HL7.TERMINOLOGY\v3 Code System ActReason

This page is part of the HL7 Terminology (v2.1.0: Release) based on FHIR R4. The current version which supercedes this version is 5.2.0. For a full list of available versions, see the Directory of published versions

ValueSet: v3 Code System ActReason

Summary

Defining URL:

http://terminology.hl7.org/ValueSet/v3-ActReason

Version:

2.0.0

Name:

ActReason

Title:

v3 Code System ActReason

Status:

Active as of 2018-08-12

Definition:

A set of codes specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably represented 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".

Publisher:

HL7, Inc

Committee:

Vocabulary

Maturity:

Source Resource:

XML / JSON / Turtle

References

CommunicationRequest

Logical Definition (CLD)

Include all codes defined in http://terminology.hl7.org/CodeSystem/v3-ActReason

Expansion

This value set contains 248 concepts

Expansion based on ActReason v2.0.0 (CodeSystem)

All codes from system http://terminology.hl7.org/CodeSystem/v3-ActReason

Code	Display	Definition
_ActAccommodationReason	ActAccommodationReason	Identifies the reason the patient is assigned to this accommodation type
ACCREQNA	Accommodation Requested Not Available	Accommodation requested is not available.
FLRCNV	Floor Convenience	Accommodation is assigned for floor convenience.
MEDNEC	Medical Necessity	Required for medical reasons(s).
PAT	Patient request	The Patient requested the action
_ActCoverageReason	ActCoverageReason	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.
_EligibilityActReasonCode	EligibilityActReasonCode	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.
_ActIneligibilityReason	ActIneligibilityReason	Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy. Examples are client deceased & adopted client has been given a new policy identifier.
COVSUS	coverage suspended	When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc. Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).
DECSD	deceased	Client deceased.
REGERR	registered in error	Client was registered in error.
_CoverageEligibilityReason	CoverageEligibilityReason	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.
AGE	age eligibility	A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.
CRIME	crime victim	A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program.
DIS	disability	A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
EMPLOY	employment benefit	A person becomes eligible for insurance provided as an employment benefit based on employment status.
FINAN	financial eligibility	A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
HEALTH	health status	A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
MULTI	multiple criteria eligibility	A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
PNC	property and casualty condition	A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
STATUTORY	statutory eligibility	A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
VEHIC	motor vehicle accident victim	A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
WORK	work related	A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program.
_ActCoverageProviderReason	ActCoverageProviderReason	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.
_ActCoverageServiceReason	ActCoverageServiceReason	Description:Identifies the reason or rationale for coverage of a service or product based on clinical efficacy criteria or practices prescribed by the payor.
_CoverageExclusionReason	CoverageExclusionReason	Definition: Identifies the reason or rationale for coverage of a service or product based on coverage exclusions related to the risk of adverse selection by covered parties.
_CoverageFinancialParticipationReason	CoverageFinancialParticipationReason	Description:Identifies the reason or rationale for coverage of a service or product based on financial participation responsibilities of the covered party.
_CoverageLimitationReason	CoverageLimitationReason	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.
_ActInformationManagementReason	ActInformationManagementReason	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.
_ActHealthInformationManagementReason	ActHealthInformationManagementReason	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.
_ActConsentInformationAccessOverrideReason	ActConsentInformationAccessOverrideReason	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.
OVRER	emergency treatment override	To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention. Usage Notes: The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.
OVRINCOMP	incompetency override	To perform one or more operations on information to which the patient has not consented because deemed incompetent to provide consent. Usage Note: Maps to v2 CON-16 Subject Competence Indicator (ID) 01791 Definition: Identifies whether the subject was deemed competent to provide consent. Refer to table HL7 Table 0136 - Yes/No Indicator and CON-23 Non-Subject Consenter Reason User-defined Table 0502 - Non-Subject Consenter Reason code NC "Subject is not competent to consent".
OVRPJ	professional judgment override	To perform one or more operations on information to which the patient declined to consent for providing health care. Usage Notes: The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.
OVRPS	public safety override	To perform one or more operations on information to which the patient has not consented for public safety reasons. Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.
OVRTPS	third party safety override	To perform one or more operations on information to which the patient has not consented for third party safety. Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.
PurposeOfUse	purpose of use	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.
HMARKT	healthcare marketing	To perform one or more operations on information for marketing services and products related to health care.
HOPERAT	healthcare operations	To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
CAREMGT	care management	To perform analytics, evaluation and other secondary uses of treatment and healthcare related information to manage the quality, efficacy, patient safety, population health, and cost effectiveness of healthcare delivery. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment. Usage Note: The concept of care management is narrower than the list of activities related to more general organizational objectives such as provider profiling, education of healthcare and non-healthcare professionals; insurance underwriting, premium rating, reinsurance; organizational legal, medical review, auditing, compliance and fraud and abuse detection; business planning, development, and restructuring; fund-raising; and customer service. Map: Maps to ISO 14265 Classification Term "Health service management and quality assurance" described as "To inform persons or processes responsible for determining the availability, quality, safety, equity and cost-effectiveness of health care services." There is a semantic gap in concepts. This classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
DONAT	donation	To perform one or more operations on information used for cadaveric organ, eye or tissue donation.
FRAUD	fraud	To perform one or more operations on information used for fraud detection and prevention processes.
GOV	government	To perform one or more operations on information used within government processes.
HACCRED	health accreditation	To perform one or more operations on information for conducting activities related to meeting accreditation criteria.
HCOMPL	health compliance	To perform one or more operations on information used for conducting activities required to meet a mandate.
HDECD	decedent	To perform one or more operations on information used for handling deceased patient matters.
HDIRECT	directory	To perform one or more operation operations on information used to manage a patient directory. Examples: * facility * enterprise * payer * health information exchange patient directory
HDM	healthcare delivery management	To perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment. Usage Note: Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking. Map: Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care." However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
HLEGAL	legal	To perform one or more operations on information for conducting activities required by legal proceeding.
HOUTCOMS	health outcome measure	To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
HPRGRP	health program reporting	To perform one or more operations on information used for conducting activities to meet program accounting requirements.
HQUALIMP	health quality improvement	To perform one or more operations on information used for conducting administrative activities to improve health care quality.
HSYSADMIN	health system administration	To perform one or more operations on information to administer the electronic systems used for the delivery of health care.
LABELING	labeling	To perform one or more operations on information to assign, persist, and manage labels to healthcare data to characterize various aspects, such as its security classification, sensitivity, compartment, integrity, and provenance; applicable privacy, consent, security, provenance, and trust policies; and handling caveats such as purpose of use, obligations, and refrain policies. Label management includes classification of target data by constructing and binding of a label set per applicable policies, security policy information file semantics, and classification guides. Label management also includes process and procedures for subsequent revision of a label for, e.g., reclassification, downgrading classification, and declassification. Label revisions may be triggered by, e.g., expiry of classification period; changes in applicable policy, e.g., revocation of a consent directive; or changes in the governing policy domain in which the data is relocated or a copy of the data is sent. If a label is revised, an audit log should be kept and the provenance of the label changes should be tracked.
METAMGT	metadata management	To perform one or more operations on information to assign, persist, and manage metadata to healthcare data to characterize various aspects used for its indexing, discovery, retrieval, and processing by systems, applications, and end users. For example, master index identifier, media type, and location.
MEMADMIN	member administration	To perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.
MILCDM	military command	To perform one or more operations on information for conducting activities required by military processes, procedures, policies, or law.
PATADMIN	patient administration	To perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.
PATSFTY	patient safety	To perform one or more operations on information in processes related to ensuring the safety of health care.
PERFMSR	performance measure	To perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.
RECORDMGT	records management	To perform one or more operations on information used within the health records management process.
SYSDEV	system development	To perform one or more operations on information to design, develop, implement, test, or deploy a healthcare system or application.
HTEST	test health data	To perform one or more operations on information that is simulated or synthetic health data used for testing system capabilities outside of a production or operational system environment. Usage Note: Data marked with a HTEST security label enables an access control system to permit interfacing systems or end users provisioned with a clearance, which includes a HTEST purpose of use attribute, to test, verify, or validate that a system or application will operate in production as intended based on design specifications.
TRAIN	training	To perform one or more operations on information used in training and education.
HPAYMT	healthcare payment	To perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.
CLMATTCH	claim attachment	To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
COVAUTH	coverage authorization	To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
COVERAGE	coverage under policy or program	To perform one or more operations on information for conducting activities related to coverage under a program or policy.
ELIGDTRM	eligibility determination	To perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.
ELIGVER	eligibility verification	To perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.
ENROLLM	enrollment	To perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.
MILDCRG	military discharge	To perform one or more operations on information for the process of releasing military personnel from their service obligations, which may include determining service merit, discharge benefits, and disability assessment.
REMITADV	remittance advice	To perform one or more operations on information about the amount remitted for a health care claim.
HRESCH	healthcare research	To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data iincludes basic and applied research such as biomedical, population origin or ancestry, translational research, and disease, discipline, specialty specific healthcare research and clinical trial research.
BIORCH	biomedical research	To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified biomedical basic or applied research. For example, research on rare plants to determine whether biologic properties may be useful for pharmaceutical development. May be used in combination with clinical trial and other healthcare research purposes of use.
CLINTRCH	clinical trial research	To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
CLINTRCHNPC	clinical trial research without patient care	To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge without provision of patient care. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, a clinical trial conducted on laboratory specimens collected from a specified patient population.
CLINTRCHPC	clinical trial research with patient care	To perform one or more operations on information for conducting scientific investigations with patient care in accordance with clinical trial protocols to obtain health care knowledge. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, an "off-label" drug used for cancer therapy administer to a specified patient population.
PRECLINTRCH	preclinical trial research	To perform one or more operations on information in preparation for conducting scientific investigation to obtain health care knowledge, such as research on animals or review of patient health records, to determine the feasibility of a clinical trial study; assist with protocol design; or in preparation for institutional review board or ethics committee approval process. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research.
DSRCH	disease specific healthcare research	To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified conditions, diagnosis, or disease healthcare research. For example, conducting cancer research by testing reaction of tumor cells to certain biologics. May be used in combination with clinical trial and other healthcare research purposes of use.
POARCH	population origins or ancestry healthcare research	To perform one or more operations on information, including genealogical pedigrees, historical records, surveys, family health data, health records, and genetic information, for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to population origins and/or ancestry healthcare research. For example, gathering genetic specimens from a specific population in order to determine the ancestry and population origins of that group. May be used in combination with clinical trial and other healthcare research purposes of use.
TRANSRCH	translational healthcare research	To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge related to evidence based medicine during the course of providing healthcare treatment. Sometimes referred to as "bench to bedside", which is the iterative feedback loop between healthcare research and clinical trials with input from information collected in the course of routine provision of healthcare. For example, by extending a patient encounter to conduct a survey related to a research topic such as attitudes about use of a wellness device that a patient agreed to use. May be used in combination with clinical trial and other healthcare research purposes of use.
PATRQT	patient requested	To perform one or more operations on information in response to a patient's request.
FAMRQT	family requested	To perform one or more operations on information in response to a request by a family member authorized by the patient.
PWATRNY	power of attorney	To perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.
SUPNWK	support network	To perform one or more operations on information in response to a request by a person authorized by the patient.
PUBHLTH	public health	To perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.
DISASTER	disaster	To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
THREAT	threat	To perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.
TREAT	treatment	To perform one or more operations on information for provision of health care.
CLINTRL	clinical trial	To perform health care as part of the clinical trial protocol.
COC	coordination of care	To perform one or more actions on information in order to organize the provision and case management of an individualâ€™s healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care. Usage Note: Use when describing these functions: 1. Monitoring a personâ€™s goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care. The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment. For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare. Map: Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."
ETREAT	Emergency Treatment	To perform one or more operations on information for provision of immediately needed health care for an emergent condition.
BTG	break the glass	To perform policy override operations on information for provision of immediately needed health care for an emergent condition affecting potential harm, death or patient safety by end users who are not provisioned for this purpose of use. Includes override of organizational provisioning policies and may include override of subject of care consent directive restricting access. Map: Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care." The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure.
ERTREAT	emergency room treatment	To perform one or more operations on information for provision of immediately needed health care for an emergent condition in an emergency room or similar emergent care context by end users provisioned for this purpose, which does not constitute as policy override such as in a "Break the Glass" purpose of use. Map:Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care." The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure. There is a semantic gap in concepts. This classification term is described as activities â€œto inform personsâ€? rather than the rationale for performing actions/operations on information related to the activity.
POPHLTH	population health	To perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.
_ActHealthInformationPrivacyReason	ActHealthInformationPrivacyReason	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.
_ActInformationPrivacyReason	ActInformationPrivacyReason	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.
MARKT	marketing	Description:
OPERAT	operations	Description:Administrative and contractual processes required to support an activity, product, or service
LEGAL	subpoena	Definition:To provide information as a result of a subpoena.
ACCRED	accreditation	Description:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
COMPL	compliance	Description:Operational activities required to meet a mandate related to an activity, product, or service
ENADMIN	entity administration	Description:Operational activities conducted to administer information relating to entities involves with an activity, product, or service
OUTCOMS	outcome measure	Description:Operational activities conducted for the purposes of assessing the results of an activity, product, or service
PRGRPT	program reporting	Description:Operational activities conducted to meet program accounting requirements related to an activity, product, or service
QUALIMP	quality improvement	Description:Operational activities conducted for the purposes of improving the quality of an activity, product, or service
SYSADMN	system administration	Description:Operational activities conducted to administer the electronic systems used for an activity, product, or service
PAYMT	payment	Description:Administrative, financial, and contractual processes related to payment for an activity, product, or service
RESCH	research	Description:Investigative activities conducted for the purposes of obtaining knowledge
SRVC	service	Description:Provision of a service, product, or capability to an individual or organization
_ActInvalidReason	ActInvalidReason	Description: Types of reasons why a substance is invalid for use.
ADVSTORAGE	adverse storage condition	Description: Storage conditions caused the substance to be ineffective.
COLDCHNBRK	cold chain break	Description: Cold chain was not maintained for the substance.
EXPLOT	expired lot	Description: The lot from which the substance was drawn was expired.
OUTSIDESCHED	administered outside recommended schedule or practice	The substance was administered outside of the recommended schedule or practice.
PRODRECALL	product recall	Description: The substance was recalled by the manufacturer.
_ActInvoiceCancelReason	ActInvoiceCancelReason	Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.
INCCOVPTY	incorrect covered party as patient	The covered party (patient) specified with the Invoice is not correct.
INCINVOICE	incorrect billing	The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.
INCPOLICY	incorrect policy	The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.
INCPROV	incorrect provider	The provider specified with the Invoice is not correct.
_ActNoImmunizationReason	ActNoImmunizationReason	A coded description of the reason for why a patient did not receive a scheduled immunization. (important for public health strategy
IMMUNE	immunity	Definition:Testing has shown that the patient already has immunity to the agent targeted by the immunization.
MEDPREC	medical precaution	Definition:The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.
OSTOCK	product out of stock	Definition:There was no supply of the product on hand to perform the service.
PATOBJ	patient objection	Definition:The patient or their guardian objects to receiving the vaccine.
PHILISOP	philosophical objection	Definition:The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.
RELIG	religious objection	Definition:The patient or their guardian objects to receiving the vaccine on religious grounds.
VACEFF	vaccine efficacy concerns	Definition:The intended vaccine has expired or is otherwise believed to no longer be effective. Example:Due to temperature exposure.
VACSAF	vaccine safety concerns	Definition:The patient or their guardian objects to receiving the vaccine because of concerns over its safety.
_ActSupplyFulfillmentRefusalReason	ActSupplyFulfillmentRefusalReason	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)
FRR01	order stopped	Definition:The order has been stopped by the prescriber but this fact has not necessarily captured electronically. Example:A verbal stop, a fax, etc.
FRR02	stale-dated order	Definition:Order has not been fulfilled within a reasonable amount of time, and may not be current.
FRR03	incomplete data	Definition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available Example:Lab results, diagnostic imaging, etc.
FRR04	product unavailable	Definition:Product not available or manufactured. Cannot supply.
FRR05	ethical/religious	Definition:The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.
FRR06	unable to provide care	Definition:Fulfiller not able to provide appropriate care associated with fulfilling the order. Example:Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.
_ClinicalResearchEventReason	ClinicalResearchEventReason	Definition:Specifies the reason that an event occurred in a clinical research study.
RET	retest	Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
SCH	scheduled	Definition:The event occurred due to it being scheduled in the research protocol.
TRM	termination	Definition:The event occurred in order to terminate the subject's participation in the study.
UNS	unscheduled	Definition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.
_ClinicalResearchObservationReason	ClinicalResearchObservationReason	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.
NPT	non-protocol	Definition:The observation or test was neither defined or scheduled in the study protocol.
PPT	per protocol	Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
UPT	per definition	:The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.
_CombinedPharmacyOrderSuspendReasonCode	CombinedPharmacyOrderSuspendReasonCode	Description:Indicates why the prescription should be suspended.
ALTCHOICE	try another treatment first	Description:This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.
CLARIF	prescription requires clarification	Description:Clarification is required before the order can be acted upon.
DRUGHIGH	drug level too high	Description:The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.
HOSPADM	admission to hospital	Description:The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.
LABINT	lab interference issues	Description:The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.
NON-AVAIL	patient not-available	Description:Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.
PREG	parent is pregnant/breast feeding	Description:The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.
SALG	allergy	Description:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
SDDI	drug interacts with another drug	Description:The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.
SDUPTHER	duplicate therapy	Description:Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.
SINTOL	suspected intolerance	Description:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
SURG	patient scheduled for surgery	Description:The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.
WASHOUT	waiting for old drug to wash out	Description:The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.
_ControlActNullificationReasonCode	ControlActNullificationReasonCode	Description:Identifies reasons for nullifying (retracting) a particular control act.
ALTD	altered decision	Description:The decision on which the recorded information was based was changed before the decision had an effect. Example:Aborted prescription before patient left office, released prescription before suspend took effect.
EIE	entered in error	Description:The information was recorded incorrectly or was recorded in the wrong record.
NORECMTCH	no record match	Description: There is no match for the record in the database.
_ControlActNullificationRefusalReasonType	ControlActNullificationRefusalReasonType	Description: Reasons to refuse a transaction to be undone.
INRQSTATE	in requested state	The record is already in the requested state.
NOMATCH	no match	Description: There is no match.
NOPRODMTCH	no product match	Description: There is no match for the product in the master file repository.
NOSERMTCH	no service match	Description: There is no match for the service in the master file repository.
NOVERMTCH	no version match	Description: There is no match for the record and version.
NOPERM	no permission	Description: There is no permission.
NOUSERPERM	no user permission	Definition:The user does not have permission
NOAGNTPERM	no agent permission	Description: The agent does not have permission.
NOUSRPERM	no user permission	Description: The user does not have permission.
WRNGVER	wrong version	Description: The record and version requested to update is not the current version.
_ControlActReason	ControlActReason	Identifies why a specific query, request, or other trigger event occurred.
_MedicationOrderAbortReasonCode	medication order abort reason	Description:Indicates the reason the medication order should be aborted.
DISCONT	product discontinued	Description:The medication is no longer being manufactured or is otherwise no longer available.
INEFFECT	ineffective	Description:The therapy has been found to not have the desired therapeutic benefit on the patient.
MONIT	response to monitoring	Description:Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.
NOREQ	no longer required for treatment	Description:The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.
NOTCOVER	not covered	Description:The product does not have (or no longer has) coverage under the patientaTMs insurance policy.
PREFUS	patient refuse	Description:The patient refused to take the product.
RECALL	product recalled	Description:The manufacturer or other agency has requested that stocks of a medication be removed from circulation.
REPLACE	change in order	Description:Item in current order is no longer in use as requested and a new one has/will be created to replace it.
DOSECHG	change in medication/dose	Description:The medication is being re-prescribed at a different dosage.
REPLACEFIX	error in order	Description:Current order was issued with incorrect data and a new order has/will be created to replace it.
UNABLE	unable to use	Description:<The patient is not (or is no longer) able to use the medication in a manner prescribed. Example:CanaTMt swallow.
_MedicationOrderReleaseReasonCode	medication order release reason	Definition:A collection of concepts that indicate why the prescription should be released from suspended state.
HOLDDONE	suspend reason no longer applies	Definition:The original reason for suspending the medication has ended.
HOLDINAP	suspend reason inappropriate	Definition:
_ModifyPrescriptionReasonType	ModifyPrescriptionReasonType	Types of reason why a prescription is being changed.
ADMINERROR	administrative error in order	Order was created with incorrect data and is changed to reflect the intended accuracy of the order.
CLINMOD	clinical modification	Order is changed based on a clinical reason.
_PharmacySupplyEventAbortReason	PharmacySupplyEventAbortReason	Definition:Identifies why the dispense event was not completed.
CONTRA	contraindication	Definition:Contraindication identified
FOABORT	order aborted	Definition:Order to be fulfilled was aborted
FOSUSP	order suspended	Definition:Order to be fulfilled was suspended
NOPICK	not picked up	Definition:Patient did not come to get medication
PATDEC	patient changed mind	Definition:Patient changed their mind regarding obtaining medication
QUANTCHG	change supply quantity	Definition:Patient requested a revised quantity of medication
_PharmacySupplyEventStockReasonCode	pharmacy supply event stock reason	Definition:A collection of concepts that indicates the reason for a "bulk supply" of medication.
FLRSTCK	floor stock	Definition:The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)
LTC	long term care use	Definition:The bulk supply will be administered within a long term care facility.
OFFICE	office use	Definition:The bulk supply is intended for general clinician office use.
PHARM	pharmacy transfer	Definition:The bulk supply is being transferred to another dispensing facility to. Example:Alleviate a temporary shortage.
PROG	program use	Definition:The bulk supply is intended for dispensing according to a specific program. Example:Mass immunization.
_PharmacySupplyRequestRenewalRefusalReasonCode	pharmacy supply request renewal refusal reason	Definition:A collection of concepts that identifies why a renewal prescription has been refused.
ALREADYRX	new prescription exists	Definition:Patient has already been given a new (renewal) prescription.
FAMPHYS	family physician must authorize further fills	Definition:Request for further authorization must be done through patient's family physician.
MODIFY	modified prescription exists	Definition:Therapy has been changed and new prescription issued
NEEDAPMT	patient must make appointment	Definition:Patient must see prescriber prior to further fills.
NOTAVAIL	prescriber not available	Definition:Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.
NOTPAT	patient no longer in this practice	Definition:Patient no longer or has never been under this prescribers care.
ONHOLD	medication on hold	Definition:This medication is on hold.
PRNA	product not available	Description:This product is not available or manufactured.
STOPMED	prescriber stopped medication for patient	Renewing or original prescriber informed patient to stop using the medication.
TOOEARLY	too early	Definition:The patient should have medication remaining.
_SupplyOrderAbortReasonCode	supply order abort reason	Definition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
IMPROV	condition improved	Definition:The patient's medical condition has nearly abated.
INTOL	intolerance	Description:The patient has an intolerance to the medication.
NEWSTR	new strength	Definition:The current medication will be replaced by a new strength of the same medication.
NEWTHER	new therapy	Definition:A new therapy will be commenced when current supply exhausted.
_ControlActReasonConditionNullify	ControlActReasonConditionNullify	Indicates why the ConditionaTMs status was changed to Nullified. Examples administrative error, diagnostic error.
_GenericUpdateReasonCode	GenericUpdateReasonCode	Description:Identifies why a change is being made to a record.
CHGDATA	information change	Description:Information has changed since the record was created.
FIXDATA	error correction	Description:Previously recorded information was erroneous and is being corrected.
MDATA	merge data	Information is combined into the record.
NEWDATA	new information	Description:New information has become available to supplement the record.
UMDATA	unmerge data	Information is separated from the record.
_PatientProfileQueryReasonCode	patient profile query reason	Definition:A collection of concepts identifying why the patient's profile is being queried.
ADMREV	administrative review	Definition: To evaluate for service authorization, payment, reporting, or performance/outcome measures.
PATCAR	patient care	Definition:To obtain records as part of patient care.
PATREQ	patient request query	Definition:Patient requests information from their profile.
PRCREV	practice review	Definition:To evaluate the provider's current practice for professional-improvement reasons.
REGUL	regulatory review	Description:Review for the purpose of regulatory compliance.
RSRCH	research	Definition:To provide research data, as authorized by the patient.
VALIDATION	validation review	Description:To validate the patient's record. Example:Merging or unmerging records.
_PharmacySupplyRequestFulfillerRevisionRefusalReasonCode	PharmacySupplyRequestFulfillerRevisionRefusalReasonCode	Definition:Indicates why the request to transfer a prescription from one dispensing facility to another has been refused.
LOCKED	locked	Definition:The prescription may not be reassigned from the original pharmacy.
UNKWNTARGET	unknown target	Definition:The target facility does not recognize the dispensing facility.
_RefusalReasonCode	RefusalReasonCode	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.
_SchedulingActReason	SchedulingActReason	Reasons for cancelling or rescheduling an Appointment
BLK	Unexpected Block (of Schedule)	The time slots previously allocated are now blocked and no longer available for booking Appointments
DEC	Patient Deceased	The Patient is deceased
FIN	No Financial Backing	Patient unable to pay and not covered by insurance
MED	Medical Status Altered	The medical condition of the Patient has changed
MTG	In an outside meeting	The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment
PHY	Physician request	The Physician requested the action
_StatusRevisionRefusalReasonCode	StatusRevisionRefusalReasonCode	Indicates why the act revision (status update) is being refused.
FILLED	fully filled	Ordered quantity has already been completely fulfilled.
_SubstanceAdministrationPermissionRefusalReasonCode	SubstanceAdministrationPermissionRefusalReasonCode	Definition:Indicates why the requested authorization to prescribe or dispense a medication has been refused.
PATINELIG	patient not eligible	Definition:Patient not eligible for drug
PROTUNMET	protocol not met	Definition:Patient does not meet required protocol
PROVUNAUTH	provider not authorized	Definition:Provider is not authorized to prescribe or dispense
_SubstanceAdminSubstitutionNotAllowedReason	SubstanceAdminSubstitutionNotAllowedReason	Reasons why substitution of a substance administration request is not permitted.
ALGINT	allergy intolerance	Definition: Patient has had a prior allergic intolerance response to alternate product or one of its components.
COMPCON	compliance concern	Definition: Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.
THERCHAR	therapeutic characteristics	The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.
TRIAL	clinical trial drug	Definition: The specific manufactured drug is part of a clinical trial.
_SubstanceAdminSubstitutionReason	SubstanceAdminSubstitutionReason
CT	continuing therapy	Indicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.
FP	formulary policy	Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.
OS	out of stock	In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.
RR	regulatory requirement	Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
_TransferActReason	TransferActReason	The explanation for why a patient is moved from one location to another within the organization
ER	Error	Moved to an error in placing the patient in the original location.
RQ	Request	Moved at the request of the patient.
_ActAdjudicationReason	ActAdjudicationReason	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.
_ActBillableServiceReason	ActBillableServiceReason	Definition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
_ActBillableClinicalServiceReason	ActBillableClinicalServiceReason	Reason for Clinical Service being performed. This domain excludes reasons specified by diagnosed conditions. Examples of values from this domain include duplicate therapy and fraudulent prescription.
_MedicallyNecessaryDuplicateProcedureReason	MedicallyNecessaryDuplicateProcedureReason	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.
_ActCoverageLevelRasonCode	ActCoverageLevelRasonCode	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.
_ActImmunizationReason	ActImmunizationReason	Description:A coded description of the reason for why a patient was administered an immunization. Examples:Post Exposure - Reason, Universal Immunization Program, Outbreak Control, Universal School Program
_ConrolActNullificationReasonCode	ConrolActNullificationReasonCode	Description:Identifies reasons for nullifying (retracting) a particular control act. Examples:"Entered in error", "altered decision", etc.
_NonPerformanceReasonCode	NonPerformanceReasonCode	The reason the action wasn't performed, e.g. why the medication was not taken. If an action wasn"t performed, it is often clinically important to know why the action wasn"t taken. Examples:Patient refused, clinically inappropriate, absolute contraindication etc.
_ReasonForNotEvaluatingDevice	ReasonForNotEvaluatingDevice	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.
_ReferralReasonCode	ReferralReasonCode	The reason a referral was made. Examples:Specialized Medical Assistance, Other Care Requirements.
BONUS
CHD	Children only	Description:The level of coverage under the policy or program is available only to children
DEP	Dependents only	Description:The level of coverage under the policy or program is available only to a subscriber's dependents.
ECH	Employee and children	Description:The level of coverage under the policy or program is available to an employee and his or her children.
EDU
EMP	Employee only	Description:The level of coverage under the policy or program is available only to an employee.
ESP	Employee and spouse	Description:The level of coverage under the policy or program is available to an employee and his or her spouse.
FAM	Family	Description:The level of coverage under the policy or program is available to a subscriber's family.
IND	Individual	Description:The level of coverage under the policy or program is available to an individual.
INVOICE
PROA
RECOV
RETRO
SPC	Spouse and children	Description:The level of coverage under the policy or program is available to a subscriber's spouse and children
SPO	Spouse only	Description:The level of coverage under the policy or program is available only to a subscribers spouse
TRAN

Explanation of the columns that may appear on this page:

Level

A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies

Source

The source of the definition of the code (when the value set draws in codes defined elsewhere)

Code

The code (used as the code in the resource instance)

Display

The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application

Definition

An explanation of the meaning of the concept

Comments

Additional notes about how to use the code

History

Date

Action

Author

Custodian

Comment

2021-01-20

deprecate