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) Diet

Code set to define specialized/allowed diets

1-L BR (en-US) breikost (GE)

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

1-L DM (en-US) 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) fasting

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

1-L GF (en-US) gluten free

Gluten free diet for celiac disease.

1-L LF (en-US) low fat

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

1-L LP (en-US) low protein

A low protein diet for patients with renal failure.

1-L LQ (en-US) 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) low sodium

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

1-L N (en-US) 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) no fat

A no fat diet for acute hepatic diseases.

1-L PAF (en-US) phenylalanine free

Phenylketonuria diet.

1-L PAR (en-US) parenteral

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

1-L RD (en-US) reduction diet

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

1-L SCH (en-US) 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) 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) 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) 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) 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) Cash

1-S CC (en-US) 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) American Express

2-L DN (en-US) Diner's Club

2-L DV (en-US) Discover Card

2-L MC (en-US) Master Card

2-L V (en-US) Visa

1-L PBILLACCT (en-US) patient billing account

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

0-A _ActAdjudicationCode (en-US) 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) 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) 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) 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) 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) ActAdjudicationGroupCode

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

2-L CONT (en-US) contract

Transaction counts and value totals by Contract Identifier.

2-L DAY (en-US) day

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

2-L LOC (en-US) location

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

2-L MONTH (en-US) month

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

2-L PERIOD (en-US) period

Transaction counts and value totals for the date range specified.

2-L PROV (en-US) provider

Transaction counts and value totals by Provider Identifier.

2-L WEEK (en-US) week

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

2-L YEAR (en-US) year

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

0-A _ActAdjudicationResultActionCode (en-US) ActAdjudicationResultActionCode

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

1-L DISPLAY (en-US) Display

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

1-L FORM (en-US) 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) 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) 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) 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) 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) 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) 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) 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) ActBoundedROICode

Type of bounded ROI.

1-L ROIFS (en-US) 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) 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) ActContainerRegistrationCode

Constrains the ActCode to the domain of Container Registration

1-L ID (en-US) Identified

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

1-L IP (en-US) 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) Left Equipment

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

1-L M (en-US) Missing

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

1-L O (en-US) 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) 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) 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) 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) auto-repeat permission

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

1-L ENDC (en-US) 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) reflex permission

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

0-A _ActCoverageConfirmationCode (en-US) ActCoverageConfirmationCode

Response to an insurance coverage eligibility query or authorization request.

1-A _ActCoverageAuthorizationConfirmationCode (en-US) 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) 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) Not Authorized

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

0-A _ActCoverageLimitCode (en-US) ActCoverageLimitCode

Criteria that are applicable to the authorized coverage.

1-S COVMX (en-US) coverage maximum

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

2-L LFEMX (en-US) 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) 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) 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) coverage period

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

2-L LFEMX (en-US) 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) Net Amount

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

2-L PRDMX (en-US) 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) Unit Price

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

2-L UNITQTY (en-US) Unit Quantity

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

0-A _ActDetectedIssueManagementCode (en-US) ActDetectedIssueManagementCode

Codes dealing with the management of Detected Issue observations

1-S 1 (en-US) Therapy Appropriate

Confirmed drug therapy appropriate

2-L 19 (en-US) Consulted Supplier

Consulted other supplier/pharmacy, therapy confirmed

2-L 2 (en-US) Assessed Patient

Assessed patient, therapy is appropriate

2-L 22 (en-US) appropriate indication or diagnosis

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

2-L 23 (en-US) prior therapy documented

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

2-L 3 (en-US) Patient Explanation

Patient gave adequate explanation

2-L 4 (en-US) Consulted Other Source

Consulted other supply source, therapy still appropriate

2-S 5 (en-US) Consulted Prescriber

Consulted prescriber, therapy confirmed

3-L 6 (en-US) Prescriber Declined Change

Consulted prescriber and recommended change, prescriber declined

2-L 7 (en-US) Interacting Therapy No Longer Active/Planned

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

1-S 14 (en-US) Supply Appropriate

Confirmed supply action appropriate

2-L 15 (en-US) Replacement

Patient's existing supply was lost/wasted

2-L 16 (en-US) Vacation Supply

Supply date is due to patient vacation

2-L 17 (en-US) Weekend Supply

Supply date is intended to carry patient over weekend

2-L 18 (en-US) Leave of Absence

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

2-L 20 (en-US) 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) Other Action Taken

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

2-L 10 (en-US) Provided Patient Education

Provided education or training to the patient on appropriate therapy use

2-L 11 (en-US) Added Concurrent Therapy

Instituted an additional therapy to mitigate potential negative effects

2-L 12 (en-US) Temporarily Suspended Concurrent Therapy

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

2-L 13 (en-US) Stopped Concurrent Therapy

Aborted existing therapy that triggered interaction.

2-L 9 (en-US) Instituted Ongoing Monitoring Program

Arranged to monitor patient for adverse effects

1-A _ActAdministrativeDetectedIssueManagementCode (en-US) ActAdministrativeDetectedIssueManagementCode

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

2-A _AuthorizationIssueManagementCode (en-US) Authorization Issue Management Code

3-S EMAUTH (en-US) 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) authorization confirmed

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

0-A _ActFinancialTransactionCode (en-US) ActFinancialTransactionCode

1-L CHRG (en-US) Standard Charge

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

1-L REV (en-US) 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) ActIncidentCode

Set of codes indicating the type of incident or accident.

1-L MVA (en-US) Motor vehicle accident

Incident or accident as the result of a motor vehicle accident

1-L SCHOOL (en-US) School Accident

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

1-L SPT (en-US) Sporting Accident

Incident or accident is the result of a sporting accident.

1-L WPA (en-US) Workplace accident

Incident or accident is the result of a work place accident

0-A _ActInvoiceElementCode (en-US) 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) 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) ActInvoiceAdjudicationPaymentGroupCode

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

3-L ALEC (en-US) 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) bonus

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

3-L CFWD (en-US) 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) education fees

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

3-L EPYMT (en-US) 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) 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) submitted invoice

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

3-L PINV (en-US) 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) 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) 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) recovery

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

3-L RETRO (en-US) retro adjustment

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

3-L TRAN (en-US) 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) 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) contract

Transaction counts and value totals by Contract Identifier.

3-L DAY (en-US) day

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

3-L INVTYPE (en-US) invoice type

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

3-L LOC (en-US) location

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

3-L MONTH (en-US) month

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

3-L PAYEE (en-US) payee

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

3-L PAYOR (en-US) payor

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

3-L PERIOD (en-US) period

Transaction counts and value totals for the date range specified.

3-L PROV (en-US) provider

Transaction counts and value totals by Provider Identifier.

3-L SENDAPP (en-US) 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) week

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

3-L YEAR (en-US) year

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

1-A _ActInvoiceDetailCode (en-US) 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) ActInvoiceDetailClinicalProductCode

An identifying data string for healthcare products.

3-L UNSPSC (en-US) 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) ActInvoiceDetailDrugProductCode

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

3-L GTIN (en-US) 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) 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) 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) ActInvoiceDetailGenericAdjudicatorCode

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

4-L COIN (en-US) 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) 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) 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) 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) 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) 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) non-normal hours

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

4-L ISOL (en-US) isolation allowance

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

4-L OOO (en-US) 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) ActInvoiceDetailGenericProviderCode

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

4-L CANCAPT (en-US) 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) 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) 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) 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) final fee

Anticipated or actual final fee associated with treating a patient.

4-L FRSTFEE (en-US) first fee

Anticipated or actual initial fee associated with treating a patient.

4-L MARKUP (en-US) 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) missed appointment

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

4-L PERFEE (en-US) 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) 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) 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) 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) urgent

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

3-A _ActInvoiceDetailTaxCode (en-US) 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) federal sales tax

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

4-L HST (en-US) harmonized sales Tax

Joint Federal/Provincial Sales Tax

4-L PST (en-US) provincial/state sales tax

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

2-A _ActInvoiceDetailPreferredAccommodationCode (en-US) ActInvoiceDetailPreferredAccommodationCode

An identifying data string for medical facility accommodations.

3-A _ActEncounterAccommodationCode (en-US) 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) 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) Isolation

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

5-L P (en-US) Private

Accommodations in which there is only 1 bed.

5-L S (en-US) Suite

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

5-L SP (en-US) Semi-private

Accommodations in which there are 2 beds.

5-L W (en-US) Ward

Accommodations in which there are 3 or more beds.

1-A _ActInvoiceGroupCode (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) preferred accommodation invoice

HealthCare facility preferred accommodation invoice.

3-L RXCINV (en-US) Rx compound invoice

Pharmacy dispense invoice for a compound.

3-L RXDINV (en-US) Rx dispense invoice

Pharmacy dispense invoice not involving a compound

3-L SBFINV (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) coverage problem

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

1-L EFORM (en-US) electronic form to follow

Electronic form with supporting or additional information to follow.

1-L FAX (en-US) fax to follow

Fax with supporting or additional information to follow.

1-L GFTH (en-US) 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) 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) 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) 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) 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) paper documentation to follow

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

1-L PIE (en-US) 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) delayed by a previous payor

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

1-L REFNR (en-US) 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) 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) 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) 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) ActListCode

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

1-S MEDLIST (en-US) medication list

List of medications.

2-L CURMEDLIST (en-US) current medication list

List of current medications.

2-L DISCMEDLIST (en-US) discharge medication list

List of discharge medications.

2-L HISTMEDLIST (en-US) medication history

Historical list of medications.

1-A _ActObservationList (en-US) ActObservationList

2-L CARELIST (en-US) 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) condition list

List of condition observations.

3-L INTOLIST (en-US) intolerance list

List of intolerance observations.

3-L PROBLIST (en-US) problem list

List of problem observations.

3-L RISKLIST (en-US) risk factors

List of risk factor observations.

2-L GOALLIST (en-US) goal list

List of observations in goal mood.

1-A _ActTherapyDurationWorkingListCode (en-US) 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) 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) 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) 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) one time

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

3-L PRN (en-US) 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) ActMonitoringProtocolCode

Identifies types of monitoring programs

1-L CTLSUB (en-US) 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) 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) limited use

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

1-L OTC (en-US) 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) 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) special authorization

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

1-L SAC (en-US) special access

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

0-A _ActPaymentCode (en-US) 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) Automated Clearing House

Automated Clearing House (ACH).

1-L CHK (en-US) Cheque

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

1-L DDP (en-US) Direct Deposit

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

1-L NON (en-US) Non-Payment Data

Non-Payment Data.

0-A _ActPharmacySupplyType (en-US) ActPharmacySupplyType

Identifies types of dispensing events

1-L DF (en-US) Daily Fill

A fill providing sufficient supply for one day

1-S EM (en-US) 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) 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) First Fill

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

2-S FFC (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) Floor stock

A supply action to restock a smaller more local dispensary.

1-L MS (en-US) Manufacturer Sample

A supply of a manufacturer sample

1-S RF (en-US) Refill

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

2-L DF (en-US) Daily Fill

A fill providing sufficient supply for one day

2-S RFC (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) Unit Dose

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

1-L UD (en-US) Unit Dose

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

1-L UDE (en-US) 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) 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) Loan

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

2-L RENT (en-US) Rent

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

1-S TRANSFER (en-US) Transfer

Transfer of ownership for a product.

2-L SALE (en-US) Sale

Transfer of ownership for a product for financial compensation.

0-A _ActSpecimenTreatmentCode (en-US) ActSpecimenTreatmentCode

Set of codes related to specimen treatments

1-L ACID (en-US) Acidification

The lowering of specimen pH through the addition of an acid

1-L ALK (en-US) Alkalization

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

1-L DEFB (en-US) Defibrination

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

1-L FILT (en-US) Filtration

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

1-L LDLP (en-US) LDL Precipitation

1-L NEUT (en-US) 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) Recalcification

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

1-L UFIL (en-US) Ultrafiltration

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

0-A _ObservationType (en-US) ObservationType

Identifies the kinds of observations that can be performed

1-L ADVERSE_REACTION (en-US) 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) 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) 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) 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) admitting diagnosis

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

2-L DISDX (en-US) discharge diagnosis

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

2-L INTDX (en-US) intermediate diagnosis

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

2-L NOI (en-US) nature of injury

The type of injury that the injury coding specifies.

1-L GISTIER (en-US) GIS tier

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

1-L HHOBS (en-US) 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) detected issue

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

2-A _ActAdministrativeDetectedIssueCode (en-US) ActAdministrativeDetectedIssueCode

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

3-A _ActAdministrativeAuthorizationDetectedIssueCode (en-US) ActAdministrativeAuthorizationDetectedIssueCode

4-L NAT (en-US) Insufficient authorization

The requesting party has insufficient authorization to invoke the interaction.

4-L SUPPRESSED (en-US) 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) validation issue

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

5-L BUS (en-US) business constraint violation

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

5-S CODE_INVAL (en-US) 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) 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) Compliance Alert

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

6-L ABUSE (en-US) 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) Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

7-L DUPTHPCLS (en-US) 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) 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) potential fraud

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

6-L PLYDOC (en-US) Poly-orderer Alert

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

6-L PLYPHRM (en-US) Poly-supplier Alert

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

5-S DOSE (en-US) Dosage problem

Proposed dosage instructions for therapy differ from standard practice.

6-L DOSECOND (en-US) dosage-condition alert

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

6-S DOSEDUR (en-US) Dose-Duration Alert

Proposed length of therapy differs from standard practice.

7-S DOSEDURH (en-US) Dose-Duration High Alert

Proposed length of therapy is longer than standard practice

8-L DOSEDURHIND (en-US) 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) Dose-Duration Low Alert

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

8-L DOSEDURLIND (en-US) 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) High Dose Alert

Proposed dosage exceeds standard practice

7-L DOSEHIND (en-US) High Dose for Indication Alert

7-L DOSEHINDA (en-US) High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

7-L DOSEHINDSA (en-US) 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) High Dose for Weight Alert

Proposed dosage exceeds standard practice for the patient's weight

6-S DOSEIVL (en-US) Dose-Interval Alert

Proposed dosage interval/timing differs from standard practice

7-L DOSEIVLIND (en-US) Dose-Interval for Indication Alert

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

6-S DOSEL (en-US) Low Dose Alert

Proposed dosage is below suggested therapeutic levels

7-L DOSELIND (en-US) Low Dose for Indication Alert

7-L DOSELINDA (en-US) Low Dose for Age Alert

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

7-L DOSELINDSA (en-US) 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) Low Dose for Weight Alert

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

6-L MDOSE (en-US) 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) invalid format

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

5-L ILLEGAL (en-US) 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) 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) 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) 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) 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) 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) 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) mandatory element missing

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

5-L NODUPS (en-US) 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) 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) Observation Alert

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

6-S AGE (en-US) Age Alert

Proposed therapy may be inappropriate or contraindicated due to patient age

7-L DOSEHINDA (en-US) High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

7-L DOSELINDA (en-US) Low Dose for Age Alert

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

6-S COND (en-US) 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) Lactation Alert

Proposed therapy may be inappropriate or contraindicated when breast-feeding

7-L PREG (en-US) Pregnancy Alert

Proposed therapy may be inappropriate or contraindicated during pregnancy

7-L WGHT
6-L CREACT (en-US) 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) Genetic Alert

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

6-L GEND (en-US) Gender Alert

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

6-L LAB (en-US) Lab Alert

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

6-S REACT (en-US) 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) 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) 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) 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) 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) 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) 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) 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) repetitions above maximum

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

6-L MINOCCURS (en-US) repetitions below minimum

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

3-A _ActAdministrativeRuleDetectedIssueCode (en-US) ActAdministrativeRuleDetectedIssueCode

4-L KEY204 (en-US) 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) 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) 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) obsolete record returned

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

2-A _ActSuppliedItemDetectedIssueCode (en-US) ActSuppliedItemDetectedIssueCode

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

3-L HISTORIC (en-US) 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) violates stated preferences

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

4-L PATPREFALT (en-US) 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) AdministrationDetectedIssueCode

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

4-S COMPLY (en-US) Compliance Alert

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

5-L ABUSE (en-US) 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) Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

6-L DUPTHPCLS (en-US) 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) 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) potential fraud

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

5-L PLYDOC (en-US) Poly-orderer Alert

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

5-L PLYPHRM (en-US) Poly-supplier Alert

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

4-L DACT (en-US) 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) Dosage problem

Proposed dosage instructions for therapy differ from standard practice.

5-L DOSECOND (en-US) dosage-condition alert

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

5-S DOSEDUR (en-US) Dose-Duration Alert

Proposed length of therapy differs from standard practice.

6-S DOSEDURH (en-US) Dose-Duration High Alert

Proposed length of therapy is longer than standard practice

7-L DOSEDURHIND (en-US) 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) Dose-Duration Low Alert

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

7-L DOSEDURLIND (en-US) 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) High Dose Alert

Proposed dosage exceeds standard practice

6-L DOSEHIND (en-US) High Dose for Indication Alert

6-L DOSEHINDA (en-US) High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

6-L DOSEHINDSA (en-US) 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) High Dose for Weight Alert

Proposed dosage exceeds standard practice for the patient's weight

5-S DOSEIVL (en-US) Dose-Interval Alert

Proposed dosage interval/timing differs from standard practice

6-L DOSEIVLIND (en-US) Dose-Interval for Indication Alert

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

5-S DOSEL (en-US) Low Dose Alert

Proposed dosage is below suggested therapeutic levels

6-L DOSELIND (en-US) Low Dose for Indication Alert

6-L DOSELINDA (en-US) Low Dose for Age Alert

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

6-L DOSELINDSA (en-US) 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) Low Dose for Weight Alert

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

5-L MDOSE (en-US) 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) Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

5-L DUPTHPCLS (en-US) 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) 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) timing detected issue

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

5-L ALRTENDLATE (en-US) 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) 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) AppropriatenessDetectedIssueCode

5-S OBSA (en-US) Observation Alert

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

6-S AGE (en-US) Age Alert

Proposed therapy may be inappropriate or contraindicated due to patient age

7-L DOSEHINDA (en-US) High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

7-L DOSELINDA (en-US) Low Dose for Age Alert

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

6-S COND (en-US) 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) Lactation Alert

Proposed therapy may be inappropriate or contraindicated when breast-feeding

7-L PREG (en-US) Pregnancy Alert

Proposed therapy may be inappropriate or contraindicated during pregnancy

7-L WGHT
6-L CREACT (en-US) 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) Genetic Alert

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

6-L GEND (en-US) Gender Alert

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

6-L LAB (en-US) Lab Alert

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

6-S REACT (en-US) 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) 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) 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) 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) 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) 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) 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) 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) InteractionDetectedIssueCode

6-L FOOD (en-US) Food Interaction Alert

Proposed therapy may interact with certain foods

6-S TPROD (en-US) Therapeutic Product Alert

Proposed therapy may interact with an existing or recent therapeutic product

7-L DRG (en-US) Drug Interaction Alert

Proposed therapy may interact with an existing or recent drug therapy

7-L NHP (en-US) Natural Health Product Alert

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

7-L NONRX (en-US) Non-Prescription Interaction Alert

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

3-A _SupplyDetectedIssueCode (en-US) SupplyDetectedIssueCode

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

4-L ALLDONE (en-US) already performed

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

4-S FULFIL (en-US) fulfillment alert

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

5-L NOTACTN (en-US) 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) not equivalent alert

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

6-L NOTEQUIVGEN (en-US) 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) 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) 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) outside requested time

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

6-L MINFREQ (en-US) 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) 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) 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) 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) 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) knowledge subtopic

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

1-S OINT (en-US) intolerance

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

2-S ALG (en-US) Allergy

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

3-L DALG (en-US) Drug Allergy

An allergy to a pharmaceutical product.

3-L EALG (en-US) Environmental Allergy

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

3-L FALG (en-US) Food Allergy

An allergy to a substance generally consumed for nutritional purposes.

2-S DINT (en-US) Drug Intolerance

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

3-L DALG (en-US) Drug Allergy

An allergy to a pharmaceutical product.

3-L DNAINT (en-US) 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) Environmental Intolerance

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

3-L EALG (en-US) Environmental Allergy

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

3-L ENAINT (en-US) 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) Food Intolerance

Hypersensitivity resulting in an adverse reaction upon exposure to food.

3-L FALG (en-US) Food Allergy

An allergy to a substance generally consumed for nutritional purposes.

3-L FNAINT (en-US) 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) 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) 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) 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) 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) Severity Observation

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

1-A _ActSpecObsCode (en-US) 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) ActSpecObsArtBldCode

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

2-S DILUTION (en-US) ActSpecObsDilutionCode

An observation that reports the dilution of a sample.

3-L AUTO-HIGH (en-US) 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) Auto-Low Dilution

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

3-L PRE (en-US) Pre-Dilution

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

3-L RERUN (en-US) 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) ActSpecObsEvntfctsCode

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

2-S INTFR (en-US) ActSpecObsInterferenceCode

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

3-L FIBRIN (en-US) 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) Hemolysis

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

3-L ICTERUS (en-US) 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) 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) ActSpecObsVolumeCode

An observation that reports the volume of a sample.

3-L AVAILABLE (en-US) 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) Consumption Volume

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

3-L CURRENT (en-US) Current Volume

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

3-L INITIAL (en-US) Initial Volume

The initial quantity of the specimen in inventory

1-A _AnnotationType (en-US) AnnotationType

2-S _ActPatientAnnotationType (en-US) ActPatientAnnotationType

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

3-L ANNDI (en-US) 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) general note

Description:A general or uncategorized note.

3-L ANNIMM (en-US) immunization note

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

3-L ANNLAB (en-US) laboratory note

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

3-L ANNMED (en-US) medication note

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

1-A _GeneticObservationType (en-US) GeneticObservationType

Description: None provided

2-L GENE (en-US) 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) ImmunizationObservationType

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

2-L OBSANTC (en-US) antigen count

Description: Indicates the valid antigen count.

2-L OBSANTV (en-US) antigen validity

Description: Indicates whether an antigen is valid or invalid.

1-A _IndividualCaseSafetyReportType (en-US) 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) 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) 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) 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) age patient qn est

Definition:Estimated age.

2-L 21612-7 (en-US) age patient qn reported

Definition:Reported age.

2-L 29553-5 (en-US) age patient qn calc

Definition:Calculated age.

2-L 30525-0 (en-US) age patient qn definition

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

2-L 30972-4 (en-US) age at onset of adverse event

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

1-A _MedicationObservationType (en-US) MedicationObservationType

2-L REP_HALF_LIFE (en-US) representative half-life

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

2-L SPLCOATING (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) animal to animal transmission

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

3-L ANHUMTRNS (en-US) animal to human transmission

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

3-L BDYFLDTRNS (en-US) 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) 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) 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) 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) 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) fomite transmission

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

3-L FOODTRNS (en-US) food-borne transmission

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

3-L HUMHUMTRNS (en-US) human to human transmission

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

3-L INDTRNS (en-US) indeterminate disease transmission mode

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

3-L LACTTRNS (en-US) 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) 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) 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) 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) 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) 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) 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) 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) ObservationQualityMeasureAttribute

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

2-L COPY (en-US) copyright

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

2-L CRS (en-US) clinical recommendation statement

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

2-L DEF (en-US) definition

Description of individual terms, provided as needed.

2-L DISC (en-US) disclaimer

Disclaimer information for the eMeasure.

2-L FINALDT (en-US) finalized date/time

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

2-L GUIDE (en-US) 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) 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) items counted

Describes the items counted by the measure (e.g., patients, encounters, procedures, etc.)

2-L KEY (en-US) keyword

A significant word that aids in discoverability.

2-L MEDT (en-US) measurement end date

The end date of the measurement period.

2-L MSD (en-US) measurement start date

The start date of the measurement period.

2-L MSRADJ (en-US) 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) 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) 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) measure scoring

Indicates how the calculation is performed for the eMeasure (e.g., proportion, continuous variable, ratio)

2-L MSRSET (en-US) 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) health quality measure topic type

2-L MSRTP (en-US) measurement period

The time period for which the eMeasure applies.

2-L MSRTYPE (en-US) 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) 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) 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) 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) 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) 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) notice of use

Usage notes.

1-A _ObservationSequenceType (en-US) ObservationSequenceType

2-L TIME_ABSOLUTE (en-US) 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) 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) ObservationSeriesType

2-A _ECGObservationSeriesType (en-US) ECGObservationSeriesType

3-L REPRESENTATIVE_BEAT (en-US) 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) 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) PatientImmunizationRelatedObservationType

Description: Reporting codes that are related to an immunization event.

2-L CLSSRM (en-US) classroom

Description: The class room associated with the patient during the immunization event.

2-L GRADE (en-US) grade

Description: The school grade or level the patient was in when immunized.

2-L SCHL (en-US) school

Description: The school the patient attended when immunized.

2-L SCHLDIV (en-US) school division

Description: The school division or district associated with the patient during the immunization event.

2-L TEACHER (en-US) teacher

Description: The patient's teacher when immunized.

0-A _ROIOverlayShape (en-US) ROIOverlayShape

Shape of the region on the object being referenced

1-L CIRCLE (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) pedestrian transport

2-S AMBT (en-US) ambulance transport

3-L AMBAIR (en-US) fixed-wing ambulance transport

3-L AMBGRND (en-US) ground ambulance transport

3-L AMBHELO (en-US) helicopter ambulance transport

2-L LAWENF (en-US) law enforcement transport

2-L PRVTRN (en-US) private transport

2-L PUBTRN (en-US) public transport

0-A _ActCareProvisionCode (en-US) 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) 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) 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) 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) 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) 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) certified anesthesiology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CAPC (en-US) 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) 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) 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) 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) 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) 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) certified dermatology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CDRC (en-US) 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) 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) 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) 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) 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) certified neurology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board

3-L CNMC (en-US) 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) 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) 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) 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) 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) certified ophthalmology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L COSC (en-US) 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) certified otolaryngology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPEC (en-US) certified pediatrics care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CPGC (en-US) 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) 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) 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) 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) certified psychiatry care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CROC (en-US) 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) 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) certified surgery care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CTSC (en-US) 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) certified urology care

Description:Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

3-L CVSC (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) certified migraine headache care

Description:.

3-L CMSC (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) ActEncounterCode

Domain provides codes that qualify the ActEncounterClass (ENC)

2-L AMB (en-US) 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) 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) 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) home health

Healthcare encounter that takes place in the residence of the patient or a designee

2-S IMP (en-US) 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) inpatient acute

An acute inpatient encounter.

3-L NONAC (en-US) inpatient non-acute

Any category of inpatient encounter except 'acute'

2-L SS (en-US) 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) 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) ActMedicalServiceCode

General category of medical service provided to the patient during their encounter.

2-L ALC (en-US) 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) Cardiology

Provision of diagnosis and treatment of diseases and disorders affecting the heart

2-L CHR (en-US) Chronic

Provision of recurring care for chronic illness.

2-L DNTL (en-US) Dental

Provision of treatment for oral health and/or dental surgery.

2-L DRGRHB (en-US) Drug Rehab

Provision of treatment for drug abuse.

2-L GENRL (en-US) General

General care performed by a general practitioner or family doctor as a responsible provider for a patient.

2-L MED (en-US) Medical

Provision of diagnostic and/or therapeutic treatment.

2-L OBS (en-US) Obstetrics

Provision of care of women during pregnancy, childbirth and immediate postpartum period. Also known as Maternity.

2-L ONC (en-US) Oncology

Provision of treatment and/or diagnosis related to tumors and/or cancer.

2-L PALL (en-US) Palliative

Provision of care for patients who are living or dying from an advanced illness.

2-L PED (en-US) Pediatrics

Provision of diagnosis and treatment of diseases and disorders affecting children.

2-L PHAR (en-US) Pharmaceutical

Pharmaceutical care performed by a pharmacist.

2-L PHYRHB (en-US) Physical Rehab

Provision of treatment for physical injury.

2-L PSYCH (en-US) Psychiatric

Provision of treatment of psychiatric disorder relating to mental illness.

2-L SURG (en-US) Surgical

Provision of surgical treatment.

0-A _ActObservationVerificationType (en-US) 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) 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) 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) 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) 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) ActBillableModifierCode

Definition:An identifying modifier code for healthcare interventions or procedures.

1-L CPTM (en-US) CPT modifier codes

Description:CPT modifier codes are found in Appendix A of CPT 2000 Standard Edition.

1-L HCPCSA (en-US) 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) 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) order entry task

A clinician creates a request for a service to be performed for a given patient.

2-L LABOE (en-US) 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) 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) patient documentation task

A person enters documentation about a given patient.

2-L ALLERLREV (en-US) allergy list review

Description: A person reviews a list of known allergies of a given patient.

2-S CLINNOTEE (en-US) clinical note entry task

A clinician enters a clinical note about a given patient

3-L DIAGLISTE (en-US) diagnosis list entry task

A clinician enters a diagnosis for a given patient.

3-L DISCHSUME (en-US) discharge summary entry task

A clinician enters a discharge summary for a given patient.

3-L PATREPE (en-US) pathology report entry task

A pathologist enters a report for a given patient.

3-L PROBLISTE (en-US) problem list entry task

A clinician enters a problem for a given patient.

3-L RADREPE (en-US) radiology report entry task

A radiologist enters a report for a given patient.

2-L IMMLREV (en-US) immunization list review

Description: A person reviews a list of immunizations due or received for a given patient.

2-S REMLREV (en-US) reminder list review

Description: A person reviews a list of health care reminders for a given patient.

3-L WELLREMLREV (en-US) 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) 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) allergy list entry

Description: A person enters a known allergy for a given patient.

2-L CDSREV (en-US) 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) clinical note review task

A person reviews a clinical note of a given patient.

3-L DISCHSUMREV (en-US) discharge summary review task

A person reviews a discharge summary of a given patient.

2-L DIAGLISTREV (en-US) diagnosis list review task

A person reviews a list of diagnoses of a given patient.

2-L IMMLE (en-US) immunization list entry

Description: A person enters an immunization due or received for a given patient.

2-L LABRREV (en-US) laboratory results review task

A person reviews a list of laboratory results of a given patient.

2-S MICRORREV (en-US) microbiology results review task

A person reviews a list of microbiology results of a given patient.

3-L MICROORGRREV (en-US) microbiology organisms results review task

A person reviews organisms of microbiology results of a given patient.

3-L MICROSENSRREV (en-US) microbiology sensitivity test results review task

A person reviews the sensitivity test of microbiology results of a given patient.

2-S MLREV (en-US) medication list review task

A person reviews a list of medication orders submitted to a given patient

3-L MARWLREV (en-US) 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) orders review task

A person reviews a list of orders submitted to a given patient.

2-L PATREPREV (en-US) pathology report review task

A person reviews a pathology report of a given patient.

2-L PROBLISTREV (en-US) problem list review task

A person reviews a list of problems of a given patient.

2-L RADREPREV (en-US) radiology report review task

A person reviews a radiology report of a given patient.

2-S REMLE (en-US) reminder list entry

Description: A person enters a health care reminder for a given patient.

3-L WELLREMLE (en-US) wellness reminder list entry

Description: A person enters a wellness or preventive care reminder for a given patient.

2-S RISKASSESS (en-US) risk assessment instrument task

A person reviews a Risk Assessment Instrument report of a given patient.

3-L FALLRISK (en-US) falls risk assessment instrument task

A person reviews a Falls Risk Assessment Instrument report of a given patient.

0-A _ActCoverageTypeCode (en-US) 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) ActInsurancePolicyCode

Set of codes indicating the type of insurance policy or other source of funds to cover healthcare costs.

2-S AUTOPOL (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) mandatory health program

3-L MENTPRG (en-US) 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) 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) 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) 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) 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) 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) worker's compensation

Insurance policy for injuries sustained in the work place or in the course of employment.

1-A _ActInsuranceTypeCode (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) dental care policy

Definition: A health insurance policy that that covers benefits for dental services.

3-L DISEASE (en-US) 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) drug policy

Definition: A health insurance policy that covers benefits for prescription drugs, pharmaceuticals, and supplies.

3-L EHCPOL (en-US) 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) 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) 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) 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) 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) 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) 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) 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) mental health policy

Definition: A health insurance policy that covers benefits for mental health services and prescriptions.

3-L POS (en-US) 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) substance use policy

Definition: A health insurance policy that covers benefits for substance use services.

3-L VISPOL (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) mandatory health program

3-L MENTPRG (en-US) 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) 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) 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) 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) 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) 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) 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) 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) veteran health program

Definition: Services provided directly and through contracted and operated veteran health programs.

2-L WCBPOL (en-US) worker's compensation

Insurance policy for injuries sustained in the work place or in the course of employment.

0-L DRUGPRG (en-US) 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) 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) (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) ActPolicyType

Description:Types of policies that further specify the ActClassPolicy value set.

1-L COVPOL (en-US) 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) 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) 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) anonymize

Custodian system must remove any information that could result in identifying the information subject.

3-L AOD (en-US) 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) audit

Custodian system must monitor systems to ensure that all users are authorized to operate on information objects.

3-L AUDTR (en-US) audit trail

Custodian system must monitor and maintain retrievable log for each user and operation on information.

3-L CPLYCC (en-US) 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) comply with consent directive

Custodian security system must retrieve, evaluate, and comply with applicable information subject consent directives.

3-L CPLYJPP (en-US) 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) 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) 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) comply with policy

Custodian security system must retrieve, evaluate, and comply with applicable policies associated with the target information.

3-L DEID (en-US) 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) delete after use

Custodian system must remove target information from access after use.

3-S ENCRYPT (en-US) 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) 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) 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) 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) human approval

Custodian system must require human review and approval for permission requested.

3-L MASK (en-US) 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) 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) 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) 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) prohibit disclosure without subject authorization

Prohibition on disclosure without information subject's authorization.

3-L NOCOLLECT (en-US) prohibit collection

Prohibition on collection or storage of the information.

3-L NODSCLCD (en-US) prohibit disclosure without consent directive

Prohibition on disclosure without organizational approved patient restriction.

3-L NOINTEGRATE (en-US) prohibit integration

Prohibition on Integration into other records.

3-L NOLIST (en-US) prohibit unlisted entity disclosure

Prohibition on disclosure except to entities on specific access list.

3-L NOMOU (en-US) prohibit disclosure without MOU

Prohibition on disclosure without an interagency service agreement or memorandum of understanding (MOU).

3-L NOORGPOL (en-US) prohibit disclosure without organizational authorization

Prohibition on disclosure without organizational authorization.

3-L NOPERSISTP (en-US) 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) prohibit disclosure without jurisdictional authorization

Prohibition on disclosure without authorization under jurisdictional law.

3-L NORDSLCD (en-US) prohibit redisclosure without consent directive

Prohibition on redisclosure without patient consent directive.

3-L NORELINK (en-US) 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) prohibit reuse beyond purpose of use

Prohibition on use of the information beyond the purpose of use initially authorized.

3-L NOVIP (en-US) prohibit unauthorized VIP disclosure

Prohibition on disclosure except to principals with access permission to specific VIP information.

3-L ORCON (en-US) prohibit disclosure without originator authorization

Prohibition on disclosure except as permitted by the information originator.

1-A _ActPrivacyPolicy (en-US) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) 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) information disclosure

Definition: Consent to have collected healthcare information disclosed.

1-S INFA (en-US) information access

Definition: Consent to access healthcare information.

2-L INFAO (en-US) 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) 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) information redisclosure

Definition: Information re-disclosed without the patient's consent.

1-S RESEARCH (en-US) research information access

Definition: Consent to have healthcare information in an electronic health record accessed for research purposes.

2-L RSDID (en-US) 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) 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) 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) 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) all access

Description: Provide consent to collect, use, disclose, or access all information for a patient.

1-L ACALLG (en-US) allergy access

Description: Provide consent to collect, use, disclose, or access allergy information for a patient.

1-L ACCONS (en-US) informational consent access

Description: Provide consent to collect, use, disclose, or access informational consent information for a patient.

1-L ACDEMO (en-US) demographics access

Description: Provide consent to collect, use, disclose, or access demographics information for a patient.

1-L ACDI (en-US) diagnostic imaging access

Description: Provide consent to collect, use, disclose, or access diagnostic imaging information for a patient.

1-L ACIMMUN (en-US) immunization access

Description: Provide consent to collect, use, disclose, or access immunization information for a patient.

1-L ACLAB (en-US) 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) medication access

Description: Provide consent to collect, use, disclose, or access medical condition information for a patient.

1-L ACMEDC (en-US) medical condition access

Definition: Provide consent to view or access medical condition information for a patient.

1-L ACMEN (en-US) mental health access

Description:Provide consent to collect, use, disclose, or access mental health information for a patient.

1-L ACOBS (en-US) common observations access

Description: Provide consent to collect, use, disclose, or access common observation information for a patient.

1-L ACPOLPRG (en-US) 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) provider information access

Description: Provide consent to collect, use, disclose, or access provider information for a patient.

1-L ACPSERV (en-US) professional service access

Description: Provide consent to collect, use, disclose, or access professional service information for a patient.

1-L ACSUBSTAB (en-US) substance abuse access

Description:Provide consent to collect, use, disclose, or access substance abuse information for a patient.

0-A _ActInformationAccessContextCode (en-US) 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) authorized information transfer

Description: Information transfer in accordance with subjectaTMs consent directive.

1-L INFCON (en-US) after explicit consent

Consent to collect, access, use, or disclose specified patient health information only after explicit consent.

1-L INFCRT (en-US) only on court order

Description: Information transfer in accordance with judicial system protocol.

1-L INFDNG (en-US) 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) only in an emergency

Description: Information transfer in accordance with emergency information transfer protocol.

1-L INFPWR (en-US) 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) regulatory information transfer

Description: Information transfer in accordance with regulatory protocol, e.g., for public health, welfare, and safety.

0-A _ActExposureCode (en-US) 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) Day care - Child care Interaction

Description: Exposure participants' interaction occurred in a child care setting

1-L CONVEYNC (en-US) 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) 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) 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) 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) 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) 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) 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) Intimate Interaction

Description: Exposure interaction was intimate, i.e. participants are intimate companions (e.g. spouses, domestic partners).

1-L LTRMCARE (en-US) 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) Common Space Interaction

Description: An interaction where the exposure participants were both present in the same location/place/space.

1-L PTNTCARE (en-US) 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) 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) 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) 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) 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) Work Interaction

Description: Exposure interaction occurred in a work setting, i.e. participants are co-workers.

0-A _ActInformationCategoryCode (en-US) 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) all categories

Description: All patient information.

1-L ALLGCAT (en-US) allergy category

Definition:All information pertaining to a patient's allergy and intolerance records.

1-L ARCAT (en-US) adverse drug reaction category

Description: All information pertaining to a patient's adverse drug reactions.

1-L COBSCAT (en-US) 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) 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) diagnostic image category

Definition:All information pertaining to a patient's diagnostic image records (orders & results).

1-L IMMUCAT (en-US) immunization category

Definition:All information pertaining to a patient's vaccination records.

1-L LABCAT (en-US) lab test category

Description: All information pertaining to a patient's lab test records (orders & results)

1-L MEDCCAT (en-US) medical condition category

Definition:All information pertaining to a patient's medical condition records.

1-L MENCAT (en-US) mental health category

Description: All information pertaining to a patient's mental health records.

1-L PSVCCAT (en-US) 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) medication category

Definition:All information pertaining to a patient's medication records (orders, dispenses and other active medications).

0-A _ActNonObservationIndicationCode (en-US) ActNonObservationIndicationCode

Description:Concepts representing indications (reasons for clinical action) other than diagnosis and symptoms.

1-L IND01 (en-US) imaging study requiring contrast

Description:Contrast agent required for imaging study.

1-L IND02 (en-US) 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) prophylaxis

Description:Provision of medication as a preventative measure during a treatment or other period of increased risk.

1-L IND04 (en-US) 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) pregnancy prophylaxis

Description:Provision of medication for pregnancy --e.g., vitamins, antibiotic treatments for vaginal tract colonization, etc.

0-A _ActSpecimenTransportCode (en-US) ActSpecimenTransportCode

Transportation of a specimen.

1-L SREC (en-US) specimen received

Description:Specimen has been received by the participating organization/department.

1-L SSTOR (en-US) specimen in storage

Description:Specimen has been placed into storage at a participating location.

1-L STRAN (en-US) specimen in transit

Description:Specimen has been put in transit to a participating receiver.

0-L PRLMN (en-US) 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) 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) corrected

Description:Indicates that result data has been corrected.

0-A _ActClaimAttachmentCategoryCode (en-US) ActClaimAttachmentCategoryCode

Description: Coded types of attachments included to support a healthcare claim.

1-L AUTOATTCH (en-US) auto attachment

Description: Automobile Information Attachment

1-L DOCUMENT (en-US) document

Description: Document Attachment

1-L HEALTHREC (en-US) health record

Description: Health Record Attachment

1-L IMG (en-US) image attachment

Description: Image Attachment

1-L LABRESULTS (en-US) lab results

Description: Lab Results Attachment

1-L MODEL (en-US) model

Description: Digital Model Attachment

1-L WIATTCH (en-US) work injury report attachment

Description: Work Injury related additional Information Attachment

1-L XRAY (en-US) x-ray

Description: Digital X-Ray Attachment