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: There is no match.

Description: There is no match for the record in the database.

Description: There is no match for the product in the master file repository.

Description: There is no match for the service in the master file repository.

Description: There is no match for the record and version.

Description: There is no permission.

**Definition:**The user does not have permission

Description: The agent does not have permission.

Description: The user does not have permission.

There is a clinical issue for the therapy that makes continuation of the therapy inappropriate.

Open Issue: The definition of this code does not correctly represent the concept space of its specializations (children)

Identifies types of detectyed issues for Act class "ALRT" for the administrative and patient administrative acts domains.

The requesting party has insufficient authorization to invoke the interaction.

Description: One or more records in the query response have been suppressed due to consent or privacy restrictions.

**Description:**The specified element did not pass business-rule validation.

The ID of the patient, order, etc., was not found. Used for transactions other than additions, e.g. transfer of a non-existent patient.

The ID of the patient, order, etc., already exists. Used in response to addition transactions (Admit, New Order, etc.).

There may be an issue with the patient complying with the intentions of the proposed therapy

The proposed therapy appears to duplicate an existing therapy

**Description:**The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy, though the specific mechanisms of action vary.

**Description:**The proposed therapy appears to have the same intended therapeutic benefit as an existing therapy and uses the same mechanisms of action as the existing therapy.

**Description:**The proposed therapy is frequently misused or abused and therefore should be used with caution and/or monitoring.

**Description:**The request is suspected to have a fraudulent basis.

A similar or identical therapy was recently ordered by a different practitioner.

This patient was recently supplied a similar or identical therapy from a different pharmacy or supplier.

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

Proposed dosage exceeds standard practice for the patient's age

Proposed dosage exceeds standard practice for the patient's height or body surface area

Proposed dosage exceeds standard practice for the patient's weight

Proposed dosage interval/timing differs from standard practice

Proposed dosage interval/timing differs from standard practice for the identified indication or diagnosis

Proposed dosage is below suggested therapeutic levels

Proposed dosage is below suggested therapeutic levels for the patient's age

Proposed dosage is below suggested therapeutic levels for the patient's height or body surface area

Proposed dosage is below suggested therapeutic levels for the patient's weight

**Description:**The maximum quantity of this drug allowed to be administered within a particular time-range (month, year, lifetime) has been reached or exceeded.

Proposed therapy may be inappropriate or contraindicated due to conditions or characteristics of the patient

Proposed therapy may be inappropriate or contraindicated due to patient age

Proposed therapy is outside of the standard practice for an adult patient.

Proposed therapy is outside of standard practice for a geriatric patient.

Proposed therapy is outside of the standard practice for a pediatric patient.

Proposed therapy may be inappropriate or contraindicated due to an existing/recent patient condition or diagnosis

Proposed therapy may be inappropriate or contraindicated when breast-feeding

Proposed therapy may be inappropriate or contraindicated during pregnancy

**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.

Proposed therapy may be inappropriate or contraindicated due to patient genetic indicators.

Proposed therapy may be inappropriate or contraindicated due to patient gender.

Proposed therapy may be inappropriate or contraindicated due to recent lab test results

Proposed therapy may be inappropriate or contraindicated based on the potential for a patient reaction to the proposed product

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to the proposed product. (Allergies are immune based reactions.)

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to the proposed product. (Intolerances are non-immune based sensitivities.)

Proposed therapy may be inappropriate or contraindicated because of a potential patient reaction to a cross-sensitivity related product.

Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to a cross-sensitivity related product. (Allergies are immune based reactions.)

Proposed therapy may be inappropriate or contraindicated because of a recorded prior adverse reaction to a cross-sensitivity related product.

Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to a cross-sensitivity related product. (Intolerances are non-immune based sensitivities.)

**Description:**A local business rule relating multiple elements has been violated.

**Description:**The specified code is not valid against the list of codes allowed for the element.

**Description:**The specified code has been deprecated and should no longer be used. Select another code from the code system.

**Description:**The element does not follow the formatting or type rules defined for the field.

**Description:**The request is missing elements or contains elements which cause it to not meet the legal standards for actioning.

**Description:**The length of the data specified falls out of the range defined for the element.

**Description:**The length of the data specified is greater than the maximum length defined for the element.

**Description:**The length of the data specified is less than the minimum length defined for the element.

**Description:**The specified element must be specified with a non-null value under certain conditions. In this case, the conditions are true but the element is still missing or null.

**Description:**The specified element is mandatory and was not included in the instance.

**Description:**More than one element with the same value exists in the set. Duplicates not permission in this set in a set.

Description: Element in submitted message will not persist in data storage based on detected issue.

**Description:**The number of repeating elements falls outside the range of the allowed number of repetitions.

**Description:**The number of repeating elements is above the maximum number of repetitions allowed.

**Description:**The number of repeating elements is below the minimum number of repetitions allowed.

Description: Metadata associated with the identification (e.g. name or gender) does not match the identification being verified.

Description: One or more records in the query response have a status of 'obsolete'.

Identifies types of detected issues regarding the administration or supply of an item to a patient.

Administration of the proposed therapy may be inappropriate or contraindicated as proposed

Proposed therapy may interact with certain foods

Proposed therapy may interact with an existing or recent therapeutic product

Proposed therapy may interact with an existing or recent drug therapy

Proposed therapy may interact with existing or recent natural health product therapy

Proposed therapy may interact with a non-prescription drug (e.g. alcohol, tobacco, Aspirin)

**Definition:**The same or similar treatment has previously been attempted with the patient without achieving a positive effect.

**Description:**Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy.

**Description:**Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

**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.

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

Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy

Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition

Supplying the product at this time may be inappropriate or indicate compliance issues with the associated therapy

**Definition:**The requested action has already been performed and so this request has no effect

**Definition:**The therapy being performed is in some way out of alignment with the requested therapy.

**Definition:**The status of the request being fulfilled has changed such that it is no longer actionable. This may be because the request has expired, has already been completely fulfilled or has been otherwise stopped or disabled. (Not used for 'suspended' orders.)

**Definition:**The therapy being performed is not sufficiently equivalent to the therapy which was requested.

**Definition:**The therapy being performed is not generically equivalent (having the identical biological action) to the therapy which was requested.

**Definition:**The therapy being performed is not therapeutically equivalent (having the same overall patient effect) to the therapy which was requested.

**Definition:**The therapy is being performed at a time which diverges from the time the therapy was requested

**Definition:**The therapy action is being performed outside the bounds of the time period requested

**Definition:**The therapy action is being performed too soon after the previous occurrence based on the requested frequency

**Definition:**There should be no actions taken in fulfillment of a request that has been held or suspended.

The patient is receiving a subsequent fill significantly later than would be expected based on the amount previously supplied and the therapy dosage instructions

The patient is receiving a subsequent fill significantly earlier than would be expected based on the amount previously supplied and the therapy dosage instructions

Description: While the record was accepted in the repository, there is a more recent version of a record of this type.

**Definition:**The proposed therapy goes against preferences or consent constraints recorded in the patient's record.

**Definition:**The proposed therapy goes against preferences or consent constraints recorded in the patient's record. An alternate therapy meeting those constraints is available.

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

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

Identifies the type of detected issue is a care gap

Identifies the type of detected issue is a risk adjustment coding gap