| ADDRESS CHANGE DT/TM | PATIENT | PRIOR STREET ADDRESS [LINE 2] | PRIOR CITY | PRIOR COUNTY | PRIOR STATE | PRIOR ZIP+4 | PRIOR PROVINCE | PRIOR POSTAL CODE | PRIOR COUNTRY | PRIOR BAD ADDRESS INDICATOR | PRIOR STREET ADDRESS [LINE 3] | ADDRESS CHANGE USER | ADDRESS CHANGE SOURCE | ADDRESS CHANGE SITE | PRIOR ADDRESS CHANGE DT/TM | PRIOR ADDRESS CHANGE USER | PRIOR ADDRESS CHANGE SITE | PRIOR ADDRESS CHANGE SOURCE | PRIOR PHONE NUMBER [RESIDENCE] | PRIOR STREET ADDRESS [LINE 1] |
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