2.16.840.1.113883.5.4/static-2012-07-24

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Codesystem Name Codesystem Id Version / Eingangsdatum Status
ActCode 2.16.840.1.113883.5.4 2012-07-24 definitiv
Level/Typ Code Anzeigename Beschreibung
0-S DIET EN-US.png Diet

Code set to define specialized/allowed diets

1-L BR EN-US.png breikost (GE)

A diet exclusively composed of oatmeal, semolina, or rice, to be extremely easy to eat and digest.

1-L DM EN-US.png diabetes mellitus diet

A diet that uses carbohydrates sparingly. Typically with a restriction in daily energy content (e.g. 1600-2000 kcal).

1-L FAST EN-US.png fasting

No enteral intake of foot or liquids whatsoever, no smoking. Typically 6 to 8 hours before anesthesia.

1-L GF EN-US.png gluten free

Gluten free diet for celiac disease.

1-L LF EN-US.png low fat

A diet low in fat, particularly to patients with hepatic diseases.

1-L LP EN-US.png low protein

A low protein diet for patients with renal failure.

1-L LQ EN-US.png liquid

A strictly liquid diet, that can be fully absorbed in the intestine, and therefore may not contain fiber. Used before enteral surgeries.

1-L LS EN-US.png low sodium

A diet low in sodium for patients with congestive heart failure and/or renal failure.

1-L N EN-US.png normal diet

A normal diet, i.e. no special preparations or restrictions for medical reasons. This is notwithstanding any preferences the patient might have regarding special foods, such as vegetarian, kosher, etc.

1-L NF EN-US.png no fat

A no fat diet for acute hepatic diseases.

1-L PAF EN-US.png phenylalanine free

Phenylketonuria diet.

1-L PAR EN-US.png parenteral

Patient is supplied with parenteral nutrition, typically described in terms of i.v. medications.

1-L RD EN-US.png reduction diet

A diet that seeks to reduce body fat, typically low energy content (800-1600 kcal).

1-L SCH EN-US.png schonkost (GE)

A diet that avoids ingredients that might cause digestion problems, e.g., avoid excessive fat, avoid too much fiber (cabbage, peas, beans).

1-L T EN-US.png tea only

This is not really a diet, since it contains little nutritional value, but is essentially just water. Used before coloscopy examinations.

1-L VLI EN-US.png low valin, leucin, isoleucin

Diet with low content of the amino-acids valin, leucin, and isoleucin, for "maple syrup disease."

0-A _ActAccountCode EN-US.png ActAccountCode

An account represents a grouping of financial transactions that are tracked and reported together with a single balance. Examples of account codes (types) are Patient billing accounts (collection of charges), Cost centers; Cash.

1-L ACCTRECEIVABLE EN-US.png account receivable

An account for collecting charges, reversals, adjustments and payments, including deductibles, copayments, coinsurance (financial transactions) credited or debited to the account receivable account for a patient's encounter.

1-L CASH EN-US.png Cash

1-S CC EN-US.png credit card

Description: Types of advance payment to be made on a plastic card usually issued by a financial institution used of purchasing services and/or products.

2-L AE EN-US.png American Express

2-L DN EN-US.png Diner's Club

2-L DV EN-US.png Discover Card

2-L MC EN-US.png Master Card

2-L V EN-US.png Visa

1-L PBILLACCT EN-US.png patient billing account

An account representing charges and credits (financial transactions) for a patient's encounter.

0-A _ActAdjudicationCode EN-US.png ActAdjudicationCode

Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

1-S AA EN-US.png adjudicated with adjustments

The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges). Also includes the concept 'Adjudicate as zero' and items not covered under a particular Policy. Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

2-L ANF EN-US.png adjudicated with adjustments and no financial impact

The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges) without changing the amount. Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

1-L AR EN-US.png adjudicated as refused

The invoice element has passed through the adjudication process but payment is refused due to one or more reasons. Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late'). If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected. A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer. Invoice element cannot be reversed (nullified) as there is nothing to reverse. Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting).

1-L AS EN-US.png adjudicated as submitted

The invoice element was/will be paid exactly as submitted, without financial adjustment(s). If the dollar amount stays the same, but the billing codes have been amended or financial adjustments have been applied through the adjudication process, the invoice element is treated as "Adjudicated with Adjustment". If information items are included in the adjudication results that do not affect the monetary amounts paid, then this is still Adjudicated as Submitted (e.g. 'reached Plan Maximum on this Claim'). Invoice element can be reversed (nullified). Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

1-A _ActAdjudicationGroupCode EN-US.png ActAdjudicationGroupCode

Catagorization of grouping criteria for the associated transactions and/or summary (totals, subtotals).

2-L CONT EN-US.png contract

Transaction counts and value totals by Contract Identifier.

2-L DAY EN-US.png day

Transaction counts and value totals for each calendar day within the date range specified.

2-L LOC EN-US.png location

Transaction counts and value totals by service location (e.g clinic).

2-L MONTH EN-US.png month

Transaction counts and value totals for each calendar month within the date range specified.

2-L PERIOD EN-US.png period

Transaction counts and value totals for the date range specified.

2-L PROV EN-US.png provider

Transaction counts and value totals by Provider Identifier.

2-L WEEK EN-US.png week

Transaction counts and value totals for each calendar week within the date range specified.

2-L YEAR EN-US.png year

Transaction counts and value totals for each calendar year within the date range specified.

0-A _ActAdjudicationResultActionCode EN-US.png ActAdjudicationResultActionCode

Actions to be carried out by the recipient of the Adjudication Result information.

1-L DISPLAY EN-US.png Display

The adjudication result associated is to be displayed to the receiver of the adjudication result.

1-L FORM EN-US.png Print on Form

The adjudication result associated is to be printed on the specified form, which is then provided to the covered party.

0-A _ActBillingArrangementCode EN-US.png ActBillingArrangementCode

The type of provision(s) made for reimbursing for the deliver of healthcare services and/or goods provided by a Provider, over a specified period.

1-L BLK EN-US.png block funding

A billing arrangement where a Provider charges a lump sum to provide a prescribed group (volume) of services to a single patient which occur over a period of time. Services included in the block may vary. This billing arrangement is also known as Program of Care for some specific Payors and Program Fees for other Payors.

1-L CAP EN-US.png capitation funding

A billing arrangement where the payment made to a Provider is determined by analyzing one or more demographic attributes about the persons/patients who are enrolled with the Provider (in their practice).

1-L CONTF EN-US.png contract funding

A billing arrangement where a Provider charges a lump sum to provide a particular volume of one or more interventions/procedures or groups of interventions/procedures.

1-L FINBILL EN-US.png financial

A billing arrangement where a Provider charges for non-clinical items. This includes interest in arrears, mileage, etc. Clinical content is not included in Invoices submitted with this type of billing arrangement.

1-L ROST EN-US.png roster funding

A billing arrangement where funding is based on a list of individuals registered as patients of the Provider.

1-L SESS EN-US.png sessional funding

A billing arrangement where a Provider charges a sum to provide a group (volume) of interventions/procedures to one or more patients within a defined period of time, typically on the same date. Interventions/procedures included in the session may vary.

0-A _ActBoundedROICode EN-US.png ActBoundedROICode

Type of bounded ROI.

1-L ROIFS EN-US.png fully specified ROI

A fully specified bounded Region of Interest (ROI) delineates a ROI in which only those dimensions participate that are specified by boundary criteria, whereas all other dimensions are excluded. For example a ROI to mark an episode of "ST elevation" in a subset of the EKG leads V2, V3, and V4 would include 4 boundaries, one each for time, V2, V3, and V4.

1-L ROIPS EN-US.png partially specified ROI

A partially specified bounded Region of Interest (ROI) specifies a ROI in which at least all values in the dimensions specified by the boundary criteria participate. For example, if an episode of ventricular fibrillations (VFib) is observed, it usually doesn't make sense to exclude any EKG leads from the observation and the partially specified ROI would contain only one boundary for time indicating the time interval where VFib was observed.

0-A _ActContainerRegistrationCode EN-US.png ActContainerRegistrationCode

Constrains the ActCode to the domain of Container Registration

1-L ID EN-US.png Identified

Used by one system to inform another that it has received a container.

1-L IP EN-US.png In Position

Used by one system to inform another that the container is in position for specimen transfer (e.g., container removal from track, pipetting, etc.).

1-L L EN-US.png Left Equipment

Used by one system to inform another that the container has been released from that system.

1-L M EN-US.png Missing

Used by one system to inform another that the container did not arrive at its next expected location.

1-L O EN-US.png In Process

Used by one system to inform another that the specific container is being processed by the equipment. It is useful as a response to a query about Container Status, when the specific step of the process is not relevant.

1-L R EN-US.png Process Completed

Status is used by one system to inform another that the processing has been completed, but the container has not been released from that system.

1-L X EN-US.png Container Unavailable

Used by one system to inform another that the container is no longer available within the scope of the system (e.g., tube broken or discarded).

0-A _ActControlVariable EN-US.png ActControlVariable

An observation form that determines parameters or attributes of an Act. Examples are the settings of a ventilator machine as parameters of a ventilator treatment act; the controls on dillution factors of a chemical analyzer as a parameter of a laboratory observation act; the settings of a physiologic measurement assembly (e.g., time skew) or the position of the body while measuring blood pressure. Control variables are forms of observations because just as with clinical observations, the Observation.code determines the parameter and the Observation.value assigns the value. While control variables sometimes can be observed (by noting the control settings or an actually measured feedback loop) they are not primary observations, in the sense that a control variable without a primary act is of no use (e.g., it makes no sense to record a blood pressure position without recording a blood pressure, whereas it does make sense to record a systolic blood pressure without a diastolic blood pressure).

1-L AUTO EN-US.png auto-repeat permission

Specifies whether or not automatic repeat testing is to be initiated on specimens.

1-L ENDC EN-US.png endogenous content

A baseline value for the measured test that is inherently contained in the diluent. In the calculation of the actual result for the measured test, this baseline value is normally considered.

1-L REFLEX EN-US.png reflex permission

Specifies whether or not further testing may be automatically or manually initiated on specimens.

0-A _ActCoverageConfirmationCode EN-US.png ActCoverageConfirmationCode

Response to an insurance coverage eligibility query or authorization request.

1-A _ActCoverageAuthorizationConfirmationCode EN-US.png ActCoverageAuthorizationConfirmationCode

Indication of authorization for healthcare service(s) and/or product(s). If authorization is approved, funds are set aside.

2-L AUTH EN-US.png Authorized

Authorization approved and funds have been set aside to pay for specified healthcare service(s) and/or product(s) within defined criteria for the authorization.

2-L NAUTH EN-US.png Not Authorized

Authorization for specified healthcare service(s) and/or product(s) denied.

0-A _ActCoverageLimitCode EN-US.png ActCoverageLimitCode

Criteria that are applicable to the authorized coverage.

1-S COVMX EN-US.png coverage maximum

Definition: Codes representing the maximum coverate or financial participation requirements.

2-L LFEMX EN-US.png life time maximum

Definition: Maximum amount paid by payer or covered party; or maximum number of services or products covered under the policy or program during a covered party's lifetime.

2-L PRDMX EN-US.png period maximum

Definition: Maximum amount paid by payer or covered party; or maximum number of services/products covered under the policy or program by time period specified by the effective time on the act.

1-A _ActCoverageQuantityLimitCode EN-US.png ActCoverageQuantityLimitCode

Maximum amount paid or maximum number of services/products covered; or maximum amount or number covered during a specified time period under the policy or program.

2-L COVPRD EN-US.png coverage period

Codes representing the time period during which coverage is available; or financial participation requirements are in effect.

2-L LFEMX EN-US.png life time maximum

Definition: Maximum amount paid by payer or covered party; or maximum number of services or products covered under the policy or program during a covered party's lifetime.

2-L NETAMT EN-US.png Net Amount

Maximum net amount that will be covered for the product or service specified.

2-L PRDMX EN-US.png period maximum

Definition: Maximum amount paid by payer or covered party; or maximum number of services/products covered under the policy or program by time period specified by the effective time on the act.

2-L UNITPRICE EN-US.png Unit Price

Maximum unit price that will be covered for the authorized product or service.

2-L UNITQTY EN-US.png Unit Quantity

Maximum number of items that will be covered of the product or service specified.

0-A _ActDetectedIssueManagementCode EN-US.png ActDetectedIssueManagementCode

Codes dealing with the management of Detected Issue observations

1-S 1 EN-US.png Therapy Appropriate

Confirmed drug therapy appropriate

2-L 19 EN-US.png Consulted Supplier

Consulted other supplier/pharmacy, therapy confirmed

2-L 2 EN-US.png Assessed Patient

Assessed patient, therapy is appropriate

2-L 22 EN-US.png appropriate indication or diagnosis

Description: The patient has the appropriate indication or diagnosis for the action to be taken.

2-L 23 EN-US.png prior therapy documented

Description: It has been confirmed that the appropriate pre-requisite therapy has been tried.

2-L 3 EN-US.png Patient Explanation

Patient gave adequate explanation

2-L 4 EN-US.png Consulted Other Source

Consulted other supply source, therapy still appropriate

2-S 5 EN-US.png Consulted Prescriber

Consulted prescriber, therapy confirmed

3-L 6 EN-US.png Prescriber Declined Change

Consulted prescriber and recommended change, prescriber declined

2-L 7 EN-US.png Interacting Therapy No Longer Active/Planned

Concurrent therapy triggering alert is no longer on-going or planned

1-S 14 EN-US.png Supply Appropriate

Confirmed supply action appropriate

2-L 15 EN-US.png Replacement

Patient's existing supply was lost/wasted

2-L 16 EN-US.png Vacation Supply

Supply date is due to patient vacation

2-L 17 EN-US.png Weekend Supply

Supply date is intended to carry patient over weekend

2-L 18 EN-US.png Leave of Absence

Supply is intended for use during a leave of absence from an institution.

2-L 20 EN-US.png additional quantity on separate dispense

Description: Supply is different than expected as an additional quantity has been supplied in a separate dispense.

1-S 8 EN-US.png Other Action Taken

Order is performed as issued, but other action taken to mitigate potential adverse effects

2-L 10 EN-US.png Provided Patient Education

Provided education or training to the patient on appropriate therapy use

2-L 11 EN-US.png Added Concurrent Therapy

Instituted an additional therapy to mitigate potential negative effects

2-L 12 EN-US.png Temporarily Suspended Concurrent Therapy

Suspended existing therapy that triggered interaction for the duration of this therapy

2-L 13 EN-US.png Stopped Concurrent Therapy

Aborted existing therapy that triggered interaction.

2-L 9 EN-US.png Instituted Ongoing Monitoring Program

Arranged to monitor patient for adverse effects

1-A _ActAdministrativeDetectedIssueManagementCode EN-US.png ActAdministrativeDetectedIssueManagementCode

Codes dealing with the management of Detected Issue observations for the administrative and patient administrative acts domains.

2-A _AuthorizationIssueManagementCode EN-US.png Authorization Issue Management Code

3-S EMAUTH EN-US.png emergency authorization override

Used to temporarily override normal authorization rules to gain access to data in a case of emergency. Use of this override code will typically be monitored, and a procedure to verify its proper use may be triggered when used.

4-L 21 EN-US.png authorization confirmed

Description: Indicates that the permissions have been externally verified and the request should be processed.

0-A _ActFinancialTransactionCode EN-US.png ActFinancialTransactionCode

1-L CHRG EN-US.png Standard Charge

A type of transaction that represents a charge for a service or product. Expressed in monetary terms.

1-L REV EN-US.png Standard Charge Reversal

A type of transaction that represents a reversal of a previous charge for a service or product. Expressed in monetary terms. It has the opposite effect of a standard charge.

0-A _ActIncidentCode EN-US.png ActIncidentCode

Set of codes indicating the type of incident or accident.

1-L MVA EN-US.png Motor vehicle accident

Incident or accident as the result of a motor vehicle accident

1-L SCHOOL EN-US.png School Accident

Incident or accident is the result of a school place accident.

1-L SPT EN-US.png Sporting Accident

Incident or accident is the result of a sporting accident.

1-L WPA EN-US.png Workplace accident

Incident or accident is the result of a work place accident

0-A _ActInvoiceElementCode EN-US.png ActInvoiceElementCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

1-A _ActInvoiceAdjudicationPaymentCode EN-US.png ActInvoiceAdjudicationPaymentCode

Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

2-A _ActInvoiceAdjudicationPaymentGroupCode EN-US.png ActInvoiceAdjudicationPaymentGroupCode

Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.

3-L ALEC EN-US.png alternate electronic

Payment initiated by the payor as the result of adjudicating a submitted invoice that arrived to the payor from an electronic source that did not provide a conformant set of HL7 messages (e.g. web claim submission).

3-L BONUS EN-US.png bonus

Bonus payments based on performance, volume, etc. as agreed to by the payor.

3-L CFWD EN-US.png carry forward adjusment

An amount still owing to the payor but the payment is 0$ and this cannot be settled until a future payment is made.

3-L EDU EN-US.png education fees

Fees deducted on behalf of a payee for tuition and continuing education.

3-L EPYMT EN-US.png early payment fee

Fees deducted on behalf of a payee for charges based on a shorter payment frequency (i.e. next day versus biweekly payments.

3-L GARN EN-US.png garnishee

Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

3-L INVOICE EN-US.png submitted invoice

Payment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results..

3-L PINV EN-US.png paper invoice

Payment initiated by the payor as the result of adjudicating a paper (original, may have been faxed) invoice.

3-L PPRD EN-US.png prior period adjustment

An amount that was owed to the payor as indicated, by a carry forward adjusment, in a previous payment advice

3-L PROA EN-US.png professional association deduction

Professional association fee that is collected by the payor from the practitioner/provider on behalf of the association

3-L RECOV EN-US.png recovery

Retroactive adjustment such as fee rate adjustment due to contract negotiations.

3-L RETRO EN-US.png retro adjustment

Bonus payments based on performance, volume, etc. as agreed to by the payor.

3-L TRAN EN-US.png transaction fee

Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

2-A _ActInvoiceAdjudicationPaymentSummaryCode EN-US.png ActInvoiceAdjudicationPaymentSummaryCode

Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee, etc.

3-L CONT EN-US.png contract

Transaction counts and value totals by Contract Identifier.

3-L DAY EN-US.png day

Transaction counts and value totals for each calendar day within the date range specified.

3-L INVTYPE EN-US.png invoice type

Transaction counts and value totals by invoice type (e.g. RXDINV - Pharmacy Dispense)

3-L LOC EN-US.png location

Transaction counts and value totals by service location (e.g clinic).

3-L MONTH EN-US.png month

Transaction counts and value totals for each calendar month within the date range specified.

3-L PAYEE EN-US.png payee

Transaction counts and value totals by each instance of an invoice payee.

3-L PAYOR EN-US.png payor

Transaction counts and value totals by each instance of an invoice payor.

3-L PERIOD EN-US.png period

Transaction counts and value totals for the date range specified.

3-L PROV EN-US.png provider

Transaction counts and value totals by Provider Identifier.

3-L SENDAPP EN-US.png sending application

Transaction counts and value totals by each instance of a messaging application on a single processor. It is a registered identifier known to the receivers.

3-L WEEK EN-US.png week

Transaction counts and value totals for each calendar week within the date range specified.

3-L YEAR EN-US.png year

Transaction counts and value totals for each calendar year within the date range specified.

1-A _ActInvoiceDetailCode EN-US.png ActInvoiceDetailCode

Codes representing a service or product that is being invoiced (billed). The code can represent such concepts as "office visit", "drug X", "wheelchair" and other billable items such as taxes, service charges and discounts.

2-A _ActInvoiceDetailClinicalProductCode EN-US.png ActInvoiceDetailClinicalProductCode

An identifying data string for healthcare products.

3-L UNSPSC EN-US.png United Nations Standard Products and Services Classification

Description:United Nations Standard Products and Services Classification, managed by Uniform Code Council (UCC): www.unspsc.org

2-A _ActInvoiceDetailDrugProductCode EN-US.png ActInvoiceDetailDrugProductCode

An identifying data string for A substance used as a medication or in the preparation of medication.

3-L GTIN EN-US.png Global Trade Item Number

Description:Global Trade Item Number is an identifier for trade items developed by GS1 (comprising the former EAN International and Uniform Code Council).

3-L UPC EN-US.png Universal Product Code

Description:Universal Product Code is one of a wide variety of bar code languages widely used in the United States and Canada for items in stores.

2-A _ActInvoiceDetailGenericCode EN-US.png ActInvoiceDetailGenericCode

The detail item codes to identify charges or changes to the total billing of a claim due to insurance rules and payments.

3-A _ActInvoiceDetailGenericAdjudicatorCode EN-US.png ActInvoiceDetailGenericAdjudicatorCode

The billable item codes to identify adjudicator specified components to the total billing of a claim.

4-L COIN EN-US.png coinsurance

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

4-L COPAYMENT EN-US.png patient co-pay

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

4-L DEDUCTIBLE EN-US.png deductible

That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

4-L PAY EN-US.png payment

The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.

4-L SPEND EN-US.png spend down

That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results

3-A _ActInvoiceDetailGenericModifierCode EN-US.png ActInvoiceDetailGenericModifierCode

The billable item codes to identify modifications to a billable item charge. As for example after hours increase in the office visit fee.

4-L AFTHRS EN-US.png non-normal hours

Premium paid on service fees in compensation for practicing outside of normal working hours.

4-L ISOL EN-US.png isolation allowance

Premium paid on service fees in compensation for practicing in a remote location.

4-L OOO EN-US.png out of office

Premium paid on service fees in compensation for practicing at a location other than normal working location.

3-A _ActInvoiceDetailGenericProviderCode EN-US.png ActInvoiceDetailGenericProviderCode

The billable item codes to identify provider supplied charges or changes to the total billing of a claim.

4-L CANCAPT EN-US.png cancelled appointment

A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.

4-L DSC EN-US.png discount

A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.

4-L ESA EN-US.png extraordinary service assessment

A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.

4-L FFSTOP EN-US.png fee for service top off

Under agreement between the parties (payor and provider), a guaranteed level of income is established for the provider over a specific, pre-determined period of time. The normal course of business for the provider is submission of fee-for-service claims. Should the fee-for-service income during the specified period of time be less than the agreed to amount, a top-up amount is paid to the provider equal to the difference between the fee-for-service total and the guaranteed income amount for that period of time. The details of the agreement may specify (or not) a requirement for repayment to the payor in the event that the fee-for-service income exceeds the guaranteed amount.

4-L FNLFEE EN-US.png final fee

Anticipated or actual final fee associated with treating a patient.

4-L FRSTFEE EN-US.png first fee

Anticipated or actual initial fee associated with treating a patient.

4-L MARKUP EN-US.png markup or up-charge

An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.

4-L MISSAPT EN-US.png missed appointment

A charge to compensate the provider when a patient does not show for an appointment.

4-L PERFEE EN-US.png periodic fee

Anticipated or actual periodic fee associated with treating a patient. For example, expected billing cycle such as monthly, quarterly. The actual period (e.g. monthly, quarterly) is specified in the unit quantity of the Invoice Element.

4-L PERMBNS EN-US.png performance bonus

The amount for a performance bonus that is being requested from a payor for the performance of certain services (childhood immunizations, influenza immunizations, mammograms, pap smears) on a sliding scale. That is, for 90% of childhood immunizations to a maximum of $2200/yr. An invoice is created at the end of the service period (one year) and a code is submitted indicating the percentage achieved and the dollar amount claimed.

4-L RESTOCK EN-US.png restocking fee

A charge is requested because the patient failed to pick up the item and it took an amount of time to return it to stock for future use.

4-L TRAVEL EN-US.png travel

A charge to cover the cost of travel time and/or cost in conjuction with providing a service or product. It may be charged per kilometer or per hour based on the effective agreement.

4-L URGENT EN-US.png urgent

Premium paid on service fees in compensation for providing an expedited response to an urgent situation.

3-A _ActInvoiceDetailTaxCode EN-US.png ActInvoiceDetailTaxCode

The billable item codes to identify modifications to a billable item charge by a tax factor applied to the amount. As for example 7% provincial sales tax.

4-L FST EN-US.png federal sales tax

Federal tax on transactions such as the Goods and Services Tax (GST)

4-L HST EN-US.png harmonized sales Tax

Joint Federal/Provincial Sales Tax

4-L PST EN-US.png provincial/state sales tax

Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax

2-A _ActInvoiceDetailPreferredAccommodationCode EN-US.png ActInvoiceDetailPreferredAccommodationCode

An identifying data string for medical facility accommodations.

3-A _ActEncounterAccommodationCode EN-US.png ActEncounterAccommodationCode

Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

4-A _HL7AccommodationCode EN-US.png HL7AccommodationCode

Description:Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

5-L I EN-US.png Isolation

Accommodations used in the care of diseases that are transmitted through casual contact or respiratory transmission.

5-L P EN-US.png Private

Accommodations in which there is only 1 bed.

5-L S EN-US.png Suite

Uniquely designed and elegantly decorated accommodations with many amenities available for an additional charge.

5-L SP EN-US.png Semi-private

Accommodations in which there are 2 beds.

5-L W EN-US.png Ward

Accommodations in which there are 3 or more beds.

1-A _ActInvoiceGroupCode EN-US.png ActInvoiceGroupCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results. Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

2-A _ActInvoiceInterGroupCode EN-US.png ActInvoiceInterGroupCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results. Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements. The domain is only specified for an intermediate invoice element group (non-root or non-top level) for an Invoice.

3-L CPNDDRGING EN-US.png compound drug invoice group

A grouping of invoice element groups and details including the ones specifying the compound ingredients being invoiced. It may also contain generic detail items such as markup.

3-L CPNDINDING EN-US.png compound ingredient invoice group

A grouping of invoice element details including the one specifying an ingredient drug being invoiced. It may also contain generic detail items such as tax or markup.

3-L CPNDSUPING EN-US.png compound supply invoice group

A grouping of invoice element groups and details including the ones specifying the compound supplies being invoiced. It may also contain generic detail items such as markup.

3-L DRUGING EN-US.png drug invoice group

A grouping of invoice element details including the one specifying the drug being invoiced. It may also contain generic detail items such as markup.

3-L FRAMEING EN-US.png frame invoice group

A grouping of invoice element details including the ones specifying the frame fee and the frame dispensing cost that are being invoiced.

3-L LENSING EN-US.png lens invoice group

A grouping of invoice element details including the ones specifying the lens fee and the lens dispensing cost that are being invoiced.

3-L PRDING EN-US.png product invoice group

A grouping of invoice element details including the one specifying the product (good or supply) being invoiced. It may also contain generic detail items such as tax or discount.

2-A _ActInvoiceRootGroupCode EN-US.png ActInvoiceRootGroupCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results. Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements. Codes from this domain reflect the type of Invoice such as Pharmacy Dispense, Clinical Service and Clinical Product. The domain is only specified for the root (top level) invoice element group for an Invoice.

3-L CPINV EN-US.png clinical product invoice

Clinical product invoice where the Invoice Grouping contains one or more billable item and is supported by clinical product(s). For example, a crutch or a wheelchair.

3-L CSINV EN-US.png clinical service invoice

Clinical Services Invoice which can be used to describe a single service, multiple services or repeated services. [1] Single Clinical services invoice where the Invoice Grouping contains one billable item and is supported by one clinical service. For example, a single service for an office visit or simple clinical procedure (e.g. knee mobilization). [2] Multiple Clinical services invoice where the Invoice Grouping contains more than one billable item, supported by one or more clinical services. The services can be distinct and over multiple dates, but for the same patient. This type of invoice includes a series of treatments which must be adjudicated together. For example, an adjustment and ultrasound for a chiropractic session where fees are associated for each of the services and adjudicated (invoiced) together. [3] Repeated Clinical services invoice where the Invoice Grouping contains one or more billable item, supported by the same clinical service repeated over a period of time. For example, the same Chiropractic adjustment (service or treatment) delivered on 3 separate occasions over a period of time at the discretion of the provider (e.g. month).

3-L CSPINV EN-US.png clinical service and product

A clinical Invoice Grouping consisting of one or more services and one or more product. Billing for these service(s) and product(s) are supported by multiple clinical billable events (acts). All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator. For example , a brace (product) invoiced together with the fitting (service).

3-L FININV EN-US.png financial invoice

Invoice Grouping without clinical justification. These will not require identification of participants and associations from a clinical context such as patient and provider. Examples are interest charges and mileage.

3-L OHSINV EN-US.png oral health service

A clinical Invoice Grouping consisting of one or more oral health services. Billing for these service(s) are supported by multiple clinical billable events (acts). All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator.

3-L PAINV EN-US.png preferred accommodation invoice

HealthCare facility preferred accommodation invoice.

3-L RXCINV EN-US.png Rx compound invoice

Pharmacy dispense invoice for a compound.

3-L RXDINV EN-US.png Rx dispense invoice

Pharmacy dispense invoice not involving a compound

3-L SBFINV EN-US.png sessional or block fee invoice

Clinical services invoice where the Invoice Group contains one billable item for multiple clinical services in one or more sessions.

3-L VRXINV EN-US.png vision dispense invoice

Vision dispense invoice for up to 2 lens (left and right), frame and optional discount. Eye exams are invoiced as a clinical service invoice.

0-A _ActInvoiceElementSummaryCode EN-US.png ActInvoiceElementSummaryCode

Identifies the different types of summary information that can be reported by queries dealing with Statement of Financial Activity (SOFA). The summary information is generally used to help resolve balance discrepancies between providers and payors.

1-A _InvoiceElementAdjudicated EN-US.png InvoiceElementAdjudicated

Total counts and total net amounts adjudicated for all Invoice Groupings that were adjudicated within a time period based on the adjudication date of the Invoice Grouping.

2-L ADNFPPELAT EN-US.png adjud. nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

2-L ADNFPPELCT EN-US.png adjud. nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

2-L ADNFPPMNAT EN-US.png adjud. nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

2-L ADNFPPMNCT EN-US.png adjud. nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

2-L ADNFSPELAT EN-US.png adjud. nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

2-L ADNFSPELCT EN-US.png adjud. nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

2-L ADNFSPMNAT EN-US.png adjud. nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

2-L ADNFSPMNCT EN-US.png adjud. nullified same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

2-L ADNPPPELAT EN-US.png adjud. non-payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L ADNPPPELCT EN-US.png adjud. non-payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L ADNPPPMNAT EN-US.png adjud. non-payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L ADNPPPMNCT EN-US.png adjud. non-payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L ADNPSPELAT EN-US.png adjud. non-payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L ADNPSPELCT EN-US.png adjud. non-payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L ADNPSPMNAT EN-US.png adjud. non-payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L ADNPSPMNCT EN-US.png adjud. non-payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L ADPPPPELAT EN-US.png adjud. payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L ADPPPPELCT EN-US.png adjud. payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L ADPPPPMNAT EN-US.png adjud. payee payable prior-period manual amout

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L ADPPPPMNCT EN-US.png adjud. payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L ADPPSPELAT EN-US.png adjud. payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L ADPPSPELCT EN-US.png adjud. payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L ADPPSPMNAT EN-US.png adjud. payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L ADPPSPMNCT EN-US.png adjud. payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L ADRFPPELAT EN-US.png adjud. refused prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

2-L ADRFPPELCT EN-US.png adjud. refused prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

2-L ADRFPPMNAT EN-US.png adjud. refused prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

2-L ADRFPPMNCT EN-US.png adjud. refused prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

2-L ADRFSPELAT EN-US.png adjud. refused same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

2-L ADRFSPELCT EN-US.png adjud. refused same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

2-L ADRFSPMNAT EN-US.png adjud. refused same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

2-L ADRFSPMNCT EN-US.png adjud. refused same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

1-A _InvoiceElementPaid EN-US.png InvoiceElementPaid

Total counts and total net amounts paid for all Invoice Groupings that were paid within a time period based on the payment date.

2-L PDNFPPELAT EN-US.png paid nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

2-L PDNFPPELCT EN-US.png paid nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

2-L PDNFPPMNAT EN-US.png paid nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

2-L PDNFPPMNCT EN-US.png paid nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

2-L PDNFSPELAT EN-US.png paid nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

2-L PDNFSPELCT EN-US.png paid nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently cancelled in the specified period and submitted electronically.

2-L PDNFSPMNAT EN-US.png paid nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

2-L PDNFSPMNCT EN-US.png paid nullified same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

2-L PDNPPPELAT EN-US.png paid non-payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L PDNPPPELCT EN-US.png paid non-payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L PDNPPPMNAT EN-US.png paid non-payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L PDNPPPMNCT EN-US.png paid non-payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L PDNPSPELAT EN-US.png paid non-payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L PDNPSPELCT EN-US.png paid non-payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

2-L PDNPSPMNAT EN-US.png paid non-payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L PDNPSPMNCT EN-US.png paid non-payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

2-L PDPPPPELAT EN-US.png paid payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L PDPPPPELCT EN-US.png paid payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L PDPPPPMNAT EN-US.png paid payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L PDPPPPMNCT EN-US.png paid payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L PDPPSPELAT EN-US.png paid payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L PDPPSPELCT EN-US.png paid payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

2-L PDPPSPMNAT EN-US.png paid payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

2-L PDPPSPMNCT EN-US.png paid payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

1-A _InvoiceElementSubmitted EN-US.png InvoiceElementSubmitted

Total counts and total net amounts billed for all Invoice Groupings that were submitted within a time period. Adjudicated invoice elements are included.

2-L SBBLELAT EN-US.png submitted billed electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

2-L SBBLELCT EN-US.png submitted billed electronic count

Identifies the total number of submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

2-L SBNFELAT EN-US.png submitted nullified electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

2-L SBNFELCT EN-US.png submitted cancelled electronic count

Identifies the total number of submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

2-L SBPDELAT EN-US.png submitted pending electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

2-L SBPDELCT EN-US.png submitted pending electronic count

Identifies the total number of submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

0-A _ActInvoiceOverrideCode EN-US.png ActInvoiceOverrideCode

Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

1-L COVGE EN-US.png coverage problem

Insurance coverage problems have been encountered. Additional explanation information to be supplied.

1-L EFORM EN-US.png electronic form to follow

Electronic form with supporting or additional information to follow.

1-L FAX EN-US.png fax to follow

Fax with supporting or additional information to follow.

1-L GFTH EN-US.png good faith indicator

The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered.

1-L LATE EN-US.png late invoice

Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied.

1-L MANUAL EN-US.png manual review

Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.

1-L OOJ EN-US.png out of jurisdiction

The medical service and/or product was provided to a patient that has coverage in another jurisdiction.

1-L ORTHO EN-US.png orthodontic service

The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.

1-L PAPER EN-US.png paper documentation to follow

Paper documentation (or other physical format) with supporting or additional information to follow.

1-L PIE EN-US.png public insurance exhausted

Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission.

1-L PYRDELAY EN-US.png delayed by a previous payor

Allows provider to explain lateness of invoice to a subsequent payor.

1-L REFNR EN-US.png referral not required

Rules of practice do not require a physician's referral for the provider to perform a billable service.

1-L REPSERV EN-US.png repeated service

The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate.

1-L UNRELAT EN-US.png unrelated service

The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items.

1-L VERBAUTH EN-US.png verbal authorization

The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.

0-A _ActListCode EN-US.png ActListCode

Provides codes associated with ActClass value of LIST (working list)

1-S MEDLIST EN-US.png medication list

List of medications.

2-L CURMEDLIST EN-US.png current medication list

List of current medications.

2-L DISCMEDLIST EN-US.png discharge medication list

List of discharge medications.

2-L HISTMEDLIST EN-US.png medication history

Historical list of medications.

1-A _ActObservationList EN-US.png ActObservationList

2-L CARELIST EN-US.png care plan

List of acts representing a care plan. The acts can be in a varierty of moods including event (EVN) to record acts that have been carried out as part of the care plan.

2-S CONDLIST EN-US.png condition list

List of condition observations.

3-L INTOLIST EN-US.png intolerance list

List of intolerance observations.

3-L PROBLIST EN-US.png problem list

List of problem observations.

3-L RISKLIST EN-US.png risk factors

List of risk factor observations.

2-L GOALLIST EN-US.png goal list

List of observations in goal mood.

1-A _ActTherapyDurationWorkingListCode EN-US.png ActTherapyDurationWorkingListCode

Codes used to identify different types of 'duration-based' working lists. Examples include "Continuous/Chronic", "Short-Term" and "As-Needed".

2-A _ActMedicationTherapyDurationWorkingListCode EN-US.png act medication therapy duration working list

Definition:A collection of concepts that identifies different types of 'duration-based' mediation working lists. Examples:"Continuous/Chronic" "Short-Term" and "As Needed"

3-L ACU EN-US.png short term/acute

Definition:A list of medications which the patient is only expected to consume for the duration of the current order or limited set of orders and which is not expected to be renewed.

3-L CHRON EN-US.png continuous/chronic

Definition:A list of medications which are expected to be continued beyond the present order and which the patient should be assumed to be taking unless explicitly stopped.

3-L ONET EN-US.png one time

Definition:A list of medications which the patient is intended to be administered only once.

3-L PRN EN-US.png as needed

Definition:A list of medications which the patient will consume intermittently based on the behavior of the condition for which the medication is indicated.

0-A _ActMonitoringProtocolCode EN-US.png ActMonitoringProtocolCode

Identifies types of monitoring programs

1-L CTLSUB EN-US.png Controlled Substance

A monitoring program that focuses on narcotics and/or commonly abused substances that are subject to legal restriction.

1-L INV EN-US.png investigational

Definition:A monitoring program that focuses on a drug which is under investigation and has not received regulatory approval for the condition being investigated

1-L LU EN-US.png limited use

Description:A drug that can be prescribed (and reimbursed) only if it meets certain criteria.

1-L OTC EN-US.png non prescription medicine

Medicines designated in this way may be supplied for patient use without a prescription. The exact form of categorisation will vary in different realms.

1-L RX EN-US.png prescription only medicine

Some form of prescription is required before the related medicine can be supplied for a patient. The exact form of regulation will vary in different realms.

1-L SA EN-US.png special authorization

Definition:A drug that requires prior approval (to be reimbursed) before being dispensed

1-L SAC EN-US.png special access

Description:A drug that requires special access permission to be prescribed and dispensed.

0-A _ActPaymentCode EN-US.png ActPaymentCode

Code identifying the method or the movement of payment instructions. Codes are drawn from X12 data element 591 (PaymentMethodCode)

1-L ACH EN-US.png Automated Clearing House

Automated Clearing House (ACH).

1-L CHK EN-US.png Cheque

A written order to a bank to pay the amount specified from funds on deposit.

1-L DDP EN-US.png Direct Deposit

Electronic Funds Transfer (EFT) deposit into the payee's bank account

1-L NON EN-US.png Non-Payment Data

Non-Payment Data.

0-A _ActPharmacySupplyType EN-US.png ActPharmacySupplyType

Identifies types of dispensing events

1-L DF EN-US.png Daily Fill

A fill providing sufficient supply for one day

1-S EM EN-US.png Emergency Supply

A supply action where there is no 'valid' order for the supplied medication. E.g. Emergency vacation supply, weekend supply (when prescriber is unavailable to provide a renewal prescription)

2-L SO EN-US.png Script Owing

An emergency supply where the expectation is that a formal order authorizing the supply will be provided at a later date.

1-S FF EN-US.png First Fill

The initial fill against an order. (This includes initial fills against refill orders.)

2-S FFC EN-US.png First Fill - Complete

A first fill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets).

3-L FFCS EN-US.png first fill complete, partial strength

A first fill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets) and also where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-L FFP EN-US.png First Fill - Part Fill

A first fill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.)

2-L FFPS EN-US.png first fill, part fill, partial strength

A first fill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.) and also where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets)

2-S FFSS EN-US.png first fill, partial strength

A first fill where the strength supplied is less than the ordered strength. (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

3-L FFCS EN-US.png first fill complete, partial strength

A first fill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets) and also where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

3-L FFPS EN-US.png first fill, part fill, partial strength

A first fill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.) and also where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets)

3-L TFS EN-US.png trial fill partial strength

A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance and also where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-S TF EN-US.png Trial Fill

A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance.

3-L TFS EN-US.png trial fill partial strength

A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance and also where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

1-L FS EN-US.png Floor stock

A supply action to restock a smaller more local dispensary.

1-L MS EN-US.png Manufacturer Sample

A supply of a manufacturer sample

1-S RF EN-US.png Refill

A fill against an order that has already been filled (or partially filled) at least once.

2-L DF EN-US.png Daily Fill

A fill providing sufficient supply for one day

2-S RFC EN-US.png Refill - Complete

A refill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets.)

3-L RFCS EN-US.png refill complete partial strength

A refill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets.) and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-S RFF EN-US.png Refill (First fill this facility)

The first fill against an order that has already been filled at least once at another facility.

3-L RFFS EN-US.png refill partial strength (first fill this facility)

The first fill against an order that has already been filled at least once at another facility and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-S RFP EN-US.png Refill - Part Fill

A refill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.)

3-L RFPS EN-US.png refill part fill partial strength

A refill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.) and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-L RFS EN-US.png refill partial strength

A fill against an order that has already been filled (or partially filled) at least once and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-S TB EN-US.png Trial Balance

A fill where the remainder of a 'complete' fill is provided after a trial fill has been provided.

3-L TBS EN-US.png trial balance partial strength

A fill where the remainder of a 'complete' fill is provided after a trial fill has been provided and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).

2-L UD EN-US.png Unit Dose

A supply action that provides sufficient material for a single dose.

1-L UD EN-US.png Unit Dose

A supply action that provides sufficient material for a single dose.

1-L UDE EN-US.png unit dose equivalent

A supply action that provides sufficient material for a single dose via multiple products. E.g. 2 50mg tablets for a 100mg unit dose.

0-A _ActProductAcquisitionCode EN-US.png ActProductAcquisitionCode

The method that a product is obtained for use by the subject of the supply act (e.g. patient). Product examples are consumable or durable goods.

1-S LOAN EN-US.png Loan

Temporary supply of a product without transfer of ownership for the product.

2-L RENT EN-US.png Rent

Temporary supply of a product with financial compensation, without transfer of ownership for the product.

1-S TRANSFER EN-US.png Transfer

Transfer of ownership for a product.

2-L SALE EN-US.png Sale

Transfer of ownership for a product for financial compensation.

0-A _ActSpecimenTreatmentCode EN-US.png ActSpecimenTreatmentCode

Set of codes related to specimen treatments

1-L ACID EN-US.png Acidification

The lowering of specimen pH through the addition of an acid

1-L ALK EN-US.png Alkalization

The act rendering alkaline by impregnating with an alkali; a conferring of alkaline qualities.

1-L DEFB EN-US.png Defibrination

The removal of fibrin from whole blood or plasma through physical or chemical means

1-L FILT EN-US.png Filtration

The passage of a liquid through a filter, accomplished by gravity, pressure or vacuum (suction).

1-L LDLP EN-US.png LDL Precipitation

1-L NEUT EN-US.png Neutralization

The act or process by which an acid and a base are combined in such proportions that the resulting compound is neutral.

1-L RECA EN-US.png Recalcification

The addition of calcium back to a specimen after it was removed by chelating agents

1-L UFIL EN-US.png Ultrafiltration

The filtration of a colloidal substance through a semipermeable medium that allows only the passage of small molecules.

0-A _ObservationType EN-US.png ObservationType

Identifies the kinds of observations that can be performed

1-L ADVERSE_REACTION EN-US.png Adverse Reaction

Indicates that the observation is of an unexpected negative occurrence in the subject suspected to result from the subject's exposure to one or more agents. Observation values would be the symptom resulting from the reaction.

1-L ASSERTION EN-US.png Assertion

Description:Refines classCode OBS to indicate an observation in which observation.value contains a finding or other nominalized statement, where the encoded information in Observation.value is not altered by Observation.code. For instance, observation.code="ASSERTION" and observation.value="fracture of femur present" is an assertion of a clinical finding of femur fracture.

1-L CASESER EN-US.png case seriousness criteria

Definition:An observation that provides a characterization of the level of harm to an investigation subject as a result of a reaction or event.

1-S DX EN-US.png ObservationDiagnosisTypes

Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests.

2-L ADMDX EN-US.png admitting diagnosis

Admitting diagnosis are the diagnoses documented for administrative purposes as the basis for a hospital admission.

2-L DISDX EN-US.png discharge diagnosis

Discharge diagnosis are the diagnoses documented for administrative purposes as the time of hospital discharge.

2-L INTDX EN-US.png intermediate diagnosis

Intermediate diagnoses are those diagnoses documented for administrative purposes during the course of a hospital stay.

2-L NOI EN-US.png nature of injury

The type of injury that the injury coding specifies.

1-L GISTIER EN-US.png GIS tier

Description: Accuracy determined as per the GIS tier code system.

1-L HHOBS EN-US.png household situation observation

Indicates that the observation is of a person’s living situation in a household including the household composition and circumstances.

1-S ISSUE EN-US.png detected issue

Description:There is a clinical issue for the therapy that makes continuation of the therapy inappropriate.

2-A _ActAdministrativeDetectedIssueCode EN-US.png ActAdministrativeDetectedIssueCode

Identifies types of detectyed issues for Act class "ALRT" for the administrative and patient administrative acts domains.

3-A _ActAdministrativeAuthorizationDetectedIssueCode EN-US.png ActAdministrativeAuthorizationDetectedIssueCode

4-L NAT EN-US.png Insufficient authorization

The requesting party has insufficient authorization to invoke the interaction.

4-L SUPPRESSED EN-US.png record suppressed

Description: One or more records in the query response have been suppressed due to consent or privacy restrictions.

4-S VALIDAT EN-US.png validation issue

Description:The specified element did not pass business-rule validation.

5-L BUS EN-US.png business constraint violation

Description:A local business rule relating multiple elements has been violated.

5-S CODE_INVAL EN-US.png code is not valid

Description:The specified code is not valid against the list of codes allowed for the element.

6-L CODE_DEPREC EN-US.png code has been deprecated

Description:The specified code has been deprecated and should no longer be used. Select another code from the code system.

5-S COMPLY EN-US.png Compliance Alert

There may be an issue with the patient complying with the intentions of the proposed therapy

6-L ABUSE EN-US.png commonly abused/misused alert

Description:The proposed therapy is frequently misused or abused and therefore should be used with caution and/or monitoring.

6-S DUPTHPY EN-US.png Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

7-L DUPTHPCLS EN-US.png duplicate therapeutic alass alert

Description:The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy, though the specific mechanisms of action vary.

7-L DUPTHPGEN EN-US.png duplicate generic alert

Description:The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy and uses the same mechanisms of action as the existing therapy.

6-L FRAUD EN-US.png potential fraud

Description:The request is suspected to have a fraudulent basis.

6-L PLYDOC EN-US.png Poly-orderer Alert

A similar or identical therapy was recently ordered by a different practitioner.

6-L PLYPHRM EN-US.png Poly-supplier Alert

This patient was recently supplied a similar or identical therapy from a different pharmacy or supplier.

5-S DOSE EN-US.png Dosage problem

Proposed dosage instructions for therapy differ from standard practice.

6-L DOSECOND EN-US.png dosage-condition alert

Description:Proposed dosage is inappropriate due to patient's medical condition.

6-S DOSEDUR EN-US.png Dose-Duration Alert

Proposed length of therapy differs from standard practice.

7-S DOSEDURH EN-US.png Dose-Duration High Alert

Proposed length of therapy is longer than standard practice

8-L DOSEDURHIND EN-US.png Dose-Duration High for Indication Alert

Proposed length of therapy is longer than standard practice for the identified indication or diagnosis

7-S DOSEDURL EN-US.png Dose-Duration Low Alert

Proposed length of therapy is shorter than that necessary for therapeutic effect

8-L DOSEDURLIND EN-US.png Dose-Duration Low for Indication Alert

Proposed length of therapy is shorter than standard practice for the identified indication or diagnosis

6-S DOSEH EN-US.png High Dose Alert

Proposed dosage exceeds standard practice

7-L DOSEHIND EN-US.png High Dose for Indication Alert

7-L DOSEHINDA EN-US.png High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

7-L DOSEHINDSA EN-US.png High Dose for Height/Surface Area Alert

Proposed dosage exceeds standard practice for the patient's height or body surface area

7-L DOSEHINDW EN-US.png High Dose for Weight Alert

Proposed dosage exceeds standard practice for the patient's weight

6-S DOSEIVL EN-US.png Dose-Interval Alert

Proposed dosage interval/timing differs from standard practice

7-L DOSEIVLIND EN-US.png Dose-Interval for Indication Alert

Proposed dosage interval/timing differs from standard practice for the identified indication or diagnosis

6-S DOSEL EN-US.png Low Dose Alert

Proposed dosage is below suggested therapeutic levels

7-L DOSELIND EN-US.png Low Dose for Indication Alert

7-L DOSELINDA EN-US.png Low Dose for Age Alert

Proposed dosage is below suggested therapeutic levels for the patient's age

7-L DOSELINDSA EN-US.png Low Dose for Height/Surface Area Alert

Proposed dosage is below suggested therapeutic levels for the patient's height or body surface area

7-L DOSELINDW EN-US.png Low Dose for Weight Alert

Proposed dosage is below suggested therapeutic levels for the patient's weight

6-L MDOSE EN-US.png maximum dosage reached

Description:The maximum quantity of this drug allowed to be administered within a particular time-range (month, year, lifetime) has been reached or exceeded.

5-L FORMAT EN-US.png invalid format

Description:The element does not follow the formatting or type rules defined for the field.

5-L ILLEGAL EN-US.png illegal

Description:The request is missing elements or contains elements which cause it to not meet the legal standards for actioning.

5-L KEY204 EN-US.png Unknown key identifier

The ID of the patient, order, etc., was not found. Used for transactions other than additions, e.g. transfer of a non-existent patient.

5-L KEY205 EN-US.png Duplicate key identifier

The ID of the patient, order, etc., already exists. Used in response to addition transactions (Admit, New Order, etc.).

5-S LEN_RANGE EN-US.png length out of range

Description:The length of the data specified falls out of the range defined for the element.

6-L LEN_LONG EN-US.png length is too long

Description:The length of the data specified is greater than the maximum length defined for the element.

6-L LEN_SHORT EN-US.png length is too short

Description:The length of the data specified is less than the minimum length defined for the element.

5-L MISSCOND EN-US.png conditional element missing

Description:The specified element must be specified with a non-null value under certain conditions. In this case, the conditions are true but the element is still missing or null.

5-L MISSMAND EN-US.png mandatory element missing

Description:The specified element is mandatory and was not included in the instance.

5-L NODUPS EN-US.png duplicate values are not permitted

Description:More than one element with the same value exists in the set. Duplicates not permission in this set in a set.

5-L NOPERSIST EN-US.png element will not be persisted

Description: Element in submitted message will not persist in data storage based on detected issue.

5-S OBSA EN-US.png Observation Alert

Proposed therapy may be inappropriate or contraindicated due to conditions or characteristics of the patient

6-S AGE EN-US.png Age Alert

Proposed therapy may be inappropriate or contraindicated due to patient age

7-L DOSEHINDA EN-US.png High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

7-L DOSELINDA EN-US.png Low Dose for Age Alert

Proposed dosage is below suggested therapeutic levels for the patient's age

6-S COND EN-US.png Condition Alert

Proposed therapy may be inappropriate or contraindicated due to an existing/recent patient condition or diagnosis

7-L HGHT
7-L LACT EN-US.png Lactation Alert

Proposed therapy may be inappropriate or contraindicated when breast-feeding

7-L PREG EN-US.png Pregnancy Alert

Proposed therapy may be inappropriate or contraindicated during pregnancy

7-L WGHT
6-L CREACT EN-US.png common reaction alert

Description:Proposed therapy may be inappropriate or contraindicated because of a common but non-patient specific reaction to the product. Example:There is no record of a specific sensitivity for the patient, but the presence of the sensitivity is common and therefore caution is warranted.

6-L GEN EN-US.png Genetic Alert

Proposed therapy may be inappropriate or contraindicated due to patient genetic indicators.

6-L GEND EN-US.png Gender Alert

Proposed therapy may be inappropriate or contraindicated due to patient gender.

6-L LAB EN-US.png Lab Alert

Proposed therapy may be inappropriate or contraindicated due to recent lab test results

6-S REACT EN-US.png Reaction Alert

Proposed therapy may be inappropriate or contraindicated based on the potential for a patient reaction to the proposed product

7-L ALGY EN-US.png Allergy Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to the proposed product. (Allergies are immune based reactions.)

7-L INT EN-US.png Intolerance Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to the proposed product. (Intolerances are non-immune based sensitivities.)

6-S RREACT EN-US.png Related Reaction Alert

Proposed therapy may be inappropriate or contraindicated because of a potential patient reaction to a cross-sensitivity related product.

7-L RALG EN-US.png Related Allergy Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to a cross-sensitivity related product. (Allergies are immune based reactions.)

7-L RAR EN-US.png Related Prior Reaction Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded prior adverse reaction to a cross-sensitivity related product.

7-L RINT EN-US.png Related Intolerance Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to a cross-sensitivity related product. (Intolerances are non-immune based sensitivities.)

5-S REP_RANGE EN-US.png repetitions out of range

Description:The number of repeating elements falls outside the range of the allowed number of repetitions.

6-L MAXOCCURS EN-US.png repetitions above maximum

Description:The number of repeating elements is above the maximum number of repetitions allowed.

6-L MINOCCURS EN-US.png repetitions below minimum

Description:The number of repeating elements is below the minimum number of repetitions allowed.

3-A _ActAdministrativeRuleDetectedIssueCode EN-US.png ActAdministrativeRuleDetectedIssueCode

4-L KEY204 EN-US.png Unknown key identifier

The ID of the patient, order, etc., was not found. Used for transactions other than additions, e.g. transfer of a non-existent patient.

4-L KEY205 EN-US.png Duplicate key identifier

The ID of the patient, order, etc., already exists. Used in response to addition transactions (Admit, New Order, etc.).

4-L KEY206 EN-US.png non-matching identification

Description: Metadata associated with the identification (e.g. name or gender) does not match the identification being verified.

4-L OBSOLETE EN-US.png obsolete record returned

Description: One or more records in the query response have a status of 'obsolete'.

2-A _ActSuppliedItemDetectedIssueCode EN-US.png ActSuppliedItemDetectedIssueCode

Identifies types of detected issues regarding the administration or supply of an item to a patient.

3-L HISTORIC EN-US.png record recorded as historical

Description: While the record was accepted in the repository, there is a more recent version of a record of this type.

3-S PATPREF EN-US.png violates stated preferences

Definition:The proposed therapy goes against preferences or consent constraints recorded in the patient's record.

4-L PATPREFALT EN-US.png violates stated preferences, alternate available

Definition:The proposed therapy goes against preferences or consent constraints recorded in the patient's record. An alternate therapy meeting those constraints is available.

3-A _AdministrationDetectedIssueCode EN-US.png AdministrationDetectedIssueCode

Administration of the proposed therapy may be inappropriate or contraindicated as proposed

4-S COMPLY EN-US.png Compliance Alert

There may be an issue with the patient complying with the intentions of the proposed therapy

5-L ABUSE EN-US.png commonly abused/misused alert

Description:The proposed therapy is frequently misused or abused and therefore should be used with caution and/or monitoring.

5-S DUPTHPY EN-US.png Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

6-L DUPTHPCLS EN-US.png duplicate therapeutic alass alert

Description:The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy, though the specific mechanisms of action vary.

6-L DUPTHPGEN EN-US.png duplicate generic alert

Description:The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy and uses the same mechanisms of action as the existing therapy.

5-L FRAUD EN-US.png potential fraud

Description:The request is suspected to have a fraudulent basis.

5-L PLYDOC EN-US.png Poly-orderer Alert

A similar or identical therapy was recently ordered by a different practitioner.

5-L PLYPHRM EN-US.png Poly-supplier Alert

This patient was recently supplied a similar or identical therapy from a different pharmacy or supplier.

4-L DACT EN-US.png drug action detected issue

Description:Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy.

4-S DOSE EN-US.png Dosage problem

Proposed dosage instructions for therapy differ from standard practice.

5-L DOSECOND EN-US.png dosage-condition alert

Description:Proposed dosage is inappropriate due to patient's medical condition.

5-S DOSEDUR EN-US.png Dose-Duration Alert

Proposed length of therapy differs from standard practice.

6-S DOSEDURH EN-US.png Dose-Duration High Alert

Proposed length of therapy is longer than standard practice

7-L DOSEDURHIND EN-US.png Dose-Duration High for Indication Alert

Proposed length of therapy is longer than standard practice for the identified indication or diagnosis

6-S DOSEDURL EN-US.png Dose-Duration Low Alert

Proposed length of therapy is shorter than that necessary for therapeutic effect

7-L DOSEDURLIND EN-US.png Dose-Duration Low for Indication Alert

Proposed length of therapy is shorter than standard practice for the identified indication or diagnosis

5-S DOSEH EN-US.png High Dose Alert

Proposed dosage exceeds standard practice

6-L DOSEHIND EN-US.png High Dose for Indication Alert

6-L DOSEHINDA EN-US.png High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

6-L DOSEHINDSA EN-US.png High Dose for Height/Surface Area Alert

Proposed dosage exceeds standard practice for the patient's height or body surface area

6-L DOSEHINDW EN-US.png High Dose for Weight Alert

Proposed dosage exceeds standard practice for the patient's weight

5-S DOSEIVL EN-US.png Dose-Interval Alert

Proposed dosage interval/timing differs from standard practice

6-L DOSEIVLIND EN-US.png Dose-Interval for Indication Alert

Proposed dosage interval/timing differs from standard practice for the identified indication or diagnosis

5-S DOSEL EN-US.png Low Dose Alert

Proposed dosage is below suggested therapeutic levels

6-L DOSELIND EN-US.png Low Dose for Indication Alert

6-L DOSELINDA EN-US.png Low Dose for Age Alert

Proposed dosage is below suggested therapeutic levels for the patient's age

6-L DOSELINDSA EN-US.png Low Dose for Height/Surface Area Alert

Proposed dosage is below suggested therapeutic levels for the patient's height or body surface area

6-L DOSELINDW EN-US.png Low Dose for Weight Alert

Proposed dosage is below suggested therapeutic levels for the patient's weight

5-L MDOSE EN-US.png maximum dosage reached

Description:The maximum quantity of this drug allowed to be administered within a particular time-range (month, year, lifetime) has been reached or exceeded.

4-S DUPTHPY EN-US.png Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

5-L DUPTHPCLS EN-US.png duplicate therapeutic alass alert

Description:The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy, though the specific mechanisms of action vary.

5-L DUPTHPGEN EN-US.png duplicate generic alert

Description:The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy and uses the same mechanisms of action as the existing therapy.

4-S TIME EN-US.png timing detected issue

Description:Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

5-L ALRTENDLATE EN-US.png end too late alert

Definition:Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy.

5-L ALRTSTRTLATE EN-US.png start too late alert

Definition:Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition.

4-A _AppropriatenessDetectedIssueCode EN-US.png AppropriatenessDetectedIssueCode

5-S OBSA EN-US.png Observation Alert

Proposed therapy may be inappropriate or contraindicated due to conditions or characteristics of the patient

6-S AGE EN-US.png Age Alert

Proposed therapy may be inappropriate or contraindicated due to patient age

7-L DOSEHINDA EN-US.png High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

7-L DOSELINDA EN-US.png Low Dose for Age Alert

Proposed dosage is below suggested therapeutic levels for the patient's age

6-S COND EN-US.png Condition Alert

Proposed therapy may be inappropriate or contraindicated due to an existing/recent patient condition or diagnosis

7-L HGHT
7-L LACT EN-US.png Lactation Alert

Proposed therapy may be inappropriate or contraindicated when breast-feeding

7-L PREG EN-US.png Pregnancy Alert

Proposed therapy may be inappropriate or contraindicated during pregnancy

7-L WGHT
6-L CREACT EN-US.png common reaction alert

Description:Proposed therapy may be inappropriate or contraindicated because of a common but non-patient specific reaction to the product. Example:There is no record of a specific sensitivity for the patient, but the presence of the sensitivity is common and therefore caution is warranted.

6-L GEN EN-US.png Genetic Alert

Proposed therapy may be inappropriate or contraindicated due to patient genetic indicators.

6-L GEND EN-US.png Gender Alert

Proposed therapy may be inappropriate or contraindicated due to patient gender.

6-L LAB EN-US.png Lab Alert

Proposed therapy may be inappropriate or contraindicated due to recent lab test results

6-S REACT EN-US.png Reaction Alert

Proposed therapy may be inappropriate or contraindicated based on the potential for a patient reaction to the proposed product

7-L ALGY EN-US.png Allergy Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to the proposed product. (Allergies are immune based reactions.)

7-L INT EN-US.png Intolerance Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to the proposed product. (Intolerances are non-immune based sensitivities.)

6-S RREACT EN-US.png Related Reaction Alert

Proposed therapy may be inappropriate or contraindicated because of a potential patient reaction to a cross-sensitivity related product.

7-L RALG EN-US.png Related Allergy Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to a cross-sensitivity related product. (Allergies are immune based reactions.)

7-L RAR EN-US.png Related Prior Reaction Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded prior adverse reaction to a cross-sensitivity related product.

7-L RINT EN-US.png Related Intolerance Alert

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to a cross-sensitivity related product. (Intolerances are non-immune based sensitivities.)

5-L PREVINEF EN-US.png previously ineffective

Definition:The same or similar treatment has previously been attempted with the patient without achieving a positive effect.

5-A _InteractionDetectedIssueCode EN-US.png InteractionDetectedIssueCode

6-L FOOD EN-US.png Food Interaction Alert

Proposed therapy may interact with certain foods

6-S TPROD EN-US.png Therapeutic Product Alert

Proposed therapy may interact with an existing or recent therapeutic product

7-L DRG EN-US.png Drug Interaction Alert

Proposed therapy may interact with an existing or recent drug therapy

7-L NHP EN-US.png Natural Health Product Alert

Proposed therapy may interact with existing or recent natural health product therapy

7-L NONRX EN-US.png Non-Prescription Interaction Alert

Proposed therapy may interact with a non-prescription drug (e.g. alcohol, tobacco, Aspirin)

3-A _SupplyDetectedIssueCode EN-US.png SupplyDetectedIssueCode

Supplying the product at this time may be inappropriate or indicate compliance issues with the associated therapy

4-L ALLDONE EN-US.png already performed

Definition:The requested action has already been performed and so this request has no effect

4-S FULFIL EN-US.png fulfillment alert

Definition:The therapy being performed is in some way out of alignment with the requested therapy.

5-L NOTACTN EN-US.png no longer actionable

Definition:The status of the request being fulfilled has changed such that it is no longer actionable. This may be because the request has expired, has already been completely fulfilled or has been otherwise stopped or disabled. (Not used for 'suspended' orders.)

5-S NOTEQUIV EN-US.png not equivalent alert

Definition:The therapy being performed is not sufficiently equivalent to the therapy which was requested.

6-L NOTEQUIVGEN EN-US.png not generically equivalent alert

Definition:The therapy being performed is not generically equivalent (having the identical biological action) to the therapy which was requested.

6-L NOTEQUIVTHER EN-US.png not therapeutically equivalent alert

Definition:The therapy being performed is not therapeutically equivalent (having the same overall patient effect) to the therapy which was requested.

5-S TIMING EN-US.png event timing incorrect alert

Definition:The therapy is being performed at a time which diverges from the time the therapy was requested

6-L INTERVAL EN-US.png outside requested time

Definition:The therapy action is being performed outside the bounds of the time period requested

6-L MINFREQ EN-US.png too soon within frequency based on the usage

Definition:The therapy action is being performed too soon after the previous occurrence based on the requested frequency

4-L HELD EN-US.png held/suspended alert

Definition:There should be no actions taken in fulfillment of a request that has been held or suspended.

4-L TOOLATE EN-US.png Refill Too Late Alert

The patient is receiving a subsequent fill significantly later than would be expected based on the amount previously supplied and the therapy dosage instructions

4-L TOOSOON EN-US.png Refill Too Soon Alert

The patient is receiving a subsequent fill significantly earlier than would be expected based on the amount previously supplied and the therapy dosage instructions

1-L KSUBJ EN-US.png knowledge subject

Categorization of types of observation that capture the main clinical knowledge subject which may be a medication, a laboratory test, a disease.

1-L KSUBT EN-US.png knowledge subtopic

Categorization of types of observation that capture a knowledge subtopic which might be treatment, etiology, or prognosis.

1-S OINT EN-US.png intolerance

Hypersensitivity resulting in an adverse reaction upon exposure to an agent.

2-S ALG EN-US.png Allergy

Hypersensitivity to an agent caused by an immunologic response to an initial exposure

3-L DALG EN-US.png Drug Allergy

An allergy to a pharmaceutical product.

3-L EALG EN-US.png Environmental Allergy

An allergy to a substance other than a drug or a food. E.g. Latex, pollen, etc.

3-L FALG EN-US.png Food Allergy

An allergy to a substance generally consumed for nutritional purposes.

2-S DINT EN-US.png Drug Intolerance

Hypersensitivity resulting in an adverse reaction upon exposure to a drug.

3-L DALG EN-US.png Drug Allergy

An allergy to a pharmaceutical product.

3-L DNAINT EN-US.png Drug Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

2-S EINT EN-US.png Environmental Intolerance

Hypersensitivity resulting in an adverse reaction upon exposure to environmental conditions.

3-L EALG EN-US.png Environmental Allergy

An allergy to a substance other than a drug or a food. E.g. Latex, pollen, etc.

3-L ENAINT EN-US.png Environmental Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

2-S FINT EN-US.png Food Intolerance

Hypersensitivity resulting in an adverse reaction upon exposure to food.

3-L FALG EN-US.png Food Allergy

An allergy to a substance generally consumed for nutritional purposes.

3-L FNAINT EN-US.png Food Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

2-S NAINT EN-US.png Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

3-L DNAINT EN-US.png Drug Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

3-L ENAINT EN-US.png Environmental Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

3-L FNAINT EN-US.png Food Non-Allergy Intolerance

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

1-L SEV EN-US.png Severity Observation

Indicates a subjective evaluation of the criticality associated with another observation.

1-A _ActSpecObsCode EN-US.png ActSpecObsCode

Identifies the type of observation that is made about a specimen that may affect its processing, analysis or further result interpretation

2-L ARTBLD EN-US.png ActSpecObsArtBldCode

Describes the artificial blood identifier that is associated with the specimen.

2-S DILUTION EN-US.png ActSpecObsDilutionCode

An observation that reports the dilution of a sample.

3-L AUTO-HIGH EN-US.png Auto-High Dilution

The dilution of a sample performed by automated equipment. The value is specified by the equipment

3-L AUTO-LOW EN-US.png Auto-Low Dilution

The dilution of a sample performed by automated equipment. The value is specified by the equipment

3-L PRE EN-US.png Pre-Dilution

The dilution of the specimen made prior to being loaded onto analytical equipment

3-L RERUN EN-US.png Rerun Dilution

The value of the dilution of a sample after it had been analyzed at a prior dilution value

2-L EVNFCTS EN-US.png ActSpecObsEvntfctsCode

Domain provides codes that qualify the ActLabObsEnvfctsCode domain. (Environmental Factors)

2-S INTFR EN-US.png ActSpecObsInterferenceCode

An observation that relates to factors that may potentially cause interference with the observation

3-L FIBRIN EN-US.png Fibrin

The Fibrin Index of the specimen. In the case of only differentiating between Absent and Present, recommend using 0 and 1

3-L HEMOLYSIS EN-US.png Hemolysis

An observation of the hemolysis index of the specimen in g/L

3-L ICTERUS EN-US.png Icterus

An observation that describes the icterus index of the specimen. It is recommended to use mMol/L of bilirubin

3-L LIPEMIA EN-US.png Lipemia

An observation used to describe the Lipemia Index of the specimen. It is recommended to use the optical turbidity at 600 nm (in absorbance units).

2-S VOLUME EN-US.png ActSpecObsVolumeCode

An observation that reports the volume of a sample.

3-L AVAILABLE EN-US.png Available Volume

The available quantity of specimen. This is the current quantity minus any planned consumption (e.g., tests that are planned)

3-L CONSUMPTION EN-US.png Consumption Volume

The quantity of specimen that is used each time the equipment uses this substance

3-L CURRENT EN-US.png Current Volume

The current quantity of the specimen, i.e., initial quantity minus what has been actually used.

3-L INITIAL EN-US.png Initial Volume

The initial quantity of the specimen in inventory

1-A _AnnotationType EN-US.png AnnotationType

2-S _ActPatientAnnotationType EN-US.png ActPatientAnnotationType

Description:Provides a categorization for annotations recorded directly against the patient .

3-L ANNDI EN-US.png diagnostic image note

Description:A note that is specific to a patient's diagnostic images, either historical, current or planned.

3-L ANNGEN EN-US.png general note

Description:A general or uncategorized note.

3-L ANNIMM EN-US.png immunization note

A note that is specific to a patient's immunizations, either historical, current or planned.

3-L ANNLAB EN-US.png laboratory note

Description:A note that is specific to a patient's laboratory results, either historical, current or planned.

3-L ANNMED EN-US.png medication note

Description:A note that is specific to a patient's medications, either historical, current or planned.

1-A _GeneticObservationType EN-US.png GeneticObservationType

Description: None provided

2-L GENE EN-US.png gene

Description: A DNA segment that contributes to phenotype/function. In the absence of demonstrated function a gene may be characterized by sequence, transcription or homology

1-S _ImmunizationObservationType EN-US.png ImmunizationObservationType

Description: Observation codes which describe characteristics of the immunization material.

2-L OBSANTC EN-US.png antigen count

Description: Indicates the valid antigen count.

2-L OBSANTV EN-US.png antigen validity

Description: Indicates whether an antigen is valid or invalid.

1-A _IndividualCaseSafetyReportType EN-US.png Individual Case Safety Report Type

A code that is used to indicate the type of case safety report received from sender. The current code example reference is from the International Conference on Harmonisation (ICH) Expert Workgroup guideline on Clinical Safety Data Management: Data Elements for Transmission of Individual Case Safety Reports. The unknown/unavailable option allows the transmission of information from a secondary sender where the initial sender did not specify the type of report. Example concepts include: Spontaneous, Report from study, Other.

2-L PAT_ADV_EVNT EN-US.png patient adverse event

Indicates that the ICSR is describing problems that a patient experienced after receiving a vaccine product.

2-L VAC_PROBLEM EN-US.png vaccine product problem

Indicates that the ICSR is describing a problem with the actual vaccine product such as physical defects (cloudy, particulate matter) or inability to confer immunity.

1-A _LOINCObservationActContextAgeType EN-US.png LOINCObservationActContextAgeType

Definition:The set of LOINC codes for the act of determining the period of time that has elapsed since an entity was born or created.

2-L 21611-9 EN-US.png age patient qn est

Definition:Estimated age.

2-L 21612-7 EN-US.png age patient qn reported

Definition:Reported age.

2-L 29553-5 EN-US.png age patient qn calc

Definition:Calculated age.

2-L 30525-0 EN-US.png age patient qn definition

Definition:General specification of age with no implied method of determination.

2-L 30972-4 EN-US.png age at onset of adverse event

Definition:Age at onset of associated adverse event; no implied method of determination.

1-A _MedicationObservationType EN-US.png MedicationObservationType

2-L REP_HALF_LIFE EN-US.png representative half-life

Description:This observation represents an 'average' or 'expected' half-life typical of the product.

2-L SPLCOATING EN-US.png coating

Definition: A characteristic of an oral solid dosage form of a medicinal product, indicating whether it has one or more coatings such as sugar coating, film coating, or enteric coating. Only coatings to the external surface or the dosage form should be considered (for example, coatings to individual pellets or granules inside a capsule or tablet are excluded from consideration). Constraints: The Observation.value must be a Boolean (BL) with true for the presence or false for the absence of one or more coatings on a solid dosage form.

2-L SPLCOLOR EN-US.png color

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the color or colors that most predominantly define the appearance of the dose form. SPLCOLOR is not an FDA specification for the actual color of solid dosage forms or the names of colors that can appear in labeling. Constraints: The Observation.value must be a single coded value or a list of multiple coded values, specifying one or more distinct colors that approximate of the color(s) of distinct areas of the solid dosage form, such as the different sides of a tablet or one-part capsule, or the different halves of a two-part capsule. Bands on banded capsules, regardless of the color, are not considered when assigning an SPLCOLOR. Imprints on the dosage form, regardless of their color are not considered when assigning an SPLCOLOR. If more than one color exists on a particular side or half, then the most predominant color on that side or half is recorded. If the gelatin capsule shell is colorless and transparent, use the predominant color of the contents that appears through the colorless and transparent capsule shell. Colors can include: Black;Gray;White;Red;Pink;Purple;Green;Yellow;Orange;Brown;Blue;Turquoise.

2-L SPLIMAGE EN-US.png image

Description: A characteristic representing a single file reference that contains two or more views of the same dosage form of the product; in most cases this should represent front and back views of the dosage form, but occasionally additional views might be needed in order to capture all of the important physical characteristics of the dosage form. Any imprint and/or symbol should be clearly identifiable, and the viewer should not normally need to rotate the image in order to read it. Images that are submitted with SPL should be included in the same directory as the SPL file.

2-L SPLIMPRINT EN-US.png imprint

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the alphanumeric text that appears on the solid dosage form, including text that is embossed, debossed, engraved or printed with ink. The presence of other non-textual distinguishing marks or symbols is recorded by SPLSYMBOL. Examples: Included in SPLIMPRINT are alphanumeric text that appears on the bands of banded capsules and logos and other symbols that can be interpreted as letters or numbers. Constraints: The Observation.value must be of type Character String (ST). Excluded from SPLIMPRINT are internal and external cut-outs in the form of alphanumeric text and the letter 'R' with a circle around it (when referring to a registered trademark) and the letters 'TM' (when referring to a 'trade mark'). To record text, begin on either side or part of the dosage form. Start at the top left and progress as one would normally read a book. Enter a semicolon to show separation between words or line divisions.

2-L SPLSCORING EN-US.png scoring

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the number of equal pieces that the solid dosage form can be divided into using score line(s). Example: One score line creating two equal pieces is given a value of 2, two parallel score lines creating three equal pieces is given a value of 3. Constraints: Whether three parallel score lines create four equal pieces or two intersecting score lines create two equal pieces using one score line and four equal pieces using both score lines, both have the scoring value of 4. Solid dosage forms that are not scored are given a value of 1. Solid dosage forms that can only be divided into unequal pieces are given a null-value with nullFlavor other (OTH).

2-L SPLSHAPE EN-US.png shape

Description: A characteristic of an oral solid dosage form of a medicinal product, specifying the two dimensional representation of the solid dose form, in terms of the outside perimeter of a solid dosage form when the dosage form, resting on a flat surface, is viewed from directly above, including slight rounding of corners. SPLSHAPE does not include embossing, scoring, debossing, or internal cut-outs. SPLSHAPE is independent of the orientation of the imprint and logo. Shapes can include: Triangle (3 sided); Square; Round; Semicircle; Pentagon (5 sided); Diamond; Double circle; Bullet; Hexagon (6 sided); Rectangle; Gear; Capsule; Heptagon (7 sided); Trapezoid; Oval; Clover; Octagon (8 sided); Tear; Freeform.

2-L SPLSIZE EN-US.png size

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the longest single dimension of the solid dosage form as a physical quantity in the dimension of length (e.g., 3 mm). The length is should be specified in millimeters and should be rounded to the nearest whole millimeter. Example: SPLSIZE for a rectangular shaped tablet is the length and SPLSIZE for a round shaped tablet is the diameter.

2-L SPLSYMBOL EN-US.png symbol

Definition: A characteristic of an oral solid dosage form of a medicinal product, to describe whether or not the medicinal product has a mark or symbol appearing on it for easy and definite recognition. Score lines, letters, numbers, and internal and external cut-outs are not considered marks or symbols. See SPLSCORING and SPLIMPRINT for these characteristics. Constraints: The Observation.value must be a Boolean (BL) with true indicating the presence and false for the absence of marks or symbols. Example:

1-A _ObservationIssueTriggerCodedObservationType EN-US.png ObservationIssueTriggerCodedObservationType

Distinguishes the kinds of coded observations that could be the trigger for clinical issue detection. These are observations that are not measurable, but instead can be defined with codes. Coded observation types include: Allergy, Intolerance, Medical Condition, Pregnancy status, etc.

2-A _CaseTransmissionMode EN-US.png case transmission mode

Code for the mechanism by which disease was acquired by the living subject involved in the public health case. Includes sexually transmitted, airborne, bloodborne, vectorborne, foodborne, zoonotic, nosocomial, mechanical, dermal, congenital, environmental exposure, indeterminate.

3-L AIRTRNS EN-US.png airborne transmission

Communication of an agent from a living subject or environmental source to a living subject through indirect contact via oral or nasal inhalation.

3-L ANANTRNS EN-US.png animal to animal transmission

Communication of an agent from one animal to another proximate animal.

3-L ANHUMTRNS EN-US.png animal to human transmission

Communication of an agent from an animal to a proximate person.

3-L BDYFLDTRNS EN-US.png body fluid contact transmission

Communication of an agent from one living subject to another living subject through direct contact with any body fluid.

3-L BLDTRNS EN-US.png blood borne transmission

Communication of an agent to a living subject through direct contact with blood or blood products whether the contact with blood is part of a therapeutic procedure or not.

3-L DERMTRNS EN-US.png transdermal transmission

Communication of an agent from a living subject or environmental source to a living subject via agent migration through intact skin.

3-L ENVTRNS EN-US.png environmental exposure transmission

Communication of an agent from an environmental surface or source to a living subject by direct contact.

3-L FECTRNS EN-US.png fecal-oral transmission

Communication of an agent from a living subject or environmental source to a living subject through oral contact with material contaminated by person or animal fecal material.

3-L FOMTRNS EN-US.png fomite transmission

Communication of an agent from an non-living material to a living subject through direct contact.

3-L FOODTRNS EN-US.png food-borne transmission

Communication of an agent from a food source to a living subject via oral consumption.

3-L HUMHUMTRNS EN-US.png human to human transmission

Communication of an agent from a person to a proximate person.

3-L INDTRNS EN-US.png indeterminate disease transmission mode

Communication of an agent to a living subject via an undetermined route.

3-L LACTTRNS EN-US.png lactation transmission

Communication of an agent from one living subject to another living subject through direct contact with mammalian milk or colostrum.

3-L NOSTRNS EN-US.png nosocomial transmission

Communication of an agent from any entity to a living subject while the living subject is in the patient role in a healthcare facility.

3-L PARTRNS EN-US.png parenteral transmission

Communication of an agent from a living subject or environmental source to a living subject where the acquisition of the agent is not via the alimentary canal.

3-L PLACTRNS EN-US.png transplacental transmission

Communication of an agent from a living subject to the progeny of that living subject via agent migration across the maternal-fetal placental membranes while in utero.

3-L SEXTRNS EN-US.png sexual transmission

Communication of an agent from one living subject to another living subject through direct contact with genital or oral tissues as part of a sexual act.

3-L TRNSFTRNS EN-US.png transfusion transmission

Communication of an agent from one living subject to another living subject through direct contact with blood or blood products where the contact with blood is part of a therapeutic procedure.

3-L VECTRNS EN-US.png vector-borne transmission

Communication of an agent from a living subject acting as a required intermediary in the agent transmission process to a recipient living subject via direct contact.

3-L WATTRNS EN-US.png water-borne transmission

Communication of an agent from a contaminated water source to a living subject whether the water is ingested as a food or not. The route of entry of the water may be through any bodily orifice.

1-S _ObservationQualityMeasureAttribute EN-US.png ObservationQualityMeasureAttribute

Codes used to define various metadata aspects of a health quality measure.

2-L COPY EN-US.png copyright

Identifies the organization(s) who own the intellectual property represented by the eMeasure.

2-L CRS EN-US.png clinical recommendation statement

Summary of relevant clinical guidelines or other clinical recommendations supporting this eMeasure.

2-L DEF EN-US.png definition

Description of individual terms, provided as needed.

2-L DISC EN-US.png disclaimer

Disclaimer information for the eMeasure.

2-L FINALDT EN-US.png finalized date/time

The timestamp when the eMeasure was last packaged in the Measure Authoring Tool.

2-L GUIDE EN-US.png guidance

Used to allow measure developers to provide additional guidance for implementers to understand greater specificity than could be provided in the logic for data criteria.

2-L IDUR EN-US.png improvement notation

Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

2-L ITMCNT EN-US.png items counted

Describes the items counted by the measure (e.g., patients, encounters, procedures, etc.)

2-L KEY EN-US.png keyword

A significant word that aids in discoverability.

2-L MEDT EN-US.png measurement end date

The end date of the measurement period.

2-L MSD EN-US.png measurement start date

The start date of the measurement period.

2-L MSRADJ EN-US.png risk adjustment

The method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether an eMeasure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow more useful comparisons.

2-L MSRAGG EN-US.png rate aggregation

Describes how to combine information calculated based on logic in each of several populations into one summarized result. It can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure. (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two).

2-L MSRIMPROV EN-US.png health quality measure improvement notation

Information on whether an increase or decrease in score is the preferred result. This should reflect information on which way is better, an increase or decrease in score.

2-L MSRSCORE EN-US.png measure scoring

Indicates how the calculation is performed for the eMeasure (e.g., proportion, continuous variable, ratio)

2-L MSRSET EN-US.png health quality measure care setting

Location(s) in which care being measured is rendered Usage Note: MSRSET is used rather than RoleCode because the setting applies to what is being measured, as opposed to participating directly in the health quality measure documantion itself).

2-L MSRTOPIC EN-US.png health quality measure topic type

2-L MSRTP EN-US.png measurement period

The time period for which the eMeasure applies.

2-L MSRTYPE EN-US.png measure type

Indicates whether the eMeasure is used to examine a process or an outcome over time (e.g., Structure, Process, Outcome).

2-L RAT EN-US.png rationale

Succinct statement of the need for the measure. Usually includes statements pertaining to Importance criterion: impact, gap in care and evidence.

2-L REF EN-US.png reference

Identifies bibliographic citations or references to clinical practice guidelines, sources of evidence, or other relevant materials supporting the intent and rationale of the eMeasure.

2-L SDE EN-US.png supplemental data elements

Comparison of results across strata can be used to show where disparities exist or where there is a need to expose differences in results. For example, Centers for Medicare & Medicaid Services (CMS) in the U.S. defines four required Supplemental Data Elements (payer, ethnicity, race, and gender), which are variables used to aggregate data into various subgroups. Additional supplemental data elements required for risk adjustment or other purposes of data aggregation can be included in the Supplemental Data Element section.

2-L STRAT EN-US.png stratification

Describes the strata for which the measure is to be evaluated. There are three examples of reasons for stratification based on existing work. These include: (1) evaluate the measure based on different age groupings within the population described in the measure (e.g., evaluate the whole [age 14-25] and each sub-stratum [14-19] and [20-25]); (2) evaluate the eMeasure based on either a specific condition, a specific discharge location, or both; (3) evaluate the eMeasure based on different locations within a facility (e.g., evaluate the overall rate for all intensive care units and also some strata include additional findings [specific birth weights for neonatal intensive care units]).

2-L TRANF EN-US.png transmission format

Can be a URL or hyperlinks that link to the transmission formats that are specified for a particular reporting program.

2-L USE EN-US.png notice of use

Usage notes.

1-A _ObservationSequenceType EN-US.png ObservationSequenceType

2-L TIME_ABSOLUTE EN-US.png absolute time sequence

A sequence of values in the "absolute" time domain. This is the same time domain that all HL7 timestamps use. It is time as measured by the Gregorian calendar

2-L TIME_RELATIVE EN-US.png relative time sequence

A sequence of values in a "relative" time domain. The time is measured relative to the earliest effective time in the Observation Series containing this sequence.

1-A _ObservationSeriesType EN-US.png ObservationSeriesType

2-A _ECGObservationSeriesType EN-US.png ECGObservationSeriesType

3-L REPRESENTATIVE_BEAT EN-US.png ECG representative beat waveforms

This Observation Series type contains waveforms of a "representative beat" (a.k.a. "median beat" or "average beat"). The waveform samples are measured in relative time, relative to the beginning of the beat as defined by the Observation Series effective time. The waveforms are not directly acquired from the subject, but rather algorithmically derived from the "rhythm" waveforms.

3-L RHYTHM EN-US.png ECG rhythm waveforms

This Observation type contains ECG "rhythm" waveforms. The waveform samples are measured in absolute time (a.k.a. "subject time" or "effective time"). These waveforms are usually "raw" with some minimal amount of noise reduction and baseline filtering applied.

1-S _PatientImmunizationRelatedObservationType EN-US.png PatientImmunizationRelatedObservationType

Description: Reporting codes that are related to an immunization event.

2-L CLSSRM EN-US.png classroom

Description: The class room associated with the patient during the immunization event.

2-L GRADE EN-US.png grade

Description: The school grade or level the patient was in when immunized.

2-L SCHL EN-US.png school

Description: The school the patient attended when immunized.

2-L SCHLDIV EN-US.png school division

Description: The school division or district associated with the patient during the immunization event.

2-L TEACHER EN-US.png teacher

Description: The patient's teacher when immunized.

0-A _ROIOverlayShape EN-US.png ROIOverlayShape

Shape of the region on the object being referenced

1-L CIRCLE EN-US.png circle

A circle defined by two (column,row) pairs. The first point is the center of the circle and the second point is a point on the perimeter of the circle.

1-L ELLIPSE EN-US.png ellipse

An ellipse defined by four (column,row) pairs, the first two points specifying the endpoints of the major axis and the second two points specifying the endpoints of the minor axis.

1-L POINT EN-US.png point

A single point denoted by a single (column,row) pair, or multiple points each denoted by a (column,row) pair.

1-L POLY EN-US.png polyline

A series of connected line segments with ordered vertices denoted by (column,row) pairs; if the first and last vertices are the same, it is a closed polygon.

0-A _ActSubstanceAdministrationCode EN-US.png ActSubstanceAdministrationCode

Description: Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information.

1-L DRUG EN-US.png Drug therapy

The introduction of a drug into a subject with the intention of altering its biologic state with the intent of improving its health status.

1-L FD EN-US.png food

Description: The introduction of material into a subject with the intent of providing nutrition or other dietary supplements (e.g. minerals or vitamins).

1-L IMMUNIZ EN-US.png Immunization

The introduction of an immunogen with the intent of stimulating an immune response, aimed at preventing subsequent infections by more viable agents.

0-A _ActTransportationModeCode EN-US.png ActTransportationModeCode

Characterizes how a transportation act was or will be carried out. Examples: Via private transport, via public transit, via courier.

1-A _ActPatientTransportationModeCode EN-US.png ActPatientTransportationModeCode

Definition: Characterizes how a patient was or will be transported to the site of a patient encounter. Examples: Via ambulance, via public transit, on foot.

2-L AFOOT EN-US.png pedestrian transport

2-S AMBT EN-US.png ambulance transport

3-L AMBAIR EN-US.png fixed-wing ambulance transport

3-L AMBGRND EN-US.png ground ambulance transport

3-L AMBHELO EN-US.png helicopter ambulance transport

2-L LAWENF EN-US.png law enforcement transport

2-L PRVTRN EN-US.png private transport

2-L PUBTRN EN-US.png public transport

0-A _ActCareProvisionCode EN-US.png act care provision

Description:The type and scope of responsibility taken-on by the performer of the Act for a specific subject of care.

1-A _ActCredentialedCareCode EN-US.png act credentialed care

Description:The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by a credentialing agency, i.e. government or non-government agency. Failure in executing this Act may result in loss of credential to the person or organization who participates as performer of the Act. Excludes employment agreements. Example:Hospital license; physician license; clinic accreditation.

2-A _ActCredentialedCareProvisionPersonCode EN-US.png act credentialed care provision peron

Description:The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing individuals.

3-L CACC EN-US.png certified anatomic pathology and clinical pathology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CAIC EN-US.png certified allergy and immunology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CAMC EN-US.png certified aerospace medicine care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CANC EN-US.png certified anesthesiology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CAPC EN-US.png certified anatomic pathology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CBGC EN-US.png certified clinical biochemical genetics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CCCC EN-US.png certified clinical cytogenetics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CCGC EN-US.png certified clinical genetics (M.D.) care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CCPC EN-US.png certified clinical pathology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CCSC EN-US.png certified colon and rectal surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CDEC EN-US.png certified dermatology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CDRC EN-US.png certified diagnostic radiology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CEMC EN-US.png certified emergency medicine care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CFPC EN-US.png certified family practice care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CIMC EN-US.png certified internal medicine care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CMGC EN-US.png certified clinical molecular genetics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CNEC EN-US.png certified neurology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board

3-L CNMC EN-US.png certified nuclear medicine care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CNQC EN-US.png certified neurology with special qualifications in child neurology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CNSC EN-US.png certified neurological surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L COGC EN-US.png certified obstetrics and gynecology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L COMC EN-US.png certified occupational medicine care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L COPC EN-US.png certified ophthalmology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L COSC EN-US.png certified orthopaedic surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L COTC EN-US.png certified otolaryngology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPEC EN-US.png certified pediatrics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPGC EN-US.png certified Ph.D. medical genetics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPHC EN-US.png certified public health and general preventive medicine care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPRC EN-US.png certified physical medicine and rehabilitation care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPSC EN-US.png certified plastic surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPYC EN-US.png certified psychiatry care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CROC EN-US.png certified radiation oncology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CRPC EN-US.png certified radiological physics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CSUC EN-US.png certified surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CTSC EN-US.png certified thoracic surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CURC EN-US.png certified urology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CVSC EN-US.png certified vascular surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L LGPC EN-US.png licensed general physician care

Description:Scope of responsibility taken-on for physician care of a patient as defined by a governmental licensing agency.

2-A _ActCredentialedCareProvisionProgramCode EN-US.png act credentialed care provision program

Description:The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing programs within organizations.

3-L AALC EN-US.png accredited assisted living care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L AAMC EN-US.png accredited ambulatory care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L ABHC EN-US.png accredited behavioral health care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L ACAC EN-US.png accredited critical access hospital care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L ACHC EN-US.png accredited hospital care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L AHOC EN-US.png accredited home care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L ALTC EN-US.png accredited long term care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L AOSC EN-US.png accredited office-based surgery care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

3-L CACS EN-US.png certified acute coronary syndrome care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CAMI EN-US.png certified acute myocardial infarction care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CAST EN-US.png certified asthma care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CBAR EN-US.png certified bariatric surgery care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CCAD EN-US.png certified coronary artery disease care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CCAR EN-US.png certified cardiac care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CDEP EN-US.png certified depression care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CDGD EN-US.png certified digestive/gastrointestinal disorders care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CDIA EN-US.png certified diabetes care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CEPI EN-US.png certified epilepsy care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CFEL EN-US.png certified frail elderly care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CHFC EN-US.png certified heart failure care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CHRO EN-US.png certified high risk obstetrics care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CHYP EN-US.png certified hyperlipidemia care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CMIH EN-US.png certified migraine headache care

Description:.

3-L CMSC EN-US.png certified multiple sclerosis care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L COJR EN-US.png certified orthopedic joint replacement care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CONC EN-US.png certified oncology care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L COPD EN-US.png certified chronic obstructive pulmonary disease care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CORT EN-US.png certified organ transplant care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CPAD EN-US.png certified parkinsons disease care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CPND EN-US.png certified pneumonia disease care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CPST EN-US.png certified primary stroke center care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CSDM EN-US.png certified stroke disease management care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CSIC EN-US.png certified sickle cell care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CSLD EN-US.png certified sleep disorders care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CSPT EN-US.png certified spine treatment care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CTBU EN-US.png certified trauma/burn center care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CVDC EN-US.png certified vascular diseases care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CWMA EN-US.png certified wound management care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

3-L CWOH EN-US.png certified women's health care

Description:Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

1-A _ActEncounterCode EN-US.png ActEncounterCode

Domain provides codes that qualify the ActEncounterClass (ENC)

2-L AMB EN-US.png ambulatory

A comprehensive term for health care provided in a healthcare facility (e.g. a practitioneraTMs office, clinic setting, or hospital) on a nonresident basis. The term ambulatory usually implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter.

2-L EMER EN-US.png emergency

A patient encounter that takes place at a dedicated healthcare service delivery location where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an inpatient or transferred to another facility.)

2-L FLD EN-US.png field

A patient encounter that takes place both outside a dedicated service delivery location and outside a patient's residence. Example locations might include an accident site and at a supermarket.

2-L HH EN-US.png home health

Healthcare encounter that takes place in the residence of the patient or a designee

2-S IMP EN-US.png inpatient encounter

A patient encounter where a patient is admitted by a hospital or equivalent facility, assigned to a location where patients generally stay at least overnight and provided with room, board, and continuous nursing service.

3-L ACUTE EN-US.png inpatient acute

An acute inpatient encounter.

3-L NONAC EN-US.png inpatient non-acute

Any category of inpatient encounter except 'acute'

2-L SS EN-US.png short stay

An encounter where the patient is admitted to a health care facility for a predetermined length of time, usually less than 24 hours.

2-L VR EN-US.png virtual

A patient encounter where the patient and the practitioner(s) are not in the same physical location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference.

1-A _ActMedicalServiceCode EN-US.png ActMedicalServiceCode

General category of medical service provided to the patient during their encounter.

2-L ALC EN-US.png Alternative Level of Care

Provision of Alternate Level of Care to a patient in an acute bed. Patient is waiting for placement in a long-term care facility and is unable to return home.

2-L CARD EN-US.png Cardiology

Provision of diagnosis and treatment of diseases and disorders affecting the heart

2-L CHR EN-US.png Chronic

Provision of recurring care for chronic illness.

2-L DNTL EN-US.png Dental

Provision of treatment for oral health and/or dental surgery.

2-L DRGRHB EN-US.png Drug Rehab

Provision of treatment for drug abuse.

2-L GENRL EN-US.png General

General care performed by a general practitioner or family doctor as a responsible provider for a patient.

2-L MED EN-US.png Medical

Provision of diagnostic and/or therapeutic treatment.

2-L OBS EN-US.png Obstetrics

Provision of care of women during pregnancy, childbirth and immediate postpartum period. Also known as Maternity.

2-L ONC EN-US.png Oncology

Provision of treatment and/or diagnosis related to tumors and/or cancer.

2-L PALL EN-US.png Palliative

Provision of care for patients who are living or dying from an advanced illness.

2-L PED EN-US.png Pediatrics

Provision of diagnosis and treatment of diseases and disorders affecting children.

2-L PHAR EN-US.png Pharmaceutical

Pharmaceutical care performed by a pharmacist.

2-L PHYRHB EN-US.png Physical Rehab

Provision of treatment for physical injury.

2-L PSYCH EN-US.png Psychiatric

Provision of treatment of psychiatric disorder relating to mental illness.

2-L SURG EN-US.png Surgical

Provision of surgical treatment.

0-A _ActObservationVerificationType EN-US.png act observation verification

Identifies the type of verification investigation being undertaken with respect to the subject of the verification activity. Examples: Verification of eligibility for coverage under a policy or program - aka enrolled/covered by a policy or program Verification of record - e.g., person has record in an immunization registry Verification of enumeration - e.g. NPI Verification of Board Certification - provider specific Verification of Certification - e.g. JAHCO, NCQA, URAC Verification of Conformance - e.g. entity use with HIPAA, conformant to the CCHIT EHR system criteria Verification of Provider Credentials Verification of no adverse findings - e.g. on National Provider Data Bank, Health Integrity Protection Data Base (HIPDB)

1-L VFPAPER EN-US.png verify paper

Definition:Indicates that the paper version of the record has, should be or is being verified against the electronic version.

1-L VRFPAPER EN-US.png verify paper

Definition:Indicates that the paper version of the record has, should be or is being verified against the electronic version.

1-L VFPAPER EN-US.png verify paper

Definition:Indicates that the paper version of the record has, should be or is being verified against the electronic version.

1-L VRFPAPER EN-US.png verify paper

Definition:Indicates that the paper version of the record has, should be or is being verified against the electronic version.

0-A _ActBillableModifierCode EN-US.png ActBillableModifierCode

Definition:An identifying modifier code for healthcare interventions or procedures.

1-L CPTM EN-US.png CPT modifier codes

Description:CPT modifier codes are found in Appendix A of CPT 2000 Standard Edition.

1-L HCPCSA EN-US.png HCPCS Level II and Carrier-assigned

Description:HCPCS Level II (HCFA-assigned) and Carrier-assigned (Level III) modifiers are reported in Appendix A of CPT 2000 Standard Edition and in the Medicare Bulletin.

0-A _ActTaskCode EN-US.png ActTaskCode

Description: A task or action that a user may perform in a clinical information system (e.g., medication order entry, laboratory test results review, problem list entry).

1-S OE EN-US.png order entry task

A clinician creates a request for a service to be performed for a given patient.

2-L LABOE EN-US.png laboratory test order entry task

A clinician creates a request for a laboratory test to be done for a given patient.

2-L MEDOE EN-US.png medication order entry task

A clinician creates a request for the administration of one or more medications to a given patient.

1-S PATDOC EN-US.png patient documentation task

A person enters documentation about a given patient.

2-L ALLERLREV EN-US.png allergy list review

Description: A person reviews a list of known allergies of a given patient.

2-S CLINNOTEE EN-US.png clinical note entry task

A clinician enters a clinical note about a given patient

3-L DIAGLISTE EN-US.png diagnosis list entry task

A clinician enters a diagnosis for a given patient.

3-L DISCHSUME EN-US.png discharge summary entry task

A clinician enters a discharge summary for a given patient.

3-L PATREPE EN-US.png pathology report entry task

A pathologist enters a report for a given patient.

3-L PROBLISTE EN-US.png problem list entry task

A clinician enters a problem for a given patient.

3-L RADREPE EN-US.png radiology report entry task

A radiologist enters a report for a given patient.

2-L IMMLREV EN-US.png immunization list review

Description: A person reviews a list of immunizations due or received for a given patient.

2-S REMLREV EN-US.png reminder list review

Description: A person reviews a list of health care reminders for a given patient.

3-L WELLREMLREV EN-US.png wellness reminder list review

Description: A person reviews a list of wellness or preventive care reminders for a given patient.

1-S PATINFO EN-US.png patient information review task

A person (e.g., clinician, the patient herself) reviews patient information in the electronic medical record.

2-L ALLERLE EN-US.png allergy list entry

Description: A person enters a known allergy for a given patient.

2-L CDSREV EN-US.png clinical decision support intervention review

A person reviews a recommendation/assessment provided automatically by a clinical decision support application for a given patient.

2-S CLINNOTEREV EN-US.png clinical note review task

A person reviews a clinical note of a given patient.

3-L DISCHSUMREV EN-US.png discharge summary review task

A person reviews a discharge summary of a given patient.

2-L DIAGLISTREV EN-US.png diagnosis list review task

A person reviews a list of diagnoses of a given patient.

2-L IMMLE EN-US.png immunization list entry

Description: A person enters an immunization due or received for a given patient.

2-L LABRREV EN-US.png laboratory results review task

A person reviews a list of laboratory results of a given patient.

2-S MICRORREV EN-US.png microbiology results review task

A person reviews a list of microbiology results of a given patient.

3-L MICROORGRREV EN-US.png microbiology organisms results review task

A person reviews organisms of microbiology results of a given patient.

3-L MICROSENSRREV EN-US.png microbiology sensitivity test results review task

A person reviews the sensitivity test of microbiology results of a given patient.

2-S MLREV EN-US.png medication list review task

A person reviews a list of medication orders submitted to a given patient

3-L MARWLREV EN-US.png medication administration record work list review task

A clinician reviews a work list of medications to be administered to a given patient.

2-L OREV EN-US.png orders review task

A person reviews a list of orders submitted to a given patient.

2-L PATREPREV EN-US.png pathology report review task

A person reviews a pathology report of a given patient.

2-L PROBLISTREV EN-US.png problem list review task

A person reviews a list of problems of a given patient.

2-L RADREPREV EN-US.png radiology report review task

A person reviews a radiology report of a given patient.

2-S REMLE EN-US.png reminder list entry

Description: A person enters a health care reminder for a given patient.

3-L WELLREMLE EN-US.png wellness reminder list entry

Description: A person enters a wellness or preventive care reminder for a given patient.

2-S RISKASSESS EN-US.png risk assessment instrument task

A person reviews a Risk Assessment Instrument report of a given patient.

3-L FALLRISK EN-US.png falls risk assessment instrument task

A person reviews a Falls Risk Assessment Instrument report of a given patient.

0-A _ActCoverageTypeCode EN-US.png ActCoverageTypeCode

Definition: Set of codes indicating the type of insurance policy or program that pays for the cost of benefits provided to covered parties.

1-A _ActInsurancePolicyCode EN-US.png ActInsurancePolicyCode

Set of codes indicating the type of insurance policy or other source of funds to cover healthcare costs.

2-S AUTOPOL EN-US.png automobile

Insurance policy for injuries sustained in an automobile accident. Will also typically covered non-named parties to the policy, such as pedestrians and passengers.

3-L COL EN-US.png collision coverage policy

Definition: An automobile insurance policy under which the insurance company will cover the cost of damages to an automobile owned by the named insured that are caused by accident or intentionally by another party.

3-L UNINSMOT EN-US.png uninsured motorist policy

Definition: An automobile insurance policy under which the insurance company will indemnify a loss for which another motorist is liable if that motorist is unable to pay because he or she is uninsured. Coverage under the policy applies to bodily injury damages only. Injuries to the covered party caused by a hit-and-run driver are also covered.

2-L EHCPOL EN-US.png extended healthcare

Private insurance policy that provides coverage in addition to other policies (e.g. in addition to a Public Healthcare insurance policy).

2-L HSAPOL EN-US.png health spending account

Insurance policy that provides for an allotment of funds replenished on a periodic (e.g. annual) basis. The use of the funds under this policy is at the discretion of the covered party.

2-S PUBLICPOL EN-US.png public healthcare

Insurance policy funded by a public health system such as a provincial or national health plan. Examples include BC MSP (British Columbia Medical Services Plan) OHIP (Ontario Health Insurance Plan), NHS (National Health Service).

3-L DENTPRG EN-US.png dental program

Definition: A public or government health program that administers and funds coverage for dental care to assist program eligible who meet financial and health status criteria.

3-S DISEASEPRG EN-US.png public health program

Definition: A public or government health program that administers and funds coverage for health and social services to assist program eligible who meet financial and health status criteria related to a particular disease. Example: Reproductive health, sexually transmitted disease, and end renal disease programs.

4-L CANPRG EN-US.png women's cancer detection program

Definition: A program that provides low-income, uninsured, and underserved women access to timely, high-quality screening and diagnostic services, to detect breast and cervical cancer at the earliest stages. Example: To improve women's access to screening for breast and cervical cancers, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which guided CDC in creating the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides access to critical breast and cervical cancer screening services for underserved women in the United States. An estimated 7 to 10% of U.S. women of screening age are eligible to receive NBCCEDP services. Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250% of federal poverty level; ages 18 to 64 for cervical screening; ages 40 to 64 for breast screening.

4-L ENDRENAL EN-US.png end renal program

Definition: A public or government program that administers publicly funded coverage of kidney dialysis and kidney transplant services. Example: In the U.S., the Medicare End-stage Renal Disease program (ESRD), the National Kidney Foundation (NKF) American Kidney Fund (AKF) The Organ Transplant Fund.

4-L HIVAIDS EN-US.png HIV-AIDS program

Definition: Government administered and funded HIV-AIDS program for beneficiaries meeting financial and health status criteria. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors. Example: In the U.S., the Ryan White program, which is administered by the Health Resources and Services Administration.

3-L MANDPOL EN-US.png mandatory health program

3-L MENTPRG EN-US.png mental health program

Definition: Government administered and funded mental health program for beneficiaries meeting financial and mental health status criteria. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors. Example: In the U.S., states receive funding for substance use programs from the Substance Abuse Mental Health Administration (SAMHSA).

3-L SAFNET EN-US.png safety net clinic program

Definition: Government administered and funded program to support provision of care to underserved populations through safety net clinics. Example: In the U.S., safety net providers such as federally qualified health centers (FQHC) receive funding under PHSA Section 330 grants administered by the Health Resources and Services Administration.

3-L SUBPRG EN-US.png substance use program

Definition: Government administered and funded substance use program for beneficiaries meeting financial, substance use behavior, and health status criteria. Beneficiaries may be required to enroll as a result of legal proceedings. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors. Example: In the U.S., states receive funding for substance use programs from the Substance Abuse Mental Health Administration (SAMHSA).

3-S SUBSIDIZ EN-US.png subsidized health program

Definition: A government health program that provides coverage for health services to persons meeting eligibility criteria such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds.

4-L SUBSIDMC EN-US.png subsidized managed care program

Definition: A government health program that provides coverage through managed care contracts for health services to persons meeting eligibility criteria such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds. Discussion: The structure and business processes for underwriting and administering a subsidized managed care program is further specified by the Underwriter and Payer Role.class and Role.code.

4-L SUBSUPP EN-US.png subsidized supplemental health program

Definition: A government health program that provides coverage for health services to persons meeting eligibility criteria for a supplemental health policy or program such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds. Example: Supplemental health coverage program may cover the cost of a health program or policy financial participations, such as the copays and the premiums, and may provide coverage for services in addition to those covered under the supplemented health program or policy. In the U.S., Medicaid programs may pay the premium for a covered party who is also covered under the Medicare program or a private health policy. Discussion: The structure and business processes for underwriting and administering a subsidized supplemental retiree health program is further specified by the Underwriter and Payer Role.class and Role.code.

2-L WCBPOL EN-US.png worker's compensation

Insurance policy for injuries sustained in the work place or in the course of employment.

1-A _ActInsuranceTypeCode EN-US.png ActInsuranceTypeCode

Definition: Set of codes indicating the type of insurance policy. Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of potential financial loss. Insurance is defined as the equitable transfer of the risk of a potential loss, from one entity to another, in exchange for a premium and duty of care. A policy holder is an individual or an organization enters into a contract with an underwriter which stipulates that, in exchange for payment of a sum of money (a premium), one or more covered parties (insureds) is guaranteed compensation for losses resulting from certain perils under specified conditions. The underwriter analyzes the risk of loss, makes a decision as to whether the risk is insurable, and prices the premium accordingly. A policy provides benefits that indemnify or cover the cost of a loss incurred by a covered party, and may include coverage for services required to remediate a loss. An insurance policy contains pertinent facts about the policy holder, the insurance coverage, the covered parties, and the insurer. A policy may include exemptions and provisions specifying the extent to which the indemnification clause cannot be enforced for intentional tortious conduct of a covered party, e.g., whether the covered parties are jointly or severably insured. Discussion: In contrast to programs, an insurance policy has one or more policy holders, who own the policy. The policy holder may be the covered party, a relative of the covered party, a partnership, or a corporation, e.g., an employer. A subscriber of a self-insured health insurance policy is a policy holder. A subscriber of an employer sponsored health insurance policy is holds a certificate of coverage, but is not a policy holder; the policy holder is the employer. See CoveredRoleType.

2-S AUTOPOL EN-US.png automobile

Insurance policy for injuries sustained in an automobile accident. Will also typically covered non-named parties to the policy, such as pedestrians and passengers.

3-L COL EN-US.png collision coverage policy

Definition: An automobile insurance policy under which the insurance company will cover the cost of damages to an automobile owned by the named insured that are caused by accident or intentionally by another party.

3-L UNINSMOT EN-US.png uninsured motorist policy

Definition: An automobile insurance policy under which the insurance company will indemnify a loss for which another motorist is liable if that motorist is unable to pay because he or she is uninsured. Coverage under the policy applies to bodily injury damages only. Injuries to the covered party caused by a hit-and-run driver are also covered.

2-L DIS EN-US.png disability insurance policy

Definition: An insurance policy that provides a regular payment to compensate for income lost due to the covered party's inability to work because of illness or injury.

2-L EWB EN-US.png employee welfare benefit plan policy

Definition: An insurance policy under a benefit plan run by an employer or employee organization for the purpose of providing benefits other than pension-related to employees and their families. Typically provides health-related benefits, benefits for disability, disease or unemployment, or day care and scholarship benefits, among others. An employer sponsored health policy includes coverage of health care expenses arising from sickness or accidental injury, coverage for on-site medical clinics or for dental or vision benefits, which are typically provided under a separate policy. Coverage excludes health care expenses covered by accident or disability, workers' compensation, liability or automobile insurance.

2-L FLEXP EN-US.png flexible benefit plan policy

Definition: An insurance policy that covers qualified benefits under a Flexible Benefit plan such as group medical insurance, long and short term disability income insurance, group term life insurance for employees only up to $50,000 face amount, specified disease coverage such as a cancer policy, dental and/or vision insurance, hospital indemnity insurance, accidental death and dismemberment insurance, a medical expense reimbursement plan and a dependent care reimbursement plan. Discussion: See UnderwriterRoleTypeCode flexible benefit plan which is defined as a benefit plan that allows employees to choose from several life, health, disability, dental, and other insurance plans according to their individual needs. Also known as cafeteria plans. Authorized under Section 125 of the Revenue Act of 1978.

2-S LIFE EN-US.png life insurance policy

Definition: A policy under which the insurer agrees to pay a sum of money upon the occurrence of the covered partys death. In return, the policyholder agrees to pay a stipulated amount called a premium at regular intervals. Life insurance indemnifies the beneficiary for the loss of the insurable interest that a beneficiary has in the life of a covered party. For persons related by blood, a substantial interest established through love and affection, and for all other persons, a lawful and substantial economic interest in having the life of the insured continue. An insurable interest is required when purchasing life insurance on another person. Specific exclusions are often written into the contract to limit the liability of the insurer; for example claims resulting from suicide or relating to war, riot and civil commotion. Discussion:A life insurance policy may be used by the covered party as a source of health care coverage in the case of a viatical settlement, which is the sale of a life insurance policy by the policy owner, before the policy matures. Such a sale, at a price discounted from the face amount of the policy but usually in excess of the premiums paid or current cash surrender value, provides the seller an immediate cash settlement. Generally, viatical settlements involve insured individuals with a life expectancy of less than two years. In countries without state-subsidized healthcare and high healthcare costs (e.g. United States), this is a practical way to pay extremely high health insurance premiums that severely ill people face. Some people are also familiar with life settlements, which are similar transactions but involve insureds with longer life expectancies (two to fifteen years).

3-L ANNU EN-US.png annuity policy

Definition: A policy that, after an initial premium or premiums, pays out a sum at pre-determined intervals. For example, a policy holder may pay $10,000, and in return receive $150 each month until he dies; or $1,000 for each of 14 years or death benefits if he dies before the full term of the annuity has elapsed.

3-L TLIFE EN-US.png term life insurance policy

Definition: Life insurance under which the benefit is payable only if the insured dies during a specified period. If an insured dies during that period, the beneficiary receives the death payments. If the insured survives, the policy ends and the beneficiary receives nothing.

3-L ULIFE EN-US.png universal life insurance policy

Definition: Life insurance under which the benefit is payable upon the insuredaTMs death or diagnosis of a terminal illness. If an insured dies during that period, the beneficiary receives the death payments. If the insured survives, the policy ends and the beneficiary receives nothing

2-L PNC EN-US.png property and casualty insurance policy

Definition: A type of insurance that covers damage to or loss of the policyholderaTMs property by providing payments for damages to property damage or the injury or death of living subjects. The terms "casualty" and "liability" insurance are often used interchangeably. Both cover the policyholder's legal liability for damages caused to other persons and/or their property.

2-L REI EN-US.png reinsurance policy

Definition: An agreement between two or more insurance companies by which the risk of loss is proportioned. Thus the risk of loss is spread and a disproportionately large loss under a single policy does not fall on one insurance company. Acceptance by an insurer, called a reinsurer, of all or part of the risk of loss of another insurance company. Discussion: Reinsurance is a means by which an insurance company can protect itself against the risk of losses with other insurance companies. Individuals and corporations obtain insurance policies to provide protection for various risks (hurricanes, earthquakes, lawsuits, collisions, sickness and death, etc.). Reinsurers, in turn, provide insurance to insurance companies. For example, an HMO may purchase a reinsurance policy to protect itself from losing too much money from one insured's particularly expensive health care costs. An insurance company issuing an automobile liability policy, with a limit of $100,000 per accident may reinsure its liability in excess of $10,000. A fire insurance company which issues a large policy generally reinsures a portion of the risk with one or several other companies. Also called risk control insurance or stop-loss insurance.

2-L SURPL EN-US.png surplus line insurance policy

Definition: A risk or part of a risk for which there is no normal insurance market available. Insurance written by unauthorized insurance companies. Surplus lines insurance is insurance placed with unauthorized insurance companies through licensed surplus lines agents or brokers.

2-L UMBRL EN-US.png umbrella liability insurance policy

Definition: A form of insurance protection that provides additional liability coverage after the limits of your underlying policy are reached. An umbrella liability policy also protects you (the insured) in many situations not covered by the usual liability policies.

2-A _ActHealthInsuranceTypeCode EN-US.png ActHealthInsuranceTypeCode

Definition: Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement).

3-L DENTAL EN-US.png dental care policy

Definition: A health insurance policy that that covers benefits for dental services.

3-L DISEASE EN-US.png disease specific policy

Definition: A health insurance policy that covers benefits for healthcare services provided for named conditions under the policy, e.g., cancer, diabetes, or HIV-AIDS.

3-L DRUGPOL EN-US.png drug policy

Definition: A health insurance policy that covers benefits for prescription drugs, pharmaceuticals, and supplies.

3-L EHCPOL EN-US.png extended healthcare

Private insurance policy that provides coverage in addition to other policies (e.g. in addition to a Public Healthcare insurance policy).

3-L HIP EN-US.png health insurance plan policy

Definition: A health insurance policy that covers healthcare benefits by protecting covered parties from medical expenses arising from health conditions, sickness, or accidental injury as well as preventive care. Health insurance policies explicitly exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy. Discussion: Health insurance policies are offered by health insurance plans that typically reimburse providers for covered services on a fee-for-service basis, that is, a fee that is the allowable amount that a provider may charge. This is in contrast to managed care plans, which typically prepay providers a per-member/per-month amount or capitation as reimbursement for all covered services rendered. Health insurance plans include indemnity and healthcare services plans.

3-L HSAPOL EN-US.png health spending account

Insurance policy that provides for an allotment of funds replenished on a periodic (e.g. annual) basis. The use of the funds under this policy is at the discretion of the covered party.

3-L LTC EN-US.png long term care policy

Definition: An insurance policy that covers benefits for long-term care services people need when they no longer can care for themselves. This may be due to an accident, disability, prolonged illness or the simple process of aging. Long-term care services assist with activities of daily living including: Help at home with day-to-day activities, such as cooking, cleaning, bathing and dressing Care in the community, such as in an adult day care facility Supervised care provided in an assisted living facility Skilled care provided in a nursing home

3-S MCPOL EN-US.png managed care policy

Definition: Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well. Managed care policies specifically exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy. Discussion: Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member.

4-L HMO EN-US.png health maintenance organization policy

Definition: A policy for a health plan that provides coverage for health care only through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Eligibility to enroll in an HMO is determined by where a covered party lives or works.

4-L POS EN-US.png point of service policy

Definition: A policy for a health plan that has features of both an HMO and a FFS plan. Like an HMO, a POS plan encourages the use its HMO network to maintain discounted fees with participating providers, but recognizes that sometimes covered parties want to choose their own provider. The POS plan allows a covered party to use providers who are not part of the HMO network (non-participating providers). However, there is a greater cost associated with choosing these non-network providers. A covered party will usually pay deductibles and coinsurances that are substantially higher than the payments when he or she uses a plan provider. Use of non-participating providers often requires the covered party to pay the provider directly and then to file a claim for reimbursement, like in an FFS plan.

4-L PPO EN-US.png preferred provider organization policy

Definition: A network-based, managed care plan that allows a covered party to choose any health care provider. However, if care is received from a "preferred" (participating in-network) provider, there are generally higher benefit coverage and lower deductibles.

3-L MENTPOL EN-US.png mental health policy

Definition: A health insurance policy that covers benefits for mental health services and prescriptions.

3-L POS EN-US.png point of service policy

Definition: A policy for a health plan that has features of both an HMO and a FFS plan. Like an HMO, a POS plan encourages the use its HMO network to maintain discounted fees with participating providers, but recognizes that sometimes covered parties want to choose their own provider. The POS plan allows a covered party to use providers who are not part of the HMO network (non-participating providers). However, there is a greater cost associated with choosing these non-network providers. A covered party will usually pay deductibles and coinsurances that are substantially higher than the payments when he or she uses a plan provider. Use of non-participating providers often requires the covered party to pay the provider directly and then to file a claim for reimbursement, like in an FFS plan.

3-L SUBPOL EN-US.png substance use policy

Definition: A health insurance policy that covers benefits for substance use services.

3-L VISPOL EN-US.png vision care policy

Definition: Set of codes for a policy that provides coverage for health care expenses arising from vision services. A health insurance policy that covers benefits for vision care services, prescriptions, and products.

1-A _ActProgramTypeCode EN-US.png ActProgramTypeCode

Definition: A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds. Discussion: Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

2-L CHAR EN-US.png charity program

Definition: A program that covers the cost of services provided directly to a beneficiary who typically has no other source of coverage without charge.

2-L CRIME EN-US.png crime victim program

Definition: A program that covers the cost of services provided to crime victims for injuries or losses related to the occurrence of a crime.

2-L EAP EN-US.png employee assistance program

Definition: An employee assistance program is run by an employer or employee organization for the purpose of providing benefits and covering all or part of the cost for employees to receive counseling, referrals, and advice in dealing with stressful issues in their lives. These may include substance abuse, bereavement, marital problems, weight issues, or general wellness issues. The services are usually provided by a third-party, rather than the company itself, and the company receives only summary statistical data from the service provider. Employee's names and services received are kept confidential.

2-L GOVEMP EN-US.png government employee health program

Definition: A set of codes used to indicate a government program that is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health and financial status. Government programs are established or permitted by legislation with provisions for ongoing government oversight. Regulation mandates the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency is charged with implementing the program in accordance to the regulation Example: Federal employee health benefit program in the U.S.

2-L HIRISK EN-US.png high risk pool program

Definition: A government program that provides health coverage to individuals who are considered medically uninsurable or high risk, and who have been denied health insurance due to a serious health condition. In certain cases, it also applies to those who have been quoted very high premiums a" again, due to a serious health condition. The pool charges premiums for coverage. Because the pool covers high-risk people, it incurs a higher level of claims than premiums can cover. The insurance industry pays into the pool to make up the difference and help it remain viable.

2-L IND EN-US.png indigenous peoples health program

Definition: Services provided directly and through contracted and operated indigenous peoples health programs. Example: Indian Health Service in the U.S.

2-L MILITARY EN-US.png military health program

Definition: A government program that provides coverage for health services to military personnel, retirees, and dependents. A covered party who is a subscriber can choose from among Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Plans offering a Point of Service (POS) Product, or Health Maintenance Organizations. Example: In the U.S., TRICARE, CHAMPUS.

2-S PUBLICPOL EN-US.png public healthcare

Insurance policy funded by a public health system such as a provincial or national health plan. Examples include BC MSP (British Columbia Medical Services Plan) OHIP (Ontario Health Insurance Plan), NHS (National Health Service).

3-L DENTPRG EN-US.png dental program

Definition: A public or government health program that administers and funds coverage for dental care to assist program eligible who meet financial and health status criteria.

3-S DISEASEPRG EN-US.png public health program

Definition: A public or government health program that administers and funds coverage for health and social services to assist program eligible who meet financial and health status criteria related to a particular disease. Example: Reproductive health, sexually transmitted disease, and end renal disease programs.

4-L CANPRG EN-US.png women's cancer detection program

Definition: A program that provides low-income, uninsured, and underserved women access to timely, high-quality screening and diagnostic services, to detect breast and cervical cancer at the earliest stages. Example: To improve women's access to screening for breast and cervical cancers, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which guided CDC in creating the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides access to critical breast and cervical cancer screening services for underserved women in the United States. An estimated 7 to 10% of U.S. women of screening age are eligible to receive NBCCEDP services. Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250% of federal poverty level; ages 18 to 64 for cervical screening; ages 40 to 64 for breast screening.

4-L ENDRENAL EN-US.png end renal program

Definition: A public or government program that administers publicly funded coverage of kidney dialysis and kidney transplant services. Example: In the U.S., the Medicare End-stage Renal Disease program (ESRD), the National Kidney Foundation (NKF) American Kidney Fund (AKF) The Organ Transplant Fund.

4-L HIVAIDS EN-US.png HIV-AIDS program

Definition: Government administered and funded HIV-AIDS program for beneficiaries meeting financial and health status criteria. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors. Example: In the U.S., the Ryan White program, which is administered by the Health Resources and Services Administration.

3-L MANDPOL EN-US.png mandatory health program

3-L MENTPRG EN-US.png mental health program

Definition: Government administered and funded mental health program for beneficiaries meeting financial and mental health status criteria. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors. Example: In the U.S., states receive funding for substance use programs from the Substance Abuse Mental Health Administration (SAMHSA).

3-L SAFNET EN-US.png safety net clinic program

Definition: Government administered and funded program to support provision of care to underserved populations through safety net clinics. Example: In the U.S., safety net providers such as federally qualified health centers (FQHC) receive funding under PHSA Section 330 grants administered by the Health Resources and Services Administration.

3-L SUBPRG EN-US.png substance use program

Definition: Government administered and funded substance use program for beneficiaries meeting financial, substance use behavior, and health status criteria. Beneficiaries may be required to enroll as a result of legal proceedings. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors. Example: In the U.S., states receive funding for substance use programs from the Substance Abuse Mental Health Administration (SAMHSA).

3-S SUBSIDIZ EN-US.png subsidized health program

Definition: A government health program that provides coverage for health services to persons meeting eligibility criteria such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds.

4-L SUBSIDMC EN-US.png subsidized managed care program

Definition: A government health program that provides coverage through managed care contracts for health services to persons meeting eligibility criteria such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds. Discussion: The structure and business processes for underwriting and administering a subsidized managed care program is further specified by the Underwriter and Payer Role.class and Role.code.

4-L SUBSUPP EN-US.png subsidized supplemental health program

Definition: A government health program that provides coverage for health services to persons meeting eligibility criteria for a supplemental health policy or program such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds. Example: Supplemental health coverage program may cover the cost of a health program or policy financial participations, such as the copays and the premiums, and may provide coverage for services in addition to those covered under the supplemented health program or policy. In the U.S., Medicaid programs may pay the premium for a covered party who is also covered under the Medicare program or a private health policy. Discussion: The structure and business processes for underwriting and administering a subsidized supplemental retiree health program is further specified by the Underwriter and Payer Role.class and Role.code.

2-L RETIRE EN-US.png retiree health program

Definition: A government mandated program with specific eligibility requirements based on premium contributions made during employment, length of employment, age, and employment status, e.g., being retired, disabled, or a dependent of a covered party under this program. Benefits typically include ambulatory, inpatient, and long-term care, such as hospice care, home health care and respite care.

2-L SOCIAL EN-US.png social service program

Definition: A social service program funded by a public or governmental entity. Example: Programs providing habilitation, food, lodging, medicine, transportation, equipment, devices, products, education, training, counseling, alteration of living or work space, and other resources to persons meeting eligibility criteria.

2-L VET EN-US.png veteran health program

Definition: Services provided directly and through contracted and operated veteran health programs.

2-L WCBPOL EN-US.png worker's compensation

Insurance policy for injuries sustained in the work place or in the course of employment.

0-L DRUGPRG EN-US.png drug program

Definition: A public or government health program that administers and funds coverage for prescription drugs to assist program eligible who meet financial and health status criteria.

0-L SUBSIDFFS EN-US.png subsidized fee for service program

Definition: A government health program that provides coverage on a fee for service basis for health services to persons meeting eligibility criteria such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds. Discussion: The structure and business processes for underwriting and administering a subsidized fee for service program is further specified by the Underwriter and Payer Role.class and Role.code.

0-L WRKCOMP EN-US.png (workers compensation program

Definition: Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

0-A _ActPolicyType EN-US.png ActPolicyType

Description:Types of policies that further specify the ActClassPolicy value set.

1-L COVPOL EN-US.png benefit policy

Description:A mandate, obligation, requirement, rule, or expectation unilaterally imposed on benefit coverage under a policy or program by a sponsor, underwriter or payor on: The activity of another party The behavior of another party The manner in which an act is executed Examples:A clinical protocol imposed by a payer to which a provider must adhere in order to be paid for providing the service. A formulary from which a provider must select prescribed drugs in order for the patient to incur a lower copay.

1-S SecurityPolicy EN-US.png security policy

Types of security policies that further specify the ActClassPolicy value set. Examples: obligation to encrypt refrain from redisclosure without consent

2-S ObligationPolicy EN-US.png obligation policy

Conveys the mandated workflow action that an information custodian, receiver, or user must perform. Usage Notes: Per ISO 22600-2, ObligationPolicy instances 'are event-triggered and define actions to be performed by manager agent'. Per HL7 Composite Security and Privacy Domain Analysis Model: This value set refers to the action required to receive the permission specified in the privacy rule.

3-L ANONY EN-US.png anonymize

Custodian system must remove any information that could result in identifying the information subject.

3-L AOD EN-US.png accounting of disclosure

Custodian system must make available to an information subject upon request an accounting of certain disclosures of the individual’s protected health information over a period of time. Policy may dictate that the accounting include information about the information disclosed, the date of disclosure, the identification of the receiver, the purpose of the disclosure, the time in which the disclosing entity must provide a response and the time period for which accountings of disclosure can be requested.

3-L AUDIT EN-US.png audit

Custodian system must monitor systems to ensure that all users are authorized to operate on information objects.

3-L AUDTR EN-US.png audit trail

Custodian system must monitor and maintain retrievable log for each user and operation on information.

3-L CPLYCC EN-US.png comply with confidentiality code

Custodian security system must retrieve, evaluate, and comply with the information handling directions of the Confidentiality Code associated with an information target.

3-L CPLYCD EN-US.png comply with consent directive

Custodian security system must retrieve, evaluate, and comply with applicable information subject consent directives.

3-L CPLYJPP EN-US.png comply with jurisdictional privacy policy

Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional privacy policies associated with the target information.

3-L CPLYOPP EN-US.png comply with organizational privacy policy

Custodian security system must retrieve, evaluate, and comply with applicable organizational privacy policies associated with the target information.

3-L CPLYOSP EN-US.png comply with organizational security policy

Custodian security system must retrieve, evaluate, and comply with the organizational security policies associated with the target information.

3-L CPLYPOL EN-US.png comply with policy

Custodian security system must retrieve, evaluate, and comply with applicable policies associated with the target information.

3-L DEID EN-US.png deidentify

Custodian system must strip information of data that would allow the identification of the source of the information or the information subject.

3-L DELAU EN-US.png delete after use

Custodian system must remove target information from access after use.

3-S ENCRYPT EN-US.png encrypt

Custodian system must render information unreadable by algorithmically transforming plaintext into ciphertext. Usage Notes: A mathematical transposition of a file or data stream so that it cannot be deciphered at the receiving end without the proper key. Encryption is a security feature that assures that only the parties who are supposed to be participating in a videoconference or data transfer are able to do so. It can include a password, public and private keys, or a complex combination of all. (Per Infoway.)

4-L ENCRYPTR EN-US.png encrypt at rest

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext when "at rest" or in storage.

4-L ENCRYPTT EN-US.png encrypt in transit

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext while "in transit" or being transported by any means.

4-L ENCRYPTU EN-US.png encrypt in use

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext while in use such that operations permitted on the target information are limited by the license granted to the end user.

3-L HUAPRV EN-US.png human approval

Custodian system must require human review and approval for permission requested.

3-L MASK EN-US.png mask

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext. User may be provided a key to decrypt per license or "shared secret".

3-L PSEUD EN-US.png pseudonymize

Custodian system must strip information of data that would allow the identification of the source of the information or the information subject. Custodian may retain a key to relink data necessary to reidentify the information subject.

3-L REDACT EN-US.png redact

Custodian system must remove information, which is not authorized to be access, used, or disclosed from records made available to otherwise authorized users.

2-S RefrainPolicy EN-US.png refrain policy

Conveys prohibited actions which an information custodian, receiver, or user is not permitted to perform unless otherwise authorized or permitted under specified circumstances. Usage Notes: ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

3-L NOAUTH EN-US.png prohibit disclosure without subject authorization

Prohibition on disclosure without information subject's authorization.

3-L NOCOLLECT EN-US.png prohibit collection

Prohibition on collection or storage of the information.

3-L NODSCLCD EN-US.png prohibit disclosure without consent directive

Prohibition on disclosure without organizational approved patient restriction.

3-L NOINTEGRATE EN-US.png prohibit integration

Prohibition on Integration into other records.

3-L NOLIST EN-US.png prohibit unlisted entity disclosure

Prohibition on disclosure except to entities on specific access list.

3-L NOMOU EN-US.png prohibit disclosure without MOU

Prohibition on disclosure without an interagency service agreement or memorandum of understanding (MOU).

3-L NOORGPOL EN-US.png prohibit disclosure without organizational authorization

Prohibition on disclosure without organizational authorization.

3-L NOPERSISTP EN-US.png prohibit collection beyond purpose of use

Prohibition on collection of the information beyond time necessary to accomplish authorized purpose of use is prohibited.

3-L NORDSCLW EN-US.png prohibit disclosure without jurisdictional authorization

Prohibition on disclosure without authorization under jurisdictional law.

3-L NORDSLCD EN-US.png prohibit redisclosure without consent directive

Prohibition on redisclosure without patient consent directive.

3-L NORELINK EN-US.png prohibit relinking

Prohibition on associating de-identified or pseudonymized information with other information in a manner that could or does result in disclosing information intended to be masked.

3-L NOREUSE EN-US.png prohibit reuse beyond purpose of use

Prohibition on use of the information beyond the purpose of use initially authorized.

3-L NOVIP EN-US.png prohibit unauthorized VIP disclosure

Prohibition on disclosure except to principals with access permission to specific VIP information.

3-L ORCON EN-US.png prohibit disclosure without originator authorization

Prohibition on disclosure except as permitted by the information originator.

1-A _ActPrivacyPolicy EN-US.png ActPrivacyPolicy

A policy deeming certain information to be private to an individual or organization. Definition: A mandate, obligation, requirement, rule, or expectation relating to privacy. Discussion: ActPrivacyPolicyType codes support the designation of the 1..* policies that are applicable to an Act such as a Consent Directive, a Role such as a VIP Patient, or an Entity such as a patient who is a minor. 1..* ActPrivacyPolicyType values may be associated with an Act or Role to indicate the policies that govern the assignment of an Act or Role confidentialityCode. Use of multiple ActPrivacyPolicyType values enables fine grain specification of applicable policies, but must be carefully assigned to ensure cogency and avoid creation of conflicting policy mandates. Usage Note: Statutory title may be named in the ActClassPolicy Act Act.title to specify which privacy policy is being referenced.

2-A _ActConsentDirective EN-US.png ActConsentDirective

Definition: Specifies the type of consent directive indicated by an ActClassPolicy e.g., a 3rd party authorization to disclose or consent for a substitute decision maker (SDM) or a notice of privacy policy. Usage Note: ActConsentDirective codes are used to specify the type of Consent Directive to which a Consent Directive Act conforms.

3-L EMRGONLY EN-US.png emergency only

This general consent directive specifically limits disclosure of health information for purpose of emergency treatment. Additional parameters may further limit the disclosure to specific users, roles, duration, types of information, and impose uses obligations. Definition: Opt-in to disclosure of health information for emergency only consent directive.

3-L NOPP EN-US.png notice of privacy practices

Acknowledgement of custodian notice of privacy practices. Usage Notes: This type of consent directive acknowledges a custodian's notice of privacy practices including its permitted collection, access, use and disclosure of health information to users and for purposes of use specified.

3-L OPTIN EN-US.png opt-in

This general consent directive permits disclosure of health information. Additional parameter may limit authorized users, purpose of use, user obligations, duration, or information types permitted to be disclosed, and impose uses obligations. Definition: Opt-in to disclosure of health information consent directive.

3-L OPTOUT EN-US.png op-out

This general consent directive prohibits disclosure of health information. Additional parameters may permit access to some information types by certain users, roles, purposes of use, durations and impose user obligations. Definition: Opt-out of disclosure of health information consent directive.

2-A _ActPrivacyLaw EN-US.png ActPrivacyLaw

A mandate, obligation, requirement, rule, or expectation characterizing the value or importance of a resource and may include its vulnerability. (Based on ISO7498-2:1989. Note: The vulnerability of personally identifiable sensitive information may be based on concerns that the unauthorized disclosure may result in social stigmatization or discrimination.) Description: Types of Sensitivity policy that apply to Acts or Roles. A sensitivity policy is adopted by an enterprise or group of enterprises (a policy domain) through a formal data use agreement that stipulates the value, importance, and vulnerability of information. A sensitivity code representing a sensitivity policy may be associated with criteria such as categories of information or sets of information identifiers (e.g., a value set of clinical codes or branch in a code system hierarchy). These criteria may in turn be used for the Policy Decision Point in a Security Engine. A sensitivity code may be used to set the confidentiality code used on information about Acts and Roles to trigger the security mechanisms required to control how security principals (i.e., a person, a machine, a software application) may act on the information (e.g., collection, access, use, or disclosure). Sensitivity codes are never assigned to the transport or business envelope containing patient specific information being exchanged outside of a policy domain as this would disclose the information intended to be protected by the policy. When sensitive information is exchanged with others outside of a policy domain, the confidentiality code on the transport or business envelope conveys the receiver's responsibilities and indicates the how the information is to be safeguarded without unauthorized disclosure of the sensitive information. This ensures that sensitive information is treated by receivers as the sender intends, accomplishing interoperability without point to point negotiations.

Usage Note: Sensitivity codes are not useful for interoperability outside of a policy domain without an out-of-band agreement on semantics because sensitivity policies are typically localized and vary drastically across policy domains even for the same information category because of differing organizational business rules, security policies, and jurisdictional requirements. For example, an employee sensitivity code (EMPL) would make little sense for use outside of a policy domain. The code “taboo� (TBOO) would rarely be useful outside of a policy domain unless there are jurisdictional requirements requiring that a provider disclose sensitive information to a patient directly. Sensitivity codes may be more appropriate in a legacy system's Master Files in order to notify those who access a patient's orders and observations about the sensitivity policies that apply. Newer systems may have a security engine that uses a sensitivity policy criteria directly. The specializable InformationSensitivityPolicy Act.code may be useful in some scenarios if used in combination with a sensitivity identifier and/or Act.title.

2-A _InformationSensitivityPolicy EN-US.png InformationSensitivityPolicy

A mandate, obligation, requirement, rule, or expectation characterizing the value or importance of a resource and may include its vulnerability. (Based on ISO7498-2:1989. Note: The vulnerability of personally identifiable sensitive information may be based on concerns that the unauthorized disclosure may result in social stigmatization or discrimination.) Description: Types of Sensitivity policy that apply to Acts or Roles. A sensitivity policy is adopted by an enterprise or group of enterprises (a 'policy domain') through a formal data use agreement that stipulates the value, importance, and vulnerability of information. A sensitivity code representing a sensitivity policy may be associated with criteria such as categories of information or sets of information identifiers (e.g., a value set of clinical codes or branch in a code system hierarchy). These criteria may in turn be used for the Policy Decision Point in a Security Engine. A sensitivity code may be used to set the confidentiality code used on information about Acts and Roles to trigger the security mechanisms required to control how security principals (i.e., a person, a machine, a software application) may act on the information (e.g., collection, access, use, or disclosure). Sensitivity codes are never assigned to the transport or business envelope containing patient specific information being exchanged outside of a policy domain as this would disclose the information intended to be protected by the policy. When sensitive information is exchanged with others outside of a policy domain, the confidentiality code on the transport or business envelope conveys the receiver's responsibilities and indicates the how the information is to be safeguarded without unauthorized disclosure of the sensitive information. This ensures that sensitive information is treated by receivers as the sender intends, accomplishing interoperability without point to point negotiations. Usage Note: Sensitivity codes are not useful for interoperability outside of a policy domain because sensitivity policies are typically localized and vary drastically across policy domains even for the same information category because of differing organizational business rules, security policies, and jurisdictional requirements. For example, an employee's sensitivity code would make little sense for use outside of a policy domain. 'Taboo' would rarely be useful outside of a policy domain unless there are jurisdictional requirements requiring that a provider disclose sensitive information to a patient directly. Sensitivity codes may be more appropriate in a legacy system's Master Files in order to notify those who access a patient's orders and observations about the sensitivity policies that apply. Newer systems may have a security engine that uses a sensitivity policy's criteria directly. The specializable InformationSensitivityPolicy Act.code may be useful in some scenarios if used in combination with a sensitivity identifier and/or Act.title.

3-L ADOL EN-US.png adolescent information sensitivity

Policy for handling information related to an adolescent, which will be afforded heightened confidentiality per applicable organizational or jurisdictional policy. An enterprise may have a policy that requires that adolescent patient information be provided heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location. Usage Note: For use within an enterprise in which an adolescent is the information subject. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-L CEL EN-US.png celebrity information sensitivity

Policy for handling information related to a celebrity (people of public interest (VIP), which will be afforded heightened confidentiality. Celebrities are people of public interest (VIP) about whose information an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive may include health information and patient role information including patient status, demographics, next of kin, and location. Usage Note: For use within an enterprise in which the information subject is deemed a celebrity or very important person. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-L DIA EN-US.png diagnosis information sensitivity

Policy for handling information related to a diagnosis, health condition or health problem, which will be afforded heightened confidentiality. Diagnostic, health condition or health problem related information may be deemed sensitive by organizational policy, and require heightened confidentiality. Usage Note: For use within an enterprise that provides heightened confidentiality to diagnostic, health condition or health problem related information deemed sensitive. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-L DRGIS EN-US.png drug information sensitivity

Policy for handling information related to a drug, which will be afforded heightened confidentiality. Drug information may be deemed sensitive by organizational policy, and require heightened confidentiality. Usage Note: For use within an enterprise that provides heightened confidentiality to drug information deemed sensitive. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-L EMP EN-US.png employee information sensitivity

Policy for handling information related to an employee, which will be afforded heightened confidentiality. When a patient is an employee, an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location. Usage Note: Policy for handling information related to an employee, which will be afforded heightened confidentiality. Description: When a patient is an employee, an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

3-L PDS EN-US.png patient default sensitivity

Policy for handling information reported by the patient about another person, e.g., a family member, which will be afforded heightened confidentiality. Sensitive information reported by the patient about another person, e.g., family members may be deemed sensitive by default. The flag may be set or cleared on patient's request. Usage Note: For sensitive information relayed by or about a patient, which is deemed sensitive within the enterprise (i.e., by default regardless of whether the patient requested that the information be deemed sensitive.) If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-L PRS EN-US.png patient requested sensitivity

For sensitive information relayed by or about a patient, which is deemed sensitive within the enterprise (i.e., by default regardless of whether the patient requested that the information be deemed sensitive.) If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code. Usage Note: For use within an enterprise that provides heightened confidentiality to certain types of information designated by a patient as sensitive. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-A _ActInformationSensitivityPolicy EN-US.png ActInformationSensitivityPolicy

Types of sensitivity policies that apply to Acts. Act.confidentialityCode is defined in the RIM as "constraints around appropriate disclosure of information about this Act, regardless of mood." Usage Note: ActSensitivity codes are used to bind information to an Act.confidentialityCode according to local sensitivity policy so that those confidentiality codes can then govern its handling across enterprises. Internally to a policy domain, however, local policies guide the access control system on how end users in that policy domain are able to use information tagged with these sensitivity values.

4-L ETH EN-US.png substance abuse information sensitivity

Policy for handling alcohol or drug-abuse information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to alcohol or drug-abuse information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L GDIS EN-US.png genetic disease information sensitivity

Policy for handling genetic disease information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to genetic disease information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L HIV EN-US.png HIV/AIDS information sensitivity

Policy for handling HIV or AIDS information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to HIV or AIDS information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L PSY EN-US.png psychiatry information sensitivity

Policy for handling psychiatry information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to psychiatry information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L SDV EN-US.png sexual assault, abuse, or domestic violence information sensitivity

Policy for handling sexual assault, abuse, or domestic violence information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexual assault, abuse, or domestic violence information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L SEX EN-US.png sexuality and reproductive health information sensitivity

Policy for handling sexuality and reproductive health information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexuality and reproductive health information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L SICKLE EN-US.png sickle cell

Types of sensitivity policies that apply to Acts. Act.confidentialityCode is defined in the RIM as "constraints around appropriate disclosure of information about this Act, regardless of mood." Usage Note: ActSensitivity codes are used to bind information to an Act.confidentialityCode according to local sensitivity policy so that those confidentiality codes can then govern its handling across enterprises. Internally to a policy domain, however, local policies guide the access control system on how end users in that policy domain are able to use information tagged with these sensitivity values.

4-L STD EN-US.png sexually transmitted disease information sensitivity

Policy for handling sexually transmitted disease information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexually transmitted disease information that is deemed sensitive. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L TBOO EN-US.png taboo

Policy for handling information not to be initially disclosed or discussed with patient except by a physician assigned to patient in this case. Information handling protocols based on organizational policies related to sensitive patient information that must be initially discussed with the patient by an attending physician before being disclosed to the patient. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-A _EntitySensitivityPolicyType EN-US.png EntityInformationSensitivityPolicy

Types of sensitivity policies that may apply to a sensitive attribute on an Entity. Usage Note: EntitySensitivity codes are used to convey a policy that is applicable to sensitive information conveyed by an entity attribute. May be used to bind a Role.confidentialityCode associated with an Entity per organizational policy. Role.confidentialityCode is defined in the RIM as "an indication of the appropriate disclosure of information about this Role with respect to the playing Entity."

4-L DEMO EN-US.png all demographic information sensitivity

Policy for handling all demographic information about an information subject, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to all demographic about an information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L DOB EN-US.png date of birth information sensitivity

Policy for handling information related to an information subject's date of birth, which will be afforded heightened confidentiality.Policies may govern sensitivity of information related to an information subject's date of birth, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L GENDER EN-US.png gender and sexual orientation information sensitivity

Policy for handling information related to an information subject's gender and sexual orientation, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's gender and sexual orientation, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L LIVARG EN-US.png living arrangement information sensitivity

Policy for handling information related to an information subject's living arrangement, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's living arrangement, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L MARST EN-US.png marital status information sensitivity

Policy for handling information related to an information subject's marital status, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's marital status, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L RACE EN-US.png race information sensitivity

Policy for handling information related to an information subject's race, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's race, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L REL EN-US.png religion information sensitivity

Policy for handling information related to an information subject's religious affiliation, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's religion, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Notes: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

3-A _RoleInformationSensitivityPolicy EN-US.png RoleInformationSensitivityPolicy

Types of sensitivity policies that apply to Roles. Usage Notes: RoleSensitivity codes are used to bind information to a Role.confidentialityCode per organizational policy. Role.confidentialityCode is defined in the RIM as "an indication of the appropriate disclosure of information about this Role with respect to the playing Entity."

4-L B EN-US.png business information sensitivity

Policy for handling trade secrets such as financial information or intellectual property, which will be afforded heightened confidentiality. Description: Since the service class can represent knowledge structures that may be considered a trade or business secret, there is sometimes (though rarely) the need to flag those items as of business level confidentiality. Usage Notes: No patient related information may ever be of this confidentiality level. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L EMPL EN-US.png employer information sensitivity

Policy for handling information related to an employer which is deemed classified to protect an employee who is the information subject, and which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to an employer, such as law enforcement or national security, the identity of which could impact the privacy, well-being, or safety of an information subject who is an employee. Usage Notes: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L LOCIS EN-US.png location information sensitivity

Policy for handling information related to the location of the information subject, which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to the location of the information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject. Usage Notes: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

4-L SSP EN-US.png sensitive service provider information sensitivity

Policy for handling information related to a provider of sensitive services, which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to providers who deliver sensitive healthcare services in order to protect the privacy, well-being, and safety of the provider and of patients receiving sensitive services. Usage Notes: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

0-A _ActConsentType EN-US.png ActConsentType

Definition: The type of consent directive, e.g., to consent or dissent to collect, access, or use in specific ways within an EHRS or for health information exchange; or to disclose health information for purposes such as research.

1-L ICOL EN-US.png information collection

Definition: Consent to have healthcare information collected in an electronic health record. This entails that the information may be used in analysis, modified, updated.

1-L IDSCL EN-US.png information disclosure

Definition: Consent to have collected healthcare information disclosed.

1-S INFA EN-US.png information access

Definition: Consent to access healthcare information.

2-L INFAO EN-US.png access only

Definition: Consent to access or "read" only, which entails that the information is not to be copied, screen printed, saved, emailed, stored, re-disclosed or altered in any way. This level ensures that data which is masked or to which access is restricted will not be. Example: Opened and then emailed or screen printed for use outside of the consent directive purpose.

2-L INFASO EN-US.png access and save only

Definition: Consent to access and save only, which entails that access to the saved copy will remain locked.

1-L IRDSCL EN-US.png information redisclosure

Definition: Information re-disclosed without the patient's consent.

1-S RESEARCH EN-US.png research information access

Definition: Consent to have healthcare information in an electronic health record accessed for research purposes.

2-L RSDID EN-US.png de-identified information access

Definition: Consent to have de-identified healthcare information in an electronic health record that is accessed for research purposes, but without consent to re-identify the information under any circumstance.

2-L RSREID EN-US.png re-identifiable information access

Definition: Consent to have de-identified healthcare information in an electronic health record that is accessed for research purposes re-identified under specific circumstances outlined in the consent. Example:: Where there is a need to inform the subject of potential health issues.

0-A _ActInformationAccessCode EN-US.png ActInformationAccessCode

Description: The type of health information to which the subject of the information or the subject's delegate consents or dissents.

1-L ACADR EN-US.png adverse drug reaction access

Description: Provide consent to collect, use, disclose, or access adverse drug reaction information for a patient.

1-L ACALL EN-US.png all access

Description: Provide consent to collect, use, disclose, or access all information for a patient.

1-L ACALLG EN-US.png allergy access

Description: Provide consent to collect, use, disclose, or access allergy information for a patient.

1-L ACCONS EN-US.png informational consent access

Description: Provide consent to collect, use, disclose, or access informational consent information for a patient.

1-L ACDEMO EN-US.png demographics access

Description: Provide consent to collect, use, disclose, or access demographics information for a patient.

1-L ACDI EN-US.png diagnostic imaging access

Description: Provide consent to collect, use, disclose, or access diagnostic imaging information for a patient.

1-L ACIMMUN EN-US.png immunization access

Description: Provide consent to collect, use, disclose, or access immunization information for a patient.

1-L ACLAB EN-US.png lab test result access

Description: Provide consent to collect, use, disclose, or access lab test result information for a patient.

1-L ACMED EN-US.png medication access

Description: Provide consent to collect, use, disclose, or access medical condition information for a patient.

1-L ACMEDC EN-US.png medical condition access

Definition: Provide consent to view or access medical condition information for a patient.

1-L ACMEN EN-US.png mental health access

Description:Provide consent to collect, use, disclose, or access mental health information for a patient.

1-L ACOBS EN-US.png common observations access

Description: Provide consent to collect, use, disclose, or access common observation information for a patient.

1-L ACPOLPRG EN-US.png policy or program information access

Description: Provide consent to collect, use, disclose, or access coverage policy or program for a patient.

1-L ACPROV EN-US.png provider information access

Description: Provide consent to collect, use, disclose, or access provider information for a patient.

1-L ACPSERV EN-US.png professional service access

Description: Provide consent to collect, use, disclose, or access professional service information for a patient.

1-L ACSUBSTAB EN-US.png substance abuse access

Description:Provide consent to collect, use, disclose, or access substance abuse information for a patient.

0-A _ActInformationAccessContextCode EN-US.png ActInformationAccessContextCode

Concepts conveying the context in which consent to transfer specified patient health information for collection, access, use or disclosure applies.

1-L INFAUT EN-US.png authorized information transfer

Description: Information transfer in accordance with subjectaTMs consent directive.

1-L INFCON EN-US.png after explicit consent

Consent to collect, access, use, or disclose specified patient health information only after explicit consent.

1-L INFCRT EN-US.png only on court order

Description: Information transfer in accordance with judicial system protocol.

1-L INFDNG EN-US.png only if danger to others

Consent to collect, access, use, or disclose specified patient health information only if necessary to avert potential danger to other persons.

1-L INFEMER EN-US.png only in an emergency

Description: Information transfer in accordance with emergency information transfer protocol.

1-L INFPWR EN-US.png only if public welfare risk

Consent to collect, access, use, or disclose specified patient health information only if necessary to avert potential public welfare risk.

1-L INFREG EN-US.png regulatory information transfer

Description: Information transfer in accordance with regulatory protocol, e.g., for public health, welfare, and safety.

0-A _ActExposureCode EN-US.png ActExposureCode

Concepts that identify the type or nature of exposure interaction. Examples include "household", "care giver", "intimate partner", "common space", "common substance", etc. to further describe the nature of interaction.

1-L CHLDCARE EN-US.png Day care - Child care Interaction

Description: Exposure participants' interaction occurred in a child care setting

1-L CONVEYNC EN-US.png Common Conveyance Interaction

Description: An interaction where the exposure participants traveled in/on the same vehicle (not necessarily concurrently, e.g. both are passengers of the same plane, but on different flights of that plane).

1-L HLTHCARE EN-US.png Health Care Interaction - Not Patient Care

Description: Exposure participants' interaction occurred during the course of health care delivery or in a health care delivery setting, but did not involve the direct provision of care (e.g. a janitor cleaning a patient's hospital room).

1-L HOMECARE EN-US.png Care Giver Interaction

Description: Exposure interaction occurred in context of one providing care for the other, i.e. a babysitter providing care for a child, a home-care aide providing assistance to a paraplegic.

1-L HOSPPTNT EN-US.png Hospital Patient Interaction

Description: Exposure participants' interaction occurred when both were patients being treated in the same (acute) health care delivery facility.

1-L HOSPVSTR EN-US.png Hospital Visitor Interaction

Description: Exposure participants' interaction occurred when one visited the other who was a patient being treated in a health care delivery facility.

1-L HOUSEHLD EN-US.png Household Interaction

Description: Exposure interaction occurred in context of domestic interaction, i.e. both participants reside in the same household.

1-L INMATE EN-US.png Inmate Interaction

Description: Exposure participants' interaction occurred in the course of one or both participants being incarcerated at a correctional facility

1-L INTIMATE EN-US.png Intimate Interaction

Description: Exposure interaction was intimate, i.e. participants are intimate companions (e.g. spouses, domestic partners).

1-L LTRMCARE EN-US.png Long Term Care Facility Interaction

Description: Exposure participants' interaction occurred in the course of one or both participants being resident at a long term care facility (second participant may be a visitor, worker, resident or a physical place or object within the facility).

1-L PLACE EN-US.png Common Space Interaction

Description: An interaction where the exposure participants were both present in the same location/place/space.

1-L PTNTCARE EN-US.png Health Care Interaction - Patient Care

Description: Exposure participants' interaction occurred during the course of health care delivery by a provider (e.g. a physician treating a patient in her office).

1-L SCHOOL2 EN-US.png School Interaction

Description: Exposure participants' interaction occurred in an academic setting (e.g., participants are fellow students, or student and teacher).

1-L SOCIAL2 EN-US.png Social/Extended Family Interaction

Description: An interaction where the exposure participants are social associates or members of the same extended family

1-L SUBSTNCE EN-US.png Common Substance Interaction

Description: An interaction where the exposure participants shared or co-used a common substance (e.g. drugs, needles, or common food item).

1-L TRAVINT EN-US.png Common Travel Interaction

Description: An interaction where the exposure participants traveled together in/on the same vehicle/trip (e.g. concurrent co-passengers).

1-L WORK2 EN-US.png Work Interaction

Description: Exposure interaction occurred in a work setting, i.e. participants are co-workers.

0-A _ActInformationCategoryCode EN-US.png ActInformationCategoryCode

Definition:Indicates the set of information types which may be manipulated or referenced, such as for recommending access restrictions.

1-L ALLCAT EN-US.png all categories

Description: All patient information.

1-L ALLGCAT EN-US.png allergy category

Definition:All information pertaining to a patient's allergy and intolerance records.

1-L ARCAT EN-US.png adverse drug reaction category

Description: All information pertaining to a patient's adverse drug reactions.

1-L COBSCAT EN-US.png common observation category

Definition:All information pertaining to a patient's common observation records (height, weight, blood pressure, temperature, etc.).

1-L DEMOCAT EN-US.png demographics category

Definition:All information pertaining to a patient's demographics (such as name, date of birth, gender, address, etc).

1-L DICAT EN-US.png diagnostic image category

Definition:All information pertaining to a patient's diagnostic image records (orders & results).

1-L IMMUCAT EN-US.png immunization category

Definition:All information pertaining to a patient's vaccination records.

1-L LABCAT EN-US.png lab test category

Description: All information pertaining to a patient's lab test records (orders & results)

1-L MEDCCAT EN-US.png medical condition category

Definition:All information pertaining to a patient's medical condition records.

1-L MENCAT EN-US.png mental health category

Description: All information pertaining to a patient's mental health records.

1-L PSVCCAT EN-US.png professional service category

Definition:All information pertaining to a patient's professional service records (such as smoking cessation, counseling, medication review, mental health).

1-L RXCAT EN-US.png medication category

Definition:All information pertaining to a patient's medication records (orders, dispenses and other active medications).

0-A _ActNonObservationIndicationCode EN-US.png ActNonObservationIndicationCode

Description:Concepts representing indications (reasons for clinical action) other than diagnosis and symptoms.

1-L IND01 EN-US.png imaging study requiring contrast

Description:Contrast agent required for imaging study.

1-L IND02 EN-US.png colonoscopy prep

Description:Provision of prescription or direction to consume a product for purposes of bowel clearance in preparation for a colonoscopy.

1-L IND03 EN-US.png prophylaxis

Description:Provision of medication as a preventative measure during a treatment or other period of increased risk.

1-L IND04 EN-US.png surgical prophylaxis

Description:Provision of medication during pre-operative phase; e.g., antibiotics before dental surgery or bowel prep before colon surgery.

1-L IND05 EN-US.png pregnancy prophylaxis

Description:Provision of medication for pregnancy --e.g., vitamins, antibiotic treatments for vaginal tract colonization, etc.

0-A _ActSpecimenTransportCode EN-US.png ActSpecimenTransportCode

Transportation of a specimen.

1-L SREC EN-US.png specimen received

Description:Specimen has been received by the participating organization/department.

1-L SSTOR EN-US.png specimen in storage

Description:Specimen has been placed into storage at a participating location.

1-L STRAN EN-US.png specimen in transit

Description:Specimen has been put in transit to a participating receiver.

0-L PRLMN EN-US.png preliminary

Description:Indicates that a result is incomplete. There are further results to come. This maps to the 'active' state in the observation result status code.

0-L F EN-US.png final

Description:Indicates that a result is complete. No further results are to come. This maps to the 'complete' state in the observation result status code.

0-L C EN-US.png corrected

Description:Indicates that result data has been corrected.

0-A _ActClaimAttachmentCategoryCode EN-US.png ActClaimAttachmentCategoryCode

Description: Coded types of attachments included to support a healthcare claim.

1-L AUTOATTCH EN-US.png auto attachment

Description: Automobile Information Attachment

1-L DOCUMENT EN-US.png document

Description: Document Attachment

1-L HEALTHREC EN-US.png health record

Description: Health Record Attachment

1-L IMG EN-US.png image attachment

Description: Image Attachment

1-L LABRESULTS EN-US.png lab results

Description: Lab Results Attachment

1-L MODEL EN-US.png model

Description: Digital Model Attachment

1-L WIATTCH EN-US.png work injury report attachment

Description: Work Injury related additional Information Attachment

1-L XRAY EN-US.png x-ray

Description: Digital X-Ray Attachment

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