<?xml version="1.0" encoding="UTF-8"?>
<PreEncounter>
	<SenderData ProviderName="My Org" ProviderETIN="94203283999" BatchNumber="yyyy0504-006"/>
	<DocumentFunction DocumentNumber="yyyy0504-006-001" DocumentFunction="4" DMHID="######">
		<EpisodeCare Division="CPS" EnrollingProviderSiteName="Columbia" EnrollingProviderSiteID="406" AdmissionDateTime="yyyy-05-05 12:00">
			<ProgramAssignment Program="CPSAdult-C " ProgramFromDate="yyyy-05-05" ProgramFromTime="03:00 PM" Status="1" LivingArrangement="09" ProgramLevel="Maintenance"/> 
		</EpisodeCare>
	</DocumentFunction>
</PreEncounter>
