional

^^ = not defined

Description = Code identifying the type of unit price for an item

PO106 = product / service ID qualifier

Usage = Must Use

^VC^ = Vendor's (Seller's) Catalog Number

Description = Code identifying the type/source of the descriptive number used in

Product/Service ID

PO107 = product/service ID

Usage = Must Use

^909712^ = product ID

Description = Identifying number for a product or service

PO108 = Product/service ID qualifier

Usage = Must Use

^EN^ = European Article Number (EAN) (2-5-5-1)

Description = Code identifying the type/source of the descriptive number used in

Product/Service ID (234)

PO109 = product/service ID

Usage = Must Use

^10381780034032^= product ID

Description = Identifying number for a product or service

==================================

SEGMENT 17/ PID PRODUCT /ITEM DESCRIPTION

PID01 = ITEM DESCRIPTION

USAGE = Must Use

^F^ = Free-form

Description = Code indicating the format of a description

PID02 = Product/Process Characteristic Code

USAGE = Must Use

^^ = No Authorisation information
Description = Code identifying the general class of a product or process characteristic

PID03 = Agency Qualifier Code

USAGE = Must Use

^^ = No Authorisation code

Description = Code identifying the agency assigning the code values

PID04 = Product Description Code

USAGE = Must Use

^ VALVE ORBIS SIGMA CATH 15 CM AVEC A NTICHAMBRE^ = Product Description

Description = A code from an industry code list which provides specific data about a
product characteristic

===================================================================

SEGMENT 18/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^ZZ^ = Mutually Defined

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ EDIFACTLineStatus^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

REF03 = Description

Usage = used

^ 5^ = free form

Description = A free-form description to clarify the related data elements and their
content
==========================

SEGMENT 19/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^PO^ = Purchase order

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ 2020/Z/67111^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

==============================

SEGMENT 20/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^ZZ^ = Mutually Defined

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ EA^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

REF03 = Description

Usage = used

^ CommittedQuantityUOM^ = free form

Description = A free-form description to clarify the related data elements and their
content

===============================================

SEGMENT 21/ REFERENCE IDENTIFICATION

REF01 = Reference Identifier Qualifier

Usage = Must Use

^ZZ^ = Mutually Defined

Description = Code qualifying the Reference Identification

REF02 = Reference Identification

Usage = Must Use

^ OriginalLineItemNumber^ = identification

Description = Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

REF03 = Description

Usage = used

^1^ = free form

Description = A free-form description to clarify the related data elements and their
content

==================================

SEGMENT 22/ ACK LINE ITEM ACKNOWLEDGMENT

ACK01 = Line Item Status Code

Usage = Must Use

^IA^ = Item Accepted

================================================

SEGMENT 23/ QTY QUANTITY

QTY01 = Quantity Qualifier

USAGE = MUST USE

^27^ = Committed Quantity

Description = Code specifying the type of quantity

=========================================================
SEGMENT 19/ CTT TRANSACTION TOTALS

CTT01 = Number of Line Items

USAGE = MUST USE

^1^ = NUMBER OF ITEMS

Description = Total number of line items in the transaction set

========================================

SEGMENT / SE Functional Group Trailer

SE01 = Number of Included Segments

USAGE = MUST USE

^24^ = number of included segments

Description = Total number of segments included in a transaction set including ST and SE

segments

SE02 = Transaction Set Control Number

Usage = must use

^0001^ = number

Description = Identifying control number that must be unique within the transaction set
functional group assigned by the originator for a transaction se

===============================

SEGMENT / GE Functional Group Trailer

GE01 = Number of Transaction Sets Included

USAGE = MUST USE

^1^ = Number

Description = Total number of transaction sets included in the functional group or

interchange (transmission) group terminated by the trailer containing this data element

GE02 = Group Control Number

USAGE = MUST USE

^ 13868^ = Group control number

Description = Assigned number originated and maintained by the sender

==================================================

SEGMENT / IEA Interchange Control Trailer

IEA01 = Number of Included Functional Groups

USAGE = MUST USE

^1^ = NUMBER OF INCULDED FUNCTIONAL GROUPS

Description = A count of the number of functional groups included in an interchange

IEA02 = Interchange Control Number

USAGE = MUST USE

^ 13868^ = Interchange Control Number

Description = A control number assigned by the interchange sender

=================================================