IMPLEMENTATION GUIDE FOR SYNDROMIC SURVEILLANCE


Release 1.0 STU (US Realm)


2019/06/20 21:40:28


HL7 version 2.5.1


Generated with IGAMT version 2.0.0-beta20


About this guide

Publication history


Prior to HL7, this guide was titled "PHIN Messaging Guide for Syndromic Surveillance" and had the following revisions.
Revision   Date   Author  
Release 1.0 10/1/2011 ISDS, CDC Messaging Team
Release 1.1 8/1/2012 ISDS, CDC Messaging Team
Release 1.2 DRAFT for review 10/1/2012 ISDS, CDC Messaging Team
Release 1.3 DRAFT for review 12/1/2012 ISDS, CDC Messaging Team
Release 1.9 4/1/2013 ISDS, CDC Messaging Team
Release 2.0 DRAFT for review 8/5/2014 ISDS, CDC Messaging Team
Release 2.0 DRAFT for review 9/16/2014 ISDS, CDC Messaging Team and Standards and Interoperability activity
Release 2.0 FINAL DRAFT 4/21/2015 ISDS, CDC Messaging Team and Standards and Interoperability activity
Release 2.2 DRAFT for community contribution 5/22/2017 ISDS, CDC Messaging Team
Release 1.0 STU 7/1/2019 ISDS, Syndromic Surveillance CoP Implementation Guide Workgroup, ONC, NIST

 

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Copyrights and trademarks


HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off.

This document contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyrighted works (c) 1995-2011, Regenstrief Institute, Inc., and the Logical Observation Identifiers Names and Codes (LOINC) Committee and are available at no cost under the license at http://loinc.org/terms-of-use.

This document includes SNOMED Clinical Terms® (SNOMED CT®) that are used by permission of the International Health Terminology Standards Development Organization (IHTSDO). All rights reserved. SNOMED CT was originally created by The College of American Pathologists. "SNOMED®" and "SNOMED CT®" are registered trademarks of the IHTSDO.

Acknowledgements


This guide was developed by the Implementation Guide Work Group, led by the International Society for Disease Surveillance (ISDS), and tasked to specify a standard of transmitting data for syndromic surveillance. The work group developed a list of core data elements for syndromic surveillance in collaboration with the Centers for Disease Control and Prevention (CDC), Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), and Division of Health Informatics and Surveillance (DHIS). The DHIS National Syndromic Surveillance Program funded the activities to develop this guide through a cooperative agreement with ISDS.

CDC, CSELS, and DHIS public health informatics staff participated in the development of this implementation guide*. Numerous drafts were reviewed by national and state public health organizations, vendors  (including ISDS), the American Health Information Management Association (AHIMA), the Office of the National Coordinator (ONC), and the National Institute for Standards and Technology (NIST). Within Health Level Seven International (HL7), this standard is sponsored by the Public Health Work Group and co-sponsored by the Emergency Care Work Group and Patient Administration Work Group.

ISDS is a 501(c)3 nonprofit organization founded in 2005. ISDS ( http://www.healthsurveillance.org) strives to improve population health by advancing the science and practice of disease surveillance. ISDS's 430+ membership represents the public health surveillance community, including:


* Information included in this document does not represent the official position of the Centers for Disease Control and Prevention (CDC), but rather reflects those of the Syndromic Surveillance Community of Practice- Implementation Guide Workgroup and other key stakeholders.

In this guide


This guide provides:

This guide replaces or supersedes previous releases of syndromic surveillance guides and related documentation.

About HL7 2.5.1


This guide is based on the HL7 version 2.5.1 messaging standard, approved as an ANSI standard on February 21, 2007, as an update to the version 2.5 standard released in 2003. This guide describes the messages used for syndromic surveillance, and the constraints it imposes on the Messaging Standard.  This guide also introduces HL7 terms and concepts. For more information, see the full HL7 version 2.5.1 Messaging Standard ( http://www.hl7.org/implement/standards/index.cfm).

Intended audience


This guide has three audiences: (1) managers of healthcare and public health information systems who need to understand high-level processes; (2) technical personnel who develop or work with information systems that extract, transport, load, and transform electronic health record (EHR) data for syndromic surveillance; and (3) national health information technology policy makers who develop and implement EHR technology certification rules and procedures to improve system functionality and interoperability.

Introduction to syndromic surveillance


Syndromic surveillance is a process that regularly and systematically monitors pre-diagnostic groups of symptoms (syndromes) and then uses these and other health-related data in near real-time to make information available on the health of a community. This information includes statistics on disease trends and community health-seeking behaviors that support essential public health surveillance functions in public health authorities (PHAs). Syndromic surveillance is particularly useful to local, state, and federal PHAs for improving public health situational awareness, emergency response management, and outbreak recognition and characterization. Patient visit data from healthcare settings are a critical input for syndromic surveillance. Clinical data are provided by hospitals and urgent care centers to PHAs for all patient visits. PHAs then use these data under authorities granted to them by applicable local and state laws.

This guide uses the terms emergency department and urgent care services as defined by the Centers for Medicare and Medicaid Services (CMS), Medicare Benefit Policy Manual, Chapter 15 (Rev. 157, 06-08-12); Section 40.29-Definition of Emergency and Urgent Care Situations (Rev. 1, 10-01-03); B3-3044.29. Available online: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

CDC's Public Health Information Network (PHIN) ( https://www.cdc.gov/phin/index.html) is a national initiative to increase the capacity of PHAs to electronically exchange data and information across organizations and public health jurisdictions (e.g., clinical care to public health, public health to public health, and public health to federal agencies). PHIN promotes the use of standards and defines functional and technical requirements for public health information exchange.

HL7 is an internationally recognized, not-for-profit, ANSI-accredited health interoperability standard and vocabulary for exchanging electronic data across healthcare systems. The HL7 standard defines the syntax, or grammar, and standard vocabulary for formulating messages. HL7 is software independent and can be used on any platform.

This national standard for electronic messaging enables disparate healthcare software applications to transmit administrative and clinical data for public health surveillance and response. A set of recommendations made by expert committees convened by ISDS and CDC serve as the basis for this guide:

Policy background


On February 17, 2009, the President signed the American Recovery and Reinvestment Act of 2009 (Recovery Act). Two sections in the Recovery Act-Title XIII of Division A and Title IV of Division B-are cited together as the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act promotes meaningful use of health information technology (health IT) to improve the quality and value of healthcare in the United States.

In July 2010, the Center for Medicare and Medicaid Services (CMS) released Stage 1 Final Rule - Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, July 28, 2010. As a companion regulation, the Office of the National Coordinator for Health Information Technology (ONC) released "Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology: Final Rule July 28, 2010." The final rule defined standards, specifications, and certification criteria for the 2011 Edition Electronic Health Record (EHR) Technology necessary to meet objectives for Meaningful Use (MU), renamed the "Promoting Interoperability" program, as defined in the CMS Stage 1 Final Rule. An optional objective was to report syndromic surveillance data. Although Stage 1 (HL7 2.3.1 or HL7 2.5.1) specified a standard for reporting syndromic surveillance, there was no implementation guide or specification mandated in the 2011 Edition EHR certification criteria published in the national register.

In September 2010, CDC supported ISDS by recommending EHR requirements for core syndromic surveillance business practices. ISDS engaged the community and used a consensus-driven process to develop its recommendation, receiving input from a workgroup of local and state syndromic surveillance experts who developed early iterations (i.e., Preliminary Recommendation on 9/30/2010 and Provisional Recommendation on 12/1/2010). ISDS collected input on the provisional recommendations document during a public comment period that informed ISDS's Final Recommendation: The Core Processes & EHR Requirements of Public Health Syndromic Surveillance, published January 2011. CDC translated the ISDS business requirement recommendations into technical specifications to publish the PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data, Release 1.0, October 2011.

The CMS Stage 2 EHR Meaningful Use final rule was published in the Federal Register on September 4, 2012. The corresponding ONC final rule (also published on September 4, 2012) defined the standards, implementation specifications, and certification criteria for 2014 Edition Electronic Health Record Technology. In Stage 2, the syndromic surveillance objective became a core (required) objective for eligible hospitals but remained an optional objective for eligible providers. The 2014 Edition EHR certification criteria mandated that EHR products certified for inpatient (hospital) settings follow the HL7 2.5.1 standard and PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data, Release 1.1 (August 2012). The PHIN Messaging Guide is optional for EHR products certified for the ambulatory setting.

ONC adopted an optional 2014 Edition (Release 2.0) syndromic surveillance certification criterion (§ 170.314(f) (7)) for the ambulatory setting. In 2016, CDC released a clarification document along with an erratum for the PHIN Implementation Guide version 2.0, which provided additional guidance and clarity for interpreting the guide's specifications. In fall 2017, CDC established a cooperative agreement with ISDS to further refine the guide, renewed its engagement with the syndromic surveillance community, and began the balloting process through HL7. In 2018, ISDS released draft version 1.0 to the community for comments. ISDS received 320 comments, and the ISDS Messaging Guide Workgroup began the reconciliation process through the Syndromic Surveillance Community of Practice.

This optional certification criterion states that EHR technology can be used to submit syndrome-based public health surveillance data following the standards and guidance in this guide. The ONC 2014 Edition Release 2.0 Certification criteria included an optional set of data elements for additional specificity. The optional data elements follow:

Although several data elements in the preceding list are optional for demonstrating compliance with the certification criterion, an EHR technology developer may want to certify EHR technology to this criterion as a whole, including the optional data set. The EHR technology developer would need to demonstrate that the technology can electronically produce syndromic surveillance information that contains all data elements.

In August 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to improve the use of electronic health records, empower patients through better access to hospital service and billing information, and make it easier for providers to spend time with their patients. This final rule also renamed the "Meaningful Use" program to "Promoting Interoperability" program (https://qpp.cms.gov/mips/promoting-interoperability) and updated the Promoting Interoperability Transition Objectives and Measures. 

Scope


The scope of this document is to provide guidelines for transmitting HL7 v.2.5.1-compliant messages that also conform with specific profiles that facilitate communications from emergency departments, urgent care centers, and ambulatory care and inpatient settings to the PHAs that conduct syndromic surveillance.

The intent of this guide is to facilitate data exchange between different systems for syndromic surveillance purposes. Data include:

This guide is not intended to specify topics such as:

Local and state implementers are responsible for the topics described above. One way to ensure that these topics are not overlooked is to publish a jurisdiction-specific technical document or profile of local business rules and processes. The local profile should complement, not contradict, this guide. Throughout this guide are key issues that should be part of a local profile.

Assumptions


This guide makes the following assumptions:

Syndromic surveillance requires that multiple records for the same patient visit can be joined with limited personally identifiable information and that additional patient information can be securely looked up. Depending on the public health jurisdiction, data senders may provide a record identifier with each visit record to maintain a history of data integration that can be used in public health investigations. Guidance for these and other core syndromic surveillance processes are available from the Syndromic Surveillance Community of Practice website (formally ISDS) in Core Processes and EHR Requirements for Public Health Syndromic Surveillance. Visit http://www.healthsurveillance.org for more information.

Useful resources


HHS and CDC Resources:

Messaging and terminology standards and validation:                  

Revision of PHIN Messaging Guide, Release 2.2


The following decisions were made by the Implementation Guide Workgroup:


Updated and corrected messaging examples to pass NIST conformance testing.  To access this tool go to https://hl7v2.gvt.nist.gov, then select "Syndromic Surveillance" from the "Tool Scopes" drop down.

Reorganized the guide to reduce redundancy:

Snapshot Mode


Messages for a given visit shall always be sent in snapshot mode, indicating information related to the smallest individually identifiable unit are complete. For syndromic messages, that would be the OBX segments. If a correction and/or update to one of the OBX segments is necessary, all OBX segments, even if previously sent, shall be resent with the correction and/or current status and/or current values. If a previously sent OBX is missing from a subsequent message, then that indicates the OBX should be deleted.

Flavors


Flavor is a specialization of the base. For example, when a data type (as defined in the base HL7 v2.x standard) is constrained for a particular use, it is given an identifier ending in _SS and deemed a data type flavor. An example of a data type flavor identifier is XAD_SS. The same is true of segment flavors. In this guide, any segment or data type identifier with the suffix _SS is a flavor of the base segment or data type. An example of a segment flavor identifier is MSH_SS.

Binding Strength and Location


Binding is the association of a coded data element with a vocabulary (see the PHIN VADS site for more information: https://phinvads.cdc.gov/vads/downloads/PHINVADS_Guide.pdf).  Depending on the level of the specification, a coded data element may be bound to a concept domain, code system, or value set. The HL7 v2 tables can represent any of these three vocabulary types, depending on how the data element is defined and used. At each specification (profile) level, the binding becomes increasingly specific, refining the data semantics of the element by limiting its content to a particular set of coded values.                 

Binding strength indicates the conformance of the binding, that is, whether the vocabulary must be used or not. There are two possible values: Required ("R") and Suggested ("S," which is recommended).

Binding location defines the element location of the vocabulary binding for composite-coded element data types. For example: a field with a CWE data type and binding location of 1 restricts the vocabulary to CWE.1 (i.e., the first triplet). A location of 1 or 4 indicates that the vocabulary binding is either in element 1 or element 4 (i.e., either the first or second triplet in the CWE data type).

Usage


Segment and Field Usage: Usage of O does not require sending of receiving system support; rather, the guide only shows how to support the concept if data-trading partners agree to exchange specific data elements For more information on segment and field usage, see http://wiki.hl7.org/index.php?title=Conformance_Implementation_Manual 2.B.7.2.

Value Set Usage:  Required (R) usage indicates that the code must be supported (and thus can be used); Permitted (P) indicates that the code can be profiled to R, P, or E in a derived profile; and Excluded (E) indicates that the code must not be supported (and thus cannot be used) for the given element.

Optional Elements


If a data type or value set is defined for an Optional element like DG1-15, IN1-15, or MSH-6, then the field does not need to be supported. However, if the field is supported, it must use the data type/value set specified within the Implementation Guide.

Actors, goals and messaging transactions

Use case model


The use case model is based on business process documentation and core requirements for public health syndromic surveillance that uses electronic health record data from emergency department (ED), urgent care (UC), inpatient, and ambulatory care (AC) settings.

Table 2-1 Syndromic Surveillance Use Case Description
TABLE 2-1: USE CASE: ED/UC/AC and INPATIENT Health Record Syndromic Data to Public Health
ITEM DETAIL
Description
  • The Public Health Syndromic Surveillance Use Case focuses on transmittal of electronic health data from healthcare providers (senders) and receipt of same data by PHAs (receivers). During a patient visit to a healthcare facility, health data tare captured in a health information system.
  • Senders of data include hospitals, emergency departments, urgent care centers, ambulatory care settings, clinician networks, hospital corporations, corporate third-party operators of information brokers, regional data centers for hospitals, health information exchanges (HIEs), and regional health information organizations (RHIOs).
  • Receivers may be a designated third party or a state, regional, or local PHAs. A PHA is broadly defined to include agencies or authorities of the United States, states, territories, political subdivisions of states or territories, American Indian tribes, or an individual or entity acting under a grant of authority from such agencies and responsible for public health matters as part of an official mandate.
  • The goal of the use case is to provide secure, reliable delivery of syndromic surveillance data to PHAs. Many transport methods may be used. A secure transport mechanism should be chosen. Consideration should be given for acknowledgement of messages, whether single or batch, and/or possible acknowledgement of payload before processing or ingestion.
  • When describing the relationships between Sender and Receiver at the regional or national level; it could be determined that the Local PHA is portraying the role of Sender and a larger regional (e.g. RHIO, HIE) or national entity (CDC) portrays the role of receiver.   In such circumstances, the partner entities should resolve mutually beneficial business rules using this implementation guide as a framework to navigate potentially contradictory legislative and operational business rules.
Actors
  • Patient-A person receiving or registered to receive medical treatment.
  • Senders of syndromic surveillance data include (but are not limited to) hospitals, emergency departments, urgent care centers, and regional data centers for hospitals.
  • Receivers of syndromic surveillance data include PHA's.
Assumptions and Limitations The following assumptions are preconditions for the use of this profile:
  • Syndromic surveillance data senders are responsible for providing data that are syntactically and semantically consistent with the syndromic surveillance data receiver's requirements.
  • Before sending syndromic data, the data sender and receiver have completed all legal and administrative steps required for healthcare related data exchange.
  • The scope of data is limited to patient visit information and subsequent diagnoses related to the visit.  Scheduled (future) visit data shall not be sent.
Business Rules All settings:
  • Data must be timely for syndromic surveillance. Electronic transmission to the PHA shall occur at the time of the visit if feasible, but not later than 12 hours from the start of the visit. Any subsequent updates to a patient's record must also be transmitted within 12 hours of the update. Real-time transmission and frequent batching are allowed as long as delivery to the PHA is within 12 hours of the trigger event. A delay in transmission should only come into effect in unusual circumstances, such as a system failure or power outage.
  • Conformance Statement SS-001: Messages constrained by this guide and produced due to a single patient visit for the purpose of syndromic surveillance, SHALL have the same value for PV1-19.1 (Visit ID).
  • Conformance Statement SS-002: Messages constrained by this guide and produced due to a different patient visits for the purpose of syndromic surveillance, SHALL NOT have the same value for PV1-19.1 (Visit ID).
  • Visit ID (PV1-19) and visit time (PV1-44) should remain constant throughout the clinical encounter.
  • When the sender's system updates data elements (new or previously sent), the entire record (i.e., all specified elements) shall be resent. Message receivers will use unique identifiers to match and reconcile records.
  • Data should provide details about clinical patient visits.
  • Data should be de-identified to the level specified and required by jurisdictional regulations and legislation.  Refer to 1.11 Useful Resources for information about de-identification and HIPAA.



The Send Syndromic Surveillance Data Use Case Model has two primary actors: the Syndromic Data Sender and the Syndromic Data Receiver. A secondary actor, the patient, triggers the original provider to send data.



Dynamic interaction models

Send Syndromic surveillance data with acknowledgement


The Send Syndromic Surveillance Data with Acknowledgement activity model shows the Syndromic Surveillance Data Sender transmitting data to the Syndromic Surveillance Data Receiver. The Syndromic Surveillance Data Receiver will send an acknowledgement.


Send Syndromic surveillance data without acknowledgement


The Send Syndromic Surveillance Data without Acknowledgement model shows the Syndromic Surveillance Data Sender transmitting data to the Syndromic Surveillance Data Receiver. The Syndromic Surveillance Data Receiver will NOT send an acknowledgement.


Send Syndromic surveillance data - Batch


The Send Syndromic Surveillance Data Batch activity diagram model shows the Syndromic Surveillance Data Sender transmitting a batch to the Syndromic Surveillance Data Receiver. No acknowledgement is sent by the Syndromic Surveillance Data Receiver. 



Message acknowledgements


This guide requires a mechanism to support Acknowledgement Messages to make sure the message has been received in good order by the intended recipient. The mechanism shall support both:

Acknowledgement Choreography Applied


Acknowledgement choreography starts with the initial ADT message that uses MSH-15 and MSH-16 to tell the receiving system how to respond. The communication partners must agree to support basic acknowledgements: accept-level acknowledgements only or end-to-end acknowledgements, including application-level acknowledgements.

For basic, accept level acknowledgements only, the following MSH-15 and MSH-16 values must be supported.
TABLE 2-2 ACCEPT LEVEL ACKNOWLEDGEMENT CODES
Requirement MSH-15 MSH-16
SHALL support AL NE
MAY support* NE NE

*ONLY in point-to-point environments, where the transport protocol guarantees delivery to the intended recipient. 

When the communication partners agree to support end-to-end application level acknowledgements as well, then the following values must be supported for MSH-15 and MSH-16:
TABLE 2-3 APPLICATION LEVEL ACKNOWLEDGEMENT CODES
Requirement MSH-15 MSH-16
SHALL support AL AL
MAY support AL ER
MAY support* NE AL
MAY support* NE ER

*ONLY in point-to-point environments, where the transport protocol guarantees delivery to the intended recipient. Other values and combinations are NOT allowed.

Note:  Based on industry adoption, support for only basic, accept-level acknowledgements may be removed; only end-to-end acknowledgements covering both accept- and application-level acknowledgements to the originator may be supported.

Interactions


The following ADT trigger events represent the primary message types that PHAs use to conduct syndromic surveillance (see PHVS_EventType_SyndromicSurveillance - Event Type (Syndromic Surveillance). A normal EHR workflow could include additional ADT trigger events.
TABLE 2.4.1: INTERACTIONS - INDIVIDUAL TRANSACTION WITH ACKNOWLEDGEMENTS
EVENT TYPE MESSAGE TYPE RECEIVER ACTION SENDER DATA VALUES
Outpatient visit begins ADT^A04^ADT_A01 Accept, Reject, Error SS Data Sender MSH-9 = 'ADT^A04^ADT_A01'
Outpatient visit ends ADT^A03^ADT_A03 Accept, Reject, Error SS Data Sender MSH-9 = 'ADT^A03^ADT_A03'
Patient registers at facility ADT^A04^ADT_A01 Accept, Reject, Error SS Data Sender MSH-9 = 'ADT^A04^ADT_A01'
Patient is admitted to facility ADT^A01^ADT_A01 Accept, Reject, Error SS Data Sender MSH-9 = 'ADT^A01^ADT_A01'
Patient is discharged from facility ADT^A03^ADT_A03 Accept, Reject, Error SS Data Sender MSH-9 = 'ADT^A03^ADT_A03'
Patient record is updated ADT^A08^ADT_A01 Accept, Reject, Error SS Data Sender MSH-9 = 'ADT^A08^ADT_A01'
Accept message ACK message related to type of message sent None SS Data Receiver MSA-1 = 'AA'
Reject message ACK message related to type of message sent None SS Data Receiver MSA-1 = 'AR'
Error Message ACK message related to type of message sent None SS Data Receiver MSA-1 = 'AE'

 
TABLE 2.4.2: INTERACTIONS - INDIVIDUAL TRANSACTION WITHOUT ACKNOWLEDGEMENT / BATCH
EVENT MESSAGE TYPE RECEIVER ACTION SENDER DATA VALUES
Outpatient visit begins ADT^A04^ADT_A01 None SS Data Sender MSH-9 = 'ADT^A04^ADT_A01'
Outpatient visit ends ADT^A03^ADT_A03 None SS Data Sender MSH-9 = 'ADT^A03^ADT_A03'
Patient registers at facility ADT^A04^ADT_A01 None SS Data Sender MSH-9 = 'ADT^A04^ADT_A01'
Patient is admitted to facility ADT^A01^ADT_A01 None SS Data Sender MSH-9 = 'ADT^A01^ADT_A01'
Patient is discharged from facility ADT^A03^ADT_A03 None SS Data Sender MSH-9 = 'ADT^A03^ADT_A03'
Patient record is updated ADT^A08^ADT_A01 None SS Data Sender MSH-9 = 'ADT^A08^ADT_A01'

A08 Message Triggers


The following table relates data element changes to the triggering of an A08 message.  Optional fields would only contribute to triggering an A08 if they are present in the message.
TABLE 2.5: A08 MESSAGE TRIGGERS
DATA ELEMENT NAME DESCRIPTION OF FIELD USAGE CARDINALITY RECOMMENDED HL7 LOCATION TRIGGERS AN A08 TRANSACTION
Facility Identifier (Treating) Unique facility identifier where patient was treated (original data provider) R [1..1] EVN-7.2 Event Facility  - Facility Identifier No, would not trigger a new A08 - already included with all ADT messages
Facility Name (Treating) Name of treating facility where patient is treated RE [0..1] EVN-7.1 Event Facility  - Facility Name No, would not trigger a new A08 - already included with all ADT messages
Treating Facility Address Address of treating facility location (street address, city, state, ZIP, and county) RE [0..1] OBX Segment with OBX-3 Observation Identifier of SS002 Treating Facility Location (PHINQUESTION) and OBX-2 Value Type of XAD. No, would not trigger a new A08 - already included with all ADT messages
Facility/Visit type Facility type that patient visited for treatment R [1..1] OBX Segment with OBX-3 Observation Identifier SS003^FACILITY/VISIT TYPE Yes, if visit type changes during a specific visit
Message (Event) Date/Time Date and time that  report is created / generated from original source (from treating facility) R [1..1] EVN-2 Event Date/Time No, this field is a by-product of the trigger and when it occurred
Unique Physician Identifier Unique identifier for physician providing care O [0..1] PV1-7 Attending Doctor Yes, if this optional field is being sent, and physician assignment changes for a specific visit.  Transactions that would translate to A08:
  • CHANGE ATTENDING DOCTOR (EVENT A54)
Unique Patient Identifier / Medical Record Number Unique identifier for patient R [1..*] PID-3 Patient Identifier List Yes, if Medical Record Number or whatever identifier is being used in PID-3 changes for a specific patient. PID-3 Patient Identifier value will be the only means of identifying a patient longitudinally. Potential transactions that would translate to A08:
  • MERGE PATIENT INFORMATION (EVENT A18)
  • MERGE PERSON INFORMATION (EVENT A30)
  • UPDATE PERSON INFORMATION (EVENT A31)
  • MERGE PATIENT INFORMATION - PATIENT ID ONLY (EVENT A34)
  • CHANGE PATIENT ID (EVENT A46)
  • MERGE PATIENT INFORMATION - PATIENT ID & ACCOUNT NUMBER (EVENT A36)
  • MERGE PERSON - PATIENT ID (EVENT A39)
  • MERGE PATIENT - PATIENT IDENTIFIER LIST (EVENT A40)
  • CHANGE PATIENT ID (EVENT A46)
  • CHANGE PATIENT IDENTIFIER LIST (EVENT A47)
Unique Visit Identifier Unique identifier for visit R [1..*] PV1-19 Visit ID Yes, if visit identifier is changed for a specific visit. Potential transactions that would translate to A08:
  • CHANGE AN OUTPATIENT TO AN INPATIENT (EVENT A06)
  • CHANGE AN INPATIENT TO AN OUTPATIENT (EVENT A07) 
  • MERGE PATIENT INFORMATION (EVENT A18)
  • MERGE PERSON INFORMATION (EVENT A30)
  • UPDATE PERSON INFORMATION (EVENT A31)
  • MERGE PATIENT INFORMATION - ACCOUNT NUMBER ONLY (EVENT A35)
  • MERGE PATIENT INFORMATION - PATIENT ID & ACCOUNT NUMBER (EVENT A36)
  • MERGE VISIT - VISIT NUMBER (EVENT A42)
  • MOVE VISIT INFORMATION - VISIT NUMBER (EVENT A45)
Age/Age Units Numeric value of patient age at time of visit RE [0..1] OBX Segment with OBX-3 Observation Identifier of 21612-7 AGE - REPORTED (LOINC) and OBX-2 Value Type of NM Yes, when a new 21612-7 AGE REPORTED (LOINC) observation becomes available or changes occur in EHR
Gender Stated gender of patient RE [0..1] PID-8 Administrative Sex Yes, when PID-8 is added or updated
Race Race of patient RE [0..*] PID-10 Race Yes, when PID-10 is added or updated
Ethnicity Ethnicity of patient RE [0..*] PID-22 Ethnicity Yes, when PID-22 is added or updated
Patient City/Town City or town of patient residence RE [0..1] PID-11.3 Patient Address City Yes, when PID-11.3 is added or updated
Patient ZIP Code ZIP code of patient residence RE [0..1] PID-11.5 Patient Address Postal Code Yes, when PID-11.5 is added or updated
Patient County County of patient residence RE [0..1] PID-11.9 Patient Address County Yes, when PID-11.9 is added or updated
Patient State State of patient residence RE   [0..1] PID-11.4 Patient Address State Yes, when PID-11.4 is added or updated
Patient Country Country of patient residence RE [0..1] PID-11.6 Patient Address Country Yes, when PID-11.6 is added or updated
Patient Death Date and Time Patient Death Date and Time C [0..1] PID-29 Patient Death Date and Time Yes, when PID-29 is added or updated
Patient Death Indicator Patient Death Indicator RE [0..1] PID-30 Patient Death Indicator Yes, when PID-30 is added or updated
Chief Complaint / Reason for Visit Patient's self-reported chief complaint or reason for visit RE [0..*] OBX Segment with OBX-3 Observation Identifier of 8661-1 Chief Complaint - Reported (LOINC) of TX.  Free text chief complaint is entered as OBX-5 Observation Value. Yes, when a new 8661-1 Chief Complaint - reported (LOINC) observation becomes available in the EHR
Admit or Visit Reason Short description of provider's reason for admitting patient RE [0..1] PV2-3 Admit Reason Yes, if PV2-3 Admit or Visit Reason value changes
Admit or Visit Date / Time Date and time of visit or admission R [1..1] PV1-44 Admit Date Yes, if PV1-44 Admit or Visit Date/Time changes
Date of onset Date that patient began having  symptoms of condition being reported O [0..1] OBX Segment with OBX-3 Observation Identifier 11368-8 Illness or Injury Onset Date (LOINC) and OBX-2 Value Type of TS Yes, when a new 11368-8 Illness or Injury Onset Date (LOINC) observation becomes available in the EHR
Patient Class Patient classification within facility R [1..1] PV1-2 Patient Class Yes, if PV1-2 Patient Class value changes
Admission Type Field that indicates circumstances under which  patient was or will be admitted O [0..1] PV1-4 Admission Type Yes, if this optional field is being sent, and PV1-4 Admission Type is added or updated
Admit Source Field that indicates where patient was admitted O [0..1] PV1-14 Admit Source Yes, if PV1-14 Admit Source value is added or updated
Hospital Unit Hospital unit where patient is at time message is sent (admission and discharge) RE [0..1] OBX Segment with OBX-3 Observation Identifier of 56816-2 Patient Location (LOINC) and OBX-2 Value Type of CWE Yes, if PV1-3 Assigned Patient Location value is added or updated.  ADT^A02 event is issued as a result of the patient changing his or her assigned physical location.
Previous Hospital Unit Hospital unit where patient was before current transaction O [0..1] PV1-6 Prior Patient Location No
Diagnosis Type Qualifier for Diagnosis / Injury Code specifying type of diagnosis RE [0..*] DG1-6 Diagnosis Type Yes, any time diagnosis information is updated, the DG1 requires an Admitting, Working or Final designation in DG1-6 Diagnosis Type
Primary Diagnosis / Additional Diagnosis Primary diagnosis of patient's condition; additional diagnoses of patient's condition(s) RE [0..*] DG1-3 Diagnosis Code Yes, any time diagnosis information is added or updated, such as in  BAR/ACK - UPDATE DIAGNOSIS/PROCEDURE (EVENT P12)
Discharge Disposition Patient's anticipated location or status following discharge RE (A03 only) [0..1] PV1-36 Discharge Disposition Yes, required element for A03 Discharge Transaction but allowable in an A08 if PV1-36 is updated
Discharge or Disposition Date/Time Date and time of discharge RE (A03 only) [0..1] PV1-45 Discharge Date/Time Yes, required element for A03 Discharge Transaction but allowable in an A08 if PV145 is updated
Procedure Code Procedures administered to the patient O [0..1] PR1-3 Procedure Code Yes, any time procedure information is added or updated, such as in  BAR/ACK - UPDATE DIAGNOSIS/PROCEDURE (EVENT P12)
Triage Notes Triage notes for the patient visit RE [0..1] OBX Segment with OBX-3 Observation Identifier 54094-8 Emergency Department Triage Notes (LOINC) and OBX-2 Value Type of TX to allow free text input only in OBX-5 Observation Value. Yes, when a new 54094-8 Emergency Department Triage Notes (LOINC) observation becomes available in EHR
Clinical Impression Clinical impression (free text) of diagnosis O [0..1] OBX Segment with OBX-3 Observation Identifier 44833-2 Preliminary Diagnosis (LOINC) and OBX-2 Value Type of TX to allow free text input only in OBX-5 Observation Value. Yes, when a new 44833-2 Preliminary Diagnosis (LOINC) observation becomes available in EHR
Height Height of patient RE [0..1] OBX Segment with OBX-3 Observation Identifier 8302-2 Body Height (LOINC) and OBX-2 Value Type of NM. Yes, when a new 8302-2 Body Height (LOINC) observation becomes available in EHR (but not every time height is entered)
Weight Weight of patient RE [0..1] OBX Segment with OBX-3 Observation Identifier 3141-9 Body Weight Measured (LOINC) and OBX-2 Value Type of NM. Yes, when a 3141-9 Body Weight Measured (LOINC) observation becomes available in EHR (but not every time a weight is entered)
BMI Body Mass Index RE [0..1] OBX Segment with OBX-3 Observation Identifier 39156-5 Body Mass Index (LOINC) and OBX-2 Value Type of NM. Yes, when 39156-5 Body Mass Index (LOINC) observation becomes available in EHR
Systolic and Diastolic Blood Pressure (SBP/DBP) - Most recent Most recent systolic and diastolic blood pressure of patient. O [0..1] Blood Pressure is communicated using 2 different data elements for Systolic and Diastolic Blood Pressure. Yes, if a 8480-6 BP Systolic (LOINC) and/or 8462-4 BP Diastolic (LOINC) observation becomes available in the EHR (expecting at least one set per visit).  Every BP reading should trigger a new A08.  Also, please see previous discussion of snapshot mode.
Initial Temperature Initial temperature of patient O [0..1] OBX Segment with OBX-3 Observation Identifier 11289-6 Body temperature: Temp:Enctrfirst (LOINC) and OBX-2 Value Type of NM.   Yes, when a 11289-6 Body Temperature Initial (LOINC) observation becomes available in EHR
Initial Pulse Oximetry First recorded pulse oximetry value O [0..1] OBX Segment with OBX-3 Observation Identifier 59408-5 OXYGEN SATURATION IN ARTERIAL BLOOD BY PULSE OXIMETRY (LOINC) and OBX-2 Value Type of NM. Yes, when a 59408-5 Initial Pulse Oximetry (LOINC) observation becomes available in EHR
Smoking Status Smoking status of patient RE [0..1] OBX Segment with OBX-3 Observation Identifier 72166-2 Tobacco Smoking Status (LOINC) and OBX-2 Value Type of CWE. Yes, when a 72166-2 Tobacco Smoking Status (LOINC) observation becomes available in EHR
Initial Acuity Assessment of intensity of medical care patient requires. O [0..1] OBX Segment with OBX-3 Observation Identifier 11283-9 Initial Acuity (LOINC) and OBX-2 Value Type of CWE. Yes, when a 11283-9 Initial Acuity (LOINC) observation becomes available in EHR
Insurance Coverage Health insurance coverage of patient O [0..*] IN1-15 Insurance Plan ID Yes, when Insurance Plan information changes, which may occur in other message types such as:
  • BAR/ACK - ADD PATIENT ACCOUNT (EVENT P01)
  • DFT/ACK - POST DETAIL FINANCIAL TRANSACTIONS (EVENT P03)
  • BAR/ACK - UPDATE ACCOUNT (EVENT P05)
  • DFT/ACK - POST DETAIL FINANCIAL TRANSACTIONS - EXPANDED (EVENT P11)

          

Messaging examples


This section presents six (6) case studies to illustrate how this guide should be used for messaging syndromic surveillance information about a patient visit.  These examples passed NIST conformance testing (visit https://hl7v2.gvt.nist.gov, then select "Syndromic Surveillance" from the "Tool Scopes" drop down). The example messages in this section of are for illustration purposes and are not intended for system design. Readers should not infer requirements solely on the basis of these messages.

Minimal data are used in each case study to emphasize important aspects of the message structure. Data elements of interest are varied to emphasize clinical or administrative concepts about syndromic surveillance. Each case study describes ADT trigger events that represent core data elements for syndromic surveillance. Keep in mind, however, that a normal EHR workflow could include additional ADT trigger events.

Case 1 - Brief Urgent Care or Emergency Department Visit 

Case Study 1 provides an example of a brief patient visit that could take place in either urgent care or emergency department clinical settings. The patient's chief complaint is captured as an unstructured, free-text value using the patient's own words. ADT A04 and A03 messages for this visit are generated and sent to the PHA.

Step 1: Registration Trigger - ADT A04

A 38-year-old female walks into Midtown Urgent Care on August 17, 2017 at 12:00 PM. The patient is registered by a clerical assistant who records the patient's name, date of birth, residence information, race, ethnicity, and patient's reason for visit, which is "Fever, chills, smelly urine with burning during urination."

At 12:30 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Registration message to Big City Health Department about this visit.

Example Message - Step 1, Case 1:

MSH|^~\&||MidTwnUrgentC^2231231234^NPI|||20170817123000-0500||ADT^A04^ADT_A01|NIST-SS-001.12|P|2.5.1|||AL|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3^ISO
EVN|A04|20140817123000-0500|||||MidTwnUrgentC^2231231234^NPI
PID|1||2222^^^MidTwnUrgentC&2231231234&NPI^MR||~^^^^^^S||19790505|F||2106-3^White^CDCREC|^^Decatur^13^30303^^13121|||||||||||2135-2^Hispanic or Latino^CDCREC
PV1|1|O|1160-1^^^MidTwnUrgentC&2231231234&NPI|U|||||||||||||||2222_001^^^MidTwnUrgentC&2231231234&NPI^VN|||||||||||||||||||||||||201708171200-0500
PV2|||^Fever, chills, smelly urine with burning during urination
OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QU0200X^Urgent Care^HCPT||||||F|||201408171200-0500
OBX|2|XAD|SS002^TREATINGFACILITYLOCATION^PHINQUESTION||1234 Anywhere Street^^Doraville^13^30341^USA^C^DEKALB||||||F|||201708171200-0500
OBX|3|NM|21612-7^Age-Reported^LN||38|a^year^UCUM|||||F|||201708171200-0500
OBX|4|TX|8661-1^ChiefComplaint^LN||Fever, chills, smelly urine with burning during urination||||||F|||201708171200-0500


Step 2: Discharge Trigger: ADT A03

At 12:35 PM a nurse practitioner examines the patient and diagnoses a urinary tract infection. The nurse assigns an ICD-10-CM diagnosis code within the EHR, and orders a course of antibiotics for the patient. The patient is discharged from the urgent care center at 12:45 PM.

At 2:30 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Discharge message to Big City Health Department about this visit.

Example Message - Step 2, Case 1:

MSH|^~\&||MidTwnUrgentC^2231231234^NPI|||20170817143000-0500||ADT^A03^ADT_A03|NIST-SS-001.22|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3^ISO
EVN|A03|20170817143000-0500|||||MidTwnUrgentC^2231231234^NPI
PID|1||2222^^^MidTwnUrgentC&2231231234&NPI^MR||~^^^^^^S||19790505|F||2106-3^White^CDCREC|^^Decatur^13^30303^^13121|||||||||||2135-2^Hispanic or Latino^CDCREC
PV1|1|O|1160-1^^^MidTwnUrgentC&2231231234&NPI|U|||||||||||||||2222_001^^^MidTwnUrgentC&2231231234&NPI^VN|||||||||||||||||01||||||||201708171200-0500|201708171245-0500
PV2|||N39.0^Urinary tract infection, site not specified^I10
DG1|1|I10|N39.0^Urinary tract infection, site not specified^I10||201708171235-0500|F
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QU0200X^Urgent Care^HCPT||||||F|||201708171200-0500
OBX|2|XAD|SS002^TREATINGFACILITYLOCATION^PHINQUESTION||1234 Anywhere Street^^Doraville^13^30341^USA^C^DEKALB||||||F|||201708171200-0500
OBX|3|NM|21612-7^Age-Reported^LN||38|a^^UCUM|||||F|||201708171200-0500
OBX|4|TX|8661-1^ChiefComplaint^LN||Fever, chills, smelly urine with burning during urination||||||F|||201708171200-0500
OBX|5|CWE|8677-7^MedicationsPrescribedOrDispensed^LN||617296^Amoxicillin 500 MG / Clavulanate 125 MG Oral Tablet^RXNORM||||||F|||201708171235-0500



Case 2 - Unconscious Patient Dies in Emergency Department 

Case Study 2 provides an example of a hospital emergency department visit where the patient demographic information is unavailable at registration, chief complaint is captured as a coded value in PV2-3 Admit Reason, ICD-10-CM codes are captured as part of the working diagnoses, and the patient dies. ADT A04, A08, and A03 messages are generated for this visit and sent to the PHA.

Step 1: Registration Trigger - ADT A04

An unconscious white male with no visible injuries is brought by ambulance to Pacific Northwest Hospital's Emergency Department at 11:45 PM on August 2, 2017. The paramedics report that firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed the patient on a ventilator. Unable to find identification, the patient is registered without his true name, date of birth, or ethnicity. His reason for visit is logged as ICD-10-CM code.

At 2:00 AM on August 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an ADT A04 message for this visit to the state health department.

Example Message - Step 1, Case 2:

MSH|^~\&||PacificNWHospitalED^2231231234^NPI|||20170803020000-0500||ADT^A04^ADT_A01|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3^ISO
EVN|A04|20170802234500-0500|||||PacificNWHospitalED^2231231234^NPI
PID|1||3333^^^PacificNWHospitalED&2231231234&NPI^MR||~^^^^^^U|||M||2106-3^White^CDCREC
PV1|1|E|1108-0^TR14^2A^PacificNWHospitalED&2231231234&NPI|E|||||||||||||||3333_001^^^PacificNWHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201708022345-0500
PV2|||X00.1^Exposure to smoke in uncontrolled fire in building or structure^I10
OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QE0002X^Emergency Care^HCPT||||||F|||201708022345-0500
OBX|2|CWE|56816-2^HospitalUnit^LN||1108-0^EmergencyDepartment^HSLOC||||||F|||201708022345-0500
OBX|3|TX|54094-8^EmergencyDepartmentTriageNote^LN||firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed on a ventilator||||||F|||201708022345-0500
OBX|4|CWE|11283-9^INITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500


Step 2: Record Update Trigger: ADT A08 

ED physicians perform a physical examination and blood work and find extremely abnormal blood gas numbers. While these tests are being performed a woman shows up in the ED stating that she is a friend. She provides the clinicians with the patient's name and date of birth, and states that she believes he has been homeless recently. At 2:30 AM on August 3, 2017, a working ICD-10-CM diagnosis code is entered into the patient record along with updated name, ethnicity and date of birth. (Note that due to State reporting rules in the hospital location, the patient name is sent in PID-5).

At 4:00 AM on August 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an ADT A08 message for this visit to the state health department.

Example Message - Step 2, Case 2:

MSH|^~\&||PacificNWHospitalED^2231231234^NPI|||20170803040000-0500||ADT^A08^ADT_A01|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A08^^2.16.840.1.114222.4.10.3^ISO
EVN|A08|20170803023000-0500|||||PacificNWHospitalED^2231231234^NPI
PID|1||3333^^^PacificNWHospitalED&2231231234&NPI^MR||Chaplin^Charles^^^^^L||19650314|M||2106-3^White^CDCREC||||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|E|1108-0^TR14^2A^PacificNWHospitalED&2231231234&NPI|E|||||||||||||||3333_001^^^PacificNWHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201708022345-0500
PV2|||X00.1^Exposure to smoke in uncontrolled fire in building or structure^I10
OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QE0002X^Emergency Care^HCPT||||||F|||201708022345-0500
OBX|2|CWE|56816-2^HospitalUnit^LN||1108-0^EmergencyDepartment^HSLOC||||||F|||201708022345-0500
OBX|3|TX|54094-8^EmergencyDepartmentTriageNote^LN||firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed on a ventilator||||||F|||201708022345-0500
OBX|4|CWE|11283-9^INITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500
DG1|1|I10|J96.0^Acute respiratory failure^I10||201708030230-0500|W
DG1|2|I10|Z59.0^Homelessness^I10||201708030230-0500|W


Step 3: Discharge Trigger: ADT A03

At 8:30 AM, the patient's heart suddenly stops beating. After several minutes of resuscitation attempts, the attending physician determines the patient died of cardiopulmonary arrest. Time of patient death is 8:55 AM. Final ICD-10-CM diagnosis of I469 is assigned to the patient medical record. PV1-36 is assigned 41 to indicate that the patient died at the facility. PID-29 contains the time of death and PID-30 contains Y.

At 10:00 AM on August 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an ADT A03 message for this visit to the state health department.

Example Message - Step 3, Case 2:

MSH|^~\&||PacificNWHospitalED^2231231234^NPI|||20170803100000-0500||ADT^A03^ADT_A03|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3^ISO
EVN|A03|20170803100000-0500|||||PacificNWHospitalED^2231231234^NPI
PID|1||3333^^^PacificNWHospitalED&2231231234&NPI^MR||Chaplin^Charles^^^^^L||19650314|M||2106-3^White^CDCREC||||||||||||2186-5^Not Hispanic or Latino^CDCREC|||||||201708030855-0500|Y
PV1|1|E|1108-0^TR14^2A^PacificNWHospitalED&2231231234&NPI|E|||||||||||||||3333_001^^^PacificNWHospitalED&2231231234&NPI^VN|||||||||||||||||41||||||||201708022345-0500|201708031000-0500
DG1|1|I10|Z59.0^Homelessness^I10||201708030230-0500|F
DG1|2|I10|I46.9^Cardiac arrest^I10||201708030830-0500|F
OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QE0002X^Emergency Care^HCPT||||||F|||201708022345-0500
OBX|2|CWE|56816-2^HospitalUnit^LN||1108-0^EmergencyDepartment^HSLOC||||||F|||201708022345-0500
OBX|3|TX|54094-8^EmergencyDepartmentTriageNote^LN||firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed on a ventilator||||||F|||201708022345-0500
OBX|4|CWE|11283-9^INITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500



Case 3 - Patient Admitted from Emergency Department

Case Study 3 provides an example of a hospital emergency department visit that is captured as an unstructured, free-text chief complaint, and the patient is discharged from the ED and admitted for inpatient care. ADT A04, A08, A03, and A01 messages for this visit are generated and sent to the PHA.

Step 1: Registration Trigger - ADT A04

A 13-year-old boy is brought to the ED at Southwest Corner Hospital by his parents at 3:30 PM on December 27, 2016. The patient is complaining of fever, cough and difficulty breathing. A clerical assistant registers the patient with the parent's help. She records the patient's name, date of birth, race (note that two races are entered), ethnicity, residence, and insurance information. The clerical assistant also enters the patient's chief complaint as "fever, cough, difficulty breathing."

At 4:00 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits a Registration message about this visit to the state health department.

Example Message - Step 1, Case 3:

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20161227160000-0500||ADT^A04^ADT_A01|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3^ISO
EVN|A04|20161227153000-0500|||||SWCornerHospitalED^2231231234^NPI
PID|1||4444^^^SWCornerHospitalED&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9^Asian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|E|1108-0^^^SWCornerHospitalED&2231231234&NPI|E|||||||||||||||4444_001^^^SWCornerHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201612271530-0500
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QE0002X^Emergency Care^HCPT||||||F|||201612271530-0500
OBX|2|NM|21612-7^Age-Reported^LN||13|a^^UCUM|||||F|||201612271530-0500
OBX|3|NM|11289-6^BodyTemperature^LN||101.1|[degF]^Farenheit^UCUM|||||F|||201612271530-0500
OBX|4|NM|39156-5^BMI^LN||35|kg/m2^kilogram / (meter squared)^UCUM|||||F|||201612271530-0500
OBX|5|NM|59408-5^OxygenSaturationinArterialBloodbyPulseOximetry^LN||99|%^Percent^UCUM|||||F|||201612271530-0500
OBX|6|NM|8480-6^SystolicBloodPressure^LN||128|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]^UCUM|||||F|||201612271530-0500
OBX|7|NM|8462-4^DiastolicBloodPressure^LN||92|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]^UCUM|||||F|||201612271530-0500
OBX|8|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612271530-0500
OBX|9|TS|11368-8^IllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612271530-0500
OBX|10|CWE|11283-9^InitialAcuity^LN||2^Emergent^CDCEDACUITY||||||F|||201612271530-0500
OBX|11|TX|44833-2^ClinicalImpression^LN||Shortness of breath, cough, fever||||||F|||201612271530-0500
OBX|12|CWE|56816-2^HospitalUnit^LN||1108-0^EmergencyDepartment^HSLOC||||||F|||201612271530-0500


Step 2: Record Update Trigger - ADT A08

The attending physician orders treatment and diagnostic tests for influenza and pneumonia. At 5:00 PM, she updates the clinical record with working ICD-10-CM diagnosis codes of R0602 (shortness of breath) and R05 (cough). Shortness of breath is the primary diagnosis.

At 5:15 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits an Update message about this visit to the state health department.

 Example Message - Step 2, Case 3

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20161227171005-0500||ADT^A08^ADT_A01|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A08^^2.16.840.1.114222.4.10.3^ISO
EVN|A08|20161227171500-0500|||||SWCornerHospitalED^2231231234^NPI
PID|1||4444^^^SWCornerHospitalED&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9^Asian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|E|1108-0^^^SWCornerHospitalED&2231231234&NPI|E|||||||||||||||4444_001^^^SWCornerHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201612271530-0500
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QE0002X^Emergency Care^HCPT||||||F|||201612271530-0500
OBX|2|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612271530-0500
OBX|3|TS|11368-8^IllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612271530-0500
OBX|4|CWE|11283-9^InitialAcuity^LN||2^Emergent^CDCEDACUITY||||||F|||201612271530-0500
OBX|5|TX|44833-2^ClinicalImpression^LN||Shortness of breath, cough, fever||||||F|||201612271530-0500
OBX|6|CWE|56816-2^HospitalUnit^LN||1108-0^EmergencyDepartment^HSLOC||||||F|||201612271530-0500
DG1|1|I10|R06.02^Shortness of breath^I10||201612271700-0500|W|||||||||1
DG1|2|I10|R05^Cough^I10||201612271700-0500|W|||||||||2


 Step 3: Discharge Trigger - ADT A03*

At 7:00 PM, radiology tests indicate the patient has pneumonia and a rapid influenza test is positive. The physician orders treatment and hospital admission. At 7:30 PM, ED staff complete the patient record and administratively discharge the patient from the ED. The final ICD-10-CM diagnoses codes are J1100 (influenza with pneumonia).

At 7:40 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits a Discharge message about this visit to the state health department.

*Please note that if the patient is admitted directly from the ED without a discharge transaction, the A03 Discharge message may be created by extrapolating from existing transactions such as the ADT^A06 Change from Outpatient to Inpatient or ADT^A02 Patient Transfer. In addition to Patient Class in PV1-2, the following data elements that are often available in the ADT messages may also help for filtering in the absence of an A03 Discharge transaction: PV1-4 Admission Type, PV1-14 Admit Source, PV1-6 Prior Patient Location.

Example Message - Step 3, Case 3:

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20161227194000-0500||ADT^A03^ADT_A03|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3^ISO
EVN|A03|20161227193000-0500|||||SWCornerHospitalED^2231231234^NPI
PID|1||4444^^^SWCornerHospitalED&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9^Asian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|E|1108-0^^^SWCornerHospitalED&2231231234&NPI|E|||||||||||||||4444_001^^^SWCornerHospitalED&2231231234&NPI^VN|||||||||||||||||09||||||||201612271530-0500|201612271930-0500
DG1|1|I10|J11.00^Influenza due to unidentified influenza virus with unspecified type of pneumonia^I10||201612271700-0500|F
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QE0002X^Emergency Care^HCPT||||||F|||201612271530-0500
OBX|2|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612271530-0500
OBX|3|TS|11368-8^IllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612271530-0500
OBX|4|CWE|56816-2^HospitalUnit^LN||1108-0^EmergencyDepartment^HSLOC||||||F|||201612271530-0500


Step 4: Admission Trigger - ADT A01

At 8:00 PM the patient is transported to a hospital room in the Pediatric ICU Unit. Clinical staff complete an admission record with the admit reason recorded as ICD-10-CM diagnosis code J1100 (influenza with pneumonia).

At 8:15 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits an Admission message about to this visit to the state health department.

Example Message - Step 4, Case 3:

MSH|^~\&|| SWCornerHospitalED^2231231234^NPI|||20161227201500-0500||ADT^A01^ADT_A01|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A01^^2.16.840.1.114222.4.10.3^ISO
EVN|A01|20161227200000-0500|||||SWCornerHospital^2231231234^NPI
PID|1||4444^^^SWCornerHospital&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9^Asian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|I|1047-0^302A^^SWCornerHospital&2231231234&NPI|E||1108-0^^^SWCornerHospital&2231231234&NPI|||||||||||||4444_001^^^SWCornerHospital&2231231234&NPI^VN|||||||||||||||||||||||||201612272000-0500
PV2|||J11.00^Influenza due to unidentified influenza virus with unspecified type of pneumonia^I10
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||1021-5^InpatientPracticeSetting^HCPT||||||F|||201612272000-0500
OBX|2|NM|21612-7^Age-Reported^LN||13|a^^UCUM|||||F|||201612272000-0500
OBX|3|NM|11289-6^BodyTemperature^LN||102.5|[degF]^Farenheit^UCUM|||||F|||201612272000-0500
OBX|4|NM|39156-5^BMI^LN||35|kg/m2^kilogram / (meter squared)^UCUM|||||F|||201612272000-0500
OBX|5|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612272000-0500
OBX|6|TS|11368-8^IllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612272000-0500
OBX|7|CWE|56816-2^HospitalUnit^LN||1047-0^PediatricRespiratoryCriticalCare^HSLOC||||||F|||201612272000-0500
DG1|1|I10|J11.00^Influenza due to unidentified influenza virus with unspecified type of pneumonia^I10||201612272000-0500|A


  Step 5: Discharge Trigger: ADT A03

At 7:30 PM on December 28, 2016, the patient is feeling better and is transferred to the general Pediatrics unit. On January 2, 2017 at 3:00 PM the patient is discharged to his home. The final discharge diagnosis is ICD-10-CM diagnosis code J1100 (influenza with pneumonia).  Note that the admit time changes on the transfer, which is not ideal.  It is preferred that the admit time remains constant.

The next day, at 12:00 PM on January 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits a Discharge message about this visit to the state health department.

Example Message - Step 5, Case 3:

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20170103120000-0500||ADT^A03^ADT_A03|NIST-SS-001.12|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3^ISO
EVN|A03|20140102150000-0500|||||SWCornerHospitalED^2231231234^NPI
PID|1||4444^^^SWCornerHospital&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9^Asian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|I|1211-2^602^1B^SWCornerHospital&2231231234&NPI|E||1047-0^302A^^SWCornerHospital&2231231234&NPI|||||||||||||4444_001^^^SWCornerHospital&2231231234&NPI^VN|||||||||||||||||01||||||||201612281930-0500|201701021500-0500
DG1|1|I10|J11.00^Influenza due to unidentified influenza virus with unspecified type of pneumonia^I10||201401021500-0500|F
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||1021-5^InpatientPracticeSetting^HCPT||||||F|||201612272000-0500
OBX|2|NM|8302-2^BodyHeight^LN||45|[in_us]^inch^UCUM|||||F|||201612272000-0500
OBX|3|NM|3141-9^BodyWeighMeasured^LN||768|[oz_av]^ounce^UCUM|||||F|||201612272000-0500
OBX|4|TX|8661-1^Chief Complaint^LN||fever, cough, difficulty breathing||||||F|||201612272000-0500
OBX|5|TS|11368-8^IllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612272000-0500
OBX|6|CWE|56816-2^HospitalUnit^LN||1211-2^PediatricMixedAcuityUnit^HSLOC||||||F|||201612281930-0500
OBX|7|CWE|8677-7^MedicationsPrescribedOrDispensed^LN||1163466^Levofloxacin 25 MG/ML Oral Solution^RXNORM||||||F|||201701021500-0500



Case 4: Inpatient Visit 

Case 4 presents an example of direct hospital admission containing all of the hospital inpatient data elements of interest with a Sender Usage of R or RE. ADT A01 and A03 messages are generated and sent to the PHA about this visit.

Step 1: Admission Trigger - ADT A01

On June 7, 2017 at 12:30 PM, a black, non-Hispanic 89-year-old male shows up at the Greater North Medical Center (Facility Identifier: 4356012945) with a request from his physician to admit him for complications from influenza. During registration, the patient's address is recorded as Billings, Yellowstone County, ZIP Code 59101. He tells the physician that he is suffering from fever, chills, and body aches as well as worsening shortness of breath. These symptoms are recorded as the patient's chief complaint. At 1:00 PM on June 7, 2017, the patient is admitted to an inpatient respiratory unit with an Admit Reason of ICD-10-CM J111 (influenza with other respiratory manifestations). The diagnosis type is recorded as an admitting diagnosis. The medical record number assigned by Greater North Medical Center, 123451247, is used to uniquely identify the patient. A visit number is assigned, 100023451247, which is used to uniquely identify the visit..

At 2:00 PM on June 7, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an Admission message about this visit to the state health department. PV1-4 Admission Type = 'U' for Urgent; PV1-14 Admission Source = '1' for Physician's referral.

Example Message - Step 1, Case 4

MSH|^~\&||GreaterNorthMedCtr^4356012945^NPI|||20170607140000-0500||ADT^A01^ADT_A01|NIST-SS-001.12|P|2.5.1|||AL|NE|||||PH_SS_A01^^2.16.840.1.114222.4.10.3^ISO
EVN|A01|20170607130000-0500|||||GreaterNorthMedCtr^4356012945^NPI
PID|1||123451247^^^GreaterNorthMedCtr&4356012945&NPI^MR||~^^^^^^S||19280204|M||2054-5^Black or African American^CDCREC|^^Billings^MT^59101^^^^30111|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|I|1069-4^^^GreaterNorthMedCtr&4356012945&NPI|U||||||||||1|||||100023451247^^^GreaterNorthMedCtr&4356012945&NPI^VN|||||||||||||||||||||||||201706071300-0500
PV2|||J10.1^Influenza due to other identified influenza virus with other respiratory manifestations^I10
OBX|1|CWE|56816-2^HospitalUnit^LN||1069-4^InpatientPulmonaryWard^HSLOC||||||F|||201706071300-0500
OBX|2|NM|21612-7^Age-Reported^LN||89|a^year^UCUM|||||F|||201706071300-0500
OBX|3|TX|8661-1^Chief Complaint^LN||fever, chills and body aches; worsening shortness of breath||||||F|||201706071300-0500
OBX|4|NM|11289-6^BodyTemperature^LN||99.8|[degF]^Farenheit^UCUM|||||F|||201706071300-0500
OBX|5|NM|39156-5^BMI^LN||30|kg/m2^kilogram / (meter squared)^UCUM|||||F|||201706071300-0500
OBX|6|NM|59408-5^OxygenSaturationinArterialBloodbyPulseOximetry^LN||99|%^Percent^UCUM|||||F|||201706071300-0500
OBX|7|NM|8480-6^SystolicBloodPressure^LN||128|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]^UCUM|||||F|||201706071300-0500
OBX|8|NM|8462-4^DiastolicBloodPressure^LN||92|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]^UCUM|||||F|||201706071300-0500
OBX|9|TX|10182-4^HistoryOfTravelNarrative^LN||Travel within the past 30 days:yes~Travel outside the United States:no||||||F|||201706071300-0500
OBX|10|CWE|72166-2^TobaccoSmokingStatus^LN||449868002^Current every day smoker^SCT||||||F|||201706071300-0500
OBX|11|CWE|11450-4^ProblemList^LN|1|47372000^Adjustment disorder with anxious mood^SCT||||||F|||201706071300-0500
OBX|12|CWE|11450-4^ProblemList^LN|2|F4321^Adjustment disorder with depressed mood^I10||||||F|||201706071300-0500
OBX|13|CWE|11450-4^ProblemList^LN|3|195967001^Asthma (disorder)^SCT||||||F|||201706071300-0500
OBX|14|CWE|11450-4^ProblemList^LN|4|H547^Unspecified visual loss^I10||||||F|||201706071300-0500
OBX|15|CWE|11450-4^ProblemList^LN|5|K2970^Gastritis, unspecified, without bleeding^I10||||||F|||201706071300-0500
OBX|16|CWE|11450-4^ProblemList^LN|6|104931000119100^Chronic kidney disease due to hypertension (disorder)^SCT||||||F|||201706071300-0500
OBX|17|CWE|11450-4^ProblemList^LN|7|13644009^Hypercholesterolemia (disorder)^SCT||||||F|||201706071300-0500
OBX|18|TX|10160-0^MedicationList^LN||Lasix 20 mg po bid; Simvastatin 40 mg po qd||||||F|||201706071300-0500
DG1|1|I10|J10.1^Influenza due to other identified influenza virus with other respiratory manifestations^I10||201706071300-0500|A


 Step 2: Discharge Trigger: ADT A03

After admission, the patient is treated for influenza and over the course of the next 7 days begins to recover from the respiratory complications of his influenza. After laboratory testing, the physicians confirm that the patient suffered from the H1N1 strain of influenza, possibly accounting for its severe manifestations. On June 15, 2017 at 3:45 PM, the patient is discharged from the hospital to his home with a final discharge diagnosis of ICD-10-CM J09X9 (INFLUENZA DUE TO IDENTIFIED NOVEL INFLUENZA A VIRUS WITH OTHER MANIFESTATIONS). The final discharge message is ready 3 days after discharge.

At 2:15 PM on June 18, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits a Discharge message about this visit to the state health department.

Example Message - Step 2, Case 4:

MSH|^~\&||GreaterNorthMedCtr^4356012945^NPI|||20170618141500-0500||ADT^A03^ADT_A03|NIST-SS-001.12|P|2.5.1|||AL|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3^ISO
EVN|A03|20170615154500-0500|||||GreaterNorthMedCtr^4356012945^NPI
PID|1||123451247^^^GreaterNorthMedCtr&4356012945&NPI^MR||~^^^^^^S||19280204|M||2054-5^Black or African American^CDCREC|^^Billings^MT^59101^^^^30111|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|I|1069-4^^^GreaterNorthMedCtr&4356012945&NPI|U||||||||||1|||||100023451247^^^GreaterNorthMedCtr&4356012945&NPI^VN|||||||||||||||||01||||||||201706071300-0500|201706151545-0500
DG1|1|I10|J10.1^Influenza due to other identified influenza virus with other respiratory manifestations^I10||201706151534-0500|F
OBX|1|CWE|56816-2^HospitalUnit^LN||1069-4^InpatientPulmonaryWard^HSLOC||||||F|||201706071300-0500
OBX|2|NM|21612-7^Age-Reported^LN||89|a^year^UCUM|||||F|||201706071300-0500
OBX|3|TX|8661-1^ChiefComplaint^LN||fever, chills and body aches; worsening shortness of breath||||||F|||201706071300-0500



Case 5 - Ambulatory Care Visit 

Case Study 5 provides an example of a routine patient visit in an ambulatory care clinical setting. The patient's chief complaint is captured as an unstructured, free-text value using the patient's own words. ADT A04 and A03 messages are generated and sent to the PHA about this visit.

Step 1: Registration Trigger - ADT A04

A 28-year-old female walks into Midtown Obstetric Clinic on August 17, 2017 at 1:00 PM. The patient arrival is noted in the registration/appointment system by a clerical assistant who verifies the patient's demographics and appointment information. The patient gave her race as white and black and her ethnic group as non-Hispanic, which is captured with the demographic information in the EHR.

At 1:05 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Registration/Patient Arrival message to Big City Health Department about this visit.

Example Message - Step 1, Case 5:

MSH|^~\&||MidTwnObstetricCl^2231231234^NPI|||20170817130500-0500||ADT^A04^ADT_A01|NIST-SS-001.14|P|2.5.1|||AL|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3^ISO
EVN|A04|20170817130500-0500|||||MidTwnObstetricCl^2231231234^NPI
PID|1||233222^^^MidTwnObstetricCl&2231231234&NPI^MR||~^^^^^^S||19890312|F||2106-3^White^CDCREC~2054-5^BLACK OR AFRICAN AMERICAN^CDCREC|^^Atlanta^13^30303^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|O|1117-1^^R102^MidTwnObstetricCl&2231231234&NPI|R|||1234567890^^^^^^^^NPI&2.16.840.1.113883.4.6^ISO||||||||||||233222_04^^^MidTwnObstetricCl&2231231234&NPI^VN|||||||||||||||||||||||||201708171300-0500
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QP2300X^Primary Care^HCPT||||||F|||201708171300-0500
OBX|2|NM|21612-7^Age-Reported^LN||28|a^year^UCUM|||||F|||201708171300-0500
OBX|3|TX|8661-1^ChiefComplaint^LN||Routine obstetric appointment but may have a cold and is concerned||||||F|||201708171300-0500
OBX|4|CWE|11449-6^PregnancyStatus^LN||Y^Yes^HL70136||||||F|||201708171300-0500
OBX|5|NM|39156-5^BMI^LN||28|kg/m2^kilogram / (meter squared)^UCUM|||||F|||201708171300-0500
OBX|6|CWE|11450-4^ProblemList-Reported^LN||N390^Urinary tract infection, site not specified^I10||||||F|||201708171445-0500
OBX|7|TX|10160-6^MedicationUse^LN||Estrogen therapy (Estradiol) Antianxiety treatment (Serzone, Wellbutrin)||||||F|||201708171300-0500


 Step 2: Discharge Trigger: ADT A03

After the patient is seen for her routine visit, a discharge message is created that includes the diagnosis and procedure codes from the billing face sheet. The final discharge message is ready immediately when the patient checks out.

At 2:45 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Discharge/Visit End message to Big City Health Department about this visit.

Example Message - Step 2, Case 5:

MSH|^~\&||MidTwnObstetricCl^2231231234^NPI|||20170817144500-0500||ADT^A03^ADT_A03|NIST-SS-001.12|P|2.5.1|||AL|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3^ISO
EVN|A03|20170817144500-0500|||||MidTwnObstetricCl^2231231234^NPI
PID|1||233222^^^MidTwnObstetricCl&2231231234&NPI^MR||~^^^^^^S||19890607|F||2106-3^White^CDCREC~2054-5^BLACK OR AFRICAN AMERICAN^CDCREC|^^Atlanta^13^30303^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC
PV1|1|O|1117-1^^R102^MidTwnObstetricCl&2231231234&NPI|R|||1234567890^^^^^^^^NPI&2.16.840.1.113883.4.6^ISO||||||||||||233222_04^^^MidTwnObstetricCl&2231231234&NPI^VN|||||||||||||||||01||||||||201708171305-0500|20170817144500-0500
DG1|1|I10|Z34.9^Encounter for supervision of normal pregnancy, unspecified^I10||20170817144500-0500|F
OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QP2300X^Primary Care^HCPT||||||F|||201708171300-0500
OBX|2|NM|21612-7^Age-Reported^LN||28|a^year^UCUM|||||F|||201708171300-0500
OBX|3|TX|8661-1^Chief complaint^LN||Routine obstetric appointment but may have a cold and is concerned||||||F|||201708171300-0500
OBX|4|CWE|11449-6^Pregnancy Status^LN||Y^Yes^HL70136||||||F|||201708171300-0500
OBX|5|NM|39156-5^BMI^LN||28|kg/m2^kilogram / (meter squared)^UCUM|||||F|||201708171300-0500
OBX|6|CWE|11450-4^ProblemListReported^LN||N390^Urinary tract infection, site not specified^I10||||||F|||201708171445-0500
OBX|7|CWE|8677-7^MedicationUseReported^LN||749856^Estradiol 1 MG / noregestimate 0.09 MG OralTablet^RXNORM~151679^Serzone^RXNORM~42568^Wellbutrin^RXNORM~431722^12 HR Tramadol 100 MG Extended Release Tablet^RXNORM||||||F|||201708171445-0500



Case 6: Batch Messaging Example

Mid-Co Health Center routinely sends syndromic data to the state public health authority. Mid-Co sends the messages that have gathered during the previous 12-hour period in batch message format. There are 240 messages.

FHS|^~\&|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20110123120000-0500
BHS|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20110123120000-0500

MSH|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20110123003938-0500||ADT^A01^ADT_A01|ER1-20110123-001|P|2.5.1
.
.
.
(Last segment of 1st message)
(Continue to append subsequent messages …)
.
.
.
MSH|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|20110123115826-0500||ADT^A01^ADT_A01|ER1-20110123-240|P|2.5.1
(Last segment of 240th message)

BTS|240|MiCo reporting 1-23-2011: 0000-1200 hrs
FTS|1



Case 7: Sample International Address Formats 

Mexico

Super Manzana 3 - 403 [street name + building number - apartment number] Puerto Juarez [village] 77520 CANCUN, Q. ROO [postcode + locality name, province abbreviation MEXICO [country name]

Example PID Segment - Mexico Address, Case 7:  

PID|1||MX01059711||~^^^^^^S|||M|||Super Manzana 3 - 403^Puerto Juarez^CANCUN^Q. ROO^77520^MEX


Canada

111 FAIRFORD STREET EAST MOOSE JAW SK S6H 2X1 CANADA

Example PID Segment - Canada Address, Case 7:  

PID|1||CA01059711||~^^^^^^S|||M|||111 FAIRFORD STREET EAST^^MOOSE JAW^SK^S6H 2X1^CAN

Message Infrastructure

Conformance Profiles

Patient Admit - ADT^A01 - Inpatient Visit Begin

HL7 Version Publication Date Publication Version
2.5.1 0

Conformance Profile Definition
Segment Flavor Element name Usage Cardinality
MSH MSH_SS Message Header R [1..1]
EVN EVN_SS Event Type R [1..1]
PID PID_SS_A01 Patient Identification R [1..1]
PV1 PV1_SS_A01 Patient Visit R [1..1]
PV2 PV2_SS Patient Visit - Additional Information RE [0..1]
OBX OBX_SS Observation/Result R [1..*]
DG1 DG1_SS Diagnosis RE [0..*]
[ BEGIN PROCEDURE GROUP RE [0..*]
PR1 PR1_SS Procedures R [1..1]
] END PROCEDURE GROUP
[ BEGIN INSURANCE GROUP RE [0..*]
IN1 IN1_SS Insurance R [1..1]
] END INSURANCE GROUP

Conformance Statements
Message:
ID Description
ADT^A01_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A01'.
ADT^A01_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
ADT^A01_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A01'.
ADT^A01_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.

Patient Registration - ADT^A04 - Outpatient Visit Begin

HL7 Version Publication Date Publication Version
2.5.1 0

Conformance Profile Definition
Segment Flavor Element name Usage Cardinality
MSH MSH_SS Message Header R [1..1]
EVN EVN_SS Event Type R [1..1]
PID PID_SS_A04_A08_A03 Patient Identification R [1..1]
PV1 PV1_SS_A04 Patient Visit R [1..1]
PV2 PV2_SS Patient Visit - Additional Information RE [0..1]
OBX OBX_SS Observation/Result R [1..*]
DG1 DG1_SS Diagnosis RE [0..*]
[ BEGIN PROCEDURE GROUP RE [0..*]
PR1 PR1_SS Procedures R [1..1]
] END PROCEDURE GROUP
[ BEGIN INSURANCE GROUP RE [0..*]
IN1 IN1_SS Insurance R [1..1]
] END INSURANCE GROUP

Conformance Statements
Message:
ID Description
ADT^A04_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A04'.
ADT^A04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
ADT^A04_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A04'.
ADT^A04_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.

Patient Discharge - ADT^A03 - Visit End

HL7 Version Publication Date Publication Version
2.5.1 0

Conformance Profile Definition
Segment Flavor Element name Usage Cardinality
MSH MSH_SS Message Header R [1..1]
EVN EVN_SS Event Type R [1..1]
PID PID_SS_A04_A08_A03 Patient Identification R [1..1]
PV1 PV1_SS_A03 Patient Visit R [1..1]
PV2 PV2_SS Patient Visit - Additional Information RE [0..1]
DG1 DG1_SS Diagnosis RE [0..*]
[ BEGIN PROCEDURE GROUP RE [0..*]
PR1 PR1_SS Procedures R [1..1]
] END PROCEDURE GROUP
OBX OBX_SS Observation/Result R [1..*]
[ BEGIN INSURANCE GROUP RE [0..*]
IN1 IN1_SS Insurance R [1..1]
] END INSURANCE GROUP

Conformance Statements
Message:
ID Description
ADT^A03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A03'.
ADT^A03_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
ADT^A03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A03'.
ADT^A03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A03'.

Patient Update - ADT^A08 - Visit Update

HL7 Version Publication Date Publication Version
2.5.1 0

Conformance Profile Definition
Segment Flavor Element name Usage Cardinality
MSH MSH_SS Message Header R [1..1]
EVN EVN_SS Event Type R [1..1]
PID PID_SS_A04_A08_A03 Patient Identification R [1..1]
PV1 PV1_SS_A08 Patient Visit R [1..1]
PV2 PV2_SS Patient Visit - Additional Information RE [0..1]
OBX OBX_SS Observation/Result R [1..*]
DG1 DG1_SS Diagnosis RE [0..*]
[ BEGIN PROCEDURE GROUP RE [0..*]
PR1 PR1_SS Procedures R [1..1]
] END PROCEDURE GROUP
[ BEGIN INSURANCE GROUP RE [0..*]
IN1 IN1_SS Insurance R [1..1]
] END INSURANCE GROUP

Conformance Statements
Message:
ID Description
ADT^A03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A08'.
ADT^A03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A08'.
ADT^A03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.
ADT^A04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.

Acknowledgement - ACK - ACK

HL7 Version Publication Date Publication Version
2.5.1 0

Conformance Profile Definition
Segment Flavor Element name Usage Cardinality
MSH MSH_SS Message Header R [1..1]
MSA MSA_SS Message Acknowledgment R [1..1]

Conformance Statements
Message:
ID Description
MSH_SS_ACK_01 The value of MSH.9.1 (Message Code) SHALL be 'ACK'.
MSH_SS_ACK_02 The value of MSH.9.3 (Message Structure) SHALL be 'ACK'.
MSH_SS_ACK_03 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_ACK'.

Segments and Field Descriptions


Message segments are listed below in alphabetical order.  See the previous section for proper segment order within the message.

DG1_SS - Diagnosis


The DG1 segment contains patient diagnosis information of various types. Syndromic surveillance supports Admitting, Working and Final Diagnosis types. 

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - DG1 SI R [1..1]
2 Diagnosis Coding Method ID R [1..1]
3 Diagnosis Code - DG1 CE_SS R [1..1] PHVS_AdministrativeDiagnosis_CDC_ICD-10CM,PHVS_Disease_CDC
5 Diagnosis Date/Time TS_SS_toMinute R [1..1]
6 Diagnosis Type IS R [1..1] PHVS_DiagnosisType_HL7_2x
15 Diagnosis Priority ID O [0..1] PHVS_DiagnosisPriority_HL7_2x

Conformance Statements
ID Description
DG1_SS_8603629 The value of DG1-3.3 SHALL be one of list values: I10,SCT.

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
DG1_SS-3 PHVS_AdministrativeDiagnosis_CDC_ICD-10CM Diagnosis (ICD-10 CM)
DG1_SS-3 PHVS_Disease_CDC Disease
DG1_SS-6 PHVS_DiagnosisType_HL7_2x Diagnosis Type (HL7)
DG1_SS-15 PHVS_DiagnosisPriority_HL7_2x Diagnosis Priority (HL7)


Note:  If possible the first DG1 should contain the primary diagnosis because not all EHRs implement DG1-15, diagnosis priority.

Example segments:

DG1-6: Diagnosis Type (IS)

It is critical for a syndromic surveillance system to be able to distinguish among diagnosis types in real-time. Diagnosis Type can help identify the type/status of diagnosis since it may change over the course of the patient visit.

EVN_SS - Event Type

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Event Type Code ID O [0..1]
2 Recorded Date/Time TS_SS_toSecond R [1..1]
7 Event Facility HD_SS R [1..1]


Example Segment that shows the use of the National Provider Identifier (NPI) for the facility identifier: 

EVN-2: Recorded Date/Time (TS_SS_toSecond)

If data flows through an intermediary or third party, the intermediary must keep the original date/time of transmission.

EVN-7: Event Facility (HD_SS)

This field identifies the location where patient was treated. Use of the organization's legal name associated with the National Provider Identifier (NPI) standard provided by Centers for Medicare and Medicaid Services is recommended. If NPI is not available, use a different unique identifier, such as an OID or a state-designated identifier. This number should be specific for each facility location (not a number representing an umbrella business). NPI is a 10-digit identifier. Note: The use of NPI should be discussed during the implementation process because local public health jurisdictions may differ on their use of identifiers for this field, and sending healthcare facilities may have different NPIs for different services, staff, and departments operating at different levels across their organization.

IN1_SS - Insurance

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - IN1 SI R [1..1]
2 Insurance Plan ID CE_SS R [1..1] 0072
3 Insurance Company ID CX_SS R [1..*]
15 Plan Type IS O [0..1] PHVS_SourceOfPaymentTypology_PHDSC

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
IN1_SS-2 0072 Insurance Plan ID
IN1_SS-15 PHVS_SourceOfPaymentTypology_PHDSC Source of Payment Typology (PHDSC)

IN1-2: Insurance Plan ID (CE_SS)

This field contains a unique identifier for the insurance plan.  If an insurance plan ID is unavailable, use |UNK^UNKNOWN^NULLFL| to meet the requirement to populate the field with a CE value type for HL7 compliance.

IN1-3: Insurance Company ID (CX_SS)

This field contains unique identifiers for the insurance company.  The assigning authority and identifier type code are strongly recommended for all CX data types.  If an insurance company identifier is unavailable, use |UNKNOWN^^^UNKNOWN| to meet the requirement to populate the field as a CX value type for HL7 compliance.

MSA_SS - Message Acknowledgment

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Acknowledgment Code ID R [1..1] PHVS_AcknowledgmentCode_HL7_2x
2 Message Control ID ST R [1..1]

Conformance Statements
ID Description
MSA_SS_5067426 MSH-2 Shall match MSH-10 value of message being acknowledged

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
MSA_SS-1 PHVS_AcknowledgmentCode_HL7_2x Acknowledgment Code (HL7)

MSA-2: Message Control ID (ST)

This field contains the message control ID of the message sent by the SS Data Sender. It allows the SS Data Sender to associate this response with the message for which it is intended.

MSH_SS - Message Header

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Field Separator ST R [1..1]
2 Encoding Characters ST R [1..1]
3 Sending Application HD_SS RE [0..1] 0361
4 Sending Facility HD_SS R [1..1] 0362
5 Receiving Application HD_SS RE [0..1] 0361
6 Receiving Facility HD_SS RE [0..1] 0362
7 Date/Time Of Message TS_SS_toSecond R [1..1]
9 Message Type MSG_SS R [1..1]
10 Message Control ID ST R [1..1]
11 Processing ID PT_SS R [1..1]
12 Version ID VID_SS R [1..1]
15 Accept Acknowledgment Type ID R [1..1] 0155
16 Application Acknowledgment Type ID R [1..1] 0155
21 Message Profile Identifier EI R [1..*]

Conformance Statements
ID Description
MSH_SS_4611129 The value of MSH-1 (Field Separator) SHALL be '|'.
MSH_SS_6631423 The value of MSH-21[*].3 SHALL be '2.16.840.1.114222.4.10.3'.
MSH_SS_7465888 The value of MSH-2 (Encoding Characters) SHALL be '^~\&'.
MSH_SS_9284050 The value of MSH-21[*].4 SHALL be 'ISO'.

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
MSH_SS-3 0361 Application
MSH_SS-4 0362 Facility
MSH_SS-5 0361 Application
MSH_SS-6 0362 Facility
MSH_SS-15 0155 Accept/application acknowledgment conditions
MSH_SS-16 0155 Accept/application acknowledgment conditions

MSH-1: Field Separator (ST)

This field contains the separator (literal value of | )  between the segment ID and the first real field, MSH-2-encoding characters. As such, it serves as the separator and defines the character to be used as a separator for the rest of the message.

MSH-2: Encoding Characters (ST)

This field contains the four characters in the following order: the component separator, repetition separator, escape character, and subcomponent separator.

MSH-3: Sending Application (HD_SS)

This field uniquely identifies the sending application from the other applications in the network enterprise. The network enterprise comprises all applications that participate in the exchange of HL7 messages.

MSH-4: Sending Facility (HD_SS)

This field uniquely identifies the facility associated with the application that sends the message, as documented in MSH-3, the sending application. If Acknowledgements are in use, this facility will receive any related Acknowledgement message. Use of NPI is recommended (10-digit identifier).

MSH-5: Receiving Application (HD_SS)

This field uniquely identifies the receiving application among all other applications within the network enterprise. The network enterprise comprises all applications that participate in the exchange of HL7 messages. This field is entirely site-defined.

MSH-6: Receiving Facility (HD_SS)

This field identifies the receiving application among multiple identical instances of the application running on behalf of different organizations. If acknowledgements are in use, this represents the facility that would generate and send acknowledgement messages.

MSH-7: Date/Time Of Message (TS_SS_toSecond)

This field contains the date/time that the sending system created the message. If the time zone is specified, it will be used throughout the message as the default time zone.  

MSH-10: Message Control ID (ST)

This field contains a number or other identifier that uniquely identifies the message. The receiving system echoes this ID back to the sending system in the Message acknowledgment segment (MSA).  Note: This field is a number or other identifier that uniquely identifies the message.

MSH-11: Processing ID (PT_SS)

Indicates how to process the message as defined in HL7 processing rules; whether the message should be handled for production (P) usage, for training (T), or for debugging (D).

MSH-12: Version ID (VID_SS)

The HL7 version number is used to interpret message format and content. This field is matched by the receiving system to its own version to be sure the message will be interpreted correctly. For this guide, the value shall be 2.5.1.

MSH-21: Message Profile Identifier (EI)

Sites may use this field to assert adherence to, or reference, a message profile. Message profiles contain detailed explanations of grammar, syntax, and usage for a particular message or set of messages.

OBX_SS - Observation/Result


The OBX co-constraint is a related constraint concept used to express dependencies across a set of data values. The co-constraints table below typically follows the form "IF OBX-3 equals LOINC XXXXX-X, THEN OBX-2 shall be CWE and OBX-5 shall be constrained to value set YYY" or a similar form, sometimes involving OBX-6 as well. The USER portion of the table includes description, usage, examples, and implementation notes.

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - OBX SI R [1..1]
2 Value Type ID R [1..1] PHVS_ValueType_SyndromicSurveillance
3 Observation Identifier CE_SS R [1..1] PHVS_ObservationIdentifier_SyndromicSurveillance,PHVS_VitalSignResult_HITSP
4 Observation Sub-ID ST O [0..1]
5 Observation Value VARIES RE [1..*]
6 Units CE_SS C(R/X) [0..1]
11 Observation Result Status ID R [1..1] 0085
14 Date/Time of the Observation TS_SS_toMinute RE [0..1]

Conformance Statements
ID Description
OBX_7289447_2355451 The value of OBX-1 (Set ID - OBX) SHALL be valued sequentially starting with the value '1'.

Conditional Predicates
Location Usage Description
OBX-6 C(R/X) If the value of OBX-2 (Value Type) is 'NM'.

Co-Constraints
IF (OBX-3) Column Value
SS002 THEN
OBX-2(Value) XAD
OBX-2(Flavor) XAD_SS
USER
Description Treating Facility Location
Usage RE
Example OBX|1|XAD|SS002^TREATING FACILITY LOCATION^PHINQUESTION||1 234 Anywhere Street^^Doraville^13^303 41^USA^C^^13089||||||F|| |201102091114-0500
Implementation Notes If this data element is captured and maintained as part of the facility registration process, it may not be sent with every message. See ISDS recommendations, section 4.2, on Facility Registration.8 This data can also be accommodated in the Facility Registration process as defined by ISDS.
SS003 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
OBX-5(Value Set) PHVS_FacilityVisitType_SyndromicSurveillance
USER
Description Facility/Visit Type
Usage R
Example OBX|2|CWE|SS003^FACILIT Y/VISIT TYPE^PHINQUESTION|| 261QU0200X^Urgent Care^ HCPTNUCC||||||F|||20110 2091114-0500
Implementation Notes Relevant facility/visit type values are defined in value set. These data can also be accommodated in the Facility Registration process, as defined by Syndromic Surveillance Community of Practice for facilities where a single facility/visit type is expected.
21612-7 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_AgeUnit_SyndromicSurveillance
USER
Description Age
Usage RE
Example For a patient older than 2 years: OBX|4|NM|21612-7^AGE-REPORTED^LN||43|a^YEAR^UCUM|||||F|||201102170000-0500 For a patient younger than 2 years: OBX|4|NM|21612-7^AGE-REPORTED^LN||5|mo^month^ UCUM|||||F|||201102170000-0500
Implementation Notes Data providers and receivers should determine specific data restrictions for their jurisdiction. To de-identify age, the age must be rounded to an integer. For patient age greater than or equal to (>=) 2 years old, report in whole years. Unit value should be "Year" • Truncate age to integer. For example, 16.75 years = 16 years old. For patient age less than (<) 2 years old, report the age in integer months. Do not report days or weeks. • Truncate month to integer. For example, 5 months and 20 days = 5 months old. • Unit value should be "Months" for patient age less than (<) 2 years old.
56816-2 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
OBX-5(Value Set) PHVS_HealthcareServiceLocation_Syndromic
USER
Description Patient Service Location
Usage RE
Example OBX|3|CWE|56816-2^PATIENT LOCATION^LN||1029- 8^Medical/Surgical critical care unit^HSLOC||||||F|||201102170000-0500
Implementation Notes INPATIENT DATA ELEMENT OF INTEREST ONLY NOTE: this is a standardization of the PV1-3 Assigned Patient Location that will require a mapping to the Healthcare Service Location codes.
8302-2 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_HeightUnit_UCUM
USER
Description Height
Usage RE
Example OBX|3|NM|8302-2^BODY HEIGHT^LN||69|[in_us]^in ch [length]^UCUM |||||F|||201102170000-0500
Implementation Notes Allows calculation of Body Mass Index (BMI), which may be an indicator of obesity for chronic disease. Note: If BMI can be calculated within the EHR, then it is preferable to just receive BMI instead of height and weight.
3141-9 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_WeightUnit_UCUM
USER
Description Weight
Usage RE
Example OBX|3|NM|3141-9^BODY WEIGHT MEASURED^LN||120|[lb_av]^ pound[mass]^UCUM|||||F|||201102170800-0500
Implementation Notes Allows calculation of Body Mass Index (BMI), which may be an indicator of obesity for chronic disease. Note: If BMI can be calculated within the EHR, then it is preferable to just receive BMI instead of height and weight.
39156-5 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
USER
Description Body mass index (BMI) [Ratio]
Usage RE
Example OBX|3|NM|39156-5^Body Mass Index^LN||35|kg/m2^kilogram / (meter squared)^UCUM| ||||F|||201102170800-0500
Implementation Notes If BMI can be calculated within the EHR, then it is preferable to just receive BMI instead of height and weight
8661-1 THEN
OBX-2(Value) TX
OBX-2(Flavor) TX
USER
Description Chief complaint
Usage RE
Example OBX|3|TX|8661-1^CHIEF COMPLAINT - REPORTED^LN||STOMACH ACHE THAT HAS LASTED 2 DAYS; NAUSEA AND VOMITING; MAYBE A FEVER||||||F|||201102171 531-0500
Implementation Notes This field is the patient's self-reported chief complaint or reason for visit. The field is distinct from the Admit Reason field, which is the provider's reason for admitting the patient. Senders should send the most complete description of the patient's chief complaint. Only send a single chief complaint, but use commas and/or semicolons to break up the text as agreed upon by data-trading partners. Although free text is preferred, if text for both the free-text chief complaint and drop-down selection chief complaint are available, send both. Some systems may automatically overwrite chief complaint with final diagnosis when the final diagnosis code is assigned. The chief complaint text should NOT be replaced with other information either manually or by the data provider's system. Keep the chief complaint the same as how it was initially captured.
11368-8 THEN
OBX-2(Value) TS
OBX-2(Flavor) TS_SS_toDay
USER
Description Date of Onset
Usage O
Example OBX|7|TS|11368-8^ILLNESS OR INJURY ONSET DATE^LN||20110215||||||F|||201102170325-0500
Implementation Notes Refers to the time when the health episode described by the chief complaint(s) began.
54094-8 THEN
OBX-2(Value) TX
OBX-2(Flavor) TX
USER
Description Triage Note
Usage RE
Example OBX|7|TX|54094-8^EMERGENCY DEPARTMENT TRIAGE NOTE^LN||Pain a recurrent cramping sensation.||||||F|||201102091114-0500
Implementation Notes ED/UC DATA ELEMENT OF INTEREST ONLY This element is represented by the LOINC code: 54094-8 in the OBX observation identifier. Send Triage Notes as free text. Triage notes may benefit from additional processing (e.g., negation processing, natural language processing) to maximize the utility of the data.
44833-2 THEN
OBX-2(Value) TX
OBX-2(Flavor) TX
USER
Description Clinical impression
Usage O
Example OBX|1|TX|44833- 2^PRELIMINARY DIAGNOSIS^LN||Pain consist with appendicitis||||||F|||20 1102091115-0500
Implementation Notes Send Clinical Impression as free text.
11449-6 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
OBX-5(Value Set) 0532
USER
Description Pregnancy status
Usage RE
Example OBX|1|CWE|11449-6 Pregnancy Status ^LN||Y^Yes^HL70136||||||F|||201102170000-0500
Implementation Notes Y, N, UNK
11450-4 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
USER
Description Problem list
Usage O
Example OBX|1|CWE|11450- 4^Problem List - Reported^LN|| N39.0^Urinary tract infection, site not specified^I10 ||||||F|||201102170000-0500
Implementation Notes Rationale: Can provide co-morbidity, pregnancy status, and indications of chronic disease conditions, level of severity and medical and surgical histories. The Problem List may be derived from the HL7 Message types PPR - Patient Problem Message (Events PC1, PC2, PC3). The patient problem message is used to send problems from one application to another (e.g., a point-of-care system to a clinical repository). This option allows systems that need this information to set up transactions that fulfill requirements.
10160-0 THEN
OBX-2(Value) TX
OBX-2(Flavor) TX
USER
Description Medication List - Current medications entered as narrative
Usage O
Example OBX|1|TX|10160-0^Medication Use Reported^LN||Lasix 20 mg po bid, Simvastatin 40 mg po qd||||||F|||201102170000-0500
Implementation Notes Current medications entered as narrative. OBX-14, observation datetime, indicates when the observation was made and has nothing to do with date parameters of the prescription.
8677-7 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
OBX-6(Value Set) PHVS_MedicationClinicalDrugName_HITSP,PHVS_MedicationBrandName_HITSP
USER
Description Medications prescribed or dispensed - Current medications entered as standardized codes
Usage O
Example OBX|7|CWE|8677-7^MedicationsPrescribedOrDispensed^LN||1163466^Levofloxacin 25 MG/ML Oral Solution^RXNORM||||||F|||201401021500-0500
Implementation Notes Current medications entered as standardized codes. OBX-14, observation datetime, indicates when the observation was made and has nothing to do with date parameters of the prescription. The preferred method to send multiple medications is by repetition of OBX-5. See case 5, seventh OBX of the Messaging Examples.
8480-6 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_BloodPressureUnit_UCUM
USER
Description Systolic blood pressure
Usage O
Example OBX|5|NM|8480- 6^SYSTOLIC BLOOD PRESSURE^LN||120|mm(hg) |||||F|||201102170345-0500
Implementation Notes Allows monitoring of chronic conditions and "most recent" patient's systolic and diastolic blood pressure. "Most recent" is the blood pressure taken most closely to the time that message is constructed/assembled.
8462-4 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_BloodPressureUnit_UCUM
USER
Description Diastolic blood pressure
Usage O
Example OBX|6|NM|8462- 4^DIASTOLIC BLOOD PRESSURE^LN||90|mm(hg)| ||||F|||201102170235-0500
Implementation Notes Allows monitoring of chronic conditions and "most recent" patient's systolic and diastolic blood pressure. "Most recent" is the blood pressure taken most closely to the time that message is constructed/assembled.
11289-6 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_TemperatureUnit_UCUM
USER
Description Initial temperature
Usage O
Example OBX|3|NM|11289-6^BODY TEMPERATURE^LN||100.1|[ degF]^FARENHEIT^UCUM|||||F|||201102170000-0500
59408-5 THEN
OBX-2(Value) NM
OBX-2(Flavor) NM
OBX-6(Value Set) PHVS_PulseOximetryUnit_UCUM
USER
Description Initial pulse oximetry
Usage O
Example OBX|4|NM|59408-5^OXYGENSATURATION IN ARTERIALBLOOD BY PULSEOXIMETRY^LN||91|%^PERCENT^UCUM||A|||F|||20110217145139-0500
72166-2 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
OBX-5(Value Set) PHVS_SmokingStatus_MU
USER
Description Smoking status
Usage RE
Example OBX|1|CWE|72166-2^TOBACCO SMOKINGSTATUS^LN||428071000124 103 ^Current Heavy tobacco smoker^SCT||||||F|||201102170000-0500
Implementation Notes This data element is required by Promoting Interoperability (formerly Meaningful Use). Allows monitoring of chronic conditions.
11283-9 THEN
OBX-2(Value) CWE
OBX-2(Flavor) CWE_SS
OBX-5(Value Set) PHVS_EmergencySeverityIndexAcuity_CDC
USER
Description Initial acuity
Usage O
Example OBX|1|CWE|11283-9^INITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500
10182-4 THEN
OBX-2(Value) TX
OBX-2(Flavor) TX
USER
Description Travel history
Usage RE
Example OBX|1|TX|10182-4^History of travel Narrative^LN||Arrived home from Liberia two days ago.||||||F|||201102170000-0500
Implementation Notes Some public health jurisdictions find utility in putting "YES" or "NO" at the beginning of this field, followed by the travel location if "Yes."

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
OBX_SS-2 PHVS_ValueType_SyndromicSurveillance Value Type (Syndromic Surveillance)
OBX_SS-3 PHVS_ObservationIdentifier_SyndromicSurveillance Observation Identifier (Syndromic Surveillance)
OBX_SS-3 PHVS_VitalSignResult_HITSP Vital Sign Result Value Set
OBX_SS-11 0085 Observation result status codes interpretation

OBX-1: Set ID - OBX (SI)

This field contains the sequence number.  Set ID numbers the repetitions of the segments.

OBX-11: Observation Result Status (ID)

This field contains the observation result status.  This field reflects the current completion status of the results for one Observation Identifier.

OBX-14: Date/Time of the Observation (TS_SS_toMinute)

This field is the observation date/time which is physiologically relevant or the closest approximation.

PID_SS_A01 - Patient Identification

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PID SI R [1..1]
3 Patient Identifier List CX_SS R [1..*]
5 Patient Name XPN_SS R [1..*]
7 Date/Time of Birth TS_SS_toDay O [0..1]
8 Administrative Sex IS RE [0..1] PHVS_Gender_SyndromicSurveillance
10 Race CE_SS RE [0..*] PHVS_RaceCategory_CDC
11 Patient Address XAD_SS RE [0..1]
18 Patient Account Number CX_SS O [0..1]
22 Ethnic Group CE_SS RE [0..1] PHVS_EthnicityGroup_CDC
33 Last Update Date/Time TS_SS_toMinute O [0..1]
34 Last Update Facility HD_SS O [0..1]

Conformance Statements
ID Description
PID_SS_6738094 If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL be one of list values: |~^^^^^^S|,|~^^^^^^U|

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PID_SS_A01-8 PHVS_Gender_SyndromicSurveillance Gender (Syndromic Surveillance)
PID_SS_A01-10 PHVS_RaceCategory_CDC Race Category
PID_SS_A01-22 PHVS_EthnicityGroup_CDC Ethnicity group


Example PID Segment that shows a Hispanic white female patient.  The deceased indicator and date fields are used. Patient address is described as the mailing address, with 13 as the FIPS numeric for Georgia.  


Example PID Segment that shows a male patient with multiple patient identifiers and multiple race codes.  

PID-3: Patient Identifier List (CX_SS)

PID-3 is a repeating field that can accommodate multiple patient identifiers. Field contents can be used to crosswalk patient visits with multiple visit numbers due to one-to-many relationship between PID-3 and PV1-19. It is recommended that data providers submit the patient medical record number to quickly identify the patient if a follow-up investigation is required. Without the medical record number, the data provider might invest considerable time to follow-up on the records of interest, causing unacceptable delays in public health response. In addition, the medical record number might aid in de-duplicating records and often helps resolve apparent transcription errors.

PID-5: Patient Name (XPN_SS)

This field contains patient names, and the primary or legal name is reported first. Submit patient name in accord with applicable PHA or jurisdiction regulations and specifications. If the PHA does not require patient name to be submitted, PHAs should not use Visit or Patient ID, as specified in this guide, to join related visit data and, if working with hospitals, to find additional visit information for syndromic surveillance signal confirmation or investigation. However, since HL7 requires the patient name, the field must be populated even when patient name shall not be sent. In such an instance (i.e., patient name is not sent), patient name shall be presented in a pseudonymized manner.

PID-10: Race (CE_SS)

General race category reported by the patient - subject may have more than one race category.

PID-33: Last Update Date/Time (TS_SS_toMinute)

This field contains the last update date and time for the patient's identifying and demographic data, as defined in the PID segment.

PID-34: Last Update Facility (HD_SS)

This field identifies the facility of the last update to a patient's identifying and demographic data, as defined in the PID segment.

PID_SS_A04_A08_A03 - Patient Identification

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PID SI R [1..1]
3 Patient Identifier List CX_SS R [1..*]
5 Patient Name XPN_SS R [1..*]
7 Date/Time of Birth TS_SS_toDay O [0..1]
8 Administrative Sex IS RE [0..1] PHVS_Gender_SyndromicSurveillance
10 Race CE_SS RE [0..*] PHVS_RaceCategory_CDC
11 Patient Address XAD_SS RE [0..1]
18 Patient Account Number CX_SS O [0..1]
22 Ethnic Group CE_SS RE [0..*] PHVS_EthnicityGroup_CDC
29 Patient Death Date and Time TS_SS_toMinute C [0..1]
30 Patient Death Indicator ID RE [0..1] 0136
33 Last Update Date/Time TS_SS_toMinute O [0..1]
34 Last Update Facility HD_SS O [0..1]

Conformance Statements
ID Description
PID_SS_6738094 If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL be one of list values: |~^^^^^^S|,|~^^^^^^U|
PID_SS_A04_A08_A03_1 If PV1-36 (Discharge Disposition) is valued with any of the following: '20', '40', '41', '42', PID-30 shall be 'Y'

Conditional Predicates
Location Usage Description
PID-29 C(R/X) If the value of PID-30 is 'Y'.

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PID_SS_A04_A08_A03-8 PHVS_Gender_SyndromicSurveillance Gender (Syndromic Surveillance)
PID_SS_A04_A08_A03-10 PHVS_RaceCategory_CDC Race Category
PID_SS_A04_A08_A03-22 PHVS_EthnicityGroup_CDC Ethnicity group
PID_SS_A04_A08_A03-30 0136 Yes/no indicator

PID-3: Patient Identifier List (CX_SS)

PID-3 is a repeating field that can accommodate multiple patient identifiers. Field contents can be used to crosswalk patient visits with multiple visit numbers due to one-to-many relationship between PID-3 and PV1-19. It is recommended that data providers submit the patient medical record number to quickly identify the patient if a follow-up investigation is required. Without the medical record number, the data provider might invest considerable time to follow-up on the records of interest, causing unacceptable delays in public health response. In addition, the medical record number might aid in de-duplicating records and often helps resolve apparent transcription errors.

PID-5: Patient Name (XPN_SS)

This field contains patient names, and the primary or legal name is reported first. Submit patient name in accord with applicable PHA or jurisdiction regulations and specifications. If the PHA does not require patient name to be submitted, PHAs should not use Visit or Patient ID, as specified in this guide, to join related visit data and, if working with hospitals, to find additional visit information for syndromic surveillance signal confirmation or investigation. However, since HL7 requires the patient name, the field must be populated even when patient name shall not be sent. In such an instance (i.e., patient name is not sent), patient name shall be presented in a pseudonymized manner.

PID-33: Last Update Date/Time (TS_SS_toMinute)

This field contains the last update date and time for the patient's identifying and demographic data, as defined in the PID segment.

PID-34: Last Update Facility (HD_SS)

This field identifies the facility of the last update to a patient's identifying and demographic data, as defined in the PID segment.

PR1_SS - Procedures

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PR1 SI R [1..1]
2 Procedure Coding Method IS R [1..1] 0089
3 Procedure Code CE_SS R [1..1] 0088,PHVS_AdministrativeProcedure_CDC_ICD-10PCS
5 Procedure Date/Time TS_SS_toMinute R [1..1]

Conformance Statements
ID Description
PR1_SS_6639954 PR1-3.1 shall be populated with a value from one for the following coding systems: CPT4, ICD10-CM-PCS

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PR1_SS-2 0089 Procedure Coding Method
PR1_SS-3 0088 Procedure Code
PR1_SS-3 PHVS_AdministrativeProcedure_CDC_ICD-10PCS Procedure (ICD-10 PCS)


Example:

PV1_SS_A01 - Patient Visit

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PV1 SI R [1..1]
2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance
3 Assigned Patient Location PL_SS O [0..1]
4 Admission Type IS O [0..1] PHVS_AdmissionType_HL7_2x
6 Prior Patient Location PL_SS O [0..1]
7 Attending Doctor XCN O [0..*] 0010
10 Hospital Service IS O [0..1] 0069
14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x
15 Ambulatory Status IS O [0..*] 0009
18 Patient Type IS O 0018
19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance
44 Admit Date/Time TS_SS_toMinute R [1..1]

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PV1_SS_A01-2 PHVS_PatientClass_SyndromicSurveillance Patient Class (Syndromic Surveillance)
PV1_SS_A01-4 PHVS_AdmissionType_HL7_2x Admission Type (HL7)
PV1_SS_A01-7 0010 Physician ID
PV1_SS_A01-10 0069 Hospital Service
PV1_SS_A01-14 PHVS_AdmitSource_HL7_2x Admission Source (HL7)
PV1_SS_A01-15 0009 Ambulatory Status
PV1_SS_A01-18 0018 Patient Type
PV1_SS_A01-19 PHVS_IdentifierType_SyndromicSurveillance Identifier Type (Syndromic Surveillance)


Example PV1 for an Inpatient: This PV1 segment shows the following information 

PV1|1|I||E|||112345^Familyname^Givenname^^^DR^MD^^NEMedCtr&1234567890&NPI|||MED||||7|||||2222_001^^^GreaterNorthMedCtr&4356012945&NPI^VN|||||||||||||||||||||||||201408171200

PV1-3: Assigned Patient Location (PL_SS)

This field contains the patient's initial assigned location or the location to which the patient is being moved.  The first component may be the nursing station for inpatient locations, or clinic or department, for locations other than inpatient.

PV1-4: Admission Type (IS)

Potentially used for filtering on ED patients to create the A03 Discharge when one is not created when an ED patient is admitted as an inpatient

PV1-7: Attending Doctor (XCN)

Recommend the use of the National Provider Identifier Standard provided by Centers for Medicare and Medicaid Services. To search for, get information about, or apply for an NPI, go to https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/. If an NPI is not available, try using a different unique identifier, such as an OID or a State-designated identifier.

PV1-10: Hospital Service (IS)

This field contains the treatment or type of surgery that the patient is scheduled to receive.

PV1-14: Admit Source (IS)

This field indicates where the patient was admitted. In the US, this field is used on UB92 FL20 'Source of Admission'. The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information.

PV1-15: Ambulatory Status (IS)

This field indicates any permanent or transient handicapped conditions.

PV1-19: Visit Number (CX_SS)

This field contains the unique number assigned to each patient visit, which should remain constant throughout the visit.

PV1-44: Admit Date/Time (TS_SS_toMinute)

This field contains the admit date/time. This field also reflects the date/time of an outpatient/emergency patient registration, which should remain constant throughout the visit.

PV1_SS_A03 - Patient Visit

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PV1 SI R [1..1]
2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance
3 Assigned Patient Location PL_SS O [0..1]
4 Admission Type IS O [0..1] PHVS_AdmissionType_HL7_2x
6 Prior Patient Location PL_SS O [0..1]
7 Attending Doctor XCN O [0..*] 0010
10 Hospital Service IS O [0..1] 0069
14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x
15 Ambulatory Status IS O [0..*] 0009
18 Patient Type IS O 0018
19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance
36 Discharge Disposition IS R [1..1] PHVS_DischargeDisposition_HL7_2x
44 Admit Date/Time TS_SS_toMinute R [1..1]
45 Discharge Date/Time TS_SS_toMinute R [1..*]

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PV1_SS_A03-2 PHVS_PatientClass_SyndromicSurveillance Patient Class (Syndromic Surveillance)
PV1_SS_A03-4 PHVS_AdmissionType_HL7_2x Admission Type (HL7)
PV1_SS_A03-7 0010 Physician ID
PV1_SS_A03-10 0069 Hospital Service
PV1_SS_A03-14 PHVS_AdmitSource_HL7_2x Admission Source (HL7)
PV1_SS_A03-15 0009 Ambulatory Status
PV1_SS_A03-18 0018 Patient Type
PV1_SS_A03-19 PHVS_IdentifierType_SyndromicSurveillance Identifier Type (Syndromic Surveillance)
PV1_SS_A03-36 PHVS_DischargeDisposition_HL7_2x Discharge Disposition (HL7)

PV1-3: Assigned Patient Location (PL_SS)

This field contains the patient's initial assigned location or the location to which the patient is being moved.  The first component may be the nursing station for inpatient locations, or clinic or department, for locations other than inpatient.

PV1-4: Admission Type (IS)

Potentially used for filtering on ED patients to create the A03 Discharge when one is not created when an ED patient is admitted as an inpatient

PV1-7: Attending Doctor (XCN)

Recommend the use of the National Provider Identifier Standard provided by Centers for Medicare and Medicaid Services. To search for, get information about, or apply for an NPI, go to https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/. If an NPI is not available, try using a different unique identifier, such as an OID or a State-designated identifier.

PV1-10: Hospital Service (IS)

This field contains the treatment or type of surgery that the patient is scheduled to receive.

PV1-14: Admit Source (IS)

This field indicates where the patient was admitted. In the US, this field is used on UB92 FL20 'Source of Admission'. The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information.

PV1-15: Ambulatory Status (IS)

This field indicates any permanent or transient handicapped conditions.

PV1-19: Visit Number (CX_SS)

This field contains the unique number assigned to each patient visit, which should remain constant throughout the visit.

PV1-36: Discharge Disposition (IS)

N/A FOR AMBULATORY CARE Helps identify severity of patient's condition and any indication of death. It is expected that this field will update with multiple submissions. Include both the code and text description of the code. This field should indicate patient death, if applicable.

PV1-44: Admit Date/Time (TS_SS_toMinute)

This field contains the admit date/time. This field also reflects the date/time of an outpatient/emergency patient registration, which should remain constant throughout the visit.

PV1-45: Discharge Date/Time (TS_SS_toMinute)

This field contains the discharge date/time

PV1_SS_A04 - Patient Visit

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PV1 SI R [1..1]
2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance
3 Assigned Patient Location PL_SS O [0..1]
4 Admission Type IS O [0..1] PHVS_AdmissionType_HL7_2x
6 Prior Patient Location PL_SS O [0..1]
7 Attending Doctor XCN O [0..*] 0010
10 Hospital Service IS O [0..1] 0069
14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x
15 Ambulatory Status IS O [0..*] 0009
18 Patient Type IS O 0018
19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance
44 Admit Date/Time TS_SS_toMinute R [1..1]

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PV1_SS_A04-2 PHVS_PatientClass_SyndromicSurveillance Patient Class (Syndromic Surveillance)
PV1_SS_A04-4 PHVS_AdmissionType_HL7_2x Admission Type (HL7)
PV1_SS_A04-7 0010 Physician ID
PV1_SS_A04-10 0069 Hospital Service
PV1_SS_A04-14 PHVS_AdmitSource_HL7_2x Admission Source (HL7)
PV1_SS_A04-15 0009 Ambulatory Status
PV1_SS_A04-18 0018 Patient Type
PV1_SS_A04-19 PHVS_IdentifierType_SyndromicSurveillance Identifier Type (Syndromic Surveillance)

PV1_SS_A08 - Patient Visit

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
1 Set ID - PV1 SI R [1..1]
2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance
3 Assigned Patient Location PL_SS O [0..1]
4 Admission Type IS O [0..1] PHVS_AdmissionType_HL7_2x
6 Prior Patient Location PL_SS O [0..1]
7 Attending Doctor XCN O [0..*] 0010
10 Hospital Service IS O [0..1] 0069
14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x
15 Ambulatory Status IS O [0..*] 0009
18 Patient Type IS O 0018
19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance
36 Discharge Disposition IS RE [0..1] PHVS_DischargeDisposition_HL7_2x
44 Admit Date/Time TS_SS_toMinute R [1..1]
45 Discharge Date/Time TS_SS_toMinute RE [0..*]

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PV1_SS_A08-2 PHVS_PatientClass_SyndromicSurveillance Patient Class (Syndromic Surveillance)
PV1_SS_A08-4 PHVS_AdmissionType_HL7_2x Admission Type (HL7)
PV1_SS_A08-7 0010 Physician ID
PV1_SS_A08-10 0069 Hospital Service
PV1_SS_A08-14 PHVS_AdmitSource_HL7_2x Admission Source (HL7)
PV1_SS_A08-15 0009 Ambulatory Status
PV1_SS_A08-18 0018 Patient Type
PV1_SS_A08-19 PHVS_IdentifierType_SyndromicSurveillance Identifier Type (Syndromic Surveillance)
PV1_SS_A08-36 PHVS_DischargeDisposition_HL7_2x Discharge Disposition (HL7)

PV2_SS - Patient Visit - Additional Information


The PV2 segment is a continuation of visit-specific information and is the segment where the Admit Reason is passed. 

Segment Definition
Seq Element name Data type Usage Cardinality Value Set
3 Admit Reason CE_SS RE [0..1] PHVS_AdministrativeDiagnosis_CDC_ICD-10CM,PHVS_Disease_CDC

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PV2_SS-3 PHVS_AdministrativeDiagnosis_CDC_ICD-10CM Diagnosis (ICD-10 CM)
PV2_SS-3 PHVS_Disease_CDC Disease


Examples: 

PV2-3: Admit Reason (CE_SS)

May be coded (CE.1 - CE.3) or free text (CE.2), although free text is preferred. This field contains the provider's reason for admitting the patient. It is distinct from the Chief Complaint / Reason for Visit field, which is the patient's self-reported chief complaint or reason for visit. Senders should transmit the richest and most complete description of the patient's reason for admission or encounter. If both free-text and drop-down selection text are available, send both. If only drop-down list fields are available, then concatenate all drop-down list values selected and submit.

Datatypes

CE_SS - Coded Element

Data Type Definition
Seq Element name Data type Usage Value Set
1 Identifier ST RE
2 Text ST C(R/RE)
3 Name of Coding System ID C(R/X) 0396
6 Name of Alternate Coding System ID C(R/X) 0396

Conditional Predicates
Location Usage Description
CE.2 C(R/RE) If CE.1 (Identifier) is not valued
CE.3 C(R/X) If CE.1 (Identifier) is valued
CE.6 C(R/X) If CE.4 (Alternate Identifier) is valued

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
CE_SS-3 0396 Coding System
CE_SS-6 0396 Coding System

Component Definitions

CE.2 : Text


It is strongly recommended that text be sent to accompany any identifier. When a coded value is not known, text can still be sent, in which case no coding system should be identified.

CWE_SS - Coded with Exceptions

Data Type Definition
Seq Element name Data type Usage Value Set
1 Identifier ST RE
2 Text ST C(R/RE)
3 Name of Coding System ID C(R/X) 0396
6 Name of Alternate Coding System ID C(R/X) 0396
9 Original Text ST RE

Conditional Predicates
Location Usage Description
CWE.2 C(R/RE) If CWE.1 (Identifier) is not valued
CWE.3 C(R/X) If CWE.3 (Name of Coding System) is valued
CWE.6 C(R/X) If CWE.6 (Name of Alternate Coding System) is valued

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
CWE_SS-3 0396 Coding System
CWE_SS-6 0396 Coding System

Comments

CWE_SS.4:
The alternate identifier (from the alternate coding system) should be the closest match for the identifier found in component 1.
CWE_SS.5:
It is strongly recommended that alternate text be sent to accompany any alternate identifier.
CWE_SS.9:
The original text that was available to an automated process or a human before a specific code was assigned
CWE_SS.2:
It is strongly recommended that text be sent to accompany a code. When a coded value is not known, text can still be sent, in which case no coding system should be identified; however, in this case, the preferred method is to send the text in position 9, "original text."

CX_SS - Extended Composite ID with Check Digit

Data Type Definition
Seq Element name Data type Usage Value Set
1 ID Number ST R
4 Assigning Authority HD_SS R 0363
5 Identifier Type Code ID R PHVS_IdentifierType_SyndromicSurveillance

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
CX_SS-4 0363 Assigning authority
CX_SS-5 PHVS_IdentifierType_SyndromicSurveillance Identifier Type (Syndromic Surveillance)


Note: The check digit and check digit scheme are null if ID is alphanumeric.

Example: PID-3 Patient ID:  |PSN101059711^^^TX01&OID&ISO|

Component Definitions

CX.1 : ID Number


Identifier may be alphanumeric.

CX.4 : Assigning Authority


A unique name of the system (or organization or agency or department) that creates the data.

DTM_SS_YYYYMMDD - Date/Time

Data Type Definition
# Value Usage Predicate
1 YYYY R
2 MM R
3 DD R
4 HH O
5 MM C(O/X) If HH(Hour) is valued.
6 SS C(O/X) If MM(Minute) is valued.
7 s C(O/X) If SS(Second) is valued.
8 s C(O/X) If s(1/10 second) is valued.
9 s C(O/X) If s(1/100 second) is valued.
10 s C(O/X) If s(1/1000 second) is valued.
11 ZZZZ O

Usage Note:

Format: YYYYMMDD[HH[MM[SS[.s[s[s[s]]]]]]][+/-ZZZZ]. 

The number of characters populated (excluding the time zone) specifies the precision. 

Thus: 

Example: |199904| specifies April 1999.

The time zone (+/-ZZZZ) is represented as +/-HHMM offset from Co-ordinated Universal Time (UTC) (formerly Greenwich Mean Time [GMT]), where +0000 or 0000 both represent UTC (without offset). The specific data representations used in the HL7 encoding rules are compatible with ISO 8824-1987(E). Note that if the time zone is not included, the time zone is assumed to be that of the local time zone of the sender. Also note that a DTM- or TS-valued field with the HHMM part set to "0000" represents midnight of the night extending from the previous day to the day given by the YYYYMMDD part.

The HL7 standard recommends that all systems routinely send the time zone offset but does not require it. HL7 systems are required to accept the time zone offset, but how this is done depends on the software application. For many applications, the time of interest is the local time of the sender.

DTM_SS_YYYYMMDDHHMM - Date/Time

Data Type Definition
# Value Usage Predicate
1 YYYY R
2 MM R
3 DD R
4 HH R
5 MM R
6 SS O
7 s C(O/X) If SS(Second) is valued.
8 s C(O/X) If s(1/10 second) is valued.
9 s C(O/X) If s(1/100 second) is valued.
10 s C(O/X) If s(1/1000 second) is valued.
11 ZZZZ O

DTM_SS_YYYYMMDDHHMMSS - Date/Time

Data Type Definition
# Value Usage Predicate
1 YYYY R
2 MM R
3 DD R
4 HH R
5 MM R
6 SS R
7 s O
8 s C(O/X) If s(1/10 second) is valued.
9 s C(O/X) If s(1/100 second) is valued.
10 s C(O/X) If s(1/1000 second) is valued.
11 ZZZZ R

EI - Entity Identifier

Data Type Definition
Seq Element name Data type Usage Value Set
3 Universal ID ST C
4 Universal ID Type ID C 0301

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
EI-4 0301 Universal ID type

HD_SS - Hierarchic Designator

Data Type Definition
Seq Element name Data type Usage Value Set
1 Namespace ID IS RE 0300
2 Universal ID ST R
3 Universal ID Type ID R PHVS_UniversalIDType_SyndromicSurveillance

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
HD_SS-1 0300 Namespace ID
HD_SS-3 PHVS_UniversalIDType_SyndromicSurveillance Universal ID Type (Syndromic Surveillance)

Component Definitions

HD.2 : Universal ID


This is string formatted according to the scheme defined by the third component, <universal ID type>.The UID is intended to be unique over time within the UID type. This convention is rigorously defined. Each UID must belong to one of the specifically enumerated schemes for constructing UIDs (defined by the UID type).

HD.3 : Universal ID Type


Universal ID Type (ID) governs the interpretation of the second component of the HD. This component contains the code system identifier "NPI" if National Provider Identifiers are used. PHVS_UniversalIDType_SyndromicSurveillance lists Universal ID Types supported.

ID - Coded Value for HL7 Defined Tables

IS - Coded Value for User-Defined Tables

MSG_SS - Message Type

Data Type Definition
Seq Element name Data type Usage Value Set
1 Message Code ID R PHVS_MessageType_SyndromicSurveillance
2 Trigger Event ID R PHVS_EventType_SyndromicSurveillance
3 Message Structure ID R PHVS_MessageStructure_SyndromicSurveillance

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
MSG_SS-1 PHVS_MessageType_SyndromicSurveillance Message Type (Syndromic Surveillance)
MSG_SS-2 PHVS_EventType_SyndromicSurveillance Event Type (Syndromic Surveillance)
MSG_SS-3 PHVS_MessageStructure_SyndromicSurveillance Message Structure (Syndromic Surveillance)

NM - Numeric

PT_SS - Processing Type

Data Type Definition
Seq Element name Data type Usage Value Set
1 Processing ID ID R 0103

Conformance Statements
ID Description
PT_SS_6152904 The value of PT-1 (Processing ID) SHALL be one of list values: P,T,D.

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
PT_SS-1 0103 Processing ID

SI - Sequence ID

ST - String Data

TS_SS_toDay - Time Stamp

Data Type Definition
Seq Element name Data type Usage Value Set
1 Time DTM_SS_YYYYMMDD R

TS_SS_toMinute - Time Stamp

Data Type Definition
Seq Element name Data type Usage Value Set
1 Time DTM_SS_YYYYMMDDHHMM R

TS_SS_toSecond - Time Stamp

Data Type Definition
Seq Element name Data type Usage Value Set
1 Time DTM_SS_YYYYMMDDHHMMSS R

TX - Text Data

VID_SS - Version Identifier

Data Type Definition
Seq Element name Data type Usage Value Set
1 Version ID ID R

Conformance Statements
ID Description
VID_SS_001 The value of VID-1 (Version ID) SHALL be '2.5.1'.

Usage Note:

Example: MSH-12 Version ID:  |2.5.1|

XAD_SS - Extended Address


The mailing address of the patient is preferred, but if not available, another address such as local address may be substituted.

Data Type Definition
Seq Element name Data type Usage Value Set
3 City ST RE
4 State or Province ST RE PHVS_State_FIPS_5-2
5 Zip or Postal Code ST RE
6 Country ID RE PHVS_Country_ISO_3166-1
9 County/Parish Code IS RE PHVS_County_FIPS_6-4

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
XAD_SS-4 PHVS_State_FIPS_5-2 State
XAD_SS-6 PHVS_Country_ISO_3166-1 Country
XAD_SS-9 PHVS_County_FIPS_6-4 County

Component Definitions

XAD.4 : State or Province


Use the 2-digit (numeric) FIPS code for patient's State (domestic home address), rather than two letter abbriviations. The 2-digit FIPS code helps characterize spatial-temporal patterns for analysis based on patient's residence. Also, the state abbreviation is a readily available data element that is useful if other patient location data elements are not available.

XAD.5 : Zip or Postal Code


Provide a minimum of 5 digits for domestic ZIP codes. Foreign postal codes should be supported. Supports the federal use case. County helps to further target spatial temporal patterns since ZIP Code can cross multiple counties. This core data element allows for differences in geographical characterization across jurisdictions (e.g., some states operate public health activities on a county level, whereas others operate on a city or town level).

XAD.6 : Country


Where possible, use the 3-character country codes for Country of the patient home address

XPN_SS - Extended Person Name

Data Type Definition
Seq Element name Data type Usage Value Set
7 Name Type Code ID R PHVS_NameType_SyndromicSurveillance

Conformance Statements
ID Description
XPN_SS_007 The value of XPN-7 (Name Type Code) SHALL be one of list values: L,S,U.

Value Set Bindings
Location Value Set ID Value Set Name Single Code Value
XPN_SS-7 PHVS_NameType_SyndromicSurveillance Name Type (Syndromic Surveillance)

Value Sets

0009 - Ambulatory Status

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
A6 HL70009 Hearing impaired
B5 HL70009 Paraplegic
A1 HL70009 Ambulates with assistive device
A9 HL70009 Functional level unknown
A4 HL70009 Disoriented
B3 HL70009 Amputee
A7 HL70009 Speech impaired
B6 HL70009 Pregnant
A2 HL70009 Wheelchair/stretcher bound
B1 HL70009 Oxygen therapy
A5 HL70009 Vision impaired
B4 HL70009 Mastectomy
A0 HL70009 No functional limitations
A8 HL70009 Non-English speaking
A3 HL70009 Comatose; non-responsive
B2 HL70009 Special equipment (tubes, IVs, catheters)

0010 - Physician ID

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70010 no suggested values

0018 - Patient Type

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70018 no suggested values

0061 - Check digit scheme

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
M11 HL70061 Mod 11 algorithm
ISO HL70061 ISO 7064: 1983
NPI HL70061 Check digit algorithm in the US National Provider Identifier
M10 HL70061 Mod 10 algorithm

0069 - Hospital Service

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
SUR HL70069 Surgical Service
CAR HL70069 Cardiac Service
URO HL70069 Urology Service
MED HL70069 Medical Service
PUL HL70069 Pulmonary Service

0072 - Insurance Plan ID

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70072 No suggested values defined

0085 - Observation result status codes interpretation

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
I HL70085 Specimen in lab; results pending
X HL70085 Results cannot be obtained for this observation
P HL70085 Preliminary results
D HL70085 Deletes the OBX record
U HL70085 Results status change to final without retransmitting results already sent as 'preliminary.' E.g., radiology changes status from preliminary to final
N HL70085 Not asked; used to affirmatively document that the observation identified in the OBX was not sought when the universal service ID in OBR-4 implies that it would be sought.
R HL70085 Results entered -- not verified
F HL70085 Final results; Can only be changed with a corrected result.
W HL70085 Post original as wrong, e.g., transmitted for wrong patient
O HL70085 Order detail description only (no result)
C HL70085 Record coming over is a correction and thus replaces a final result
S HL70085 Partial results

0088 - Procedure Code

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70088 No suggested values defined

0089 - Procedure Coding Method

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70089 No suggested values defined

0103 - Processing ID

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
T HL70103 Training
D HL70103 Debugging
P HL70103 Production

0136 - Yes/no indicator

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
N HL70136 No
Y HL70136 Yes

0155 - Accept/application acknowledgment conditions

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
SU HL70155 Successful completion only
ER HL70155 Error/reject conditions only
NE HL70155 Never
AL HL70155 Always

0190 - Address type

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
C HL70190 Current Or Temporary
RH HL70190 Registry home. Refers to the information system, typically managed by a public health agency, that stores patient information such as immunization histories or cancer data, regardless of where the patient obtains services.
L HL70190 Legal Address
BDL HL70190 Birth delivery location (address where birth occurred)
O HL70190 Office
F HL70190 Country Of Origin
B HL70190 Firm/Business
M HL70190 Mailing
BR HL70190 Residence at birth (home address at time of birth)
P HL70190 Permanent
H HL70190 Home
BA HL70190 Bad address
N HL70190 Birth (nee) (birth address, not otherwise specified)

0207 - Processing mode

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
R HL70207 Restore from archive
I HL70207 Initial load
T HL70207 Current processing, transmitted at intervals (scheduled or on demand)
Not present HL70207 Not present (the default, meaning current processing)
A HL70207 Archive

0288 - Census tract

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70288 No suggested values defined

0300 - Namespace ID

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70300 No suggested values defined

0301 - Universal ID type

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
L,M,N HL70301 These are reserved for locally defined coding schemes.
GUID HL70301 Same as UUID.
URI HL70301 Uniform Resource Identifier
ISO HL70301 An International Standards Organization Object Identifier
x500 HL70301 An X.500 directory name
B HL70301
M HL70301
HCD HL70301 The CEN Healthcare Coding Scheme Designator. (Identifiers used in DICOM follow this assignment scheme.)
UUID HL70301 The DCE Universal Unique Identifier
L HL70301
DNS HL70301 An Internet dotted name. Either in ASCII or as integers
Random HL70301 Usually a base64 encoded string of random bits.<p>The uniqueness depends on the length of the bits. Mail systems often generate ASCII string "unique names," from a combination of random bits and system names. Obviously, such identifiers will not be constr
HL7 HL70301 Reserved for future HL7 registration schemes
x400 HL70301 An X.400 MHS format identifier

0360 - Degree/license/certificate

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
MCE HL70360 Master of Civil Engineering
MME HL70360 Master of Mechanical Engineering
PharmD HL70360 Doctor of Pharmacy
TS HL70360 Trade School Graduate
BBA HL70360 Bachelor of Business Administration
CNM HL70360 Certified Nurse Midwife
DO HL70360 Doctor of Osteopathy
MDI HL70360 Master of Divinity
MSN HL70360 Master of Science - Nursing
PHS HL70360 Doctor of Science
AAS HL70360 Associate of Applied Science
BN HL70360 Bachelor of Nursing
BSN HL70360 Bachelor on Science - Nursing
CPNP HL70360 Certified Pediatric Nurse Practitioner
FPNP HL70360 Family Practice Nurse Practitioner
MEE HL70360 Master of Electrical Engineering
NP HL70360 Nurse Practitioner
RPH HL70360 Registered Pharmacist
AS HL70360 Associate of Science
CER HL70360 Certificate
DED HL70360 Doctor of Education
MA HL70360 Master of Arts
MD HL70360 Doctor of Medicine
MS HL70360 Master of Science
PHD HL70360 Doctor of Philosophy
BE HL70360 Bachelor or Engineering
CNP HL70360 Certified Nurse Practitioner
EMT HL70360 Emergency Medical Technician
ME HL70360 Master of Engineering
MT HL70360 Master of Theology
PN HL70360 Advanced Practice Nurse
ABA HL70360 Associate of Business Administration
BS HL70360 Bachelor of Science
BT HL70360 Bachelor of Theology
CRN HL70360 Certified Registered Nurse
HS HL70360 High School Graduate
MFA HL70360 Master of Fine Arts
PA HL70360 Physician Assistant
SEC HL70360 Secretarial Certificate
BA HL70360 Bachelor of Arts
CMA HL70360 Certified Medical Assistant
DIP HL70360 Diploma
MBA HL70360 Master of Business Administration
MDA HL70360 Medical Assistant
MSL HL70360 Master of Science - Law
PHE HL70360 Doctor of Engineering
AA HL70360 Associate of Arts
BFA HL70360 Bachelor of Fine Arts
CNS HL70360 Certified Nurse Specialist
EMTP HL70360 Emergency Medical Technician - Paramedic
MED HL70360 Master of Education
NG HL70360 Non-Graduate
RMA HL70360 Registered Medical Assistant
AE HL70360 Associate of Engineering
BSL HL70360 Bachelor of Science - Law
CANP HL70360 Certified Adult Nurse Practitioner
DBA HL70360 Doctor of Business Administration
JD HL70360 Juris Doctor

0361 - Application

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70361 No suggested values defined

0362 - Facility

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70362 No suggested values defined

0363 - Assigning authority

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70363 No suggested values

0396 - Coding System

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Dynamic Open Extensional

Reference URL: http://www.hl7.org/documentcenter/public/wg/vocab/Tbl0396.xls


Codes
Value Code System Description
99zzz or L HL70396 Local general code for a site-defined code system used for a specific set of trading partners. The 'zzz' SHALL be any printable ASCII string. Length of the name SHALL not exceed field width, and is subject to local implementation.
ACR HL70396 American College of Radiology finding codes
ACTCODE HL70396 Table of HL7 Version 3 ActCode values
ACTRELSS HL70396 Used to indicate that the target of the relationship will be a filtered subset of the total related set of targets. Used when there is a need to limit the number of components to the first, the last, the next, the total, the average or some other filtered or calculated subset.
ALPHAID2006 HL70396 German Alpha-ID v2006
ALPHAID2007 HL70396 German Alpha-ID v2007
ALPHAID2008 HL70396 German Alpha-ID v2008
ALPHAID2009 HL70396 German Alpha-ID v2009
AMTv2 HL70396 Australian Medicines Terminology (v2)
ANS+ HL70396 HL7 set of units of measure
ART HL70396 WHO Adverse Reaction Terms
AS4 HL70396 ASTM E1238/ E1467 Universal
AS4E HL70396 AS4 Neurophysiology Codes
ATC HL70396 American Type Culture Collection
C4 HL70396 CPT-4
CAPECC HL70396 College of American Pathologists Electronic Cancer Checklist
CAS HL70396 Chemical abstract codes
CCC HL70396 Clinical Care Classification system
CD2 HL70396 CDT-2 Codes
CDCA HL70396 CDC Analyte Codes
CDCEDACUITY HL70396 CDC Emergency Department Acuity
cdcgs1vis HL70396 VIS Bar Codes (IIS)
CDCINDUSTRY2010 HL70396 Industry CDC Census 2010
CDCM HL70396 CDC Methods/Instruments Codes
CDCNHSN HL70396 CDC National Healthcare Safety Network Codes
CDCOBS HL70396 CDC BioSense RT observations (Census) - CDC
CDCOCCUPATION2010 HL70396 Occupation CDC Census 2010
CDCODH HL70396 Occupational Data for Health (ODH)
CDCPHINVS HL70396 CDC PHIN Vocabulary Coding System
CDCREC HL70396 Race & Ethnicity - CDC
CDS HL70396 CDC Surveillance
Chrom-Loc HL70396 Cytogenetic (chromosome) location
CLINVAR-V HL70396 ClinVar Variant ID
CLP HL70396 CLIP
CMSOEC HL70396 OCE Edit Code
CMSOMC HL70396 OCE Modifier Code
COSMIC-Smpl HL70396 COSMIC - Simple variants
COSMIC-Strc HL70396 COSMIC-Structural variants
CPTM HL70396 CPT Modifier Code
CST HL70396 COSTART
CVX HL70396 CDC Vaccine Codes
dbVar-GL HL70396 dbVar-Germline
dbVar-som HL70396 dbVar-Somatic
DCM HL70396 DICOM Controlled Terminology
E HL70396 EUCLIDES
E5 HL70396 Euclides quantity codes
E6 HL70396 Euclides Lab method codes
E7 HL70396 Euclides Lab equipment codes
EDLEVEL HL70396 Education Level
ensembl-G HL70396 Ensembl genomic reference sequence
Ensembl-P HL70396 Ensembl protein reference sequence
ensembl-T HL70396 Ensembl transcript reference sequence
ENTITYCODE HL70396 Entity Code
ENTITYHDLG HL70396 Entity Handling Code
ENZC HL70396 Enzyme Codes
EPASRS HL70396 EPA SRS
FDAUNII HL70396 Unique Ingredient Identifier (UNII)
FDDC HL70396 First DataBank Drug Codes
FDDX HL70396 First DataBank Diagnostic Codes
FDK HL70396 FDA K10
FIPS5_2 HL70396 FIPS 5-2 (State)
FIPS55_3 HL70396 Populated Places (FIPS 55-3)
FIPS6_4 HL70396 FIPS 6-4 (County)
GDRG2006 HL70396 G-DRG German DRG Codes v 2006
GDRG2007 HL70396 G-DRG German DRG Codes v2007
GDRG2008 HL70396 G-DRG German DRG Codes v2008
GDRG2009 HL70396 G-DRG German DRG Codes v2008
GMDC2006 HL70396 German Major v2006 Diagnostic Codes
GMDC2007 HL70396 German Major Diagnostic Codes v2007
GMDC2008 HL70396 German Major Diagnostic Codes v2008
HB HL70396 HIBCC
HCPCS HL70396 CMS (formerly HCFA) Common Procedure Coding System
HCPT HL70396 Health Care Provider Taxonomy
HGNC-Symb HL70396 HGNC-symb
HGVS.c HL70396 HGVS- Transcript syntax
HGVS.g HL70396 HGVS- Genomic syntax
HGVS.p HL70396 HGVS-Protein syntax
HHC HL70396 Home Health Care
HI HL70396 Health Outcomes
HOT HL70396 Japanese Nationwide Medicine Code
HPC HL70396 CMS (formerly HCFA )Procedure Codes (HCPCS)
HSLOC HL70396 Healthcare Service Location
I10 HL70396 ICD-10
I10C HL70396 International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
I10G2006 HL70396 ICD 10 Germany 2006
I10P HL70396 International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS)
I10P0 HL70396 ICD-10 Place of Occurrence
I9 HL70396 ICD9
I9C HL70396 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
I9CDX HL70396 ICD-9CM Diagnosis codes
I9CP HL70396 ICD-9CM Procedure codes
IBT0001 HL70396 ISBT 128 Standard transfusion/transplantation data items
IC2 HL70396 ICHPPC-2
ICD10AM HL70396 ICD-10 Australian modification
ICD10CA HL70396 ICD-10 Canada
ICD10GM2007 HL70396 ICD 10 Germany v2007
ICD10GM2008 HL70396 ICD 10 Germany v2008
ICD10GM2009 HL70396 ICD 10 Germany v2009
ICDO HL70396 International Classification of Diseases for Oncology
ICDO2 HL70396 International Classification of Disease for Oncology Second Edition
ICDO3 HL70396 International Classification of Disease for Oncology Third Edition
ICF HL70396 International Classification of Functioning, Disability and Health (ICF)
ICS HL70396 ICCS
ICSD HL70396 International Classification of Sleep Disorders
IHELAW HL70396 IHE Laboratory Analytical Workflow (LAW) Profile Codes.
ISCN HL70396 International System for Human Cytogenetic Nomenclature (ISCN)
ISO+ HL70396 ISO 2955.83 (units of measure) with HL7 extensions
ISO3166_1 HL70396 ISO 3166-1 Country Codes
ISO3166_2 HL70396 ISO 3166-2 Country subdivisions
ISO4217 HL70396 ISO4217 Currency Codes
ISO639 HL70396 ISO 639 Language
ITIS HL70396 Integrated Taxonomic Information System
IUPC HL70396 IUPAC/IFCC Component Codes
IUPP HL70396 IUPAC/IFCC Property Codes
JC10 HL70396 JLAC/JSLM, nationwide laboratory code
JC8 HL70396 Japanese Chemistry
JJ1017 HL70396 Japanese Image Examination Cache
LANGUAL HL70396 LanguaL
LB HL70396 Local billing code
LN HL70396 Logical Observation Identifier Names and Codes (LOINC®)
LRG-RefSeq HL70396 Locus Reference Genomic (LRG)
MCD HL70396 Medicaid
MCR HL70396 Medicare
MDC HL70396 Medical Device Communication
MDDX HL70396 Medispan Diagnostic Codes
MEDC HL70396 Medical Economics Drug Codes
Medgen-Dis HL70396 NCBI MedGen disease subset
MEDIATYPE HL70396 MIME Media Type IANA
MEDR HL70396 Medical Dictionary for Drug Regulatory Affairs (MEDDRA)
MEDX HL70396 Medical Economics Diagnostic Codes
MGPI HL70396 Medispan GPI
MVX HL70396 CDC Vaccine Manufacturer Codes
NAICS HL70396 Industry (NAICS)
NCPDPnnnnsss HL70396 NCPDP code list for data element nnnn [as used in segment sss]
NDA HL70396 NANDA
NDC HL70396 National drug codes
NDFRT HL70396 NDF-RT (Drug Classification)
NIC HL70396 Nursing Interventions Classification
NIP001 HL70396 Source of Information (Immunization)
NIP002 HL70396 Substance refusal reason
NIP004 HL70396 Vaccination - Contraindications, Precautions, and Immunities
NIP007 HL70396 Vaccinated at location (facility)
NIP008 HL70396 Vaccine purchased with (Type of funding)
NIP009 HL70396 Reported adverse event previously
NIP010 HL70396 VAERS Report type
NND HL70396 Notifiable Event (Disease/Condition) Code List
NPI HL70396 National Provider Identifier
NUBC HL70396 National Uniform Billing Committee Code
NULLFL HL70396 Flavors of NULL
O3012006 HL70396 Ops Germany 2006
OBSMETHOD HL70396 Observation Method Code
OHA HL70396 Omaha System
OPS2007 HL70396 OPS Germany v2007
OPS2008 HL70396 OPS Germany v2008
OPS2009 HL70396 OPS Germany v2008
PHDSCSOPT HL70396 Source of Payment Typology
PHINQUESTION HL70396 CDC Public Health Information Network (PHIN) Question
PLR HL70396 CDC PHLIP Lab result codes that are not covered in SNOMED at the time of this implementation
PLT HL70396 CDC PHLIP Lab test codes, where LOINC concept is too broad or not yet available, especially as needed for ordering and or lab to lab reporting )
POS HL70396 POS Codes
PRTCPTNMODE HL70396 Paticipation Mode Code
RC HL70396 Read Classification
refSeq-G HL70396 NCBI - genomic and chromosome reference sequences
RefSeq-P HL70396 NCBI - protein reference sequence
refSeq-T HL70396 NCBI-transcript reference sequences (RefSeq)
ROLECLASS HL70396 Used initially for contact roles.
ROLECODE HL70396 Participation Mode
RSPMODE HL70396 Specifies the mode, immediate versus deferred or queued, by which a receiver should communicate its receiver responsibilities.
RXNORM HL70396 RxNorm
RxT-Ingrd HL70396 RxTerms-Ingredients Subset
SCT HL70396 SNOMED Clinical Terms
SCT2 HL70396 SNOMED Clinical Terms alphanumeric codes
SDM HL70396 SNOMED- DICOM Microglossary
SIC HL70396 Industry (SIC)
SNM HL70396 Systemized Nomenclature of Medicine (SNOMED)
SNM3 HL70396 SNOMED International
SNT HL70396 SNOMED topology codes (anatomic sites)
SOC HL70396 Occupation (SOC 2000)
UB04FL14 HL70396 Priority (Type) of Visit
UB04FL15 HL70396 Point of Origin
UB04FL17 HL70396 Patient Discharge Status
UB04FL31 HL70396 Occurrence Code
UB04FL35 HL70396 Occurrence Span
UB04FL39 HL70396 Value Code
UB04FL42 HL70396 Revenue Code
UB04FL67 HL70396 Present on Admission
UC HL70396 UCDS
UCUM HL70396 UCUM code set for units of measure(from Regenstrief)
UMD HL70396 MDNS
UML HL70396 Unified Medical Language
UPC HL70396 Universal Product Code
UPIN HL70396 UPIN
USGSGNIS HL70396 U.S. Board on Geographic Names (USGS - GNIS)
USPS HL70396 United States Postal Service
VIS HL70396 Clinicians are required to track the Vaccine Information Sheet (VIS) that was shared with the recipient of a vaccination. This code system contains codes that identify the document type and the owner of the document.
W1 HL70396 WHO record # drug codes (6 digit)
W2 HL70396 WHO record # drug codes (8 digit)
W4 HL70396 WHO record # code with ASTM extension
WC HL70396 WHO ATC
X12DEnnnn HL70396 ASC X12 Code List nnnn

0399 - Country code

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70399 use 3-character (alphabetic) form of ISO 3166

0444 - Name assembly order

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
F HL70444 Prefix Family Middle Given Suffix
G HL70444 Prefix Given Middle Family Suffix

0448 - Name context

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
... HL70448 No suggested values defined

0465 - Name/address representation

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
P HL70465 Phonetic (i.e., ASCII, Katakana, Hiragana, etc.)
A HL70465 Alphabetic (i.e., Default or some single-byte)
I HL70465 Ideographic (i.e., Kanji)

0532 - Expanded yes/no indicator

Metadata

Type: Internally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Codes
Value Code System Description
NP HL70532 not present
N HL70532 No
NAV HL70532 temporarily unavailable
UNK HL70532 unknown
NA HL70532 not applicable
NI HL70532 No Information
ASKU HL70532 asked but unknown
Y HL70532 Yes
NASK HL70532 not asked

PHVS_AcknowledgmentCode_HL7_2x - Acknowledgment Code (HL7)

Metadata

OID: 2.16.840.1.114222.4.11.958

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.958


Codes
Value Code System Description
CA HL70008 Enhanced mode: Accept acknowledgment: Commit Accept
CE HL70008 Enhanced mode: Accept acknowledgment: Commit Error
CR HL70008 Enhanced mode: Accept acknowledgment: Commit Reject
AA HL70008 Original mode: Application Accept - Enhanced mode: Application acknowledgment: Accept
AE HL70008 Original mode: Application Error - Enhanced mode: Application acknowledgment: Error
AR HL70008 Original mode: Application Reject - Enhanced mode: Application acknowledgment: Reject

Acknowledgment code indicating receipt of message. (See message processing rules. Refer to HL7 Table 0008 - Acknowledgment code for valid values.) Null flavors are not allowed.

PHVS_AdministrativeDiagnosis_CDC_ICD-10CM - Diagnosis (ICD-10 CM)

ICD-10 CM Administrative Diagnosis Codes used for billing purposes, Reason for Study, DG1 Diagnosis segments Keyword: ICD-10 CM

Metadata

OID: 2.16.840.1.114222.4.11.7356

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7356


ICD-10 CM Administrative Diagnosis Codes used for billing purposes, Reason for Study, DG1 Diagnosis segments Keyword: ICD-10 CM

PHVS_AdministrativeProcedure_CDC_ICD-10PCS - Procedure (ICD-10 PCS)

ICD-10 PCS Procedure Codes used for billing purposes, Reason for Study, PR1 Diagnosis segments

Metadata

OID: 2.16.840.1.114222.4.11.7371

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7371


ICD-10 PCS Procedure Codes used for billing purposes, Reason for Study, PR1 Diagnosis segments

PHVS_AdmissionType_HL7_2x - Admission Type (HL7)

Metadata

OID: 2.16.840.1.114222.4.11.913

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.913


Codes
Value Code System Description
A HL70007 Accident
C HL70007 Elective
E HL70007 Emergency
L HL70007 Labor and Delivery
N HL70007 Newborn (Birth in healthcare facility)
R HL70007 Routine
U HL70007 Urgent

HL7 version 2.5 User-Defined Table 0007 Admit Type codes used in ADT messages

PHVS_AdmitSource_HL7_2x - Admission Source (HL7)

A user defined set of codes that can be used to indicate from where the patient came in.

Metadata

OID: 2.16.840.1.114222.4.11.918

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.918


Codes
Value Code System Description
born HL70023 Born in hospital
emd HL70023 From accident/emergency department
nursing HL70023 From nursing home
outp HL70023 From outpatient department
psych HL70023 From psychiatric hospital
rehab HL70023 From rehabilitation facility
gp HL70023 General Practitioner referral
mp HL70023 Medical Practitioner/physician referral
other HL70023 Other
Self HL70023 Self-Referral
hosp-trans HL70023 Transferred from other hospital
1 HL70023 Physician referral
2 HL70023 Clinic referral
3 HL70023 HMO referral
4 HL70023 Transfer from a hospital
5 HL70023 Transfer from a skilled nursing facility
6 HL70023 Transfer from another health care facility
7 HL70023 Emergency room
8 HL70023 Court/law enforcement
9 HL70023 Information not available

HL7 version 2.5 User-Defined Table 0023 Admit Source codes used in ADT messages

PHVS_AgeUnit_SyndromicSurveillance - Age Unit (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.3402

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3402


Codes
Value Code System Description
d UCUM day
mo UCUM month
UNK NULLFL unknown
wk UCUM week
a UCUM year

Unit corresponding to numeric value of patient age (e.g. Days, Month or Years) specific for syndromic surveillance

PHVS_BloodPressureUnit_UCUM - Blood Pressure Unit

Metadata

OID: 2.16.840.1.114222.4.11.920

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.920


Codes
Value Code System Description
mm[Hg] UCUM MilliMeters of Mercury [Blood Pressure Unit]

Units of measure for Blood Pressure

PHVS_Country_ISO_3166-1 - Country

Codes representing country of origin, nationality, citizenship, address country

Metadata

OID: 2.16.840.1.114222.4.11.828

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.828


Codes
Value Code System Description
AFG ISO3166_1 AFGHANISTAN
ALA ISO3166_1 ÅLAND ISLANDS
ALB ISO3166_1 ALBANIA
DZA ISO3166_1 ALGERIA
ASM ISO3166_1 AMERICAN SAMOA
AND ISO3166_1 ANDORRA
AGO ISO3166_1 ANGOLA
AIA ISO3166_1 ANGUILLA
ATA ISO3166_1 ANTARCTICA
ATG ISO3166_1 ANTIGUA AND BARBUDA
ARG ISO3166_1 ARGENTINA
ARM ISO3166_1 ARMENIA
ABW ISO3166_1 ARUBA
AUS ISO3166_1 AUSTRALIA
AUT ISO3166_1 AUSTRIA
AZE ISO3166_1 AZERBAIJAN
BHS ISO3166_1 BAHAMAS
BHR ISO3166_1 BAHRAIN
BGD ISO3166_1 BANGLADESH
BRB ISO3166_1 BARBADOS
BLR ISO3166_1 BELARUS
BEL ISO3166_1 BELGIUM
BLZ ISO3166_1 BELIZE
BEN ISO3166_1 BENIN
BMU ISO3166_1 BERMUDA
BTN ISO3166_1 BHUTAN
BOL ISO3166_1 BOLIVIA
BES ISO3166_1 BONAIRE, SINT EUSTATIUS and SABA
BIH ISO3166_1 BOSNIA AND HERZEGOVINA
BWA ISO3166_1 BOTSWANA
BVT ISO3166_1 BOUVET ISLAND
BRA ISO3166_1 BRAZIL
IOT ISO3166_1 BRITISH INDIAN OCEAN TERRITORY
BRN ISO3166_1 BRUNEI DARUSSALAM
BGR ISO3166_1 BULGARIA
BFA ISO3166_1 BURKINA FASO
BDI ISO3166_1 BURUNDI
KHM ISO3166_1 CAMBODIA
CMR ISO3166_1 CAMEROON
CAN ISO3166_1 CANADA
CPV ISO3166_1 CAPE VERDE
CYM ISO3166_1 CAYMAN ISLANDS
CAF ISO3166_1 CENTRAL AFRICAN REPUBLIC
TCD ISO3166_1 CHAD
CHL ISO3166_1 CHILE
CHN ISO3166_1 CHINA
CXR ISO3166_1 CHRISTMAS ISLAND
CCK ISO3166_1 COCOS (KEELING) ISLANDS
COL ISO3166_1 COLOMBIA
COM ISO3166_1 COMOROS
COG ISO3166_1 CONGO
COD ISO3166_1 CONGO, THE DEMOCRATIC REPUBLIC OF THE
COK ISO3166_1 COOK ISLANDS
CRI ISO3166_1 COSTA RICA
CIV ISO3166_1 CÔTE D'IVOIRE
HRV ISO3166_1 CROATIA
CUB ISO3166_1 CUBA
CUW ISO3166_1 CURACAO
CYP ISO3166_1 CYPRUS
CZE ISO3166_1 CZECH REPUBLIC
DNK ISO3166_1 DENMARK
DJI ISO3166_1 DJIBOUTI
DMA ISO3166_1 DOMINICA
DOM ISO3166_1 DOMINICAN REPUBLIC
ECU ISO3166_1 ECUADOR
EGY ISO3166_1 EGYPT
SLV ISO3166_1 EL SALVADOR
GNQ ISO3166_1 EQUATORIAL GUINEA
ERI ISO3166_1 ERITREA
EST ISO3166_1 ESTONIA
SWZ ISO3166_1 ESWATINI
ETH ISO3166_1 ETHIOPIA
FLK ISO3166_1 FALKLAND ISLANDS (MALVINAS)
FRO ISO3166_1 FAROE ISLANDS
FJI ISO3166_1 FIJI
FIN ISO3166_1 FINLAND
FRA ISO3166_1 FRANCE
GUF ISO3166_1 FRENCH GUIANA
PYF ISO3166_1 FRENCH POLYNESIA
ATF ISO3166_1 FRENCH SOUTHERN TERRITORIES
GAB ISO3166_1 GABON
GMB ISO3166_1 GAMBIA
GEO ISO3166_1 GEORGIA
DEU ISO3166_1 GERMANY
GHA ISO3166_1 GHANA
GIB ISO3166_1 GIBRALTAR
GRC ISO3166_1 GREECE
GRL ISO3166_1 GREENLAND
GRD ISO3166_1 GRENADA
GLP ISO3166_1 GUADELOUPE
GUM ISO3166_1 GUAM
GTM ISO3166_1 GUATEMALA
GGY ISO3166_1 GUERNSEY
GIN ISO3166_1 GUINEA
GNB ISO3166_1 GUINEA-BISSAU
GUY ISO3166_1 GUYANA
HTI ISO3166_1 HAITI
HMD ISO3166_1 HEARD ISLAND AND MCDONALD ISLANDS
VAT ISO3166_1 HOLY SEE
HND ISO3166_1 HONDURAS
HKG ISO3166_1 HONG KONG
HUN ISO3166_1 HUNGARY
ISL ISO3166_1 ICELAND
IND ISO3166_1 INDIA
IDN ISO3166_1 INDONESIA
IRN ISO3166_1 IRAN, ISLAMIC REPUBLIC OF
IRQ ISO3166_1 IRAQ
IRL ISO3166_1 IRELAND
IMN ISO3166_1 ISLE OF MAN
ISR ISO3166_1 ISRAEL
ITA ISO3166_1 ITALY
JAM ISO3166_1 JAMAICA
JPN ISO3166_1 JAPAN
JEY ISO3166_1 JERSEY
JOR ISO3166_1 JORDAN
KAZ ISO3166_1 KAZAKHSTAN
KEN ISO3166_1 KENYA
KIR ISO3166_1 KIRIBATI
PRK ISO3166_1 KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
KOR ISO3166_1 KOREA, REPUBLIC OF
KWT ISO3166_1 KUWAIT
KGZ ISO3166_1 KYRGYZSTAN
LAO ISO3166_1 LAO PEOPLE'S DEMOCRATIC REPUBLIC
LVA ISO3166_1 LATVIA
LBN ISO3166_1 LEBANON
LSO ISO3166_1 LESOTHO
LBR ISO3166_1 LIBERIA
LBY ISO3166_1 LIBYAN ARAB JAMAHIRIYA
LIE ISO3166_1 LIECHTENSTEIN
LTU ISO3166_1 LITHUANIA
LUX ISO3166_1 LUXEMBOURG
MAC ISO3166_1 MACAO
MKD ISO3166_1 MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
MDG ISO3166_1 MADAGASCAR
MWI ISO3166_1 MALAWI
MYS ISO3166_1 MALAYSIA
MDV ISO3166_1 MALDIVES
MLI ISO3166_1 MALI
MLT ISO3166_1 MALTA
MHL ISO3166_1 MARSHALL ISLANDS
MTQ ISO3166_1 MARTINIQUE
MRT ISO3166_1 MAURITANIA
MUS ISO3166_1 MAURITIUS
MYT ISO3166_1 MAYOTTE
MEX ISO3166_1 MEXICO
FSM ISO3166_1 MICRONESIA, FEDERATED STATES OF
MDA ISO3166_1 MOLDOVA, REPUBLIC OF
MCO ISO3166_1 MONACO
MNG ISO3166_1 MONGOLIA
MNE ISO3166_1 MONTENEGRO
MSR ISO3166_1 MONTSERRAT
MAR ISO3166_1 MOROCCO
MOZ ISO3166_1 MOZAMBIQUE
MMR ISO3166_1 MYANMAR
NAM ISO3166_1 NAMIBIA
NRU ISO3166_1 NAURU
NPL ISO3166_1 NEPAL
NLD ISO3166_1 NETHERLANDS
NCL ISO3166_1 NEW CALEDONIA
NZL ISO3166_1 NEW ZEALAND
NIC ISO3166_1 NICARAGUA
NER ISO3166_1 NIGER
NGA ISO3166_1 NIGERIA
NIU ISO3166_1 NIUE
NFK ISO3166_1 NORFOLK ISLAND
MNP ISO3166_1 NORTHERN MARIANA ISLANDS
NOR ISO3166_1 NORWAY
OMN ISO3166_1 OMAN
OTH NULLFL other
PAK ISO3166_1 PAKISTAN
PLW ISO3166_1 PALAU
PSE ISO3166_1 PALESTINE, STATE OF
PAN ISO3166_1 PANAMA
PNG ISO3166_1 PAPUA NEW GUINEA
PRY ISO3166_1 PARAGUAY
PER ISO3166_1 PERU
PHL ISO3166_1 PHILIPPINES
PCN ISO3166_1 PITCAIRN
POL ISO3166_1 POLAND
PRT ISO3166_1 PORTUGAL
PRI ISO3166_1 PUERTO RICO
QAT ISO3166_1 QATAR
REU ISO3166_1 RÉUNION
ROU ISO3166_1 ROMANIA
RUS ISO3166_1 RUSSIAN FEDERATION
RWA ISO3166_1 RWANDA
BLM ISO3166_1 SAINT BARTHÉLEMY
SHN ISO3166_1 SAINT HELENA
KNA ISO3166_1 SAINT KITTS AND NEVIS
LCA ISO3166_1 SAINT LUCIA
MAF ISO3166_1 SAINT MARTIN (FRENCH PART)
SPM ISO3166_1 SAINT PIERRE AND MIQUELON
VCT ISO3166_1 SAINT VINCENT AND THE GRENADINES
WSM ISO3166_1 SAMOA
SMR ISO3166_1 SAN MARINO
STP ISO3166_1 SAO TOME AND PRINCIPE
SAU ISO3166_1 SAUDI ARABIA
SEN ISO3166_1 SENEGAL
SRB ISO3166_1 SERBIA
SYC ISO3166_1 SEYCHELLES
SLE ISO3166_1 SIERRA LEONE
SGP ISO3166_1 SINGAPORE
SXM ISO3166_1 SINT MAARTEN (DUTCH PART)
SVK ISO3166_1 SLOVAKIA
SVN ISO3166_1 SLOVENIA
SLB ISO3166_1 SOLOMON ISLANDS
SOM ISO3166_1 SOMALIA
ZAF ISO3166_1 SOUTH AFRICA
SGS ISO3166_1 SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SSD ISO3166_1 South Sudan
ESP ISO3166_1 SPAIN
LKA ISO3166_1 SRI LANKA
SDN ISO3166_1 SUDAN
SUR ISO3166_1 SURINAME
SJM ISO3166_1 SVALBARD AND JAN MAYEN
SWE ISO3166_1 SWEDEN
CHE ISO3166_1 SWITZERLAND
SYR ISO3166_1 SYRIAN ARAB REPUBLIC
TWN ISO3166_1 TAIWAN, PROVINCE OF CHINA
TJK ISO3166_1 TAJIKISTAN
TZA ISO3166_1 TANZANIA, UNITED REPUBLIC OF
THA ISO3166_1 THAILAND
TLS ISO3166_1 TIMOR-LESTE
TGO ISO3166_1 TOGO
TKL ISO3166_1 TOKELAU
TON ISO3166_1 TONGA
TTO ISO3166_1 TRINIDAD AND TOBAGO
TUN ISO3166_1 TUNISIA
TUR ISO3166_1 TURKEY
TKM ISO3166_1 TURKMENISTAN
TCA ISO3166_1 TURKS AND CAICOS ISLANDS
TUV ISO3166_1 TUVALU
UGA ISO3166_1 UGANDA
UKR ISO3166_1 UKRAINE
ARE ISO3166_1 UNITED ARAB EMIRATES
GBR ISO3166_1 UNITED KINGDOM
USA ISO3166_1 UNITED STATES
UMI ISO3166_1 UNITED STATES MINOR OUTLYING ISLANDS
UNK NULLFL unknown
URY ISO3166_1 URUGUAY
UZB ISO3166_1 UZBEKISTAN
VUT ISO3166_1 VANUATU
VEN ISO3166_1 VENEZUELA, BOLIVARIAN REPUBLIC OF
VNM ISO3166_1 VIET NAM
VGB ISO3166_1 VIRGIN ISLANDS, BRITISH
VIR ISO3166_1 VIRGIN ISLANDS, U.S.
WLF ISO3166_1 WALLIS AND FUTUNA
ESH ISO3166_1 WESTERN SAHARA
YEM ISO3166_1 YEMEN
ZMB ISO3166_1 ZAMBIA
ZWE ISO3166_1 ZIMBABWE

Codes representing country of origin, nationality, citizenship, address country

PHVS_County_FIPS_6-4 - County

Metadata

OID: 2.16.840.1.114222.4.11.829

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.829


Codes representing county of origin, address county, reporting county.

PHVS_DiagnosisPriority_HL7_2x - Diagnosis Priority (HL7)

Metadata

OID: 2.16.840.1.114222.4.11.914

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.914


Codes
Value Code System Description
0 HL70359 Not included in diagnosis ranking
1 HL70359 The primary diagnosis
2 HL70359 For ranked secondary diagnoses
3 HL70359 For ranked secondary diagnosis
4 HL70359 For ranked secondary diagnosis
5 HL70359 For ranked secondary diagnosis
6 HL70359 For ranked secondary diagnosis
7 HL70359 For ranked secondary diagnosis
8 HL70359 For ranked secondary diagnosis
9 HL70359 For ranked secondary diagnosis
10 HL70359 For ranked secondary diagnosis
11 HL70359 For ranked secondary diagnosis
12 HL70359 For ranked secondary diagnosis
13 HL70359 For ranked secondary diagnosis
14 HL70359 For ranked secondary diagnosis
15 HL70359 For ranked secondary diagnosis
16 HL70359 For ranked secondary diagnosis
17 HL70359 For ranked secondary diagnosis
18 HL70359 For ranked secondary diagnosis
19 HL70359 For ranked secondary diagnosis
20 HL70359 For ranked secondary diagnosis
21 HL70359 For ranked secondary diagnosis
22 HL70359 For ranked secondary diagnosis
23 HL70359 For ranked secondary diagnosis
24 HL70359 For ranked secondary diagnosis
25 HL70359 For ranked secondary diagnosis
26 HL70359 For ranked secondary diagnosis
27 HL70359 For ranked secondary diagnosis
28 HL70359 For ranked secondary diagnosis
29 HL70359 For ranked secondary diagnosis
30 HL70359 For ranked secondary diagnosis
31 HL70359 For ranked secondary diagnosis
32 HL70359 For ranked secondary diagnosis
33 HL70359 For ranked secondary diagnosis
34 HL70359 For ranked secondary diagnosis
35 HL70359 For ranked secondary diagnosis
36 HL70359 For ranked secondary diagnosis
37 HL70359 For ranked secondary diagnosis
38 HL70359 For ranked secondary diagnosis
39 HL70359 For ranked secondary diagnosis
40 HL70359 For ranked secondary diagnosis
41 HL70359 For ranked secondary diagnosis
42 HL70359 For ranked secondary diagnosis
43 HL70359 For ranked secondary diagnosis
44 HL70359 For ranked secondary diagnosis
45 HL70359 For ranked secondary diagnosis
46 HL70359 For ranked secondary diagnosis
47 HL70359 For ranked secondary diagnosis
48 HL70359 For ranked secondary diagnosis
49 HL70359 For ranked secondary diagnosis
50 HL70359 For ranked secondary diagnosis

The number from HL7 Table 0359 - Diagnosis Priority that identifies the significance or priority of the diagnosis code, with 1 being the Primary diagnosis, etc.

PHVS_DiagnosisType_HL7_2x - Diagnosis Type (HL7)

Metadata

OID: 2.16.840.1.114222.4.11.827

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.827


Codes
Value Code System Description
A HL70052 Admitting
F HL70052 Final
W HL70052 Working

A code from HL7 2.5 User-defined Table 0052 - Diagnosis Type that identifies the type of diagnosis being sent (Admitting, Working, Final).

PHVS_DischargeDisposition_HL7_2x - Discharge Disposition (HL7)

The disposition of the patient at time of discharge (i.e., discharged to home, expired, etc.). Uses User-defined Table 0112 - Discharge Disposition; this field is used on UB92 FL22.

Metadata

OID: 2.16.840.1.114222.4.11.915

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.915


Codes
Value Code System Description
01 HL70112 Discharged to home care or self care (routine discharge)
02 HL70112 "Discharged/transferred to a short term general hospital for inpatient care"
03 HL70112 "Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care"
04 HL70112 "Discharged/transferred to a facility that provides custodial or supportive care"
05 HL70112 Discharged/transferred to a designated cancer center or children’s hospital
06 HL70112 "Discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care"
07 HL70112 Left against medical advice or discontinued care
08 HL70112 Discharged/transferred to home under care of a Home IV provider
09 HL70112 Admitted as an inpatient to this hospital
10 HL70112 Discharge to be defined at state level, if necessary
11 HL70112 Discharge to be defined at state level, if necessary
12 HL70112 Discharge to be defined at state level, if necessary
13 HL70112 Discharge to be defined at state level, if necessary
14 HL70112 Discharge to be defined at state level, if necessary
15 HL70112 Discharge to be defined at state level, if necessary
16 HL70112 Discharge to be defined at state level, if necessary
17 HL70112 Discharge to be defined at state level, if necessary
18 HL70112 Discharge to be defined at state level, if necessary
19 HL70112 Discharge to be defined at state level, if necessary
20 HL70112 Expired
21 HL70112 Discharged/transferred to court/law enforcement
22 HL70112 Expired to be defined at state level, if necessary
23 HL70112 Expired to be defined at state level, if necessary
24 HL70112 Expired to be defined at state level, if necessary
25 HL70112 Expired to be defined at state level, if necessary
26 HL70112 Expired to be defined at state level, if necessary
27 HL70112 Expired to be defined at state level, if necessary
28 HL70112 Expired to be defined at state level, if necessary
29 HL70112 Expired to be defined at state level, if necessary
30 HL70112 Still Patient
31 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
32 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
33 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
34 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
35 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
36 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
37 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
38 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
39 HL70112 "Still patient to be defined at state level, if necessary (i.e. still a patient)"
40 HL70112 Expired (i.e. died) at home
41 HL70112 "Expired (i.e. died) in a medical facility; e.g., hospital, SNF, ICF, or free standing hospice"
42 HL70112 Expired - place unknown
43 HL70112 Discharged/transferred to a federal health care facility
44 HL70112 Reserved for national assignment
45 HL70112 Reserved for national assignment
46 HL70112 Reserved for national assignment
47 HL70112 Reserved for national assignment
48 HL70112 Reserved for national assignment
49 HL70112 Reserved for national assignment
50 HL70112 Hospice - home
51 HL70112 Hospice - medical facility (certified) providing hospice level of care
52 HL70112 Reserved for national assignment
53 HL70112 Reserved for national assignment
54 HL70112 Reserved for national assignment
55 HL70112 Reserved for national assignment
56 HL70112 Reserved for national assignment
57 HL70112 Reserved for national assignment
58 HL70112 Reserved for national assignment
59 HL70112 Reserved for national assignment
60 HL70112 Reserved for national assignment
61 HL70112 Discharged/transferred to hospital-based Medicare approved swing bed
62 HL70112 "Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital"
63 HL70112 "Discharged/transferred to a Medicare certified long term care hospital (LTCH)"
64 HL70112 "Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare"
65 HL70112 "Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital"
66 HL70112 Discharged/transferred to a Critical Access Hospital (CAH)
67 HL70112 Reserved for national assignment
68 HL70112 Reserved for national assignment
69 HL70112 Reserved for national assignment
70 HL70112 "Discharged/transferred to another type of health care institution not defined elsewhere in this code list (See Code 05)"
71 HL70112 Reserved for national assignment (Discontinued effective 4/1/03)
72 HL70112 Reserved for national assignment (Discontinued effective 4/1/03)
73 HL70112 Reserved for national assignment
74 HL70112 Reserved for national assignment
75 HL70112 Reserved for national assignment
76 HL70112 Reserved for national assignment
77 HL70112 Reserved for national assignment
78 HL70112 Reserved for national assignment
79 HL70112 Reserved for national assignment
80 HL70112 Reserved for national assignment
81 HL70112 Discharged to home or self-care with a planned acute care hospital readmission
82 HL70112 Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission
83 HL70112 Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission
84 HL70112 Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission
85 HL70112 Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission
86 HL70112 Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission
87 HL70112 Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission
88 HL70112 Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission
89 HL70112 Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission
90 HL70112 Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission
91 HL70112 Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission
92 HL70112 Discharged/transferred to nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission
93 HL70112 Discharged/transferred to a psychiatric hospital/distinct part unit of a hospital with a planned acute care hospital inpatient readmission
94 HL70112 Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission
95 HL70112 Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission
96 HL70112 Reserved for national assignment
97 HL70112 Reserved for national assignment
98 HL70112 Reserved for national assignment
99 HL70112 Reserved for national assignment
100 HL70112 Discharged for Other Reasons
101 HL70112 Discharged to Care of Family/Friend(s)
102 HL70112 Discharged to Care of Paid Caregiver
103 HL70112 Discharged to Court/ Law Enforcement/Jail
104 HL70112 Discharged to Other Facility per Legal Guidelines
105 HL70112 Discharge required by Carrier Change
106 HL70112 Internal Transfer per Legal Guidelines
107 HL70112 Other Home Care
108 HL70112 Regular Discharge with Follow-up
109 HL70112 Return Transfer

The disposition of the patient at time of discharge (i.e., discharged to home, expired, etc.). Uses User-defined Table 0112 - Discharge Disposition; this field is used on UB92 FL22.

PHVS_Disease_CDC - Disease

Disease or Disorder - 64572001 SNOMED Domain

Metadata

OID: 2.16.840.1.114222.4.11.909

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.909


Disease or Disorder - 64572001 SNOMED Domain

PHVS_EmergencySeverityIndexAcuity_CDC - Emergency Severity Index - Acuity

Metadata

OID: 2.16.840.1.114222.4.11.7776

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7776


Codes
Value Code System Description
1 CDCEDACUITY Resuscitation
2 CDCEDACUITY Emergent
3 CDCEDACUITY Urgent
4 CDCEDACUITY Less Urgent
5 CDCEDACUITY Nonurgent

The Emergency Severity Index (ESI) is a tool for use in emergency department (ED) triage. The ESI triage algorithm yields rapid, reproducible, and clinically relevant stratification of patients into five groups, from level 1 (most urgent) to level 5 (least urgent). The ESI provides a method for categorizing ED patients by both acuity and resource needs. (https://www.ahrq.gov/professionals/systems/hospital/esi/index.html ) Based upon AHRQ 2012 Edition on the Implementation Handbook - version 4. ??

PHVS_EthnicityGroup_CDC - Ethnicity group

Metadata

OID: 2.16.840.1.114222.4.11.837

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.837


Codes
Value Code System Description
2135-2 CDCREC Hispanic or Latino
2186-5 CDCREC Not Hispanic or Latino

Whether the patient is hispanic or not

PHVS_EventType_SyndromicSurveillance - Event Type (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.6048

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6048


Codes
Value Code System Description
A03 HL70003 ADT/ACK - Discharge/end visit
A04 HL70003 ADT/ACK - Register a patient
A08 HL70003 ADT/ACK - Update patient information
A01 HL70003 ADT/ACK - Admit/visit notification

List of Table 0003:?Event Types associated with Syndromic Surveillance IG.

PHVS_FacilityVisitType_SyndromicSurveillance - Facility / Visit Type (Syndromic Surveillance)

Type of facility that the patient visited for treatment.

Metadata

OID: 2.16.840.1.114222.4.11.3401

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3401


Codes
Value Code System Description
261QE0002X HCPTNUCC Emergency Care [Ambulatory Health Care Facilities\Clinic/Center]
1021-5 HSLOC Inpatient practice setting
261QM2500X HCPTNUCC Medical Specialty [Ambulatory Health Care Facilities\Clinic/Center]
261QP2300X HCPTNUCC Primary Care [Ambulatory Health Care Facilities\Clinic/Center]
261QU0200X HCPTNUCC Urgent Care [Ambulatory Health Care Facilities\Clinic/Center]

Type of facility that the patient visited for treatment.

PHVS_Gender_SyndromicSurveillance - Gender (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.3403

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3403


Codes
Value Code System Description
F HL70001 Female
M HL70001 Male
O HL70001 Other
U HL70001 Unknown

PHVS_HealthcareServiceLocation_Syndromic - Healthcare Service Location (Syndromic)

Metadata

OID: 2.16.840.1.114222.4.11.7777

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7777


Codes
Value Code System Description
1162-7 HSLOC 24-Hour Observation Area
1184-1 HSLOC Administrative Areas
1075-1 HSLOC Adolescent Behavioral Health Ward
1210-4 HSLOC Adult Mixed Acuity Unit
1099-1 HSLOC Adult Step Down Unit
1021-5 HSLOC All Inpatient Beds combined
1110-6 HSLOC Allergy Clinic
1243-5 HSLOC Ambulatory Surgery Center
1245-0 HSLOC Ambulatory Surgery Recovery Room
1205-4 HSLOC Antenatal Care Ward
1106-4 HSLOC Assisted Living Area
1145-2 HSLOC Behavioral Health Clinic
1051-2 HSLOC Behavioral Health/Psych Ward
1185-8 HSLOC Blood Bank
1195-7 HSLOC Blood Collection (Blood Drive Campaign)
1147-8 HSLOC Blood Collection Center
1026-4 HSLOC Burn Critical Care
1052-0 HSLOC Burn Ward
1005-8 HSLOC Cardiac Catheterization Room/Suite
1112-2 HSLOC Cardiac Rehabilitation Center
1113-0 HSLOC Cardiology Clinic
1186-6 HSLOC Central Sterile Supply
1187-4 HSLOC Central Trash Area
1261-7 HSLOC Centralized Transfusion Service
1095-9 HSLOC Cesarean Section Room/Suite
1103-1 HSLOC Chronic Alzheimer's Unit
1104-9 HSLOC Chronic Behavioral Health/Psych Unit
1102-3 HSLOC Chronic Care Unit
1105-6 HSLOC Chronic Rehabilitation Unit
1011-6 HSLOC Clinical Chemistry Laboratory
1148-6 HSLOC Continence Clinic
1150-2 HSLOC Dental Clinic
1115-5 HSLOC Dermatology Clinic
1116-3 HSLOC Diabetes-Endocrinology Clinic
1198-1 HSLOC Dialysis Specialty Care Area
1126-2 HSLOC Ear, Nose, Throat Clinic
1053-8 HSLOC Ear, Nose, Throat Ward
1108-0 HSLOC Emergency Department
1007-4 HSLOC Endoscopy Suite
1188-2 HSLOC Facility Grounds
1250-0 HSLOC Facility-wide Inpatient (FacWIDEIn)
1251-8 HSLOC Facility-wide Outpatient (FacWIDEOut)
1117-1 HSLOC Family Medicine Clinic
1206-2 HSLOC Float
1118-9 HSLOC Gastrointestinal Clinic
1054-6 HSLOC Gastrointestinal Ward
1010-8 HSLOC General Laboratory
1122-1 HSLOC Genetics Clinic
1055-3 HSLOC Genitourinary Ward
1056-1 HSLOC Gerontology Ward
1121-3 HSLOC Gynecology Clinic
1057-9 HSLOC Gynecology Ward
1012-4 HSLOC Hematology Laboratory
1200-5 HSLOC Hematology-Oncology Clinic
1013-2 HSLOC Histology-Surgical Pathology Laboratory
1154-4 HSLOC HIV Clinic
1161-9 HSLOC Holistic Medicine Center
1192-4 HSLOC Home Care
1262-1 HSLOC Home Hemodialysis
1194-0 HSLOC Home-based Hospice
1182-5 HSLOC Housekeeping/Environmental Services
1017-3 HSLOC Hyperbaric Oxygen Center
1018-1 HSLOC Infusion Center
1165-0 HSLOC Inpatient Hospice
1203-9 HSLOC Interventional Radiology
1171-8 HSLOC Jail Unit
1058-7 HSLOC Labor and Delivery Ward
1059-5 HSLOC Labor, Delivery, Recovery, Postpartum Suite
1183-3 HSLOC Laundry Room
1204-7 HSLOC Location outside facility
1220-3 HSLOC Long Term Acute Care Intensive Care Unit
1222-9 HSLOC Long Term Acute Care Pediatric Intensive Care Unit
1214-6 HSLOC Long Term Acute Care Pediatric Ward
1221-1 HSLOC Long Term Acute Care Ward
1260-9 HSLOC Long Term Care Facility Bariatric Unit
1255-9 HSLOC Long Term Care Facility Dementia Unit
1258-3 HSLOC Long Term Care Facility General Nursing Unit
1254-2 HSLOC Long Term Care Facility Inpatient Hospice Unit
1256-7 HSLOC Long Term Care Facility Psychiatric Unit
1257-5 HSLOC Long Term Care Facility Skilled Nursing-Short Term Rehabilitation Unit
1259-1 HSLOC Long Term Care Facility Ventilator Dependent Unit
1090-0 HSLOC Long-Term Acute Care
1028-0 HSLOC Medical Cardiac Critical Care
1120-5 HSLOC Medical Clinic
1027-2 HSLOC Medical Critical Care
1060-3 HSLOC Medical Ward
1029-8 HSLOC Medical-Surgical Critical Care
1061-1 HSLOC Medical-Surgical Ward
1014-0 HSLOC Microbiology Laboratory
1212-0 HSLOC Mixed Age Mixed Acuity Unit
1176-7 HSLOC Mobile Blood Collection center
1174-2 HSLOC Mobile Emergency Services/EMS
1175-9 HSLOC Mobile MRI/CT
1189-0 HSLOC Morgue/Autopsy Room
1040-5 HSLOC Neonatal Critical Care (Level III)
1039-7 HSLOC Neonatal Critical Care(Level II/III)
1037-1 HSLOC Neonatal unit
1135-3 HSLOC Nephrology clinic
1035-5 HSLOC Neurologic Critical Care
1123-9 HSLOC Neurology Clinic
1062-9 HSLOC Neurology Ward
1031-4 HSLOC Neurosurgical Critical Care
1063-7 HSLOC Neurosurgical Ward
1151-0 HSLOC Occupational Health Clinic
1152-8 HSLOC Occupational Therapy Clinic
1232-8 HSLOC Oncology General Hematology-Oncology Ward
1231-0 HSLOC Oncology Hematopoietic Stem Cell Transplant Ward
1226-0 HSLOC Oncology Leukemia Ward
1229-4 HSLOC Oncology Leukemia-Lymphoma Ward
1228-6 HSLOC Oncology Lymphoma Ward
1223-7 HSLOC Oncology Medical Critical Care
1225-2 HSLOC Oncology Medical-Surgical Critical Care
1236-9 HSLOC Oncology Mixed Acuity Unit (all ages)
1233-6 HSLOC Oncology Pediatric Critical Care
1235-1 HSLOC Oncology Pediatric General Hematology-Oncology Ward
1234-4 HSLOC Oncology Pediatric Hematopoietic Stem Cell Transplant Ward
1230-2 HSLOC Oncology Solid Tumor Ward
1227-8 HSLOC Oncology Step Down Unit
1224-5 HSLOC Oncology Surgical Critical Care
1094-2 HSLOC Operating and recovery rooms
1096-7 HSLOC Operating Room/Suite
1124-7 HSLOC Ophthalmology Clinic
1064-5 HSLOC Ophthalmology Ward
1125-4 HSLOC Orthopedic Clinic
1066-0 HSLOC Orthopedic Trauma Ward
1065-2 HSLOC Orthopedic Ward
1149-4 HSLOC Ostomy Clinic
1246-8 HSLOC Outpatient Ambulatory Pediatric Surgery Center
1247-6 HSLOC Outpatient Ambulatory Plastic Surgery Center
1153-6 HSLOC Outpatient Hemodialysis Clinic
1268-2 HSLOC Outpatient Hemodialysis Clinic - Acute Kidney Injury
1219-5 HSLOC Outpatient Hemodialysis Clinic (in Inpatient Facility)
1242-7 HSLOC Outpatient Operating Room/Suite (Attached)
1244-3 HSLOC Outpatient Operating Room/Suite (Detached)
1127-0 HSLOC Pain Clinic
1146-0 HSLOC Pediatric Behavioral Health Clinic
1077-7 HSLOC Pediatric Behavioral Health Ward
1042-1 HSLOC Pediatric Burn Critical Care
1078-5 HSLOC Pediatric Burn Ward
1129-6 HSLOC Pediatric Cardiology Center
1043-9 HSLOC Pediatric Cardiothoracic Critical Care
1128-8 HSLOC Pediatric Clinic
1130-4 HSLOC Pediatric Dental Clinic
1131-2 HSLOC Pediatric Dermatology Clinic
1132-0 HSLOC Pediatric Diabetes-Endocrinology Clinic
1091-8 HSLOC Pediatric Dialysis Specialty Care Area
1079-3 HSLOC Pediatric Ear, Nose, Throat Ward
1109-8 HSLOC Pediatric Emergency Department
1119-7 HSLOC Pediatric Gastrointestinal Clinic
1080-1 HSLOC Pediatric Genitourinary Ward
1136-1 HSLOC Pediatric Hematology-Oncology Clinic
1044-7 HSLOC Pediatric Medical Critical Care
1076-9 HSLOC Pediatric Medical Ward
1045-4 HSLOC Pediatric Medical-Surgical Critical Care
1081-9 HSLOC Pediatric Medical-Surgical Ward
1211-2 HSLOC Pediatric Mixed Acuity Unit
1137-9 HSLOC Pediatric Nephrology Clinic
1082-7 HSLOC Pediatric Neurology Ward
1046-2 HSLOC Pediatric Neurosurgical Critical Care
1083-5 HSLOC Pediatric Neurosurgical Ward
1133-8 HSLOC Pediatric Orthopedic Clinic
1084-3 HSLOC Pediatric Orthopedic Ward
1248-4 HSLOC Pediatric Outpatient Operating Room/Suite (Attached)
1249-2 HSLOC Pediatric Outpatient Operating Room/Suite (Detached)
1085-0 HSLOC Pediatric Rehabilitation Ward (within Acute Care Hospital)
1047-0 HSLOC Pediatric Respiratory Critical Care
1138-7 HSLOC Pediatric Rheumatology Clinic
1134-6 HSLOC Pediatric Scoliosis Clinic
1093-4 HSLOC Pediatric Solid Organ Transplant Specialty Care Area
1100-7 HSLOC Pediatric Step Down Unit
1048-8 HSLOC Pediatric Surgical Critical Care
1086-8 HSLOC Pediatric Surgical Ward
1049-6 HSLOC Pediatric Trauma Critical Care
1074-4 HSLOC Pediatric ward
1179-1 HSLOC Pharmacy
1181-7 HSLOC Physical Plant Operations Center
1202-1 HSLOC Physical Therapy Clinic
1141-1 HSLOC Physician's Office
1067-8 HSLOC Plastic Surgery Ward
1140-3 HSLOC Podiatry Clinic
1169-2 HSLOC Post-Anesthesia Care Unit
1097-5 HSLOC Post-Anesthesia Care Unit/Recovery Room
1068-6 HSLOC Postpartum Ward
1156-9 HSLOC Prenatal Clinic
1034-8 HSLOC Prenatal Critical Care
1180-9 HSLOC Public Area in Facility
1157-7 HSLOC Pulmonary Clinic
1009-0 HSLOC Pulmonary Function Testing
1069-4 HSLOC Pulmonary Ward
1008-2 HSLOC Radiology
1155-1 HSLOC Rehabilitation Clinic
1218-7 HSLOC Rehabilitation Pediatric Ward (freestanding Inpatient Rehabilitation Facility)
1217-9 HSLOC Rehabilitation Ward (freestanding Inpatient Rehabilitation Facility)
1070-2 HSLOC Rehabilitation Ward (within Acute Care Hospital)
1033-0 HSLOC Respiratory Critical Care
1142-9 HSLOC Rheumatology Clinic
1172-6 HSLOC School Infirmary
1170-0 HSLOC School or Prison Infirmary
1201-3 HSLOC Scoliosis clinic
1015-7 HSLOC Serology Laboratory
1020-7 HSLOC Sleep Study Unit
1190-8 HSLOC Soiled Utility Area
1092-6 HSLOC Solid Organ Transplant Specialty Care Area
1196-5 HSLOC Specimen Collection Area (Community)
1019-9 HSLOC Specimen Collection Area (Healthcare)
1158-5 HSLOC Speech Therapy Clinic
1041-3 HSLOC Step down Neonatal Nursery (Level II)
1071-0 HSLOC Stroke (Acute) Ward
1032-2 HSLOC Surgical Cardiothoracic Critical Care
1030-6 HSLOC Surgical Critical Care
1143-7 HSLOC Surgical Services Clinic
1072-8 HSLOC Surgical Ward
1208-8 HSLOC Telemetry Ward
1207-0 HSLOC Therapeutic Apheresis Clinic
1178-3 HSLOC Transport Service
1025-6 HSLOC Trauma Critical Care
1209-6 HSLOC Treatment Room
1160-1 HSLOC Urgent Care Center
1073-6 HSLOC Vascular Surgery Ward
1164-3 HSLOC Ventilator Dependent Unit
1016-5 HSLOC Virology Laboratory
1139-5 HSLOC Well Baby Clinic
1038-9 HSLOC Well Baby Nursery (Level I)
1144-5 HSLOC Wound Center
1159-3 HSLOC Wound Ostomy Continence Clinic

Value set for healthcare service location used by the Implementation Guide for Syndromic Surveillance.

PHVS_HeightUnit_UCUM - Height Unit

Metadata

OID: 2.16.840.1.114222.4.11.891

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.891


Codes
Value Code System Description
cm UCUM CentiMeter [SI Length Units]
[ft_us] UCUM foot
[in_us] UCUM inch
m UCUM meter

Units for measuring height

PHVS_IdentifierType_SyndromicSurveillance - Identifier Type (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.3597

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3597


Codes
Value Code System Description
AN HL70203 Account number
ANC HL70203 Account number Creditor
AND HL70203 Account number debitor
APRN HL70203 Advanced Practice Registered Nurse number
AM HL70203 American Express
ANON HL70203 Anonymous identifier
BA HL70203 Bank Account Number
BC HL70203 Bank Card Number
BR HL70203 Birth registry number
CY HL70203 County number
DDS HL70203 Dentist license number
DI HL70203 Diner_s Club card
DS HL70203 Discover Card
DN HL70203 Doctor number
DR HL70203 Donor Registration Number
DL HL70203 Driver_s license number
DEA HL70203 Drug Enforcement Administration registration number
DFN HL70203 Drug Furnishing or prescriptive authority Number
EI HL70203 Employee number
GL HL70203 General ledger number
GN HL70203 Guarantor external identifier
GI HL70203 Guarantor internal identifier
HC HL70203 Health Card Number
IND HL70203 Indigenous/Aboriginal
JHN HL70203 Jurisdictional health number (Canada)
LI HL70203 Labor and industries number
LN HL70203 License number
PE HL70203 Living Subject Enterprise Number
LR HL70203 Local Registry ID
MS HL70203 MasterCard
MD HL70203 Medical License number
MR HL70203 Medical record number
UPIN HL70203 Medicare/CMS (formerly HCFA)_s Universal Physician Identification numbers
MB HL70203 Member Number
MCN HL70203 Microchip Number
MI HL70203 Military ID number
NH HL70203 National Health Plan Identifier
NII HL70203 National Insurance Organization Identifier
NNxxx HL70203 National Person Identifier where the xxx is the ISO table 3166 3-character (alphabetic) country code
NPI HL70203 National provider identifier
NI HL70203 National unique individual identifier
NP HL70203 Nurse practitioner number
OD HL70203 Optometrist license number
DO HL70203 Osteopathic License number
PPN HL70203 Passport number
PT HL70203 Patient external identifier
PI HL70203 Patient internal identifier
MA HL70203 Patient Medicaid number
MC HL70203 Patient's Medicare number
PCN HL70203 Penitentiary/correctional institution Number
PEN HL70203 Pension Number
PRC HL70203 Permanent Resident Card Number
PN HL70203 Person number
RPH HL70203 Pharmacist license number
PA HL70203 Physician Assistant number
DPM HL70203 Podiatrist license number
MCD HL70203 Practitioner Medicaid number
MCR HL70203 Practitioner Medicare number
PRN HL70203 Provider number
QA HL70203 QA number
RR HL70203 Railroad Retirement number
RRI HL70203 Regional registry ID
RN HL70203 Registered Nurse Number
RI HL70203 Resource identifier
SS HL70203 Social Security number
SL HL70203 State license
SR HL70203 State registry ID
SN HL70203 Subscriber Number
TAX HL70203 Tax ID number
ANT HL70203 Temporary Account Number
PNT HL70203 Temporary Living Subject Number
MRT HL70203 Temporary Medical Record Number
TN HL70203 Treaty Number/ (Canada)
U HL70203 Unspecified identifier
VS HL70203 VISA
VN HL70203 Visit number
WC HL70203 WIC identifier
WCN HL70203 Workers_ Comp Number

Subset of HL7 2.x Identifier Type table (excluding organization identifier)

PHVS_MedicationBrandName_HITSP - Medication Brand Name Value Set

This identifies the product brand name of drugs, such as Tylenol, Claritin, etc. Shall contain RxNorm normal forms for concepts type of "Brand Name" or Brand Name Packs.

Metadata

OID: 2.16.840.1.113883.3.88.12.80.16

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.88.12.80.16


This identifies the product brand name of drugs, such as Tylenol, Claritin, etc. Shall contain RxNorm normal forms for concepts type of "Brand Name" or Brand Name Packs.

PHVS_MedicationClinicalDrugName_HITSP - Medication Clinical Drug Name Value Set

Shall contain RxNorm normal forms for concepts type of "Ingredient Name" or Generic Packs. The ingredient name concepts can be found in the RxNORM file RXCONSO.RRF selecting all terms where SAB=RXNORM (selecting the normal forms), and TTY=SCD (selecting the ingredient names) or TTY=GPCK (selecting the generic packs)

Metadata

OID: 2.16.840.1.113883.3.88.12.80.17

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.88.12.80.17


Shall contain RxNorm normal forms for concepts type of "Ingredient Name" or Generic Packs. The ingredient name concepts can be found in the RxNORM file RXCONSO.RRF selecting all terms where SAB=RXNORM (selecting the normal forms), and TTY=SCD (selecting the ingredient names) or TTY=GPCK (selecting the generic packs)

PHVS_MessageStructure_SyndromicSurveillance - Message Structure (Syndromic Surveillance)

List of HL7 Table 0354:?Message Structure associated with Syndromic Surveillance

Metadata

OID: 2.16.840.1.114222.4.11.6047

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6047


Codes
Value Code System Description
ADT_A01 HL70354 A01, A04, A08, A13
ADT_A03 HL70354 A03
ACK HL70354 Varies

List of HL7 Table 0354:?Message Structure associated with Syndromic Surveillance

PHVS_MessageType_SyndromicSurveillance - Message Type (Syndromic Surveillance)

List of Table 0076 Message Types supported by Syndromic Surveillance IG

Metadata

OID: 2.16.840.1.114222.4.11.6049

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6049


Codes
Value Code System Description
ADT HL70076 ADT message
ACK HL70076 General acknowledgment message

List of Table 0076 Message Types supported by Syndromic Surveillance IG

PHVS_NameType_SyndromicSurveillance - Name Type (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.6056

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6056


Codes
Value Code System Description
S HL70200 Coded Pseudo-Name to ensure anonymity
L HL70200 Legal Name
U HL70200 Unspecified

Contains the constrained value set for syndromic surveillance (ED) IG with Legal, psuedonym and Unspecified name types.

PHVS_ObservationIdentifier_SyndromicSurveillance - Observation Identifier (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.3589

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3589


Codes
Value Code System Description
11283-9 LN Acuity assessment [Function] at First encounter
21612-7 LN Age:Time:Pt:Patient:Qn:Reported
39156-5 LN BMI
11289-6 LN Body temperature:Temp:Enctr-frst:Patient:Qn:
8661-1 LN Chief complaint:Find:Pt:Patient:Nom:Reported
44833-2 LN Diagnosis.preliminary:Imp:Pt:Patient:Nom:
SS003 PHINQUESTION Facility / Visit Type
11368-8 LN Illness or injury onset date and time:TmStp:Pt:Patient:Qn:
8677-7 LN Medication use Hx Reported
10160-0 LN Medication use Hx Reported
59408-5 LN Oxygen saturation:MFr:Pt:BldA:Qn:Pulse oximetry
56816-2 LN Patient location
11449-6 LN Pregnancy status - reported
11450-4 LN Problem list Reported
54582-2 LN Provider type [MDSv3]
72166-2 LN Tobacco smoking status
10182-4 LN Travel Hx Reported
SS001 PHINQUESTION Treating Facility Identifier
SS002 PHINQUESTION Treating Facility Location
54094-8 LN Triage note:Find:Pt:Emergency department:Doc:

List of observation identifiers associated with syndromic surveillance that would be coming in the observation identifier field (OBX-3) in HL7 2.x messaging.

PHVS_PatientClass_SyndromicSurveillance - Patient Class (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.3404

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3404


Codes
Value Code System Description
D HL70004 Direct admit
E HL70004 Emergency
I HL70004 Inpatient
V HL70004 Observation patient
B HL70004 Obstetrics
O HL70004 Outpatient
P HL70004 Preadmit
R HL70004 Recurring patient

Patient classification within facility

PHVS_PulseOximetryUnit_UCUM - Pulse Oximetry Unit

Metadata

OID: 2.16.840.1.114222.4.11.3590

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3590


Codes
Value Code System Description
% UCUM percent

UCUM units associated with Pulse Oximetry such as percent

PHVS_RaceCategory_CDC - Race Category

Metadata

OID: 2.16.840.1.114222.4.11.836

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.836


Codes
Value Code System Description
1002-5 CDCREC American Indian or Alaska Native
2028-9 CDCREC Asian
2054-5 CDCREC Black or African American
2076-8 CDCREC Native Hawaiian or Other Pacific Islander
2131-1 CDCREC Other Race
2106-3 CDCREC White

General race category reported by the patient - subject may have more than one

PHVS_SmokingStatus_MU - Smoking Status

Metadata

OID: 2.16.840.1.114222.4.11.6027

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6027


Codes
Value Code System Description
8517006 SCT Ex-smoker (finding)
77176002 SCT Smoker (finding)
266919005 SCT Never smoked tobacco (finding)
266927001 SCT Tobacco smoking consumption unknown (finding)
449868002 SCT Smokes tobacco daily (finding)
428041000124106 SCT Current some day smoker
428061000124105 SCT Current Light tobacco smoker
428071000124103 SCT Current Heavy tobacco smoker

Smoking Status - Meaningful Use

PHVS_SourceOfPaymentTypology_PHDSC - Source of Payment Typology (PHDSC)

Metadata

OID: 2.16.840.1.114222.4.11.3591

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3591


Codes
Value Code System Description
1 PHDSCPT MEDICARE
2 PHDSCPT MEDICAID
3 PHDSCPT OTHER GOVERNMENT (Federal/State/Local) (excluding Department of Corrections)
4 PHDSCPT DEPARTMENTS OF CORRECTIONS
5 PHDSCPT PRIVATE HEALTH INSURANCE
6 PHDSCPT BLUE CROSS/BLUE SHIELD
7 PHDSCPT MANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private)
8 PHDSCPT NO PAYMENT from an Organization/Agency/Program/Private Payer Listed
9 PHDSCPT MISCELLANEOUS/OTHER
11 PHDSCPT Medicare (Managed Care)
12 PHDSCPT Medicare (Non-managed Care)
13 PHDSCPT Medicare Hospice
14 PHDSCPT Dual Eligibility Medicare/Medicaid Organization
19 PHDSCPT Medicare Other
21 PHDSCPT Medicaid (Managed Care)
22 PHDSCPT Medicaid (Non-managed Care Plan)
23 PHDSCPT Medicaid/SCHIP
25 PHDSCPT Medicaid - Out of State
26 PHDSCPT Medicaid - Long Term Care
29 PHDSCPT Medicaid Other
31 PHDSCPT Department of Defense
32 PHDSCPT Department of Veterans Affairs
33 PHDSCPT Indian Health Service or Tribe
34 PHDSCPT HRSA Program
35 PHDSCPT Black Lung
36 PHDSCPT State Government
37 PHDSCPT Local Government
38 PHDSCPT Other Government (Federal, State, Local not specified)
39 PHDSCPT Other Federal
41 PHDSCPT Corrections Federal
42 PHDSCPT Corrections State
43 PHDSCPT Corrections Local
44 PHDSCPT Corrections Unknown Level
51 PHDSCPT Managed Care (Private)
52 PHDSCPT Private Health Insurance - Indemnity
53 PHDSCPT Managed Care (private) or private health insurance (indemnity), not otherwise specified
54 PHDSCPT Organized Delivery System
55 PHDSCPT Small Employer Purchasing Group
56 PHDSCPT Specialized Stand Alone Plan
59 PHDSCPT Other Private Insurance
61 PHDSCPT BC Managed Care
62 PHDSCPT BC Indemnity
63 PHDSCPT BC (Indemnity or Managed Care) - Out of State
64 PHDSCPT BC (Indemnity or Managed Care) - Unspecified
69 PHDSCPT BC (Indemnity or Managed Care) - Other
71 PHDSCPT HMO
72 PHDSCPT PPO
73 PHDSCPT POS
79 PHDSCPT Other Managed Care, Unknown if public or private
81 PHDSCPT Self-pay (Includes applicants for insurance and Medicaid applicants)
82 PHDSCPT No Charge
83 PHDSCPT Refusal to Pay/Bad Debt
84 PHDSCPT Hill Burton Free Care
85 PHDSCPT Research/Donor
89 PHDSCPT No Payment, Other
91 PHDSCPT Foreign National
92 PHDSCPT Other (Non-government)
93 PHDSCPT Disability Insurance
94 PHDSCPT Long-term Care Insurance
95 PHDSCPT Worker's Compensation
96 PHDSCPT Auto Insurance (no fault)
97 PHDSCPT Legal Liability / Liability Insurance
98 PHDSCPT Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)
99 PHDSCPT No Typology Code available for payment source
111 PHDSCPT Medicare HMO
112 PHDSCPT Medicare PPO
113 PHDSCPT Medicare POS
119 PHDSCPT Medicare Managed Care Other
121 PHDSCPT Medicare FFS
122 PHDSCPT Medicare Drug Benefit
123 PHDSCPT Medicare Medical Savings Account (MSA)
129 PHDSCPT Medicare Non-managed Care Other
191 PHDSCPT Medicare Pharmacy Benefit Manager
211 PHDSCPT Medicaid HMO
212 PHDSCPT Medicaid PPO
213 PHDSCPT Medicaid PCCM (Primary Care Case Management)
219 PHDSCPT Medicaid Managed Care Other
291 PHDSCPT Medicaid Pharmacy Benefit Manager
299 PHDSCPT Medicaid - Dental
311 PHDSCPT TRICARE (CHAMPUS)
312 PHDSCPT Military Treatment Facility
313 PHDSCPT Dental --Stand Alone
321 PHDSCPT Veteran care--Care provided to Veterans
322 PHDSCPT Non-veteran care
331 PHDSCPT Indian Health Service - Regular
332 PHDSCPT Indian Health Service - Contract
333 PHDSCPT Indian Health Service - Managed Care
334 PHDSCPT Indian Tribe - Sponsored Coverage
341 PHDSCPT Title V (MCH Block Grant)
342 PHDSCPT Migrant Health Program
343 PHDSCPT Ryan White Act
349 PHDSCPT Other
361 PHDSCPT State SCHIP program (codes for individual states)
362 PHDSCPT Specific state programs (list/ local code)
369 PHDSCPT State, not otherwise specified (other state)
371 PHDSCPT Local - Managed care
372 PHDSCPT FFS/Indemnity
379 PHDSCPT Local, not otherwise specified (other local, county)
381 PHDSCPT Federal, State, Local not specified managed care
382 PHDSCPT Federal, State, Local not specified - FFS
389 PHDSCPT Federal, State, Local not specified - Other
391 PHDSCPT Federal Employee Health Plan
511 PHDSCPT Commercial Managed Care - HMO
512 PHDSCPT Commercial Managed Care - PPO
513 PHDSCPT Commercial Managed Care - POS
514 PHDSCPT Exclusive Provider Organization
515 PHDSCPT Gatekeeper PPO (GPPO)
516 PHDSCPT Commercial Managed Care - Pharmacy Benefit Manager
517 PHDSCPT Commercial Managed Care - Dental
519 PHDSCPT Managed Care, Other (non HMO)
521 PHDSCPT Commercial Indemnity
522 PHDSCPT Self-insured (ERISA) Administrative Services Only (ASO) plan
523 PHDSCPT Medicare supplemental policy (as second payer)
524 PHDSCPT Indemnity Insurance - Dental
529 PHDSCPT Private health insurance-other commercial Indemnity
561 PHDSCPT Dental
562 PHDSCPT Vision
611 PHDSCPT BC Managed Care - HMO
612 PHDSCPT BC Managed Care - PPO
613 PHDSCPT BC Managed Care - POS
614 PHDSCPT BC Managed Care - Dental
619 PHDSCPT BC Managed Care - Other
621 PHDSCPT BC Indemnity
622 PHDSCPT BC Self-insured (ERISA) Administrative Services Only (ASO) Plan
623 PHDSCPT BC Medicare Supplemental Plan
629 PHDSCPT BC Indemnity - Dental
821 PHDSCPT Charity
822 PHDSCPT Professional Courtesy
823 PHDSCPT Research/Clinical Trial
951 PHDSCPT Worker's Comp HMO
953 PHDSCPT Worker's Comp Fee-for-Service
954 PHDSCPT Worker's Comp Other Managed Care
959 PHDSCPT Worker's Comp, Other unspecified
3111 PHDSCPT TRICARE Prime--HMO
3112 PHDSCPT TRICARE Extra--PPO
3113 PHDSCPT TRICARE Standard - Fee For Service
3114 PHDSCPT TRICARE For Life--Medicare Supplement
3115 PHDSCPT TRICARE Reserve Select
3116 PHDSCPT Uniformed Services Family Health Plan (USFHP) -- HMO
3119 PHDSCPT Department of Defense - (other)
3121 PHDSCPT Enrolled Prime--HMO
3122 PHDSCPT Non-enrolled Space Available
3123 PHDSCPT TRICARE For Life (TFL)
3211 PHDSCPT Direct Care--Care provided in VA facilities
3212 PHDSCPT Indirect Care--Care provided outside VA facilities
3221 PHDSCPT Civilian Health and Medical Program for the VA (CHAMPVA)
3222 PHDSCPT Spina Bifida Health Care Program (SB)
3223 PHDSCPT Children of Women Vietnam Veterans (CWVV)
3229 PHDSCPT Other non-veteran care
3711 PHDSCPT HMO
3712 PHDSCPT PPO
3713 PHDSCPT POS
3811 PHDSCPT Federal, State, Local not specified - HMO
3812 PHDSCPT Federal, State, Local not specified - PPO
3813 PHDSCPT Federal, State, Local not specified - POS
3819 PHDSCPT Federal, State, Local not specified - not specified managed care
9999 PHDSCPT Unavailable /No Payer Specified / Blank
32121 PHDSCPT Fee Basis
32122 PHDSCPT Foreign Fee/Foreign Medical Program(FMP)
32123 PHDSCPT Contract Nursing Home/Community Nursing Home
32124 PHDSCPT State Veterans Home
32125 PHDSCPT Sharing Agreements
32126 PHDSCPT Other Federal Agency
32127 PHDSCPT Dental Care
32128 PHDSCPT Vision Care

The development of a standard source of payment classification system is a high priority for public health and can be used for a wide variety of public health activities such as monitoring healthcare access and documenting disparities.

PHVS_State_FIPS_5-2 - State

Metadata

OID: 2.16.840.1.114222.4.11.830

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.830


Codes
Value Code System Description
01 FIPS5_2 Alabama
02 FIPS5_2 Alaska
04 FIPS5_2 Arizona
05 FIPS5_2 Arkansas
06 FIPS5_2 California
08 FIPS5_2 Colorado
09 FIPS5_2 Connecticut
10 FIPS5_2 Delaware
11 FIPS5_2 District of Columbia
12 FIPS5_2 Florida
13 FIPS5_2 Georgia
15 FIPS5_2 Hawaii
16 FIPS5_2 Idaho
17 FIPS5_2 Illinois
18 FIPS5_2 Indiana
19 FIPS5_2 Iowa
20 FIPS5_2 Kansas
21 FIPS5_2 Kentucky
22 FIPS5_2 Louisiana
23 FIPS5_2 Maine
24 FIPS5_2 Maryland
25 FIPS5_2 Massachusetts
26 FIPS5_2 Michigan
27 FIPS5_2 Minnesota
28 FIPS5_2 Mississippi
29 FIPS5_2 Missouri
30 FIPS5_2 Montana
31 FIPS5_2 Nebraska
32 FIPS5_2 Nevada
33 FIPS5_2 New Hampshire
34 FIPS5_2 New Jersey
35 FIPS5_2 New Mexico
36 FIPS5_2 New York
37 FIPS5_2 North Carolina
38 FIPS5_2 North Dakota
39 FIPS5_2 Ohio
40 FIPS5_2 Oklahoma
41 FIPS5_2 Oregon
42 FIPS5_2 Pennsylvania
44 FIPS5_2 Rhode Island
45 FIPS5_2 South Carolina
46 FIPS5_2 South Dakota
47 FIPS5_2 Tennessee
48 FIPS5_2 Texas
49 FIPS5_2 Utah
50 FIPS5_2 Vermont
51 FIPS5_2 Virginia
53 FIPS5_2 Washington
54 FIPS5_2 West Virginia
55 FIPS5_2 Wisconsin
56 FIPS5_2 Wyoming
60 FIPS5_2 American Samoa
64 FIPS5_2 Federated States of Micronesia
66 FIPS5_2 Guam
67 FIPS5_2 Johnston Atoll
68 FIPS5_2 Marshall Islands
69 FIPS5_2 Northern Mariana Islands
70 FIPS5_2 Palau
71 FIPS5_2 Midway Islands
72 FIPS5_2 Puerto Rico
74 FIPS5_2 U.S. Minor Outlying Islands
76 FIPS5_2 Navassa Island
78 FIPS5_2 Virgin Islands of the U.S.
79 FIPS5_2 Wake Island
81 FIPS5_2 Baker Island
84 FIPS5_2 Howland Island
86 FIPS5_2 Jarvis Island
89 FIPS5_2 Kingman Reef
95 FIPS5_2 Palmyra Atoll

State codes for U.S. based on FIPS 5-2

PHVS_TemperatureUnit_UCUM - Temperature Unit

Metadata

OID: 2.16.840.1.114222.4.11.919

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.919


Codes
Value Code System Description
Cel UCUM degree Celsius
[degF] UCUM degree Fahrenheit

Units of measure for temperature

PHVS_UniversalIDType_SyndromicSurveillance - Universal ID Type (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.6050

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6050


Codes
Value Code System Description
ISO HL70301 An International Standards Organization Object Identifier
DNS HL70301 An Internet dotted name. Either in ASCII or as integers
x400 HL70301 An X.400 MHS format identifier
x500 HL70301 An X.500 directory name
CLIA HL70301 Clinical Laboratory Improvement Amendments
NPI HL70203 National provider identifier
HL7 HL70301 Reserved for future HL7 registration schemes
GUID HL70301 Same as UUID.
HCD HL70301 The CEN Healthcare Coding Scheme Designator. (Identifiers used in DICOM follow this assignment scheme.)
UUID HL70301 The DCE Universal Unique Identifier
L,M,N HL70301 These are reserved for locally defined coding schemes.
URI HL70301 Uniform Resource Identifier
Random HL70301 Usually a base64 encoded string of random bits.

List of Universal ID Types supported by Syndromic Surveillance IG.

PHVS_ValueType_SyndromicSurveillance - Value Type (Syndromic Surveillance)

Metadata

OID: 2.16.840.1.114222.4.11.6057

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6057


Codes
Value Code System Description
CWE HL70125 Coded With Exceptions
XAD HL70125 Extended Address
HD HL70125 Hierarchic designator
NM HL70125 Numeric
TX HL70125 Text Data (Display)
TS HL70125 Time Stamp (Date & Time)

Constrained value set of Hl7 Table 0125 Value Type for Syndromic Surveillance (ED).

PHVS_VitalSignResult_HITSP - Vital Sign Result Value Set

Metadata

OID: 2.16.840.1.113883.3.88.12.80.62

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.88.12.80.62


Codes
Value Code System Description
8302-2 LN Body height:Len:Pt:Patient:Qn:
8306-3 LN Body height-lying:Len:Pt:Patient:Qn:
8310-5 LN Body temperature:Temp:Pt:Patient:Qn:
3141-9 LN Body weight:Mass:Pt:Patient:Qn:Measured
9279-1 LN Breaths:NRat:Pt:Respiratory system:Qn:
8287-5 LN Circumference.occipital-frontal:Len:Pt:Head:Qn:Tape measure
8867-4 LN Heart beat:NRat:Pt:XXX:Qn:
8462-4 LN Intravascular diastolic:Pres:Pt:Arterial system:Qn:
8480-6 LN Intravascular systolic:Pres:Pt:Arterial system:Qn:
2710-2 LN Oxygen saturation:SFr:Pt:BldC:Qn:Oximetry

This identifies the vital sign result type

PHVS_WeightUnit_UCUM - Weight Unit

Metadata

OID: 2.16.840.1.114222.4.11.879

Type: Externally managed

Attributes
Stability Extensibility Content Definition
Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.879


Codes
Value Code System Description
g UCUM gram
kg UCUM KiloGram [SI Mass Units]
[oz_av] UCUM ounce
[lb_av] UCUM pound

Units for measuring weight based on UCUM std.

Conformance information

Conformance statements

Conformance profile level

Patient Admit
ID Description
ADT^A01_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A01'.
ADT^A01_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
ADT^A01_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A01'.
ADT^A01_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.
Patient Registration
ID Description
ADT^A04_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A04'.
ADT^A04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
ADT^A04_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A04'.
ADT^A04_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.
Patient Discharge
ID Description
ADT^A03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A03'.
ADT^A03_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
ADT^A03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A03'.
ADT^A03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A03'.
Patient Update
ID Description
ADT^A03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A08'.
ADT^A03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A08'.
ADT^A03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.
ADT^A04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.
Acknowledgement
ID Description
MSH_SS_ACK_01 The value of MSH.9.1 (Message Code) SHALL be 'ACK'.
MSH_SS_ACK_02 The value of MSH.9.3 (Message Structure) SHALL be 'ACK'.
MSH_SS_ACK_03 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_ACK'.

Segment level

DG1_SS - Diagnosis
ID Description
DG1_SS_8603629 The value of DG1-3.3 SHALL be one of list values: I10,SCT.
MSA_SS - Message Acknowledgment
ID Description
MSA_SS_5067426 MSH-2 Shall match MSH-10 value of message being acknowledged
MSH_SS - Message Header
ID Description
MSH_SS_4611129 The value of MSH-1 (Field Separator) SHALL be '|'.
MSH_SS_6631423 The value of MSH-21[*].3 SHALL be '2.16.840.1.114222.4.10.3'.
MSH_SS_7465888 The value of MSH-2 (Encoding Characters) SHALL be '^~\&'.
MSH_SS_9284050 The value of MSH-21[*].4 SHALL be 'ISO'.
OBX_SS - Observation/Result
ID Description
OBX_7289447_2355451 The value of OBX-1 (Set ID - OBX) SHALL be valued sequentially starting with the value '1'.
PID_SS_A01 - Patient Identification
ID Description
PID_SS_6738094 If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL be one of list values: |~^^^^^^S|,|~^^^^^^U|
PID_SS_A04_A08_A03 - Patient Identification
ID Description
PID_SS_6738094 If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL be one of list values: |~^^^^^^S|,|~^^^^^^U|
PID_SS_A04_A08_A03_1 If PV1-36 (Discharge Disposition) is valued with any of the following: '20', '40', '41', '42', PID-30 shall be 'Y'
PR1_SS - Procedures
ID Description
PR1_SS_6639954 PR1-3.1 shall be populated with a value from one for the following coding systems: CPT4, ICD10-CM-PCS

Datatype level

XPN - Extended Person Name
ID Description
XPN_SS_007 The value of XPN-7 (Name Type Code) SHALL be one of list values: L,S,U.
PT - Processing Type
ID Description
PT_SS_6152904 The value of PT-1 (Processing ID) SHALL be one of list values: P,T,D.
VID - Version Identifier
ID Description
VID_SS_001 The value of VID-1 (Version ID) SHALL be '2.5.1'.

Conditional predicates

Segment level

OBX_SS - Observation/Result
Location Usage Description
OBX-6 C(R/X) If the value of OBX-2 (Value Type) is 'NM'.
PID_SS_A04_A08_A03 - Patient Identification
Location Usage Description
PID-29 C(R/X) If the value of PID-30 is 'Y'.

Datatype level

CWE - Coded with Exceptions
Location Usage Description
CWE.2 C(R/RE) If CWE.1 (Identifier) is not valued
CWE.3 C(R/X) If CWE.3 (Name of Coding System) is valued
CWE.6 C(R/X) If CWE.6 (Name of Alternate Coding System) is valued
CE - Coded Element
Location Usage Description
CE.2 C(R/RE) If CE.1 (Identifier) is not valued
CE.3 C(R/X) If CE.1 (Identifier) is valued
CE.6 C(R/X) If CE.4 (Alternate Identifier) is valued