2.16.840.1.113883.5.8

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Kodesystem ActReason

Beschreibung

A set of codes specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably represented as an ActRelationship of type "has reason" linking to another Act. Examples: Example reasons that might qualify for being coded in this field might be: "routine requirement", "infectious disease reporting requirement", "on patient request", "required by law".

Aktuelle Version

Codesystem Name Codesystem Id Version / Eingangsdatum Status
ActReason 2.16.840.1.113883.5.8 2012-07-24 definitiv
Level/Typ Code Anzeigename Beschreibung
0-A _ActAccommodationReason EN-US.png ActAccommodationReason

Identifies the reason the patient is assigned to this accommodation type

1-L ACCREQNA EN-US.png Accommodation Requested Not Available

Accommodation requested is not available.

1-L FLRCNV EN-US.png Floor Convenience

Accommodation is assigned for floor convenience.

1-L MEDNEC EN-US.png Medical Necessity

Required for medical reasons(s).

1-L PAT EN-US.png Patient request

The Patient requested the action

0-A _ActInvoiceCancelReason EN-US.png ActInvoiceCancelReason

Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.

1-L INCCOVPTY EN-US.png incorrect covered party as patient

The covered party (patient) specified with the Invoice is not correct.

1-L INCINVOICE EN-US.png incorrect billing

The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.

1-L INCPOLICY EN-US.png incorrect policy

The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.

1-L INCPROV EN-US.png incorrect provider

The provider specified with the Invoice is not correct.

0-A _SchedulingActReason EN-US.png SchedulingActReason

Reasons for cancelling or rescheduling an Appointment

1-L BLK EN-US.png Unexpected Block (of Schedule)

The time slots previously allocated are now blocked and no longer available for booking Appointments

1-L DEC EN-US.png Patient Deceased

The Patient is deceased

1-L FIN EN-US.png No Financial Backing

Patient unable to pay and not covered by insurance

1-L MED EN-US.png Medical Status Altered

The medical condition of the Patient has changed

1-L MTG EN-US.png In an outside meeting

The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment

1-L PAT EN-US.png Patient request

The Patient requested the action

1-L PHY EN-US.png Physician request

The Physician requested the action

0-A _SubstanceAdminSubstitutionReason EN-US.png SubstanceAdminSubstitutionReason

1-L CT EN-US.png continuing therapy

Indicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.

1-L FP EN-US.png formulary policy

Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.

1-L OS EN-US.png out of stock

In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.

1-L RR EN-US.png regulatory requirement

Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.

0-A _TransferActReason EN-US.png TransferActReason

The explanation for why a patient is moved from one location to another within the organization

1-L ER EN-US.png Error

Moved to an error in placing the patient in the original location.

1-L RQ EN-US.png Request

Moved at the request of the patient.

0-A _ControlActReason EN-US.png ControlActReason

Identifies why a specific query, request, or other trigger event occurred.

1-A _MedicationOrderAbortReasonCode EN-US.png medication order abort reason

Description:Indicates the reason the medication order should be aborted.

2-L DISCONT EN-US.png product discontinued

Description:The medication is no longer being manufactured or is otherwise no longer available.

2-L INEFFECT EN-US.png ineffective

Description:The therapy has been found to not have the desired therapeutic benefit on the patient.

2-L MONIT EN-US.png response to monitoring

Description:Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.

2-L NOREQ EN-US.png no longer required for treatment

Description:The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.

2-L NOTCOVER EN-US.png not covered

Description:The product does not have (or no longer has) coverage under the patientaTMs insurance policy.

2-L PREFUS EN-US.png patient refuse

Description:The patient refused to take the product.

2-L RECALL EN-US.png product recalled

Description:The manufacturer or other agency has requested that stocks of a medication be removed from circulation.

2-S REPLACE EN-US.png change in order

Description:Item in current order is no longer in use as requested and a new one has/will be created to replace it.

3-L DOSECHG EN-US.png change in medication/dose

Description:The medication is being re-prescribed at a different dosage.

2-L REPLACEFIX EN-US.png error in order

Description:Current order was issued with incorrect data and a new order has/will be created to replace it.

2-L UNABLE EN-US.png unable to use

Description:<The patient is not (or is no longer) able to use the medication in a manner prescribed. Example:CanaTMt swallow.

1-A _MedicationOrderReleaseReasonCode EN-US.png medication order release reason

Definition:A collection of concepts that indicate why the prescription should be released from suspended state.

2-L HOLDDONE EN-US.png suspend reason no longer applies

Definition:The original reason for suspending the medication has ended.

2-L HOLDINAP EN-US.png suspend reason inappropriate

Definition:

1-S _PharmacySupplyEventAbortReason EN-US.png PharmacySupplyEventAbortReason

Definition:Identifies why the dispense event was not completed.

2-L CONTRA EN-US.png contraindication

Definition:Contraindication identified

2-L FOABORT EN-US.png order aborted

Definition:Order to be fulfilled was aborted

2-L FOSUSP EN-US.png order suspended

Definition:Order to be fulfilled was suspended

2-L NOPICK EN-US.png not picked up

Definition:Patient did not come to get medication

2-L PATDEC EN-US.png patient changed mind

Definition:Patient changed their mind regarding obtaining medication

2-L QUANTCHG EN-US.png change supply quantity

Definition:Patient requested a revised quantity of medication

1-A _PharmacySupplyEventStockReasonCode EN-US.png pharmacy supply event stock reason

Definition:A collection of concepts that indicates the reason for a "bulk supply" of medication.

2-L FLRSTCK EN-US.png floor stock

Definition:The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)

2-L LTC EN-US.png long term care use

Definition:The bulk supply will be administered within a long term care facility.

2-L OFFICE EN-US.png office use

Definition:The bulk supply is intended for general clinician office use.

2-L PHARM EN-US.png pharmacy transfer

Definition:The bulk supply is being transferred to another dispensing facility to. Example:Alleviate a temporary shortage.

2-L PROG EN-US.png program use

Definition:The bulk supply is intended for dispensing according to a specific program. Example:Mass immunization.

1-A _PharmacySupplyRequestRenewalRefusalReasonCode EN-US.png pharmacy supply request renewal refusal reason

Definition:A collection of concepts that identifies why a renewal prescription has been refused.

2-L ALREADYRX EN-US.png new prescription exists

Definition:Patient has already been given a new (renewal) prescription.

2-L DISCONT EN-US.png product discontinued

Description:The medication is no longer being manufactured or is otherwise no longer available.

2-L FAMPHYS EN-US.png family physician must authorize further fills

Definition:Request for further authorization must be done through patient's family physician.

2-L MODIFY EN-US.png modified prescription exists

Definition:Therapy has been changed and new prescription issued

2-L NEEDAPMT EN-US.png patient must make appointment

Definition:Patient must see prescriber prior to further fills.

2-L NOTAVAIL EN-US.png prescriber not available

Definition:Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.

2-L NOTPAT EN-US.png patient no longer in this practice

Definition:Patient no longer or has never been under this prescribers care.

2-L ONHOLD EN-US.png medication on hold

Definition:This medication is on hold.

2-L PRNA EN-US.png product not available

Description:This product is not available or manufactured.

2-L TOOEARLY EN-US.png too early

Definition:The patient should have medication remaining.

1-A _SupplyOrderAbortReasonCode EN-US.png supply order abort reason

Definition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).

2-L IMPROV EN-US.png condition improved

Definition:The patient's medical condition has nearly abated.

2-L INTOL EN-US.png intolerance

Description:The patient has an intolerance to the medication.

2-L NEWSTR EN-US.png new strength

Definition:The current medication will be replaced by a new strength of the same medication.

2-L NEWTHER EN-US.png new therapy

Definition:A new therapy will be commenced when current supply exhausted.

0-A _ActNoImmunizationReason EN-US.png ActNoImmunizationReason

A coded description of the reason for why a patient did not receive a scheduled immunization. (important for public health strategy

1-L IMMUNE EN-US.png immunity

Definition:Testing has shown that the patient already has immunity to the agent targeted by the immunization.

1-L MEDPREC EN-US.png medical precaution

Definition:The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.

1-L OSTOCK EN-US.png product out of stock

Definition:There was no supply of the product on hand to perform the service.

1-L PATOBJ EN-US.png patient objection

Definition:The patient or their guardian objects to receiving the vaccine.

1-L PHILISOP EN-US.png philosophical objection

Definition:The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.

1-L RELIG EN-US.png religious objection

Definition:The patient or their guardian objects to receiving the vaccine on religious grounds.

1-L VACEFF EN-US.png vaccine efficacy concerns

Definition:The intended vaccine has expired or is otherwise believed to no longer be effective. Example:Due to temperature exposure.

1-L VACSAF EN-US.png vaccine safety concerns

Definition:The patient or their guardian objects to receiving the vaccine because of concerns over its safety.

0-A _ActSupplyFulfillmentRefusalReason EN-US.png ActSupplyFulfillmentRefusalReason

Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated". (used when capturing 'refusal to fill' annotations)

1-L FRR01 EN-US.png order stopped

Definition:The order has been stopped by the prescriber but this fact has not necessarily captured electronically. Example:A verbal stop, a fax, etc.

1-L FRR02 EN-US.png stale-dated order

Definition:Order has not been fulfilled within a reasonable amount of time, and may not be current.

1-L FRR03 EN-US.png incomplete data

Definition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available Example:Lab results, diagnostic imaging, etc.

1-L FRR04 EN-US.png product unavailable

Definition:Product not available or manufactured. Cannot supply.

1-L FRR05 EN-US.png ethical/religious

Definition:The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.

1-L FRR06 EN-US.png unable to provide care

Definition:Fulfiller not able to provide appropriate care associated with fulfilling the order. Example:Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.

0-A _SubstanceAdminSubstitutionNotAllowedReason EN-US.png SubstanceAdminSubstitutionNotAllowedReason

Reasons why substitution of a substance administration request is not permitted.

1-L ALGINT EN-US.png allergy intolerance

Definition: Patient has had a prior allergic intolerance response to alternate product or one of its components.

1-L COMPCON EN-US.png compliance concern

Definition: Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.

1-L PAT EN-US.png Patient request

The Patient requested the action

1-L THERCHAR EN-US.png therapeutic characteristics

The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.

1-L TRIAL EN-US.png clinical trial drug

Definition: The specific manufactured drug is part of a clinical trial.

0-A _PatientProfileQueryReasonCode EN-US.png patient profile query reason

Definition:A collection of concepts identifying why the patient's profile is being queried.

1-L ADMREV EN-US.png administrative review

Definition: To evaluate for service authorization, payment, reporting, or performance/outcome measures.

1-L LEGAL EN-US.png subpoena

Definition:To provide information as a result of a subpoena.

1-L PATCAR EN-US.png patient care

Definition:To obtain records as part of patient care.

1-L PATREQ EN-US.png patient request query

Definition:Patient requests information from their profile.

1-L PRCREV EN-US.png practice review

Definition:To evaluate the provider's current practice for professional-improvement reasons.

1-L REGUL EN-US.png regulatory review

Description:Review for the purpose of regulatory compliance.

1-L RSRCH EN-US.png research

Definition:To provide research data, as authorized by the patient.

1-L VALIDATION EN-US.png validation review

Description:To validate the patient's record. Example:Merging or unmerging records.

0-A _ActCoverageReason EN-US.png ActCoverageReason

Description:Codes used to specify reasons or criteria relating to coverage provided under a policy or program. May be used to convey reasons pertaining to coverage contractual provisions, including criteria for eligibility, coverage limitations, coverage maximums, or financial participation required of covered parties.

1-A _EligibilityActReasonCode EN-US.png EligibilityActReasonCode

Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.

2-A _ActIneligibilityReason EN-US.png ActIneligibilityReason

Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy. Examples are client deceased & adopted client has been given a new policy identifier.

3-L COVSUS EN-US.png coverage suspended

When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc. Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).

3-L DECSD EN-US.png deceased

Client deceased.

3-L REGERR EN-US.png registered in error

Client was registered in error.

2-A _CoverageEligibilityReason EN-US.png CoverageEligibilityReason

Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.

3-L AGE EN-US.png age eligibility

A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.

3-L CRIME EN-US.png crime victim

A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program.

3-L DIS EN-US.png disability

A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.

3-L EMPLOY EN-US.png employment benefit

A person becomes eligible for insurance provided as an employment benefit based on employment status.

3-L FINAN EN-US.png financial eligibility

A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.

3-L HEALTH EN-US.png health status

A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program

3-L MULTI EN-US.png multiple criteria eligibility

A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.

3-L PNC EN-US.png property and casualty condition

A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.

3-L STATUTORY EN-US.png statutory eligibility

A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.

3-L VEHIC EN-US.png motor vehicle accident victim

A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.

3-L WORK EN-US.png work related

A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program.

0-A _ClinicalResearchEventReason EN-US.png ClinicalResearchEventReason

Definition:Specifies the reason that an event occurred in a clinical research study.

1-L RET EN-US.png retest

Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.

1-L SCH EN-US.png scheduled

Definition:The event occurred due to it being scheduled in the research protocol.

1-L TRM EN-US.png termination

Definition:The event occurred in order to terminate the subject's participation in the study.

1-L UNS EN-US.png unscheduled

Definition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.

0-A _ClinicalResearchObservationReason EN-US.png ClinicalResearchObservationReason

Definition:SSpecifies the reason that a test was performed or observation collected in a clinical research study. Note:This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.

1-L NPT EN-US.png non-protocol

Definition:The observation or test was neither defined or scheduled in the study protocol.

1-L PPT EN-US.png per protocol

Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.

1-L UPT EN-US.png per definition

:The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.

0-A _CombinedPharmacyOrderSuspendReasonCode EN-US.png CombinedPharmacyOrderSuspendReasonCode

Description:Indicates why the prescription should be suspended.

1-L ALTCHOICE EN-US.png try another treatment first

Description:This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.

1-L CLARIF EN-US.png prescription requires clarification

Description:Clarification is required before the order can be acted upon.

1-L DRUGHIGH EN-US.png drug level too high

Description:The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.

1-L HOSPADM EN-US.png admission to hospital

Description:The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.

1-L LABINT EN-US.png lab interference issues

Description:The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.

1-L NON-AVAIL EN-US.png patient not-available

Description:Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.

1-L PREG EN-US.png parent is pregnant/breast feeding

Description:The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.

1-L SALG EN-US.png allergy

Description:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.

1-L SDDI EN-US.png drug interacts with another drug

Description:The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.

1-L SDUPTHER EN-US.png duplicate therapy

Description:Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.

1-L SINTOL EN-US.png suspected intolerance

Description:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.

1-L SURG EN-US.png patient scheduled for surgery

Description:The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.

1-L WASHOUT EN-US.png waiting for old drug to wash out

Description:The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.

0-A _GenericUpdateReasonCode EN-US.png GenericUpdateReasonCode

Description:Identifies why a change is being made to a record.

1-L CHGDATA EN-US.png information change

Description:Information has changed since the record was created.

1-L FIXDATA EN-US.png error correction

Description:Previously recorded information was erroneous and is being corrected.

1-L NEWDATA EN-US.png new information

Description:New information has become available to supplement the record.

0-A _ActInformationManagementReason EN-US.png ActInformationManagementReason

Description:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.

1-A _ActHealthInformationManagementReason EN-US.png ActHealthInformationManagementReason

Description:The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.

2-S PurposeOfUse EN-US.png purpose of use

Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives. Usage Notes: The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.

3-L HMARKT EN-US.png healthcare marketing

To perform one or more operations on information for marketing services and products related to health care.

3-S HOPERAT EN-US.png healthcare operations

To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.

4-L DONAT EN-US.png donation

To perform one or more operations on information used for cadaveric organ, eye or tissue donation.

4-L FRAUD EN-US.png fraud

To perform one or more operations on information used for fraud detection and prevention processes.

4-L GOV EN-US.png government

To perform one or more operations on information used within government processes.

4-L HACCRED EN-US.png health accreditation

To perform one or more operations on information for conducting activities related to meeting accreditation criteria.

4-L HCOMPL EN-US.png health compliance

To perform one or more operations on information used for conducting activities required to meet a mandate.

4-L HDECD EN-US.png decedent

To perform one or more operations on information used for handling deceased patient matters.

4-L HDIRECT EN-US.png directory

To perform one or more operation operations on information used to manage a patient directory. Examples: facility enterprise payer health information exchange patient directory

4-L HLEGAL EN-US.png legal

To perform one or more operations on information for conducting activities required by legal proceeding.

4-L HOUTCOMS EN-US.png health outcome measure

To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.

4-L HPRGRP EN-US.png health program reporting

To perform one or more operations on information used for conducting activities to meet program accounting requirements.

4-L HQUALIMP EN-US.png health quality improvement

To perform one or more operations on information used for conducting administrative activities to improve health care quality.

4-L HSYSADMIN EN-US.png health system administration

To perform one or more operations on information to administer the electronic systems used for the delivery of health care.

4-L MEMADMIN EN-US.png member administration

To perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.

4-L PATADMIN EN-US.png patient administration

To perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.

4-L PATSFTY EN-US.png patient safety

To perform one or more operations on information in processes related to ensuring the safety of health care.

4-L PERFMSR EN-US.png performance measure

To perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.

4-L RECORDMGT EN-US.png records management

To perform one or more operations on information used within the health records management process.

4-L TRAIN EN-US.png training

To perform one or more operations on information used in training and education.

3-S HPAYMT EN-US.png healthcare payment

To perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.

4-L CLMATTCH EN-US.png claim attachment

To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.

4-L COVAUTH EN-US.png coverage authorization

To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.

4-S COVERAGE EN-US.png coverage under policy or program

To perform one or more operations on information for conducting activities related to coverage under a program or policy.

5-L ELIGDTRM EN-US.png eligibility determination

To perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.

5-L ELIGVER EN-US.png eligibility verification

To perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.

5-L ENROLLM EN-US.png enrollment

To perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.

4-L REMITADV EN-US.png remittance advice

To perform one or more operations on information about the amount remitted for a health care claim.

3-S HRESCH EN-US.png healthcare research

To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge.

4-L CLINTRCH EN-US.png clinical trial research

To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.

3-S PATRQT EN-US.png patient requested

To perform one or more operations on information in response to a patient's request.

4-L FAMRQT EN-US.png family requested

To perform one or more operations on information in response to a request by a family member authorized by the patient.

4-L PWATRNY EN-US.png power of attorney

To perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.

4-L SUPNWK EN-US.png support network

To perform one or more operations on information in response to a request by a person authorized by the patient.

3-S PUBHLTH EN-US.png public health

To perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.

4-L DISASTER EN-US.png disaster

To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.

4-L THREAT EN-US.png threat

To perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.

3-S TREAT EN-US.png treatment

To perform one or more operations on information for provision of health care.

4-L CAREMGT EN-US.png Care Management

To perform one or more operations on information for provision of health care coordination.

4-L CLINTRL EN-US.png clinical trial

To perform health care as part of the clinical trial protocol.

4-L ETREAT EN-US.png Emergency Treatment

To perform one or more operations on information for provision of immediately needed health care for an emergent condition.

4-L POPHLTH EN-US.png population health

To perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.

2-A _ActConsentInformationAccessOverrideReason EN-US.png ActConsentInformationAccessOverrideReason

To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety. Usage Notes: Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.

3-L OVRER EN-US.png emergency treatment override

To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention. Usage Notes: The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.

3-L OVRPJ EN-US.png professional judgment override

To perform one or more operations on information to which the patient declined to consent for providing health care. Usage Notes: The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.

3-L OVRPS EN-US.png public safety override

To perform one or more operations on information to which the patient has not consented for public safety reasons. Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.

3-L OVRTPS EN-US.png third party safety override

To perform one or more operations on information to which the patient has not consented for third party safety. Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.

1-A _ActInformationPrivacyReason EN-US.png ActInformationPrivacyReason

Description:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.

2-L MARKT EN-US.png marketing

Description:

2-S OPERAT EN-US.png operations

Description:Administrative and contractual processes required to support an activity, product, or service

3-L ACCRED EN-US.png accreditation

Description:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service

3-L COMPL EN-US.png compliance

Description:Operational activities required to meet a mandate related to an activity, product, or service

3-L ENADMIN EN-US.png entity administration

Description:Operational activities conducted to administer information relating to entities involves with an activity, product, or service

3-L LEGAL EN-US.png subpoena

Definition:To provide information as a result of a subpoena.

3-L OUTCOMS EN-US.png outcome measure

Description:Operational activities conducted for the purposes of assessing the results of an activity, product, or service

3-L PRGRPT EN-US.png program reporting

Description:Operational activities conducted to meet program accounting requirements related to an activity, product, or service

3-L QUALIMP EN-US.png quality improvement

Description:Operational activities conducted for the purposes of improving the quality of an activity, product, or service

3-L SYSADMN EN-US.png system administration

Description:Operational activities conducted to administer the electronic systems used for an activity, product, or service

2-L PAYMT EN-US.png payment

Description:Administrative, financial, and contractual processes related to payment for an activity, product, or service

2-L RESCH EN-US.png research

Description:Investigative activities conducted for the purposes of obtaining knowledge

2-L SRVC EN-US.png service

Description:Provision of a service, product, or capability to an individual or organization

0-S _ControlActNullificationReasonCode EN-US.png ControlActNullificationReasonCode

Description:Identifies reasons for nullifying (retracting) a particular control act.

1-L ALTD EN-US.png altered decision

Description:The decision on which the recorded information was based was changed before the decision had an effect. Example:Aborted prescription before patient left office, released prescription before suspend took effect.

1-L EIE EN-US.png entered in error

Description:The information was recorded incorrectly or was recorded in the wrong record.

1-L NORECMTCH EN-US.png no record match

Description: There is no match for the record in the database.

0-S _SubstanceAdministrationPermissionRefusalReasonCode EN-US.png SubstanceAdministrationPermissionRefusalReasonCode

Definition:Indicates why the requested authorization to prescribe or dispense a medication has been refused.

1-L NOUSERPERM EN-US.png no user permission

Definition:The user does not have permission

1-L PATINELIG EN-US.png patient not eligible

Definition:Patient not eligible for drug

1-L PROTUNMET EN-US.png protocol not met

Definition:Patient does not meet required protocol

1-L PROVUNAUTH EN-US.png provider not authorized

Definition:Provider is not authorized to prescribe or dispense

0-S _PharmacySupplyRequestFulfillerRevisionRefusalReasonCode EN-US.png PharmacySupplyRequestFulfillerRevisionRefusalReasonCode

Definition:Indicates why the request to transfer a prescription from one dispensing facility to another has been refused.

1-L LOCKED EN-US.png locked

Definition:The prescription may not be reassigned from the original pharmacy.

1-L NOUSERPERM EN-US.png no user permission

Definition:The user does not have permission

1-L UNKWNTARGET EN-US.png unknown target

Definition:The target facility does not recognize the dispensing facility.

0-A _RefusalReasonCode EN-US.png RefusalReasonCode

Description: Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.

1-S NOMATCH EN-US.png no match

Description: There is no match.

2-L NOPRODMTCH EN-US.png no product match

Description: There is no match for the product in the master file repository.

2-L NORECMTCH EN-US.png no record match

Description: There is no match for the record in the database.

2-L NOSERMTCH EN-US.png no service match

Description: There is no match for the service in the master file repository.

2-L NOVERMTCH EN-US.png no version match

Description: There is no match for the record and version.

1-S NOPERM EN-US.png no permission

Description: There is no permission.

2-L NOAGNTPERM EN-US.png no agent permission

Description: The agent does not have permission.

2-L NOUSERPERM EN-US.png no user permission

Definition:The user does not have permission

0-S _StatusRevisionRefusalReasonCode EN-US.png StatusRevisionRefusalReasonCode

Indicates why the act revision (status update) is being refused.

1-L FILLED EN-US.png fully filled

Ordered quantity has already been completely fulfilled.

1-L INRQSTATE EN-US.png in requested state

The record is already in the requested state.

1-L NORECMTCH EN-US.png no record match

Description: There is no match for the record in the database.

1-L NOUSERPERM EN-US.png no user permission

Definition:The user does not have permission

0-S _ActInvalidReason EN-US.png ActInvalidReason

Description: Types of reasons why a substance is invalid for use.

1-S ADVSTORAGE EN-US.png adverse storage condition

Description: Storage conditions caused the substance to be ineffective.

2-L COLDCHNBRK EN-US.png cold chain break

Description: Cold chain was not maintained for the substance.

1-L EXPLOT EN-US.png expired lot

Description: The lot from which the substance was drawn was expired.

1-L OUTSIDESCHED EN-US.png administered outside recommended schedule

Description: The substance was administered outside of the recommended schedule.

1-L PRODRECALL EN-US.png product recall

Description: The substance was recalled by the manufacturer.

0-A _ControlActNullificationRefusalReasonType EN-US.png ControlActNullificationRefusalReasonType

Description: Reasons to refuse a transaction to be undone.

1-L INRQSTATE EN-US.png in requested state

The record is already in the requested state.

1-S NOMATCH EN-US.png no match

Description: There is no match.

2-L NOPRODMTCH EN-US.png no product match

Description: There is no match for the product in the master file repository.

2-L NORECMTCH EN-US.png no record match

Description: There is no match for the record in the database.

2-L NOSERMTCH EN-US.png no service match

Description: There is no match for the service in the master file repository.

2-L NOVERMTCH EN-US.png no version match

Description: There is no match for the record and version.

1-S NOPERM EN-US.png no permission

Description: There is no permission.

2-L NOAGNTPERM EN-US.png no agent permission

Description: The agent does not have permission.

2-L NOUSERPERM EN-US.png no user permission

Definition:The user does not have permission

1-L WRNGVER EN-US.png wrong version

Description: The record and version requested to update is not the current version.

Verwendung in Value Sets

Zusammenstellung aller Versionen dieses Kodesystems