<?xml version="1.0" encoding="UTF-8"?>
<PreEncounter>
	<SenderData ProviderName="My Org" ProviderETIN="94203283999" BatchNumber="20060504-001"/>
	<DocumentFunction DocumentNumber="20060504-001-001" DocumentFunction="0">
		<ConsumerData>
			<Name LastName="Smith" FirstName="John" MiddleName="M" Prefix="Mr"/>
			<Demographics Gender="01" DateOfBirth="1958-03-23" HearingStatus="144" PreferredLanguage="164" EmploymentStatus="8" SSN="000-00-0000" MaritalStatus="1" Occupation="01"/>
			<Address Street1="923 10th Street West" City="Jefferson City" State="MO" County="099" Country="US" Zip="63405-2345"/>
		</ConsumerData>
	</DocumentFunction>
</PreEncounter>
