| Patient Info | 
        0010 0010 PN 1 Patient's Name 0010 0020 LO 1 Patient ID 0010 1005 PN 1 Patient's Birth Name 0010 1040 LO 1 Patient's Address 0010 2154 SH 1-n Patient's Telephone Numbers  | 
    
      | Physician Info | 
        0008 0090 PN 1 Referring Physician's Name 0008 0092 ST 1 Referring Physician's Address 0008 0094 SH 1-n Referring Physician's Telephone Numbers 0008 1048 PN 1-n Physician(s) of Record 0008 1050 PN 1-n Performing Physician's Name 0008 1060 PN 1-n Name of Physician(s) Reading Study 0032 1032 PN 1 Requesting Physician 0040 0006 PN 1 Scheduled Performing Physician's Name 4008 0114 PN 1 Physician Approving Interpretation  | 
    
      | Operator Info | 
        0008 1070 PN 1-n Operator's Name  |