(a) Each general acute care hospital and freestanding ambulatory surgery clinic shall file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed. The Ambulatory Surgery Data Record shall include all of the following:

1. (1) Date of birth.
2. (2) Sex.
3. (3) Race.
4. (4) Ethnicity.
5. (5) Preferred language spoken.
6. (6) ZIP Code.
7. (7) Patient social security number, if it is contained in the patient’s medical record.
8. (8) Service date.
9. (9) Principal diagnosis.
10. (10) Other diagnoses.
11. (11) Principal procedure.
12. (12) Other procedures.
13. (13) External causes of morbidity.
14. (14) Disposition of patient.
15. (15) Expected source of payment.
16. (16) Elements added pursuant to Section 128738.