This
page
is
part
of
the
FHIR
Specification
(v3.0.2:
STU
3).
(v3.5.0:
R4
Ballot
#2).
The
current
version
which
supercedes
this
version
is
5.0.0
.
For
a
full
list
of
available
versions,
see
the
Directory
of
published
versions
.
Page
versions:
R4
R3
Vocabulary
Work
Group
|
Maturity
Level
:
|
|
Use Context : Any |
This
code
system
(http://hl7.org/fhir/v3/ActCode)
(http://terminology.hl7.org/CodeSystem/v3-ActCode)
is
defined
as
part
of
HL7
v3.
Summary
| Defining URL: |
|
| Version: | 2018-08-12 |
| Name: | v3.ActCode |
| Title: | v3 Code System ActCode |
| Definition: |
A
code
specifying
the
particular
kind
of
Act
that
the
Act-instance
represents
within
its
class.
Constraints:
The
kind
of
Act
(e.g.
physical
examination,
serum
potassium,
inpatient
encounter,
charge
financial
transaction,
etc.)
is
specified
with
a
code
from
one
of
several,
typically
external,
coding
systems.
The
coding
system
will
depend
on
the
class
of
Act,
such
as
LOINC
for
observations,
etc.
Conceptually,
the
Act.code
must
be
a
specialization
of
the
Act.classCode.
This
is
why
the
structure
of
ActClass
domain
should
be
reflected
in
the
superstructure
of
the
ActCode
domain
and
then
individual
codes
or
externally
referenced
vocabularies
subordinated
under
these
domains
that
reflect
the
ActClass
structure.
Act.classCode
and
Act.code
are
not
modifiers
of
each
other
but
the
Act.code
concept
should
really
imply
the
Act.classCode
concept.
For
a
negative
example,
it
is
not
appropriate
to
use
an
Act.code
|
| OID: | 2.16.840.1.113883.5.4 (for OID based terminology systems) |
| Source Resource | XML / JSON |
This Code system is used in the following value sets:
Release
Date:
2016-11-11
2018-08-12
| Level | Code | Display | Definition |
| 1 | (_ActAccountCode) Abstract |
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.
|
|
| 2 | ACCTRECEIVABLE | 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.
|
| 2 | CASH | Cash | |
| 2 | CC | 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.
|
| 3 | AE | American Express | |
| 3 | DN | Diner's Club | |
| 3 | DV | Discover Card | |
| 3 | MC | Master Card | |
| 3 | V | Visa | |
| 2 | PBILLACCT | patient billing account |
An
account
representing
charges
and
credits
(financial
transactions)
for
a
patient's
encounter.
|
| 1 | (_ActAdjudicationCode) Abstract |
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.
|
|
| 2 | (_ActAdjudicationGroupCode) Abstract |
Catagorization
of
grouping
criteria
for
the
associated
transactions
and/or
summary
(totals,
subtotals).
|
|
| 3 | CONT | contract |
Transaction
counts
and
value
totals
by
Contract
Identifier.
|
| 3 | DAY | day |
Transaction
counts
and
value
totals
for
each
calendar
day
within
the
date
range
specified.
|
| 3 | LOC | location |
Transaction
counts
and
value
totals
by
service
location
(e.g
clinic).
|
| 3 | MONTH | month |
Transaction
counts
and
value
totals
for
each
calendar
month
within
the
date
range
specified.
|
| 3 | PERIOD | period |
Transaction
counts
and
value
totals
for
the
date
range
specified.
|
| 3 | PROV | provider |
Transaction
counts
and
value
totals
by
Provider
Identifier.
|
| 3 | WEEK | week |
Transaction
counts
and
value
totals
for
each
calendar
week
within
the
date
range
specified.
|
| 3 | YEAR | year |
Transaction
counts
and
value
totals
for
each
calendar
year
within
the
date
range
specified.
|
| 2 | AA | 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). |
| 3 | ANF | 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). |
| 2 | AR | 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). |
| 2 | AS | 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 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 | (_ActAdjudicationResultActionCode) Abstract |
Actions
to
be
carried
out
by
the
recipient
of
the
Adjudication
Result
information.
|
|
| 2 | DISPLAY | Display |
The
adjudication
result
associated
is
to
be
displayed
to
the
receiver
of
the
adjudication
result.
|
| 2 | FORM | Print on Form |
The
adjudication
result
associated
is
to
be
printed
on
the
specified
form,
which
is
then
provided
to
the
covered
party.
|
| 1 | (_ActBillableModifierCode) Abstract |
Definition:An
identifying
modifier
code
for
healthcare
interventions
or
procedures.
|
|
| 2 | CPTM | CPT modifier codes |
Description:CPT
modifier
codes
are
found
in
Appendix
A
of
CPT
2000
Standard
Edition.
|
| 2 | HCPCSA | 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.
|
| 1 | (_ActBillingArrangementCode) Abstract |
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.
|
|
| 2 | BLK | 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. |
| 2 | CAP | 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).
|
| 2 | CONTF | 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.
|
| 2 | FINBILL | 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.
|
| 2 | ROST | roster funding |
A
billing
arrangement
where
funding
is
based
on
a
list
of
individuals
registered
as
patients
of
the
Provider.
|
| 2 | SESS | 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.
|
| 2 | FFS | fee for service |
A
billing
arrangement
where
a
Provider
charges
a
separate
fee
for
each
intervention/procedure/event
or
product.
Fee for Service is used when an individual intervention/procedure/event is used for billing purposes. In other words, fees are associated with the intervention/procedure/event. For example, a specific CCI (Canadian Classification of Interventions) code has an associated fee and is used for billing purposes. |
| 3 | FFPS | 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 | FFCS | 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 | TFS | 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 | (_ActBoundedROICode) Abstract |
Type
of
bounded
ROI.
|
|
| 2 | ROIFS | 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
|
| 2 | ROIPS | 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.
|
| 1 | (_ActCareProvisionCode) Abstract |
Description:The
type
and
scope
of
responsibility
taken-on
by
the
performer
of
the
Act
for
a
specific
subject
of
care.
|
|
| 2 | (_ActCredentialedCareCode) Abstract |
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. |
|
| 3 | (_ActCredentialedCareProvisionPersonCode) Abstract |
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.
|
|
| 4 | CACC | certified anatomic pathology and clinical pathology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CAIC | certified allergy and immunology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CAMC | certified aerospace medicine care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CANC | certified anesthesiology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CAPC | certified anatomic pathology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CBGC | certified clinical biochemical genetics care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CCCC | certified clinical cytogenetics care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CCGC | certified clinical genetics (M.D.) care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CCPC | certified clinical pathology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CCSC | certified colon and rectal surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CDEC | certified dermatology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CDRC | certified diagnostic radiology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CEMC | certified emergency medicine care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CFPC | certified family practice care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CIMC | certified internal medicine care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CMGC | certified clinical molecular genetics care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CNEC | certified neurology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board
|
| 4 | CNMC | certified nuclear medicine care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CNQC | 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.
|
| 4 | CNSC | certified neurological surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | COGC | certified obstetrics and gynecology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | COMC | certified occupational medicine care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | COPC | certified ophthalmology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | COSC | certified orthopaedic surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | COTC | certified otolaryngology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CPEC | certified pediatrics care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CPGC | certified Ph.D. medical genetics care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CPHC | certified public health and general preventive medicine care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CPRC | certified physical medicine and rehabilitation care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CPSC | certified plastic surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CPYC | certified psychiatry care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CROC | certified radiation oncology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CRPC | certified radiological physics care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CSUC | certified surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CTSC | certified thoracic surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CURC | certified urology care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | CVSC | certified vascular surgery care |
Description:Scope
of
responsibility
taken
on
for
specialty
care
as
defined
by
the
respective
Specialty
Board.
|
| 4 | LGPC | licensed general physician care |
Description:Scope
of
responsibility
taken-on
for
physician
care
of
a
patient
as
defined
by
a
governmental
licensing
agency.
|
| 3 | (_ActCredentialedCareProvisionProgramCode) Abstract |
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.
|
|
| 4 | AALC | 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.
|
| 4 | AAMC | accredited ambulatory care |
Description:Scope
of
responsibility
taken
on
by
an
organization
for
care
of
a
patient
as
defined
by
the
respective
accreditation
agency.
|
| 4 | ABHC | 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.
|
| 4 | ACAC | 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.
|
| 4 | ACHC | accredited hospital care |
Description:Scope
of
responsibility
taken
on
by
an
organization
for
care
of
a
patient
as
defined
by
the
respective
accreditation
agency.
|
| 4 | AHOC | accredited home care |
Description:Scope
of
responsibility
taken
on
by
an
organization
for
care
of
a
patient
as
defined
by
the
respective
accreditation
agency.
|
| 4 | ALTC | 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.
|
| 4 | AOSC | 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.
|
| 4 | CACS | 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.
|
| 4 | CAMI | 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.
|
| 4 | CAST | 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.
|
| 4 | CBAR | 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.
|
| 4 | CCAD | 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.
|
| 4 | CCAR | 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.
|
| 4 | CDEP | 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.
|
| 4 | CDGD | 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.
|
| 4 | CDIA | 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.
|
| 4 | CEPI | 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.
|
| 4 | CFEL | 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.
|
| 4 | CHFC | 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.
|
| 4 | CHRO | 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.
|
| 4 | CHYP | 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.
|
| 4 | CMIH | certified migraine headache care |
Description:.
|
| 4 | CMSC | 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.
|
| 4 | COJR | 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.
|
| 4 | CONC | 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.
|
| 4 | COPD | 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.
|
| 4 | CORT | 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.
|
| 4 | CPAD | 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.
|
| 4 | CPND | 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.
|
| 4 | CPST | 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.
|
| 4 | CSDM | 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.
|
| 4 | CSIC | 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.
|
| 4 | CSLD | 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.
|
| 4 | CSPT | 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.
|
| 4 | CTBU | 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.
|
| 4 | CVDC | 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.
|
| 4 | CWMA | 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.
|
| 4 | CWOH | 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.
|
| 2 | (_ActEncounterCode) Abstract |
Domain
provides
codes
that
qualify
the
ActEncounterClass
(ENC)
|
|
| 3 | AMB | 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.
|
| 3 | EMER | 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.)
|
| 3 | FLD | 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.
|
| 3 | HH | home health |
Healthcare
encounter
that
takes
place
in
the
residence
of
the
patient
or
a
designee
|
| 3 | IMP | 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.
|
| 4 | ACUTE | inpatient acute |
An
acute
inpatient
encounter.
|
| 4 | NONAC | inpatient non-acute |
Any
category
of
inpatient
encounter
except
'acute'
|
| 3 | OBSENC | observation encounter |
An
encounter
where
the
patient
usually
will
start
in
different
encounter,
such
as
one
in
the
emergency
department
(EMER)
but
then
transition
to
this
type
of
encounter
because
they
require
a
significant
period
of
treatment
and
monitoring
to
determine
whether
or
not
their
condition
warrants
an
inpatient
admission
or
discharge.
In
the
majority
of
cases
the
decision
about
admission
or
discharge
will
occur
within
a
time
period
determined
by
local,
regional
or
national
regulation,
often
between
24
and
48
hours.
|
| 3 | PRENC | pre-admission |
A
patient
encounter
where
patient
is
scheduled
or
planned
to
receive
service
delivery
in
the
future,
and
the
patient
is
given
a
pre-admission
account
number.
When
the
patient
comes
back
for
subsequent
service,
the
pre-admission
encounter
is
selected
and
is
encapsulated
into
the
service
registration,
and
a
new
account
number
is
generated.
Usage Note: This is intended to be used in advance of encounter types such as ambulatory, inpatient encounter, virtual, etc. |
| 3 | SS | 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.
|
| 3 | VR | 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.
|
| 2 | (_ActMedicalServiceCode) Abstract |
General
category
of
medical
service
provided
to
the
patient
during
their
encounter.
|
|
| 3 | ALC | 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.
|
| 3 | CARD | Cardiology |
Provision
of
diagnosis
and
treatment
of
diseases
and
disorders
affecting
the
heart
|
| 3 | CHR | Chronic |
Provision
of
recurring
care
for
chronic
illness.
|
| 3 | DNTL | Dental |
Provision
of
treatment
for
oral
health
and/or
dental
surgery.
|
| 3 | DRGRHB | Drug Rehab |
Provision
of
treatment
for
drug
abuse.
|
| 3 | GENRL | General |
General
care
performed
by
a
general
practitioner
or
family
doctor
as
a
responsible
provider
for
a
patient.
|
| 3 | MED | Medical |
Provision
of
diagnostic
and/or
therapeutic
treatment.
|
| 3 | OBS | Obstetrics |
Provision
of
care
of
women
during
pregnancy,
childbirth
and
immediate
postpartum
period.
Also
known
as
Maternity.
|
| 3 | ONC | Oncology |
Provision
of
treatment
and/or
diagnosis
related
to
tumors
and/or
cancer.
|
| 3 | PALL | Palliative |
Provision
of
care
for
patients
who
are
living
or
dying
from
an
advanced
illness.
|
| 3 | PED | Pediatrics |
Provision
of
diagnosis
and
treatment
of
diseases
and
disorders
affecting
children.
|
| 3 | PHAR | Pharmaceutical |
Pharmaceutical
care
performed
by
a
pharmacist.
|
| 3 | PHYRHB | Physical Rehab |
Provision
of
treatment
for
physical
injury.
|
| 3 | PSYCH | Psychiatric |
Provision
of
treatment
of
psychiatric
disorder
relating
to
mental
illness.
|
| 3 | SURG | Surgical |
Provision
of
surgical
treatment.
|
| 1 | (_ActClaimAttachmentCategoryCode) Abstract |
Description:
Coded
types
of
attachments
included
to
support
a
healthcare
claim.
|
|
| 2 | AUTOATTCH | auto attachment |
Description:
Automobile
Information
Attachment
|
| 2 | DOCUMENT | document |
Description:
Document
Attachment
|
| 2 | HEALTHREC | health record |
Description:
Health
Record
Attachment
|
| 2 | IMG | image attachment |
Description:
Image
Attachment
|
| 2 | LABRESULTS | lab results |
Description:
Lab
Results
Attachment
|
| 2 | MODEL | model |
Description:
Digital
Model
Attachment
|
| 2 | WIATTCH | work injury report attachment |
Description:
Work
Injury
related
additional
Information
Attachment
|
| 2 | XRAY | x-ray |
Description:
Digital
X-Ray
Attachment
|
| 1 | (_ActConsentType) Abstract |
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.
|
|
| 2 | ICOL | 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.
|
| 2 | IDSCL | information disclosure |
Definition:
Consent
to
have
collected
healthcare
information
disclosed.
|
| 2 | INFA | information access |
Definition:
Consent
to
access
healthcare
information.
|
| 3 | INFAO | access only |
Definition:
Consent
to
access
or
Example: Opened and then emailed or screen printed for use outside of the consent directive purpose. |
| 3 | INFASO | access and save only |
Definition:
Consent
to
access
and
save
only,
which
entails
that
access
to
the
saved
copy
will
remain
locked.
|
| 2 | IRDSCL | information redisclosure |
Definition:
Information
re-disclosed
without
the
patient's
consent.
|
| 2 | RESEARCH | research information access |
Definition:
Consent
to
have
healthcare
information
in
an
electronic
health
record
accessed
for
research
purposes.
|
| 3 | RSDID | 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.
|
| 3 | RSREID | 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. |
| 1 | (_ActContainerRegistrationCode) Abstract |
Constrains
the
ActCode
to
the
domain
of
Container
Registration
|
|
| 2 | ID | Identified |
Used
by
one
system
to
inform
another
that
it
has
received
a
container.
|
| 2 | IP | 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.).
|
| 2 | L | Left Equipment |
Used
by
one
system
to
inform
another
that
the
container
has
been
released
from
that
system.
|
| 2 | M | Missing |
Used
by
one
system
to
inform
another
that
the
container
did
not
arrive
at
its
next
expected
location.
|
| 2 | O | 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.
|
| 2 | R | 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.
|
| 2 | X | 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).
|
| 1 | (_ActControlVariable) Abstract |
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). |
|
| 2 | AUTO | auto-repeat permission |
Specifies
whether
or
not
automatic
repeat
testing
is
to
be
initiated
on
specimens.
|
| 2 | ENDC | 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.
|
| 2 | REFLEX | reflex permission |
Specifies
whether
or
not
further
testing
may
be
automatically
or
manually
initiated
on
specimens.
|
| 1 | (_ActCoverageConfirmationCode) Abstract |
Response
to
an
insurance
coverage
eligibility
query
or
authorization
request.
|
|
| 2 | (_ActCoverageAuthorizationConfirmationCode) Abstract |
Indication
of
authorization
for
healthcare
service(s)
and/or
product(s).
If
authorization
is
approved,
funds
are
set
aside.
|
|
| 3 | AUTH | 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.
|
| 3 | NAUTH | Not Authorized |
Authorization
for
specified
healthcare
service(s)
and/or
product(s)
denied.
|
| 2 | (_ActCoverageEligibilityConfirmationCode) Abstract |
Indication
of
eligibility
coverage
for
healthcare
service(s)
and/or
product(s).
|
|
| 3 | ELG | Eligible |
Insurance
coverage
is
in
effect
for
healthcare
service(s)
and/or
product(s).
|
| 3 | NELG | Not Eligible |
Insurance
coverage
is
not
in
effect
for
healthcare
service(s)
and/or
product(s).
May
optionally
include
reasons
for
the
ineligibility.
|
| 1 | (_ActCoverageLimitCode) Abstract |
Criteria
that
are
applicable
to
the
authorized
coverage.
|
|
| 2 | (_ActCoverageQuantityLimitCode) Abstract |
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.
|
|
| 3 | COVPRD | coverage period |
Codes
representing
the
time
period
during
which
coverage
is
available;
or
financial
participation
requirements
are
in
effect.
|
| 3 | LFEMX | 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.
|
| 3 | NETAMT | Net Amount |
Maximum
net
amount
that
will
be
covered
for
the
product
or
service
specified.
|
| 3 | PRDMX | 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.
|
| 3 | UNITPRICE | Unit Price |
Maximum
unit
price
that
will
be
covered
for
the
authorized
product
or
service.
|
| 3 | UNITQTY | Unit Quantity |
Maximum
number
of
items
that
will
be
covered
of
the
product
or
service
specified.
|
| 2 | COVMX | coverage maximum |
Definition:
Codes
representing
the
maximum
coverate
or
financial
participation
requirements.
|
| 3 | LFEMX | ||
| 3 | PRDMX | ||
| 2 | (_ActCoveredPartyLimitCode) Abstract |
Codes
representing
the
types
of
covered
parties
that
may
receive
covered
benefits
under
a
policy
or
program.
|
|
| 1 | (_ActCoverageTypeCode) Abstract |
Definition:
Set
of
codes
indicating
the
type
of
insurance
policy
or
program
that
pays
for
the
cost
of
benefits
provided
to
covered
parties.
|
|
| 2 | (_ActInsurancePolicyCode) Abstract |
Set
of
codes
indicating
the
type
of
insurance
policy
or
other
source
of
funds
to
cover
healthcare
costs.
|
|
| 3 | EHCPOL | extended healthcare |
Private
insurance
policy
that
provides
coverage
in
addition
to
other
policies
(e.g.
in
addition
to
a
Public
Healthcare
insurance
policy).
|
| 3 | HSAPOL | 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 | AUTOPOL | 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.
|
| 4 | COL | 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.
|
| 4 | UNINSMOT | 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.
|
| 3 | PUBLICPOL | 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).
|
| 4 | DENTPRG | 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.
|
| 4 | DISEASEPRG | 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. |
| 5 | CANPRG | 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. |
| 5 | ENDRENAL | 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. |
| 5 | HIVAIDS | 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. |
| 4 | MANDPOL | mandatory health program | |
| 4 | MENTPRG | 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). |
| 4 | SAFNET | 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. |
| 4 | SUBPRG | 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). |
| 4 | SUBSIDIZ | 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.
|
| 5 | SUBSIDMC | 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. |
| 5 | SUBSUPP | 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. |
| 3 | WCBPOL | worker's compensation |
Insurance
policy
for
injuries
sustained
in
the
work
place
or
in
the
course
of
employment.
|
| 2 | (_ActInsuranceTypeCode) Abstract |
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. |
|
| 3 | AUTOPOL | ||
| 3 | (_ActHealthInsuranceTypeCode) Abstract |
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).
|
|
| 4 | DENTAL | dental care policy |
Definition:
A
health
insurance
policy
that
that
covers
benefits
for
dental
services.
|
| 4 | DISEASE | 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.
|
| 4 | DRUGPOL | drug policy |
Definition:
A
health
insurance
policy
that
covers
benefits
for
prescription
drugs,
pharmaceuticals,
and
supplies.
|
| 4 | EHCPOL | ||
| 4 | HIP | 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. |
| 4 | HSAPOL | ||
| 4 | LTC | 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 |
| 4 | MCPOL | 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. |
| 5 | POS | 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.
|
| 5 | HMO | 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.
|
| 5 | PPO | 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
|
| 4 | MENTPOL | mental health policy |
Definition:
A
health
insurance
policy
that
covers
benefits
for
mental
health
services
and
prescriptions.
|
| 4 | POS | ||
| 4 | SUBPOL | substance use policy |
Definition:
A
health
insurance
policy
that
covers
benefits
for
substance
use
services.
|
| 4 | VISPOL | 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. |
| 3 | DIS | 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.
|
| 3 | EWB | 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.
|
| 3 | FLEXP | 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. |
| 3 | LIFE | 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). |
| 4 | ANNU | 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. |
| 4 | TLIFE | 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.
|
| 4 | ULIFE | 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
|
| 3 | PNC | 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
|
| 3 | REI | 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. |
| 3 | SURPL | 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. |
| 3 | UMBRL | 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 | (_ActProgramTypeCode) Abstract |
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. |
|
| 3 | PUBLICPOL | ||
| 3 | WCBPOL | ||
| 3 | CHAR | 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.
|
| 3 | CRIME | 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.
|
| 3 | EAP | 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.
|
| 3 | GOVEMP | 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. |
| 3 | HIRISK | 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
|
| 3 | IND | 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. |
| 3 | MILITARY | 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. |
| 3 | RETIRE | 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.
|
| 3 | SOCIAL | 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. |
| 3 | VET | veteran health program |
Definition:
Services
provided
directly
and
through
contracted
and
operated
veteran
health
programs.
|
| 1 | (_ActDetectedIssueManagementCode) Abstract |
Codes
dealing
with
the
management
of
Detected
Issue
observations
|
|
| 2 | (_ActAdministrativeDetectedIssueManagementCode) Abstract |
Codes
dealing
with
the
management
of
Detected
Issue
observations
for
the
administrative
and
patient
administrative
acts
domains.
|
|
| 3 | (_AuthorizationIssueManagementCode) Abstract | ||
| 4 | EMAUTH | 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.
|
| 5 | 21 | authorization confirmed |
Description:
Indicates
that
the
permissions
have
been
externally
verified
and
the
request
should
be
processed.
|
| 2 | 1 | Therapy Appropriate |
Confirmed
drug
therapy
appropriate
|
| 3 | 19 | Consulted Supplier |
Consulted
other
supplier/pharmacy,
therapy
confirmed
|
| 3 | 2 | Assessed Patient |
Assessed
patient,
therapy
is
appropriate
|
| 3 | 22 | appropriate indication or diagnosis |
Description:
The
patient
has
the
appropriate
indication
or
diagnosis
for
the
action
to
be
taken.
|
| 3 | 23 | prior therapy documented |
Description:
It
has
been
confirmed
that
the
appropriate
pre-requisite
therapy
has
been
tried.
|
| 3 | 3 | Patient Explanation |
Patient
gave
adequate
explanation
|
| 3 | 4 | Consulted Other Source |
Consulted
other
supply
source,
therapy
still
appropriate
|
| 3 | 5 | Consulted Prescriber |
Consulted
prescriber,
therapy
confirmed
|
| 4 | 6 | Prescriber Declined Change |
Consulted
prescriber
and
recommended
change,
prescriber
declined
|
| 3 | 7 | Interacting Therapy No Longer Active/Planned |
Concurrent
therapy
triggering
alert
is
no
longer
on-going
or
planned
|
| 2 | 14 | Supply Appropriate |
Confirmed
supply
action
appropriate
|
| 3 | 15 | Replacement |
Patient's
existing
supply
was
lost/wasted
|
| 3 | 16 | Vacation Supply |
Supply
date
is
due
to
patient
vacation
|
| 3 | 17 | Weekend Supply |
Supply
date
is
intended
to
carry
patient
over
weekend
|
| 3 | 18 | Leave of Absence |
Supply
is
intended
for
use
during
a
leave
of
absence
from
an
institution.
|
| 3 | 20 | additional quantity on separate dispense |
Description:
Supply
is
different
than
expected
as
an
additional
quantity
has
been
supplied
in
a
separate
dispense.
|
| 2 | 8 | Other Action Taken |
Order
is
performed
as
issued,
but
other
action
taken
to
mitigate
potential
adverse
effects
|
| 3 | 10 | Provided Patient Education |
Provided
education
or
training
to
the
patient
on
appropriate
therapy
use
|
| 3 | 11 | Added Concurrent Therapy |
Instituted
an
additional
therapy
to
mitigate
potential
negative
effects
|
| 3 | 12 | Temporarily Suspended Concurrent Therapy |
Suspended
existing
therapy
that
triggered
interaction
for
the
duration
of
this
therapy
|
| 3 | 13 | Stopped Concurrent Therapy |
Aborted
existing
therapy
that
triggered
interaction.
|
| 3 | 9 | Instituted Ongoing Monitoring Program |
Arranged
to
monitor
patient
for
adverse
effects
|
| 1 | (_ActExposureCode) Abstract |
Concepts
that
identify
the
type
or
nature
of
exposure
interaction.
Examples
include
|
|
| 2 | CHLDCARE | Day care - Child care Interaction |
Description:
Exposure
participants'
interaction
occurred
in
a
child
care
setting
|
| 2 | CONVEYNC | 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).
|
| 2 | HLTHCARE | 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).
|
| 2 | HOMECARE | 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.
|
| 2 | HOSPPTNT | Hospital Patient Interaction |
Description:
Exposure
participants'
interaction
occurred
when
both
were
patients
being
treated
in
the
same
(acute)
health
care
delivery
facility.
|
| 2 | HOSPVSTR | 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.
|
| 2 | HOUSEHLD | Household Interaction |
Description:
Exposure
interaction
occurred
in
context
of
domestic
interaction,
i.e.
both
participants
reside
in
the
same
household.
|
| 2 | INMATE | Inmate Interaction |
Description:
Exposure
participants'
interaction
occurred
in
the
course
of
one
or
both
participants
being
incarcerated
at
a
correctional
facility
|
| 2 | INTIMATE | Intimate Interaction |
Description:
Exposure
interaction
was
intimate,
i.e.
participants
are
intimate
companions
(e.g.
spouses,
domestic
partners).
|
| 2 | LTRMCARE | 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).
|
| 2 | PLACE | Common Space Interaction |
Description:
An
interaction
where
the
exposure
participants
were
both
present
in
the
same
location/place/space.
|
| 2 | PTNTCARE | 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).
|
| 2 | SCHOOL2 | School Interaction |
Description:
Exposure
participants'
interaction
occurred
in
an
academic
setting
(e.g.,
participants
are
fellow
students,
or
student
and
teacher).
|
| 2 | SOCIAL2 | Social/Extended Family Interaction |
Description:
An
interaction
where
the
exposure
participants
are
social
associates
or
members
of
the
same
extended
family
|
| 2 | SUBSTNCE | 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).
|
| 2 | TRAVINT | Common Travel Interaction |
Description:
An
interaction
where
the
exposure
participants
traveled
together
in/on
the
same
vehicle/trip
(e.g.
concurrent
co-passengers).
|
| 2 | WORK2 | Work Interaction |
Description:
Exposure
interaction
occurred
in
a
work
setting,
i.e.
participants
are
co-workers.
|
| 1 | (_ActFinancialTransactionCode) Abstract | ||
| 2 | CHRG | Standard Charge |
A
type
of
transaction
that
represents
a
charge
for
a
service
or
product.
Expressed
in
monetary
terms.
|
| 2 | REV | 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.
|
| 1 | (_ActIncidentCode) Abstract |
Set
of
codes
indicating
the
type
of
incident
or
accident.
|
|
| 2 | MVA | Motor vehicle accident |
Incident
or
accident
as
the
result
of
a
motor
vehicle
accident
|
| 2 | SCHOOL | School Accident |
Incident
or
accident
is
the
result
of
a
school
place
accident.
|
| 2 | SPT | Sporting Accident |
Incident
or
accident
is
the
result
of
a
sporting
accident.
|
| 2 | WPA | Workplace accident |
Incident
or
accident
is
the
result
of
a
work
place
accident
|
| 1 | (_ActInformationAccessCode) Abstract |
Description:
The
type
of
health
information
to
which
the
subject
of
the
information
or
the
subject's
delegate
consents
or
dissents.
|
|
| 2 | ACADR | adverse drug reaction access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
adverse
drug
reaction
information
for
a
patient.
|
| 2 | ACALL | all access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
all
information
for
a
patient.
|
| 2 | ACALLG | allergy access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
allergy
information
for
a
patient.
|
| 2 | ACCONS | informational consent access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
informational
consent
information
for
a
patient.
|
| 2 | ACDEMO | demographics access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
demographics
information
for
a
patient.
|
| 2 | ACDI | diagnostic imaging access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
diagnostic
imaging
information
for
a
patient.
|
| 2 | ACIMMUN | immunization access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
immunization
information
for
a
patient.
|
| 2 | ACLAB | lab test result access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
lab
test
result
information
for
a
patient.
|
| 2 | ACMED | medication access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
medical
condition
information
for
a
patient.
|
| 2 | ACMEDC | medical condition access |
Definition:
Provide
consent
to
view
or
access
medical
condition
information
for
a
patient.
|
| 2 | ACMEN | mental health access |
Description:Provide
consent
to
collect,
use,
disclose,
or
access
mental
health
information
for
a
patient.
|
| 2 | ACOBS | common observations access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
common
observation
information
for
a
patient.
|
| 2 | ACPOLPRG | policy or program information access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
coverage
policy
or
program
for
a
patient.
|
| 2 | ACPROV | provider information access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
provider
information
for
a
patient.
|
| 2 | ACPSERV | professional service access |
Description:
Provide
consent
to
collect,
use,
disclose,
or
access
professional
service
information
for
a
patient.
|
| 2 | ACSUBSTAB | substance abuse access |
Description:Provide
consent
to
collect,
use,
disclose,
or
access
substance
abuse
information
for
a
patient.
|
| 1 | (_ActInformationAccessContextCode) Abstract |
Concepts
conveying
the
context
in
which
authorization
given
under
jurisdictional
law,
by
organizational
policy,
or
by
a
patient
consent
directive
permits
the
collection,
access,
use
or
disclosure
of
specified
patient
health
information.
|
|
| 2 | INFAUT | authorized information transfer |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
in
accordance
with
jurisdictional
law,
organizational
policy,
or
a
patient's
consent
directive,
which
may
be
implied,
deemed,
opt-in,
opt-out,
or
explicit.
|
| 3 | INFCON | after explicit consent |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
as
explicitly
consented
to
by
the
subject
of
the
information
or
the
subject's
representative.
|
| 2 | INFCRT | only on court order |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
in
accordance
with
judicial
system
protocol,
such
as
in
the
case
of
a
subpoena
or
court
order.
|
| 2 | INFDNG | only if danger to others |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
where
deemed
necessary
to
avert
potential
danger
to
other
persons
in
accordance
with
jurisdictional
law,
organizational
policy,
or
standards
of
practice.
For
example,
disclosure
about
a
person
threatening
violence.
|
| 2 | INFEMER | only in an emergency |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
in
accordance
with
emergency
information
transfer
protocol
dictated
by
jurisdictional
law,
organization
policy,
or
standards
of
practice.
For
example,
sharing
of
health
information
during
disaster
response.
|
| 2 | INFPWR | only if public welfare risk |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
necessary
to
avert
potential
public
welfare
risk
in
accordance
with
jurisdictional
law,
organizational
policy,
or
standards
of
practice.
For
example,
reporting
that
a
person
is
a
victim
of
abuse
or
demonstrating
suicidal
tendencies.
|
| 2 | INFREG | regulatory information transfer |
Authorization
to
collect,
access,
use,
or
disclose
specified
patient
health
information
for
public
health,
welfare,
and
safety
purposes
in
accordance
with
jurisdictional
law,
organizational
policy,
or
standards
of
practice.
For
example,
public
health
reporting
of
notifiable
conditions.
|
| 1 | (_ActInformationCategoryCode) Abstract |
Definition:Indicates
the
set
of
information
types
which
may
be
manipulated
or
referenced,
such
as
for
recommending
access
restrictions.
|
|
| 2 | ALLCAT | all categories |
Description:
All
patient
information.
|
| 2 | ALLGCAT | allergy category |
Definition:All
information
pertaining
to
a
patient's
allergy
and
intolerance
records.
|
| 2 | ARCAT | adverse drug reaction category |
Description:
All
information
pertaining
to
a
patient's
adverse
drug
reactions.
|
| 2 | COBSCAT | common observation category |
Definition:All
information
pertaining
to
a
patient's
common
observation
records
(height,
weight,
blood
pressure,
temperature,
etc.).
|
| 2 | DEMOCAT | demographics category |
Definition:All
information
pertaining
to
a
patient's
demographics
(such
as
name,
date
of
birth,
gender,
address,
etc).
|
| 2 | DICAT | diagnostic image category |
Definition:All
information
pertaining
to
a
patient's
diagnostic
image
records
(orders
&
results).
|
| 2 | IMMUCAT | immunization category |
Definition:All
information
pertaining
to
a
patient's
vaccination
records.
|
| 2 | LABCAT | lab test category |
Description:
All
information
pertaining
to
a
patient's
lab
test
records
(orders
&
results)
|
| 2 | MEDCCAT | medical condition category |
Definition:All
information
pertaining
to
a
patient's
medical
condition
records.
|
| 2 | MENCAT | mental health category |
Description:
All
information
pertaining
to
a
patient's
mental
health
records.
|
| 2 | PSVCCAT | professional service category |
Definition:All
information
pertaining
to
a
patient's
professional
service
records
(such
as
smoking
cessation,
counseling,
medication
review,
mental
health).
|
| 2 | RXCAT | medication category |
Definition:All
information
pertaining
to
a
patient's
medication
records
(orders,
dispenses
and
other
active
medications).
|
| 1 | (_ActInvoiceElementCode) Abstract |
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.
|
|
| 2 | (_ActInvoiceAdjudicationPaymentCode) Abstract |
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.
|
|
| 3 | (_ActInvoiceAdjudicationPaymentGroupCode) Abstract |
Codes
representing
adjustments
to
a
Payment
Advice
such
as
retroactive,
clawback,
garnishee,
etc.
|
|
| 4 | ALEC | 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).
|
| 4 | BONUS | bonus |
Bonus
payments
based
on
performance,
volume,
etc.
as
agreed
to
by
the
payor.
|
| 4 | CFWD | 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.
|
| 4 | EDU | education fees |
Fees
deducted
on
behalf
of
a
payee
for
tuition
and
continuing
education.
|
| 4 | EPYMT | 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.
|
| 4 | GARN | garnishee |
Fees
deducted
on
behalf
of
a
payee
for
charges
based
on
a
per-transaction
or
time-period
(e.g.
monthly)
fee.
|
| 4 | INVOICE | submitted invoice |
Payment
is
based
on
a
payment
intent
for
a
previously
submitted
Invoice,
based
on
formal
adjudication
results..
|
| 4 | PINV | paper invoice |
Payment
initiated
by
the
payor
as
the
result
of
adjudicating
a
paper
(original,
may
have
been
faxed)
invoice.
|
| 4 | PPRD | prior period adjustment |
An
amount
that
was
owed
to
the
payor
as
indicated,
by
a
carry
forward
adjusment,
in
a
previous
payment
advice
|
| 4 | PROA | professional association deduction |
Professional
association
fee
that
is
collected
by
the
payor
from
the
practitioner/provider
on
behalf
of
the
association
|
| 4 | RECOV | recovery |
Retroactive
adjustment
such
as
fee
rate
adjustment
due
to
contract
negotiations.
|
| 4 | RETRO | retro adjustment |
Bonus
payments
based
on
performance,
volume,
etc.
as
agreed
to
by
the
payor.
|
| 4 | TRAN | transaction fee |
Fees
deducted
on
behalf
of
a
payee
for
charges
based
on
a
per-transaction
or
time-period
(e.g.
monthly)
fee.
|
| 3 | (_ActInvoiceAdjudicationPaymentSummaryCode) Abstract |
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.
|
|
| 4 | CONT | ||
| 4 | DAY | ||
| 4 | LOC | ||
| 4 | MONTH | ||
| 4 | PERIOD | ||
| 4 | PROV | ||
| 4 | WEEK | ||
| 4 | YEAR | ||
| 4 | INVTYPE | invoice type |
Transaction
counts
and
value
totals
by
invoice
type
(e.g.
RXDINV
-
Pharmacy
Dispense)
|
| 4 | PAYEE | payee |
Transaction
counts
and
value
totals
by
each
instance
of
an
invoice
payee.
|
| 4 | PAYOR | payor |
Transaction
counts
and
value
totals
by
each
instance
of
an
invoice
payor.
|
| 4 | SENDAPP | 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.
|
| 2 | (_ActInvoiceDetailCode) Abstract |
Codes
representing
a
service
or
product
that
is
being
invoiced
(billed).
The
code
can
represent
such
concepts
as
|
|
| 3 | (_ActInvoiceDetailClinicalProductCode) Abstract |
An
identifying
data
string
for
healthcare
products.
|
|
| 4 | UNSPSC | United Nations Standard Products and Services Classification |
Description:United
Nations
Standard
Products
and
Services
Classification,
managed
by
Uniform
Code
Council
(UCC):
www.unspsc.org
|
| 3 | (_ActInvoiceDetailDrugProductCode) Abstract |
An
identifying
data
string
for
A
substance
used
as
a
medication
or
in
the
preparation
of
medication.
|
|
| 4 | GTIN | 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).
|
| 4 | UPC | 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.
|
| 3 | (_ActInvoiceDetailGenericCode) Abstract |
The
detail
item
codes
to
identify
charges
or
changes
to
the
total
billing
of
a
claim
due
to
insurance
rules
and
payments.
|
|
| 4 | (_ActInvoiceDetailGenericAdjudicatorCode) Abstract |
The
billable
item
codes
to
identify
adjudicator
specified
components
to
the
total
billing
of
a
claim.
|
|
| 5 | COIN | 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.
|
| 5 | COPAYMENT | 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.
|
| 5 | DEDUCTIBLE | 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.
|
| 5 | PAY | 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.
|
| 5 | SPEND | 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
|
| 5 | COINS | co-insurance |
The
covered
party
pays
a
percentage
of
the
cost
of
covered
services.
|
| 4 | (_ActInvoiceDetailGenericModifierCode) Abstract |
The
billable
item
codes
to
identify
modifications
to
a
billable
item
charge.
As
for
example
after
hours
increase
in
the
office
visit
fee.
|
|
| 5 | AFTHRS | non-normal hours |
Premium
paid
on
service
fees
in
compensation
for
practicing
outside
of
normal
working
hours.
|
| 5 | ISOL | isolation allowance |
Premium
paid
on
service
fees
in
compensation
for
practicing
in
a
remote
location.
|
| 5 | OOO | out of office |
Premium
paid
on
service
fees
in
compensation
for
practicing
at
a
location
other
than
normal
working
location.
|
| 4 | (_ActInvoiceDetailGenericProviderCode) Abstract |
The
billable
item
codes
to
identify
provider
supplied
charges
or
changes
to
the
total
billing
of
a
claim.
|
|
| 5 | CANCAPT | 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.
|
| 5 | DSC | discount |
A
reduction
in
the
amount
charged
as
a
percentage
of
the
amount.
For
example
a
5%
discount
for
volume
purchase.
|
| 5 | ESA | 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.
|
| 5 | FFSTOP | 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.
|
| 5 | FNLFEE | final fee |
Anticipated
or
actual
final
fee
associated
with
treating
a
patient.
|
| 5 | FRSTFEE | first fee |
Anticipated
or
actual
initial
fee
associated
with
treating
a
patient.
|
| 5 | MARKUP | markup or up-charge |
An
increase
in
the
amount
charged
as
a
percentage
of
the
amount.
For
example,
12%
markup
on
product
cost.
|
| 5 | MISSAPT | missed appointment |
A
charge
to
compensate
the
provider
when
a
patient
does
not
show
for
an
appointment.
|
| 5 | PERFEE | 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.
|
| 5 | PERMBNS | 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.
|
| 5 | RESTOCK | 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.
|
| 5 | TRAVEL | 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.
|
| 5 | URGENT | urgent |
Premium
paid
on
service
fees
in
compensation
for
providing
an
expedited
response
to
an
urgent
situation.
|
| 4 | (_ActInvoiceDetailTaxCode) Abstract |
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.
|
|
| 5 | FST | federal sales tax |
Federal
tax
on
transactions
such
as
the
Goods
and
Services
Tax
(GST)
|
| 5 | HST | harmonized sales Tax |
Joint
Federal/Provincial
Sales
Tax
|
| 5 | PST | provincial/state sales tax |
Tax
levied
by
the
provincial
or
state
jurisdiction
such
as
Provincial
Sales
Tax
|
| 3 | (_ActInvoiceDetailPreferredAccommodationCode) Abstract |
An
identifying
data
string
for
medical
facility
accommodations.
|
|
| 4 | (_ActEncounterAccommodationCode) Abstract |
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 | (_HL7AccommodationCode) Abstract |
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.
|
|
| 6 | I | Isolation |
Accommodations
used
in
the
care
of
diseases
that
are
transmitted
through
casual
contact
or
respiratory
transmission.
|
| 6 | P | Private |
Accommodations
in
which
there
is
only
1
bed.
|
| 6 | S | Suite |
Uniquely
designed
and
elegantly
decorated
accommodations
with
many
amenities
available
for
an
additional
charge.
|
| 6 | SP | Semi-private |
Accommodations
in
which
there
are
2
beds.
|
| 6 | W | Ward |
Accommodations
in
which
there
are
3
or
more
beds.
|
| 3 | (_ActInvoiceDetailClinicalServiceCode) Abstract |
An
identifying
data
string
for
healthcare
procedures.
|
|
| 2 | (_ActInvoiceGroupCode) Abstract |
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. |
|
| 3 | (_ActInvoiceInterGroupCode) Abstract |
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. |
|
| 4 | CPNDDRGING | 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.
|
| 4 | CPNDINDING | 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.
|
| 4 | CPNDSUPING | 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.
|
| 4 | DRUGING | 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.
|
| 4 | FRAMEING | 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.
|
| 4 | LENSING | 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.
|
| 4 | PRDING | 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.
|
| 3 | (_ActInvoiceRootGroupCode) Abstract |
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. |
|
| 4 | CPINV | 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. |
| 4 | CSINV | 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). |
| 4 | CSPINV | 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). |
| 4 | FININV | 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. |
| 4 | OHSINV | 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. |
| 4 | PAINV | preferred accommodation invoice |
HealthCare
facility
preferred
accommodation
invoice.
|
| 4 | RXCINV | Rx compound invoice |
Pharmacy
dispense
invoice
for
a
compound.
|
| 4 | RXDINV | Rx dispense invoice |
Pharmacy
dispense
invoice
not
involving
a
compound
|
| 4 | SBFINV | 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.
|
| 4 | VRXINV | 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.
|
| 1 | (_ActInvoiceElementSummaryCode) Abstract |
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.
|
|
| 2 | (_InvoiceElementAdjudicated) Abstract |
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.
|
|
| 3 | ADNFPPELAT | 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.
|
| 3 | ADNFPPELCT | 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.
|
| 3 | ADNFPPMNAT | 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.
|
| 3 | ADNFPPMNCT | 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.
|
| 3 | ADNFSPELAT | 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.
|
| 3 | ADNFSPELCT | 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.
|
| 3 | ADNFSPMNAT | 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.
|
| 3 | ADNFSPMNCT | 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.
|
| 3 | ADNPPPELAT | 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.
|
| 3 | ADNPPPELCT | 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.
|
| 3 | ADNPPPMNAT | 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.
|
| 3 | ADNPPPMNCT | 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.
|
| 3 | ADNPSPELAT | 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.
|
| 3 | ADNPSPELCT | 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.
|
| 3 | ADNPSPMNAT | 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.
|
| 3 | ADNPSPMNCT | 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.
|
| 3 | ADPPPPELAT | 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.
|
| 3 | ADPPPPELCT | 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.
|
| 3 | ADPPPPMNAT | 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.
|
| 3 | ADPPPPMNCT | 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.
|
| 3 | ADPPSPELAT | 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.
|
| 3 | ADPPSPELCT | 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.
|
| 3 | ADPPSPMNAT | 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.
|
| 3 | ADPPSPMNCT | 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.
|
| 3 | ADRFPPELAT | 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.
|
| 3 | ADRFPPELCT | 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.
|
| 3 | ADRFPPMNAT | 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.
|
| 3 | ADRFPPMNCT | 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.
|
| 3 | ADRFSPELAT | 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.
|
| 3 | ADRFSPELCT | 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.
|
| 3 | ADRFSPMNAT | 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.
|
| 3 | ADRFSPMNCT | 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.
|
| 2 | (_InvoiceElementPaid) Abstract |
Total
counts
and
total
net
amounts
paid
for
all
Invoice
Groupings
that
were
paid
within
a
time
period
based
on
the
payment
date.
|
|
| 3 | PDNFPPELAT | 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.
|
| 3 | PDNFPPELCT | 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.
|
| 3 | PDNFPPMNAT | 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.
|
| 3 | PDNFPPMNCT | 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.
|
| 3 | PDNFSPELAT | 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.
|
| 3 | PDNFSPELCT | 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.
|
| 3 | PDNFSPMNAT | 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.
|
| 3 | PDNFSPMNCT | 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.
|
| 3 | PDNPPPELAT | 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.
|
| 3 | PDNPPPELCT | 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.
|
| 3 | PDNPPPMNAT | 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.
|
| 3 | PDNPPPMNCT | 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.
|
| 3 | PDNPSPELAT | 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.
|
| 3 | PDNPSPELCT | 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.
|
| 3 | PDNPSPMNAT | 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.
|
| 3 | PDNPSPMNCT | 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.
|
| 3 | PDPPPPELAT | 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.
|
| 3 | PDPPPPELCT | 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.
|
| 3 | PDPPPPMNAT | 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.
|
| 3 | PDPPPPMNCT | 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.
|
| 3 | PDPPSPELAT | 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.
|
| 3 | PDPPSPELCT | 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.
|
| 3 | PDPPSPMNAT | 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.
|
| 3 | PDPPSPMNCT | 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.
|
| 2 | (_InvoiceElementSubmitted) Abstract |
Total
counts
and
total
net
amounts
billed
for
all
Invoice
Groupings
that
were
submitted
within
a
time
period.
Adjudicated
invoice
elements
are
included.
|
|
| 3 | SBBLELAT | 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.
|
| 3 | SBBLELCT | submitted billed electronic count |
Identifies
the
total
number
of
submitted
Invoice
Groupings
within
a
time
period
and
submitted
electronically.
Adjudicated
invoice
elements
are
included.
|
| 3 | SBNFELAT | 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.
|
| 3 | SBNFELCT | 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.
|
| 3 | SBPDELAT | 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.
|
| 3 | SBPDELCT | 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.
|
| 1 | (_ActInvoiceOverrideCode) Abstract |
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.
|
|
| 2 | COVGE | coverage problem |
Insurance
coverage
problems
have
been
encountered.
Additional
explanation
information
to
be
supplied.
|
| 2 | EFORM | electronic form to follow |
Electronic
form
with
supporting
or
additional
information
to
follow.
|
| 2 | FAX | fax to follow |
Fax
with
supporting
or
additional
information
to
follow.
|
| 2 | GFTH | 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.
|
| 2 | LATE | 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.
|
| 2 | MANUAL | manual review |
Manual
review
of
the
invoice
is
requested.
Additional
information
to
be
supplied.
This
may
be
used
in
the
case
of
an
appeal.
|
| 2 | OOJ | out of jurisdiction |
The
medical
service
and/or
product
was
provided
to
a
patient
that
has
coverage
in
another
jurisdiction.
|
| 2 | ORTHO | orthodontic service |
The
service
provided
is
required
for
orthodontic
purposes.
If
the
covered
party
has
orthodontic
coverage,
then
the
service
may
be
paid.
|
| 2 | PAPER | paper documentation to follow |
Paper
documentation
(or
other
physical
format)
with
supporting
or
additional
information
to
follow.
|
| 2 | PIE | 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.
|
| 2 | PYRDELAY | delayed by a previous payor |
Allows
provider
to
explain
lateness
of
invoice
to
a
subsequent
payor.
|
| 2 | REFNR | referral not required |
Rules
of
practice
do
not
require
a
physician's
referral
for
the
provider
to
perform
a
billable
service.
|
| 2 | REPSERV | 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.
|
| 2 | UNRELAT | 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.
|
| 2 | VERBAUTH | verbal authorization |
The
provider
has
received
a
verbal
permission
from
an
authoritative
source
to
perform
the
service
or
supply
the
item
being
invoiced.
|
| 1 | (_ActListCode) Abstract |
Provides
codes
associated
with
ActClass
value
of
LIST
(working
list)
|
|
| 2 | (_ActObservationList) Abstract | ||
| 3 | CARELIST | 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.
|
| 3 | CONDLIST | condition list |
List
of
condition
observations.
|
| 4 | INTOLIST | intolerance list |
List
of
intolerance
observations.
|
| 4 | PROBLIST | problem list |
List
of
problem
observations.
|
| 4 | RISKLIST | risk factors |
List
of
risk
factor
observations.
|
| 3 | GOALLIST | goal list |
List
of
observations
in
goal
mood.
|
| 2 | (_ActTherapyDurationWorkingListCode) Abstract |
Codes
used
to
identify
different
types
of
'duration-based'
working
lists.
Examples
include
|
|
| 3 | (_ActMedicationTherapyDurationWorkingListCode) Abstract |
Definition:A
collection
of
concepts
that
identifies
different
types
of
'duration-based'
mediation
working
lists.
|
|
| 4 | ACU | 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.
|
| 4 | CHRON | 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.
|
| 4 | ONET | one time |
Definition:A
list
of
medications
which
the
patient
is
intended
to
be
administered
only
once.
|
| 4 | PRN | 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.
|
| 2 | MEDLIST | medication list |
List
of
medications.
|
| 3 | CURMEDLIST | current medication list |
List
of
current
medications.
|
| 3 | DISCMEDLIST | discharge medication list |
List
of
discharge
medications.
|
| 3 | HISTMEDLIST | medication history |
Historical
list
of
medications.
|
| 1 | (_ActMonitoringProtocolCode) Abstract |
Identifies
types
of
monitoring
programs
|
|
| 2 | CTLSUB | Controlled Substance |
A
monitoring
program
that
focuses
on
narcotics
and/or
commonly
abused
substances
that
are
subject
to
legal
restriction.
|
| 2 | INV | 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
|
| 2 | LU | limited use |
Description:A
drug
that
can
be
prescribed
(and
reimbursed)
only
if
it
meets
certain
criteria.
|
| 2 | OTC | 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.
|
| 2 | RX | 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.
|
| 2 | SA | special authorization |
Definition:A
drug
that
requires
prior
approval
(to
be
reimbursed)
before
being
dispensed
|
| 2 | SAC | special access |
Description:A
drug
that
requires
special
access
permission
to
be
prescribed
and
dispensed.
|
| 1 | (_ActNonObservationIndicationCode) Abstract |
Description:Concepts
representing
indications
(reasons
for
clinical
action)
other
than
diagnosis
and
symptoms.
|
|
| 2 | IND01 | imaging study requiring contrast |
Description:Contrast
agent
required
for
imaging
study.
|
| 2 | IND02 | colonoscopy prep |
Description:Provision
of
prescription
or
direction
to
consume
a
product
for
purposes
of
bowel
clearance
in
preparation
for
a
colonoscopy.
|
| 2 | IND03 | prophylaxis |
Description:Provision
of
medication
as
a
preventative
measure
during
a
treatment
or
other
period
of
increased
risk.
|
| 2 | IND04 | surgical prophylaxis |
Description:Provision
of
medication
during
pre-operative
phase;
e.g.,
antibiotics
before
dental
surgery
or
bowel
prep
before
colon
surgery.
|
| 2 | IND05 | pregnancy prophylaxis |
Description:Provision
of
medication
for
pregnancy
--e.g.,
vitamins,
antibiotic
treatments
for
vaginal
tract
colonization,
etc.
|
| 1 | (_ActObservationVerificationType) Abstract |
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) |
|
| 2 | VFPAPER | verify paper |
Definition:Indicates
that
the
paper
version
of
the
record
has,
should
be
or
is
being
verified
against
the
electronic
version.
|
| 1 | (_ActPaymentCode) Abstract |
Code
identifying
the
method
or
the
movement
of
payment
instructions.
Codes are drawn from X12 data element 591 (PaymentMethodCode) |
|
| 2 | ACH | Automated Clearing House |
Automated
Clearing
House
(ACH).
|
| 2 | CHK | Cheque |
A
written
order
to
a
bank
to
pay
the
amount
specified
from
funds
on
deposit.
|
| 2 | DDP | Direct Deposit |
Electronic
Funds
Transfer
(EFT)
deposit
into
the
payee's
bank
account
|
| 2 | NON | Non-Payment Data |
Non-Payment
Data.
|
| 1 | (_ActPharmacySupplyType) Abstract |
Identifies
types
of
dispensing
events
|
|
| 2 | DF | Daily Fill |
A
fill
providing
sufficient
supply
for
one
day
|
| 2 | EM | 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)
|
| 3 | SO | Script Owing |
An
emergency
supply
where
the
expectation
is
that
a
formal
order
authorizing
the
supply
will
be
provided
at
a
later
date.
|
| 2 | FF | First Fill |
The
initial
fill
against
an
order.
(This
includes
initial
fills
against
refill
orders.)
|
| 3 | FFS | ||
| 3 | FFC | 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).
|
| 4 | FFCS | ||
| 3 | FFP | 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.)
|
| 3 | FFPS | ||
| 3 | FFSS | 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).
|
| 4 | FFPS | ||
| 4 | FFCS | ||
| 4 | TFS | ||
| 3 | TF | Trial Fill |
A
fill
where
a
small
portion
is
provided
to
allow
for
determination
of
the
therapy
effectiveness
and
patient
tolerance.
|
| 4 | TFS | ||
| 2 | FS | Floor stock |
A
supply
action
to
restock
a
smaller
more
local
dispensary.
|
| 2 | MS | Manufacturer Sample |
A
supply
of
a
manufacturer
sample
|
| 2 | RF | Refill |
A
fill
against
an
order
that
has
already
been
filled
(or
partially
filled)
at
least
once.
|
| 3 | DF | ||
| 3 | UD | Unit Dose |
A
supply
action
that
provides
sufficient
material
for
a
single
dose.
|
| 3 | RFC | 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.)
|
| 4 | RFCS | 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).
|
| 3 | RFF | Refill (First fill this facility) |
The
first
fill
against
an
order
that
has
already
been
filled
at
least
once
at
another
facility.
|
| 4 | RFFS | 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).
|
| 3 | RFP | 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.)
|
| 4 | RFPS | 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).
|
| 3 | RFS | 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).
|
| 3 | TB | Trial Balance |
A
fill
where
the
remainder
of
a
'complete'
fill
is
provided
after
a
trial
fill
has
been
provided.
|
| 4 | TBS | 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 | UD | ||
| 2 | UDE | 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.
|
| 1 | (_ActPolicyType) Abstract |
Description:Types
of
policies
that
further
specify
the
ActClassPolicy
value
set.
|
|
| 2 | (_ActPrivacyPolicy) Abstract |
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. |
|
| 3 | (_ActConsentDirective) Abstract |
Specifies
the
type
of
agreement
between
one
or
more
grantor
and
grantee
in
which
rights
and
obligations
related
to
one
or
more
shared
items
of
interest
are
allocated.
Usage Note: Such agreements may be considered Examples: Healthcare Privacy Consent Directive permitting or restricting in whole or part the collection, access, use, and disclosure of health information, and any associated handling caveats. Healthcare Medical Consent Directive to receive medical procedures after being informed of risks and benefits, thereby reducing the grantee's liability. Research Informed Consent for participation in clinical trials and disclosure of health information after being informed of risks and benefits, thereby reducing the grantee's liability. Substitute decision maker delegation in which the grantee assumes responsibility to act on behalf of the grantor. Contracts in which the agreement requires assent/dissent by the grantor of terms offered by a grantee, a consumer opts out of an |
|
| 4 | EMRGONLY | 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. |
| 4 | GRANTORCHOICE | grantor choice |
A
grantor's
terms
of
agreement
to
which
a
grantee
may
assent
or
dissent,
and
which
may
include
an
opportunity
for
a
grantee
to
request
restrictions
or
extensions.
Comment: A grantor typically is able to stipulate preferred terms of agreement when the grantor has control over the topic of the agreement, which a grantee must accept in full or may be offered an opportunity to extend or restrict certain terms. Usage Note: If the grantor's term of agreement must be accepted in full, then this is considered Examples: Healthcare: A PHR account holder [grantor] may require any PHR user [grantee] to accept the terms of agreement in full, or may permit a PHR user to extend or restrict terms selected by the account holder or requested by the PHR user. Non-healthcare: The owner of a resource server [grantor] may require any authorization server [grantee] to meet authorization requirements stipulated in the grantor's terms of agreement. |
| 4 | IMPLIED | implied consent |
A
grantor's
presumed
assent
to
the
grantee's
terms
of
agreement
is
based
on
the
grantor's
behavior,
which
may
result
from
not
expressly
assenting
to
the
consent
directive
offered,
or
from
having
no
right
to
assent
or
dissent
offered
by
the
grantee.
Comment: Implied or Usage Note: Implied consent with no opportunity to assent or dissent to certain terms is considered Examples: Healthcare: A patient schedules an appointment with a provider, and either does not take the opportunity to expressly assent or dissent to the provider's consent directive, does not have an opportunity to do so, as in the case where emergency care is required, or simply behaves as though the patient [grantor] agrees to the rights granted to the provider [grantee] in an implicit consent directive. An injured and unconscious patient is deemed to have assented to emergency treatment by those permitted to do so under jurisdictional laws, e.g., Good Samaritan laws. Non-healthcare: Upon receiving a driver's license, the driver is deemed to have assented without explicitly consenting to undergoing field sobriety tests. A corporation that does business in a foreign nation is deemed to have deemed to have assented without explicitly consenting to abide by that nation's laws. |
| 4 | IMPLIEDD | implied consent with opportunity to dissent |
A
grantor's
presumed
assent
to
the
grantee's
terms
of
agreement,
which
is
based
on
the
grantor's
behavior,
and
includes
a
right
to
dissent
to
certain
terms.
Comment: A grantor assenting to the grantee's terms of agreement may or may not exercise a right to dissent to grantor selected terms or to grantee's selected terms to which a grantor may dissent. Usage Note: Implied or Examples: Healthcare Examples: A healthcare provider deems a patient's assent to disclosure of health information to family members and friends, but offers an opportunity or permits the patient to dissent to such disclosures. A health information exchanges deems a patient to have assented to disclosure of health information for treatment purposes, but offers the patient an opportunity to dissents to disclosure to particular provider organizations. Non-healthcare Examples: A bank deems a banking customer's assent to specified collection, access, use, or disclosure of financial information as a requirement of holding a bank account, but provides the user an opportunity to limit third-party collection, access, use or disclosure of that information for marketing purposes. |
| 4 | NOCONSENT | no consent |
No
notification
or
opportunity
is
provided
for
a
grantor
to
assent
or
dissent
to
a
grantee's
terms
of
agreement.
Comment: A Usage Note: The grantee's terms of agreement, may be available to the grantor by reviewing the grantee's privacy policies, but there is no notice by which a grantor is apprised of the policy directly or able to acknowledge. Examples: Healthcare: Without notification or an opportunity to assent or dissent, a patient's health information is automatically included in and available (often according to certain rules) through a health information exchange. Note that this differs from implied consent, where the patient is assumed to have consented. Without notification or an opportunity to assent or dissent, a patient's health information is collected, accessed, used, or disclosed for research, public health, security, fraud prevention, court order, or law enforcement. Non-healthcare: Without notification or an opportunity to assent or dissent, a consumer's healthcare or non-healthcare internet searches are aggregated for secondary uses such as behavioral tracking and profiling. Without notification or an opportunity to assent or dissent, a consumer's location and activities in a shopping mall are tracked by RFID tags on purchased items. |
| 4 | NOPP | 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. |
| 4 | OPTIN | opt-in |
A
grantor's
assent
to
the
terms
of
an
agreement
offered
by
a
grantee
without
an
opportunity
for
to
dissent
to
any
terms.
Comment: Acceptance of a grantee's terms pertaining, for example, to permissible activities, purposes of use, handling caveats, expiry date, and revocation policies. Usage Note: Opt-in with no opportunity for a grantor to restrict certain permissions sought by the grantee is considered Examples: Healthcare: A patient [grantor] signs a provider's [grantee's] consent directive form, which lists permissible collection, access, use, or disclosure activities, purposes of use, handling caveats, and revocation policies. Non-healthcare: An employee [grantor] signs an employer's [grantee's] non-disclosure and non-compete agreement. |
| 4 | OPTINR | opt-in with restrictions |
A
grantor's
assent
to
the
grantee's
terms
of
an
agreement
with
an
opportunity
for
to
dissent
to
certain
grantor
or
grantee
selected
terms.
Comment: A grantor dissenting to the grantee's terms of agreement may or may not exercise a right to assent to grantor's pre-approved restrictions or to grantee's selected terms to which a grantor may dissent. Usage Note: Opt-in with restrictions is considered Examples: Healthcare: A patient assent to grantee's consent directive terms for collection, access, use, or disclosure of health information, and dissents to disclosure to certain recipients as allowed by the provider's pre-approved restriction list. Non-Healthcare: A cell phone user assents to the cell phone's privacy practices and terms of use, but dissents from location tracking by turning off the cell phone's tracking capability. |
| 4 | OPTOUT | op-out |
A
grantor's
dissent
to
the
terms
of
agreement
offered
by
a
grantee
without
an
opportunity
for
to
assent
to
any
terms.
Comment: Rejection of a grantee's terms of agreement pertaining, for example, to permissible activities, purposes of use, handling caveats, expiry date, and revocation policies. Usage Note: Opt-out with no opportunity for a grantor to permit certain permissions sought by the grantee is considered Examples: Healthcare: A patient [grantor] declines to sign a provider's [grantee's] consent directive form, which lists permissible collection, access, use, or disclosure activities, purposes of use, handling caveats, revocation policies, and consequences of not assenting. Non-healthcare: An employee [grantor] refuses to sign an employer's [grantee's] agreement not to join unions or participate in a strike where state law protects employee's collective bargaining rights. A citizen [grantor] refuses to enroll in mandatory government [grantee] health insurance based on religious beliefs, which is an exemption. |
| 4 | OPTOUTE | opt-out with exceptions |
A
grantor's
dissent
to
the
grantee's
terms
of
agreement
except
for
certain
grantor
or
grantee
selected
terms.
Comment: A rejection of a grantee's terms of agreement while assenting to certain permissions sought by the grantee or requesting approval of additional grantor terms. Usage Note: Opt-out with exceptions is considered a Examples: Healthcare: A patient [grantor] dissents to a health information exchange consent directive with the exception of disclosure based on a limited |
| 3 | (_ActPrivacyLaw) Abstract |
A
jurisdictional
mandate,
regulation,
obligation,
requirement,
rule,
or
expectation
deeming
certain
information
to
be
private
to
an
individual
or
organization,
which
is
imposed
on:
The activity of a governed party The behavior of a governed party The manner in which an act is executed by a governed party |
|
| 4 | _ActUSPrivacyLaw | _ActUSPrivacyLaw |
Definition:
A
jurisdictional
mandate
in
the
U.S.
relating
to
privacy.
Usage Note: ActPrivacyLaw codes may be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialtyCode complies. May be used to further specify rationale for assignment of other ActPrivacyPolicy codes in the US realm, e.g., ETH and 42CFRPart2 can be differentiated from ETH and Title38Part1. |
| 5 | 42CFRPart2 | 42 CFR Part2 |
42
CFR
Part
2
stipulates
the
right
of
an
individual
who
has
applied
for
or
been
given
diagnosis
or
treatment
for
alcohol
or
drug
abuse
at
a
federally
assisted
program.
Definition: Non-disclosure of health information relating to health care paid for by a federally assisted substance abuse program without patient consent. Usage Note: May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies. |
| 5 | CommonRule | Common Rule |
U.S.
Federal
regulations
governing
the
protection
of
human
subjects
in
research
(codified
at
Subpart
A
of
45
CFR
part
46)
that
has
been
adopted
by
15
U.S.
Federal
departments
and
agencies
in
an
effort
to
promote
uniformity,
understanding,
and
compliance
with
human
subject
protections.
Existing
regulations
governing
the
protection
of
human
subjects
in
Food
and
Drug
Administration
(FDA)-regulated
research
(21
CFR
parts
50,
56,
312,
and
812)
are
separate
from
the
Common
Rule
but
include
similar
requirements.
Definition: U.S. federal laws governing research-related privacy policies. Usage Note: May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialtyCode complies. |
| 5 | HIPAANOPP | HIPAA notice of privacy practices |
The
U.S.
Public
Law
104-191
Health
Insurance
Portability
and
Accountability
Act
(HIPAA)
Privacy
Rule
(45
CFR
Part
164
Subpart
E)
permits
access,
use
and
disclosure
of
certain
personal
health
information
(PHI
as
defined
under
the
law)
for
purposes
of
Treatment,
Payment,
and
Operations,
and
requires
that
the
provider
ask
that
patients
acknowledge
the
Provider's
Notice
of
Privacy
Practices
as
permitted
conduct
under
the
law.
Definition: Notification of HIPAA Privacy Practices. Usage Note: May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialtyCode complies. |
| 5 | HIPAAPsyNotes | HIPAA psychotherapy notes |
The
U.S.
Public
Law
104-191
Health
Insurance
Portability
and
Accountability
Act
(HIPAA)
Privacy
Rule
(45
CFR
Part
164
Section
164.508)
requires
authorization
for
certain
uses
and
disclosure
of
psychotherapy
notes.
Definition: Authorization that must be obtained for disclosure of psychotherapy notes. Usage Note: May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies. |
| 5 | HIPAASelfPay | HIPAA self-pay |
Section
13405(a)
of
the
Health
Information
Technology
for
Economic
and
Clinical
Health
Act
(HITECH)
stipulates
the
right
of
an
individual
to
have
disclosures
regarding
certain
health
care
items
or
services
for
which
the
individual
pays
out
of
pocket
in
full
restricted
from
a
health
plan.
Definition: Non-disclosure of health information to a health plan relating to health care items or services for which an individual pays out of pocket in full. Usage Note: May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies. |
| 5 | Title38Section7332 | Title 38 Section 7332 |
Title
38
Part
1-protected
information
may
only
be
disclosed
to
a
third
party
with
the
special
written
consent
of
the
patient
except
where
expressly
authorized
by
38
USC
7332.
VA
may
disclose
this
information
for
specific
purposes
to:
VA
employees
on
a
need
to
know
basis
-
more
restrictive
than
Privacy
Act
need
to
know;
contractors
who
need
the
information
in
order
to
perform
or
fulfil
the
duties
of
the
contract;
and
researchers
who
provide
assurances
that
the
information
will
not
be
identified
in
any
report.
This
information
may
also
be
disclosed
without
consent
where
patient
lacks
decision-making
capacity;
in
a
medical
emergency
for
the
purpose
of
treating
a
condition
which
poses
an
immediate
threat
to
the
health
of
any
individual
and
which
requires
immediate
medical
intervention;
for
eye,
tissue,
or
organ
donation
purposes;
and
disclosure
of
HIV
information
for
public
health
purposes.
Definition: Title 38 Part 1 - Section 1.462 Confidentiality restrictions. (a) General. The patient records to which Sections 1.460 through 1.499 of this part apply may be disclosed or used only as permitted by these regulations and may not otherwise be disclosed or used in any civil, criminal, administrative, or legislative proceedings conducted by any Federal, State, or local authority. Any disclosure made under these regulations must be limited to that information which is necessary to carry out the purpose of the disclosure. SUBCHAPTER III--PROTECTION OF PATIENT RIGHTS Sec. 7332. Confidentiality of certain medical records (a)(1) Records of the identity, diagnosis, prognosis, or treatment of any patient or subject which are maintained in connection with the performance of any program or activity (including education, training, treatment, rehabilitation, or research) relating to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia which is carried out by or for the Department under this title shall, except as provided in subsections (e) and (f), be confidential, and (section 5701 of this title to the contrary notwithstanding) such records may be disclosed only for the purposes and under the circumstances expressly authorized under subsection (b). Usage Note: May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies. |
| 3 | (_InformationSensitivityPolicy) Abstract |
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. |
|
| 4 | (_ActInformationSensitivityPolicy) Abstract |
Types
of
sensitivity
policies
that
apply
to
Acts.
Act.confidentialityCode
is
defined
in
the
RIM
as
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. |
|
| 5 | ETH | 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. |
| 5 | GDIS | 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. |
| 5 | HIV | 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. |
| 5 |
|
|
Policy
for
handling
Access control concerns for military sexual trauma is based on Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law |
| 5 | SCA | sickle cell anemia information sensitivity |
Policy
for
handling
sickle
cell
disease
information,
which
is
afforded
heightened
confidentiality.
Information
handling
protocols
are
based
on
organizational
policies
related
to
sickle
cell
disease
information,
which
is
deemed
sensitive.
Usage Note: If there is a jurisdictional mandate, then the Act valued with this ActCode should be associated with an Act valued with any applicable laws from the ActPrivacyLaw code system. |
| 5 |
|
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.
SDV code covers violence perpetrated by related and non-related persons. This code should be specific to physical and mental trauma caused by a related person only. The access control concerns are keeping the patient safe from the perpetrator who may have an abusive psychological control over the patient, may be stalking the patient, or may try to manipulate care givers into allowing the perpetrator to make contact with the patient. The definition needs to be clarified. 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. |
| 5 | SEX | 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. |
| 5 | SPI | specially protected information sensitivity |
Policy
for
handling
information
deemed
specially
protected
by
law
or
policy
including
substance
abuse,
substance
use,
psychiatric,
mental
health,
behavioral
health,
and
cognitive
disorders,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 6 | BH | behavioral health information sensitivity |
Policy
for
handling
information
related
to
behavioral
and
emotional
disturbances
affecting
social
adjustment
and
physical
health,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 7 | COGN | cognitive disability information sensitivity |
Policy
for
handling
information
related
to
cognitive
disability
disorders
and
conditions
caused
by
these
disorders,
which
are
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. Examples may include dementia, traumatic brain injury, attention deficit, hearing and visual disability such as dyslexia and other disorders and related conditions which impair learning and self-sufficiency. However, the cognitive disabilities to which this term may apply versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used. |
| 7 | DVD | developmental disability information sensitivity |
Policy
for
handling
information
related
to
developmental
disability
disorders
and
conditions
caused
by
these
disorders,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. A diverse group of chronic conditions that are due to mental or physical impairments impacting activities of daily living, self-care, language acuity, learning, mobility, independent living and economic self-sufficiency. Examples may include Down syndrome and Autism spectrum. However, the developmental disabilities to which this term applies versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used. |
| 7 | EMOTDIS | emotional disturbance information sensitivity |
Policy
for
handling
information
related
to
emotional
disturbance
disorders
and
conditions
caused
by
these
disorders,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. Typical used to characterize behavioral and mental health issues of adolescents where the disorder may be temporarily diagnosed in order to avoid the potential and unnecessary stigmatizing diagnoses of disorder long term. |
| 6 | MH | mental health information sensitivity |
Policy
for
handling
information
related
to
psychological
disorders,
which
is
afforded
heightened
confidentiality.
Mental
health
information
may
be
deemed
specifically
sensitive
and
distinct
from
physical
health,
substance
use
disorders,
and
behavioral
disabilities
and
disorders
in
some
jurisdictions.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 6 | PSY | psychiatry disorder information sensitivity |
Policy
for
handling
psychiatry
psychiatric
disorder
information,
which
is
afforded
heightened
confidentiality.
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. |
| 6 | PSYTHPN | psychotherapy note information sensitivity |
Policy
for
handling
psychotherapy
note
information,
which
is
afforded
heightened
confidentiality.
Usage Note: In some jurisdiction, disclosure of psychotherapy notes requires patient consent. 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. |
| 6 | SUD | substance use disorder information sensitivity |
Policy
for
handling
information
related
to
alcohol
or
drug
use
disorders
and
conditions
caused
by
these
disorders,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 7 | ETHUD | alcohol use disorder information sensitivity |
Policy
for
handling
information
related
to
alcohol
use
disorders
and
conditions
caused
by
these
disorders,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 7 | OPIOIDUD | opioid use disorder information sensitivity |
Policy
for
handling
information
related
to
opioid
use
disorders
and
conditions
caused
by
these
disorders,
which
is
afforded
heightened
confidentiality.
Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 5 | STD | 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. |
| 5 | TBOO | 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. Open Issue: This definition conflates a rule and a characteristic, and there may be a similar issue with ts sibling codes. |
| 5 | VIO | violence information sensitivity |
Policy
for
handling
information
related
to
harm
by
violence,
which
is
afforded
heightened
confidentiality.
Harm
by
violence
is
perpetrated
by
an
unrelated
person.
Access control concerns for information about mental or physical harm resulting from violence caused by an unrelated person may include manipulation of care givers or access to records that enable the perpetrator contact or locate the patient, but the perpetrator will likely not have established abusive psychological control over the patient. Usage Note: If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code. |
| 5 | SICKLE | sickle cell |
Types
of
sensitivity
policies
that
apply
to
Acts.
Act.confidentialityCode
is
defined
in
the
RIM
as
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 | (_EntitySensitivityPolicyType) Abstract |
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 |
|
| 5 | DEMO | 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. |
| 5 | DOB | 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. |
| 5 | GENDER | 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. |
| 5 | LIVARG | 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. |
| 5 | MARST | 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. |
| 5 | RACE | 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. |
| 5 | REL | 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. |
| 4 | (_RoleInformationSensitivityPolicy) Abstract |
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 |
|
| 5 | B | 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. |
| 5 | EMPL | 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. |
| 5 | LOCIS | 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. |
| 5 | SSP | 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. |
| 4 | ADOL | 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. |
| 4 | CEL | 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. |
| 4 | DIA | 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. |
| 4 | DRGIS | 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. |
| 4 | EMP | 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. |
| 4 | PDS | patient default information sensitivity |
Policy
for
Usage Note: For example, VA deems employee information sensitive by default. Information about a patient who is being stalked or a victim of abuse or violence may be deemed sensitive by default per a provider organization's policies. |
| 4 |
|
|
Usage Note: For use within an enterprise that |
| 4 | PRS |
patient
requested
information
|
Policy
for
specially
protecting
information
reported
by
or
about
a
patient,
which
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 | COMPT | compartment |
This
is
the
healthcare
analog
to
the
US
Intelligence
Community's
concept
of
a
Special
Access
Program.
Compartment
codes
may
be
used
in
as
a
field
value
in
an
initiator's
clearance
to
indicate
permission
to
access
and
use
an
IT
Resource
with
a
security
label
having
the
same
compartment
value
in
security
category
label
field.
Map: Aligns with ISO 2382-8 definition of Compartment - |
| 4 | ACOCOMPT | accountable care organization compartment |
A
group
of
health
care
entities,
which
may
include
health
care
providers,
care
givers,
hospitals,
facilities,
health
plans,
and
other
health
care
constituents
who
coordinate
care
for
reimbursement
based
on
quality
metrics
for
improving
outcomes
and
lowering
costs,
and
may
be
authorized
to
access
the
consumer's
health
information
because
of
membership
in
that
group.
Security Compartment Labels assigned to a consumer's information use in accountable care workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a an accountable care workflow who is requesting access to that information |
| 4 | CTCOMPT | care team compartment |
Care
coordination
across
participants
in
a
care
plan
requires
sharing
of
a
healthcare
consumer's
information
specific
to
that
workflow.
A
care
team
member
should
only
have
access
to
that
information
while
participating
in
that
workflow
or
for
other
authorized
uses.
Security Compartment Labels assigned to a consumer's information use in care coordination workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a care team member workflow who is requesting access to that information |
| 4 | FMCOMPT | financial management compartment |
Financial
management
department
members
who
have
access
to
healthcare
consumer
information
as
part
of
a
patient
account,
billing
and
claims
workflows.
Security Compartment Labels assigned to consumer information used in these workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a financial management workflow who is requesting access to that information. |
| 4 | HRCOMPT | human resource compartment |
A
security
category
label
field
value,
which
indicates
that
access
and
use
of
an
IT
resource
is
restricted
to
members
of
human
resources
department
or
workflow.
|
| 4 | LRCOMPT | legitimate relationship compartment |
Providers
and
care
givers
who
have
an
established
relationship
per
criteria
determined
by
policy
are
considered
to
have
an
established
care
provision
relations
with
a
healthcare
consumer,
and
may
be
authorized
to
access
the
consumer's
health
information
because
of
that
relationship.
Providers
and
care
givers
should
only
have
access
to
that
information
while
participating
in
legitimate
relationship
workflows
or
for
other
authorized
uses.
Security Compartment Labels assigned to a consumer's information use in legitimate relationship workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a legitimate relationship workflow who is requesting access to that information. |
| 4 | PACOMPT | patient administration compartment |
Patient
administration
members
who
have
access
to
healthcare
consumer
information
as
part
of
a
patient
administration
workflows.
Security Compartment Labels assigned to consumer information used in these workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a patient administration workflow who is requesting access to that information. |
| 4 | RESCOMPT | research project compartment |
A
security
category
label
field
value,
which
indicates
that
access
and
use
of
an
IT
resource
is
restricted
to
members
of
a
research
project.
|
| 4 | RMGTCOMPT | records management compartment |
A
security
category
label
field
value,
which
indicates
that
access
and
use
of
an
IT
resource
is
restricted
to
members
of
records
management
department
or
workflow.
|
| 2 | (ActTrustPolicyType) Abstract |
A
mandate,
obligation,
requirement,
rule,
or
expectation
conveyed
as
security
metadata
between
senders
and
receivers
required
to
establish
the
reliability,
authenticity,
and
trustworthiness
of
their
transactions.
Trust security metadata are observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability). Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. [Based on ISO IEC 10181-1 and NIST SP 800-63-2] For example, identity proofing , level of assurance, and Trust Framework. |
|
| 3 | TRSTACCRD | trust accreditation |
Type
of
security
metadata
about
the
formal
declaration
by
an
authority
or
neutral
third
party
that
validates
the
technical,
security,
trust,
and
business
practice
conformance
of
Trust
Agents
to
facilitate
security,
interoperability,
and
trust
among
participants
within
a
security
domain
or
trust
framework.
|
| 3 | TRSTAGRE | trust agreement |
Type
of
security
metadata
about
privacy
and
security
requirements
with
which
a
security
domain
must
comply.
[ISO
IEC
10181-1]
|
| 3 | TRSTASSUR | trust assurance |
Type
of
security
metadata
about
the
digital
quality
or
reliability
of
a
trust
assertion,
activity,
capability,
information
exchange,
mechanism,
process,
or
protocol.
|
| 3 | TRSTCERT | trust certificate |
Type
of
security
metadata
about
a
set
of
security-relevant
data
issued
by
a
security
authority
or
trusted
third
party,
together
with
security
information
which
is
used
to
provide
the
integrity
and
data
origin
authentication
services
for
an
IT
resource
(data,
information
object,
service,
or
system
capability).
[Based
on
ISO
IEC
10181-1]
|
| 3 | TRSTFWK | trust framework |
Type
of
security
metadata
about
a
complete
set
of
contracts,
regulations,
or
commitments
that
enable
participating
actors
to
rely
on
certain
assertions
by
other
actors
to
fulfill
their
information
security
requirements.
[Kantara
Initiative]
|
| 3 | TRSTMEC | trust mechanism |
Type
of
security
metadata
about
a
security
architecture
system
component
that
supports
enforcement
of
security
policies.
|
| 2 | COVPOL | 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. |
| 2 | SecurityPolicy | security policy |
Types
of
security
policies
that
further
specify
the
ActClassPolicy
value
set.
Examples: obligation to encrypt refrain from redisclosure without consent |
| 3 | AUTHPOL | authorization policy |
Authorisation
policies
are
essentially
security
policies
related
to
access-control
and
specify
what
activities
a
subject
is
permitted
or
forbidden
to
do,
to
a
set
of
target
objects.
They
are
designed
to
protect
target
objects
so
are
interpreted
by
access
control
agents
or
the
run-time
systems
at
the
target
system.
A positive authorisation policy defines the actions that a subject is permitted to perform on a target. A negative authorisation policy specifies the actions that a subject is forbidden to perform on a target. Positive authorisation policies may also include filters to transform the parameters associated with their actions. (Based on PONDERS) |
| 4 | ACCESSCONSCHEME | access control scheme |
An
access
control
policy
specific
to
the
type
of
access
control
scheme,
which
is
used
to
enforce
one
or
more
authorization
policies.
Usage Note: Access control schemes are the type of access control policy, which is comprised of access control policy rules concerning the provision of the access control service. There are two categories of access control policies, rule-based and identity-based, which are identified in CCITT Rec. X.800 aka ISO 7498-2. Rule-based access control policies are intended to apply to all access requests by any initiator on any target in a security domain. Identity-based access control policies are based on rules specific to an individual initiator, a group of initiators, entities acting on behalf of initiators, or originators acting in a specific role. Context can modify rule-based or identity-based access control policies. Context rules may define the entire policy in effect. Real systems will usually employ a combination of these policy types; if a rule-based policy is used, then an identity-based policy is usually in effect also. An access control scheme may be based on access control lists, capabilities, labels, and context or a combination of these. An access control scheme is a component of an access control mechanism or "service") along with the supporting mechanisms required by that scheme to provide access control decision information (ADI) supplied by the scheme to the access decision facility (ADF also known as a PDP). (Based on ISO/IEC 10181-3:1996) Examples: Attribute Based Access Control (ABAC) Discretionary Access Control (DAC) History Based Access Control (HBAC) Identity Based Access Control (IBAC) Mandatory Access Control (MAC) Organization Based Access Control (OrBAC) Relationship Based Access Control (RelBac) Responsibility Based Access Control (RespBAC) Risk Adaptable Access Control (RAdAC) > |
| 3 | DELEPOL | delegation policy |
Delegation
policies
specify
which
actions
subjects
are
allowed
to
delegate
to
others.
A
delegation
policy
thus
specifies
an
authorisation
to
delegate.
Subjects
must
already
possess
the
access
rights
to
be
delegated.
Delegation policies are aimed at subjects delegating rights to servers or third parties to perform actions on their behalf and are not meant to be the means by which security administrators would assign rights to subjects. A negative delegation policy identifies what delegations are forbidden. A Delegation policy specifies the authorisation policy from which delegated rights are derived, the grantors, which are the entities which can delegate these access rights, and the grantees, which are the entities to which the access rights can be delegated. There are two types of delegation policy, positive and negative. (Based on PONDERS) |
| 3 | ObligationPolicy | 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. Per OASIS XACML, an obligation is an operation specified in a policy or policy that is performed in conjunction with the enforcement of an access control decision. |
| 4 | ANONY | anonymize |
Custodian
system
must
remove
any
information
that
could
result
in
identifying
the
information
subject.
|
| 4 | AOD | 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.
|
| 4 | AUDIT | audit |
Custodian
system
must
monitor
systems
to
ensure
that
all
users
are
authorized
to
operate
on
information
objects.
|
| 4 | AUDTR | audit trail |
Custodian
system
must
monitor
and
maintain
retrievable
log
for
each
user
and
operation
on
information.
|
| 4 | CPLYCC | 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.
|
| 4 | CPLYCD | comply with consent directive |
Custodian
security
system
must
retrieve,
evaluate,
and
comply
with
applicable
information
subject
consent
directives.
|
| 4 | CPLYJPP | comply with jurisdictional privacy policy |
Custodian
security
system
must
retrieve,
evaluate,
and
comply
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
|
| 4 | CPLYOPP | comply with organizational privacy policy |
Custodian
security
system
must
retrieve,
evaluate,
and
comply
with
applicable
organizational
privacy
policies
associated
with
the
target
information.
|
| 4 | CPLYOSP | comply with organizational security policy |
Custodian
security
system
must
retrieve,
evaluate,
and
comply
with
the
organizational
security
policies
associated
with
the
target
information.
|
| 4 | CPLYPOL | comply with policy |
Custodian
security
system
must
retrieve,
evaluate,
and
comply
with
applicable
policies
associated
with
the
target
information.
|
| 4 | DECLASSIFYLABEL | declassify security label |
Custodian
security
system
must
declassify
information
assigned
security
labels
by
instantiating
a
new
version
of
the
classified
information
so
as
to
break
the
binding
of
the
classifying
security
label
when
assigning
a
new
security
label
that
marks
the
information
as
unclassified
in
accordance
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
The
system
must
retain
an
immutable
record
of
the
previous
assignment
and
binding.
|
| 4 | DEID | deidentify |
Custodian
system
must
strip
information
of
data
that
would
allow
the
identification
of
the
source
of
the
information
or
the
information
subject.
|
| 4 | DELAU | delete after use |
Custodian
system
must
remove
target
information
from
access
after
use.
|
| 4 | DOWNGRDLABEL | downgrade security label |
Custodian
security
system
must
downgrade
information
assigned
security
labels
by
instantiating
a
new
version
of
the
classified
information
so
as
to
break
the
binding
of
the
classifying
security
label
when
assigning
a
new
security
label
that
marks
the
information
as
classified
at
a
less
protected
level
in
accordance
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
The
system
must
retain
an
immutable
record
of
the
previous
assignment
and
binding.
|
| 4 | DRIVLABEL | derive security label |
Custodian
security
system
must
assign
and
bind
security
labels
derived
from
compilations
of
information
by
aggregation
or
disaggregation
in
order
to
classify
information
compiled
in
the
information
systems
under
its
control
for
collection,
access,
use
and
disclosure
in
accordance
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
The
system
must
retain
an
immutable
record
of
the
previous
assignment
and
binding.
|
| 4 | ENCRYPT | 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.) |
| 5 | ENCRYPTR | encrypt at rest |
Custodian
system
must
render
information
unreadable
and
unusable
by
algorithmically
transforming
plaintext
into
ciphertext
when
|
| 5 | ENCRYPTT | encrypt in transit |
Custodian
system
must
render
information
unreadable
and
unusable
by
algorithmically
transforming
plaintext
into
ciphertext
while
|
| 5 | ENCRYPTU | 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.
|
| 4 | HUAPRV | human approval |
Custodian
system
must
require
human
review
and
approval
for
permission
requested.
|
| 4 | LABEL | assign security label |
Custodian
security
system
must
assign
and
bind
security
labels
in
order
to
classify
information
created
in
the
information
systems
under
its
control
for
collection,
access,
use
and
disclosure
in
accordance
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
The
system
must
retain
an
immutable
record
of
the
assignment
and
binding.
Usage Note: In security systems, security policy label assignments do not change, they may supersede prior assignments, and such reassignments are always tracked for auditing and other purposes. |
| 4 | MASK | 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
|
| 4 | MINEC | minimum necessary |
Custodian
must
limit
access
and
disclosure
to
the
minimum
information
required
to
support
an
authorized
user's
purpose
of
use.
Usage Note: Limiting the information available for access and disclosure to that an authorized user or receiver |
| 4 | PERSISTLABEL | persist security label |
Custodian
security
system
must
persist
the
binding
of
security
labels
to
classify
information
received
or
imported
by
information
systems
under
its
control
for
collection,
access,
use
and
disclosure
in
accordance
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
The
system
must
retain
an
immutable
record
of
the
assignment
and
binding.
|
| 4 | PRIVMARK | privacy mark |
Custodian
must
create
and/or
maintain
human
readable
security
label
tags
as
required
by
policy.
Map: Aligns with ISO 22600-3 Section A.3.4.3 description of privacy mark: |
| 4 | PSEUD | 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.
|
| 4 | REDACT | redact |
Custodian
system
must
remove
information,
which
is
not
authorized
to
be
access,
used,
or
disclosed
from
records
made
available
to
otherwise
authorized
users.
|
| 4 | UPGRDLABEL | upgrade security label |
Custodian
security
system
must
declassify
information
assigned
security
labels
by
instantiating
a
new
version
of
the
classified
information
so
as
to
break
the
binding
of
the
classifying
security
label
when
assigning
a
new
security
label
that
marks
the
information
as
classified
at
a
more
protected
level
in
accordance
with
applicable
jurisdictional
privacy
policies
associated
with
the
target
information.
The
system
must
retain
an
immutable
record
of
the
previous
assignment
and
binding.
|
| 3 | RefrainPolicy | 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 |
| 4 | NOAUTH | no disclosure without subject authorization |
Prohibition
on
disclosure
without
information
subject's
authorization.
|
| 4 | NOCOLLECT | no collection |
Prohibition
on
collection
or
storage
of
the
information.
|
| 4 | NODSCLCD | no disclosure without consent directive |
Prohibition
on
disclosure
without
organizational
approved
patient
restriction.
|
| 4 | NODSCLCDS | no disclosure without information subject's consent directive |
Prohibition
on
disclosure
without
a
consent
directive
from
the
information
subject.
|
| 4 | NOINTEGRATE | no integration |
Prohibition
on
Integration
into
other
records.
|
| 4 | NOLIST | no unlisted entity disclosure |
Prohibition
on
disclosure
except
to
entities
on
specific
access
list.
|
| 4 | NOMOU | no disclosure without MOU |
Prohibition
on
disclosure
without
an
interagency
service
agreement
or
memorandum
of
understanding
(MOU).
|
| 4 | NOORGPOL | no disclosure without organizational authorization |
Prohibition
on
disclosure
without
organizational
authorization.
|
| 4 | NOPAT | no disclosure to patient, family or caregivers without attending provider's authorization |
Prohibition
on
disclosing
information
to
patient,
family
or
caregivers
without
attending
provider's
authorization.
Usage Note: The information may be labeled with the ActInformationSensitivity TBOO code, triggering application of this RefrainPolicy code as a handling caveat controlling access. Maps to FHIR NOPAT: Typically, this is used on an Alert resource, when the alert records information on patient abuse or non-compliance. FHIR print name is displayName: Document non visible par le patient codingScheme: 1.2.250.1.213.1.1.4.13 French use case: A label for documents that the author chose to hide from the patient until the content can be disclose to the patient in a face to face meeting between a healthcare professional and the patient (in French law some results like cancer diagnosis or AIDS diagnosis must be announced to the patient by a healthcare professional and should not be find out by the patient alone). |
| 4 | NOPERSISTP | no collection beyond purpose of use |
Prohibition
on
collection
of
the
information
beyond
time
necessary
to
accomplish
authorized
purpose
of
use
is
prohibited.
|
| 4 | NORDSCLCD | no redisclosure without consent directive |
Prohibition
on
redisclosure
without
patient
consent
directive.
|
| 4 | NORDSCLCDS | no redisclosure without information subject's consent directive |
Prohibition
on
redisclosure
without
a
consent
directive
from
the
information
subject.
|
| 4 | NORDSCLW | no disclosure without jurisdictional authorization |
Prohibition
on
disclosure
without
authorization
under
jurisdictional
law.
|
| 4 | NORELINK | no 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.
|
| 4 | NOREUSE | no reuse beyond purpose of use |
Prohibition
on
use
of
the
information
beyond
the
purpose
of
use
initially
authorized.
|
| 4 | NOVIP | no unauthorized VIP disclosure |
Prohibition
on
disclosure
except
to
principals
with
access
permission
to
specific
VIP
information.
|
| 4 | ORCON | no disclosure without originator authorization |
Prohibition
on
disclosure
except
as
permitted
by
the
information
originator.
|
| 1 | (_ActProductAcquisitionCode) Abstract |
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.
|
|
| 2 | LOAN | Loan |
Temporary
supply
of
a
product
without
transfer
of
ownership
for
the
product.
|
| 3 | RENT | Rent |
Temporary
supply
of
a
product
with
financial
compensation,
without
transfer
of
ownership
for
the
product.
|
| 2 | TRANSFER | Transfer |
Transfer
of
ownership
for
a
product.
|
| 3 | SALE | Sale |
Transfer
of
ownership
for
a
product
for
financial
compensation.
|
| 1 | (_ActSpecimenTransportCode) Abstract |
Transportation
of
a
specimen.
|
|
| 2 | SREC | specimen received |
Description:Specimen
has
been
received
by
the
participating
organization/department.
|
| 2 | SSTOR | specimen in storage |
Description:Specimen
has
been
placed
into
storage
at
a
participating
location.
|
| 2 | STRAN | specimen in transit |
Description:Specimen
has
been
put
in
transit
to
a
participating
receiver.
|
| 1 | (_ActSpecimenTreatmentCode) Abstract |
Set
of
codes
related
to
specimen
treatments
|
|
| 2 | ACID | Acidification |
The
lowering
of
specimen
pH
through
the
addition
of
an
acid
|
| 2 | ALK | Alkalization |
The
act
rendering
alkaline
by
impregnating
with
an
alkali;
a
conferring
of
alkaline
qualities.
|
| 2 | DEFB | Defibrination |
The
removal
of
fibrin
from
whole
blood
or
plasma
through
physical
or
chemical
means
|
| 2 | FILT | Filtration |
The
passage
of
a
liquid
through
a
filter,
accomplished
by
gravity,
pressure
or
vacuum
(suction).
|
| 2 | LDLP | LDL Precipitation | |
| 2 | NEUT | Neutralization |
The
act
or
process
by
which
an
acid
and
a
base
are
combined
in
such
proportions
that
the
resulting
compound
is
neutral.
|
| 2 | RECA | Recalcification |
The
addition
of
calcium
back
to
a
specimen
after
it
was
removed
by
chelating
agents
|
| 2 | UFIL | Ultrafiltration |
The
filtration
of
a
colloidal
substance
through
a
semipermeable
medium
that
allows
only
the
passage
of
small
molecules.
|
| 1 | (_ActSubstanceAdministrationCode) Abstract |
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.
|
|
| 2 | DRUG | 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.
|
| 2 | FD | food |
Description:
The
introduction
of
material
into
a
subject
with
the
intent
of
providing
nutrition
or
other
dietary
supplements
(e.g.
minerals
or
vitamins).
|
| 2 | IMMUNIZ | Immunization |
The
introduction
of
an
immunogen
with
the
intent
of
stimulating
an
immune
response,
aimed
at
preventing
subsequent
infections
by
more
viable
agents.
|
| 3 | BOOSTER | Booster Immunization |
An
additional
immunization
administration
within
a
series
intended
to
bolster
or
enhance
immunity.
|
| 3 | INITIMMUNIZ | Initial Immunization |
The
first
immunization
administration
in
a
series
intended
to
produce
immunity
|
| 1 | (_ActTaskCode) Abstract |
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).
|
|
| 2 | OE | order entry task |
A
clinician
creates
a
request
for
a
service
to
be
performed
for
a
given
patient.
|
| 3 | LABOE | laboratory test order entry task |
A
clinician
creates
a
request
for
a
laboratory
test
to
be
done
for
a
given
patient.
|
| 3 | MEDOE | medication order entry task |
A
clinician
creates
a
request
for
the
administration
of
one
or
more
medications
to
a
given
patient.
|
| 2 | PATDOC | patient documentation task |
A
person
enters
documentation
about
a
given
patient.
|
| 3 | ALLERLREV | allergy list review |
Description:
A
person
reviews
a
list
of
known
allergies
of
a
given
patient.
|
| 3 | CLINNOTEE | clinical note entry task |
A
clinician
enters
a
clinical
note
about
a
given
patient
|
| 4 | DIAGLISTE | diagnosis list entry task |
A
clinician
enters
a
diagnosis
for
a
given
patient.
|
| 4 | DISCHINSTE | discharge instruction entry |
A
person
provides
a
discharge
instruction
to
a
patient.
|
| 4 | DISCHSUME | discharge summary entry task |
A
clinician
enters
a
discharge
summary
for
a
given
patient.
|
| 4 | PATEDUE | patient education entry |
A
person
provides
a
patient-specific
education
handout
to
a
patient.
|
| 4 | PATREPE | pathology report entry task |
A
pathologist
enters
a
report
for
a
given
patient.
|
| 4 | PROBLISTE | problem list entry task |
A
clinician
enters
a
problem
for
a
given
patient.
|
| 4 | RADREPE | radiology report entry task |
A
radiologist
enters
a
report
for
a
given
patient.
|
| 3 | IMMLREV | immunization list review |
Description:
A
person
reviews
a
list
of
immunizations
due
or
received
for
a
given
patient.
|
| 3 | REMLREV | reminder list review |
Description:
A
person
reviews
a
list
of
health
care
reminders
for
a
given
patient.
|
| 4 | WELLREMLREV | wellness reminder list review |
Description:
A
person
reviews
a
list
of
wellness
or
preventive
care
reminders
for
a
given
patient.
|
| 2 | PATINFO | patient information review task |
A
person
(e.g.,
clinician,
the
patient
herself)
reviews
patient
information
in
the
electronic
medical
record.
|
| 3 | ALLERLE | allergy list entry |
Description:
A
person
enters
a
known
allergy
for
a
given
patient.
|
| 3 | CDSREV | clinical decision support intervention review |
A
person
reviews
a
recommendation/assessment
provided
automatically
by
a
clinical
decision
support
application
for
a
given
patient.
|
| 3 | CLINNOTEREV | clinical note review task |
A
person
reviews
a
clinical
note
of
a
given
patient.
|
| 4 | DISCHSUMREV | discharge summary review task |
A
person
reviews
a
discharge
summary
of
a
given
patient.
|
| 3 | DIAGLISTREV | diagnosis list review task |
A
person
reviews
a
list
of
diagnoses
of
a
given
patient.
|
| 3 | IMMLE | immunization list entry |
Description:
A
person
enters
an
immunization
due
or
received
for
a
given
patient.
|
| 3 | LABRREV | laboratory results review task |
A
person
reviews
a
list
of
laboratory
results
of
a
given
patient.
|
| 3 | MICRORREV | microbiology results review task |
A
person
reviews
a
list
of
microbiology
results
of
a
given
patient.
|
| 4 | MICROORGRREV | microbiology organisms results review task |
A
person
reviews
organisms
of
microbiology
results
of
a
given
patient.
|
| 4 | MICROSENSRREV | microbiology sensitivity test results review task |
A
person
reviews
the
sensitivity
test
of
microbiology
results
of
a
given
patient.
|
| 3 | MLREV | medication list review task |
A
person
reviews
a
list
of
medication
orders
submitted
to
a
given
patient
|
| 4 | MARWLREV | medication administration record work list review task |
A
clinician
reviews
a
work
list
of
medications
to
be
administered
to
a
given
patient.
|
| 3 | OREV | orders review task |
A
person
reviews
a
list
of
orders
submitted
to
a
given
patient.
|
| 3 | PATREPREV | pathology report review task |
A
person
reviews
a
pathology
report
of
a
given
patient.
|
| 3 | PROBLISTREV | problem list review task |
A
person
reviews
a
list
of
problems
of
a
given
patient.
|
| 3 | RADREPREV | radiology report review task |
A
person
reviews
a
radiology
report
of
a
given
patient.
|
| 3 | REMLE | reminder list entry |
Description:
A
person
enters
a
health
care
reminder
for
a
given
patient.
|
| 4 | WELLREMLE | wellness reminder list entry |
Description:
A
person
enters
a
wellness
or
preventive
care
reminder
for
a
given
patient.
|
| 3 | RISKASSESS | risk assessment instrument task |
A
person
reviews
a
Risk
Assessment
Instrument
report
of
a
given
patient.
|
| 4 | FALLRISK | falls risk assessment instrument task |
A
person
reviews
a
Falls
Risk
Assessment
Instrument
report
of
a
given
patient.
|
| 1 | (_ActTransportationModeCode) Abstract |
Characterizes
how
a
transportation
act
was
or
will
be
carried
out.
Examples: Via private transport, via public transit, via courier. |
|
| 2 | (_ActPatientTransportationModeCode) Abstract |
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. |
|
| 3 | AFOOT | pedestrian transport | |
| 3 | AMBT | ambulance transport | |
| 4 | AMBAIR | fixed-wing ambulance transport | |
| 4 | AMBGRND | ground ambulance transport | |
| 4 | AMBHELO | helicopter ambulance transport | |
| 3 | LAWENF | law enforcement transport | |
| 3 | PRVTRN | private transport | |
| 3 | PUBTRN | public transport | |
| 1 | (_ObservationType) Abstract |
Identifies
the
kinds
of
observations
that
can
be
performed
|
|
| 2 | (_ActSpecObsCode) Abstract |
Identifies
the
type
of
observation
that
is
made
about
a
specimen
that
may
affect
its
processing,
analysis
or
further
result
interpretation
|
|
| 3 | ARTBLD | ActSpecObsArtBldCode |
Describes
the
artificial
blood
identifier
that
is
associated
with
the
specimen.
|
| 3 | DILUTION | ActSpecObsDilutionCode |
An
observation
that
reports
the
dilution
of
a
sample.
|
| 4 | AUTO-HIGH | Auto-High Dilution |
The
dilution
of
a
sample
performed
by
automated
equipment.
The
value
is
specified
by
the
equipment
|
| 4 | AUTO-LOW | Auto-Low Dilution |
The
dilution
of
a
sample
performed
by
automated
equipment.
The
value
is
specified
by
the
equipment
|
| 4 | PRE | Pre-Dilution |
The
dilution
of
the
specimen
made
prior
to
being
loaded
onto
analytical
equipment
|
| 4 | RERUN | Rerun Dilution |
The
value
of
the
dilution
of
a
sample
after
it
had
been
analyzed
at
a
prior
dilution
value
|
| 3 | EVNFCTS | ActSpecObsEvntfctsCode |
Domain
provides
codes
that
qualify
the
ActLabObsEnvfctsCode
domain.
(Environmental
Factors)
|
| 3 | INTFR | ActSpecObsInterferenceCode |
An
observation
that
relates
to
factors
that
may
potentially
cause
interference
with
the
observation
|
| 4 | FIBRIN | Fibrin |
The
Fibrin
Index
of
the
specimen.
In
the
case
of
only
differentiating
between
Absent
and
Present,
recommend
using
0
and
1
|
| 4 | HEMOLYSIS | Hemolysis |
An
observation
of
the
hemolysis
index
of
the
specimen
in
g/L
|
| 4 | ICTERUS | Icterus |
An
observation
that
describes
the
icterus
index
of
the
specimen.
It
is
recommended
to
use
mMol/L
of
bilirubin
|
| 4 | LIPEMIA | 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).
|
| 3 | VOLUME | ActSpecObsVolumeCode |
An
observation
that
reports
the
volume
of
a
sample.
|
| 4 | AVAILABLE | Available Volume |
The
available
quantity
of
specimen.
This
is
the
current
quantity
minus
any
planned
consumption
(e.g.,
tests
that
are
planned)
|
| 4 | CONSUMPTION | Consumption Volume |
The
quantity
of
specimen
that
is
used
each
time
the
equipment
uses
this
substance
|
| 4 | CURRENT | Current Volume |
The
current
quantity
of
the
specimen,
i.e.,
initial
quantity
minus
what
has
been
actually
used.
|
| 4 | INITIAL | Initial Volume |
The
initial
quantity
of
the
specimen
in
inventory
|
| 2 | (_AnnotationType) Abstract | ||
| 3 | _ActPatientAnnotationType | ActPatientAnnotationType |
Description:Provides
a
categorization
for
annotations
recorded
directly
against
the
patient
.
|
| 4 | ANNDI | diagnostic image note |
Description:A
note
that
is
specific
to
a
patient's
diagnostic
images,
either
historical,
current
or
planned.
|
| 4 | ANNGEN | general note |
Description:A
general
or
uncategorized
note.
|
| 4 | ANNIMM | immunization note | A note that is specific to a patient's immunizations, either historical, current or planned. |
| 4 | ANNLAB | laboratory note |
Description:A
note
that
is
specific
to
a
patient's
laboratory
results,
either
historical,
current
or
planned.
|
| 4 | ANNMED | medication note |
Description:A
note
that
is
specific
to
a
patient's
medications,
either
historical,
current
or
planned.
|
| 2 | (_GeneticObservationType) Abstract |
Description:
None
provided
|
|
| 3 | GENE | 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
|
| 2 | _ImmunizationObservationType | ImmunizationObservationType |
Description:
Observation
codes
which
describe
characteristics
of
the
immunization
material.
|
| 3 | OBSANTC | antigen count |
Description:
Indicates
the
valid
antigen
count.
|
| 3 | OBSANTV | antigen validity |
Description:
Indicates
whether
an
antigen
is
valid
or
invalid.
|
| 2 | (_IndividualCaseSafetyReportType) Abstract |
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. |
|
| 3 | PAT_ADV_EVNT | patient adverse event | Indicates that the ICSR is describing problems that a patient experienced after receiving a vaccine product. |
| 3 | VAC_PROBLEM | 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. |
| 2 | (_LOINCObservationActContextAgeType) Abstract |
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.
|
|
| 3 | 21611-9 | age patient qn est |
Definition:Estimated
age.
|
| 3 | 21612-7 | age patient qn reported |
Definition:Reported
age.
|
| 3 | 29553-5 | age patient qn calc |
Definition:Calculated
age.
|
| 3 | 30525-0 | age patient qn definition |
Definition:General
specification
of
age
with
no
implied
method
of
determination.
|
| 3 | 30972-4 | age at onset of adverse event |
Definition:Age
at
onset
of
associated
adverse
event;
no
implied
method
of
determination.
|
| 2 | (_MedicationObservationType) Abstract | ||
| 3 | REP_HALF_LIFE | representative half-life |
Description:This
observation
represents
an
'average'
or
'expected'
half-life
typical
of
the
product.
|
| 3 | SPLCOATING | 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. |
| 3 | SPLCOLOR | 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. |
| 3 | SPLIMAGE | 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.
|
| 3 | SPLIMPRINT | 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. |
| 3 | SPLSCORING | 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). |
| 3 | SPLSHAPE | 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.
|
| 3 | SPLSIZE | 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. |
| 3 | SPLSYMBOL | 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 <u>true</u> indicating the presence and <u>false</u> for the absence of marks or symbols. Example: |
| 2 | (_ObservationIssueTriggerCodedObservationType) Abstract |
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.
|
|
| 3 | (_CaseTransmissionMode) Abstract |
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.
|
|
| 4 | AIRTRNS | 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.
|
| 4 | ANANTRNS | animal to animal transmission |
Communication
of
an
agent
from
one
animal
to
another
proximate
animal.
|
| 4 | ANHUMTRNS | animal to human transmission |
Communication
of
an
agent
from
an
animal
to
a
proximate
person.
|
| 4 | BDYFLDTRNS | body fluid contact transmission |
Communication
of
an
agent
from
one
living
subject
to
another
living
subject
through
direct
contact
with
any
body
fluid.
|
| 4 | BLDTRNS | 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.
|
| 4 | DERMTRNS | transdermal transmission |
Communication
of
an
agent
from
a
living
subject
or
environmental
source
to
a
living
subject
via
agent
migration
through
intact
skin.
|
| 4 | ENVTRNS | environmental exposure transmission |
Communication
of
an
agent
from
an
environmental
surface
or
source
to
a
living
subject
by
direct
contact.
|
| 4 | FECTRNS | 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.
|
| 4 | FOMTRNS | fomite transmission |
Communication
of
an
agent
from
an
non-living
material
to
a
living
subject
through
direct
contact.
|
| 4 | FOODTRNS | food-borne transmission |
Communication
of
an
agent
from
a
food
source
to
a
living
subject
via
oral
consumption.
|
| 4 | HUMHUMTRNS | human to human transmission |
Communication
of
an
agent
from
a
person
to
a
proximate
person.
|
| 4 | INDTRNS | indeterminate disease transmission mode |
Communication
of
an
agent
to
a
living
subject
via
an
undetermined
route.
|
| 4 | LACTTRNS | lactation transmission |
Communication
of
an
agent
from
one
living
subject
to
another
living
subject
through
direct
contact
with
mammalian
milk
or
colostrum.
|
| 4 | NOSTRNS | 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.
|
| 4 | PARTRNS | 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.
|
| 4 | PLACTRNS | 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.
|
| 4 | SEXTRNS | 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.
|
| 4 | TRNSFTRNS | 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.
|
| 4 | VECTRNS | 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.
|
| 4 | WATTRNS | 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.
|
| 2 | _ObservationQualityMeasureAttribute | ObservationQualityMeasureAttribute |
Codes
used
to
define
various
metadata
aspects
of
a
health
quality
measure.
|
| 3 | AGGREGATE | aggregate measure observation |
Indicates
that
the
observation
is
carrying
out
an
aggregation
calculation,
contained
in
the
value
element.
|
| 3 | CMPMSRMTH | composite measure method |
Indicates
what
method
is
used
in
a
quality
measure
to
combine
the
component
measure
results
included
in
an
composite
measure.
|
| 3 | CMPMSRSCRWGHT | component measure scoring weight |
An
attribute
of
a
quality
measure
describing
the
weight
this
component
measure
score
is
to
carry
in
determining
the
overall
composite
measure
final
score.
The
value
is
real
value
greater
than
0
and
less
than
1.0.
Each
component
measure
score
will
be
multiplied
by
its
CMPMSRSCRWGHT
and
then
summed
with
the
other
component
measures
to
determine
the
final
overall
composite
measure
score.
The
sum
across
all
CMPMSRSCRWGHT
values
within
a
single
composite
measure
SHALL
be
1.0.
The
value
assigned
is
scoped
to
the
composite
measure
referencing
this
component
measure
only.
|
| 3 | COPY | copyright |
Identifies
the
organization(s)
who
own
the
intellectual
property
represented
by
the
eMeasure.
|
| 3 | CRS | clinical recommendation statement |
Summary
of
relevant
clinical
guidelines
or
other
clinical
recommendations
supporting
this
eMeasure.
|
| 3 | DEF | definition |
Description
of
individual
terms,
provided
as
needed.
|
| 3 | DISC | disclaimer |
Disclaimer
information
for
the
eMeasure.
|
| 3 | FINALDT | finalized date/time |
The
timestamp
when
the
eMeasure
was
last
packaged
in
the
Measure
Authoring
Tool.
|
| 3 | GUIDE | 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.
|
| 3 | IDUR | 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).
|
| 3 | ITMCNT | items counted |
Describes
the
items
counted
by
the
measure
(e.g.,
patients,
encounters,
procedures,
etc.)
|
| 3 | KEY | keyword |
A
significant
word
that
aids
in
discoverability.
|
| 3 | MEDT | measurement end date |
The
end
date
of
the
measurement
period.
|
| 3 | MSD | measurement start date |
The
start
date
of
the
measurement
period.
|
| 3 | MSRADJ | 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.
|
| 3 | MSRAGG | 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).
Open Issue: The description does NOT align well with the definition used in the HQMF specfication; correct the MSGAGG definition, and the possible distinction of MSRAGG as a child of AGGREGATE. |
| 3 | MSRIMPROV | 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.
|
| 3 | MSRJUR | jurisdiction |
The
list
of
jurisdiction(s)
for
which
the
measure
applies.
|
| 3 | MSRRPTR | reporter type |
Type
of
person
or
organization
that
is
expected
to
report
the
issue.
|
| 3 | MSRRPTTIME | timeframe for reporting |
The
maximum
time
that
may
elapse
following
completion
of
the
measure
until
the
measure
report
must
be
sent
to
the
receiver.
|
| 3 | MSRSCORE | measure scoring |
Indicates
how
the
calculation
is
performed
for
the
eMeasure
(e.g.,
proportion,
continuous
variable,
ratio)
|
| 3 | MSRSET | 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). |
| 3 | MSRTOPIC | health quality measure topic type |
|
| 3 | MSRTP | measurement period |
The
time
period
for
which
the
eMeasure
applies.
|
| 3 | MSRTYPE | measure type |
Indicates
whether
the
eMeasure
is
used
to
examine
a
process
or
an
outcome
over
time
(e.g.,
Structure,
Process,
Outcome).
|
| 3 | RAT | rationale |
Succinct
statement
of
the
need
for
the
measure.
Usually
includes
statements
pertaining
to
Importance
criterion:
impact,
gap
in
care
and
evidence.
|
| 3 | REF | 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.
|
| 3 | SDE | 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.
|
| 3 | STRAT | 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]).
|
| 3 | TRANF | transmission format |
Can
be
a
URL
or
hyperlinks
that
link
to
the
transmission
formats
that
are
specified
for
a
particular
reporting
program.
|
| 3 | USE | notice of use |
Usage
notes.
|
| 2 | (_ObservationSequenceType) Abstract | ||
| 3 | TIME_ABSOLUTE | absolute time sequence |
A
sequence
of
values
in
the
|
| 3 | TIME_RELATIVE | relative time sequence |
A
sequence
of
values
in
a
|
| 2 | (_ObservationSeriesType) Abstract | ||
| 3 | (_ECGObservationSeriesType) Abstract | ||
| 4 | REPRESENTATIVE_BEAT | ECG representative beat waveforms |
This
Observation
Series
type
contains
waveforms
of
a
|
| 4 | RHYTHM | ECG rhythm waveforms |
This
Observation
type
contains
ECG
|
| 2 | _PatientImmunizationRelatedObservationType | PatientImmunizationRelatedObservationType |
Description:
Reporting
codes
that
are
related
to
an
immunization
event.
|
| 3 | CLSSRM | classroom |
Description:
The
class
room
associated
with
the
patient
during
the
immunization
event.
|
| 3 | GRADE | grade |
Description:
The
school
grade
or
level
the
patient
was
in
when
immunized.
|
| 3 | SCHL | school |
Description:
The
school
the
patient
attended
when
immunized.
|
| 3 | SCHLDIV | school division |
Description:
The
school
division
or
district
associated
with
the
patient
during
the
immunization
event.
|
| 3 | TEACHER | teacher |
Description:
The
patient's
teacher
when
immunized.
|
| 2 | (_PopulationInclusionObservationType) Abstract |
Observation
types
for
specifying
criteria
used
to
assert
that
a
subject
is
included
in
a
particular
population.
|
|
| 3 | DENEX | denominator exclusions |
Criteria
which
specify
subjects
who
should
be
removed
from
the
eMeasure
population
and
denominator
before
determining
if
numerator
criteria
are
met.
Denominator
exclusions
are
used
in
proportion
and
ratio
measures
to
help
narrow
the
denominator.
|
| 3 | DENEXCEP | denominator exceptions |
Criteria
which
specify
the
removal
of
a
subject,
procedure
or
unit
of
measurement
from
the
denominator,
only
if
the
numerator
criteria
are
not
met.
Denominator
exceptions
allow
for
adjustment
of
the
calculated
score
for
those
providers
with
higher
risk
populations.
Denominator
exceptions
are
used
only
in
proportion
eMeasures.
They
are
not
appropriate
for
ratio
or
continuous
variable
eMeasures.
Denominator
exceptions
allow
for
the
exercise
of
clinical
judgment
and
should
be
specifically
defined
where
capturing
the
information
in
a
structured
manner
fits
the
clinical
workflow.
Generic
denominator
exception
reasons
used
in
proportion
eMeasures
fall
into
three
general
categories:
Medical reasons Patient (or subject) reasons System reasons |
| 3 | DENOM | denominator |
Criteria
for
specifying
the
entities
to
be
evaluated
by
a
specific
quality
measure,
based
on
a
shared
common
set
of
characteristics
(within
a
specific
measurement
set
to
which
a
given
measure
belongs).
The
denominator
can
be
the
same
as
the
initial
population,
or
it
may
be
a
subset
of
the
initial
population
to
further
constrain
it
for
the
purpose
of
the
eMeasure.
Different
measures
within
an
eMeasure
set
may
have
different
denominators.
Continuous
Variable
eMeasures
do
not
have
a
denominator,
but
instead
define
a
measure
population.
|
| 3 | IPOP | initial population |
Criteria
for
specifying
the
entities
to
be
evaluated
by
a
specific
quality
measure,
based
on
a
shared
common
set
of
characteristics
(within
a
specific
measurement
set
to
which
a
given
measure
belongs).
|
| 4 | IPPOP | initial patient population |
Criteria
for
specifying
the
patients
to
be
evaluated
by
a
specific
quality
measure,
based
on
a
shared
common
set
of
characteristics
(within
a
specific
measurement
set
to
which
a
given
measure
belongs).
Details
often
include
information
based
upon
specific
age
groups,
diagnoses,
diagnostic
and
procedure
codes,
and
enrollment
periods.
|
| 3 | MSROBS | measure observation |
Defines
the
observation
to
be
performed
for
each
patient
or
event
in
the
measure
population.
Measure
observations
for
each
case
in
the
population
are
aggregated
to
determine
the
overall
measure
score
for
the
population.
Examples: the median time from arrival in the Emergency Room to departure the median time from decision to admit to a hospital to the actual admission for Emergency Room patients |
| 3 | MSRPOPL | measure population |
Criteria
for
specifying
the
measure
population
as
a
narrative
description
(e.g.,
all
patients
seen
in
the
Emergency
Department
during
the
measurement
period).
This
is
used
only
in
continuous
variable
eMeasures.
|
| 3 | MSRPOPLEX | measure population exclusions |
Criteria
for
specifying
subjects
who
should
be
removed
from
the
eMeasure's
Initial
Population
and
Measure
Population.
Measure
Population
Exclusions
are
used
in
Continuous
Variable
measures
to
help
narrow
the
Measure
Population
before
determining
the
value(s)
of
the
continuous
variable(s).
|
| 3 | NUMER | numerator |
Criteria
for
specifying
the
processes
or
outcomes
expected
for
each
patient,
procedure,
or
other
unit
of
measurement
defined
in
the
denominator
for
proportion
measures,
or
related
to
(but
not
directly
derived
from)
the
denominator
for
ratio
measures
(e.g.,
a
numerator
listing
the
number
of
central
line
blood
stream
infections
and
a
denominator
indicating
the
days
per
thousand
of
central
line
usage
in
a
specific
time
period).
|
| 3 | NUMEX | numerator exclusions |
Criteria
for
specifying
instances
that
should
not
be
included
in
the
numerator
data.
(e.g.,
if
the
number
of
central
line
blood
stream
infections
per
1000
catheter
days
were
to
exclude
infections
with
a
specific
bacterium,
that
bacterium
would
be
listed
as
a
numerator
exclusion).
Numerator
Exclusions
are
used
only
in
ratio
eMeasures.
|
| 2 | (_PreferenceObservationType) Abstract |
Types
of
observations
that
can
be
made
about
Preferences.
|
|
| 3 | PREFSTRENGTH | preference strength |
An
observation
about
how
important
a
preference
is
to
the
target
of
the
preference.
|
| 2 | ADVERSE_REACTION | 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.
|
| 2 | ASSERTION | 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,
|
| 2 | CASESER | 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.
|
| 2 | CDIO | case disease imported observation |
An
observation
that
states
whether
the
disease
was
likely
acquired
outside
the
jurisdiction
of
observation,
and
if
so,
the
nature
of
the
inter-jurisdictional
relationship.
OpenIssue: This code could be moved to LOINC if it can be done before there are significant implemenations using it. |
| 2 | CRIT | criticality |
A
clinical
judgment
as
to
the
worst
case
result
of
a
future
exposure
(including
substance
administration).
When
the
worst
case
result
is
assessed
to
have
a
life-threatening
or
organ
system
threatening
potential,
it
is
considered
to
be
of
high
criticality.
|
| 2 | CTMO | case transmission mode observation |
An
observation
that
states
the
mechanism
by
which
disease
was
acquired
by
the
living
subject
involved
in
the
public
health
case.
OpenIssue: This code could be moved to LOINC if it can be done before there are significant implemenations using it. |
| 2 | DX | ObservationDiagnosisTypes |
Includes
all
codes
defining
types
of
indications
such
as
diagnosis,
symptom
and
other
indications
such
as
contrast
agents
for
lab
tests.
|
| 3 | ADMDX | admitting diagnosis |
Admitting
diagnosis
are
the
diagnoses
documented
for
administrative
purposes
as
the
basis
for
a
hospital
admission.
|
| 3 | DISDX | discharge diagnosis |
Discharge
diagnosis
are
the
diagnoses
documented
for
administrative
purposes
as
the
time
of
hospital
discharge.
|
| 3 | INTDX | intermediate diagnosis |
Intermediate
diagnoses
are
those
diagnoses
documented
for
administrative
purposes
during
the
course
of
a
hospital
stay.
|
| 3 | NOI | nature of injury |
The
type
of
injury
that
the
injury
coding
specifies.
|
| 2 | GISTIER | GIS tier |
Description:
Accuracy
determined
as
per
the
GIS
tier
code
system.
|
| 2 | HHOBS | household situation observation |
Indicates
that
the
observation
is
of
a
person’s
living
situation
in
a
household
including
the
household
composition
and
circumstances.
|
| 2 | ISSUE | detected issue |
There
is
a
clinical
issue
for
the
therapy
that
makes
continuation
of
the
therapy
inappropriate.
Open Issue: The definition of this code does not correctly represent the concept space of its specializations (children) |
| 3 | (_ActAdministrativeDetectedIssueCode) Abstract |
Identifies
types
of
detectyed
issues
for
Act
class
|
|
| 4 | (_ActAdministrativeAuthorizationDetectedIssueCode) Abstract | ||
| 5 | NAT | Insufficient authorization |
The
requesting
party
has
insufficient
authorization
to
invoke
the
interaction.
|
| 5 | SUPPRESSED | record suppressed |
Description:
One
or
more
records
in
the
query
response
have
been
suppressed
due
to
consent
or
privacy
restrictions.
|
| 5 | VALIDAT | validation issue |
Description:The
specified
element
did
not
pass
business-rule
validation.
|
| 6 | KEY204 | 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.
|
| 6 | KEY205 | Duplicate key identifier |
The
ID
of
the
patient,
order,
etc.,
already
exists.
Used
in
response
to
addition
transactions
(Admit,
New
Order,
etc.).
|
| 6 | COMPLY | Compliance Alert |
There
may
be
an
issue
with
the
patient
complying
with
the
intentions
of
the
proposed
therapy
|
| 7 | DUPTHPY | Duplicate Therapy Alert |
The
proposed
therapy
appears
to
duplicate
an
existing
therapy
|
| 8 | DUPTHPCLS | 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.
|
| 8 | DUPTHPGEN | 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.
|
| 7 | ABUSE | commonly abused/misused alert |
Description:The
proposed
therapy
is
frequently
misused
or
abused
and
therefore
should
be
used
with
caution
and/or
monitoring.
|
| 7 | FRAUD | potential fraud |
Description:The
request
is
suspected
to
have
a
fraudulent
basis.
|
| 7 | PLYDOC | Poly-orderer Alert |
A
similar
or
identical
therapy
was
recently
ordered
by
a
different
practitioner.
|
| 7 | PLYPHRM | Poly-supplier Alert |
This
patient
was
recently
supplied
a
similar
or
identical
therapy
from
a
different
pharmacy
or
supplier.
|
| 6 | DOSE | Dosage problem |
Proposed
dosage
instructions
for
therapy
differ
from
standard
practice.
|
| 7 | DOSECOND | dosage-condition alert |
Description:Proposed
dosage
is
inappropriate
due
to
patient's
medical
condition.
|
| 7 | DOSEDUR | Dose-Duration Alert |
Proposed
length
of
therapy
differs
from
standard
practice.
|
| 8 | DOSEDURH | Dose-Duration High Alert |
Proposed
length
of
therapy
is
longer
than
standard
practice
|
| 9 | DOSEDURHIND | Dose-Duration High for Indication Alert |
Proposed
length
of
therapy
is
longer
than
standard
practice
for
the
identified
indication
or
diagnosis
|
| 8 | DOSEDURL | Dose-Duration Low Alert |
Proposed
length
of
therapy
is
shorter
than
that
necessary
for
therapeutic
effect
|
| 9 | DOSEDURLIND | Dose-Duration Low for Indication Alert |
Proposed
length
of
therapy
is
shorter
than
standard
practice
for
the
identified
indication
or
diagnosis
|
| 7 | DOSEH | High Dose Alert |
Proposed
dosage
exceeds
standard
practice
|
| 8 | DOSEHINDA | High Dose for Age Alert |
Proposed
dosage
exceeds
standard
practice
for
the
patient's
age
|
| 8 | DOSEHIND | High Dose for Indication Alert | |
| 8 | DOSEHINDSA | High Dose for Height/Surface Area Alert |
Proposed
dosage
exceeds
standard
practice
for
the
patient's
height
or
body
surface
area
|
| 8 | DOSEHINDW | High Dose for Weight Alert |
Proposed
dosage
exceeds
standard
practice
for
the
patient's
weight
|
| 7 | DOSEIVL | Dose-Interval Alert |
Proposed
dosage
interval/timing
differs
from
standard
practice
|
| 8 | DOSEIVLIND | Dose-Interval for Indication Alert |
Proposed
dosage
interval/timing
differs
from
standard
practice
for
the
identified
indication
or
diagnosis
|
| 7 | DOSEL | Low Dose Alert |
Proposed
dosage
is
below
suggested
therapeutic
levels
|
| 8 | DOSELINDA | Low Dose for Age Alert |
Proposed
dosage
is
below
suggested
therapeutic
levels
for
the
patient's
age
|
| 8 | DOSELIND | Low Dose for Indication Alert | |
| 8 | DOSELINDSA | Low Dose for Height/Surface Area Alert |
Proposed
dosage
is
below
suggested
therapeutic
levels
for
the
patient's
height
or
body
surface
area
|
| 8 | DOSELINDW | Low Dose for Weight Alert |
Proposed
dosage
is
below
suggested
therapeutic
levels
for
the
patient's
weight
|
| 7 | MDOSE | 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.
|
| 6 | OBSA | Observation Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
due
to
conditions
or
characteristics
of
the
patient
|
| 7 | AGE | Age Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
due
to
patient
age
|
| 8 | ADALRT | adult alert |
Proposed
therapy
is
outside
of
the
standard
practice
for
an
adult
patient.
|
| 8 | DOSEHINDA | ||
| 8 | DOSELINDA | ||
| 8 | GEALRT | geriatric alert |
Proposed
therapy
is
outside
of
standard
practice
for
a
geriatric
patient.
|
| 8 | PEALRT | pediatric alert |
Proposed
therapy
is
outside
of
the
standard
practice
for
a
pediatric
patient.
|
| 7 | COND | Condition Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
due
to
an
existing/recent
patient
condition
or
diagnosis
|
| 8 | HGHT | ||
| 8 | LACT | Lactation Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
when
breast-feeding
|
| 8 | PREG | Pregnancy Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
during
pregnancy
|
| 8 | WGHT | ||
| 7 | CREACT | 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. |
| 7 | GEN | Genetic Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
due
to
patient
genetic
indicators.
|
| 7 | GEND | Gender Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
due
to
patient
gender.
|
| 7 | LAB | Lab Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
due
to
recent
lab
test
results
|
| 7 | REACT | Reaction Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
based
on
the
potential
for
a
patient
reaction
to
the
proposed
product
|
| 8 | ALGY | Allergy Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
because
of
a
recorded
patient
allergy
to
the
proposed
product.
(Allergies
are
immune
based
reactions.)
|
| 8 | INT | 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.)
|
| 7 | RREACT | Related Reaction Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
because
of
a
potential
patient
reaction
to
a
cross-sensitivity
related
product.
|
| 8 | RALG | 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.)
|
| 8 | RAR | Related Prior Reaction Alert |
Proposed
therapy
may
be
inappropriate
or
contraindicated
because
of
a
recorded
prior
adverse
reaction
to
a
cross-sensitivity
related
product.
|
| 8 | RINT | 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.)
|
| 6 | BUS | business constraint violation |
Description:A
local
business
rule
relating
multiple
elements
has
been
violated.
|
| 6 | CODE_INVAL | code is not valid |
Description:The
specified
code
is
not
valid
against
the
list
of
codes
allowed
for
the
element.
|
| 7 | CODE_DEPREC | code has been deprecated |
Description:The
specified
code
has
been
deprecated
and
should
no
longer
be
used.
Select
another
code
from
the
code
system.
|
| 6 | FORMAT | invalid format |
Description:The
element
does
not
follow
the
formatting
or
type
rules
defined
for
the
field.
|
| 6 | ILLEGAL | illegal |
Description:The
request
is
missing
elements
or
contains
elements
which
cause
it
to
not
meet
the
legal
standards
for
actioning.
|
| 6 | LEN_RANGE | length out of range |
Description:The
length
of
the
data
specified
falls
out
of
the
range
defined
for
the
element.
|
| 7 | LEN_LONG | length is too long |
Description:The
length
of
the
data
specified
is
greater
than
the
maximum
length
defined
for
the
element.
|
| 7 | LEN_SHORT | length is too short |
Description:The
length
of
the
data
specified
is
less
than
the
minimum
length
defined
for
the
element.
|
| 6 | MISSCOND | 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.
|
| 6 | MISSMAND | mandatory element missing |
Description:The
specified
element
is
mandatory
and
was
not
included
in
the
instance.
|
| 6 | NODUPS | 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.
|
| 6 | NOPERSIST | element will not be persisted |
Description:
Element
in
submitted
message
will
not
persist
in
data
storage
based
on
detected
issue.
|
| 6 | REP_RANGE | repetitions out of range |
Description:The
number
of
repeating
elements
falls
outside
the
range
of
the
allowed
number
of
repetitions.
|
| 7 | MAXOCCURS | repetitions above maximum |
Description:The
number
of
repeating
elements
is
above
the
maximum
number
of
repetitions
allowed.
|
| 7 | MINOCCURS | repetitions below minimum |
Description:The
number
of
repeating
elements
is
below
the
minimum
number
of
repetitions
allowed.
|
| 4 | (_ActAdministrativeRuleDetectedIssueCode) Abstract | ||
| 5 | KEY204 | ||
| 5 | KEY205 | ||
| 5 | KEY206 | non-matching identification |
Description:
Metadata
associated
with
the
identification
(e.g.
name
or
gender)
does
not
match
the
identification
being
verified.
|
| 5 | OBSOLETE | obsolete record returned |
Description:
One
or
more
records
in
the
query
response
have
a
status
of
'obsolete'.
|
| 3 | (_ActSuppliedItemDetectedIssueCode) Abstract |
Identifies
types
of
detected
issues
regarding
the
administration
or
supply
of
an
item
to
a
patient.
|
|
| 4 | (_AdministrationDetectedIssueCode) Abstract |
Administration
of
the
proposed
therapy
may
be
inappropriate
or
contraindicated
as
proposed
|
|
| 5 | (_AppropriatenessDetectedIssueCode) Abstract | ||
| 6 | (_InteractionDetectedIssueCode) Abstract | ||
| 7 | FOOD | Food Interaction Alert |
Proposed
therapy
may
interact
with
certain
foods
|
| 7 | TPROD | Therapeutic Product Alert |
Proposed
therapy
may
interact
with
an
existing
or
recent
therapeutic
product
|
| 8 | DRG | Drug Interaction Alert |
Proposed
therapy
may
interact
with
an
existing
or
recent
drug
therapy
|
| 8 | NHP | Natural Health Product Alert |
Proposed
therapy
may
interact
with
existing
or
recent
natural
health
product
therapy
|
| 8 | NONRX | Non-Prescription Interaction Alert |
Proposed
therapy
may
interact
with
a
non-prescription
drug
(e.g.
alcohol,
tobacco,
Aspirin)
|
| 6 | OBSA | ||
| 6 | PREVINEF | previously ineffective |
Definition:The
same
or
similar
treatment
has
previously
been
attempted
with
the
patient
without
achieving
a
positive
effect.
|
| 5 | COMPLY | ||
| 5 | DACT | drug action detected issue |
Description:Proposed
therapy
may
be
contraindicated
or
ineffective
based
on
an
existing
or
recent
drug
therapy.
|
| 5 | DOSE | ||
| 5 | DUPTHPY | ||
| 5 | TIME | timing detected issue |
Description:Proposed
therapy
may
be
inappropriate
or
ineffective
based
on
the
proposed
start
or
end
time.
|
| 6 | ALRTENDLATE | end too late alert |
Definition:Proposed
therapy
may
be
inappropriate
or
ineffective
because
the
end
of
administration
is
too
close
to
another
planned
therapy.
|
| 6 | ALRTSTRTLATE | 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.
|
| 5 | (_TimingDetectedIssueCode) Abstract |
Proposed
therapy
may
be
inappropriate
or
ineffective
based
on
the
proposed
start
or
end
time.
|
|
| 6 | ENDLATE | End Too Late Alert |
Proposed
therapy
may
be
inappropriate
or
ineffective
because
the
end
of
administration
is
too
close
to
another
planned
therapy
|
| 6 | STRTLATE | Start Too Late Alert |
Proposed
therapy
may
be
inappropriate
or
ineffective
because
the
start
of
administration
is
too
late
after
the
onset
of
the
condition
|
| 4 | (_SupplyDetectedIssueCode) Abstract |
Supplying
the
product
at
this
time
may
be
inappropriate
or
indicate
compliance
issues
with
the
associated
therapy
|
|
| 5 | ALLDONE | already performed |
Definition:The
requested
action
has
already
been
performed
and
so
this
request
has
no
effect
|
| 5 | FULFIL | fulfillment alert |
Definition:The
therapy
being
performed
is
in
some
way
out
of
alignment
with
the
requested
therapy.
|
| 6 | NOTACTN | 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.)
|
| 6 | NOTEQUIV | not equivalent alert |
Definition:The
therapy
being
performed
is
not
sufficiently
equivalent
to
the
therapy
which
was
requested.
|
| 7 | NOTEQUIVGEN | not generically equivalent alert |
Definition:The
therapy
being
performed
is
not
generically
equivalent
(having
the
identical
biological
action)
to
the
therapy
which
was
requested.
|
| 7 | NOTEQUIVTHER | 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.
|
| 6 | TIMING | event timing incorrect alert |
Definition:The
therapy
is
being
performed
at
a
time
which
diverges
from
the
time
the
therapy
was
requested
|
| 7 | INTERVAL | outside requested time |
Definition:The
therapy
action
is
being
performed
outside
the
bounds
of
the
time
period
requested
|
| 7 | MINFREQ | 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
|
| 5 | HELD | held/suspended alert |
Definition:There
should
be
no
actions
taken
in
fulfillment
of
a
request
that
has
been
held
or
suspended.
|
| 5 | TOOLATE | 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
|
| 5 | TOOSOON | 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
|
| 4 | HISTORIC | 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.
|
| 4 | PATPREF | violates stated preferences |
Definition:The
proposed
therapy
goes
against
preferences
or
consent
constraints
recorded
in
the
patient's
record.
|
| 5 | PATPREFALT | 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.
|
| 2 | KSUBJ | knowledge subject | Categorization of types of observation that capture the main clinical knowledge subject which may be a medication, a laboratory test, a disease. |
| 2 | KSUBT | knowledge subtopic | Categorization of types of observation that capture a knowledge subtopic which might be treatment, etiology, or prognosis. |
| 2 | OINT | intolerance |
Hypersensitivity
resulting
in
an
adverse
reaction
upon
exposure
to
an
agent.
|
| 3 | ALG | Allergy |
Hypersensitivity
to
an
agent
caused
by
an
immunologic
response
to
an
initial
exposure
|
| 4 | DALG | Drug Allergy |
An
allergy
to
a
pharmaceutical
product.
|
| 4 | EALG | Environmental Allergy |
An
allergy
to
a
substance
other
than
a
drug
or
a
food.
E.g.
Latex,
pollen,
etc.
|
| 4 | FALG | Food Allergy |
An
allergy
to
a
substance
generally
consumed
for
nutritional
purposes.
|
| 3 | DINT | Drug Intolerance |
Hypersensitivity
resulting
in
an
adverse
reaction
upon
exposure
to
a
drug.
|
| 4 | DALG | ||
| 4 | DNAINT | Drug Non-Allergy Intolerance |
Hypersensitivity
to
an
agent
caused
by
a
mechanism
other
than
an
immunologic
response
to
an
initial
exposure
|
| 3 | EINT | Environmental Intolerance |
Hypersensitivity
resulting
in
an
adverse
reaction
upon
exposure
to
environmental
conditions.
|
| 4 | EALG | ||
| 4 | ENAINT | Environmental Non-Allergy Intolerance |
Hypersensitivity
to
an
agent
caused
by
a
mechanism
other
than
an
immunologic
response
to
an
initial
exposure
|
| 3 | FINT | Food Intolerance |
Hypersensitivity
resulting
in
an
adverse
reaction
upon
exposure
to
food.
|
| 4 | FALG | ||
| 4 | FNAINT | Food Non-Allergy Intolerance |
Hypersensitivity
to
an
agent
caused
by
a
mechanism
other
than
an
immunologic
response
to
an
initial
exposure
|
| 3 | NAINT | Non-Allergy Intolerance |
Hypersensitivity
to
an
agent
caused
by
a
mechanism
other
than
an
immunologic
response
to
an
initial
exposure
|
| 4 | DNAINT | ||
| 4 | ENAINT | ||
| 4 | FNAINT | ||
| 2 | SEV | Severity Observation |
A
subjective
evaluation
of
the
seriousness
or
intensity
associated
with
another
observation.
|
| 2 | (_FDALabelData) Abstract |
FDA
label
data
|
|
| 3 | FDACOATING | coating |
FDA
label
coating
|
| 3 | FDACOLOR | color |
FDA
label
color
|
| 3 | FDAIMPRINTCD | imprint code |
FDA
label
imprint
code
|
| 3 | FDALOGO | logo |
FDA
label
logo
|
| 3 | FDASCORING | scoring |
FDA
label
scoring
|
| 3 | FDASHAPE | shape |
FDA
label
shape
|
| 3 | FDASIZE | size |
FDA
label
size
|
| 1 | (_ROIOverlayShape) Abstract |
Shape
of
the
region
on
the
object
being
referenced
|
|
| 2 | CIRCLE | 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.
|
| 2 | ELLIPSE | 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.
|
| 2 | POINT | point |
A
single
point
denoted
by
a
single
(column,row)
pair,
or
multiple
points
each
denoted
by
a
(column,row)
pair.
|
| 2 | POLY | 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.
|
| 1 | C | corrected |
Description:Indicates
that
result
data
has
been
corrected.
|
| 1 | DIET | Diet |
Code
set
to
define
specialized/allowed
diets
|
| 2 | BR | breikost (GE) |
A
diet
exclusively
composed
of
oatmeal,
semolina,
or
rice,
to
be
extremely
easy
to
eat
and
digest.
|
| 2 | DM | diabetes mellitus diet |
A
diet
that
uses
carbohydrates
sparingly.
Typically
with
a
restriction
in
daily
energy
content
(e.g.
1600-2000
kcal).
|
| 2 | FAST | fasting |
No
enteral
intake
of
foot
or
liquids
whatsoever,
no
smoking.
Typically
6
to
8
hours
before
anesthesia.
|
| 2 | FORMULA | formula diet |
A
diet
consisting
of
a
formula
feeding,
either
for
an
infant
or
an
adult,
to
provide
nutrition
either
orally
or
through
the
gastrointestinal
tract
via
tube,
catheter
or
stoma.
|
| 2 | GF | gluten free |
Gluten
free
diet
for
celiac
disease.
|
| 2 | LF | low fat |
A
diet
low
in
fat,
particularly
to
patients
with
hepatic
diseases.
|
| 2 | LP | low protein |
A
low
protein
diet
for
patients
with
renal
failure.
|
| 2 | LQ | liquid |
A
strictly
liquid
diet,
that
can
be
fully
absorbed
in
the
intestine,
and
therefore
may
not
contain
fiber.
Used
before
enteral
surgeries.
|
| 2 | LS | low sodium |
A
diet
low
in
sodium
for
patients
with
congestive
heart
failure
and/or
renal
failure.
|
| 2 | N | 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.
|
| 2 | NF | no fat |
A
no
fat
diet
for
acute
hepatic
diseases.
|
| 2 | PAF | phenylalanine free |
Phenylketonuria
diet.
|
| 2 | PAR | parenteral |
Patient
is
supplied
with
parenteral
nutrition,
typically
described
in
terms
of
i.v.
medications.
|
| 2 | RD | reduction diet |
A
diet
that
seeks
to
reduce
body
fat,
typically
low
energy
content
(800-1600
kcal).
|
| 2 | SCH | schonkost (GE) |
A
diet
that
avoids
ingredients
that
might
cause
digestion
problems,
e.g.,
avoid
excessive
fat,
avoid
too
much
fiber
(cabbage,
peas,
beans).
|
| 2 | SUPPLEMENT | nutritional supplement |
A
diet
that
is
not
intended
to
be
complete
but
is
added
to
other
diets.
|
| 2 | T | tea only |
This
is
not
really
a
diet,
since
it
contains
little
nutritional
value,
but
is
essentially
just
water.
Used
before
coloscopy
examinations.
|
| 2 | VLI | low valin, leucin, isoleucin |
Diet
with
low
content
of
the
amino-acids
valin,
leucin,
and
isoleucin,
for
|
| 1 | DRUGPRG | 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.
|
| 1 | F | 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.
|
| 1 | PRLMN | 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.
|
| 1 | (SECOBS) Abstract |
An
observation
identifying
security
metadata
about
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Security
metadata
are
used
to
name
security
labels.
Rationale: According to ISO/TS 22600-3:2009(E) A.9.1.7 SECURITY LABEL MATCHING, Security label matching compares the initiator's clearance to the target's security label. All of the following must be true for authorization to be granted: The security policy identifiers shall be identical The classification level of the initiator shall be greater than or equal to that of the target (that is, there shall be at least one value in the classification list of the clearance greater than or equal to the classification of the target), and For each security category in the target label, there shall be a security category of the same type in the initiator's clearance and the initiator's classification level shall dominate that of the target. Examples: SecurityObservationType security label fields include: Confidentiality classification Compartment category Sensitivity category Security mechanisms used to ensure data integrity or to perform authorized data transformation Indicators of an IT resource completeness, veracity, reliability, trustworthiness, or provenance. Usage Note: SecurityObservationType codes designate security label field types, which are valued with an applicable SecurityObservationValue code as the |
|
| 2 | SECCATOBS | security category observation |
Type
of
security
metadata
observation
made
about
the
category
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Security
category
metadata
is
defined
by
ISO/IEC
2382-8:1998(E/F)/
T-REC-X.812-1995
as:
Rationale: A security category observation supports requirement to specify the type of IT resource to facilitate application of appropriate levels of information security according to a range of levels of impact or consequences that might result from the unauthorized disclosure, modification, or use of the information or information system. A resource is assigned to a specific category of information (e.g., privacy, medical, proprietary, financial, investigative, contractor sensitive, security management) defined by an organization or in some instances, by a specific law, Executive Order, directive, policy, or regulation. [FIPS 199] Examples: Types of security categories include: Compartment: A division of data into isolated blocks with separate security controls for the purpose of reducing risk. (ISO 2382-8). A security label tag that |
| 2 | SECCLASSOBS | security classification observation |
Type
of
security
metadata
observation
made
about
the
classification
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Security
classification
is
defined
by
ISO/IEC
2382-8:1998(E/F)/
T-REC-X.812-1995
as:
Rationale: A security classification observation may indicate that the confidentiality level indicated by an Act or Role confidentiality attribute has been overridden by the entity responsible for ascribing the SecurityClassificationObservationValue. This supports the business requirement for increasing or decreasing the level of confidentiality (classification or declassification) based on parameters beyond the original assignment of an Act or Role confidentiality. Examples: Types of security classification include: HL7 Confidentiality Codes such as very restricted, unrestricted, and normal. Intelligence community examples include top secret, secret, and confidential. Usage Note: Security classification observation type codes designate security label field types, which are valued with an applicable SecurityClassificationObservationValue code as the |
| 2 | SECCONOBS | security control observation |
Type
of
security
metadata
observation
made
about
the
control
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Security
control
metadata
convey
instructions
to
users
and
receivers
for
secure
distribution,
transmission,
and
storage;
dictate
obligations
or
mandated
actions;
specify
any
action
prohibited
by
refrain
policy
such
as
dissemination
controls;
and
stipulate
the
permissible
purpose
of
use
of
an
IT
resource.
Rationale: A security control observation supports requirement to specify applicable management, operational, and technical controls (i.e., safeguards or countermeasures) prescribed for an information system to protect the confidentiality, integrity, and availability of the system and its information. [FIPS 199] Examples: Types of security control metadata include: handling caveats dissemination controls obligations refrain policies purpose of use constraints |
| 2 | SECINTOBS | security integrity observation |
Type
of
security
metadata
observation
made
about
the
integrity
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Rationale: A security integrity observation supports the requirement to guard against improper information modification or destruction, and includes ensuring information non-repudiation and authenticity. (44 U.S.C., SEC. 3542) Examples: Types of security integrity metadata include: Integrity status, which indicates the completeness or workflow status of an IT resource (data, information object, service, or system capability) Integrity confidence, which indicates the reliability and trustworthiness of an IT resource Integrity control, which indicates pertinent handling caveats, obligations, refrain policies, and purpose of use for the resource Data integrity, which indicate the security mechanisms used to ensure that the accuracy and consistency are preserved regardless of changes made (ISO/IEC DIS 2382-8) Alteration integrity, which indicate the security mechanisms used for authorized transformations of the resource Integrity provenance, which indicates the entity responsible for a report or assertion relayed |
| 3 | SECALTINTOBS | security alteration integrity observation |
Type
of
security
metadata
observation
made
about
the
alteration
integrity
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
indicates
the
mechanism
used
for
authorized
transformations
of
the
resource.
Examples: Types of security alteration integrity observation metadata, which may value the observation with a code used to indicate the mechanism used for authorized transformation of an IT resource, including: translation syntactic transformation semantic mapping redaction masking pseudonymization anonymization |
| 3 | SECDATINTOBS | security data integrity observation |
Type
of
security
metadata
observation
made
about
the
data
integrity
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
indicates
the
security
mechanism
used
to
preserve
resource
accuracy
and
consistency.
Data
integrity
is
defined
by
ISO
22600-23.3.21
as:
Examples: Types of security data integrity observation metadata, which may value the observation, include cryptographic hash function and digital signature. |
| 3 | SECINTCONOBS | security integrity confidence observation |
Type
of
security
metadata
observation
made
about
the
integrity
confidence
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Examples: Types of security integrity confidence observation metadata, which may value the observation, include highly reliable, uncertain reliability, and not reliable. Usage Note: A security integrity confidence observation on an Act may indicate that a valued Act.uncertaintycode attribute has been overridden by the entity responsible for ascribing the SecurityIntegrityConfidenceObservationValue. This supports the business requirements for increasing or decreasing the assessment of the reliability or trustworthiness of an IT resource based on parameters beyond the original assignment of an Act statement level of uncertainty. |
| 3 | (SECINTPRVOBS) Abstract |
Type
of
security
metadata
observation
made
about
the
provenance
integrity
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
indicates
the
lifecycle
completeness
of
an
IT
resource
in
terms
of
workflow
status
such
as
its
creation,
modification,
suspension,
and
deletion;
locations
in
which
the
resource
has
been
collected
or
archived,
from
which
it
may
be
retrieved,
and
the
history
of
its
distribution
and
disclosure.
Integrity
provenance
metadata
about
an
IT
resource
may
be
used
to
assess
its
veracity,
reliability,
and
trustworthiness.
Examples: Types of security integrity provenance observation metadata, which may value the observation about an IT resource, include: completeness or workflow status, such as authentication the entity responsible for original authoring or informing about an IT resource the entity responsible for a report or assertion about an IT resource relayed “second-hand� the entity responsible for excerpting, transforming, or compiling an IT resource |
|
| 4 | SECINTPRVABOBS | security integrity provenance asserted by observation |
Type
of
security
metadata
observation
made
about
the
integrity
provenance
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
indicates
the
entity
that
made
assertions
about
the
resource.
The
asserting
entity
may
not
be
the
original
informant
about
the
resource.
Examples: Types of security integrity provenance asserted by observation metadata, which may value the observation, including: assertions about an IT resource by a patient assertions about an IT resource by a clinician assertions about an IT resource by a device |
| 4 | SECINTPRVRBOBS | security integrity provenance reported by observation |
Type
of
security
metadata
observation
made
about
the
integrity
provenance
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
indicates
the
entity
that
reported
the
existence
of
the
resource.
The
reporting
entity
may
not
be
the
original
author
of
the
resource.
Examples: Types of security integrity provenance reported by observation metadata, which may value the observation, include: reports about an IT resource by a patient reports about an IT resource by a clinician reports about an IT resource by a device |
| 3 | SECINTSTOBS | security integrity status observation |
Type
of
security
metadata
observation
made
about
the
integrity
status
of
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
to
make
access
control
decisions.
Indicates
the
completeness
of
an
IT
resource
in
terms
of
workflow
status,
which
may
impact
users
that
are
authorized
to
access
and
use
the
resource.
Examples: Types of security integrity status observation metadata, which may value the observation, include codes from the HL7 DocumentCompletion code system such as legally authenticated, in progress, and incomplete. |
| 2 | (SECTRSTOBS) Abstract |
An
observation
identifying
trust
metadata
about
an
IT
resource
(data,
information
object,
service,
or
system
capability),
which
may
be
used
as
a
trust
attribute
to
populate
a
computable
trust
policy,
trust
credential,
trust
assertion,
or
trust
label
field
in
a
security
label
or
trust
policy,
which
are
principally
used
for
authentication,
authorization,
and
access
control
decisions.
|
|
| 3 | TRSTACCRDOBS | trust accreditation observation |
Type
of
security
metadata
observation
made
about
the
formal
declaration
by
an
authority
or
neutral
third
party
that
validates
the
technical,
security,
trust,
and
business
practice
conformance
of
Trust
Agents
to
facilitate
security,
interoperability,
and
trust
among
participants
within
a
security
domain
or
trust
framework.
|
| 3 | TRSTAGREOBS | trust agreement observation |
Type
of
security
metadata
observation
made
about
privacy
and
security
requirements
with
which
a
security
domain
must
comply.
[ISO
IEC
10181-1]
|
| 3 | TRSTCERTOBS | trust certificate observation |
Type
of
security
metadata
observation
made
about
a
set
of
security-relevant
data
issued
by
a
security
authority
or
trusted
third
party,
together
with
security
information
which
is
used
to
provide
the
integrity
and
data
origin
authentication
services
for
an
IT
resource
(data,
information
object,
service,
or
system
capability).
[Based
on
ISO
IEC
10181-1]
For example, A Certificate Policy (CP), which is a named set of rules that indicates the applicability of a certificate to a particular community and/or class of application with common security requirements. For example, a particular Certificate Policy might indicate the applicability of a type of certificate to the authentication of electronic data interchange transactions for the trading of goods within a given price range. [Trust Service Principles and Criteria for Certification Authorities Version 2.0 March 2011 Copyright 2011 by Canadian Institute of Chartered Accountants. A Certificate Practice Statement (CSP), which is a statement of the practices which an Authority employs in issuing and managing certificates. [Trust Service Principles and Criteria for Certification Authorities Version 2.0 March 2011 Copyright 2011 by Canadian Institute of Chartered Accountants.] |
| 3 | TRSTFWKOBS | trust framework observation |
Type
of
security
metadata
observation
made
about
a
complete
set
of
contracts,
regulations
or
commitments
that
enable
participating
actors
to
rely
on
certain
assertions
by
other
actors
to
fulfill
their
information
security
requirements.
[Kantara
Initiative]
|
| 3 | TRSTLOAOBS | trust assurance observation |
Type
of
security
metadata
observation
made
about
the
digital
quality
or
reliability
of
a
trust
assertion,
activity,
capability,
information
exchange,
mechanism,
process,
or
protocol.
|
| 3 | TRSTMECOBS | trust mechanism observation |
Type
of
security
metadata
observation
made
about
a
security
architecture
system
component
that
supports
enforcement
of
security
policies.
|
| 1 | SUBSIDFFS | 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. |
| 1 | WRKCOMP | (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.
|
| 1 | (_ActProcedureCode) Abstract |
An
identifying
code
for
healthcare
interventions/procedures.
|
|
| 2 | (_ActBillableServiceCode) Abstract |
Definition:
An
identifying
code
for
billable
services,
as
opposed
to
codes
for
similar
services
used
to
identify
them
for
functional
purposes.
|
|
| 1 | (_HL7DefinedActCodes) Abstract |
Domain
provides
the
root
for
HL7-defined
detailed
or
rich
codes
for
the
Act
classes.
|
|
| 1 | COPAY | ||
| 1 | DEDUCT | ||
| 1 | DOSEIND | ||
| 1 | PRA | ||
| 1 | STORE Deprecated | Storage |
The
act
of
putting
something
away
for
safe
keeping.
The
|
®©
HL7.org
2011+.
FHIR
Release
3
(STU;
v3.0.2-11200)
Mixed
Nomative/Trial
Use
Ballot
#2
(v3.5.0-14907)
generated
on
Thurs,
Oct
24,
2019
11:53+1100.
Sun,
Aug
19,
2018
21:54+1000.
QA
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