<CF5 pHospitalCode="300829">
	<DRGCLAIM ClaimNumber="2601" PrimaryCode="A01.0" NewBornAdmWeight="" Remarks="">
		<SECONDARYDIAGS>
			<SECONDARYDIAG SecondaryCode="A03.0" Remarks="" />
		</SECONDARYDIAGS>
		<PROCEDURES>
			<PROCEDURE RvsCode="219ss20" Laterality="" Ext1="" Ext2="" Remarks="" />
			<PROCEDURE RvsCode="69000" Laterality="" Ext1="" Ext2="" Remarks="" />
			<PROCEDURE RvsCode="41108" Laterality="" Ext1="" Ext2="" Remarks="" />
			<PROCEDURE RvsCode="93631" Laterality="" Ext1="" Ext2="" Remarks="" />
			<PROCEDURE RvsCode="93631" Laterality="" Ext1="" Ext2="" Remarks="" />
		</PROCEDURES>
	</DRGCLAIM>
</CF5>