Acknowledgement Condition codes describe the conditions under which accept or application level acknowledgements are required to be returned in response to the message send operation.

A site specific code indicating the specific problem being reported by this Ack Detail.

Refelects rejections because elements of the communication are not supported in the current context.

Reflects errors in the syntax or structure of the communication.

A code identifying the specific message to be provided.

A textual value may be specified as the print name, or for non-coded messages, as the original text.*Discussion:*

'Required attribute xxx is missing', 'System will be unavailable March 19 from 0100 to 0300'*Examples:*

Acknowledgement code as described in HL7 message processing rules.

Identifies the the kind of information specified in the acknowledgement message. Options are: Error, Warning or Information.

Description:Types of representation groupings of financial transactions that are tracked and reported together with a single balance.Examples:

* Patient billing accounts * Cost center * Cash

Explanatory codes that provide information derived by an Adjudicator during the course of adjudicating an Invoice. Codes from this domain are purely information and do not materially affect the adjudicated Invoice. That is, codes do not impact or explain financial adjustments to an Invoice.

A companion domain (ActAdjudicationReason) includes information reasons which have a financial impact on an Invoice (claim).

Example adjudication information code is 54540 - Patient has reached Plan Maximum for current year.

Codes from this domain further rationalizes ActAdjudicationCodes (e.g. AA - Adjudicated with Adjustment), which are used to describe the process of adjudicating an Invoice.

Explanatory codes that describe reasons why an Adjudicator has financially adjusted an invoice (claim).

A companion domain (ActAdjudicationInformationCode) includes information reasons which do not have a financial impact on an invoice (claim).

Example adjudication reason code is AA-CLAIM-0011 - Only Basic Procedure/Test Eligible.

Codes from this domain further rationalizes ActAdjudicationCodes (e.g. AA - Adjudicated with Adjustment), which are used to describe the process of adjudicating an invoice. For AS - Adjudicated as Submitted, there should be no specification of ActAdjudicationReason codes, as there are no financial adjustments against the invoice.

Description:Actions to be carried out by the recipient of the Adjudication Result information. Description:Types of responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.Examples:

* adjudicated with adjustments * adjudicated as refused * adjudicated as submitted

Description:Describe why an antigen is considered to be invalid for use. Description:Types of acts that can be scheduled.Examples:

* Follow-up appointment * New referral appointment * Consultation appointment * Specimen Collection appointment * Procedure appointment

Description:May be sent to indicate one or more reasons for the performance of a billable clinical service or product, and not related or specified by a diagnosis.Examples:

* Duplicate Therapy * Care protocol * Insurance requirement

Description:Maybe sent to indicate one or more reasons for the performance of a non clinical service or product, and not related or specified by diagnosis.Examples:

* Fraudulent prescription * Patient's preference * Physiotherapy equipment

Definition:An identifying code for billable services, as opposed to codes for similar services used to identify them for functional purposes.OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode. Definition:This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services. OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode. Description:Types of provision(s) made for reimbursing for the deliver of healthcare services and/or goods provided by a Provider for one or more occurrence or over a specified period.Examples:

* Contract * Rostering * Capitation

Description:Sites used for blood donation.Examples:

* arm * leg * heel

Description:Defines the type of blood donation.Examples:

* autologous * directed * volunteer

**Description:**The type and scope of responsibility taken-on by the performer of the Act for a specific subject of care.

**Description:**Concepts identifying different types of referral requests. These concepts identify the general type of care or category of services requested. They are not used to represent the indication or diagnosis which triggered the need for the referral. E.g. Anger management service, Intensive Care service, Orthodontics service.

**Description:**Contrains the type of attachment (document, XRAY, bit map image, etc.) included to support a healthcare claim. Vocabulary bound to this domain should be a specification for the type of document (i.e. WCB First Report of Acccident - Form 8).

A code specifying the major type of Act that this Act-instance represents.

Constraints:The classCode domain is a tightly controlled vocabulary, not an external or user-defined vocabulary.

Every Act-instance must have a classCode. If the act class is not further specified, the most general Act.classCode (ACT) is used.

The Act.classCode must be a generalization of the specific Act concept (e.g., as expressed in Act.code), in other words, the Act concepts conveyed in an Act must be specializations of the Act.classCode. Especially, Act.code is not a "modifier" that can alter the meaning of a class code. (See Act.code for contrast.)

**Description:**The interaction of entities whereupon a subject entity is brought into proximity to a physical, chemical or biological agent. This includes intended exposure (e.g. administering a drug product) as well as accidental or environmental exposure. (Note: This class deals only with proximity and not the effectiveness of the exposure, i.e. not all exposed will suffer actual harm or benefit.)

**Examples:**Exposure to radiation, drug administration, inhalation of peanut aerosol or viral particles.

**Description:**An observation of genomic phenomena.

**Description:**A mandate, regulation, obligation, requirement, rule, or expectation unilaterally imposed by one party on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

An Act whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the subject.

Examples:: Procedures may involve the disruption of some body surface (e.g. an incision in a surgical procedure), but they also include conservative procedures such as reduction of a luxated join, chiropractic treatment, massage, balneotherapy, acupuncture, shiatsu, etc. Outside of clinical medicine, procedures may be such things as alteration of environments (e.g. straightening rivers, draining swamps, building dams) or the repair or change of machinery etc.

The act of putting something away for safe keeping. The "something" may be physical object such as a specimen, or information, such as observations regarding a specimen.

The table that provides the detailed or rich codes for the Act classes.

Open Issue:The hierarchy has issues and several of the existing domains may be moved under this new one; this must be examined and a proposal to clean up the hierarncy in the near future is neededOpen Issue:The description of this domain seems odd and may be a leftover from long ago and needs improvement.
Description:Codes for general process steps.Examples:

* lab process steps * diagnostic imaging process steps * etc. *(Missing third example)*

Denotes the specific service that has been performed. This is obtained from the professional service catalog pertaining to the discipline of the health service provider. Professional services are generally cognitive in nature and exclude surgical procedures. E.g. Provided training, Provided drug therapy review, Gave smoking-cessation counseling, etc.

**Description:**Lists of high-level categorizations for clinical coded observations that do not require numeric values with a specific unit of measure.

Examples:

* Symptoms * History * Observations

A context representing a grouped commitment of information to the EHR. It is considered the unit of modification of the record, the unit of transmission in record extracts, and the unit of attestation by authorizing clinicians.

Examples:document; authentication unit; transmission unit.

**Description:**Specifies the type of consent directive indicated by an ActClassPolicy e.g., a 3rd party authorization to disclose or consent for a substitute decision maker (SDM) or a notice of privacy policy. Sibling to ActPrivacyPolicyType and Child of ActPolicyType.

To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.

Usage Notes:Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.
Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.
Definition:The type of consent directive, e.g., to consent or dissent to collect, access, or use in specific ways within an EHRS or for health information exchange; or to disclose health information for purposes such as research. Description:Code specifying the level within a hierarchical Act composition structure and the kind of contextual information attached to composite Acts ("containers") and propagated to component Acts within those containers. The levelCode signifies the position within such a containment hierarchy and the applicable constraints.Examples:The "extract level" and the "folder level" must contain data about a single individual, whereas the "multiple subject level" may contain data about multiple individuals. While "extract" can originate from multiple sources, a "folder" should originate from a single source. The "composition" level usually has a single author.Constraints:The constraints applicable to a particular level may include differing requirements for participations (e.g. patient, source organization, author or other signatory), relationships to or inclusion of other Acts, documents or use of templates. The constraints pertaining to a level may also specify the permissible levels that may be contained as components of that level. Several nested levels with the same levelCode may be permitted, prohibited (or limited). Instance of the next subordinate level are usually permitted within any level but some levels may be omitted from a model and it may be permissible to skip several layers.Discussion:The levelCode concepts have been defined to meet specific health record transfer requirements. While these concepts are known to be applicable to some other types of transactions, they are not intended to a be a complete closed list. Options exist for other sets of orthogonal levels where required to meet a business purpose (e.g. a multiple patient communication may be subdivided by a super-ordinate level of subject areas).

Identifies the heading under which a document is to appear in a pre-defined, pro forma table of contents for a collection of documents within a regulatory category.

Examples:

* m1-1-forms (eCTD module 1, forms) * m1-1-1-fda-form-1571 (eCTD. Module 1, specific FDA form) * m3-2-s-drug-substance (eCTD module 3, section 2, drug substance by substance)

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

An agreement of obligation between two or more parties that is subject to contractual law and enforcement.

Examples:approvals granted by a regulatory agency; contracts measured in financial terms; insurance coverage contracts.

Codes specify the category of observation, evidence, or document used to assess for services, e.g., discharge planning, or to establish eligibility for coverage under a policy or program. The type of evidence is coded as observation values.

Indication of eligibility coverage for healthcare service(s) and/or product(s).

**Description:**Represents the reason for the level of coverage provided under the policy or program in terms of the types of entities that may play covered parties based on their personal relationships or employment status.

Criteria that are applicable to the authorized coverage.

Codes representing the level of coverage provided under the policy or program in terms of the types of entities that may play covered parties based on their personal relationships or employment status.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Identifies the reason or rationale for coverage of a service or product based on characteristics of the provider, e.g., contractual relationship to payor, such as in or out-of-network; relationship of the covered party to the provider.

**Example:**In closed managed care plan, a covered party is assigned a primary care provider who provides primary care services and authorizes referrals and ancillary and non-primary care services.

Maximum amount paid or maximum number of services/products covered; or maximum amount or number covered during a specified time period under the policy or program.

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

**Description:**Identifies the reason or rationale for coverage of a service or product based on clinical efficacy criteria or practices prescribed by the payor.

Definition:Set of codes indicating the type of insurance policy or program that pays for the cost of benefits provided to covered parties.

Codes representing the types of covered parties that may receive covered benefits under a policy or program.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by a credentialing agency, i.e. government or non-government agency. Failure in executing this Act may result in loss of credential to the person or organization who participates as performer of the Act. Excludes employment agreements.

**Example:**Hospital license; physician license; clinic accreditation.

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing individuals.

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing programs within organizations.

Description:Types of operations that may accomplish access of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.Examples:

* Query * Search * Transport * Send * Receive

Description:Types of operations that may accomplish collection or related management of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.Examples:

* Create * Store * Archive

**Description:**The type of data consent directive.

Description:Types of operations that may accomplish disclosure of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.Examples:

* Disclose * Forward * Publish

Description:Types of operations that may be performed on objects. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.Examples:

* Create * Update * Delete

Open Issue:This is too restrictive to deal with what CBCC wants.
Description:Types of operations that may accomplish usage of information. Here, objects are broadly understood as information system-related entities (e.g., devices, files, records, tables, processes, programs, domains) containing or receiving information.Examples:

* Activate * Release * Execute Read * Display * Update * Append * Amend

**Definition:**Identifies what type of issue detected during occurrence of an act (e.g. unrecognized identifiers, drug-drug contraindications, drug-allergy alerts).

Examples:

* High dosage alert * Conditional element missing * Timing detected issue

Description:Issue management types that dealing with detected issue observations.Rationale:Allows for consistent specification and interpretation of issue management.

Includes coded types of actions that can be taken by a supervising entity in response to inappropriate action (or inaction) on the part of a supervised entity.

**Definition:**A comprehensive term for health care provided in a healthcare facility (e.g. a practitioneraTMs office, clinic setting, or hospital) on a nonresident basis. The term ambulatory usually implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter.

**Definition:**A patient encounter that takes place at a dedicated healthcare service delivery location where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an inpatient or transferred to another facility.)

**Definition:**A patient encounter that takes place both outside a dedicated service delivery location and outside a patient's residence. Example locations might include an accident site and at a supermarket.

**Definition:**Healthcare encounter that takes place in the residence of the patient or a designee

**Definition:**A patient encounter where a patient is admitted by a hospital or equivalent facility, assigned to a location where patients generally stay at least overnight and provided with room, board, and continuous nursing service.

Description:Types of priorities to determine start of an encounter. Description:Administration reasons for patient encounters.

**Definition:**An encounter where the patient is admitted to a health care facility for a predetermined length of time, usually less than 24 hours.

Concepts representing types of patient encounter such as ambulatory encounter, inpatient encounter or emergency encounter.

**Definition:**A patient encounter where the patient and the practitioner(s) are not in the same physical location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference.

Description:Types of Sensitivity policies that may apply to a sensitive attribute on an Entity. Description:List of broad catagorizations of clinical event records.Examples:

* Allergies * Drugs * Referrals

Description:Describes types of criteria used when making observations, conducting procedures, and substance administrations.Examples:

* medications * immunizations

Concepts that identify the type or nature of exposure interaction. Examples include "household", "care giver", "intimate partner", "common space", "common substance", etc. to further describe the nature of interaction.

A qualitative measure of the degree of exposure to the causative agent. This includes concepts such as "low", "medium" and "high". This quantifies how the quantity that was available to be administered to the target differs from typical or background levels of the substance.

A type of Act representing a contract whose value is measured in monetary terms.

Examples:

* insurance policy * providercontract * billing arrangement

Identifies types of detected issues for Act class "ALRT" for the financial acts domain.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Codes dealing with the management of Detected Issue observations for the financial acts domain.

**Description:**The type of financial participation consent directive.

Examples:The Advanced Beneficiary Notice that Medicare patients consent or dissent to prior to receiving health services in the U.S. \\ Current values include consent to financial responsibility (1) if the service is not deemed medically necessary; (2) will self pay for a service; or (3) requests that payer be billed.

Code specifying financial indicators used to assess or establish eligibility for coverage under a policy or program; e.g., pay stub; tax or income document; asset document; living expenses.

**Description:**Identifies the type of document that was attached to support the processing of claims, adjudication decision determination or extensions to coverage.

A type of Act representing any transaction between two accounts whose value is measured in monetary terms.

Examples:

* patient account transaction * encounter accounttransaction * cost center transaction

Description:Further defines the type of grouping of orders or events. This concept domain is intended to be used with the GROUPER Act class code.Examples:

* requisition * pre-coordinated order set * custom order set

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

Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.

Usage Notes:The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.
The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.
Definition:Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement). Description:A type of document that has information related to the investigation of an adverse event or product problem report.Examples:

* Autopsy report * toxicology report * clinical journal article

Description:A type of concept that is used within adverse event and product problem reporting to organize data - often clinical in nature - provided for an investigative subject or other party within the scope of the investigation.Examples:

* Medical history * previous drug reactions * immunization history

Code identifying the type of identification document (e.g. passport, drivers license)

**Implementation Note:**The proposal called for a domain, but a code was also provided. When codes are available for the value set the code IDENTDOC (identity document) will be used as the headcode for the specializable value set.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Reasons why an immunization was administered.

Definition:Set of codes indicating the type of incident or accident.

The act of storing information to long term storage.

Description:Information type for which a provider is requesting routing of health information. This could include messaging of results or documents especially in the context of a specific service delivery location.Examples:

* Diagnostic Image Interpretations * Lab Test Results * Electrocardiogram Reports

Description:The type of health information to which the subject of the information or the subject&\#039;s delegate consents or dissents.Examples:

* allergy information * medication information * professional services information

Description:Use to convey the reason that a provider may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.

**Definition:**Indicates the set of information types which may be manipulated or referenced, such as for recommending access restrictions.

Description:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy. Description:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order. Description:Types of sensitivity policies that apply to Acts. Description:Conveyance of the type of information transfer protocol. Description:Types of insurance coverage legal documentation to cover healthcare costs.Examples:

* Automobile * Extended healthcare * Worker's compensation

Definition:Set of codes indicating the type of insurance policy. Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of potential financial loss. Insurance is defined as the equitable transfer of the risk of a potential loss, from one entity to another, in exchange for a premium and duty of care. A policy holder is an individual or an organization enters into a contract with an underwriter which stipulates that, in exchange for payment of a sum of money (a premium), one or more covered parties (insureds) is guaranteed compensation for losses resulting from certain perils under specified conditions. The underwriter analyzes the risk of loss, makes a decision as to whether the risk is insurable, and prices the premium accordingly. A policy provides benefits that indemnify or cover the cost of a loss incurred by a covered party, and may include coverage for services required to remediate a loss. An insurance policy contains pertinent facts about the policy holder, the insurance coverage, the covered parties, and the insurer. A policy may include exemptions and provisions specifying the extent to which the indemnification clause cannot be enforced for intentional tortious conduct of a covered party, e.g., whether the covered parties are jointly or severably insured.Discussion:In contrast to programs, an insurance policy has one or more policy holders, who own the policy. The policy holder may be the covered party, a relative of the covered party, a partnership, or a corporation, e.g., an employer. A subscriber of a self-insured health insurance policy is a policy holder. A subscriber of an employer sponsored health insurance policy is holds a certificate of coverage, but is not a policy holder; the policy holder is the employer. See CoveredRoleType. Description:Types of grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

An identifying data string for healthcare procedures.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Codes representing a service or product that is being invoiced (billed). The code can represent such concepts as "office visit", "drug X", "wheelchair" and other billable items such as taxes, service charges and discounts.

Description:Types of tax associated with billable services or products.Examples:

* Provincial or State sales tax * Harmonized sales tax * Federal sales tax

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Processing consideration and clarification codes.

Description:Types of summary information that can be reported by queries dealing with Statement of Financial Activity (SOFA). The summary information is generally used to help resolve balance discrepancies between providers and payors.Examples:

* number and total value of payable items; * number and value of same period nullify items; * number and value of prior nullify; * number of non-payable nullify items; * number of pending items; * number of rejected items; * number of adjudicated to zero items; * reimbursement items (e.g., pay patient) * Adjudicated non-payee payable prior-period electronic amount * Adjudicated nullified prior-period electronic amount * Adjudicated refused prior-period electronic amount

Description:Types of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for its immediate children invoice elements.

Examples:

* CPINV - Clinical product invoice * CSINV- Clinical service invoice * RXDINV - Drug invoice * RXCINV - Compound invoice * CSPINV - Combined service and clinical product invoice

Description:Types of responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.Examples:

* Re-bill for the professional fee * Good faith override * Wasted Drug

Indicates the importance or priority associated with a detected issue.

Codes for additional metadata to be assigned to document or context of use instances to organize a group of documents within the same table of contents heading. These external code systems specify the category or type of keyword (e.g. Species) and the applicable values.

Examples:

* Species code system * Species code * Sponsor's manufacturing site code system

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Codes for general laboratory process steps.

Provides codes associated with ActClass value of LIST (working list)

Definition:An identifying code for billable medical services, as opposed to codes for similar services to identify them for clinical purposes.OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Indicates the types of documents that can be associated with a medication or group of medications.

Examples include:Patient monographs, Provider monographs, Drug protocols, etc.

**Definition:**A collection of concepts that identifies different types of 'duration-based' mediation working lists.

**Examples:**"Continuous/Chronic" "Short-Term" and "As Needed"

Chemical reactions in the widest sense of the word.

Examples:Transcription (creating mRNA from a DNA gene), translation (creating a protein from mRNA), cleavage (hydrolysis of a peptide), substitution (replacing an element or residue with another, such as in glycosylation, phosphorylation), addition (adding a residue to a double bond), receptor binding.
Description:Identifies types of monitoring programs such as tracking specified medication prescribing e.g. narcotic(s), identifying investigational studies or identifying programs regarding reimbursement or prescribing privileges.

A code distinguishing whether an Act is conceived of as a factual statement or in some other manner as a command, possibility, goal, etc.

Constraints:An Act-instance must have one and only one moodCode value.

The moodCode of a single Act-instance never changes. Mood is not state.

To describe the progression of a business activity from defined to planned to executed, etc. one must instantiate different Act-instances in the different moods and link them using ActRelationship of general type "sequel". (See ActRelationship.type.)

Discussion:The Act.moodCode includes the following notions: (1) event, i.e., factual description of an actions that occurred; (2) definition of possible actions and action plans (the master file layer); (3) intent, i.e., an action plan instantiated for a patient as a care plan or order; (4) goal, i.e., an desired outcome attached to patient problems and plans; and (5) criterion, i.e., a predicate used as

The Act.moodCode modifies the meaning of the Act class in a controlled way, just as in natural language, grammatical form of a verb modify the meaning of a sentence in defined ways. For example, if the mood is factual (event,) then the entire act object represents a known fact. If the mood expresses a plan (intent,) the entire act object represents the expectation of what should be done. The mood does not change the meaning of individual act properties in peculiar ways.

Since the mood code is a determining factor for the meaning of an entire Act object, the mood must always be known. This means, whenever an act object is instantiated, the mood attribute must be assigned to a valid code, and the mood assignment can not change throughout the lifetime of an act object.

As the meaning of an act object is factored in the mood code, the mood code affects the interpretation of the entire Act object and with it every property (attributes and associations.) Note that the mood code affects the interpretation of the act object, and the meaning of the act object in turn determines the meaning of the attributes. However, the mood code does not arbitrarily change the meaning of individual attributes.

Inert vs. descriptive properties of Acts:Acts have two kinds of act properties, inert and descriptive properties. Inert properties are not affected by the mood, descriptive properties follow the mood of the object. For example, there is an identifier attribute Act.id, which gives a unique identification to an act object. Being a unique identifier for the object is in no way dependent on the mood of the act object. Therefore, the "interpretation" of the Act.id attribute is inert with respect to the act object's mood.

By contrast, most of the Act class' attributes are descriptive for what the Act statement expresses. Descriptive properties of the Act class give answer to the questions who, whom, where, with what, how and when the action is done. The questions who, whom, with what, and where are answered by Participatons, while how and when is answered by descriptive attributes and ActRelationships. The interpretation of a descriptive attribute is aligned to the interpretation of the entire act object, and controlled by the mood.

Examples:To illustrate the effect of mood code, consider a "blood glucose" observation:

The DEFINITION mood specifies the Act of "obtaining blood glucose". Participations describe in general the characteristics of the people who must be involved in the act, and the required objects, e.g., specimen, facility, equipment, etc. involved. The Observation.value specifies the absolute domain (range) of the observation (e.g., 15-500 mg/dl.)

In INTENT mood the author of the intent expresses the intent that he or someone else "should obtain blood glucose". The participations are the people actually or supposedly involved in the intended act, especially the author of the intent or any individual assignments for group intents, and the objects actually or supposedly involved in the act (e.g., specimen sent, equipment requirements, etc.) The Observation.value is usually not specified, since the intent is not to measure blood glucose, not to measure blood glucose in a specific range. (But compare with GOAL below.)

In ORDER mood, a kind of intent, the author requests to "please obtain blood glucose". The Participations are the people actually and supposedly involved in the act, especially the placer and the designated filler, and the objects actually or supposedly involved in the act (e.g., specimen sent, equipment requirements, etc.) The Observation.value is usually not specified, since the order is not to measure blood glucose in a specific range.

In EVENT mood, the author states that "blood glucose was obtained". Participations are the people actually involved in the act, and the objects actually involved (e.g., specimen, facilities, equipment.) The Observation.value is the value actually obtained (e.g., 80 mg/dL, or <15 mg/dL.)

In event-CRITERION mood, an author considers a certain class of "obtaining blood glucose" possibly with a certain value (range) as outcome. The Participations constrain the criterion, for instance, to a particular patient. The Observation.value is the range in which the criterion would hold (e.g. > 180 mg/dL or 200?300 mg/dL.)

In GOAL mood (a kind of criterion) the author states that "our goal is to be able to obtain blood glucose with the given value (range)". The Participations are similar to intents, especially the author of the goal and the patient for whom the goal is made. The Observation.value is the range which defined when the goal is met (e.g. 80?120 mg/dl.)

Rationale:The notion of "mood" is borrowed from natural language grammar, the mood of a verb (lat. modus verbi).

The notion of mood also resembles the various extensions of the logic of facts in modal logic and logic with modalities, where the moodCode specifies the modality (fact, possibility, intention, goal, etc.) under which the Act-statement is judged as appropriate or defective.

A non-mandated intent to perform an act. Used to record intents that are explicitly not Orders. Professional responsibility for the 'proposal' may or may not be present.

Reasons why a patient did not receive an immunization.

Definition:An identifying code for billable services that are not medical procedures, such as social services or governmental program services.Example:Building a wheelchair ramp, help with groceries, giving someone a ride, etc.OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Concepts representing indications (reasons for clinical action) other than diagnosis and symptoms.

Conveys the mandated workflow action that an information custodian, receiver, or user must perform.

Usage Note:Per ISO 22600-2, ObligationPolicy instances "are event-triggered and define actions to be performed by manager agent". Per HL7 Composite Security and Privacy Domain Analysis Model: This value set refers to the action required to receive the permission specified in the privacy rule. Per OASIS XACML, an obligation is an operation specified in a policy or policy that is performed in conjunction with the enforcement of an access control decision.

The act of verifying an observations. The subject act related to the observation verification (act relationship SUBJ) must be an observation (OBS)

Identifies the type of verification investigation being undertaken with respect to the subject of the verification activity.

Examples:
  • Verification of eligibility for coverage under a policy or program - aka enrolled/covered by a policy or program

  • Verification of record - e.g., person has record in an immunization registry

  • Verification of enumeration - e.g. NPI

  • Verification of Board Certification - provider specific

  • Verification of Certification - e.g. JAHCO, NCQA, URAC

  • Verification of Conformance - e.g. entity use with HIPAA, conformant to the CCHIT EHR system criteria

  • Verification of Provider Credentials

  • Verification of no adverse findings - e.g. on National Provider Data Bank, Health Integrity Protection Data Base (HIPDB)

**Description:**An identifying code for oral health interventions/procedures.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

The type of order that was fulfilled by the clinical service

Description:Concept domain which includes those ActProcedureCodes which are appropriate for ordering.Examples:

* physical therapies * excisions * surgery

**Description:**Provides a categorization for annotations recorded directly against the patient

Definition:A code specifying the particular kind of Patient Safety Incident that the Incident class instance represents.

**Examples:**"Medication incident", "slips, trips and falls incident".The actual value set for the domain will be determined by each (realm) implementation, whose Patient Safety terminology will be specific, although probably linked to the WHO Patient Safety Taxonomy that is currently under development

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Definition: Characterizes how a patient was or will be transported to the site of a patient encounter.

Examples:Via ambulance, via public transit, on foot.

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

**Definition:**Identifies types of dispensing events.

**Description:**Types of policies that further specify the ActClassPolicy value set.

Reasons why a preference has been specified.

Examples:

* Side Effects * Religious * Request

Concepts representing a type of preference that can be specified.

Examples:

* Food * Drug * Vegetarian * Sweets

A code or set of codes (e.g., for routine, emergency,) specifying the urgency under which the Act happened, can happen, is happening, is intended to happen, or is requested/demanded to happen.

Discussion:This attribute is used in orders to indicate the ordered priority, and in event documentation it indicates the actual priority used to perform the act. In definition mood it indicates the available priorities.
Description:Types of jurisdictional mandates relating to privacy.

**Description:**Types of privacy policies that further specify the ActClassPolicy value set e.g. override policy, minor's rights to mask sensitive information policy, opt-in, opt-out policy.

An Act which characterizes a Privilege can have additional observations to provide a finer definition of the requested or conferred privilege. This domain describes the categories under which this additional information is classified.

This domain includes observations used to characterize a privilege, under which this additional information is classified.

*Examples:*A privilege to prescribe drugs has a RESTRICTION that excludes prescribing narcotics; a surgical procedure privilege has a PRE-CONDITION that it requires prior Board approval.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Describes the high level classification of professional services for grouping.

**Examples:**Education, Counseling, Surgery, etc.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:An identifying code for healthcare interventions/procedures.Examples:

* immunization * appendectomy * physiotherapy

Description:of procedure used for evaluating a precondition, goal, or trigger.Examples:

* some radiology procedures * respiratory therapy * physical therapy

Description:Financial Acquisition Terms: categorizations of acquisition terms for a product.

Types of method a product can be obtained for use by the subject of the supply act (e.g. patient). Product examples are consumable or durable goods.

Examples:

* Loan * Rent * Sale

Description:A type of application made in order to obtain a product approval from a regulatory agency or other government body.Examples:

* Application for new approval * Application for renewal of approval * Application for variation of approval

Description:A type of approval process by which a product approval is obtained from a regulatory agency or other government body.Examples:

* Centralized process approval * Mutual recognition process approval * National process approval

Description:An approval granted to a product by a regulatory agency or other government body.Examples:

* Approval to sell * Approval to initiate clinical trial * Approval to market (i.e., advertise)

Description:

A type of documentation that is used to convey information about a product or an aspect of its life as a product - ranging from production to disposition.

Examples:

* Bill of lading * product label * Report of Product Disposal

Description:A type of activity that takes place during the life of a product as it moves from the point of production to the point of consumption, use, or disposition (most notably in the case of contaminated products). It will be possible for concepts at different levels of granularity to be included.Examples:

* Manufacture * paint * wholesale * dispose

DESCRIPTION

Identifies the nature (or type) of transformation that a (medicinal) product may undergo, prior to its administration to a patient.

Examples:

* Dilution * Dissolution * Suspension

Description:Denotes the specific professional service that has been performed. This is obtained from the professional service catalog pertaining to the discipline of the health service provider.Examples:

* adjustment of hearing aid * excision of skin lesion * stitching skin lacerations

Definition:A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds.Discussion:Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

Types of state an act may exist in.

A type of document used to represent a health quality measure (aka eMeasure).

A type of document section within a health quality measure (aka eMeasure), used to cluster the various parts of the eMeasure into a more human navigable format.

Identifies the document type from a regulator-defined set of codes similar to the ICH-defined File Tags used on clinical study documents in an eCTD.

Examples:

* Pre-clinical study report * Study report * Sample CRF

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies the legal or administrative category assigned to a regulated product that determines or influences the way in which its submission is reviewed.

Examples:

* New active ingredients * New ethical combination drug * New administrative route

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies different classes of regulatory policy that can be applied within a Regulated Product Submission.

Usage Note:This Domain is used to administratively group its subdomains specifically for usage in the RPS model, and is not intended to participate in any binidngs.

Identifies the reason for citing a related application.

Examples:

* Data protection period expiry reference * Bioequivalence reference * Drug Master File reference

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies the time period in which a submission of a given type is to be reviewed as established by law or practice in the particular regulatory realm.

Examples:

* 30 days, reduced time * 60 days, regular time * 90 days, extended time

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.
Description:A type of act that indicates the action taken by a practitioner or other responsible party in response to the reaction/event that is reported in the ICSR.Examples:

* failing device replaced * medication stopped * medication dose adjusted

A code specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably representable as an ActRelationship of type "has reason" linking to another Act.

Examples:Example reasons that might qualify for being coded in this field might be: "routine requirement", "infectious disease reporting requirement", "on patient request", "required by law".

Discussion

Most reasons for acts can be clearly expressed by linking the new Act to another prior Act using an ActRelationship of type "has reason". This simply states that the prior Act is a reason for the new Act (see ActRelationship.) The prior act can then be a specific existing act or a textual explanation. This works for most cases, and the more specific the reason data is, the more should this reason ActRelationship be used instead of the reasonCode.

The reasonCode remains as a place for common reasons that are not related to a prior Act or any other condition expressed in Acts. Indicators that something was required by law or was on the request of a patient etc. may qualify. However, if that piece of legislation, regulation, or the contract or the patient request can be represented as an Act (and they usually can), the reasonCode should not be used.

Description:Container of clinical statements. Navigational. No semantic content. Knowledge of the section code is not required to interpret contained observations. Represents a heading in a heading structure, or "container tree".Examples:category; document section; document body. Description:A code further classifying the type of record organizer. Used with the ActClassRecordOrganizer ActClass concept domain.Examples:

* CDA R2 * * Electrolytes Battery * Specimen Cluster

Conveys prohibited actions which an information custodian, receiver, or user is not permitted to perform unless otherwise authorized or permitted under specified circumstances.

Usage Notes:ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.
ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

This is the domain of registry types. Examples include Master Patient Registry, Staff Registry, Employee Registry, Tumor Registry.

Identifies the regulatory processes and/or submission contents specified in law or practice for a particular realm used to organize submitted materials.

Examples:

* Application Type: NDA * Submission Type: Efficacy Supplement * Submission Unit Type: Amendment

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

Identifies a temporary or final legal status assigned to a submission by a particular regulatory realm based on the laws and practices of the realm.

Examples:

* Active (as authorized by section abc) * Approved (under section xyz) * Withdrawn (under section pqr)

Usage Note:This usage is confined to a specific set of requirements related to regulatory documents in the context of RPS documents.

A code specifying when in the course of an Act a precondition for the Act is evaluated (e.g., before the Act starts for the first time, before every repetition, after each repetition but not before the first, or throughout the entire time of the Act.)

Discussion:This attribute is part of the workflow control suite of attributes. An action plan is a composite Act with component Acts. In a sequential plan, each component has a sequenceNumber that specifies the ordering of the plan steps. Before each step is executed and has preconditions these conditions are tested and if the test is positive, the Act has clearance for execution. The repeatNumber may indicate that an Act may be repeatedly executed. The checkpointCode is specifies when the precondition is checked and is analogous to the various conditional statements and loop constructs in programming languages "while-do" vs. "do-while" or "repeat-until" vs. "loop-exit".

For all checkpointCodes, except "end", preconditions are being checked at the time when the preceding step of the plan has terminated and this step would be next in the sequence established by the sequenceNumber attribute.

When the checkpointCode for a criterion of a repeatable Act is "end", the criterion is tested only at the end of each repetition of that Act. When the condition holds true, the next repetition is ready for execution.

When the checkpointCode is "entry" the criterion is checked at the beginning of each repetition (if any) whereas "beginning" means the criterion is checked only once before the repetition "loop" starts.

The checkpointCode "through" is special in that it requires the condition to hold throughout the execution of the Act, even throughout a single execution. As soon as the condition turns false, the Act should receive an interrupt event (see interruptibleInd) and will eventually terminate.

The checkpointCode "exit" is only used on a special plan step that represents a loop exit step. This allows an action plan to exit due to a condition tested inside the execution of this plan. Such exit criteria are sequenced with the other plan components using the ActRelationship.sequenceNumber.

Used to enumerate the relationships between a CDA section and its contained entries.

Description still needed

A code specifying how concurrent Acts are resynchronized in a parallel branch construct.

Discussion:This attribute is part of the workflow control suite of attributes. An action plan is a composite Act with component Acts. In a sequential plan, each component has a sequenceNumber that specifies the ordering of the plan steps. Branches exist when multiple components have the same sequenceNumber. Branches are parallel if the splitCode specifies that more than one branch can be executed at the same time. The joinCode then specifies if and how the braches are resynchronized.

The principal re-synchronization actions are (1) the control flow waits for a branch to terminate (wait-branch), (2) the branch that is not yet terminated is aborted (kill-branch), (3) the branch is not re-synchronized at all and continues in parallel (detached branch).

A kill branch is only executed if there is at least one active wait (or exclusive wait) branch. If there is no other wait branch active, a kill branch is not started at all (rather than being aborted shortly after it is started.) Since a detached branch is unrelated to all other branches, active detached branches do not protect a kill-branch from being aborted.

Description still needed

A code specifying how branches in an action plan are selected among other branches.

Discussion:This attribute is part of the workflow control suite of attributes. An action plan is a composite Act with component Acts. In a sequential plan, each component has a sequenceNumber that specifies the ordering of the plan steps. Branches exist when multiple components have the same sequenceNumber. The splitCode specifies whether a branch is executed exclusively (case-switch) or inclusively, i.e., in parallel with other branches.

In addition to exlusive and inclusive split the splitCode specifies how the pre-condition (also known as "guard conditions" on the branch) are evaluated. A guard condition may be evaluated once when the branching step is entered and if the conditions do not hold at that time, the branch is abandoned. Conversely execution of a branch may wait until the guard condition turns true.

In exclusive wait branches, the first branch whose guard conditions turn true will be executed and all other branches abandoned. In inclusive wait branches some branches may already be executed while other branches still wait for their guard conditions to turn true.

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.

A code specifying the meaning and purpose of every ActRelationship instance. Each of its values implies specific constraints to what kinds of Act objects can be related and in which way.

Discussion:The types of act relationships fall under one of 5 categories:

1.) (De)-composition, with composite (source) and component (target)

2.) Sequel which includes follow-up, fulfillment, instantiation, replacement, transformation, etc. that all have in common that source and target are Acts of essentially the same kind but with variances in mood and other attributes, and where the target exists before the source and the source refers to the target that it links back to.

3.) Pre-condition, trigger, reason, contraindication, with the conditioned Act at the source and the condition or reason at the target.

4.) Post-condition, outcome, goal and risk, with the Act at the source having the outcome or goal at the target.

5.) A host of functional relationships including support, cause, derivation, etc. generalized under the notion of "pertinence".

Description:Types of sensitivity policies that apply to Roles.

**Description:**An access control object used to manage permissions and capabilities of users within information systems. (See HL7 RBAC specification fo examples of thes objects.)

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Types of security policies that further specify the ActClassPolicy value set.

A sensitivity policy is adopted by an enterprise or group of enterprises (a "policy domain") through a formal data use agreement that stipulates the value, importance, and vulnerability of information. A sensitivity code representing a sensitivity policy may be associated with criteria such as categories of information or sets of information identifiers (e.g., a value set of clinical codes or branch in a code system hierarchy). These criteria may in turn be used for the Policy Decision Point in a Security Engine. A sensitivity code may be used to set the confidentiality code used on information about Acts and Roles to trigger the security mechanisms required to control how security principals (i.e., a person, a machine, a software application) may act on the information (e.g., collection, access, use, or disclosure). Sensitivity codes are never assigned to the transport or business envelope containing patient specific information being exchanged outside of a policy domain as this would disclose the information intended to be protected by the policy. When sensitive information is exchanged with others outside of a policy domain, the confidentiality code on the transport or business envelope conveys the receiver's responsibilities and indicates the how the information is to be safeguarded without unauthorized disclosure of the sensitive information. This ensures that sensitive information is treated by receivers as the sender intends, accomplishing interoperability without point to point negotiations.

**Description:**Concepts representing the categorization of health services available at a particular delivery location site.

Examples:

* anesthetic service * colonoscopy service * orthopedic service

Concepts identifying the general type of care or category of services being documented.

Examples:

* Colonoscopy * appendectomy * laboratory test

Description:of high-level categorization for clinical non-laboratory and non-diagnostic image measured observations with numeric values and specific units of measure.Examples:

* Vital Signs * Physiological Measurements * Procedure Results

An anatomical location on an organism which can be the focus of an act.

**Description:**Identifies the type of document that is used to support a request which requires special authorization. Example values in this concept domain could be: coverage extensions, step therapy, medical report, lab result, etc.

**Description:**Constrains vocabulary to that which describes the type of documents that can be attached to a financial transaction such as a Special Authorization Request.

Example values under this concept domain could be: drug, device, service, etc.

The accession act related to a specimen or group of specimens.

Description:Used to further classify the type of specimen collection procedure being documented.Examples:

* Venipuncture * Swab * Biopsy

The act of printing a specimen label. The printing of a label for a specimen container is a significant act in the workflow for collecting specimens.

The act of adding a specimen to a transportation manifest. For example a laboratory will pack together in a carton all the specimens to be shipped to a reference lab. An electronic manifest showing all the specimens in the shippment is communicated to the reference lab.

Transportation of a specimen.

Concepts representing the states in the state-machine of the RIM Act class.

**Definition:**Identifies the types of substitution that may be permitted when ordering a medication, as well as those which have actually occurred during the act of dispensing.

Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information.

Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information.

Description:Type of substance administration used for evaluating a precondition, goal, or trigger.Examples:

* other substance administrations * respiratory therapy * immunizations

The introduction of ??? with the intent of stimulating an immune response, aimed at preventing subsequent infections by more viable agents.

Acts of producing a substance by processing input material in any way thus deriving the product substance from the inputs

Examples:Fermentation, filtration, separation, extraction, or any complex procedure involving multiple such steps.UsageNotes:This domain may involve molecular interactions as components, but substance derivation - even if implementing a single defined reaction on the molecular level - implies not only that reaction but the methods and devices by which to induce that reaction.
This domain may involve molecular interactions as components, but substance derivation - even if implementing a single defined reaction on the molecular level - implies not only that reaction but the methods and devices by which to induce that reaction.
Description:In addition to the class code, further defines the type of substance extraction.Examples:

* excision * surgical * passive

Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated".

(used when capturing 'refusal to fill' annotations)

Description:Further defines the type of supply for order or distribution.Examples:

* central supply * materials management * nurse station supply

Description:A task or action that a user may perform in a clinical information systemExamples:

* medication order entry * laboratory test results review * problem list entry

Codes used to identify different types of 'duration-based' working lists. Examples include "Continuous/Chronic", "Short-Term" and "As-Needed".

Characterizes how a transportation act was or will be carried out.

Examples:Via private transport, via public transit, via courier.

A mandate, obligation, requirement, rule, or expectation conveyed as security metadata between senders and receivers required to establish the reliability, authenticity, and trustworthiness of their transactions.

Trust security metadata are observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability).

Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. \[Based on ISO IEC 10181-1 and NIST SP 800-63-2\]

For example, identity proofing level of assurance and Trust Framework.

A code indicating whether the Act statement as a whole, with its subordinate components has been asserted to be uncertain in any way.

Examples:Patient might have had a cholecystectomy procedure in the past (but isn't sure).Constraints:Uncertainty asserted using this attribute applies to the combined meaning of the Act statement established by all descriptive attributes (e.g., Act.code, Act.effectiveTime, Observation.value, SubstanceAdministration.doseQuantity, etc.), and the meanings of any components.

*Discussion:*This is not intended for use to replace or compete with uncertainty associated with a Observation.values alone or other individual attributes of the class. Such pointed indications of uncertainty should be specified by applying the PPD, UVP or UVN data type extensions to the specific attribute. Particularly if the uncertainty is uncertainty of a quantitative measurement value, this must still be represented by a PPD<PQ> in the value and NOT using the uncertaintyCode. Also, when differential diagnoses are enumerated or weighed for probability, the UVP<CD> or UVN<CD> must be used, not the uncertaintyCode. The use of the uncertaintyCode is appropriate only if the entirety of the Act and its dependent Acts is questioned.

Note that very vague uncertainty may be thought related to negationInd, however, the two concepts are really independent. One may be very uncertain about an event, but that does not mean that one is certain about the negation of the event.

Any substance which, when combined with other ingredients, delivers all or part of the therapeutic benefit associated with a medication.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

A molecular structure (molecule or part of a molecule) which is the part of the molecule causing the intended pharmacological action. The value set for ActiveMoietySubstanceType may often be a subset of a SubstanceType value set. Candidate value sets are subsets of ChEBI, PubChem CID, CAS Number, InChi Key, and UNII.

Examples:

* Metoprolol (without the succinate or tartrate) * Amoxicillin (anhydrous) * Heparin (ion, without the matching Na or K cation)

Discussion: The hierarchical nature of these concepts shows composition. E.g. "Street Name" is part of "Street Address Line"

Indicates the form in which the drug product should be administered.

This element only needs to be specified when (a) the form in which the drug is measured for dispensing differs from the form in which the drug is administered; and (b) the form in which the quantity of the administered drug being administered is not expressed as a discrete measured mass or volume, e.g. the dose is to be measured in "number of actuations."

Indicates the form in which the drug product should be administered.

This element only needs to be specified when (a) the form in which the drug is measured for dispensing differs from the form in which the drug is administered; and (b) the form in which the quantity of the administered drug being administered is not expressed as a discrete measured mass or volume, e.g. the dose is to be measured in "number of actuations."

**Description:**Indicates the role an entity (player) is playing as the appropriate contact on behalf of another entity (scoper).

The gender of a person used for adminstrative purposes (as opposed to clinical gender)

OpenIssue:This concept domain has **no valid description**. Description:

Represents types of consent that patient must sign prior to receipt of service, which is required for billing purposes.

Examples:

* Advanced beneficiary medically necessity notice. * Advanced beneficiary agreement to pay notice. * Advanced beneficiary requests payer billed.

Description:Different types that are used to organize and classify product related investigations.Examples:

* Original source investigation * Secondary party investigation * Report to regulatory authority

Definition:Indicates the class of actions taken with regard to a substance administration related adverse event. This characterization offers a judgment of the practitioner"s response to the patient"s problem.Examples:Example values include dose withdrawn, dose reduced, dose not changed.NOTE:The concept domain is currently supported by a value set created by the International Conference on HarmonizationOpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Concepts characterizing the type of association formed by player and scoper when there is a recognized Affiliate role by which the two parties are related.

Examples:Business Partner, Business Associate, Colleague

Observation value of a person's age group (e.g., newborn infant, child preschool, young adult).

Categorization of types of observation that captures a person's age as a numeric quantity.

An entity (player) that acts or is authorized to act on behalf of another entity (scoper).

Examples:next of kin; assigned entity; contact.

**Description:**Provides additional methodology information not present in the associated AllergyTestCode term.

Indicates the result of a particular allergy test. E.g. Negative, Mild, Moderate, Severe

An anatomical location on a non-human animal which can be the focus of an act.

Description:A categorizing and grouping mechanism for different types of animal in order to support treatment and reporting. The categories are expected to correspond to a single animal species, or to a related group of species.Examples:

* Dog * Reptile * Deer

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

A role type that is used to further qualify an inanimate subject playing a role where the playing entity acts or is authorized to act on behalf of a scoping entity.

Examples:

* Assistive device for impaired or challenged person * Non-living entities that may participate as assigned therapeutic agents * Entities that may be provided to patients to improve general mood, decrease depression and loneliness, and distract from stress-inducing concerns to improve quality of life.

**Description:**A role type that is used to further qualify a non-person subject playing a role where the role class attribute is set to RoleClass AssignedEntity

Open Issue:The definition should be modified to clarify the fact that it is a living non-person subject. (AK 11/2014 cycle)
Description:A role type that is used to further qualify an entity playing a role where the role class attribute is set to RoleClass AssignedEntity. The suggested values from V2.x include clinic receptionist, referral agent, staff physician, courtesy physician, resident, physician assistant, physical therapist, psychiatrist, psychologist, pharmacist, registered nurse, licensed practical nurse, licensed vocational nurse, nurse practitioner, etc.Examples:

* Janitor * Chief of Staff * Referral Agent * Security Guard * ICU Runner * Visiting professor

Open Issue:There needs to be work undertaken to clean up the hierarchy under this Domain as there seems to be some muddling between D:ProductLifecycleAssginedRoleType and D:ClinicalOrganizationRoleType and this new D:AssignedNonLivingSubjectRoleType. There may be other issues that need improvement in this hierarchy, and there may be some issue with the corresponding hierarchy in the code system. (identified in 11/2014 cycle)

A general association between two entities that is neither partitive nor ontological.

Examples:affiliate; agent; birthplace.

Provides coded key words for attribute AttentionLine.keyWordText, which has data type SC.

**Definition:**The domain of possible values used as the value of attention line specifications in AttentionLine directives.

This code is used to specify the exact function an actor is authorized to have in a service in all necessary detail.

This code is used to specify the exact function an actor is authorized to have as a receiver of information that is the subject of a consent directive or consent override.

Provides coded names for attribute Batch.name, which has data type SC.

Description:Specific method used to extract the blood from the donor subject.Examples: No examples supplied with proposal.

**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

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One letter calendar cycle abbreviations (Temporary - remove when RoseTree is fixed)

Two letter calendar cycle abbreviations (Temporary - remove when RoseTree is fixed)

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Code for the method by which the public health department was made aware of the case. Includes provider report, patient self-referral, laboratory report, case or outbreak investigation, contact investigation, active surveillance, routine physical, prenatal testing, perinatal testing, prison entry screening, occupational disease surveillance, medical record review, etc.

Code that indicates whether the disease was likely acquired outside the jurisdiction of observation, and if so, the nature of the inter-jurisdictional relationship. Possible values include not imported, imported from another country, imported from another state, imported from another jurisdiction, and insufficient information to determine.

A code that provides information on the overall effect or outcome of the adverse reaction/adverse event reported in the ICSR. Note the criterion applies to the case as a whole and not to an individual reaction.

Example concepts are: death, disability, hospitalization, congenital anomaly/ birth defect, and other medically important condition.

Code for the mechanism by which disease was acquired by the living subject involved in the public health case. Includes sexually transmitted, airborne, bloodborne, vectorborne, foodborne, zoonotic, nosocomial, mechanical, dermal, congenital, environmental exposure, indeterminate.

OpenIssue: Consider moving this attribute to Observation.

Defines types of certifications for all entities

Internet Assigned Numbers Authority (IANA) Charset Types

A role type used to qualify a person's legal status within a country or nation.

Examples:

* Full citizen * Asylum seeker * Permit card holder

Identifies types of issues detected regarding the performance of a clinical action on a patient.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Any substance or mixture of substances manufactured, sold or represented for use in: (a) the diagnosis, treatment, mitigation or prevention of a disease, disorder, abnormal physical state, or its symptoms, in human beings or animals; (b) restoring, correcting or modifying organic functions in human beings or animals.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

A role of an organization that further classifies the clincial responsibility for the healthcare care delivered during an encounter. E.g. cardiology service, pediatric service, nursing services.

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

**Definition:**SSpecifies the reason that a test was performed or observation collected in a clinical research study.

**Note:**This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.

**Definition:**Contains domains for act reasons used in clinical research.

Identifies how to interpret the instance of the code, codeSystem value in a set of translations. Since HL7 (or a government body) may mandate that codes from certain code systems be sent in conformant messages, other synonyms that are sent in the translation set need to be distinguished among the originally captured source, the HL7 specified code, or some future role. When this code is NULL, it indicates that the translation is an undefined type. When valued, this property must contain one of the following values:

SRC - Source (or original) code HL7 - HL7 Specified or Mandated SH - both HL7 mandated and the original code (precoordination)

There may be additional values added to this value set as we work through the use of codes in messages and determine other Use Cases requiring special interpretation of the translations.

The description of this is: "Identifies, as a single concept, a combination dose form description for those products that contain two or more manufactured items in a single authorized product".

Usage Notes:This element needs only to be specified when the product entity describes a complete product that contains two or more manufactured items (sometimes called a combination product or a kit product); it should not be valued for (normal) products which consist of a single manufactured item with a single dose form. The combined dose form describes the orderable (manufactured) dose form of each manufactured item and (if appropriate, separately) the administrable dose form of the pharmaceutical product (as in example one below).Examples:

* Powder and solvent for solution for injection * Pessary and vaginal cream * Tablets and capsules

This element needs only to be specified when the product entity describes a complete product that contains two or more manufactured items (sometimes called a combination product or a kit product); it should not be valued for (normal) products which consist of a single manufactured item with a single dose form. The combined dose form describes the orderable (manufactured) dose form of each manufactured item and (if appropriate, separately) the administrable dose form of the pharmaceutical product (as in example one below).

**Description:**Indicates why the prescription should be suspended.

OpenIssue:This concept domain has **no valid description**. Definition:The non-laboratory, non-DI (diagnostic imaging) coded observation if no value is also required to convey the full meaning of the observation. This may be a single concept code or a complex expression. Description:Represents observations for components of a clinical observation whose value is expressed as a code.Examples:

* results for individual components of an APGAR score * aberrant * ABO incompatibility reaction

**Description:**Used in a patient care message to value simple clinical (non-lab) observation methods, such as found in SOAP (subjective, objective, assessment, plan) progress notes: subjective section (used for history from patient and other informants); objective section (used for physical exam, lab, and other common results), and assessment section (used for the clinicians assessment of the implications of subjective and objective sections).

Definition:The non-laboratory, non-diagnostic imaging coded result of the coded observable or "question" represented by the paired concept from the the NonLabDICodedObservationType domain.

\]

**Examples:**An APGAR result, a functional assessment, etc. The value must not require a specific unit of measure.

Used in a patient care message to report and query simple clinical (non-lab) observations.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Used in a patient care message to value simple clinical (non-lab) observations.

Description:Represents the components of a coded clinical observation.Examples:

* ability to articulate * ability to chop food * ability to crouch

Description:Identifies the type for a clinical observation whose value is expressed as a code.Examples:

* Home support level * Tumor staging * abdominal pain characteristic

Describes the type of communication function that the associated entity plays in the associated transmission.

**Definition:**A container intended to contain sufficient material for more than one use, but grouped or organized to provide individual access to sufficient material for a single use. Often used to ensure that the proper type and amount of material is consumed/expended for each use.

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Types of privacy metadata classifying an IT resource (data, information object, service, or system capability) according to its level of sensitivity, which is based on an analysis of applicable privacy policies and the risk of financial, reputational, or other harm to an individual or entity that could result if made available or disclosed to unauthorized individuals, entities, or processes.

Usage Note:Confidentiality codes may be used in security labels and privacy markings to classify IT resources based on sensitivity to indicate the obligation of a custodian or receiver to ensure that the protected resource is not made available or disclosed to individuals, entities, or processes (security principals) unless authorized per applicable policies. Confidentiality codes may also be used in the clearances of initiators requesting access to protected resources.Map:Definition aligns with ISO 7498-2:1989 - Confidentiality is the property that information is not made available or disclosed to unauthorized individuals, entities, or processes.

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

**Examples:**"Entered in error", "altered decision", etc.

This code is used to specify the exact function an actor is authorized to have in authoring a consent directive.

Description:Identifies functions appropriate to consultant participations.Examples:

* cardiologist * anesthetist * dietician

Description:A role type that is used to further qualify or describe the role of the contact person or organization.Examples:

* Legal representative * Primary contact * Alternative contact

The type of cap associated with a container

**Definition:**An object used to hold other entities.

Examples:

* Test tube * Shoe box * Drinking glass

Describes the nature (or type) of the container.

Examples:

* Carton * Bottle * Vial

**DesignNote:**The material of the container should be separately specified (e.g. the "cardboard" part of cardboard carton or the "glass" part of glass vial should be described elsewhere).

**OpenIssue:**This usage of material form is used in Common Product Model,but it is at variance of what has been done in Specimen where the same information is captured in the Entity.code values. These differences need further study.

A material in a blood collection container that facilites the separation of of blood cells from serum or plasma

**Description:**Identifies the order in which content should be processed.

The styles of context conduction usable by relationships within a static model derived from tyhe HL7 Reference Information Model.

Identifies the control codes that are used to manage the propagation and scope of a particular ActRelationship or Participation within a set of Acts.

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

**Examples:**"Entered in error", "altered decision", etc.

Description:Indicates why a specific transaction which was requested to be undone; was not undone. Description:Indicates the motivation, cause or rationale of an Act which results in a trigger event. Indicates why the ConditionaTMs status was changed to Nullified.Examplesadministrative error, diagnostic error.

Countries of the world. ISO 3166, part 1, alpha-3 set.

Definition:The category of addiction used for coverage purposes that may refer to a substance, the consumption of which may result in physical or emotional harm.

Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.

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

**Description:**Identifies the reason or rationale for coverage of a service or product based on coverage exclusions related the risk of adverse selection by covered parties.

**Description:**Identifies the reason or rationale for coverage of a service or product based on financial participation responsibilities of the covered party.

**Description:**Coded observation values for types or instances of items for which coverage is provided under a policy or program, e.g., a type of vehicle or a named work of art.

**Description:**Coded observation values for types of covered parties under a policy or program based on their personal relationships or employment status.

**Description:**Coded observation values for coverage limitations, for e.g., types of claims or types of parties covered under a policy or program.

**Description:**Identifies the reason or rationale for limitations on the coverage of a service or product based on coverage contract provisions.

**Example:**The maximum cost per unit; or the maximum number of units per period, which is typically the policy or program effective time.

**Description:**Coded observation values for types or instances of locations for which coverage is provided under a policy or program, e.g., in the covered party home, in state or in the country.

Definition:Set of codes indicating the manner in which sponsors, underwriters, and payers participate in a policy or program.

**Description:**Codes that indicate a specific type of sponsor. Used when the sponsor's role is only either as a fully insured sponsor or only as a self-insured sponsor. NOTE: Where a sponsor may be either, use the SponsorParticipationFunction.code (fully insured or self insured) to indicate the type of responsibility. (CO6-0057)

A role recognized through the eligibility of an identified living subject for benefits covered under an insurance policy or a program. Eligibility as a covered party may be conditioned on a relationship with (1) the policy holder such as the policy holder who is covered as an individual under a poliy or as a party sponsored for coverage by the policy holder.

**Example:**An employee as a subscriber; or (2) on being scoped another covered party such as the subscriber, as in the case of a dependent.

Discussion:The Abstract Value Set "CoverageRoleType", which was developed for use in the Canadian realm "pre-coordinate" coverage roles with other roles that a covered party must play in order to be eligible for coverage, e.g., "handicapped dependent". Other codes in the Abstract Value Set CoveredPartyRoleType domain can be "post-coordinated" with the EligiblePartyRoleType codes to denote comparable concepts. Decoupling the concepts is intended to support a wider range of concepts and semantic comparability of coded concepts.

Values that represent a clinical judgment as to the worst case result of a future exposure (including substance administration).

Examples:

* High criticality * Low criticality * Unable to assess criticality

**Description:**To be used to code and identify the Microbiology laboratory orderable and resultable observation question.

Examples:

* Urine; Culture * Deep Wound; Aerobic Culture * Microscopic Examination; Gram Stain

**Description:**Used to code and identify the Microbiology laboratory result value when a result is reported.

Examples:

* Gram Positive Rods * Epithelial Cells * Polymorphonuclear Leukocyte

The currency unit as defined in ISO 4217

DEA schedule for a drug.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Provides codes for decision methods, initially for assessing the causality of events.

A role of a place that further classifies a setting that is intended to house the provision of services.

Description:Specimen types which further classify the types of specimens that are derived from other specimens.Examples:Examples include specimen sections and specimen components.

Domain values for the Device.Alert\_levelCode

Identifies characteristics (physical, visual, clinical) that may be observed for a particular device or device type.

Examples:

* Height * Sterility * External diameter

Includes the set of codes used to identify a device that may be referred to in an ICSR report. Example code set reference is the FDA Center for Devices and Radiological Health product code list.

Example product codes include: FOZ = Catheter, Intravascular, Therapeutic, short-term less than 30 days, MOP = Rotator, Prosthetic Heart Valve.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

A code set that includes codes that are used to characterize the outcome of the device evaluation process. The code defines the manufacturer's conclusions following the evaluation.

Examples include: inadequate alarms, device maintenance contributed to event, device failed just prior to use, user error caused event

Code assigned to indicate a relevant fact within the context of the evaluation of a reported product. There are a number of concept types including the status of the evaluation, the type of evaluation findings, and the type of activity carried out as part of the evaluation process.

Examples include: Actual device involved in incident was evaluated, electrical tests performed, visual examination.

Code assigned to indicate an outcome of the manufacturer's investigation of a product for which a defect has been reported.

Examples include:.component/subassembly failure: air cleaner, computer-, imaging system-, microprocessor-controlled device problem: cache memory, design -- not fail safe.

Indicates the type of person that is responsible for operating the device related to the incident reported in ICSR.

Examples include: Physician, Nurse, Medical Technician, Respiratory Technician.

Set of codes depicting clinical disease and conditions

Diagnosis Value

Identifies the types of diagnostic image.

Examples:Echocardiogram, electocardiogram, X-ray.

Identifies the type of diagnostic image report.

Examples:

* Echocardiogram Report * Ultrasound Report * Nuclear Medicine Imaging Report

A set of concepts that identifies any texture modifications that should be made to a diet order.

Examples:

* Pudding Thick * Pureed * Easy to Chew

Description:An observation that categorizes an existing observation of a disease, symptom or condition.Usage Note:The act being categorized should be an observation of a disease, symptom or condition; the categorizing act should be an observation of the category of that disease, symptom or condition, and the relationship between the two acts should be a "has generalization" relationship.Examples:

* \[Observation of\] "thrombocytopenia" is categorized as an observation of "Haematologic system" category * \[Observation of\] "duodenal ulcer" is categorized as an observation of "Gastro-intestinal system" category * \[Observation of\] "eczema" is categorized as an observation of "Dermatologic system" category

**Description:**Codes that further characterize the distribution of a material. Used only with the DST (distributed material) role classCode.

**Examples:**Intensive distribution, Selective distribution and Exclusive distribution.

Identifies the current completion state of a clinical document.

A type of document section (specialization of ActClass "DOCSECT").

Identifies the storage status of a document.

The kind of document. Possible values: discharge summary, progress note, Oncology note, etc.

**Description:**The physical manifestation "entity" that contains the active and/or inactive ingredients that deliver a dose of medicine (i.e., drug). The key defining characteristics of the dose form can be the state of matter, delivery method, release characteristics, and the administration site or route for which the product is formulated. (Derived from ISO IDMP specification, and SNOMED CT).

Examples:

* Tablet * Capsule * Oral solution

Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

A substance whose therapeutic effect is produced by chemical action within the body.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

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Identifies types of observations about the parameters required for acquisition and processing of ECG data.

Examples:

* item byte order * sample rate * displayed sweep rate

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode. Description:Highest level of education a person has achieved.Examples:

* Elementary School * College or baccalaureate degree complete * High School

Rationale:These are levels, not numeric years

Provides coded names for attribute SortControl.elementName , which has data type SC.

Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.

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

A code specifying the job performed by the employee for the employer. For example, accountant, programmer analyst, patient care associate, staff nurse, etc.

A code qualifying the employment in various ways, such as, full-time vs. part time, etc.

Industry and/or jurisdictional classification system for kind-of-work performed by an employee.

Occupation codes are intended primarily as work descriptions that are suitable for a multitude of public uses e.g., job matching, employment counseling, occupational and career guidance, and labor market information services.

Description:A role type that is used to further qualify an entity playing a role where the role class attribute is set to RoleClass Employee. This specifies the relationship the staff person has with the institution for whom he/she provides services.Examples:

* Employee * Volunteer * Consultant

A value representing the method used by an employer to compute an employee's salary or wages.

Examples:Hourly, annual, commission

A code used to define the employment status of the insured individual identified in UB-92 FL 58. UB-92 Form locator 64:Employment Status Code of the Insured. Can be used with Employee\_Employer\_statusCode in HL7. Values include Employed Full Time, Employed Part Time, Not Employed, Retired, On Active Military Duty

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A code depicting the acuity (complexity of patient care, resource intensiveness of the patient care) of a patient's medical condition upon arrival. Values may be derived from formal acuity coding schemes such as RBS.

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A code indicating patient status as of the ending service date of the period covered on this bill, as reported in FL6, Statement Covers Period. Values such as: Discharged to home or self care; Discharged/transferred to SNF, Discharged/transferred to an intermediate care facility (ICF); Expired; Hospice-medical facility. NUBC Form Locator 22

A code used to define the place or organization responsible for the patient immediately prior to their admission; for example, in the United States, as this is identified in UB-92 Form Locator 20, Source of Adm(ission).

A code identifying special courtesies extended to the patient. For example, no courtesies, extended courtesies, professional courtesy, VIP courtesies.

A concept that conveys how a material will be administered enterally.

Examples:

* Continuous Tube Feeding * Gravity Drip * Bolus Feeding

Classifies the Entity class and all of its subclasses. The terminology is hierarchical. At the top is this HL7-defined domain of high-level categories (such as represented by the Entity subclasses). Each of these terms must be harmonized and is specializable.

The value sets beneath are encoded in Entity.code and are drawn from multiple, frequently external, domains that reflect much more fine-grained typing.

A value representing the specific kind of Entity the instance represents.

Examples:A medical building, a Doberman Pinscher, a blood collection tube, a tissue biopsy.Rationale:For each Entity, the value for this attribute is drawn from one of several coding systems depending on the Entity classCode, such as living subjects (animal and plant taxonomies), chemical substance (e.g., IUPAC code), organizations, insurance company, government agency, hospital, park, lake, syringe, etc. It is possible that Entity.code may be so fine grained that it represents a single instance. An example is the CDC vaccine manufacturer code, modeled as a concept vocabulary, when in fact each concept refers to a single instance.

EntityDeterminer in natural language grammar is the class of words that comprises articles, demonstrative pronouns, and quantifiers. In the RIM, determiner is a structural code in the Entity class to distinguish whether any given Entity object stands for some, any one, or a specific thing.

**Description:**The specific kind of location-tracking tag.

Examples:

* RFID * WiFi * Infrared

A type of manufactured material used in an activity, without being substantially changed through that activity.

Special handling requirements for an Entity.

*Example:*Keep at room temperature; Keep frozen below 0 C; Keep in a dry environment; Keep upright, do not turn upside down.

Description:The qualifier is a set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type. For example, a given name may be flagged as a nickname, a family name may be a pseudonym or a name of public records.

**Description:**The qualifier is a set of codes each of which specifies a certain subcategory of the name part in addition to the main name part type. For example, a given name may be flagged as a nickname, a family name may be a pseudonym or a name of public records.

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**Description:**Indicates whether the name part is a given name, family name, prefix, suffix, etc.

A name intended for use in searching or matching

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**Description:**A set of codes advising a system or user which name in a set of names to select for a given purpose.

**Description:**Risk associated with the handling of the material.

The status of an instance of the RIM Entity class.

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A code specifying in what way two products are considered equivalent. One example for a value set in the US can be found in U.S. FDA "Orange Book" at the FDA website but the concept is universal and not a U.S. only issue.

Examples:

* No known or suspected bioequivalence problems * Potential bioequivalence problems have been resolved with evidence supporting bioequivalence * Bioequivalence problems have not been fully resolved

In the United States, federal standards for classifying data on ethnicity determine the categories used by federal agencies and exert a strong influence on categorization by state and local agencies and private sector organizations. The federal standards do not conceptually define ethnicity, and they recognize the absence of an anthropological or scientific basis for ethnicity classification. Instead, the federal standards acknowledge that ethnicity is a social-political construct in which an individual's own identification with a particular ethnicity is preferred to observer identification. The standards specify two minimum ethnicity categories: Hispanic or Latino, and Not Hispanic or Latino. The standards define a Hispanic or Latino as a person of "Mexican, Puerto Rican, Cuban, South or Central America, or other Spanish culture or origin, regardless of race." The standards stipulate that ethnicity data need not be limited to the two minimum categories, but any expansion must be collapsible to those categories. In addition, the standards stipulate that an individual can be Hispanic or Latino or can be Not Hispanic or Latino, but cannot be both.

OpenIssue:This concept domain definition does not align with current vocabulary practices and is much too US-centric to be appropriate as a "universal" domain.
Description:Identifies types of observations that describe or categorize an observation in terms of the frequency of the observed event occurring.Examples:

* Very common * Uncommon * Rare

Indicates the material to which the patient was exposed which is believed to be related to the adverse reaction

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Code for the mechanism by which the exposure agent was exchanged or potentially exchanged by the participants involved in the exposure.

FDA label data

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

The type of familial relationship between a living subject and another living subject.

Examples:

* Father * Mother * Uncle

A manufactured material that is used during the nutrition process but is not changed via the process.

Examples:

* Disposable Utensils * Plate Guard * Sippy Cup

**Description:**Describes the supporting information for financial transactions such as a Special Authorization Request.

Example values under this concept domain could be: height, weight, duration of disease, site of fistula, etc.

This concept domain is intended to be used as part of a code/value pair within a generic structure that would convey ANY sort of information or proof of criteria that is needed to support a special authorization request.

**Description:**Contains the supporting information values for financial transactions such as a Special Authorization Request.

This concept domain is intended to be used as the "value" part of a code/value pair within a generic structure that would convey any sort of information or proof of criteria that is needed to support a special authorization request. For example:

One wishes to convey a patient's DSM IV diagnosis to support a special authorization request. One code/value pair is used:

ActSupportingInformationCode1 = DSM IV Diagnosis, value= 315.4

Concepts that identify raw, cooked or edible substances or ingredients that are intended for consumption by humans or animals to supply nourishment.

Examples:

* Orange * Meat * Milk

A relationship between two entities that is formally recognized, frequently by a contract or similar agreement.

Examples:agent; guarantor; patient.
Description:Categorizes the accuracy of spatial data assignment utilizing a variety of tools for capturing coordinates including digitizers, geocoding software and global positioning system devices.

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A value representing whether the primary reproductive organs of NonPersonLivingSubject are present.

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

Concepts that specify interpretation of genetic analysis.

Examples:

* positive * negative * carrier * responsive

A code that provides additional detail about the means or technique used to ascertain the genetic analysis. Example, PCR, Micro Array.

Description:Identifies the kinds of genetic observations that can be performed. Description:The domain contains genetic analysis specific observation values, e.g. Homozygote, Heterozygote, etc. Description:The specific kinds of organizational roles that issue information privacy grants that permit or prohibit potential actions on information artifacts.Examples:

* Clearinghouse * Billing Service * Health Information Exchange

Description:The specific kinds of person roles that issue information privacy grants that permit or prohibit potential actions on information artifacts.Examples:

* Self * Parent * Legal Guardian

Description:The specific kinds of roles that issue information privacy grants that permit or prohibit potential actions on information artifacts.Examples:

* Parent * Legal Guardian * Health Information Exchange

Qualify the holder or scope of a guardianship relationship over a living subject.

Examples:

* Guardianship held jointly by separated parents * Guardianship held jointly by parent and another person * Natural guardian * Special guardian * Guardian of property

**Description:**Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes are procedure identifying codes. HCPCS is Health Care Finance AdministrationaTMs (HFCA) coding scheme to group procedures performed for payment to providers. contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**External value set for accommodation types used in the U.S. Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

HL7 implementation technology specification versions. These codes will document the ITS type and version for message encoding. The code will appear in the instances based upon rules expressed in the ITS, and do not appear in the abstract message, either as it is presented to received from the ITS.

This is the domain of HL7 version codes for the Version 3 standards. Values are to be determined by HL7 and added with each new version of the HL7 Standard.

The trigger event referenced by the Control Act instance. Values are drawn from the available trigger events used in the release of HL7 identified by the versionCode.

The possible modes of updating that occur when an attribute is received by a system that already contains values for that attribute.

Open Issue:From April 2008 harmonization: "Definition needs to be modified. Make contents to HL7 content mode code system match contents in this table" Clear that this needs to be revisited.

A role type that is used to categorize an entity that delivers health care in an expected and professional manner to a subject in need of health care services.

Examples:

* Registered Nurse * Physician * Custodial Care Clinic

A set of concepts representing locations and settings where healthcare services are provided.

Description:Holders are containers that hold other containers or holders.Examples:

* Tube rack * Specimen carrier * Tray

HtmlLinkType values are drawn from HTML 4.0 and describe the relationship between the current document and the anchor that is the target of the link

An anatomical location on a human which can be the focus of an act.

Description:To be used to code the anatomic component of the human-sourced specimen that the lab observation relates to.Examples:

* Endometrial biopsy * Thyroid fine needle aspirate * Urine

Codes for the representation of the names of human languages.

Description:The set of body locations to or through which a substance or product may be administered.Examples:

* buttock * left upper arm * bilateral eyes

**Description:**International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) are procedure identifying codes. ICD-10-PCS describes the classification of inpatient procedures for statistical purposes.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**International Classification of Diseases, 9th Revision, Procedure Coding System (ICD-9-PCS) are procedure identifying codes. ICD-9-PCS describes the classification of inpatient procedures for statistical purposes.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:A type of observation on an investigative subject or a related entity that might be collected to provide the medical and social context for an adverse event report.Examples:

* Diagnosis * laboratory result * autopsy determined cause of death

**Description:**Different types of qualification that could be applicable for a party involved in sending or receiving a case safety report, providing the original notification or report of an adverse event or product problem.

Examples:

* Physician * Veterinarian * Lawyer * Member of the public

Description:A role that is played by a party which is involved in the process originating or managing reports of adverse events or product problems.Examples:

* Marketing Authorization Holder * Regulatory Agency * Healthcare Practitioner

Description:Concepts that define the primary orientation of a product related investigation.Examples:

* Product defect * adverse event

Provides a set of values for defining the type of Pharmaceutical Product that is related to a PhPID. This in turn determines the type of information that may be conveyed when using the Common Product Model as a vehicle for IDMP model data.

Examples:

* Chemical Type * Radionuclides (radioactive) Type * Biological Substance

Provides a set of values for defining the relationship between different concepts when using the Common Product Model as a vehicle for IDMP model data

Examples:

* Medicinal identifier * Pharmaceutical identifier * Underlying pharmaceutical concept identifier

Defines elements of the IDMP model, whether concepts defined by role, or relationships between concepts defined by role, that cannot otherwise easily be distinguished within the Common Product Model structures and associated vocabulary. This domain is a collector for the different types of semantics associated with the IDMP role concept spaces.

Definition:A code representing the type of identifier that has been assigned to the identified entity (IDENT).Examples:Example values include Social Insurance Number, Product Catalog ID, Product Model Number. Description:The identifier was issued by the system responsible for constructing the instance. Description:Codes to specify the scope in which the identifier applies to the object with which it is associated, and used in the datatype property II.

A code specifying qualitatively the spatial relation between imaged object and imaging film or detector.

Specifies the type of date that is specified in an immunization forecast. The immunization forecast defines the schedule for a vaccine based on variables like the subject's age, the type of vaccine, and the supply unit. The immunization forecast may involve multiple administrations in a series or just one administration. Each of the administrations has one or more recommended dates.

Examples:

* Earliest recommended date * Recommended date * Latest acceptable date * Overdue date (date after which to start sending reminders)

Used to represent the patient's status with respect to their immunization guideline as of an evaluation date.

Description:Types of observations which describe characteristics of the immunization material.

Types of locations,that are not designed for the purpose of providing health care services but where care provision takes place.

Examples:

* Accident site * Patient's residence * School * Work site

Indicates the specific observation result which is the reason for the action (prescription, lab test, etc.). E.g. Headache, Ear infection, planned diagnostic image (requiring contrast agent), etc.

Description:Includes those concepts that are provided to justify the fact that an adverse event or product problem is required to be reported in an expedited fashion. Description:Includes relevant pieces of information about a product or its process of creation. The vocabulary domain is used to characterize products when they are cited in adverse event or product problem reports.

**Examples:**Weight, color, dimensions.

A code that is used to indicate the type of organization which is originating and sending the ICSR. The current code example reference is from the International Conference on Harmonisation (ICH) Expert Workgroup guideline on Clinical Safety Data Management: Data Elements for Transmission of Individual Case Safety Reports.

Example concepts are: Pharmaceutical Company, Regulatory Authority, Health Professional, Regional Pharmacovigilence Center, World Health Organization Collaborating Center for International Drug Monitoring.

Types of case safety report received from sender. The current code example reference is from the International Conference on Harmonization (ICH) Expert Workgroup guideline on Clinical Safety Data Management: Data Elements for Transmission of Individual Case Safety Reports. The unknown/unavailable option allows the transmission of information from a secondary sender where the initial sender did not specify the type of report.

This domain is established as a parent to a variety of value domains being defined to support the communication of Individual Case Safety Reports to regulatory bodies. Arguably, this aggregation is not taxonomically pure, but the grouping will facilitate the management of these domains.

North American Industry Classification System(NAICS) for the United States, a new economic classification system that replaces the 1987 Standard Industrial Classification (SIC) for statistical purposes. NAICS is a system for classifying establishments by type of economic activity. Its purposes are: (1) to facilitate the collection, tabulation, presentation, and analysis of data relating to establishments, and (2) to promote uniformity and comparability in the presentation of statistical data describing the economy. NAICS will be used by Federal statistical agencies that collect or publish data by industry. http://www.census.gov/epcd/www/naicsusr.html

An anatomical location on a human of an injury or disease which is the focus of an act.

Values for observations of injuries.

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

Codes identifying pariticular groupings of allergens and other agents which cause allergies and intolerances. E.g. the drug, allergen group, food or environmental agent which triggers the intolerance

Description:A code further classifying the type of investigated subject role. Used with the INVSBJ role class code.Examples:

* Case subject * Suspect * Person of interest

Designates a modifier to the code attribute to provide additional information about the invoice element.

Examples:Isolation allowance; After-hours serviceRationale:This is not pre-coordinated into the CD attribute because the modifier code set may not be specifically designed for use with the Act.code code set. This violates the constraint for using the 'modifier' property that the modifier code set must be defined as part of, or specifically for the base code set.

**Description:**To be used in the message when there is a requirement to communicate a result observation code that relates to a specific isolate.

Examples:

* Colony count * Colony count; Viability count FDA method * Growth rate; Visual method

**Description:**Used to code and identify the Isolate observation result value when a coded result is reported.

Examples:

* Heavy growth * Scant growth * Moderate growth

**Description:**Indicates how result sets should be filtered based on whether they have associated issues.

The combined domain for different types of coded observation issue triggers, such as diagnoses, allergies, etc.

Provides coded names for attribute Employee.jobTitleName, which has data type SC.

Categorization of types of observation that capture a knowledge subtopic which might be treatment, etiology, or prognosis.

Observation values that document the types of observations belonging to the domain KnowledgeSubTopicObservationType.

Categorization of types of observation that capture the main clinical knowledge subject which may be a medication, a laboratory test, a disease.

Observation values that document the types of observations belonging to the domain KnowledgeSubjectObservationType.

Description:Used to code and identify the laboratory result value when a coded result is reported.Examples:

* Sickle cell trait * Hereditary Spherocytosis * Deficiency of butyryl-CoA dehydrogenase

**Definition:**Used to identify if a lab result is reported as preliminary, final, or corrected. Provides a consistent way to distinguish the business or reporting status of the lab result.

**Description:**Providers used in Laboratory messaging.

Description:Trigger events associated with laboratory results.Examples:

* Lab result activate * Lab result complete * Lab result abort

A value representing the method of expression of the language.

*Example:*Expressed spoken, expressed written, expressed signed, received spoken, received written, received signed.

A value representing the level of proficiency in a language.

*Example:*Excellent, good, fair, poor.

OpenIssue:This concept domain has **no valid description**.

A dynamic list of individual instances of Act which reflect the needs of an individual worker, team of workers, or an organization to view roups of Acts for clinical or administrative reasons.

Discussion:The grouped Acts are related to the WorkingList via an ActRelationship of type 'COMP' component).Examples:Problem lists, goal lists, allergy lists, to-do lists, etc.Design note:This physical class contains but a single attribute, other than those that it inherits from Act. Use of that attribute in the design of RIM-based static models has beenDEPRECATEDin HL7 RIM Harmonization, effective November 2005. This action was based on ecommendations from the Patient Care Technical Committee.

As a consequence, this class will cease to be shown as a physical class in the RIM, once the attribute is retired. Nevertheless, use of this class via an Act.classCode value of 'LIST' is entirely appropriate so long as only the attibutes inherited from Act are used.

A code depicting the living arrangements of a person

Anything that essentially has the property of life, independent of current state (a dead human corpse is still essentially a living subject).

Examples:persons, animals, trees .

Types of language sourced from an entity that is a living subject.

Usage Note:Intended to be used for CD or CV data types. Use HumanLanguage concept domain to convey languages represented in ED.Language or other CS data types.

Tells a receiver to ignore just the local markup tags (local\_markup, local\_header, local\_attr) when value="markup", or to ignore the local markup tags and all contained content when value="all"

A value representing the current state of control associated with the device.

Examples:A device can either work autonomously (localRemoteControlStateCode="Local") or it can be controlled by another system (localRemoteControlStateCode="Remote").Rationale:The control status of a device must be communicated between devices prior to remote commands being transmitted. If the device is not in "Remote" status then external commands will be ignored.
Description:Constrains the concepts used to further characterize the association between an entity and itaTMs location. Used only with the LOCE (located entity) role classCode.Example:home, business and vacation home.

**Description:**Describes types of identifiers other than the primary location registry identifier for a service delivery location. Identifiers may be assigned by a local service delivery organization, a formal body capable of accrediting the location for the capability to provide specific services or the identifier may be assigned at a jurisdictional level.

The status of an instance of the RIM Participation class.

Identifies a drug or the use of a drug as produced by a specific manufacturer

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

An Entity or combination of Entities transformed for a particular purpose by a manufacturing process.

Examples:Processed food products, disposable syringes, chemistry analyzer, saline for infusion
Description:A specimen that is manufactured or a specimen from a manufactured material. This may be a quality control specimen or a manufactured substance.Examples:

* Quality control specimen * Aspirin * Breakfast sausage

**Description:**A role type that is used to further qualify an entity playing a role where the role class attribute is set to RoleClass ManufacturedProduct.

Description:The activity of businesses operating in the manufacture and distribution of products.Examples:

* manufacture * repack * import

Provides coded names for attribute Device.manufacturerModelName, which has data type SC.

The closeness or quality of the mapping between the HL7 concept (as represented by the HL7 concept identifier) and the source coding system. The values are patterned after the similar relationships used in the UMLS Metathesaurus. Because the HL7 coding sy

The domestic partnership status of a person.

*Example:*Married, separated, divorced, widowed, common-law marriage.

Description:The broad activity of businesses operating in the distribution of products, the general act of making a product available to the public.Examples:

* Marketing, (this is required as a singleton value set, as there may be no other use case for this than to distinguish one Act of handling products from other Acts, such as manufacturing.)

Description:Indicates the types of products whose associated records are allowed to be masked.

Types of Material for EntityClass "MAT"

This identifies the physical state, nature or manifestation of the material.

Usage Notes:When the Material class is specialised to Manufactured Material, which it is to routinely to describe Medicinal products and ingredient Substances, and to Containers and Devices, the Material Form attribute is used more explicitly to describe the form and manifestation of these types of concepts - for example for medicinal products, the formCode describes their dose form (tablet, ointment); and for containers, it is their physical type (box, carton, vial).

Examples:

* Powder * Liquid * Gas

When the Material class is specialised to Manufactured Material, which it is to routinely to describe Medicinal products and ingredient Substances, and to Containers and Devices, the Material Form attribute is used more explicitly to describe the form and manifestation of these types of concepts - for example for medicinal products, the formCode describes their dose form (tablet, ointment); and for containers, it is their physical type (box, carton, vial). Examples: Powder Liquid Gas

Observation values used for an items counted measure attribute in a health quality measure (eMeasure).

Observation values used for a jurisdiction measure attribute in a health quality measure (eMeasure).

Examples:

* ISO Country codes * State and County codes * FIPS value sets of postal codes * districts * regions

Observation values used for various types of coded measure attributes in a health quality measure (eMeasure).

Observation values used for a reporter type measure attribute in a health quality measure (eMeasure).

Examples:

* Laboratory * Healthcare Providers * Hospitals * Healthcare facilities that are NOT hospitals * Schools * Pharmacists * Veterinary lab * Veterinarian * Prison/Jail * Institutions * Employers

Observation values used for a service delivery location measure attribute in a health quality measure (eMeasure).

Internet Assigned Numbers Authority (IANA) Mime Media Types

**Definition:**A device with direct or indirect therapeutic purpose.

Definition:This domain is used to document why the procedure is a duplicate of one ordered/charged previously for the same patient within the same date of service and has been determined to be medically necessary.Example:A doctor needs a different view in a chest X-Ray.

Identifies the specific hierarchical relationship between the playing and scoping medications.

Examples:Generic, Generic Formulation, Therapeutic Class, etc.
Description:Any type of issue that identifies a potential adverse situation that would or might occur with the described substance administration.Examples:

* adverse effect * drug interaction * drug-food interaction

Identifies types of observations that can be made about a particular drug or medication.

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

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

Description:Identifies types of observations about the Safety Reports required for a particular medication.Examples:

* \[Observation of\] International Birth Date * \[Observation of\] Data Lock Point * \[Observation of\] Frequency of Safety Report Submission

A classification for further qualifying an entity playing a Member RoleClass.

Examples:

* tribal member * elected member * *ex officio* member * part-time member

Indicates the highest importance level of the set of messages the acknowledging application has waiting on a queue for the receiving application.

Discussion:These messages would need to be retrieved via a query. This facilitates receiving applications that cannot receive unsolicited messages (i.e. polling). The specific code specified identifies how important the most important waiting message is (and may govern how soon the receiving application is required to poll for the message).

Priority may be used by local agreement to determine the timeframe in which the receiving application is expected to retrieve the messages from the queue.

**Description:**To be used to identify a microorganism when required by an act.

Examples:

* Escherichia coli * Caulimoviridae * Pseudomonas aeruginosa

Indicates whether the subscription to a query is new or is being modified.

Types of reason why a prescription is revised.

The nature of the bonds by which two molecular parts may be connected.

Examples:(1) simple bonds such as, single bond, double bond, triple bond, (2) specialized bonds such as peptide bond, disulfide bond, etc., (3) weak bonds such as van-der-Waals, chelate, and ion-associations.

The generalization of molecular parts (partitive role) and molecular bonds (associative role), or possibly any other role type used for the expression of structural molecular features.

Examples:(1) acetyl group (a moiety), (2) disulfide bond (a bond), (3) O-linked glycosylation (a moiety).

Specific functiona that a participant may have in a molecular interaction.

Examples:Receptor, allosteric inhibitor, co-factor, catalyst, co-enzyme, competitive inhibitor, etc.

The senses in which a molecule may be conceptually or actually divided into parts.

Examples:
  • sub-unit of a protein (i.e., sequences held together usually by disulfide bonds);

  • domain of a protein or component of a nucleic acid sequence (i.e., a sub-sequence identified to have a certain folding structure or function, e.g. signaling peptide of a protein precursor or promoter and open reading frame of a nucleic acid);

  • residue on a molecular base skeleton; atom of a molecule (e.g., to identify substitution with a radioactive isotope);

  • dissociable ion.

UsageNotes:The specific code system and concepts are left to be externally defined. However, when the positionNumber attribute is to be used with the part role to indicate where the part is placed, the part role code must specify how the position number vector is to be interpreted. For example, for subunits of a protein oligomer (such as fibrinogen) held together by disulfide bonds, the part relationship would need to specify the position of the links
The specific code system and concepts are left to be externally defined. However, when the positionNumber attribute is to be used with the part role to indicate where the part is placed, the part role code must specify how the position number vector is to be interpreted. For example, for subunits of a protein oligomer (such as fibrinogen) held together by disulfide bonds, the part relationship would need to specify the position of the links

**Description:**Concepts which further characterizing the type of mutual relationships. Used only with the abstract code\_RoleClassMutualRelationship.

NDC Regulated Drug Entity Type

Codes identifying nation states. Allows for finer grained specification of Entity with classcode <= NAT

*Example:*ISO3166 country codes.

Description:A duplicate non-clinical service or product is being re-billed.Examples:

* Duplicate transportation required for physician visit * Wrong size of a product * Rebuilding wheel chair ramp due to a weather condition

Indicates types of allergy and intolerance agents which are non-drugs. (E.g. foods, latex, etc.)

The reason the action was not performed, e.g. why the medication was not taken. If an action was not performed, it is often clinically important to know why the action was not taken.

*Examples:*Patient refused, clinically inappropriate, absolute contraindication etc.

**Description:**Types of NonPersonLivingSubjects for the EntityClass "NLIV"

Indication or reason why a valid value is not present.

Concepts that identify the component source substance (e.g., chemical compound class and/or element) that supply nourishment by providing energy or metabolic support.

Examples:

* Carbohydrates * Protein * Fat * Calcium * Vitamin D * Fiber

Concepts that are used to convey modifications to the food or serving utensils that should be given in a diet order. These can be derived from patient allergies, intolerances, or preferences. They can also be specific to the order and not have any relationship to the allergies, intolerances, or preferences.

Examples:

* Vegetarian * Liquids separate from solids * Small Portions * disposable utensils (for psych or isolation rooms)

Concepts that identify a type of natural or manufactured food product, typically liquid or powder mixed with water, for complete or supplemental feeding.

Examples:

* Milk-based * Breast-milk * Soy-based * Peptide-based * Elemental

A material that is used to provide nutritional value.

Examples:

* Food * Formula * Supplements

Concepts that identify a type of natural or manufactured food product used to provide additional nutrients or nourishment replacements beyond those consumed in the normal diet.

Examples:

* High-calorie * High-protein * Clear liquid * Oral electrolyte Replacement

**Description:**To allow queries to specify useful information about the age of the patient without disclosing possible protected health information.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

**Description:**Dianostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge actiivities.

**Example:**Skin tests and eosinophilia evaluations.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Indicates the type of allergy test performed or to be performed. E.g. the specific antibody or skin test performed

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:A code used to further identify the type of case status observation. Used with the OBS ActClass.Examples:

* Clinical status * Administrative status * Reporting status

Description:A code used to identify the status of a case. Used with the OBS ActClass.Examples:

* Suspect * Confirmed * Probable

**Description:**A kind of observation that allows a Secondary Observation (source act) to assert (at various levels of probability) that the target act of the association (which may be of any type of act) is implicated in the etiology of another observation that is named as the subject of the Secondary Observation

**Example:**Causality assertions where an accident is the cause of a symptom; predisposition assertions where the genetic state plus environmental factors are implicated in the development of a disease; reaction assertions where a substance exposure is associated with a finding of wheezing.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:Identifies the individual coordinate in the coordinate system inclusive of any transformations or projections.Examples:meridian, range, township, longitude, latitude, lot, block, etc. Description:Identifies the coordinate system inclusive of any transformation projections.

**Description:**Type of coded observation values in evaluating reference ranges.

Examples:

* Surgically transgendered transsexual, female-to-male * AIDS-associated disorder * Asian race

Definition:

The set of observation type concepts that can be used to express pre-conditions to a particular dosage definition.

Rationale: Used to constrain the set of observations to those related to the applicability of a dosage, such as height, weight, age, pregnancy, liver function, kidney function, etc. For example, in drug master-file type records indicating when a specified dose is applicable.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:of observation used for evaluating a precondition, goal, or trigger.Examples:

* age-based criteria * diagnostic-based criteria * simple observation-based criteria (vital signs)

Description:Type of observation used in lab for evaluating reference ranges.Examples:

* age-based criteria * sex-based criteria * condition-based criteria

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

The domain of possible values for a categorical assessment of an observation value.

Discussion:These interpretation codes are sometimes called "abnormal flags", however, the judgment of normalcy is just one of the common rough interpretations, and is often not relevant. For example, the susceptibility interpretations are not about "normalcy", and for any observation of a pathologic condition, it does not make sense to state the normalcy, since pathologic conditions are never considered "normal."

Interpretations of change of quantity and/or severity.

Examples:

* better * worse * increased

Interpretations of the presence or absence of a component / analyte or organism in a test or of a sign in a clinical observation. In keeping with laboratory data processing practice, this provides a categorical interpretation of the "meaning" of the quantitative value for the same observation.

Technical exceptions resulting in the inability to provide an interpretation, such as "off scale". Does not include normality or severity.

Interpretation of the observed result taking into account additional information (contraindicators) about the patient's situation. Concepts in this category are mutually exclusive, i.e., at most one is allowed.

Interpretations of normality or degree of abnormality (including critical or "alert" level). Concepts in this category are mutually exclusive, i.e., at most one is allowed.

Interpretations of anti-microbial susceptibility testing results (microbiology). At most one allowed.

Description:Types of sensitivity caused by an exposure to a substance which results in an abnormal immunologic or non-immunologic response.Examples:

* Food allergy * Environmental allergy * Fod intolerance

Description:Used to further classify the type of investigation being documented. This concept domain is intended to be used with the INVSTG Act class code.Examples:

* Public health case investigation * Safety investigation * Surveillance investigation

Distinguishes the kinds of coded observations that could be the trigger for clinical issue detection. These are observations that are not measurable, but instead can be defined with codes. Coded observation types include: Allergy, Intolerance, Medical Condition, Pregnancy status, etc.

Distinguishes between the kinds of measurable observations that could be the trigger for clinical issue detection. Measurable observation types include: Lab Results, Height, Weight.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:A set of codes specifying the type of Laboratory Report.Examples:

* Hematology reports * Chemistry reports * Blood gas reports

Observation values used to indicate the type of scoring (e.g. proportion, ratio) used by a health quality measure.

Observation values used to indicate whether a health quality measure is used to sample a process or outcome over time.

A code that provides additional detail about the means or technique used to ascertain the observation.

Examples:Blood pressure measurement method: arterial puncture vs. sphygmomanometer (Riva-Rocci), sitting vs. supine position, etc.Constraints:In all observations the method is already partially specified by the Act.code. In this case, the methodCode NEED NOT be used at all. The methodCode MAY still be used to identify this method more clearly in addition to what is implied from the Act.code. However, an information consumer system or process SHOULD NOT depend on this methodCode information for method detail that is implied by the Act.code.

If the methodCode is used to express method detail that is also implied by the Act.code, the methodCode MUST NOT be in conflict with the implied method of the Act.code.

Discussion:In all observations the method is already partially specified by simply knowing the kind of observation (observation definition, Act.code) and this implicit information about the method does not need to be specified in Observation.methodCode. Particularly, most LOINC codes are defined for specific methods as long as the method makes a practical difference in interpretation. For example, the difference between susceptibility studies using the "minimal inhibitory concentration" (MIC) or the "agar diffusion method" (Kirby-Baur) are specifically assigned to different LOINC codes. The methodCode therefore is only an additional qualifier to specify what may not be known already from the Act.code.

Also, some variances in methods may be tied to the particular device used. The methodCode should not be used to identify the specific device or test-kit material used in the observation. Such information about devices or test-kits should be associated with the observation as "device" participations.

Description:Identifies the ordered lab test. Also known as the lab order code or test code.Examples:

* red blood cell count * components of a chemistry panel * microbiology sensitivity testing

Description:Identifies the type of observations that can be ordered.Examples:

* lab tests * diagnostic imaging * device summary

Description:A code used to further identify the type of Outbreak Extent Observation. Used with the OBS ActClass.Examples:

* Geographic extent * Jurisdictional extent

Description:A code used to identify the extent of an outbreak. Used with the OBS.Examples:

* Local * Regional * National

Observation values used to assert that a subject falls into a particular population.

Examples:

* Included in denominator * Included in numerator

This element was deprecated as of the release indicated.

Description:Identifies the type of position accuracy carried in observation value.

**Definition:**Identifies the kinds of public health cases. Used only with the CASE Act class code.

Examples of types of public health cases includes reportable disease cases, radiation exposure cases and chemical exposure cases.

Description:

Used to further classify the type of Outbreak being documented. This concept domain is intended to be used with the OUTB Act class code.

Examples:

* Epidemic * Pandemic * Endemic

Codes used to define various metadata aspects of a health quality measure (specialization of ActClass "OBS").

Definition:An observation related to a query response.

**Example:**The degree of match or match weight returned by a matching algorithm in a response to a query.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:The type of lab observation being resulted. There are some lab tests which are not ordered and are performed and resulted when the outcome of an ordered test meets some criteria.Examples:

* red blood cell count * results of micro sensitivity testing * *Missing third example*

Description:Identifies the type of observation that can be resulted. There are some labs which are not ordered and are performed and resulted when the outcome of an ordered test meets some criteria.Examples:

* outcomes of lab tests * device summary * therapeutic drug level testing

Identifies the kinds of observations that can be performed

This domain is the root domain to which all HL7-recognized value sets for the Observation.value attribute will be linked when Observation.value has a coded data type.

Definition:Identifies the type of Vision Prescription Observation that is being described.OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

A relationship in which the scoping Entity defines or specifies what the playing Entity is. Thus, the player's "being" (Greek: ontos) is specified.

Examples:sameness; instance; generalization.

Concepts representing diets that can be taken via the mouth.

Examples:

* General * Pureed * Easy to Chew

**Description:**Indicates the form in which the drug product must be, or has been manufactured, or extemporaneous/magistral prepared .

**Description:**To be used to code and identify the Microbiology laboratory observation code that relates to the microorganism identification.

Examples:

* Bacteria identified * Bacteria identified in tissue * Fungus identified

Further classifies entities of EntityClass ORG.

Examples:

* HL7 workgroup * corporation * fraternal organization

Domain provides classification systems for industries.

Concepts which further characterize the association between two Entities which are organizations where the playing Entity (the part) is a component of the whole (scoper). Used only with the PART (part) role classCode.

Examples:

* business unit * department * executive team

Indicates an observed reason for a medical action other than an indication or symptom. E.g. Need for a contrast agent prior to a diagnostic image, need for anesthesia prior to surgery, etc.

Description:The OutbreakObservationValue is used to identify the primary condition or disease associated with an Outbreak. This concept domain is intended to be used with the OUTB Act class code and the ObservationPublicHealthOutbreakType ActCode concept domain.Examples:

* Tuberculosis * Lyme Disease * SARS

This code is used to specify the exact function an actor is authorized to have in authoring a consent override.

A drug product identified at the level of the package in which it is commonly distributed. Code systems such as UPC (Universal Product Code), NDC (National Drug Code), GTIN(Global Trade Item Number) might be bound to this domain in a given realm.

Description:Identifies products such as (1) the GS1 (was UPC and EAN); (2) the U.S., the National Drug Code, which is the U.S. version of what is internationally named the (3) "Medicinal Product Identifier" (MPID). For device products such product code is also known as the "Unique Device Identifier" and may or may not use the GS1 system of product codes. In local contexts the product code can come from local coding systems also, as long as it is a code that denotes to a description of a manufactured product.Examples:

* 0049-3980-41 (NDC for Geodon Roerig 80 mg capsules 10 capsules x 8 blister packs in a carton)

A code indicating the name of a parameter item. ParameterItem classes are defined in the RIM as name-value pairs and this domain provides the name part of the ParameterItem.

Examples:Patient Name, Drug Code, Order Effective Date
Description:Concepts which further characterizing the association two Entities where the playing Entity (the part) is a component of the whole (scoper). Used only with the PART (part) role classCode.

Example: Body part, organization part and moiety.

This code is used to specify the exact function an actor had in a service in all necessary detail. This domain may include local extensions (CWE).

Identifies a means by which an Entity participates in an Act.

A code specifying whether and how the participant has attested his participation through a signature and or whether such a signature is needed.

Examples:A surgical Procedure act object (representing a procedure report) requires a signature of the performing and responsible surgeon, and possibly other participants. (See also: Participation.signatureText.)

Used to indicate that the participation is a filtered subset of the total participations of the same type owned by the Act.

Used when there is a need to limit the participations to the first, the last, the next or some other filtered subset.

A code specifying the kind of Participation or involvement the Entity playing the Role associated with the Participation has with regard to the associated Act.

Constraints:The Participant.typeCode contains only categories that have crisp semantic relevance in the scope of HL7. It is a coded attribute without exceptions and no alternative coding systems allowed.

An association between two Entities where the playing Entity is considered in some way "part" of the scoping Entity, e.g., as a member, component, ingredient, or content. Being "part" in the broadest sense of the word can mean anything from being an integral structural component to a mere incidental temporary association of a playing Entity with a (generally larger) scoping Entity.

Examples:part; member; ingredient.

An association for a playing Entity that is used, known, treated, handled, built, or destroyed, etc. under the auspices of the scoping Entity. The playing Entity is passive in these roles (even though it may be active in other roles), in the sense that the kinds of things done to it in this role happen without an agreement from the playing Entity.

Examples:birthplace; owned entity; used entity.

Indicates the type of characteristics a patient should have for a given therapy to be appropriate. E.g. Weight, Age, certain lab values, etc.

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.
Description:Reporting codes that are related to an immunization event.

Patient VIP code

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

Describes payment terms for a financial transaction, used in an invoice.

This is typically expressed as a responsibility of the acceptor or payor of an invoice.

Definition:Set of codes indicating the manner in which payors participate in a policy or program.</

**Description:**PayorRoleType for a particular type of policy or program benefit package or plan where more detail about the coverage administration role of the Payor is required. The functions performed by a Payor qualified by a PayorRoleType may be specified by the PayorParticpationFunction value set.

**Examples:**A Payor that is a TPA may administer a managed care plan without underwriting the risk.

Description:Identifies functions appropriate to performer participations.Examples:

* surgeon * lab technician * janitor

A code identifying a person's disability.

Types of identifiers for persons.

Examples:

* Social insurance number * Passport number * Drivers license number * Jurisdiction health number

A "personal and legal" assigned relationship records the role of a person in relation to another person, or a person to himself or herself. These concepts are to be used when recording relationships based on personal or family ties or through legal assignment of responsibility.

Description:Types of personal relationships between two living subjects.Examples:

* Parent * sibling * unrelated friend * neighbor

A code to capture the reporter's assessment of the extent to which the reaction is related to the suspect product reported in the ICSR.

Example concepts include: related, not related, possibly related and unlikely related.

**Definition:**Identifies why the dispense event was not completed

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

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

Identifies the reason why a request for a prescription renewal has been refused.

Identifies physical characteristics that may be observed for a particular medicinal product or medicinal product package of types thereof.

Examples:

* Height * Imprint * Shape * Color

A physical place or site with its containing structure. May be natural or man-made. The geographic position of a place may or may not be constant.

Examples:dam; city; state.

Observation types for specifying criteria used to assert that a subject is included in a particular population.

Examples:

* denominator * numerator * initial population

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

A relationship between two people in which one person authorizes another to act for him in a manner which is a legally binding upon the person giving such authority as if he or she personally were to do the acts.

Defines types of certifications for practitioners

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Values that indicate how important a preference is to the target of the reporter.

Examples:

* Very Important * Important * Suggested

A "helper" vocabulary used to construct complex query filters based on how and whether a prescription has been dispensed.

Observations specific to a particular prescription to express concepts that cannot be expressed via other modeling approaches.

Examples:"Patient Medication On Hand Quantity", "Patient Medication On Hand Days Supply", "Patient Expected Supply Run-out Date", "Percentage Dispensed".

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

**Description:**A concept whose description/definition provides additional detail about the means or technique used for the procedure.

Examples:

* neuromuscular reeducation * functional activity * Laparoscopic Gastric Bypass Roux-en-Y

This attribute defines whether the message is part of a production, training, or debugging system.

This attribute defines whether the message is being sent in current processing, archive mode, initial load mode, restore from archive mode, etc.

A code that characterizes the role that the primary reporter felt that the suspect intervention -- either a substance administration or a device related procedure - played in the incident being reported. This code will capture the primary reporter's assessment of the role that the suspect product played in the incident reported in the ICSR.

Examples include: Suspect, Concomitant, Interacting, Re-challenge.

An identifying data string for healthcare products.

Example code sets include Healthcare Common Procedure Coding System (HCPCS) and Universal Product Code (UPC).

Description:A type of substance that is used as an ingredient within a product.Examples:

* Morphine * wheat germ * calcium

A code specifying a type of responsibility that an entity may take on with respect the lifecycle of a product.

Examples:

* Manufacturer * Distributor * Retailer

Description:Indicates the role that an organization takes in the process by which a product goes from an original manufacturer to the eventual consumer.

**Examples:**Manufacturer, re-processor

**Note:**These two values are currently used in adverse event and product problem reporting.

Description:Provides the description of the role of a place in terms of its provision of services and functions in the product regulatory domain.Examples:

* pharmacovigilance masterfile location * COSHH (Control of Substances Hazardous to Health) masterfile location * regulatory dossier storage location * batch release masterfile location

**Description:**Concepts characterizing product related roles.

**Description:**Captures the different roles that are recorded to characterize the qualifications or stations in life of persons or organizations who participate as senders or as receivers of adverse event or product problem reports.

**Example:**Example values may include: physician, healthcare facility, attorney, family member, regulatory agency. Initial effort to find defined concepts for this value set will focus on the HIPAA provider taxonomy.

A role type, which indicates the type of device that authors or in some manner contributes to the generation, management, and/or transmission of health information, the use of which may be tracked for purposes of determining the provenance of health information. The playing device acts or is authorized to act on behalf of a scoping entity..

Examples:

* Patient selected home monitoring device e.g., to detect and report falls * Provider selected medication adherence monitoring, reporting, and alerting device * Provider designated EKG measuring and reporting device

A role type, which indicates the type of device that in some manner contributes to the generation, management, and/or transmission of health information, the use of which may be tracked for purposes of determining the provenance of health information. The playing device is passive in these roles in the sense that the device is not authorized to act on behalf of a scoping entity.

Examples:

* Software that aggregates pre-existing content to facilitate the authorship of a new artifact by an assigned entity * Software that translates pre-existing content to facilitate the management of that content by an assigned entity * Software that transmits content to facilitate the exchange of that content by an assigned entity * Privacy protective software that facilitates privacy protection and security enforcement by filtering health information and applying protections such as de-identification, masking, or redaction, and privacy marking.

Healthcare Provider Taxonomy Codes

Description:The PublicHealthCaseObservationValue is used to identify the primary condition or disease associated with a Public Health Case.. This concept domain is intended to be used with the CASE Act class code and the ObservationInvestigationType ActCode concept domain.Examples:

* Tuberculosis * Lyme Disease * SARS * Lung Cancer

Description:A category to which a person can be assigned on the basis of professional qualification, experience, and/or job assignment.Examples:

* Physician * Registered Nurse * Product Quality Manager

The domain of coded values used as parameters within QueryByParameter queries.

Identifies the time frame in which the response is expected.

Defines the units associated with the magnitude of the maximum size limit of a query response that can be accepted by the requesting application

Values in this domain allow a query response system to return a precise response status.

State attributes for Query event

In the United States, federal standards for classifying data on race determine the categories used by federal agencies and exert a strong influence on categorization by state and local agencies and private sector organizations. The federal standards do not conceptually define race, and they recognize the absence of an anthropological or scientific basis for racial classification. Instead, the federal standards acknowledge that race is a social-political construct in which an individual's own identification with one more race categories is preferred to observer identification. The standards use a variety of features to define five minimum race categories. Among these features are descent from "the original peoples" of a specified region or nation. The minimum race categories are American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White. The federal standards stipulate that race data need not be limited to the five minimum categories, but any expansion must be collapsible to those categories.

OpenIssue:This concept domain definition does not align with current vocabulary practices and is much too US-centric to be appropriate as a "universal" domain.

Interpretations of the presence and level of reactivity of the specified component / analyte with the reagent in the performed laboratory test.

Description:All binding realms allowed for linking concept domains to value sets.

Code assigned to indicate the rationale for not performing an evaluation investigation on a device for which a defect has been reported.

Examples include: device received in a condition that made analysis impossible, device evaluation anticipated but not yet begun, device not made by company.

The reason a referral was made.

*Examples:*Specialized Medical Assistance, Other Care Requirements.

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

**Description:**Codes that further characterize a regulated product role. Used only with the RGPR (regulated product) role classCode.

Example:Regulated drug and regulated device.
Description:A rule set by regulators of product that somehow constrain the use of products. Regulator may be any organization with a mandate to issue such rules, regardless of level, regional, country, state, and local (e.g., an institutional Pharmaceutical and Treatment Committee.)Examples:

* Prescription Only * Controlled Substance Schedule II * Standard of Practice

Provides coded names for attribute RelationalExpression.elementName, which has data type SC.

Identifies common relational operators used in selection criteria.

A code specifying the logical conjunction of the criteria among all the condition-links of Acts (e.g., and, or, exclusive-or.)

Constraints:All AND criteria must be true. If OR and AND criteria occur together, one criterion out of the OR-group must be true and all AND criteria must be true also. If XOR criteria occur together with OR and AND criteria, exactly one of the XOR criteria must be true, and at least one of the OR criteria and all AND criteria must be true. In other words, the sets of AND, OR, and XOR criteria are in turn combined by a logical AND operator (all AND criteria and at least one OR criterion and exactly one XOR criterion.) To overcome this ordering, Act criteria can be nested in any way necessary.

Assigment of spiritual faith affiliation

Description:Different types of research studies that may be conducted and reported on.Examples:

* Observational * Investigational

Specifies the administrative functionality within a formal experimental design for which the ResearchSubject role was established. Examples: screening - role is used for pre-enrollment evaluation portion of the design; enrolled - role is used for subjects admitted to the active treatment portion of the design.

Codes to characterize a Resource Group using categories that typify its membership and/or function

.

Example:PractitionerGroup

Specifies whether a response is expected from the addressee of this interaction and what level of detail that response should include

Defines the timing and grouping of the response instances.

Specifies the mode, immediate versus deferred or queued, by which a receiver should communicate its receiver responsibilities.

The role played by a party who has legal responsibility for another party.

**Description:**Codes that further characterize the association of a material playing the role of a retailed material to the scoper which retails the material. Used only with the RET (retailed material) role classCode.

Examples:Department store, Self-service and Online.

Type of material that provides access to another entity.

This table includes codes for the Role class hierarchy. The values in this hierarchy, represent a Role which is an association or relationship between two entities - the entity that plays the role and the entity that scopes the role. Roles names are derived from the name of the playing entity in that role.

The role hierarchy stems from three core concepts, or abstract domains:

* **RoleClassOntological** is an abstract domain that collects roles in which the playing entity is defined or specified by the scoping entity. * **RoleClassPartitive** collects roles in which the playing entity is in some sense a "part" of the scoping entity. * **RoleClassAssociative** collects all of the remaining forms of association between the playing entity and the scoping entity. This set of roles is further partitioned between: * **RoleClassPassive** which are roles in which the playing entity is used, known, treated, handled, built, or destroyed, etc. under the auspices of the scoping entity. The playing entity is passive in these roles in that the role exists without an agreement from the playing entity. * **RoleClassMutualRelationship** which are relationships based on mutual behavior of the two entities. The basis of these relationship may be formal agreements or they may be *de facto* behavior. Thus, this sub-domain is further divided into: * **RoleClassRelationshipFormal** in which the relationship is formally defined, frequently by a contract or agreement. * **Personal relationship** which inks two people in a personal relationship.

The hierarchy discussed above is represented In the current vocabulary tables as a set of abstract domains, with the exception of the "Personal relationship" which is a leaf concept.

Specific classification codes for further qualifying RoleClass codes.

**Description:**The status of an instance of the RIM RoleLink class.

Constraint:It is intended to be used based on usage of the ParticipationType concept domain.Examples:

* Active * No longer active * Nullified

A code specifying the kind of connection represented by this RoleLink, e.g., has-part, has-authority.

The status of an instance of the RIM Role class.

**Description:**This describes which path the administered medication takes to get into the body or into contact with the body and constitutes part of thewhere(the other part being site - see below). It is theway inor the course the medication must take to get to its destination.

Note that a path is in no sense a description of a *final destination*; it is a stylized description of the path taken. For example, an oral antibiotic may be used to treat a severe infection on a toe; the oral route is used to get the medicine to be able to reach and treat the infection in the toe. For some specific routes of administration there may be an incidental sense of *final destination*, for example an ocular administration usually occurs when treatment of an eye condition is required. However, this is in no sense definitional: rectal administration of a medicine may be for a local effect (a steroid foam for treatment of colitis) or for a systemic effect (metronidazole for treatment of infection). The route of administration of a medicine should only be a description of the path taken and not the form.

Examples:

* oral * rectal * intravenous (IV) * subcutaneous (SC) * intramuscular (IM)

Description:Possible reasons generating a report providing information developed during the investigation of an adverse event or a product problem.Examples:

* Correction * Additional information/Follow-up * Response to regulatory agency request

Type of security metadata observation made about the alteration integrity of an altered IT resource (data, information object, service, or system capability), which indicates the mechanism used for authorized transformation of the resource.

Examples:Types of security alteration integrity observation metadata, which may value the observation with a code used to indicate the mechanism used for authorized transformation of an IT resource, include:

* translation * syntactic transformation * semantic mapping * redaction * masking * pseudonymization * anonymization

Usage Note:SecurityAlterationIntegrityObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityAlterationIntegrityObservationValue" value set, which convey the mechanism used for authorized transformation of an IT resource.

Security observation values used to indicate security alteration integrity metadata.

Examples:Codes conveying the mechanisms used to make authorized alteration of an IT resource, such as:

* translation * masking * anonymization

Usage Note:SecurityAlterationIntegrityObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityAlterationIntegrityObservationType code. \[FIPS 188\]

Type of security metadata observation made about the category of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security category metadata is defined by ISO/IEC 2382-8:1998(E/F)/ T-REC-X.812-1995 as: "A nonhierarchical grouping of sensitive information used to control access to data more finely than with hierarchical security classification alone."

Rationale:A security category observation supports the requirement to specify the type of IT resource in order to facilitate application of appropriate levels of security according to a range of levels of impact or consequences that might result form the unauthorized disclosure, modification, or use of the information or information system. A resource is assigned to a specific category of information (e.g., privacy, medical, proprietary, financial, investigative, contractor sensitive, security management) defined by an organization or in some instances, by a specific law, Executive Order, directive, policy, or regulation. \[FIPS 188\]Examples:Types of security categories include:

* Compartment: A division of data into isolated blocks with separate security controls for the purpose of reducing risk. (ISO 2382-8). Security label metadata that "segments" an IT resource by indicating that access and use is restricted to members of a defined community or project. (HL7 Healthcare Classification System) * Sensitivity: The characteristic of a resource which implies its value or importance and may include its vulnerability. (ISO 7492-2) Privacy metadata for information perceived as undesirable to share. (HL7 Healthcare Classification System)

Usage Note:SecurityCategoryObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tage set "SecurityCategoryObservatonValue" value set.

Codes may be drawn from the union of the following value sets: V:PrivacyPolicyType, V:ActPrivacyLaw, V:ActConsentDirective, V:InformationSensitivityPolicy, V:ActInformationSensitivityPolicy, V:RoleInformationSensitivityPolicy, EntitySensitivityPolicy, and V:ActConsentType. Could be bound R1 to a V:ActUSPrivacyPolicy in a future US Realm.

Security observation values used to indicate security category metadata.

Examples:Codes conveying the category of an IT resource such as:

* applicable privacy policy * sensitivity * consent directive type

Usage Note:SecurityCategoryObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityCategoryObservationType code. \[FIPS 188\]

Type of security metadata observation made about the classification of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security classification is defined by ISO/IEC 2382-8:1998(E/F)/ T-REC-X.812-1995 as: "The determination of which specific degree of protection against access the data or information requires, together with a designation of that degree of protection." Security classification metadata is based on an analysis of applicable policies and the risk of harm to an individual that could result from unauthorized disclosure.

Examples:Types of security classification include: HL7 Confidentiality Codes such as very restricted, unrestricted, and normal. Intelligence community examples include top secret, security, and confidential.Usage Note:SecurityClassificationObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityClassificationObservationValue" value set.

Note that an Act or Role may be associated with an Observation coded as SecurityClassificationObservationType with a SecurityClassificationObservationValue coded with a confidentiality code from V:Confidentiality Code to indicate that the confidentiality level indicated by an Act or Role confidentiality attribute has been overridden by the entity responsible for assigning the SecurityClassificationObservationValue. This supports the business requirement for increasing or decreasing the level of confidentiality (classification or declassification) based on parameters beyond the original assignment of an Act or Role confidentiality.

Security observation values used to indicate security classification metadata.

Examples:Codes conveying the classification of an IT resource, such as confidentiality codes.Usage Note:SecurityClassificationObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityClassificationObservationType code. \[FIPS 188\]

Type of security metadata observation made about the control of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security control metadata convey instructions to users and receivers for secure distribution, transmission,and storage; dictate obligations or mandated actions; specify any action prohibited by refrain policy such as dissemination controls; and stipulate the permissible purpose of use of an IT resource.

Examples:Types of security control metadata include handling:

* caveats * dissemination controls * obligations * refrain policies * purpose of use constraints

Usage Note:SecurityControlObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityControlObservationValue" value set. Codes may be drawn from the union of the following value sets: V:SecurityPolicy, V:ObligationiPolicy, V:RefrainPolicy, V:PurposeOfUse, and V:GeneralPurposeOfUse.

Security observation values used to indicate security control metadata.

Examples:Codes conveying dissemination controls, handling caveats, purpose of use, and obligations to which an IT resource custodian or receiver must comply.Usage Note:SecurityControlObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityControlObservationType code. \[FIPS 188\]

Type of security metadata observation made about the data integrity of an IT resource (data, information object, service, or system capability), which indicates the security mechanism used to preserve resource accuracy and consistency. Data integrity is defined by ISO 22600-23.3.21 as: "The property that data has not been altered or destroyed in an unauthorized manner", and by ISO/IEC 2382-8: "The property of data whose accuracy and consistency are preserved regardless of changes made."

Rationale:In accordance with the HL7 RM-ES EHR-FM Profile Standard: The validity of a patient record entry requires an indelible statement (e.g., attestation or electronic signature) by the author(s) of completeness, accuracy, and affirmation that the record cannot be repudiated, assigning each author to his/her actual contributed content.Examples:Types of security data integrity observation metadata, which may value the observation, include:

* cryptographic hash function * digital signature

Usage Note:SecurityDataIntegrityObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityIntegrityConfidenceObservationValue" value set.

Security observation values used to indicate security data integrity metadata.

Examples:Codes conveying the mechanisms used to preserve the accuracy and consistency of an IT resource such as:

* a digital signature * a cryptographic hash function

Usage Note:SecurityDataIntegrityObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityDataIntegrityObservationType code. \[FIPS 188\]

Type of security metadata observation made about the integrity confidence of an IT resource (data, information object,service, or system capability) that indicates the reliability or trustworthiness of a resource, which may be used to make access control decisions.

Examples:Types of security integrity confidence observation metadata, which may value the observation, include:

* highly reliable * uncertain reliability * not reliable

Usage Note:A security integrity confidence observation on an Act may indicated that a valued Act.uncertainty attribute has been overridden by the entity responsible for assigning the SecurityIntegrityConfidenceObservationValue. This supports the business requirements for increasing or decreasing the assessment of the reliability or trustworthiness of an IT resource based on parameters beyond the original assignment of an Act.uncertaintyCode.

Security observation values used to indicate security integrity confidence metadata.

Examples:Codes conveying the level of veracity, reliability, and trustworthiness of an IT resource.Usage Note:Codes conveying the level of veracity, reliability, and trustworthiness of an IT resource.

Type of security metadata observation made about the integrity of an IT resource (data, information object,service, or system capability), which may be used to make access control decisions.

Rationale:Integrity security label fields support integrity models such as the Biba Integrity Model, the Lipner Full Integrity Model, and the Clar-Wilson Model. The value in the integrity label field indicates the degree of confidence that may be placed in the data and also indicates which measures the data requires for protection from modification and destruction.Examples:Types of security integrity observation metadata, which may value the observation include:

* Integrity status, which indicates the completeness or workflow status of a resource (data, information object, service, or system capability); * Integrity confidence, which indicates the reliability and trustworthiness of the resource; * Integrity control, which indicates pertinent handling caveats, obligations, refrain policies, and purpose of use for the resource; * Data integrity, which indicate the security mechanisms used to ensure that the accuracy and consistency are preserved regardless of changes made (ISO/IEC DIS 2382-8); * Alteration integrity, which indicate the security mechanisms used for authorized transformations of the resource; * Integrity provenance, which indicates the second-hand origins of a reported or asserted resource.

Usage Note:SecurityIntegrityObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityIntegrityObservationValue" value set.

Security observation values used to indicate security integrity metadata.

Examples:Codes conveying an IT resource:

* veracity * reliability * trustworthiness * provenance

Usage Note:SecurityIntegrityObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityIntegrityObservationType code. \[FIPS 188\]

Type of security metadata observation made about the provenance integrity of an IT resource (data, information object, service, or system capability), which indicates the entity responsible for an assertion relayed "second-hand" about an IT resource.

Rationale:In accordance with HL7 RM-ES EHR-FM Profile at IN:1.8: If more than one author contributed to the EHR content, then the system shall provide the ability to associate and maintain all authors/contributors with their content.Examples:Types of security integrity provenance asserted by observation metadata, which may value the observation, include assertions about an IT resource by a patient, a clinician, or a device.Usage Note:SecurityIntegrityProvenanceAssertedByObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityIntegrityProvenanceAssertedByObservationValue" value set.

Security observation values used to indicate security integrity provenance asserted by metadata.

Examples:Codes conveying the provenance metadata about the entity asserting an IT resource.Usage Note:SecurityIntegrityProvenanceAssertedByObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityIntegrityProvenanceAssertedByObservationType code. \[FIPS 188\]

Type of security metadata observation made about the provenance integrity of an IT resource (data, information object, service, or system capability), which indicates the lifecycle completeness and workflow status of an IT resource, such as create, modify, append, amend, suspend, archive, and delete; locations in which the resource has been collected or archived, from which it may be retrieved, and the history of its distribution and disclosure. Integrity provenance metadata about an IT resource may be used to assess its veracity, reliability, and trustworthiness.

Examples:Types of security integrity provenance observation metadata, which may value the observation with a code used to indicate provenance, include the entity responsible for a report or assertion relayed "second-hand" about an IT resource.Usage Note:SecurityIntegrityProvenanceObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityIntegrityProvenanceObservationValue" value set.

Security observation values used to indicate security alteration integrity metadata.

Examples:Codes conveying the provenance of an IT resource such as the entity responsible for a report or assertion relayed "second-hand" about an IT resource.Usage Note:SecurityIntegrityProvenanceObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityIntegrityProvenanceObservationType code. \[FIPS 188\]

Type of security metadata observation made about the provenance integrity of an IT resource (data, information object, service, or system capability), which indicates the entity responsible for a report relayed "second-hand" about an IT resource.

Rationale:In accordance with HL7 RM-ES EHR-FM Profile at IN:1.8: If more than one author contributed to the EHR content, then the system shall provide the ability to associate and maintain all authors/contributors with their content.Examples:Types of security integrity provenance observation metadata, which may value the observation with a code used to indicate provenance, include reports about an IT resource by a patient, a clinician, or a device.Usage Note:SecurityIntegrityProvenanceReportedByObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityIntegrityProvenanceReportedByObservationValue" value set.

Security observation values used to indicate security integrity provenance reported by metadata.

Examples:Codes conveying the provenance metadata about the entity reporting an IT resource.Usage Note:SecurityIntegrityProvenanceReportedByObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityIntegrityProvenanceReportedByObservationType code. \[FIPS 188\]

Type of security metadata observation made about the integrity status of an IT resource (data, information object,service, or system capability), which may be used to make access control decisions. Indicates the completeness or workflow status of an IT resource, which may impact which users that are authorized to access and use the resource.

Rationale:In accordance with the HL7 RM-ES Profile Standard: The validity of a patient record entry requires an indelible statement (e.g., attestation or electronic signature) by the author(s) of completeness, accuracy, and affirmation that the record cannot be repudiated, assigning each author to his/her actual contributed content.Examples:Types of security integrity status observation metadata, which may value the observation, include codes from the HL7 DocumentCompletion value set such as:

* legally authenticated * in progress * incomplete

Usage Note:SecurityIntegrityStatusObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the security label tag set "SecurityIntegrityStatusObservationValue" concept domain, which may be valued with coded concepts from the HL7 DocumentCompletion value set.

Security observation values used to indicate security integrity status metadata.

Examples:Codes conveying the completeness of an IT resource in terms of workflow status such as:

* authenticated * legally authenticated * in progress

Usage Note:SecurityIntegrityStatusObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityIntegrityStatusObservationType code. \[FIPS 188\]

Type of security metadata observation made about an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security metadata are used in security labels.

Rationale:According to ISO/TS 22600-3:2009(E) A.9.1.7 SECURITY LABEL MATCHING, Security label matching compares the initiatorÃs clearance to the targetÃs security label. All of the following must be true for authorization to be granted:

* The security policy identifiers shall be identical, * The classification level of the initiator shall be greater than or equal to that of the target (that is, there shall be at least one value in the classification list of the clearance greater than or equal to the classification of the target), and * For each security category in the target label, there shall be a security category of the same type in the initiatorÃs clearance and the initiatorÃs classification level shall dominate that of the target.

Usage Note:SecurityObservationType concept domain designates a code system used to name a security label field type that may be valued with a "security label tag" such as a code from the securty label tag set "SecurityObservationValue" value set.

Observation values used to indicate security observation metadata.

Examples:

* Codes conveying the classification of an IT resource, such as confidentiality codes * Codes conveying privacy law, sensitivity, and consent directive types governing an IT resource * Codes conveying dissemination controls, handling caveats, purpose of use, refrain policies, and obligations to which an IT resource custodian or receiver must comply. * Codes conveying an IT resource completeness, veracity, reliability, trustworthiness, and provenance * Codes conveying the mechanism used to preserve the accuracy and consistency of an IT resource such as a digital signature and a cryptographic hash function * Codes conveying the mechanism used to make authorized alterations of an IT resource, such as translation, masking, and anonymization

Usage Note:SecurityObservationValue codes are members of a security label "tag set" used to populate or "tag" a security label field named by the associated SecurityObservationType code. \[FIPS 188\]

Type of security metadata observation made about the formal declaration by an authority or neutral third party that validates the technical, security, trust, and business practice conformance of Trust Agents to facilitate security, interoperability, and trust among participants within a security domain or trust framework.

Values for security metadata observation made about the formal declaration by an authority or neutral third party that validates the technical, security, trust, and business practice conformance of Trust Agents to facilitate security, interoperability, and trust among participants within a security domain or trust framework.

For example, DirectTrust, Kantara Initiative, Open Identity

Type of security metadata observation made about security requirements for a security domain. \[ISO IEC 10181-1\]

Values for security metadata observation made about security requirements with which a security domain must comply. \[ISO IEC 10181-1\] Conveys the agreement of an asserter to comply with jurisdictional, community, or contractual (security domains) codes of conduct which an information custodian requires as a condition of authorizing collection, access, use or disclosure.

For example, DURSA, DIRECT Applicability Statement, HIPAA Covered Entity and Business Associate Agreement, and FTC PHR Vendor, Related Entity, and third party agreements.

Type of security metadata observation made about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.

Values for security metadata observation made about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.

For example, authentication, identity proofing, and non-repudiation level of assurance.

Type of security metadata observation made about a set of security-relevant data issued by a security authority or trusted third party, together with security information which is used to provide the integrity and data origin authentication services for an IT resource (data, information object, service, or system capability). \[Based on ISO IEC 10181-1\]

Values for security metadata observation made about a set of security-relevant data issued by a security authority or trusted third party, together with security information which is used to provide the integrity and data origin authentication services for an IT resource (data, information object, service, or system capability). \[Based on ISO IEC 10181-1\]

For example, a single use certificate, dual use certificate, digital signature certificate.

Type of security metadata observation made about a complete set of contracts, regulations, or commitments that enable participating actors to rely on certain assertions by other actors to fulfill their information security requirements. \[Kantara Initiative\]

Values for security metadata observation made about a complete set of contracts, regulations or commitments that enable participating actors to rely on certain assertions by other actors to fulfill their information security requirements. \[Kantara Initiative\]

For example, FICAM, DirectTrust, and HITRUST.

Type of security metadata observation made about a security architecture system component that supports enforcement of security policies.

Values for security metadata observation made about a security architecture system component that supports enforcement of security policies.

For example, Digital signature, authorization scheme, and certificate token.

Type of security metadata observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability). Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. \[Based on ISO IEC 10181-1 and NIST SP 800-63-2\]

Usage Note:SecurityTrustObservationType may be used as a trust attribute in a computable trust policy, trust credential, trust assertion, or trust label field in a security label and populated with trust observation values. The valued trust attributes may be used for used for authentication, authorization, and access control decisions. These may also be used to negotiate trust relationships, adjudicate or bridge trust policies, and to specify requirements for participation in a Trust Domain or for asserting compliance with a Trust Framework.

Observation value used to indicate aspects of trust policy applicable to an IT resource (data, information object, service, or system capability).

For example, applicable trust framework, policy, or mechanisms.

Usage Note:Security trust metadata values may be used as the trust attribute value populating a computable trust policy, trust credential, trust assertion, or trust label field in a security label and principally used for authentication, authorization, and access control decisions.

SecurityTrustObservationValue may be used as a trust attribute value populating a computable trust policy, trust credential, trust assertion, or trust label field in a security label with trust observation values. The valued trust attributes may be used for used for authentication, authorization, and access control decisions. These may also be used to negotiate trust relationships, adjudicate or bridge trust policies, and to specify requirements for participation in a Trust Domain or for asserting compliance with a Trust Framework.

DESCRIPTION:

Specifies direction of sort.

Examples:

* Ascending * Descending * None

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

Categorization of types of observation that capture the interpretation of the result of a laboratory test in terms of normality.

Description:An indication of the seriousness of the subject's condition or issue.Examples:

* Mild * Moderate * Severe

Description:Represents the components of a measured clinical observation.Examples:

* the systolic and diastolic components of a blood pressure * 24-hour urine output * ARAC gene

Types of measurement observations typically performed in a clinical (non-lab) setting. E.g. Height, Weight, Blood-pressure

OpenIssue:This concept domain should be reviewed to determine whether it needs a "ConceptualSpaceForClassCode" property to link to a RIM classCode.

Provides coded names for attribute Device.softwareName, which has data type SC.

A code indicating the type of special arrangements provided for a patient encounter (e.g., wheelchair, stretcher, interpreter, attendant, seeing eye dog). For encounters in intention moods, this information can be used to identify special arrangements that will need to be made for the incoming patient.

**Definition:**Materials introduced to a specimen. These additives may be introduced in order to preserve, maintain or enhance the particular nature or component of the specimen.

Examples:

* Ammonium heparin * Boric Acid * Phenol

Description:A specimen is defined as a physical entity that is an individual, a group, an item, or a part representative of a larger group, class or whole that is the target of an observation or analysis for the purpose of drawing conclusions about the group, class, or whole. This can be used to code a component of the specimen that the observation diagnosis relates to. Note that any physical entity in the universe has the potential to become a specimen.Examples:

* Blood * Water * Animal cadaver

Description:A role by which one can communicate additional identifiers for a specimen.Examples:

* specimen identifier * accession identifier * container identifier

Description:Trigger events associated with specimen process steps.Examples:

* Specimen process step activate * Specimen process step complete * Specimen process step abort

Description:Further classifies the types of specimen roles.Examples:Examples include Quality control specimens, grouped specimens and patient specimens. Definition:Set of codes indicating the manner in which sponsors participate in a policy or program. NOTE: use only when the Sponsor is not further specified with a SponsorRoleType as being either a fully insured sponsor or a self insured sponsor.

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

Type of role attendance the covered party has at a recognized educational institution as defined by a particular insurance policy.

(abstract) Used within an instance to give the author some control over various aspects of rendering

Contains codes for defining the observed, physical position of a subject, such as during an observation, assessment, collection of a specimen, etc. ECG waveforms and vital signs, such as blood pressure, are two examples where a general, observed position typically needs to be noted.

The spatial relationship of a subject whether human, other animal, or plant, to a frame of reference such as gravity or a collection device.

A code to capture the kind of reaction that was suffered by the investigated subject, and that is being reported in the ICSR. At this point, SNOMED or MedDRA have been suggested as code systems to be used for providing this information.

Example concepts include hives, swelling, rash, anaphylactic shock.

Code that captures the emphasis that the reporter placed on this reaction.

Examples include: highlighted by the reporter, NOT serious, Not highlighted by the reporter, NOT serious, Highlighted by the reporter, SERIOUS, Not highlighted by the reporter, SERIOUS.

Code that captures the type of outcome from an individual outcome of a reaction to the suspect product reported in the ICSR.

Examples include: Recovered/resolved. Recovering/resolving, Not recovered/not resolved, Recovered/resolved with sequelae, Fatal.

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

Indicates the reason for substitution when substitution occurs, or reason for non-substitution when substitution is expected.

Indicates the reason for non-substitution when substitution was expected.

Examples:

* prescriber request * patient request * continuing therapy (where this latter means that the prescribed item was not substituted, even though "policy" implied it should be, so as not to change from the item that the patient had previously received)

Indicates the reason for substitution when substitution has occurred.

Examples:

* formulary policy * regulatory requirement * out of stock (where this latter means that the prescribed item was out of stock and an equivalent product was substituted)

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

Distinguishing traits, qualities, or properties given about substances, including chemical structure (as encapsulated data in SMILES, MolFile, InChi), nucleic acid sequence, amino acid sequence, molecular sum formula; molecular mass; stereochemistry and optical activity properties; viscosity; pH, pKa, catalytic activity, etc.

Identifies what sort of change is permitted or has occurred between the item that was ordered/requested and the one that was/will be provided.

Indicates why the prescription should no longer be allowed to be dispensed (but can still administer what already has been dispensed).

UsageNote:This is typically used in the scenario where the prescription allows for repeats or refills.

**Description:**Ensures consistent coding of the susceptibility battery or panel.

Examples:

* Bacterial susceptibility panel * Fungal susceptibility panel * Mycobacterial susceptibility panel * Viral susceptibility panel

Description: Examples:

* Disk Diffusion (Kirby-Bauer) * Minimum Inhibitory Concentration * Viral Genotype Susceptibility * Gradient Strip (E-Strip)

**Description:**Ensures consistent coding of antimicrobial information in the Microbiology lab message.

Examples:

* Ciprofloxacin; Disk Diffusion (Kirby-Bauer) * Vancomycin * Tetracycline; Minimum Inhibitory Concentration

**Description:**Used to code and identify the Susceptibility Observation result value when a coded result is reported.

Examples:

* Susceptible * Resistant * Moderately susceptible

Indicates an observed abnormality in the patientaTMs condition, but does not assert causation. E.g. Runny nose, swelling, flaky skin, etc.

These values are defined within the XHTML 4.0 Table Model

These values are defined within the XHTML 4.0 Table Model

These values are defined within the XHTML 4.0 Table Model

These values are defined within the XHTML 4.0 Table Model

These values are defined within the XHTML 4.0 Table Model

A code specifying the extent to which the Entity playing the participating Role (usually as a target Participation) is aware of the associated Act.

Examples:For diagnostic observations, is the patient, family member or other participant aware of his terminal illness?Discussion:If the awareness, denial, unconsciousness, etc. is the subject of medical considerations (e.g., part of the problem list), one should use explicit observations in these matters as well, and should not solely rely on this simple attribute in the Participation.

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

Description:Concepts that define the telecommunication capabilities of a particular device. Used to identify the expected capabilities to be found at a particular telecommunication address. Description:Concepts which further characterizing the type of territorial authority. Used only with the TERR (territorial authority) role classCode.Example:public health authority, judicial authority and national authority. Description:A territorial entity that may be cited as the body over which an agency exercises jurisdiction, or which defines a sphere in which a party has a particular responsibility.Examples:

* United States * New York * European Union

**Description:**Codes that further characterize the Theraputic Agent as a manufactured product. Used only with the THER (therapeutic agent) role classCode.

Examples:Generic and Brand name.

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

A codes specifying the meaning and purpose of every TransmissionRelationship instance. Each of the values implies specific constraints to what kinds of Transmission objects can be related and in which way.

This element was deprecated as of the release indicated.

**Description:**A code specifying the meaning and purpose of every TransmissionRelationship instance. Each of its values implies specific constraints to what kinds of Transmission objects can be related and in which way.

Description:Trigger Event ID as published in the standard.Deprecation Comment:This Domain has been deprecated as the Domain HL7TriggerEventCode is being used instead, along with its subDomains. Please update designs that refer to this Domain and instead refer to the appropriate Domain in the HL7TriggerEventCode hierarchy.

This element was deprecated as of the release indicated.

A Universal Resource Locator (URL) is a type of telecommunications address specified as Internet standard RFC 1738 \[http://www.isi.edu/in-notes/rfc1738.txt\]. The URL specifies the protocol and the contact point defined by that protocol for the resource.

Definition:Set of codes indicating the manner in which underwriters participate in a policy or program.

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

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

The manufacturer of a vaccine.

Types of manufactured material that when administered are intended to confer protection against specific disease(s).

\*\*\*\* MISSING DEFINITIONS \*\*\*\*

Values for observations of verification act results

Examples:Verified, not verified, verified with warning.

**Description:**A role type that is used to further qualify an entity playing a role where the role is that of a vision product such as lenses, frames, etc.

**Description:**Codes that further characterize a warranted product role. Used only with the WRTE (warranted product) role classCode.

Example:Express warranty, Implied Warranty and Lifetime Warranty.

Five character alphabetic codes fit into current claims processing software or onto standard paper claim forms. ABC Codes give business parity to licensed CAM and nurse providers who file claims to insurance companies. .

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.

The codes identify the conditions under which accept acknowledgements are required to be returned in response to this message. Note that accept acknowledgement address two different issues at the same time: reliable transport as well as syntactical correctness

en The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Inverse of Specializes. Only included as a derived relationship. The internal identifier for the concept in the HL7 Access database repository. Designation of a concept's state. Normally is not populated unless the state is retired..

Always send an acknowledgement.

Send an acknowledgement for error/reject conditions only.

Never send an acknowledgement.

Send an acknowledgement for successful completions only.

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.

*OpenIssue:*Missing description.

en The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Inverse of Specializes. Only included as a derived relationship. The internal identifier for the concept in the HL7 Access database repository. Designation of a concept's state. Normally is not populated unless the state is retired..

An internal software component (database, application, queue mechanism, etc.) has failed, leading to inability to process the message.

Rejection:The message can't be stored by the receiver due to an unspecified internal application issue. The message was neither processed nor stored by the receiving application.

The interaction (or: this version of the interaction) is not supported.

The Processing ID is not supported.

The Version ID is not supported.

The processing mode is not supported.

The Device.id of the sender is unknown.

The receiver requires information in the attentionLine classes for routing purposes.

Error:The destination of this message is known to the receiving application. Messages have been successfully routed to that destination in the past. The link to the destination application or an intermediate application is unavailable.

The destination of this message is unknown to the receiving application. The receiving application in the message does not match the application which received the message. The message was neither routed, processed nor stored by the receiving application.

Warning:The destination of this message is known to the receiving application. Messages have been successfully routed to that destination in the past. The link to the destination application or an intermediate application is (temporarily) unavailable. The receiving application will forward the message as soon as the destination can be reached again.

Reflects errors in the syntax or structure of the communication.

Required association missing in message; or the sequence of the classes is different than required by the standard or one of the conformance profiles identified in the message.

A required attribute is missing in a class.

The attribute contained data of the wrong data type, e.g. a numeric attribute contained "FOO".

An attribute value was compared against the corresponding code system, and no match was found.

An attribute value referenced a code system that is not valid for an attribute constrained to CNE.

Description:Required association or attribute missing in message; or the sequence of the classes is different than required by the standard or one of the conformance profiles identified in the message. Description:A coded attribute or datatype property violates one of the terminology constraints specified in the standard or one of the conformance profiles or templates declared by the instance. Description:A coded attribute is referencing a code that has been deprecated by the owning code system. Description:The number of repetitions of a (group of) association(s) or attribute(s) exceeds the limits of the standard or of one of the conformance profiles or templates identified in the message. Description:An attribute or association identified as mandatory in a specification or declared conformance profile or template has been specified with a null flavor.

The number of repetitions of a (group of) association(s) exceeds the limits of the standard or of one of the conformance profiles identified in the message.

Description:The value of an attribute or property differs from the fixed value asserted in the standard or one of the conformance profiles or templates declared in the message.

The number of repetitions of an attribute exceeds the limits of the standard or of one of the conformance profiles identified in the message.

Description:A formal constraint asserted in the standard or one of the conformance profiles or templates declared in the message has been violated. Description:The number of repetitions of a group of association or attributes is less than the required minimum for the standard or of one of the conformance profiles or templates identified in the message.

Refelects rejections because elements of the communication are not supported in the current context.

Reflects errors in the syntax or structure of the communication.

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.

A code identifying the specific message to be provided.

Discussion:A textual value may be specified as the print name, or for non-coded messages, as the original text.Examples:'Required attribute xxx is missing', 'System will be unavailable March 19 from 0100 to 0300'
en The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Inverse of Specializes. Only included as a derived relationship. The internal identifier for the concept in the HL7 Access database repository. Designation of a concept's state. Normally is not populated unless the state is retired..

**Definition:**An issue which has prevented, or will prevent (unless a management is provided for the issue by the sender), the successful processing of an interaction. Response interactions which include an issue which is an Error are a 'rejection', indicating that the request was not successfully processed.

**Example:**Unable to find specified patient.

Definition:The message relates to an issue which has no bearing on the successful processing of the request. Information issues cannot be overridden by specifying a management.Example:A Patient's coverage will expire in 5 days. Definition:The message relates to an issue which cannot prevent the successful processing of a request, but which could result in the processing not having the ideal or intended effect. Managing a warning issue is not required for successful processing, but will suppress the warning from being raised.Example:

Unexpected additional repetitions of phone number have been ignored.

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.

This attribute contains an acknowledgement code as described in the HL7 message processing rules.

OpenIssue:Description was copied from attribute and needs to be improved to be appropriate for a code system.
en The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Inverse of Specializes. Only included as a derived relationship. The internal identifier for the concept in the HL7 Access database repository. Designation of a concept's state. Normally is not populated unless the state is retired.

Receiving application successfully processed message.

Receiving application found error in processing message. Sending error response with additional error detail information.

Receiving application failed to process message for reason unrelated to content or format. Original message sender must decide on whether to automatically send message again.

Receiving message handling service accepts responsibility for passing message onto receiving application.

Receiving message handling service cannot accept message for any other reason (e.g. message sequence number, etc.).

Receiving message handling service rejects message if interaction identifier, version or processing mode is incompatible with known receiving application role information.

American College of Radiology finding codes

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.
en The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Inverse of Specializes. Only included as a derived relationship. The internal identifier for the concept in the HL7 Access database repository. A property that indicates the status of the concept. One of active, experimental, deprecated, or retired. The formal name for the class clone under this code The formal name for relationship from Participation to Act An additional concept code that was also attributed to a concept

An accommodation is a service provided for a Person or other LivingSubject in which a place is provided for the subject to reside for a period of time. Commonly used to track the provision of ward, private and semi-private accommodations for a patient.

A financial account established to track the net result of financial acts.

A unit of work, a grouper of work items as defined by the system performing that work. Typically some laboratory order fulfillers communicate references to accessions in their communications regarding laboratory orders. Often one or more specimens are related to an accession such that in some environments the accession number is taken as an identifier for a specimen (group).

A record of something that is being done, has been done, can be done, or is intended or requested to be done.

*Examples:*The kinds of acts that are common in health care are (1) a clinical observation, (2) an assessment of health condition (such as problems and diagnoses), (3) healthcare goals, (4) treatment services (such as medication, surgery, physical and psychological therapy), (5) assisting, monitoring or attending, (6) training and education services to patients and their next of kin, (7) and notary services (such as advanced directives or living will), (8) editing and maintaining documents, and many others.

Discussion and Rationale:Acts are the pivot of the RIM; all domain information and processes are represented primarily in Acts. Any profession or business, including healthcare, is primarily constituted of intentional and occasionally non-intentional actions, performed and recorded by responsible actors. An Act-instance is a record of such an action.

Acts connect to Entities in their Roles through Participations and connect to other Acts through ActRelationships. Participations are the authors, performers and other responsible parties as well as subjects and beneficiaries (which includes tools and material used in the performance of the act, which are also subjects). The moodCode distinguishes between Acts that are meant as factual records, vs. records of intended or ordered services, and the other modalities in which act can appear.

One of the Participations that all acts have (at least implicitly) is a primary author, who is responsible of the Act and who "owns" the act. Responsibility for the act means responsibility for what is being stated in the Act and as what it is stated. Ownership of the act is assumed in the sense of who may operationally modify the same act. Ownership and responsibility of the Act is not the same as ownership or responsibility of what the Act-object refers to in the real world. The same real world activity can be described by two people, each being the author of their Act, describing the same real world activity. Yet one can be a witness while the other can be a principal performer. The performer has responsibilities for the physical actions; the witness only has responsibility for making a true statement to the best of his or her ability. The two Act-instances may even disagree, but because each is properly attributed to its author, such disagreements can exist side by side and left to arbitration by a recipient of these Act-instances.

In this sense, an Act-instance represents a "statement" according to Rector and Nowlan (1991) \[Foundations for an electronic medical record. Methods Inf Med. 30.\] Rector and Nowlan have emphasized the importance of understanding the medical record not as a collection of facts, but "a faithful record of what clinicians have heard, seen, thought, and done." Rector and Nowlan go on saying that "the other requirements for a medical record, e.g., that it be attributable and permanent, follow naturally from this view." Indeed the Act class is this attributable statement, and the rules of updating acts (discussed in the state-transition model, see Act.statusCode) versus generating new Act-instances are designed according to this principle of permanent attributable statements.

Rector and Nolan focus on the electronic medical record as a collection of statements, while attributed statements, these are still mostly factual statements. However, the Act class goes beyond this limitation to attributed factual statements, representing what is known as "speech-acts" in linguistics and philosophy. The notion of speech-act includes that there is pragmatic meaning in language utterances, aside from just factual statements; and that these utterances interact with the real world to change the state of affairs, even directly cause physical activities to happen. For example, an order is a speech act that (provided it is issued adequately) will cause the ordered action to be physically performed. The speech act theory has culminated in the seminal work by Austin (1962) \[How to do things with words. Oxford University Press\].

An activity in the real world may progress from defined, through planned and ordered to executed, which is represented as the mood of the Act. Even though one might think of a single activity as progressing from planned to executed, this progression is reflected by multiple Act-instances, each having one and only one mood that will not change along the Act-instance life cycle. This is because the attribution and content of speech acts along this progression of an activity may be different, and it is often critical that a permanent and faithful record be maintained of this progression. The specification of orders or promises or plans must not be overwritten by the specification of what was actually done, so as to allow comparing actions with their earlier specifications. Act-instances that describe this progression of the same real world activity are linked through the ActRelationships (of the relationship category "sequel").

Act as statements or speech-acts are the only representation of real world facts or processes in the HL7 RIM. The truth about the real world is constructed through a combination (and arbitration) of such attributed statements only, and there is no class in the RIM whose objects represent "objective state of affairs" or "real processes" independent from attributed statements. As such, there is no distinction between an activity and its documentation. Every Act includes both to varying degrees. For example, a factual statement made about recent (but past) activities, authored (and signed) by the performer of such activities, is commonly known as a procedure report or original documentation (e.g., surgical procedure report, clinic note etc.). Conversely, a status update on an activity that is presently in progress, authored by the performer (or a close observer) is considered to capture that activity (and is later superceded by a full procedure report). However, both status update and procedure report are acts of the same kind, only distinguished by mood and state (see statusCode) and completeness of the information.

Sender asks addressee to do something depending on the focal Act of the payload. An example is "fulfill this order". Addressee has responsibilities to either reject the message or to act on it in an appropriate way (specified by the specific receiver responsibilities for the interaction).

A transformation process where a requested invoice is transformed into an agreed invoice. Represents the adjudication processing of an invoice (claim). Adjudication results can be adjudicated as submitted, with adjustments or refused.

Adjudication results comprise 2 components: the adjudication processing results and a restated (or adjudicated) invoice or claim

Description:

An acquisition exposure act describes the proximity (location and time) through which the participating entity was potentially exposed to a physical (including energy), chemical or biological agent from another entity. The acquisition exposure act is used in conjunction with transmission exposure acts as part of an analysis technique for contact tracing. Although an exposure can be decomposed into transmission and acquisition exposures, there is no requirement that all exposures be treated in this fashion.

Constraints:The Acquisition Exposure inherits the participation constraints that apply to Exposure with the following exception. The EXPSRC (exposure source) participation must never be associated with the Transmission Exposure either directly or via context conduction.

An observation identifying a potential adverse outcome as a result of an Act or combination of Acts.

Examples:Detection of a drug-drug interaction; Identification of a late-submission for an invoice; Requesting discharge for a patient who does not meet hospital-defined discharge criteria.Discussion:This class is commonly used for identifying 'business rule' or 'process' problems that may result in a refusal to carry out a particular request. In some circumstances it may be possible to 'bypass' a problem by modifying the request to acknowledge the issue and/or by providing some form of mitigation.Constraints:the Act or Acts that may cause the the adverse outcome are the target of a subject ActRelationship. The subbtypes of this concept indicate the type of problem being detected (e.g. drug-drug interaction) while the Observation.value is used to repesent a specific problem code (e.g. specific drug-drug interaction id).
Definition:An observation that is composed of a set of observations. These observations typically have a logical or practical grouping for generally accepted clinical or functional purposes, such as observations that are run together because of automation. A battery can define required and optional component observations and, in some cases, will define complex rules that determine whether or not a particular observation is made. BATTERY is a constraint on the Observation class in that it is understood to always be composed of component observations.UsageNotes:The focus in a BATTERY is that it is composed of individual observations. In request (RQO) mood, a battery is a request to perform the component observations. In event (EVN) mood a battery is a reporting of associated set of observation events. In definition mood a battery is the definition of the associated set of observations.Examples:Vital signs, Full blood count, Chemistry panel. The focus in a BATTERY is that it is composed of individual observations. In request (RQO) mood, a battery is a request to perform the component observations. In event (EVN) mood a battery is a reporting of associated set of observation events. In definition mood a battery is the definition of the associated set of observations.

An act representing a system action such as the change of state of another act or the initiation of a query. All control acts represent trigger events in the HL7 context. ControlActs may occur in different moods.

A public health case is an Observation representing a condition or event that has a specific significance for public health. Typically it involves an instance or instances of a reportable infectious disease or other condition. The public health case can include a health-related event concerning a single individual or it may refer to multiple health-related events that are occurrences of the same disease or condition of interest to public health. An outbreak involving multiple individuals may be considered as a type of public health case. A public health case definition (Act.moodCode = "definition") includes the description of the clinical, laboratory, and epidemiologic indicators associated with a disease or condition of interest to public health. There are case definitions for conditions that are reportable, as well as for those that are not. There are also case definitions for outbreaks. A public health case definition is a construct used by public health for the purpose of counting cases, and should not be used as clinical indications for treatment. Examples include AIDS, toxic-shock syndrome, and salmonellosis and their associated indicators that are used to define a case.

A group of entries within a composition or topic that have a common characteristic - for example, Examination, Diagnosis, Management OR Subjective, Objective, Analysis, Plan.

The distinction from Topic relates to value sets. For Category there is a bounded list of things like "Examination", "Diagnosis" or SOAP categories. For Topic the list is wide open to any clinical condition or reason for a part of an encounter.

A CATEGORY MAY CONTAIN ENTRIES.

A clinical document that conforms to Level One of the HL7 Clinical Document Architecture (CDA)

The set of actions that define an experiment to assess the effectiveness and/or safety of a biopharmaceutical product (food, drug, device, etc.). In definition mood, this set of actions is often embodied in a clinical trial protocol; in event mood, this designates the aggregate act of applying the actions to one or more subjects.

**Description:**An ACT that organizes a set of component acts into a semantic grouping that have a shared subject. The subject may be either a subject participation (SBJ), subject act relationship (SUBJ), or child participation/act relationship types.

Discussion:The focus in a CLUSTER act is the grouping of the contained acts. For example "a request to cluster" (RQO), "a type of cluster that is allowed to occur" (DEF), etc.Examples:

* Radiologic investigations that might include administration of a dye, followed by radiographic observations; * "Isolate cluster" which includes all testing and specimen processing performed on a specific isolate; * a set of actions to perform at a particular stage in a clinical trial.

An instance of Observation of a Condition at a point in time that includes any Observations or Procedures associated with that Condition as well as links to previous instances of Condition Node for the same Condition

Deprecation Comment:This concept has been deprecated because an alternative structure for tracking the evolution of a problem has been presented and adopted by the Care Provision Work Group.

An agreement of obligation between two or more parties that is subject to contractual law and enforcement.

A context representing a grouped commitment of information to the EHR. It is considered the unit of modification of the record, the unit of transmission in record extracts, and the unit of attestation by authorizing clinicians.

A composition represents part of a patient record originating from a single interaction between an authenticator and the record.

Unless otherwise stated all statements within a composition have the same authenticator, apply to the same patient and were recorded in a single session of use of a single application.

A composition contains organizers and entries.

Definition:A worry that tends to persist over time and has as its subject a state or process. The subject of the worry has the potential to require intervention or management.Examples:an observation result, procedure, substance administration, equipment repair status, device recall status, a health risk, a financial risk, public health risk, pregnancy, health maintenance, allergy, and acute or chronic illness.

An observable finding or state that persists over time and tends to require intervention or management, and, therefore, distinguished from an Observation made at a point in time; may exist before an Observation of the Condition is made or after interventions to manage the Condition are undertaken. Examples: equipment repair status, device recall status, a health risk, a financial risk, public health risk, pregnancy, health maintenance, chronic illness

The Consent class represents informed consents and all similar medico-legal transactions between the patient (or his legal guardian) and the provider. Examples are informed consent for surgical procedures, informed consent for clinical trials, advanced beneficiary notice, against medical advice decline from service, release of information agreement, etc.

The details of consents vary. Often an institution has a number of different consent forms for various purposes, including reminding the physician about the topics to mention. Such forms also include patient education material. In electronic medical record communication, consents thus are information-generating acts on their own and need to be managed similar to medical activities. Thus, Consent is modeled as a special class of Act.

The "signatures" to the consent document are represented electronically through Participation instances to the consent object. Typically an informed consent has Participation.typeCode of "performer", the healthcare provider informing the patient, and "consenter", the patient or legal guardian. Some consent may associate a witness or a notary public (e.g., living wills, advanced directives). In consents where a healthcare provider is not required (e.g. living will), the performer may be the patient himself or a notary public.

Some consent has a minimum required delay between the consent and the service, so as to allow the patient to rethink his decisions. This minimum delay can be expressed in the act definition by the ActRelationship.pauseQuantity attribute that delays the service until the pause time has elapsed after the consent has been completed.

Description:Container of clinical statements. Navigational. No semantic content. Knowledge of the section code is not required to interpret contained observations. Represents a heading in a heading structure, or "container tree".

The record entries relating to a single clinical session are usually grouped under headings that represent phases of the encounter, or assist with layout and navigation. Clinical headings usually reflect the clinical workflow during a care session, and might also reflect the main author's reasoning processes. Much research has demonstrated that headings are used differently by different professional groups and specialties, and that headings are not used consistently enough to support safe automatic processing of the E H R.

An Act where a container is registered either via an automated sensor, such as a barcode reader, or by manual receipt

When used in the EVN mood, this concept means with respect to a covered party:

  • A health care insurance policy or plan that is contractually binding between two or more parties; or

  • A health care program, usually administered by government entities, that provides coverage to persons determined eligible under the terms of the program.

* When used in the definition (DEF) mood, COV means potential coverage for a patient who may or may not be a covered party. * The concept's meaning is fully specified by the choice of ActCoverageTypeCode (abstract) ActProgramCode or ActInsurancePolicyCode.

An identified point during a clinical trial at which one or more actions are scheduled to be performed (definition mood), or are actually performed (event mood). The actions may or may not involve an encounter between the subject and a healthcare professional.

**Description:**A determinant peptide in a polypeptide as described by polypeptide.

Class for holding attributes unique to diagnostic images.

Diet services are supply services, with some aspects resembling Medication services: the detail of the diet is given as a description of the Material associated via Participation.typeCode="product". Medically relevant diet types may be communicated in the Diet.code attribute using domain ActDietCode, however, the detail of the food supplied and the various combinations of dishes should be communicated as Material instances.

Deprecation Note Class:Use either the Supply class (if dealing with what should be given to the patient) or SubstanceAdministration class (if dealing with what the patient should consume)energyQuantity:This quantity can be conveyed by using a Content relationship with a quantity attribute expressing the calories

**carbohydrateQuantity:**This quantity can be conveyed using a Content relationship to an Entity with a code of carbohydrate and a quantity attribute on the content relationship.

An action taken with respect to a subject Entity by a regulatory or authoritative body with supervisory capacity over that entity. The action is taken in response to behavior by the subject Entity that body finds to be undesirable.

Suspension, license restrictions, monetary fine, letter of reprimand, mandated training, mandated supervision, etc.*Examples:*

The notion of a document comes particularly from the paper world, where it corresponds to the contents recorded on discrete pieces of paper. In the electronic world, a document is a kind of composition that bears resemblance to their paper world counter-parts. Documents typically are meant to be human-readable.

HL7's notion of document differs from that described in the W3C XML Recommendation, in which a document refers specifically to the contents that fall between the root element's start-tag and end-tag. Not all XML documents are HL7 documents.

A context that distinguishes the body of a document from the document header. This is seen, for instance, in HTML documents, which have discrete <head> and <body> elements.

A clinical document is a documentation of clinical observations and services, with the following characteristics:

  • Persistence - A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements;

  • Stewardship - A clinical document is maintained by a person or organization entrusted with its care;

  • Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated;

  • Wholeness - Authentication of a clinical document applies to the whole and does not apply to portions of the document without the full context of the document;

  • Human readability - A clinical document is human readable.

A context that subdivides the body of a document. Document sections are typically used for human navigation, to give a reader a clue as to the expected content. Document sections are used to organize and provide consistency to the contents of a document body. Document sections can contain document sections and can contain entries.

A context that comprises all compositions. The EHR is an extract that includes the entire chart.

NOTE:In an exchange scenario, an EHR is a specialization of an extract.

An interaction between a patient and healthcare participant(s) for the purpose of providing patient service(s) or assessing the health status of a patient. For example, outpatient visit to multiple departments, home health support (including physical therapy), inpatient hospital stay, emergency room visit, field visit (e.g., traffic accident), office visit, occupational therapy, telephone call.

This context represents the information acquired and recorded for an observation, a clinical statement such as a portion of the patient's history or an inference or assertion, or an action that might be intended or has actually been performed. This class may represent both the actual data describing the observation, inference, or action, and optionally the details supporting the clinical reasoning process such as a reference to an electronic guideline, decision support system, or other knowledge reference.

**Description:**An expression level of genes/proteins or other expressed genomic entities.

An interaction between entities that provides opportunity for transmission of a physical, chemical, or biological agent from an exposure source entity to an exposure target entity.

Examples:The following examples are provided to indicate what interactions are considered exposures rather than other types of Acts:

* A patient accidentally receives three times the recommended dose of their medication due to a dosing error. * This is a substance administration. Public health and/or safety authorities may also be interested in documenting this with an associated exposure. * A patient accidentally is dispensed an incorrect medicine (e.g., clomiphene instead of clomipramine). They have taken several doses before the mistake is detected. They are therefore "exposed" to a medicine that there was no therapeutic indication for them to receive. * There are several substance administrations in this example. Public health and/or safety authorities may also be interested in documenting this with associated exposures. * In a busy medical ward, a patient is receiving chemotherapy for a lymphoma. Unfortunately, the IV infusion bag containing the medicine splits, spraying cytotoxic medication over the patient being treated and the patient in the adjacent bed. * There are three substance administrations in this example. The first is the intended one (IV infusion) with its associated (implicit) exposure. There is an incident with an associated substance administration to the same patient involving the medication sprayed over the patient as well as an associated exposure. Additionally, the incident includes a substance administration involving the spraying of medication on the adjacent patient, also with an associated exposure. * A patient who is a refugee from a war-torn African nation arrives in a busy inner city A&E department suffering from a cough with bloody sputum. Not understanding the registration and triage process, they sit in the waiting room for several hours before it is noticed that they have not booked in. As soon as they are being processed, it is suspected that they are suffering from TB. Vulnerable (immunosuppressed) patients who were sharing the waiting room with this patient may have been exposed to the tubercule bacillus, and must be traced for investigation. * This is an exposure (or possibly multiple exposures) in the waiting room involving the refugee and everyone else in the waiting room during the period. There might also be a number of known or presumed substance administrations (coughing) via several possible routes. The substance administrations are only hypotheses until confirmed by further testing. * A patient who has received an elective total hip replacement procedure suffers a prolonged stay in hospital, due to contracting an MRSA infection in the surgical wound site after the surgery. * This is an exposure to MRSA. Although there was some sort of substance administration, it's possible the exact mechanism for introduction of the MRSA into the wound will not be identified. * Routine maintenance of the X-ray machines at a local hospital reveals a serious breach of the shielding on one of the machines. Patients who have undergone investigations using that machine in the last month are likely to have been exposed to significantly higher doses of X-rays than was intended, and must be tracked for possible adverse effects. * There has been an exposure of each patient who used the machine in the past 30 days. Some patients may have had substance administrations. * A new member of staff is employed in the laundry processing room of a small cottage hospital, and a misreading of the instructions for adding detergents results in fifty times the usual concentration of cleaning materials being added to a batch of hospital bedding. As a result, several patients have been exposed to very high levels of detergents still present in the "clean" bedding, and have experienced dermatological reactions to this. * There has been an incident with multiple exposures to several patients. Although there are substance administrations involving the application of the detergent to the skin of the patients, it is expected that the substance administrations would not be directly documented. * Seven patients who are residents in a health care facility for the elderly mentally ill have developed respiratory problems. After several months of various tests having been performed and various medications prescribed to these patients, the problem is traced to their being "sensitive" to a new fungicide used in the wall plaster of the ward where these patients reside. * The patients have been continuously exposed to the fungicide. Although there have been continuous substance administrations (via breathing) this would not normally be documented as a substance administration. * A patient with osteoarthritis of the knees is treated symptomatically using analgesia, paracetamol (acetaminophen) 1g up to four times a day for pain relief. His GP does not realize that the patient has, 20 years previously (while at college) had severe alcohol addiction problems, and now, although this is completely under control, his liver has suffered significantly, leaving him more sensitive to hepatic toxicity from paracetamol use. Later that year, the patient returns with a noticeable level of jaundice. Paracetamol is immediately withdrawn and alternative solutions for the knee pain are sought. The jaundice gradually subsides with conservative management, but referral to the gastroenterologist is required for advice and monitoring. * There is a substance administration with an associated exposure. The exposure component is based on the relative toxic level of the substance to a patient with a compromised liver function. * A patient goes to their GP complaining of abdominal pain, having been discharged from the local hospital ten days' previously after an emergency appendectomy. The GP can find nothing particularly amiss, and presumes it is post operative surgical pain that will resolve. The patient returns a fortnight later, when the GP prescribes further analgesia, but does decide to request an outpatient surgical follow-up appointment. At this post-surgical outpatient review, the registrar decides to order an ultrasound, which, when performed three weeks later, shows a small faint inexplicable mass. A laparoscopy is then performed, as a day case procedure, and a piece of a surgical swab is removed from the patient's abdominal cavity. Thankfully, a full recovery then takes place. * This is a procedural sequelae. There may be an Incident recorded for this also. * A patient is slightly late for a regular pacemaker battery check in the Cardiology department of the local hospital. They are hurrying down the second floor corridor. A sudden summer squall has recently passed over the area, and rain has come in through an open corridor window leaving a small puddle on the corridor floor. In their haste, the patient slips in the puddle and falls so badly that they have to be taken to the A&E department, where it is discovered on investigation they have slightly torn the cruciate ligament in their left knee. * This is not an exposure. There has been an incident.

Usage Notes:This class deals only with opportunity and not the outcome of the exposure; i.e. not all exposed parties will necessarily experience actual harm or benefit.

Exposure differs from Substance Administration by the absence of the participation of a performer in the act.

The following participations SHOULD be used with the following participations to distinguish the specific entities:

* The exposed entity participates via the "exposure target" (EXPTRGT) participation. * An entity that has carried the agent transmitted in the exposure participates via the "exposure source" (EXSRC) participation. For example: * a person or animal who carried an infectious disease and interacts (EXSRC) with another person or animal (EXPTRGT) transmitting the disease agent; * a place or other environment (EXSRC) and a person or animal (EXPTRGT) who is exposed in the presence of this environment. * When it is unknown whether a participating entity is the source of the agent (EXSRC) or the target of the transmission (EXPTRGT), the "exposure participant" (EXPART) is used. * The physical (including energy), chemical or biological substance which is participating in the exposure uses the "exposure agent" (EXPAGNT) participation. There are at least three scenarios: 1. the player of the Role that participates as EXPAGNT is the chemical or biological substance mixed or carried by the scoper-entity of the Role (e.g., ingredient role); or 2. the player of the Role that participates as EXPAGNT is a mixture known to contain the chemical, radiological or biological substance of interest; or 3. the player of the Role that participates as a EXPAGNT is known to carry the agent (i.e., the player is a fomite, vector, etc.).

The Exposure.statusCode attribute should be interpreted as the state of the Exposure business object (e.g., active, aborted, completed) and not the clinical status of the exposure (e.g., probable, confirmed). The clinical status of the exposure should be associated with the exposure via a subject observation.

Design Comment:The usage notes require a clear criterion for determining whether an act is an exposure or substance administration-deleterious potential, uncertainty of actual transmission, or otherwise. SBADM states that the criterion is the presence of a performer-but there are examples above that call this criterion into question (e.g., the first one, concerning a dosing error).
This class deals only with opportunity and not the outcome of the exposure; i.e. not all exposed parties will necessarily experience actual harm or benefit. Exposure differs from Substance Administration by the absence of the participation of a performer in the act. The following participations SHOULD be used with the following participations to distinguish the specific entities: The exposed entity participates via the "exposure target" (EXPTRGT) participation. An entity that has carried the agent transmitted in the exposure participates via the "exposure source" (EXSRC) participation. For example: a person or animal who carried an infectious disease and interacts (EXSRC) with another person or animal (EXPTRGT) transmitting the disease agent; a place or other environment (EXSRC) and a person or animal (EXPTRGT) who is exposed in the presence of this environment. When it is unknown whether a participating entity is the source of the agent (EXSRC) or the target of the transmission (EXPTRGT), the "exposure participant" (EXPART) is used. The physical (including energy), chemical or biological substance which is participating in the exposure uses the "exposure agent" (EXPAGNT) participation. There are at least three scenarios: the player of the Role that participates as EXPAGNT is the chemical or biological substance mixed or carried by the scoper-entity of the Role (e.g., ingredient role); or the player of the Role that participates as EXPAGNT is a mixture known to contain the chemical, radiological or biological substance of interest; or the player of the Role that participates as a EXPAGNT is known to carry the agent (i.e., the player is a fomite, vector, etc.). The Exposure.statusCode attribute should be interpreted as the state of the Exposure business object (e.g., active, aborted, completed) and not the clinical status of the exposure (e.g., probable, confirmed). The clinical status of the exposure should be associated with the exposure via a subject observation.

This context represents the part of a patient record conveyed in a single communication. It is drawn from a providing system for the purposes of communication to a requesting process (which might be another repository, a client application or a middleware service such as an electronic guideline engine), and supporting the faithful inclusion of the communicated data in the receiving system.

An extract may be the entirety of the patient record as held by the sender or it may be a part of that record (e.g. changes since a specified date).

An extract contains folders or compositions.

An extract cannot contain another extract.

A contract whose value is measured in monetary terms.

A context representing the high-level organization of an extract e.g. to group parts of the record by episode, care team, clinical specialty, clinical condition, or source application. Internationally, this kind of organizing structure is used variably: in some centers and systems the folder is treated as an informal compartmentalization of the overall health record; in others it might represent a significant legal portion of the EHR relating to the originating enterprise or team.

A folder contains compositions.

Folders may be nested within folders.

**Description:**An observation of genomic phenomena.

Definition:An ACT that organizes a set of component acts into a semantic grouping that share a particular context such as timeframe, patient, etc.UsageNotes:The focus in a GROUPER act is the grouping of the contained acts. For example "a request to group" (RQO), "a type of grouping that is allowed to occur" (DEF), etc.

Unlike WorkingList, which represents a dynamic, shared, continuously updated collection to provide a "view" of a set of objects, GROUPER collections tend to be static and simply indicate a shared set of semantics. Note that sharing of semantics can be achieved using ACT as well. However, with GROUPER, the sole semantic is of grouping.

The focus in a GROUPER act is the grouping of the contained acts. For example "a request to group" (RQO), "a type of grouping that is allowed to occur" (DEF), etc. Unlike WorkingList, which represents a dynamic, shared, continuously updated collection to provide a "view" of a set of objects, GROUPER collections tend to be static and simply indicate a shared set of semantics. Note that sharing of semantics can be achieved using ACT as well. However, with GROUPER, the sole semantic is of grouping.

A public health case is a Concern about an observation or event that has a specific significance for public health. The creation of a PublicHealthCase initiates the tracking of the object of concern. The decision to track is related to but somewhat independent of the underlying event or observation.

UsageNotes:Typically a Public Health Case involves an instance or instances of a reportable infectious disease or other condition. The public health case can include a health-related event concerning a single individual or it may refer to multiple health-related events that are occurrences of the same disease or condition of interest to public health.

A public health case definition (Act.moodCode = "definition") includes the description of the clinical, laboratory, and epidemiologic indicators associated with a disease or condition of interest to public health. There are case definitions for conditions that are reportable, as well as for those that are not. A public health case definition is a construct used by public health for the purpose of counting cases, and should not be used as clinical indications for treatment. Examples include AIDS, toxic-shock syndrome, and salmonellosis and their associated indicators that are used to define a case.

Typically a Public Health Case involves an instance or instances of a reportable infectious disease or other condition. The public health case can include a health-related event concerning a single individual or it may refer to multiple health-related events that are occurrences of the same disease or condition of interest to public health. A public health case definition (Act.moodCode = "definition") includes the description of the clinical, laboratory, and epidemiologic indicators associated with a disease or condition of interest to public health. There are case definitions for conditions that are reportable, as well as for those that are not. A public health case definition is a construct used by public health for the purpose of counting cases, and should not be used as clinical indications for treatment. Examples include AIDS, toxic-shock syndrome, and salmonellosis and their associated indicators that are used to define a case.

An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.

Sender sends payload to addressee as information. Addressee does not have responsibilities beyond serving addressee's own interest (i.e., read and memorize if you see fit). This is equivalent to an FYI on a memo.

The act of transmitting information and understanding about a topic to a subject where the participation association must be SBJ.

Discussion:This act may be used to request that a patient or provider be informed about an Act, or to indicate that a person was informed about a particular act.

Represents concepts related to invoice processing in health care

An formalized inquiry into the circumstances surrounding a particular unplanned event or potential event for the purposes of identifying possible causes and contributing factors for the event. This investigation could be conducted at a local institutional level or at the level of a local or national government.

**Description:**A mandate, regulation, obligation, requirement, rule, or expectation unilaterally imposed by a jurisdiction on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

**Examples:**A jurisdictional mandate regarding the prescribing and dispensing of a particular medication. A jurisdictional privacy or security regulation dictating the manner in which personal health information is disclosed. A jurisdictional requirement that certain services or health conditions are reported to a monitoring program, e.g., immunizations, methadone treatment, or cancer registries.

Working list collects a dynamic list of individual instances of Act via ActRelationship which reflects the need of an individual worker, team of workers, or an organization to manage lists of acts for many different clinical and administrative reasons. Examples of working lists include problem lists, goal lists, allergy lists, and to-do lists.

Lying on the left side.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

**Description:**The position of a gene (or other significant sequence) on the genome.

An officially or unofficially instituted program to track acts of a particular type or categorization.

**Description:**An act that is intended to result in new information about a subject. The main difference between Observations and other Acts is that Observations have a value attribute. Thecodeattribute of Observation and thevalueattribute of Observation must be considered in combination to determine the semantics of the observation.Discussion:

Structurally, many observations are name-value-pairs, where the Observation.code (inherited from Act) is the name and the Observation.value is the value of the property. Such a construct is also known as a variable (a named feature that can assume a value) hence, the Observation class is always used to hold generic name-value-pairs or variables, even though the variable valuation may not be the result of an elaborate observation method. It may be a simple answer to a question or it may be an assertion or setting of a parameter.

As with all Act statements, Observation statements describe what was done, and in the case of Observations, this includes a description of what was actually observed (results or answers); and those results or answers are part of the observation and not split off into other objects.

The method of action is asserted by the Observation classCode or its subclasses at the least granular level, by the Observation.code attribute value at the medium level of granularity, and by the attribute value of observation.methodCode when a finer level of granularity is required. The method in whole or in part may also appear in the attribute value of Observation.value when using coded data types to express the value of the attribute. Relevant aspects of methodology may also be restated in value when the results themselves imply or state a methodology.

An observation may consist of component observations each having their own Observation.code and Observation.value. In this case, the composite observation may not have an Observation.value for itself. For instance, a white blood cell count consists of the sub-observations for the counts of the various granulocytes, lymphocytes and other normal or abnormal blood cells (e.g., blasts). The overall white blood cell count Observation itself may therefore not have a value by itself (even though it could have one, e.g., the sum total of white blood cells). Thus, as long as an Act is essentially an Act of recognizing and noting information about a subject, it is an Observation, regardless of whether it has a simple value by itself or whether it has sub-observations.

Even though observations are professional acts (see Act) and as such are intentional actions, this does not require that every possible outcome of an observation be pondered in advance of it being actually made. For instance, differential white blood cell counts (WBC) rarely show blasts, but if they do, this is part of the WBC observation even though blasts might not be predefined in the structure of a normal WBC.

Clinical documents commonly have Subjective and Objective findings, both of which are kinds of Observations. In addition, clinical documents commonly contain Assessments, which are also kinds of Observations. Thus, the establishment of a diagnosis is an Observation.

Examples:

* Recording the results of a Family History Assessment * Laboratory test and associated result * Physical exam test and associated result * Device temperature * Soil lead level

Container for Observation Sequences (Observations whose values are contained in LIST<>'s) having values correlated with each other. Each contained Observation Sequence LIST<> must be the same length. Values in the LIST<>'s are correlated based on index. E.g. the values in position 2 in all the LIST<>'s are correlated. This is analogous to a table where each column is an Observation Sequence with a LIST<> of values, and each row in the table is a correlation between the columns. For example, a 12-lead ECG would contain 13 sequences: one sequence for time, and a sequence for each of the 12 leads.

Container for Correlated Observation Sequences sharing a common frame of reference. All Observations of the same cd must be comparable and relative to the common frame of reference. For example, a 3-channel ECG device records a 12-lead ECG in 4 steps (3 leads at a time). Each of the separate 3-channel recordings would be in their own "OBSCOR". And, all 4 OBSCOR would be contained in one OBSSER because all the times are relative to the same origin (beginning of the recording) and all the ECG signals were from a fixed set of electrodes.

Organizer of entries. Navigational. No semantic content. Knowledge of the section code is not required to interpret contained observations. Represents a heading in a heading structure, or "organizer tree".

The record entries relating to a single clinical session are usually grouped under headings that represent phases of the encounter, or assist with layout and navigation. Clinical headings usually reflect the clinical workflow during a care session, and might also reflect the main author's reasoning processes. Much research has demonstrated that headings are used differently by different professional groups and specialties, and that headings are not used consistently enough to support safe automatic processing of the E H R.

**Description:**A mandate, obligation, requirement, rule, or expectation unilaterally imposed by an organization on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

**Examples:**A clinical or research protocols imposed by a payer, a malpractice insurer, or an institution to which a provider must adhere. A mandate imposed by a denominational institution for a provider to provide or withhold certain information from the patient about treatment options.

An outbreak represents a series of public health cases. The date on which an outbreak starts is the earliest date of onset among the cases assigned to the outbreak, and its ending date is the last date of onset among the cases assigned to the outbreak.

An Outbreak is a concern resulting from a series of public health cases.

UsageNotes:The date on which an outbreak starts is the earliest date of onset among the cases assigned to the outbreak and its ending date is the last date of onset among the cases assigned to the outbreak. The effectiveTime attribute is used to convey the relevant dates for the case. An outbreak definition (Act.moodCode = "definition" includes the criteria for the number, types and occurrence pattern of cases necessary to declare an outbreak and to judge the severity of an outbreak.
The date on which an outbreak starts is the earliest date of onset among the cases assigned to the outbreak and its ending date is the last date of onset among the cases assigned to the outbreak. The effectiveTime attribute is used to convey the relevant dates for the case. An outbreak definition (Act.moodCode = "definition" includes the criteria for the number, types and occurrence pattern of cases necessary to declare an outbreak and to judge the severity of an outbreak.
AnActthat of taking on whole or partial responsibility for, or attention to, safety and well-being of a subject of care.Discussion:Acare provisionevent may exist without any other care actions taking place. For example, when a patient is assigned to the care of a particular health professional.Inrequest(RQO) moodcare provisioncommunicates a referral, which is a request:

* from one party (linked as a **participant** of type **author** (AUT)), * to another party (linked as a **participant** of type **performer** (PRF), * to take responsibility for a scope specified by the code attribute, * for an entity (linked as a **participant** of type **subject** (SBJ)).

The scope of the care for which responsibility is taken is identified bycodeattribute.Inevent(EVN) moodcare provisionindicates the effective time interval of a specified scope of responsibility by aperformer(PRF) or set ofperformers(PRF) for asubject(SBJ).Examples:
  • Referral from GP to a specialist.

  • Assignment of a patient or group of patients to the case list of a health professional.

  • Assignment of inpatients to the care of particular nurses for a working shift.

**Description:**A genomic phenomenon that is expressed externally in the organism.

**Description:**A polypeptide resulting from the translation of a gene.

**Description:**A mandate, regulation, obligation, requirement, rule, or expectation unilaterally imposed by one party on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

An observation denoting the physical location of a person or thing based on a reference coordinate system.

**Description:**An observation representing the degree to which the assignment of the spatial coordinates, based on a matching algorithm by a geocoding engine against a reference spatial database, matches true or accepted values.

**Description:**An observation representing one of a set of numerical values used to determine the position of a place. The name of the coordinate value is determined by the reference coordinate system.

Lying with the front or ventral surface downward; lying face down.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

An Act whose immediate and primary outcome (post-condition) is the alteration of the physical condition of the subject.

Examples:: Procedures may involve the disruption of some body surface (e.g. an incision in a surgical procedure), but they also include conservative procedures such as reduction of a luxated join, chiropractic treatment, massage, balneotherapy, acupuncture, shiatsu, etc. Outside of clinical medicine, procedures may be such things as alteration of environments (e.g. straightening rivers, draining swamps, building dams) or the repair or change of machinery etc.

Represents the act of maintaining information about the registration of its associated registered subject. The subject can be either an Act or a Role, and includes subjects such as lab exam definitions, drug protocol definitions, prescriptions, persons, patients, practitioners, and equipment.

The registration may have a unique identifier - separate from the unique identification of the subject - as well as a core set of related participations and act relationships that characterize the registration event and aid in the disposition of the subject information by a receiving system.

The act of examining and evaluating the subject, usually another act. For example, "This prescription needs to be reviewed in 2 months."

Lying on the right side.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

A Region of Interest (ROI) specified for a multidimensional observation, such as an Observation Series (OBSSER). The ROI is specified using a set of observation criteria, each delineating the boundary of the region in one of the dimensions in the multidimensional observation. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type subject (SUBJ), which must always be present. Each of the boundary criteria observations is connected with the ROI using ActRelationships of type "has component" (COMP). In each boundary criterion, the Act.code names the dimension and the Observation.value specifies the range of values inside the region. Typically the bounded dimension is continuous, and so the Observation.value will be an interval (IVL) data type. The Observation.value need not be specified if the respective dimension is only named but not constrained. For example, an ROI for the QT interval of a certain beat in ECG Lead II would contain 2 boundary criteria, one naming the interval in time (constrained), and the other naming the interval in ECG Lead II (only named, but not constrained).

A Region of Interest (ROI) specified for an image using an overlay shape. Typically used to make reference to specific regions in images, e.g., to specify the location of a radiologic finding in an image or to specify the site of a physical finding by "circling" a region in a schematic picture of a human body. The units of the coordinate values are in pixels. The origin is in the upper left hand corner, with positive X values going to the right and positive Y values going down. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type "subject" (SUBJ), which must always be present.

Lying on the back, on an inclined plane, typically about 30-45 degrees with head raised and feet lowered.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

The act of introducing or otherwise applying a substance to the subject.

Discussion:The effect of the substance is typically established on a biochemical basis, however, that is not a requirement. For example, radiotherapy can largely be described in the same way, especially if it is a systemic therapy such as radio-iodine. This class also includes the application of chemical treatments to an area.Examples:Chemotherapy protocol; Drug prescription; Vaccination record
Description:The act of removing a substance from the subject.

**Description:**An ethical or clinical obligation, requirement, rule, or expectation imposed or strongly encouraged by organizations that oversee particular clinical domains or provider certification which define the boundaries within which a provider may practice and which may have legal basis or ramifications on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

**Examples:**An ethical obligation for a provider to fully inform a patient about all treatment options. An ethical obligation for a provider not to disclose personal health information that meets certain criteria, e.g., where disclosure might result in harm to the patient or another person. The set of health care services which a provider is credentialed or privileged to provide.

**Description:**A sequence of biomolecule like the DNA, RNA, protein and the like.

**Description:**A variation in a sequence as described by BioSequence.

A semi-sitting position in bed with the head of the bed elevated approximately 45 degrees.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

Resting the body on the buttocks, typically with upper torso erect or semi erect.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

An observation on a specimen in a laboratory environment that may affect processing, analysis or result interpretation

A procedure or treatment performed on a specimen to prepare it for analysis

A procedure for obtaining a specimen from a source entity.

Supply orders and deliveries are simple Acts that focus on the delivered product. The product is associated with the Supply Act via Participation.typeCode="product". With general Supply Acts, the precise identification of the Material (manufacturer, serial numbers, etc.) is important. Most of the detailed information about the Supply should be represented using the Material class. If delivery needs to be scheduled, tracked, and billed separately, one can associate a Transportation Act with the Supply Act. Pharmacy dispense services are represented as Supply Acts, associated with a SubstanceAdministration Act. The SubstanceAdministration class represents the administration of medication, while dispensing is supply.

Description:Sender transmits a status change pertaining to the focal act of the payload. This status of the focal act is the final state of the state transition. This can be either a request or an event, according to the mood of the control act.

**Description:**A requirement, rule, or expectation typically documented as guidelines, protocols, or formularies imposed or strongly encouraged by an organization that oversees or has authority over the practices within a domain, and which may have legal basis or ramifications on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

**Examples:**A payer may require a prescribing provider to adhere to formulary guidelines. An institution may adopt clinical guidelines and protocols and implement these within its electronic health record and decision support systems.

To be stationary, upright, vertical, on one's legs.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

The act of putting something away for safe keeping. The "something" may be physical object such as a specimen, or information, such as observations regarding a specimen.

Definition: Indicates that the subject Act has undergone or should undergo substitution of a type indicated by Act.code.

Rationale: Used to specify "allowed" substitution when creating orders, "actual" susbstitution when sending events, as well as the reason for the substitution and who was responsible for it.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system. Description:

A transmission exposure act describes the proximity (time and location) over which the participating source entity was capable of transmitting a physical (including energy), chemical or biological substance agent to another entity. The transmission exposure act is used in conjunction with acquisition exposure acts as part of an analysis technique for contact tracing. Although an exposure can be decomposed into transmission and acquisition exposures, there is no requirement that all exposures be treated in this fashion.

Constraints:The Transmission Exposure inherits the participation constraints that apply to Exposure with the following exception. The EXPTRGT (exposure target) participation must never be associated with the Transmission Exposure either directly or via context conduction.

A group of entries within a composition that are related to a common clinical theme - such as a specific disorder or problem, prevention, screening and provision of contraceptive services.

A topic may contain categories and entries.

Lying on the back, on an inclined plane, typically about 30-45 degrees, with head lowered and feet raised.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.
Definition:The act of transferring information without the intent of imparting understanding about a topic to the subject that is the recipient or holder of the transferred information where the participation association must be RCV or HLD.

Transportation is the moving of a payload (people or material) from a location of origin to a destination location. Thus, any transport service has the three target instances of type payload, origin, and destination, besides the targets that are generally used for any service (i.e., performer, device, etc.)

An act which describes the process whereby a 'verifying party' validates either the existence of the Role attested to by some Credential or the actual Vetting act and its details.

A sub-class of Act representing any transaction between two accounts whose value is measured in monetary terms.

In the "intent" mood, communicates a request for a transaction to be initiated, or communicates a transfer of value between two accounts.

In the "event" mood, communicates the posting of a transaction to an account.

Regions of Interest (ROI) within a subject Act. Primarily used for making secondary observations on a subset of a subject observation. The relationship between a ROI and its referenced Act is specified through an ActRelationship of type "subject" (SUBJ), which must always be present.

Used to group a set of acts sharing a common context. Organizer structures can nest within other context structures - such as where a document is contained within a folder, or a folder is contained within an EHR extract.

A code specifying qualitatively the spatial relation between imaged object and imaging film or detector.

Contains codes for defining the observed, physical position of a subject, such as during an observation, assessment, collection of a specimen, etc. ECG waveforms and vital signs, such as blood pressure, are two examples where a general, observed position typically needs to be noted.

Deprecation Comment:This concept has been deprecated because it does not describe a type of Act (as it should in the ActClass code system), but rather encodes the result or value of an observation. The same code has been added to the ObservationValue code system.

The spatial relationship of a subject whether human, other animal, or plant, to a frame of reference such as gravity or a collection device.

UPDATE: Migrated to the UTG maintenance environment and publishing tooling.

A code specifying the particular kind of Act that the Act-instance represents within its class.

Constraints:The kind of Act (e.g. physical examination, serum potassium, inpatient encounter, charge financial transaction, etc.) is specified with a code from one of several, typically external, coding systems. The coding system will depend on the class of Act, such as LOINC for observations, etc.

Conceptually, the Act.code must be a specialization of the Act.classCode. This is why the structure of ActClass domain should be reflected in the superstructure of the ActCode domain and then individual codes or externally referenced vocabularies subordinated under these domains that reflect the ActClass structure.

Act.classCode and Act.code are not modifiers of each other but the Act.code concept should really imply the Act.classCode concept. For a negative example, it is not appropriate to use an Act.code "potassium" together with and Act.classCode for "laboratory observation" to somehow mean "potassium laboratory observation" and then use the same Act.code for "potassium" together with Act.classCode for "medication" to mean "substitution of potassium". This mutually modifying use of Act.code and Act.classCode is not permitted.

en The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Inverse of Specializes. Only included as a derived relationship. The child code is a classification of the particular class group identified by the 'classCode' in a RIM class as the parent code. Used only in RIM backbone classes to link the code and classCode values. The internal identifier for the concept in the HL7 Access database repository. A property that indicates the status of the concept. One of active, experimental, deprecated, or retired. An additional concept code that was also attributed to a concept

Confirmed drug therapy appropriate

Provided education or training to the patient on appropriate therapy use

Instituted an additional therapy to mitigate potential negative effects

Suspended existing therapy that triggered interaction for the duration of this therapy

Aborted existing therapy that triggered interaction.

Confirmed supply action appropriate

Patient's existing supply was lost/wasted

Supply date is due to patient vacation

Supply date is intended to carry patient over weekend

Supply is intended for use during a leave of absence from an institution.

Consulted other supplier/pharmacy, therapy confirmed

Assessed patient, therapy is appropriate

Description:Supply is different than expected as an additional quantity has been supplied in a separate dispense. Description:Indicates that the permissions have been externally verified and the request should be processed.

**Definition:**Estimated age.

**Definition:**Reported age.

Description:The patient has the appropriate indication or diagnosis for the action to be taken. Description:It has been confirmed that the appropriate pre-requisite therapy has been tried.

**Definition:**Calculated age.

Patient gave adequate explanation

**Definition:**General specification of age with no implied method of determination.

**Definition:**Age at onset of associated adverse event; no implied method of determination.

Consulted other supply source, therapy still appropriate

A code representing 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records. 42 CFR Part 2 stipulates the privacy rights of an individual who has applied for or been given diagnosis or treatment for alcohol or drug abuse at a federally assisted program, which includes non-disclosure of health information relating to health care paid for by a federally assisted substance use disorder program without patient consent. https://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-part2.pdf

Usage Note:Used to indicate the legal authority for assigning security labels to governed information. In this case, the collection, access, use, and disclosure of healthcare information is governed by 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records https://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-part2.pdf use “42CFRPart2� as the security label policy code.

Since information governed by a 42 CFR Part 2 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf assign the HL7 Confidentiality code “R� (restricted).

A code representing an individual’s privacy consent directive that complies with 42 CFR Part 2.31 Consent requirements https://www.gpo.gov/fdsys/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-31.pdf, which is a US Federal law stipulating the policy elements of a written consent to a disclosure under the regulations in Part 2.

(1) The name of the patient. (2) The specific name(s) or general designation(s) of the part 2 program(s), entity(ies), or individual(s) permitted to make the disclosure. (3) How much and what kind of information is to be disclosed, including an explicit description of the substance use disorder information that may be disclosed. (4) (i) The name(s) of the individual(s) to whom a disclosure is to be made; or (ii)Entities with a treating provider relationship with the patient. If the recipient entity has a treating provider relationship with the patient whose information is being disclosed, such as a hospital, a health care clinic, or a private practice, the name of that entity; or (iii)Entities without a treating provider relationship with the patient. (A) If the recipient entity does not have a treating provider relationship with the patient whose information is being disclosed and is a third-party payer, the name of the entity; or (B) If the recipient entity does not have a treating provider relationship with the patient whose information is being disclosed and is not covered by paragraph (a)(4)(iii)(A) of this section, such as an entity that facilitates the exchange of health information or a research institution, the name(s) of the entity(-ies); and (1) The name(s) of an individual participant(s); or (2) The name(s) of an entity participant(s) that has a treating provider relationship with the patient whose information is being disclosed; or (3) A general designation of an individual or entity participant(s) or class of participants that must be limited to a participant(s) who has a treating provider relationship with the patient whose information is being disclosed. (i) When using a general designation, a statement must be included on the consent form that the patient (or other individual authorized to sign in lieu of the patient), confirms their understanding that, upon their request and consistent with this part, they must be provided a list of entities to which their information has been disclosed pursuant to the general designation (see Section 2.13(d)). (ii) \[Reserved\] (5) The purpose of the disclosure. In accordance with Section 2.13(a), the disclosure must be limited to that information which is necessary to carry out the stated purpose. (6) A statement that the consent is subject to revocation at any time except to the extent that the part 2 program or other lawful holder of patient identifying information that is permitted to make the disclosure has already acted in reliance on it. Acting in reliance includes the provision of treatment services in reliance on a valid consent to disclose information to a third-party payer (7) The date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must ensure that the consent will last no longer than reasonably necessary to serve the purpose for which it is provided. (8) The signature of the patient and, when required for a patient who is a minor, the signature of an individual authorized to give consent under Section 2.14; or, when required for a patient who is incompetent or deceased, the signature of an individual authorized to sign under Section 2.15. Electronic signatures are permitted to the extent that they are not prohibited by any applicable law. (9) The date on which the consent is signed.

Usage Note:Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual’s 42 CFR Part 2.31 consent directive, “42CFRPart2CD� as the security label policy code.

Since information governed by an individual’s 42 CFR Part 2.31 consent directive has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR § 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code “R� (restricted).

Consulted prescriber, therapy confirmed

Consulted prescriber and recommended change, prescriber declined

Concurrent therapy triggering alert is no longer on-going or planned

Order is performed as issued, but other action taken to mitigate potential adverse effects

Arranged to monitor patient for adverse effects

The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges).

Also includes the concept 'Adjudicate as zero' and items not covered under a particular Policy.

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

**Description:**The proposed therapy is frequently misused or abused and therefore should be used with caution and/or monitoring.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

Description:Provide consent to collect, use, disclose, or access adverse drug reaction information for a patient. Description:Provide consent to collect, use, disclose, or access all information for a patient. Description:Provide consent to collect, use, disclose, or access allergy information for a patient.

An access control policy specific to the type of access control scheme, which is used to enforce one or more authorization policies.

Usage Note:Access control schemes are the type of access control policy, which is comprised of access control policy rules concerning the provision of the access control service.

There are two categories of access control policies, rule-based and identity-based, which are identified in CCITT Rec. X.800 aka ISO 7498-2. Rule-based access control policies are intended to apply to all access requests by any initiator on any target in a security domain. Identity-based access control policies are based on rules specific to an individual initiator, a group of initiators, entities acting on behalf of initiators, or originators acting in a specific role. Context can modify rule-based or identity-based access control policies. Context rules may define the entire policy in effect. Real systems will usually employ a combination of these policy types; if a rule-based policy is used, then an identity-based policy is usually in effect also.

An access control scheme may be based on access control lists, capabilities, labels, and context or a combination of these. An access control scheme is a component of an access control mechanism or "service") along with the supporting mechanisms required by that scheme to provide access control decision information (ADI) supplied by the scheme to the access decision facility (ADF also known as a PDP). (Based on ISO/IEC 10181-3:1996)

Examples:

* Attribute Based Access Control (ABAC) * Discretionary Access Control (DAC) * History Based Access Control (HBAC) * Identity Based Access Control (IBAC) * Mandatory Access Control (MAC) * Organization Based Access Control (OrBAC) * Relationship Based Access Control (RelBac) * Responsibility Based Access Control (RespBAC) * Risk Adaptable Access Control (RAdAC)

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Description:Provide consent to collect, use, disclose, or access informational consent information for a patient.

An account for collecting charges, reversals, adjustments and payments, including deductibles, copayments, coinsurance (financial transactions) credited or debited to the account receivable account for a patient's encounter.

Description:Provide consent to collect, use, disclose, or access demographics information for a patient. Description:Provide consent to collect, use, disclose, or access diagnostic imaging information for a patient.

Automated Clearing House (ACH).

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

The lowering of specimen pH through the addition of an acid

Description:Provide consent to collect, use, disclose, or access immunization information for a patient. Description:Provide consent to collect, use, disclose, or access lab test result information for a patient. Description:Provide consent to collect, use, disclose, or access medical condition information for a patient. Definition:Provide consent to view or access medical condition information for a patient.

**Description:**Provide consent to collect, use, disclose, or access mental health information for a patient.

Description:Provide consent to collect, use, disclose, or access common observation information for a patient.

A group of health care entities, which may include health care providers, care givers, hospitals, facilities, health plans, and other health care constituents who coordinate care for reimbursement based on quality metrics for improving outcomes and lowering costs, and may be authorized to access the consumer's health information because of membership in that group.

Security Compartment Labels assigned to a consumer's information use in accountable care workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a an accountable care workflow who is requesting access to that information

Description:Provide consent to collect, use, disclose, or access coverage policy or program for a patient. Description:Provide consent to collect, use, disclose, or access provider information for a patient. Description:Provide consent to collect, use, disclose, or access professional service information for a patient.

**Description:**Provide consent to collect, use, disclose, or access substance abuse information for a patient.

**Definition:**A list of medications which the patient is only expected to consume for the duration of the current order or limited set of orders and which is not expected to be renewed.

An acute inpatient encounter.

Proposed therapy is outside of the standard practice for an adult patient.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

Admitting diagnosis are the diagnoses documented for administrative purposes as the basis for a hospital admission.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

Policy for handling information related to an adolescent, which will be afforded heightened confidentiality per applicable organizational or jurisdictional policy. An enterprise may have a policy that requires that adolescent patient information be provided heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

Usage Note:For use within an enterprise in which an adolescent is the information subject. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

Indicates that the observation is of an unexpected negative occurrence in the subject suspected to result from the subject's exposure to one or more agents. Observation values would be the symptom resulting from the reaction.

Premium paid on service fees in compensation for practicing outside of normal working hours.

Proposed therapy may be inappropriate or contraindicated due to patient age

Indicates that the observation is carrying out an aggregation calculation, contained in the value element.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

Communication of an agent from a living subject or environmental source to a living subject through indirect contact via oral or nasal inhalation.

Provision of Alternate Level of Care to a patient in an acute bed. Patient is waiting for placement in a long-term care facility and is unable to return home.

Payment initiated by the payor as the result of adjudicating a submitted invoice that arrived to the payor from an electronic source that did not provide a conformant set of HL7 messages (e.g. web claim submission).

Hypersensitivity to an agent caused by an immunologic response to an initial exposure

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to the proposed product. (Allergies are immune based reactions.)

The act rendering alkaline by impregnating with an alkali; a conferring of alkaline qualities.

Description:All patient information.

**Definition:**The requested action has already been performed and so this request has no effect

Description:A person enters a known allergy for a given patient. Description:A person reviews a list of known allergies of a given patient.

**Definition:**All information pertaining to a patient's allergy and intolerance records.

**Definition:**Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy.

**Definition:**Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

A comprehensive term for health care provided in a healthcare facility (e.g. a practitioneraTMs office, clinic setting, or hospital) on a nonresident basis. The term ambulatory usually implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter.

Communication of an agent from one animal to another proximate animal.

The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges) without changing the amount.

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

Communication of an agent from an animal to a proximate person.

**Description:**A note that is specific to a patient's diagnostic images, either historical, current or planned.

**Description:**A general or uncategorized note.

A note that is specific to a patient's immunizations, either historical, current or planned.

**Description:**A note that is specific to a patient's laboratory results, either historical, current or planned.

**Description:**A note that is specific to a patient's medications, either historical, current or planned.

Definition:A policy that, after an initial premium or premiums, pays out a sum at pre-determined intervals.

For example, a policy holder may pay $10,000, and in return receive $150 each month until he dies; or $1,000 for each of 14 years or death benefits if he dies before the full term of the annuity has elapsed.

Custodian system must remove any information that could result in identifying the information subject.

Custodian system must make available to an information subject upon request an accounting of certain disclosures of the individual’s protected health information over a period of time. Policy may dictate that the accounting include information about the information disclosed, the date of disclosure, the identification of the receiver, the purpose of the disclosure, the time in which the disclosing entity must provide a response and the time period for which accountings of disclosure can be requested.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

The invoice element has passed through the adjudication process but payment is refused due to one or more reasons.

Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late').

If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected.

A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer.

Invoice element cannot be reversed (nullified) as there is nothing to reverse.

Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting).

Description:All information pertaining to a patient's adverse drug reactions.

Describes the artificial blood identifier that is associated with the specimen.

The invoice element was/will be paid exactly as submitted, without financial adjustment(s).

If the dollar amount stays the same, but the billing codes have been amended or financial adjustments have been applied through the adjudication process, the invoice element is treated as "Adjudicated with Adjustment".

If information items are included in the adjudication results that do not affect the monetary amounts paid, then this is still Adjudicated as Submitted (e.g. 'reached Plan Maximum on this Claim').

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

**Description:**Refines classCode OBS to indicate an observation in which observation.value contains a finding or other nominalized statement, where the encoded information in Observation.value is not altered by Observation.code. For instance, observation.code="ASSERTION" and observation.value="fracture of femur present" is an assertion of a clinical finding of femur fracture.

Custodian system must monitor systems to ensure that all users are authorized to operate on information objects.

Custodian system must monitor and maintain retrievable log for each user and operation on information.

Authorization approved and funds have been set aside to pay for specified healthcare service(s) and/or product(s) within defined criteria for the authorization.

Authorisation policies are essentially security policies related to access-control and specify what activities a subject is permitted or forbidden to do, to a set of target objects. They are designed to protect target objects so are interpreted by access control agents or the run-time systems at the target system.

A positive authorisation policy defines the actions that a subject is permitted to perform on a target. A negative authorisation policy specifies the actions that a subject is forbidden to perform on a target. Positive authorisation policies may also include filters to transform the parameters associated with their actions. (Based on PONDERS)

Specifies whether or not automatic repeat testing is to be initiated on specimens.

The dilution of a sample performed by automated equipment. The value is specified by the equipment

The dilution of a sample performed by automated equipment. The value is specified by the equipment

Description:Automobile Information Attachment

Insurance policy for injuries sustained in an automobile accident. Will also typically covered non-named parties to the policy, such as pedestrians and passengers.

The available quantity of specimen. This is the current quantity minus any planned consumption (e.g., tests that are planned)

A mandate, obligation, requirement, rule, or expectation conveyed as security metadata between senders and receivers required to establish the reliability, authenticity, and trustworthiness of their transactions.

Trust security metadata are observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability).

Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. \[Based on ISO IEC 10181-1 and NIST SP 800-63-2\]

For example, identity proofing , level of assurance, and Trust Framework.

Policy for handling trade secrets such as financial information or intellectual property, which will be afforded heightened confidentiality. Description: Since the service class can represent knowledge structures that may be considered a trade or business secret, there is sometimes (though rarely) the need to flag those items as of business level confidentiality.

Usage Notes:No patient related information may ever be of this confidentiality level. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.
No patient related information may ever be of this confidentiality level. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

Communication of an agent from one living subject to another living subject through direct contact with any body fluid.

Policy for handling information related to behavioral and emotional disturbances affecting social adjustment and physical health, which is afforded heightened confidentiality.

Usage Note:If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.

Communication of an agent to a living subject through direct contact with blood or blood products whether the contact with blood is part of a therapeutic procedure or not.

A billing arrangement where a Provider charges a lump sum to provide a prescribed group (volume) of services to a single patient which occur over a period of time. Services included in the block may vary.

This billing arrangement is also known as Program of Care for some specific Payors and Program Fees for other Payors.

Bonus payments based on performance, volume, etc. as agreed to by the payor.

An additional immunization administration within a series intended to bolster or enhance immunity.

A diet exclusively composed of oatmeal, semolina, or rice, to be extremely easy to eat and digest.

**Description:**A local business rule relating multiple elements has been violated.

**Description:**Indicates that result data has been corrected.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.

Definition:A program that provides low-income, uninsured, and underserved women access to timely, high-quality screening and diagnostic services, to detect breast and cervical cancer at the earliest stages.Example:To improve women's access to screening for breast and cervical cancers, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which guided CDC in creating the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides access to critical breast and cervical cancer screening services for underserved women in the United States. An estimated 7 to 10% of U.S. women of screening age are eligible to receive NBCCEDP services. Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250% of federal poverty level; ages 18 to 64 for cervical screening; ages 40 to 64 for breast screening.

A billing arrangement where the payment made to a Provider is determined by analyzing one or more demographic attributes about the persons/patients who are enrolled with the Provider (in their practice).

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

Provision of diagnosis and treatment of diseases and disorders affecting the heart

List of acts representing a care plan. The acts can be in a varierty of moods including event (EVN) to record acts that have been carried out as part of the care plan.

**Definition:**An observation that provides a characterization of the level of harm to an investigation subject as a result of a reaction or event.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

Description:Types of advance payment to be made on a plastic card usually issued by a financial institution used of purchasing services and/or products.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

An observation that states whether the disease was likely acquired outside the jurisdiction of observation, and if so, the nature of the inter-jurisdictional relationship.

OpenIssue:This code could be moved to LOINC if it can be done before there are significant implemenations using it.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

A person reviews a recommendation/assessment provided automatically by a clinical decision support application for a given patient.

This compartment code may be used as a field value in an initiator's clearance to indicate permission for its Clinical Decision Support system (CDSS) to access and use an IT Resource with a security label having the same compartment value in the security category label field.

This code permits a CDS system to algorithmically process information with this compartment tag for the purpose of alerting an unauthorized end user that masked information is needed to address an emergency or a patient safety issue, such as a contraindicated medication. The alert would advise the end user to "break the glass", to access the masked information in an accountable manner, or to ask the patient about possibly masked information.

For example, releasing a list of sensitive medications with this compartment tag means that while the CDS system is permitted to use this list in its contraindication analysis, this sensitive information should not be shared directly with unauthorized end-users or end-user-facing Apps. Based on the results of the CDS system analysis (e.g., warnings about prescriptions) the end-user (e.g., a clinician) may still have the ability to access to the sensitive information by invoking "break-the-glass protocol".

Usage Note:A security label with the CDS system compartment may be used in conjunction with other security labels, e.g., a label authorizing an end user with adequate clearance to access the same CDS system compartment tagged information. For example, a patient may restrict sharing sensitive information with most care team members except in an emergency or to prevent an adverse event, and may consent to sharing with their sensitive service care team providers, e.g., for mental health or substance abuse.

Policy for handling information related to a celebrity (people of public interest (VIP), which will be afforded heightened confidentiality. Celebrities are people of public interest (VIP) about whose information an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive may include health information and patient role information including patient status, demographics, next of kin, and location.

Usage Note:For use within an enterprise in which the information subject is deemed a celebrity or very important person. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

An amount still owing to the payor but the payment is 0$ and this cannot be settled until a future payment is made.

Definition:A program that covers the cost of services provided directly to a beneficiary who typically has no other source of coverage without charge.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

A written order to a bank to pay the amount specified from funds on deposit.

Description:Exposure participants' interaction occurred in a child care setting

Provision of recurring care for chronic illness.

A type of transaction that represents a charge for a service or product. Expressed in monetary terms.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Definition:**A list of medications which are expected to be continued beyond the present order and which the patient should be assumed to be taking unless explicitly stopped.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

A circle defined by two (column,row) pairs. The first point is the center of the circle and the second point is a point on the perimeter of the circle.

A clinician enters a clinical note about a given patient

A person reviews a clinical note of a given patient.

Description:The class room associated with the patient during the immunization event.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**.

Indicates what method is used in a quality measure to combine the component measure results included in an composite measure.

An attribute of a quality measure describing the weight this component measure score is to carry in determining the overall composite measure final score. The value is real value greater than 0 and less than 1.0. Each component measure score will be multiplied by its CMPMSRSCRWGHT and then summed with the other component measures to determine the final overall composite measure score. The sum across all CMPMSRSCRWGHT values within a single composite measure SHALL be 1.0. The value assigned is scoped to the composite measure referencing this component measure only.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Definition:**All information pertaining to a patient's common observation records (height, weight, blood pressure, temperature, etc.).

**Description:**The specified code has been deprecated and should no longer be used. Select another code from the code system.

**Description:**The specified code is not valid against the list of codes allowed for the element.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

Policy for handling information related to cognitive disability disorders and conditions caused by these disorders, which are afforded heightened confidentiality.

Usage Note:If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.

Examples may include dementia, traumatic brain injury, attention deficit, hearing and visual disability such as dyslexia and other disorders and related conditions which impair learning and self-sufficiency. However, the cognitive disabilities to which this term may apply versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used.

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

The covered party pays a percentage of the cost of covered services.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

Definition:An automobile insurance policy under which the insurance company will cover the cost of damages to an automobile owned by the named insured that are caused by accident or intentionally by another party.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

There may be an issue with the patient complying with the intentions of the proposed therapy

This is the healthcare analog to the US Intelligence Community's concept of a Special Access Program. Compartment codes may be used in as a field value in an initiator's clearance to indicate permission to access and use an IT Resource with a security label having the same compartment value in security category label field.

Map: Aligns with ISO 2382-8 definition of Compartment - "A division of data into isolated blocks with separate security controls for the purpose of reducing risk."

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

Proposed therapy may be inappropriate or contraindicated due to an existing/recent patient condition or diagnosis

List of condition observations.

The quantity of specimen that is used each time the equipment uses this substance

Transaction counts and value totals by Contract Identifier.

A billing arrangement where a Provider charges a lump sum to provide a particular volume of one or more interventions/procedures or groups of interventions/procedures.

A displayed mark, required to be rendered as "CONTROLLED", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Mandatory control marking, which must be displayed on the top portion of each rendered or printed page containing controlled information. Should be displayed at the bottom of each rendered or printed page containing controlled information. Must be displayed on each portion of controlled information at the portion level if portions are uncontrolled unclassified information. Based on CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf.
Description:An interaction where the exposure participants traveled in/on the same vehicle (not necessarily concurrently, e.g. both are passengers of the same plane, but on different flights of that plane).

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

Identifies the organization(s) who own the intellectual property represented by the eMeasure.

A displayed mark indicating that the electronic or hardcopy information is a copy of an authoritative source for the information. The copy is not considered authoritative but is a duplicate of the authoritative content.

Usage Note:Applicable policy will dictate how the COPY mark will be displayed. Typical renderings include the marking appearing at the top or "banner" of electronic or hardcopy pages, or as watermarks set diagonally across each page.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

Insurance coverage problems have been encountered. Additional explanation information to be supplied.

Definition:Codes representing the maximum coverate or financial participation requirements.

**Description:**A mandate, obligation, requirement, rule, or expectation unilaterally imposed on benefit coverage under a policy or program by a sponsor, underwriter or payor on:

* The activity of another party * The behavior of another party * The manner in which an act is executed

**Examples:**A clinical protocol imposed by a payer to which a provider must adhere in order to be paid for providing the service. A formulary from which a provider must select prescribed drugs in order for the patient to incur a lower copay.

Codes representing the time period during which coverage is available; or financial participation requirements are in effect.

Clinical product invoice where the Invoice Grouping contains one or more billable item and is supported by clinical product(s).

For example, a crutch or a wheelchair.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

Custodian security system must retrieve, evaluate, and comply with the information handling directions of the Confidentiality Code associated with an information target.

Usage Note:CPLYCC may be used as a security label code to inform senders and receivers of information tagged with a Confidentiality Code to comply with applicable level of protection required by the assigned confidentiality code.

Custodian security system must retrieve, evaluate, and comply with applicable information subject consent directives.

Usage Note:CPLYCD may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType\_ActConsent code or an ActCode\_ActPolicyType\_ActPrivacyPolicy\_ActConsentDirective code to comply with applicable consent directives.

Custodian security system must retrieve, evaluate, and comply with applicable Controlled Unclassified Information (CUI) policies associated with the target information.

Usage Note:In the US, CPLYCUI may be used as a security label code to inform recipients of information designated by a US Federal Agency as Controlled Unclassified Information (CUI) to comply with the applicable laws, regulations, executive orders, and other guidances, such as included in DURSAs, to persist, mark, and enforce required CUI controls

Background:

In accordance with US 32 CFR Part 2002 and US Executive Order 13556 Controlled Unclassified Information, US Federal Agencies and their contractors are charged with classifying and marking certain information they create as Controlled Unclassified Information (CUI).

The following definitions, which are provided for context, are based on terms defined by the CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html

* CUI is defined as "information in any form that the Government creates or possesses, or that an entity creates or possesses for or on behalf of the Government, that a law, regulation, or Government-wide policy requires or permits an agency to handle using safeguarding or dissemination controls." * Designating CUI occurs when an authorized holder, consistent with 32 CFR Part 2002 and the CUI Registry, determines that a specific item of information falls into a CUI category or subcategory. * The designating agency is the executive branch agency that designates or approves the designation of a specific item of information as CUI. * The authorized holder who designates the CUI must make recipients aware of the information's CUI status when disseminating that information. * • Disseminating occurs when authorized holders provide access, transmit, or transfer CUI to other authorized holders through any means, whether internal or external to the agency.

Once designated as CUI, US Federal Agencies and their contractors must assign CUI marks as prescribed by the National Archives and Records Administration (NARA) CUI Registry, and display marks as prescribed by the CUI Marking Handbook.

CUI markings must be displayed on hard copy, on containers, electronic media, and to end users for IT systems.

When HL7 content is designated as CUI, these computable markings can be interoperably conveyed using HL7 security label CUI tags, and may be included in HL7 text and narrative elements as human readable markings.

Impact of CUI markings:

CUI Custodians must enforce CUI security controls per applicable CUI policies. Federal agencies and their contractors must adhere to FISMA and NIST SP 800-53 security controls. Custodians, who are not Federal agencies or agency contractors, and are receivers of CUI, must adhere to NIST SP 800-171 security controls and those dictated by the Authorities indicated by the assigned CUI markings.

For most participants in US healthcare information exchange, including Federal Agencies and their contractors, additional controls are required by HIPAA Security standards for health information US 42 USC 1320d-2(d)(2) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf

Federal Agencies and their contractors may be the CUI classifier of original CUI content; or a CUI derivative classifier, which reclassifies CUI content that has been aggregated with other CUI or Unclassified Uncontrolled Information (U) or dissembled from a larger CUI content; or declassifiers, depending on the designating agency's policies.

Applicable CUI policies include the following and any future applicable updates to policies or laws related to CUI:

* Executive Order 13556 https://www.federalregister.gov/articles/2010/11/09/2010-28360/controlled-unclassified-information * US 32 CFR Part 2002 https://www.govinfo.gov/content/pkg/CFR-2017-title32-vol6/pdf/CFR-2017-title32-vol6-part2002.pdf * NIST SP 800-171 https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-171r1.pdf * NIST SP 800-171A https://doi.org/10.6028/NIST.SP.800-171A * CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf * CUI Registry - Health Information Category https://www.archives.gov/cui/registry/category-detail/health-info * CUI Registry: Limited Dissemination Controls https://www.archives.gov/cui/registry/limited-dissemination * CUI Policy and Guidance https://www.archives.gov/cui/registry/policy-guidance

Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional privacy policies associated with the target information.

Usage Note:CPLYJPP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType\_ActPrivacyPolicy\_ActPrivacyLaw code or an ActCode\_ActPolicyType\_ActInformationPolicy.JurisIP code to comply with applicable jurisdictional privacy policy.

Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional security policies associated with the target information.

Usage Note:CPLYJSP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType.SecurityPolicy code to comply with applicable jurisdictional security policy.

Custodian security system must retrieve, evaluate, and comply with applicable organizational privacy policies associated with the target information.

Usage Note:CPLYOPP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType\_ActInformationPolicy.OrgIP code to comply with applicable organizational privacy policy.

Custodian security system must retrieve, evaluate, and comply with the organizational security policies associated with the target information.

Usage Note:CPLYOSP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType.SecurityPolicy code to comply with applicable organizational security policy.

Custodian security system must retrieve, evaluate, and comply with applicable policies associated with the target information.

Usage Note:CPLYPOL may be used as a security label code to inform senders and receivers of the tagged information to comply with applicable policy without specifying the specific policy type(s).

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

A grouping of invoice element groups and details including the ones specifying the compound ingredients being invoiced. It may also contain generic detail items such as markup.

A grouping of invoice element details including the one specifying an ingredient drug being invoiced. It may also contain generic detail items such as tax or markup.

A grouping of invoice element groups and details including the ones specifying the compound supplies being invoiced. It may also contain generic detail items such as markup.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**CPT modifier codes are found in Appendix A of CPT 2000 Standard Edition.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Proposed therapy may be inappropriate or contraindicated because of a common but non-patient specific reaction to the product.

**Example:**There is no record of a specific sensitivity for the patient, but the presence of the sensitivity is common and therefore caution is warranted.

Definition:A program that covers the cost of services provided to crime victims for injuries or losses related to the occurrence of a crime.

A clinical judgment as to the worst case result of a future exposure (including substance administration). When the worst case result is assessed to have a life-threatening or organ system threatening potential, it is considered to be of high criticality.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

Summary of relevant clinical guidelines or other clinical recommendations supporting this eMeasure.

Clinical Services Invoice which can be used to describe a single service, multiple services or repeated services.

\[1\] Single Clinical services invoice where the Invoice Grouping contains one billable item and is supported by one clinical service.

For example, a single service for an office visit or simple clinical procedure (e.g. knee mobilization).

\[2\] Multiple Clinical services invoice where the Invoice Grouping contains more than one billable item, supported by one or more clinical services. The services can be distinct and over multiple dates, but for the same patient. This type of invoice includes a series of treatments which must be adjudicated together.

For example, an adjustment and ultrasound for a chiropractic session where fees are associated for each of the services and adjudicated (invoiced) together.

\[3\] Repeated Clinical services invoice where the Invoice Grouping contains one or more billable item, supported by the same clinical service repeated over a period of time.

For example, the same Chiropractic adjustment (service or treatment) delivered on 3 separate occasions over a period of time at the discretion of the provider (e.g. month).

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

A clinical Invoice Grouping consisting of one or more services and one or more product. Billing for these service(s) and product(s) are supported by multiple clinical billable events (acts).

All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator.

For example , a brace (product) invoiced together with the fitting (service).

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

Care coordination across participants in a care plan requires sharing of a healthcare consumer's information specific to that workflow. A care team member should only have access to that information while participating in that workflow or for other authorized uses.

Security Compartment Labels assigned to a consumer's information use in care coordination workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a care team member workflow who is requesting access to that information

A monitoring program that focuses on narcotics and/or commonly abused substances that are subject to legal restriction.

An observation that states the mechanism by which disease was acquired by the living subject involved in the public health case.

OpenIssue:This code could be moved to LOINC if it can be done before there are significant implemenations using it.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

A displayed mark, required to be rendered as "CUI", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Mandatory control marking, which must be displayed on the top portion of each rendered or printed page containing controlled information. Should be displayed at the bottom of each rendered or printed page containing controlled information. Must be displayed on each portion of controlled information at the portion level if portions are uncontrolled unclassified information. Based on CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf.

A displayed mark, required to be rendered as "CUI//HLTH", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

A displayed mark, required to be rendered as "(CUI//HLTH)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

An originator must mark, persist, display, and convey computable and renderable Controlled Unclassified Information (CUI) marks as required by policy. A recipient must consume, persist, display, and reconvey CUI marks on information received based on agreements with the originator..

Examples:

* As CUI custodians, Federal Agencies and their contractors must mark, persist, display, and convey these marks. * All CUI receivers must consume, persist, display, and reconvey CUI markings on information further disclosed

Usage Note:

In accordance with US 32 CFR Part 2002 and US Executive Order 13556 Controlled Unclassified Information, US Federal Agencies and their contractors are charged with classifying and marking certain information they create as Controlled Unclassified Information (CUI).

The following definitions, which are provided for context, are based on terms defined by the CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html

* CUI is defined as "information in any form that the Government creates or possesses, or that an entity creates or possesses for or on behalf of the Government, that a law, regulation, or Government-wide policy requires or permits an agency to handle using safeguarding or dissemination controls" * Designating CUI occurs when an authorized holder, consistent with US 32 CFR Part 2002 and the CUI Registry, determines that a specific item of information falls into a CUI category or subcategory. * The designating agency is the executive branch agency that designates or approves the designation of a specific item of information as CUI. * The authorized holder who designates the CUI must make recipients aware of the information’s CUI status when disseminating that information. * Disseminating occurs when authorized holders provide access, transmit, or transfer CUI to other authorized holders through any means, whether internal or external to the agency.

Once designated as CUI, US Federal Agencies and their contractors must assign CUI marks as prescribed by the National Archives and Records Administration (NARA) CUI Registry, and display marks as prescribed by the CUI Marking Handbook.

CUI markings must be displayed on hard copy, on containers, electronic media, and to end users for IT systems.

When HL7 content is designated as CUI, these computable markings can be interoperably conveyed using HL7 security label CUI tags, and may be included in HL7 text and narrative elements as human readable markings.

Impact of CUI markings:

CUI Custodians must enforce CUI security controls per applicable CUI policies. Federal agencies and their contractors must adhere to FISMA and NIST SP 800-53 security controls. Custodians, who are not Federal agencies or agency contractors, and are receivers of CUI, must adhere to NIST SP 800-171 security controls and those dictated by the Authorities indicated by the assigned CUI markings.

For most participants in US healthcare information exchange, including Federal Agencies and their contractors, additional controls are required by HIPAA Security standards for health information US 42 USC 1320d-2(d)(2) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf

Federal Agencies and their contractors may be the CUI classifier of original CUI content; or a CUI derivative classifier, which reclassifies CUI content that has been aggregated with other CUI or Unclassified Uncontrolled Information (U) or dissembled from a larger CUI content; or declassifiers, depending on the designating agency's policies.

Applicable CUI policies include the following and any future applicable updates to policies or laws related to CUI:

* Executive Order 13556 https://www.federalregister.gov/articles/2010/11/09/2010-28360/controlled-unclassified-information * US 32 CFR Part 2002 https://www.govinfo.gov/content/pkg/CFR-2017-title32-vol6/pdf/CFR-2017-title32-vol6-part2002.pdf * NIST SP 800-171 https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-171r1.pdf * NIST SP 800-171A https://doi.org/10.6028/NIST.SP.800-171A * CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf * CUI Registry - Health Information Category https://www.archives.gov/cui/registry/category-detail/health-info * CUI Registry: Limited Dissemination Controls https://www.archives.gov/cui/registry/limited-dissemination * CUI Policy and Guidance https://www.archives.gov/cui/registry/policy-guidance

A displayed mark, required to be rendered as "(CUI)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

A displayed mark, required to be rendered as "CUI//PRVCY", indicating that the electronic or hardcopy controlled unclassified basic privacy information is private and must be protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of privacy regulation governing CUI Basic marking include 20 CFR 401.100 related to SSA disclosure of personal, program, and non-program information. https://www.govinfo.gov/content/pkg/CFR-2017-title20-vol2/pdf/CFR-2017-title20-vol2-sec401-100.pdf.

A displayed mark, required to be rendered as "(CUI//PRVCY)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of privacy regulation governing CUI Basic marking include 20 CFR 401.100 related to SSA disclosure of personal, program, and non-program information. https://www.govinfo.gov/content/pkg/CFR-2017-title20-vol2/pdf/CFR-2017-title20-vol2-sec401-100.pdf.

A displayed mark, required to be rendered as "CUI//SP-HLTH", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI in which the authorizing law, regulation, or Government-wide policy contains specific handling controls that it requires or permits agencies to use that differ from those for CUI Basic. The CUI Registry indicates which laws, regulations, and Government-wide policies include such specific requirements. CUI Specified controls may be more stringent than, or may simply differ from, those required by CUI Basic; the distinction is that the underlying authority spells out the controls for CUI Specified information and does not for CUI Basic information. CUI Basic controls apply to those aspects of CUI Specified where the authorizing laws, regulations, and Government-wide policies do not provide specific guidance. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of healthcare regulation governing CUI Specified marking include HIPAA Transaction and Code Sets and references the Congressional requirement that HHS promulgate Privacy, and Security rules https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf.

A displayed mark, required to be rendered as "(CUI//SP-HLTH)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of healthcare regulation governing CUI Specified marking include HIPAA Transaction and Code Sets and references the Congressional requirement that HHS promulgate Privacy, and Security rules https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf

A displayed mark, required to be rendered as "CUI//SP-PRVCY", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of privacy regulation governing CUI Specified marking is OMB M-17-12� This Memorandum sets forth the policy for Federal agencies to prepare for and respond to a breach of personally identifiable information (PII). It includes a framework for assessing and mitigating the risk of harm to individuals potentially affected by a breach, as well as guidance on whether and how to provide notification and services to those individuals. https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2017/m-17-12\_0.pdf.

A displayed mark, required to be rendered as "(CUI//SP-PRVCY)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note:Examples of privacy regulation governing CUI Specified marking is OMB M-17-12� This Memorandum sets forth the policy for Federal agencies to prepare for and respond to a breach of personally identifiable information (PII). It includes a framework for assessing and mitigating the risk of harm to individuals potentially affected by a breach, as well as guidance on whether and how to provide notification and services to those individuals. https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2017/m-17-12\_0.pdf.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

List of current medications.

The current quantity of the specimen, i.e., initial quantity minus what has been actually used.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

A code representing U.S. Federal laws governing research-related privacy policies known as the “Common Rule�. The Common Rule is the U.S. Federal regulations governing the protection of human subjects in research (codified at Subpart A of 45 CFR part 46), which has been adopted by 15 U.S. Federal departments and agencies in an effort to promote uniformity, understanding, and compliance with human subject protections. Existing regulations governing the protection of human subjects in Food and Drug Administration (FDA)-regulated research (21 CFR parts 50, 56, 312, and 812) are separate from the Common Rule but include similar requirements.

Usage Note:Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information or biospecimen is governed by the Common Rule use “COMMONRULE� as the security label policy code. Information or biospecimen disclosed under the Common Rule are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code “M� (moderate).

A code representing an individual’s consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section specific to disclosures for purposes of research when combined with a Common Rule or Federal Drug Administration consent to participate in research also known as a compound authorization.

Usage Note:The Agency for Healthcare Research and Quality (AHRQ) has developed the Informed Consent and Authorization Toolkit for Minimal Risk Research to facilitate the process of obtaining informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization from potential research subjects. This toolkit contains information for people responsible for ensuring that potential research subjects are informed in a manner that is consistent with medical ethics and regulatory guidelines. From https://www.ahrq.gov/sites/default/files/publications/files/ictoolkit.pdf.

Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual’s right of access directive under 45 CFR Section 164.508 use “CompoundResearchCD� as the security label policy code.

Information or biospecimen disclosed under the Common Rule are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code “M� (moderate).

See ActCode.\_ActPolicyType.\_ActPrivacyPolicy.\_ActPrivacyLaw.\_ActUSPrivacyLaw.HIPAAAuth (HIPAA Authorization for Disclosure). See: HIPAAAuth and NIH Sample Authorization Language for Research Uses and Disclosures of Individually Identifiable Health Information by a Covered Health Care Provider https://privacyruleandresearch.nih.gov/authorization.asp

A displayed mark rendered as "Confidential", which indicates to end users that the electronic or hardcopy information they are viewing must be protected at a level of protection as dictated by applicable policy.

May be used to indicate proprietary or classified information that is, for example, business, intelligence, or project related, e.g., secret ingredients in a therapeutic substance; location of disaster health facilities and providers, or the name of a manufacturer or project contractor. Example use cases include a display to alert authorized business system users that they are viewing additionally protected proprietary and business confidential information deemed proprietary under an applicable jurisdictional or organizational policy.

Usage Note:

The ConfidentialMark (confidential mark) description is based on the HL7 Confidentiality Concept Domain: Types of privacy metadata classifying an IT resource (data, information object, service, or system capability) according to its level of sensitivity, which is based on an analysis of applicable privacy policies and the risk of financial, reputational, or other harm to an individual or entity that could result if made available or disclosed to unauthorized individuals, entities, or processes.

Usage Note:Confidentiality codes may be used in security labels and privacy markings to classify IT resources based on sensitivity to indicate the obligation of a custodian or receiver to ensure that the protected resource is not made available or disclosed to individuals, entities, or processes (security principals) unless authorized per applicable policies. Confidentiality codes may also be used in the clearances of initiators requesting access to protected resources.

Map: Definition aligns with ISO 7498-2:1989 - Confidentiality is the property that information is not made available or disclosed to unauthorized individuals, entities, or processes.

Information the US Government creates or possesses, or that an entity creates or possesses for or on behalf of the Government, that a law, regulation, or Government-wide policy requires or permits an agency to handle using safeguarding or dissemination controls. However, CUI does not include classified information (see definition above) or information a non-executive branch entity possesses and maintains in its own systems that did not come from, or was not created or possessed by or for, an executive branch agency or an entity acting for an agency. Law, regulation, or Government-wide policy may require or permit safeguarding or dissemination controls in three ways: Requiring or permitting agencies to control or protect the information but providing no specific controls, which makes the information CUI Basic; requiring or permitting agencies to control or protect the information and providing specific controls for doing so, which makes the information CUI Specified; or requiring or permitting agencies to control the information and specifying only some of those controls, which makes the information CUI Specified, but with CUI Basic controls where the authority does not specify. Based on CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html .

Usage Note:Mandatory control marking, which must be displayed on the top portion of each rendered or printed page containing controlled information. Should be displayed at the bottom of each rendered or printed page containing controlled information. Must be displayed on each portion of controlled information at the portion level if portions are uncontrolled unclassified information. Based on CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf. For definitions of key terms see CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

**Description:**Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy.

An allergy to a pharmaceutical product.

Transaction counts and value totals for each calendar day within the date range specified.

Electronic Funds Transfer (EFT) deposit into the payee's bank account

Custodian security system must declassify information assigned security labels by instantiating a new version of the classified information so as to break the binding of the classifying security label when assigning a new security label that marks the information as unclassified in accordance with applicable jurisdictional privacy policies associated with the target information. The system must retain an immutable record of the previous assignment and binding.

That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

Description of individual terms, provided as needed.

The removal of fibrin from whole blood or plasma through physical or chemical means

Custodian system must strip information of data that would allow the identification of the source of the information or the information subject.

Custodian system must remove target information from access after use.

Delegation policies specify which actions subjects are allowed to delegate to others. A delegation policy thus specifies an authorisation to delegate. Subjects must already possess the access rights to be delegated.

Delegation policies are aimed at subjects delegating rights to servers or third parties to perform actions on their behalf and are not meant to be the means by which security administrators would assign rights to subjects. A negative delegation policy identifies what delegations are forbidden.

A Delegation policy specifies the authorisation policy from which delegated rights are derived, the grantors, which are the entities which can delegate these access rights, and the grantees, which are the entities to which the access rights can be delegated. There are two types of delegation policy, positive and negative. (Based on PONDERS)

Policy for handling all demographic information about an information subject, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to all demographic about an information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject.

Usage Note:If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

**Definition:**All information pertaining to a patient's demographics (such as name, date of birth, gender, address, etc).

Criteria which specify subjects who should be removed from the eMeasure population and denominator before determining if numerator criteria are met. Denominator exclusions are used in proportion and ratio measures to help narrow the denominator.

Criteria which specify the removal of a subject, procedure or unit of measurement from the denominator, only if the numerator criteria are not met. Denominator exceptions allow for adjustment of the calculated score for those providers with higher risk populations. Denominator exceptions are used only in proportion eMeasures. They are not appropriate for ratio or continuous variable eMeasures. Denominator exceptions allow for the exercise of clinical judgment and should be specifically defined where capturing the information in a structured manner fits the clinical workflow. Generic denominator exception reasons used in proportion eMeasures fall into three general categories:

* Medical reasons * Patient (or subject) reasons * System reasons

Criteria for specifying the entities to be evaluated by a specific quality measure, based on a shared common set of characteristics (within a specific measurement set to which a given measure belongs). The denominator can be the same as the initial population, or it may be a subset of the initial population to further constrain it for the purpose of the eMeasure. Different measures within an eMeasure set may have different denominators. Continuous Variable eMeasures do not have a denominator, but instead define a measure population.

Definition:A health insurance policy that that covers benefits for dental services. Definition:A public or government health program that administers and funds coverage for dental care to assist program eligible who meet financial and health status criteria.

Communication of an agent from a living subject or environmental source to a living subject via agent migration through intact skin.

A fill providing sufficient supply for one day

Policy for handling information related to a diagnosis, health condition or health problem, which will be afforded heightened confidentiality. Diagnostic, health condition or health problem related information may be deemed sensitive by organizational policy, and require heightened confidentiality.

Usage Note:For use within an enterprise that provides heightened confidentiality to diagnostic, health condition or health problem related information deemed sensitive. If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.

A clinician enters a diagnosis for a given patient.

A person reviews a list of diagnoses of a given patient.

**Definition:**All information pertaining to a patient's diagnostic image records (orders & results).

Code set to define specialized/allowed diets

An observation that reports the dilution of a sample.

Hypersensitivity resulting in an adverse reaction upon exposure to a drug.

Definition:An insurance policy that provides a regular payment to compensate for income lost due to the covered party's inability to work because of illness or injury.

Disclaimer information for the eMeasure.

A person provides a discharge instruction to a patient.

A clinician enters a discharge summary for a given patient.

A person reviews a discharge summary of a given patient.

List of discharge medications.

Discharge diagnosis are the diagnoses documented for administrative purposes as the time of hospital discharge.

Definition:A health insurance policy that covers benefits for healthcare services provided for named conditions under the policy, e.g., cancer, diabetes, or HIV-AIDS. Definition:A public or government health program that administers and funds coverage for health and social services to assist program eligible who meet financial and health status criteria related to a particular disease.Example:Reproductive health, sexually transmitted disease, and end renal disease programs.

The adjudication result associated is to be displayed to the receiver of the adjudication result.

A diet that uses carbohydrates sparingly. Typically with a restriction in daily energy content (e.g. 1600-2000 kcal).

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

Provision of treatment for oral health and/or dental surgery.

Policy for handling information related to an information subject's date of birth, which will be afforded heightened confidentiality.Policies may govern sensitivity of information related to an information subject's date of birth, the disclosure of which could impact the privacy, well-being, or safety of that subject.

Usage Note:If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.
Description:Document Attachment

Proposed dosage instructions for therapy differ from standard practice.

**Description:**Proposed dosage is inappropriate due to patient's medical condition.

Proposed length of therapy differs from standard practice.

Proposed length of therapy is longer than standard practice

Proposed length of therapy is longer than standard practice for the identified indication or diagnosis

Proposed length of therapy is shorter than that necessary for therapeutic effect

Proposed length of therapy is shorter than standard practice for the identified indication or diagnosis

Proposed dosage exceeds standard practice