| Field | Format Code | Example |
| Provider | [{4}] {0}, {1} - DataSet {5} | [MW] Welby, Marcus - Dataset 101 |
| Referral Source | [{0}] {1} {3} - DataSet {4} | [CSU] Crisis Stabilization Unit - Dataset 101 |
| Tag | Field | |
| Provider | {0} | Last name |
| {1} | First name | |
| {2} | Middle Initial | |
| {3} | DataSet Description | |
| {4} | Shorthand provider code | |
| {5} | DataSet number | |
| Referral Source | {0} | Shorthand code |
| {1} | Organizatoin/Last name | |
| {2} | DataSet Description | |
| {3} | First name | |
| {4} | DataSet number |