IMPLEMENTATION GUIDE FOR SYNDROMIC SURVEILLANCE

Release 1.0 STU (US Realm)

2019/06/20 21:40:28

HL7 version 2.5.1

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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

For information about HL7, contact:

Health Level Seven
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Phone: (734) 677-7777
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E-Mail: hq@hl7.org
Website: http://www.hl7.org

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:

Local, state, federal, and global public health practitioners and policy makers
Government agencies
Academic researchers
Non-profit associations
Clinical health care providers
For-profit organizations
Other stakeholders in disease surveillance

* 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:

An HL7 implementation and content reference standard for facilitating syndromic surveillance electronic health record technology certification
A template for local and state syndromic surveillance implementation guides or for profiles, trading partner agreements, or constraints on this standard for specific purposes or trading partners.
A planning resource for increasing the use of electronic health records, including details on health data elements that could become requirements for public health syndromic surveillance.

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:

International Society for Disease Surveillance. (2011, January). Final Recommendation: Core Processes and EHR Requirements for Public Health Syndromic surveillance. Available online: https://healthsurveillance.site-ym.com/?page=sys_MU_2011_recom
International Society for Disease Surveillance. Electronic Syndromic Surveillance Using Hospital Inpatient and Ambulatory Clinical Care Electronic Health Record Data: Recommendations from the ISDS Meaningful Use Workgroup. 2012. Available online: https://www.surveillancerepository.org/electronic-syndromic-surveillance-using-hospital-inpatient-and-ambulatory-clinical-care-electronic

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:

Patient demographics (age, gender, address)
Provider specialty
Provider address
Problem list
Vital signs
Triage notes
Travel history
Pregnancy status
Acuity
Admit reason
Diagnostic codes
Chief complaint
Procedures
Medications
Insurance

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:

Required data elements for all patient visits
Treatment facility information
Demographics, limited patient identifiable information as required by jurisdiction
Visit context, time, place
Diagnostic and pre-diagnostic information
Procedures
Vital measurements
Risk factor and other information
Acknowledgement of message receipt

This guide is not intended to specify topics such as:

How healthcare providers and PHAs can establish and maintain a health data sharing relationships;
Legal and governance issues about data access authorizations, data ownership and data use;
Business rules not implicit in HL7 or applied when creating a message (including data extraction from source systems);
Standard transport layer;
Business rules not implicit in HL7 or applied when processing a received message (including translating, normalizing, and preparing data for statistical analyses); and
Data quality monitoring and control.

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:

Infrastructure is in place to allow accurate and secure information exchange between systems;
Privacy and security are appropriately implemented; and
External and internal business rules are documented locally.

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:

PHIN Messaging Guide for Syndromic surveillance: Emergency Department, Urgent Care, Inpatient and Ambulatory Care Settings (Release 2.0, January 2015) https://www.cdc.gov/nssp/documents/guides/syndrsurvmessagguide2_messagingguide_phn.pdf
All historic versions of the PHIN Messaging Guide for Syndromic surveillance are posted at: https://www.cdc.gov/phin/resources/phinguides.html
Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule : https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html
HIPAA Privacy Rule and Public Health; Guidance from CDC and the U.S. Department of Health and Human Services: https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm
CDC NSSP Resource Center : https://www.cdc.gov/nssp/biosense/publications.html
CDC PHIN VADS Resources : https://www.cdc.gov/phin/tools/phinvads/index.html#2
CDC PHIN VADS Vocabulary : https://phinvads.cdc.gov/vads/SearchVocab.action
NIST HL7 V2 General Validation Tool : https://hl7v2.gvt.nist.gov/gvt/#/cf

Messaging and terminology standards and validation:

National Institute of Standards and Technology (NIST) validation tool https://hl7v2.gvt.nist.gov; then select "Syndromic Surveillance" from the "Tool Scopes" drop down.
Health Level Seven International (HL7) standards development organization http://www.hl7.org/
PHIN Vocabulary Access and Distribution System (VADS) http://phinvads.cdc.gov/
International Classification of Diseases, Tenth Revision (ICD10) http://www.icd10data.com/
Logical Observation Identifiers Names and Codes (LOINC) resource http://loinc.org/
Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) http://www.ihtsdo.org/snomed-ct/
American Medical Association Current Procedural Terminology (CPT) https://www.ama-assn.org/practice-management/cpt-current-procedural-terminology

Revision of PHIN Messaging Guide, Release 2.2

The following decisions were made by the Implementation Guide Workgroup:

Removed references to laboratory data
Removed ICD 9-CM references
Removed references to HL7 v2.3.1
Changed references of encounter to visit. Also, clarified guidance to state that visit ID (PV1-19) and visit time (PV1-44) should remain constant throughout the visit.
Reworded 2.1 Business Rules, Transmission Timeliness to "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."
Reworded patient name guidance to "Patient name may be submitted according to applicable jurisdiction or PHA regulations and specifications. If the PHA does not require patient name to be submitted, Visit or Patient ID, as specified within this guide, shall NOT be used by PHAs to join related visit data and for working with hospitals to find additional visit information for syndromic surveillance signal confirmation or investigation. Since, however, HL7 requires the patient name, the field must be populated even when data 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."
Added new or Updated Value Sets
- Discharge disposition (PV1-36) - PHVS_DischargeDisposition_HL7_2x
- Patient Class (PV1-2) - PHVS_PatientClass_SyndromicSurveillance
- Diagnosis Code (DG1-3) - PHVS_AdministrativeDiagnosis_CDC_ICD-10CM and PHVS_Disease_CDC
- Admit Reason (PV2-3) - PHVS_AdministrativeDiagnosis_CDC_ICD-10CM and PHVS_Disease_CDC
- Procedure Codes (PR1-3) - PHVS_AdministrativeProcedure_CDC_ICD-10PCS
- Medication List - PHVS_MedicationClinicalDrugName_HITSP and PHVS_MedicationBrandName_HITSP
- Patient Service Location - PHVS_HealthcareServiceLocation_Syndromic
- Initial Acuity - PHVS_EmergencySeverityIndexAcuity_CDC

Updated OBX Usage, elevating the following from O to RE
- Pregnancy Status
- Travel History
- Triage Notes
- Acuity
- Admit Reason
- Smoking status
- BMI (Body Mass Index)

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:

Section 5 - Syndromic surveillance data elements of interest into Message Infrastructure
Appendix A - Code Tables incorporated into Message Infrastructure
Appendix B - Message Examples has become section 2.6
Appendix C - Conformance Statements incorporated into Message Infrastructure
Appendix D - Future data elements was removed
Appendix E - Translation to 2.3.1 was removed
Appendix F - Useful Resources has become section 1.11
Appendix G - Discharge Disposition incorporated into Message Infrastructure
Appendix H - A08 Message Triggers has become section 2.5
Appendix I - Background has become sections 1.7 and 1.8
Appendix J - Revision History has become section 1.12

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:

Node-to-node acknowledgement-the receiving system takes responsibility of the message and lets the preceding system know without sending acknowledgements to originating healthcare setting; and
End-to-end, application-level acknowledgement choreography-the intended recipient not only assumes responsibility of message after it passes through multiple systems, such as integration engines, but also consumes the message's application-specific data and lets the preceding system know with the expectation that this acknowledgement is being passed to the message originator through any of the intermediate systems.

End-to-end, application-level acknowledgement choreography requires the use of an Enhanced Acknowledgment Mode, i.e., MSH-15 (Accept Acknowledgment Type) and MSH-16 (Application Acknowledgement Type) values by the message sender and control the creation of an accept-level message and application-level acknowledgement message by the message receiver, or a node that enables transmission of the message across the various systems between the sender and receiver (e.g., integration engines, HIEs). For details on accept- and application-level acknowledgements, see Chapter 2 of V2.5.1 (or higher).

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
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|1|I10|R11^NAUSEA AND VOMITING^I10|||W (Working diagnosis from ICD10)
DG1|2|SCT|16932000^NAUSEA AND VOMITING^SCT|||W (Working diagnosis from SNOMED-CT)

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
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||201406071300.1234-0500|||||GreaterNorthMedCtr^4356012945^NPI

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
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
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
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.

PID|1||2222^^^GreaterNorthMedCtr&4356012945&NPI^MR||~^^^^^^S|||F||2106-3^White^CDCREC|^^Decatur^13^30303^USA^M^^13121|||||||100221223^^^GreaterNorthMedCtr&4356012945&NPI^AN||||2135-2^Hispanic or Latino^CDCREC|||||||20140826202100|Y

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

PID|1||2111000222^^^NEMedCtr&1234567890&NPI^MR~12345789^^^NEMedCtr&1234567890&NPI^LR||~^^^^^^S|||M||2054-5^Black or AfricanAmerican^CDCREC~2028-9^Asian^CDCREC|^^Decatur^13^30303^USA^M^^13121|||||||100221223^^^NEMed Ctr&1234567890&NPI^AN||||2135-2^Hispanic or Latino^CDCREC

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
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-5: Patient Name (XPN_SS)

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
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:

PR1|1||0WQ.F0ZZ^Repair Abdominal Wall, Open Approach^I10P||201408081816

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
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

PV1-2 Patient Class = I (Inpatient)
PV1-4 Admission Type = E (Emergency) (US UB92 code '1')
PV1-7 Attending Doctor populated with an identifier assigned by NE Medical Center
PV1-10 Medical Service = MED (Medical Service)
PV1-14 Admit source = 7 (suggested UB code for Emergency)
PV1-19 Visit Number populated with an identifier assigned by Greater North Medical Center
PV1-44 Admit Date/time of August 17, 2014 at 12 noon

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
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)

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)

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)

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
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
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|||11530004^Brittle Diabetes^SCT (PV2-3 Admit Reason is SNOMED encoded)
PV2|||O24.4^Diabetes Mellitus arising in pregnancy^I10 (PV2-3 Admit Reason is ICD10 encoded)
PV2|||^Diabetes Mellitus (non-coded from drop-down or free text)

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:

only the first four are used to specify a precision of "year"
the first six are used to specify a precision of "month"
the first eight are used to specify a precision of "day"
the first ten are used to specify a precision of "hour"
the first twelve are used to specify a precision of "minute"
the first fourteen are used to specify a precision of "second"
the first sixteen are used to specify a precision of "one tenth of a second"
the first nineteen are used to specify a precision of "one ten thousandths of a second"

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
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
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 childrenâ€™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 childrenâ€™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

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