|
Code
|
System
|
Display
|
Definition
|
42-CFR-2
http://hl7.org/fhir/consentcategorycodes
42
CFR
Part
2
Form
of
written
consent
Required
elements
in
a
written
consent
to
a
disclosure
of
information
governed
under
42
CFR
Part
2.
http://www.ecfr.gov/cgi-bin/text-idx?SID=69c4339acd2df9fab9dcbed15181917b&mc=true&node=pt42.1.2&rgn=div5
ACD
acd
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
advance
directive
Advance
Directive
|
Any
instructions,
written
or
given
verbally
by
a
patient
to
a
health
care
provider
in
anticipation
of
potential
need
for
medical
treatment.
[2005
Honor
My
Wishes]
|
CRIC
http://hl7.org/fhir/consentcategorycodes
common
rule
informed
consent
45
CFR
part
46
§46.116
General
requirements
for
informed
consent;
and
§46.117
Documentation
of
informed
consent.
https://www.gpo.gov/fdsys/pkg/FR-2017-01-19/pdf/2017-01058.pdf
DNR
dnr
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
do
not
resuscitate
Do
Not
Resuscitate
|
A
legal
document,
signed
by
both
the
patient
and
their
provider,
stating
a
desire
not
to
have
CPR
initiated
in
case
of
a
cardiac
event.
Note:
This
form
was
replaced
in
2003
with
the
Physician
Orders
for
Life-Sustaining
Treatment
[POLST].
|
EMRGONLY
emrgonly
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
emergency
only
Emergency
Only
|
Opt-in
to
disclosure
of
health
information
for
emergency
only
consent
directive.
Comment:
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.
[ActConsentDirective
(2.16.840.1.113883.1.11.20425)]
|
Illinois-Minor-Procedure
http://hl7.org/fhir/consentcategorycodes
Illinois
Consent
by
Minors
to
Medical
Procedures
The
consent
to
the
performance
of
a
medical
or
surgical
procedure
by
a
physician
licensed
to
practice
medicine
and
surgery,
a
licensed
advanced
practice
nurse,
or
a
licensed
physician
assistant
executed
by
a
married
person
who
is
a
minor,
by
a
parent
who
is
a
minor,
by
a
pregnant
woman
who
is
a
minor,
or
by
any
person
18
years
of
age
or
older,
is
not
voidable
because
of
such
minority,
and,
for
such
purpose,
a
married
person
who
is
a
minor,
a
parent
who
is
a
minor,
a
pregnant
woman
who
is
a
minor,
or
any
person
18
years
of
age
or
older,
is
deemed
to
have
the
same
legal
capacity
to
act
and
has
the
same
powers
and
obligations
as
has
a
person
of
legal
age.
Consent
by
Minors
to
Medical
Procedures
Act.
(410
ILCS
210/0.01)
(from
Ch.
111,
par.
4500)
Sec.
0.01.
Short
title.
This
Act
may
be
cited
as
the
Consent
by
Minors
to
Medical
Procedures
Act.
(Source:
P.A.
86-1324.)
http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1539&ChapterID=35
HCD
hcd
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
health
care
directive
Health
Care
Directive
|
Patient’s
Patient's
document
telling
patient’s
patient's
health
care
provider
what
the
patient
wants
or
does
not
want
if
the
patient
is
diagnosed
as
being
terminally
ill
and
in
a
persistent
vegetative
state
or
in
a
permanently
unconscious
condition.[2005
Honor
My
Wishes]
|
HIPAA-Auth
http://hl7.org/fhir/consentcategorycodes
HIPAA
Authorization
HIPAA
45
CFR
Section
164.508
Uses
and
disclosures
for
which
an
authorization
is
required.
(a)
Standard:
Authorizations
for
uses
and
disclosures.
(1)
Authorization
required:
General
rule.
Except
as
otherwise
permitted
or
required
by
this
subchapter,
a
covered
entity
may
not
use
or
disclose
protected
health
information
without
an
authorization
that
is
valid
under
this
section.
When
a
covered
entity
obtains
or
receives
a
valid
authorization
for
its
use
or
disclosure
of
protected
health
information,
such
use
or
disclosure
must
be
consistent
with
such
authorization.
Usage
Note:
Authorizations
governed
under
this
regulation
meet
the
definition
of
an
opt
in
class
of
consent
directive.
HIPAA-NPP
npp
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
HIPAA
Notice
of
Privacy
Practices
|
§
164.520
—
Notice
of
privacy
practices
for
protected
health
information.
(1)
Right
to
notice.
Except
as
provided
by
paragraph
(a)(2)
or
(3)
of
this
section,
an
individual
has
a
right
to
adequate
notice
of
the
uses
and
disclosures
of
protected
health
information
that
may
be
made
by
the
covered
entity,
and
of
the
individual's
rights
and
the
covered
entity's
legal
duties
with
respect
to
protected
health
information.
Usage
Note:
Restrictions
governed
under
this
regulation
meet
the
definition
of
an
implied
with
an
opportunity
to
dissent
class
of
consent
directive.
HIPAA-Restrictions
http://hl7.org/fhir/consentcategorycodes
HIPAA
Restrictions
HIPAA
45
CFR
§
164.510
-
Uses
and
disclosures
requiring
an
opportunity
for
the
individual
to
agree
or
to
object.
A
covered
entity
may
use
or
disclose
protected
health
information,
provided
that
the
individual
is
informed
in
advance
of
the
use
or
disclosure
and
has
the
opportunity
to
agree
to
or
prohibit
or
restrict
the
use
or
disclosure,
in
accordance
with
the
applicable
requirements
of
this
section.
The
covered
entity
may
orally
inform
the
individual
of
and
obtain
the
individual's
oral
agreement
or
objection
to
a
use
or
disclosure
permitted
by
this
section.
Usage
Note:
Restrictions
governed
under
this
regulation
meet
the
definition
of
an
opt
out
with
exception
class
of
consent
directive.
HIPAA-Research
http://hl7.org/fhir/consentcategorycodes
HIPAA
Research
Authorization
HIPAA
45
CFR
§
164.508
-
Uses
and
disclosures
for
which
an
authorization
is
required.
(a)
Standard:
Authorizations
for
uses
and
disclosures.
(3)
Compound
authorizations.
An
authorization
for
use
or
disclosure
of
protected
health
information
may
not
be
combined
with
any
other
document
to
create
a
compound
authorization,
except
as
follows:
(i)
An
authorization
for
the
use
or
disclosure
of
protected
health
information
for
a
research
study
may
be
combined
with
any
other
type
of
written
permission
for
the
same
or
another
research
study.
This
exception
includes
combining
an
authorization
for
the
use
or
disclosure
of
protected
health
information
for
a
research
study
with
another
authorization
for
the
same
research
study,
with
an
authorization
for
the
creation
or
maintenance
of
a
research
database
or
repository,
or
with
a
consent
to
participate
in
research.
Where
a
covered
health
care
provider
has
conditioned
the
provision
of
research-related
treatment
on
the
provision
of
one
of
the
authorizations,
as
permitted
under
paragraph
(b)(4)(i)
of
this
section,
any
compound
authorization
created
under
this
paragraph
must
clearly
differentiate
between
the
conditioned
and
unconditioned
components
and
provide
the
individual
with
an
opportunity
to
opt
in
to
the
research
activities
described
in
the
unconditioned
authorization.
Usage
Notes:
See
HHS
http://www.hhs.gov/hipaa/for-professionals/special-topics/research/index.html
and
OCR
http://www.hhs.gov/hipaa/for-professionals/special-topics/research/index.html
HIPAA-Self-Pay
http://hl7.org/fhir/consentcategorycodes
HIPAA
Self-Pay
Restriction
HIPAA
45
CFR
§
164.522(a)—Right
To
Request
a
Restriction
of
Uses
and
Disclosures.
(vi)
A
covered
entity
must
agree
to
the
request
of
an
individual
to
restrict
disclosure
of
protected
health
information
about
the
individual
to
a
health
plan
if:
(A)
The
disclosure
is
for
the
purpose
of
carrying
out
payment
or
health
care
operations
and
is
not
otherwise
required
by
law;
and
(B)
The
protected
health
information
pertains
solely
to
a
health
care
item
or
service
for
which
the
individual,
or
person
other
than
the
health
plan
on
behalf
of
the
individual,
has
paid
the
covered
entity
in
full.
Usage
Note:
Restrictions
governed
under
this
regulation
meet
the
definition
of
an
opt
out
with
exception
class
of
consent
directive.
Opt
out
is
limited
to
disclosures
to
a
payer
for
payment
and
operations
purpose
of
use.
See
HL7
HIPAA
Self-Pay
code
in
ActPrivacyLaw
(2.16.840.1.113883.1.11.20426).
MDHHS-5515
http://hl7.org/fhir/consentcategorycodes
Michigan
MDHHS-5515
Consent
to
Share
Behavioral
Health
Information
for
Care
Coordination
Purposes
On
January
1,
2015,
the
Michigan
Department
of
Health
and
Human
Services
(MDHHS)
released
a
standard
consent
form
for
the
sharing
of
health
information
specific
to
behavioral
health
and
substance
use
treatment
in
accordance
with
Public
Act
129
of
2014.
In
Michigan,
while
providers
are
not
required
to
use
this
new
standard
form
(MDHHS-5515),
they
are
required
to
accept
it.
Note:
Form
is
available
at
http://www.michigan.gov/documents/mdhhs/Consent_to_Share_Behavioral_Health_Information_for_Care_Coordination_Purposes_548835_7.docx
For
more
information
see
http://www.michigan.gov/documents/mdhhs/Behavioral_Health_Consent_Form_Background_Information_548864_7.pdf
NYSSIPP
http://hl7.org/fhir/consentcategorycodes
New
York
State
Surgical
and
Invasive
Procedure
Protocol
The
New
York
State
Surgical
and
Invasive
Procedure
Protocol
(NYSSIPP)
applies
to
all
operative
and
invasive
procedures
including
endoscopy,
general
surgery
or
interventional
radiology.
Other
procedures
that
involve
puncture
or
incision
of
the
skin,
or
insertion
of
an
instrument
or
foreign
material
into
the
body
are
within
the
scope
of
the
protocol.
This
protocol
also
applies
to
those
anesthesia
procedures
either
prior
to
a
surgical
procedure
or
independent
of
a
surgical
procedure
such
as
spinal
facet
blocks.
Example:
Certain
'minor'
procedures
such
as
venipuncture,
peripheral
IV
placement,
insertion
of
nasogastric
tube
and
foley
catheter
insertion
are
not
within
the
scope
of
the
protocol.
From
http://www.health.ny.gov/professionals/protocols_and_guidelines/surgical_and_invasive_procedure/nyssipp_faq.htm
Note:
HHC
100B-1
Form
is
available
at
http://www.downstate.edu/emergency_medicine/documents/Consent_CT_with_contrast.pdf
NPP
http://hl7.org/fhir/consentcategorycodes
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.
[ActConsentDirective
(2.16.840.1.113883.1.11.20425)]
|
POLST
polst
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
POLST
|
The
Physician
Order
for
Life-Sustaining
Treatment
form
records
a
person’s
person's
health
care
wishes
for
end
of
life
emergency
treatment
and
translates
them
into
an
order
by
the
physician.
It
must
be
reviewed
and
signed
by
both
the
patient
and
the
physician,
Advanced
Registered
Nurse
Practitioner
or
Physician
Assistant.
[2005
Honor
My
Wishes]
Comment:
Opt-in
Consent
Directive
with
restrictions.
|
RESEARCH
research
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
research
information
access
Research
Information
Access
|
Consent
to
have
healthcare
information
in
an
electronic
health
record
accessed
for
research
purposes.
[VALUE
SET:
ActConsentType
(2.16.840.1.113883.1.11.19897)]
|
RSDID
rsdid
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
de-identified
information
access
De-identified
Information
Access
|
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.
[VALUE
SET:
ActConsentType
(2.16.840.1.113883.1.11.19897)
|
RSREID
rsreid
|
http://hl7.org/fhir/consentcategorycodes
http://terminology.hl7.org/CodeSystem/consentcategorycodes
|
re-identifiable
information
access
Re-identifiable
Information
Access
|
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.
[VALUE
SET:
ActConsentType
(2.16.840.1.113883.1.11.19897)]
|
SSA-827
http://hl7.org/fhir/consentcategorycodes
Form
SSA-827
SSA
Form
SSA-827
(Authorization
to
Disclose
Information
to
the
Social
Security
Administration
(SSA))and
its
affiliated
State
disability
determination
services
use
Form
SSA-827,
Authorization
to
Disclose
Information
to
the
Social
Security
Administration
(SSA)
to
obtain
medical
and
other
information
needed
to
determine
whether
or
not
a
claimant
is
disabled.
Comment:
Opt-in
Consent
Directive.
Note:
Form
is
available
at
https://www.socialsecurity.gov/forms/ssa-827-inst-sp.pdf
VA-10-0484
http://hl7.org/fhir/consentcategorycodes
VA
Form
10-0484
VA
Form
10-0484
Revocation
for
Release
of
Individually-Identifiable
Health
Information
enables
a
veteran
to
revoke
authorization
for
the
VA
to
release
specified
copies
of
individually-identifiable
health
information
with
the
non-VA
health
care
provider
organizations
participating
in
the
eHealth
Exchange
and
partnering
with
VA.
Comment:
Opt-in
Consent
Directive
with
status
=
rescinded
(aka
'revoked').
Note:
Form
is
available
at
http://www.va.gov/vaforms/medical/pdf/vha-10-0484-fill.pdf
VA-10-0485
http://hl7.org/fhir/consentcategorycodes
VA
Form
10-0485
VA
Form
10-0485
Request
for
and
Authorization
to
Release
Protected
Health
Information
to
eHealth
Exchange
enables
a
veteran
to
request
and
authorize
a
VA
health
care
facility
to
release
protected
health
information
(PHI)
for
treatment
purposes
only
to
the
communities
that
are
participating
in
the
eHealth
Exchange,
VLER
Directive,
and
other
Health
Information
Exchanges
with
who
VA
has
an
agreement.
This
information
may
consist
of
the
diagnosis
of
Sickle
Cell
Anemia,
the
treatment
of
or
referral
for
Drug
Abuse,
treatment
of
or
referral
for
Alcohol
Abuse
or
the
treatment
of
or
testing
for
infection
with
Human
Immunodeficiency
Virus.
This
authorization
covers
the
diagnoses
that
I
may
have
upon
signing
of
the
authorization
and
the
diagnoses
that
I
may
acquire
in
the
future
including
those
protected
by
38
U.S.C.
7332.
Comment:
Opt-in
Consent
Directive.
Note:
Form
is
available
at
http://www.va.gov/vaforms/medical/pdf/10-0485-fill.pdf
VA-10-5345
http://hl7.org/fhir/consentcategorycodes
VA
Form
10-5345
VA
Form
10-5345
Request
for
and
Authorization
to
Release
Medical
Records
or
Health
Information
enables
a
veteran
to
request
and
authorize
the
VA
to
release
specified
copies
of
protected
health
information
(PHI),
such
as
hospital
summary
or
outpatient
treatment
notes,
which
may
include
information
about
conditions
governed
under
Title
38
Section
7332
(drug
abuse,
alcoholism
or
alcohol
abuse,
testing
for
or
infection
with
HIV,
and
sickle
cell
anemia).
Comment:
Opt-in
Consent
Directive.
Note:
Form
is
available
at
http://www.va.gov/vaforms/medical/pdf/vha-10-5345-fill.pdf
VA-10-5345a
http://hl7.org/fhir/consentcategorycodes
VA
Form
10-5345a
VA
Form
10-5345a
Individuals'
Request
for
a
Copy
of
Their
Own
Health
Information
enables
a
veteran
to
request
and
authorize
the
VA
to
release
specified
copies
of
protected
health
information
(PHI),
such
as
hospital
summary
or
outpatient
treatment
notes.
Note:
Form
is
available
at
http://www.va.gov/vaforms/medical/pdf/vha-10-5345a-fill.pdf
VA-10-5345a-MHV
http://hl7.org/fhir/consentcategorycodes
VA
Form
10-5345a-MHV
VA
Form
10-5345a-MHV
Individual’s
Request
for
a
Copy
of
their
own
health
information
from
MyHealtheVet
enables
a
veteran
to
receive
a
copy
of
all
available
personal
health
information
to
be
delivered
through
the
veteran’s
My
HealtheVet
account.
Note:
Form
is
available
at
http://www.va.gov/vaforms/medical/pdf/vha-10-5345a-MHV-fill.pdf
VA-10-10116
http://hl7.org/fhir/consentcategorycodes
VA
Form
10-10-10116
VA
Form
10-10116
Revocation
of
Authorization
for
Use
and
Release
of
Individually
Identifiable
Health
Information
for
Veterans
Health
Administration
Research.
Comment:
Opt-in
with
Restriction
Consent
Directive
with
status
=
'completed'.
Note:
Form
is
available
at
http://www.northerncalifornia.va.gov/northerncalifornia/services/rnd/docs/vha-10-10116.pdf
VA-21-4142
http://hl7.org/fhir/consentcategorycodes
VA
Form
21-4142
VA
Form
21-4142
(Authorization
and
Consent
to
Release
Information
to
the
Department
of
Veterans
Affairs
(VA)
enables
a
veteran
to
authorize
the
US
Veterans
Administration
[VA]
to
request
veteran’s
health
information
from
non-VA
providers.
Aka
VA
Compensation
Application
Note:
Form
is
available
at
http://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf
.
For
additional
information
regarding
VA
Form
21-4142,
refer
to
the
following
website:
www.benefits.va.gov/compensation/consent_privateproviders
ICOL
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
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.
|
|
IDSCL
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
information
disclosure
|
Definition:
Consent
to
have
collected
healthcare
information
disclosed.
|
|
INFA
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
information
access
|
Definition:
Consent
to
access
healthcare
information.
|
|
INFAO
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
access
only
|
Definition:
Consent
to
access
or
"read"
"read"
only,
which
entails
that
the
information
is
not
to
be
copied,
screen
printed,
saved,
emailed,
stored,
re-disclosed
or
altered
in
any
way.
This
level
ensures
that
data
which
is
masked
or
to
which
access
is
restricted
will
not
be.
Example:
Opened
and
then
emailed
or
screen
printed
for
use
outside
of
the
consent
directive
purpose.
|
|
INFASO
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
access
and
save
only
|
Definition:
Consent
to
access
and
save
only,
which
entails
that
access
to
the
saved
copy
will
remain
locked.
|
|
IRDSCL
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
information
redisclosure
|
Definition:
Information
re-disclosed
without
the
patient's
consent.
|
|
RESEARCH
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
research
information
access
|
Definition:
Consent
to
have
healthcare
information
in
an
electronic
health
record
accessed
for
research
purposes.
|
|
RSDID
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
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.
|
|
RSREID
|
http://hl7.org/fhir/v3/ActCode
http://terminology.hl7.org/CodeSystem/v3-ActCode
|
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.
|
59284-0
|
http://loinc.org
|
Patient
Consent
|
|
|
57016-8
|
http://loinc.org
|
Privacy
policy
acknowledgement
Document
|
|
|
57017-6
|
http://loinc.org
|
Privacy
policy
Organization
Document
|
|
|
64292-6
|
http://loinc.org
|
Release
of
information
consent
|
|
Terminology
|
Propose
a
change