With each submission of data, a transmittal record shall also be supplied that contains the following information:

1. (a) Submitting hospital or community health center;
2. (b) If different from submitting healthcare facility, the name and address of the location where the encounters in the submitted records occurred;
3. (c) File name;
4. (d) Contact person name;
5. (e) Contact person address;
6. (f) Contact person telephone number;
7. (g) Contact person e-mail address;
8. (h) Period beginning date;
9. (i) Period ending date;
10. (j) Record count;
11. (k) Date processed;
12. (l) Submission date; and
13. (m) Explanatory notes to assist with processing of the file.

Source. #9806, eff 11-1-10