<?xml version="1.0" encoding="UTF-8"?>
<PreEncounter>
	<SenderData ProviderName="My Org" ProviderETIN="94203283999" BatchNumber="20060504-004"/>
	<DocumentFunction DocumentNumber="20060504-004" DocumentFunction="3" DMHID="700073">
		<ConsumerData>
			<StandardMeansTest FromDate="2007-01-01" MonthlyAbilityToPayAmt="0" PreparedBy="J C Runner"/>
		</ConsumerData>
	</DocumentFunction>
</PreEncounter>
