Concept Properties that are associated with this Code System or Value Set Version

Identifies the name of the relationship that references the inverse of the current relationship. Allows linking a relationship and its derived inverse.

Indicates whether the relationship is intended to be navigated when selecting a code

Indicates if the association always holds for a concept with itself (refexive), never holds for a concept with itself (irreflexive)

Identifies a type of relationship between codes that is supported by this code system version

Indicates if the relationship always holds in the reverse direction as well (symetric), never holds in the reverse direction as well (antisymetric)

Indicates whether the relationship always (transitive) or never (antitransitive) propagates such that if the association exists from A to B and from B to C that the relationship can be inferred to exist from A to C

The human-readable descriptive name for the code or identifier system

The business version associated with the Naming System

All codes in CPT (including metadata, modifiers, etc).

All codes in CPT that represent procedure codes (no modifiers allowed - e.g. for Claim.item.productOrService).

CPT modifiers (e.g. for Claim.item.modifier)

All CPT codes (no modifiers) that represent procedure codes (e.g. for Procedure.code).

No description

A device used to allow access to a part of a body

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 problem code

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.

** MISSING DESCRIPTION **

Identifies the reason the patient is assigned to this accommodation type

An account represents a grouping of financial transactions that are tracked and reported together with a single balance. Examples of account codes (types) are Patient billing accounts (collection of charges), Cost centers; Cash.

Includes coded 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.

Catagorization of grouping criteria for the associated transactions and/or summary (totals, subtotals).

Actions to be carried out by the recipient of the Adjudication Result information.

No description

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

Codes dealing with the management of Detected Issue observations for the administrative and patient administrative acts domains.

No description

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.

Description: Coded reasons why an antigen is considered invalid.

Definition:An identifying modifier code for healthcare interventions or procedures.

The type of provision(s) made for reimbursing for the deliver of healthcare services and/or goods provided by a Provider, over a specified period.

Type of bounded ROI.

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

No description

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.)

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).

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.

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.

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).

Description:A battery specifies 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 components and, in some cases, will define complex rules that determine whether or not a particular observation is made. Examples: “Blood pressure”, “Full blood count”, “Chemistry panel”.

Description:A sequence of biomolecule like the DNA, RNA, protein and the like.

Description:A variation in a sequence as described by BioSequence.

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).

An Act that of taking on whole or partial responsibility for, or attention to, safety and well-being of a subject of care. Discussion: A care provision event may exist without any other care actions taking place. For example, when a patient is assigned to the care of a particular health professional. In request (RQO) mood care provision communicates 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 by code attribute. In event (EVN) mood care provision indicates the effective time interval of a specified scope of responsibility by a performer (PRF) or set of performers (PRF) for a subject (SBJ). Examples:
  1. Referral from GP to a specialist.
  2. Assignment of a patient or group of patients to the case list of a health professional.
  3. Assignment of inpatients to the care of particular nurses for a working shift.

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)

A clinical document is a documentation of clinical observations and services, with the following characteristics: (1) Persistence - A clinical document continues to exist in an unaltered state, for a time period defined by local and regulatory requirements; (2) Stewardship - A clinical document is maintained by a person or organization entrusted with its care; (3) Potential for authentication - A clinical document is an assemblage of information that is intended to be legally authenticated; (4) 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; (5) Human readability - A clinical document is human readable.”

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.

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.

A group of entries within a composition, topic or category that have a logical association with one another. The representation of a single observation or action might itself be multi-part. The data might need to be represented as a nested set of values, as a table, list, or as a time series. The Cluster class permits such aggregation within an entry for such compound data. Examples include “Haematology investigations” which might include two or more distinct batteries. A cluster may contain batteries and/or individual entries

No description

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.

No description

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

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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.

Used to group a set of acts sharing a common context. Container 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. Open issue: There is a clear conflict between this act and the use of the more general “component” ActRelationship. The question that must be resolved is what should be the class code of the parent (or containing) Act.

An Act where a container is registered either via an automated sensor, such as a barcode reader, or by manual receipt

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

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.

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.

When used in the EVN mood, this concept means with respect to a covered party:

1. A health care insurance policy or plan that is contractually binding between two or more parties; or
2. 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 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).

Description:A determinant peptide in a polypeptide as described by polypeptide.

Class for holding attributes unique to diagnostic images.

No description

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:

Specialization of Act to add the characteristics unique to document management services.

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 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.

The action of coming into sufficient physical proximity to allow physical or chemical interaction. Examples include: exposure to radiation, inhalation of peanut aerosol or viral particles. This includes intended exposure (e.g. administering a drug product) as well as accidental or environmental exposure. Actual vs. potential exposure can be differentiated using Act.uncertaintyCode. The agent to which the subject was exposed is conveyed as a Direct participation or specialization there-of. Constraints: The following Participations should be used with the following Roles and Entities to distinguish the specific entities:

• The exposed entity is the entity of interest that is the recipient of the exposure and potentially affected. This is conveyed through the subject (SBJ) Participation.
• An entity that has carried the agent transmitted in the exposure is the “exposure source” (EXSRC). For example:
  • a person or animal who carried an infectious disease and interacts (EXSRC) with another person or animal (SBJ) transmitting the disease agent; or
  • a place or other environment (EXSRC) and a person or animal (SBJ) 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 (SBJ), also known as “exposure contact”, the “participant” (PART) is used.
• The substance to which the subject is exposed that carries the exposure agent or the chemical substance of interest itself, participates as a “consumable” (CSM). There are at least two configurations: (a) the player of the Role that participates as CSM is the chemical or biological substance mixed or carried by the scoper-entity of the Role (e.g., ingredient role); or (b) the player of the Role that participates as CSM is a mixture known to contain the chemical, radiological or biological substance of interest.
• The device specifically used to administer the substance is associated using the device (DEV) Participation. This may be a device intentionally used (such as applicator device) or it may be a thing that accidentally carried this substance; for instance, an infected needle or knife. The same entity may be related in the act as both EXSRC and DEV.

Description:An expression level of genes/proteins or other expressed genomic entities.

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 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

A contract whose value is measured in monetary terms.

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.

No description

Description:An observation of genomic phenomena.

No description

An event that occurred outside of the control of one or more of the parties involved. Includes the concept of an accident.

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.

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.

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.

Represents concepts related to invoice processing in health care

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.

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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. The code attribute of Observation and the value attribute 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 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.

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.

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.

Description:A genomic phenomenon that is expressed externally in the organism.

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

Description:A polypeptide resulting from the translation of a gene.

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.

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.

ActCodeProcessStep - Property applies to value sets that contain classCode values in structural vocabularies. It identifies by name the Concept Domain(s) that represent(s) the concepts that are sub-types of the concept collection established by the value sets of class codes.

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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 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.

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.

No description

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.Usage notes:

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

The act of examining and evaluating the subject, usually another act. For example, “This prescription needs to be reviewed in 2 months.”

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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.

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.

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

A procedure for obtaining a specimen from a source entity.

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

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.

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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 a command, according to the mood of the control act.

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.

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

The spatial relationship of a subject whether human, other animal, or plant, to a frame of reference such as gravity or a collection device.

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

No description

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 value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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.

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.

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.

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.

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.)

Deprecation Comment: This value set has been deprecated because its root code was deprecated in an earlier vocabulary release.

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.

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.

No description

List of condition observations.

ActConsentDirective codes are used to specify the type of Consent Directive to which a Consent Directive Act conforms.

ActConsentDirective and ActConsentType codes are used to specify the type of Consent Directive or Consent Type to which, for example, a Consent Act conforms, to which a Security Observation (Security Label) refers to, or to which a Privacy or Security Act refers. > Steward: Security WG

Definition: 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: 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.

Constrains the ActCode to the domain of Container Registration

An observation form that determines parameters or attributes of an Act. Examples are the settings of a ventilator machine as parameters of a ventilator treatment act; the controls on dillution factors of a chemical analyzer as a parameter of a laboratory observation act; the settings of a physiologic measurement assembly (e.g., time skew) or the position of the body while measuring blood pressure. Control variables are forms of observations because just as with clinical observations, the Observation.code determines the parameter and the Observation.value assigns the value. While control variables sometimes can be observed (by noting the control settings or an actually measured feedback loop) they are not primary observations, in the sense that a control variable without a primary act is of no use (e.g., it makes no sense to record a blood pressure position without recording a blood pressure, whereas it does make sense to record a systolic blood pressure without a diastolic blood pressure).

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 authorization for healthcare service(s) and/or product(s). If authorization is approved, funds are set aside.

Response to an insurance coverage eligibility query or authorization request.

Criteria that are applicable to the authorized coverage.

Definition: Codes representing the maximum coverate or financial participation requirements.

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.

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

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 individuals.

Identifies types of detected issues for Act class “ALRT”

Codes dealing with the management of Detected Issue observations

Code set to define specialized/allowed diets

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.)

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.

Domain provides codes that qualify the ActEncounterClass (ENC)

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.

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.

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.

No 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.

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).

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

Set of codes indicating the type of incident or accident.

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.

Definition: Consent to access healthcare information.

The type of personal health information to which the subject of the information, or the delegate of the subject, consents or dissents to authorize access.

Conveyance of the type of context in which authorization given under jurisdictional law, by organizational policy, or by a patient consent directive permits the collection, access, use or disclosure of specified patient health information. Steward: Security WG

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

ActSensitivity codes are used to bind information to an Act.confidentialityCode according to local sensitivity policy so that those confidentiality codes can then govern its handling across enterprises. Internally to a policy domain, however, local policies guide the access control system on how end users in that policy domain are able to use information tagged with these sensitivity values.

Description: Conveyance of the type of information transfer protocol.

No description

An inpatient encounter is an encounter in which the patient is admitted to a hospital or equivalent facility.

Set of codes indicating the type of insurance policy or other source of funds to cover healthcare costs.

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.

Codes representing a 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.

Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.

Codes representing a 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, etc.

An identifying data string for healthcare products.

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.

An identifying data string for A substance used as a medication or in the preparation of medication.

The billable item codes to identify adjudicator specified components to the total billing of a claim.

The detail item codes to identify charges or changes to the total billing of a claim due to insurance rules and payments.

The billable item codes to identify modifications to a billable item charge. As for example after hours increase in the office visit fee.

The billable item codes to identify provider supplied charges or changes to the total billing of a claim.

An identifying data string for medical facility accommodations.

The billable item codes to identify modifications to a billable item charge by a tax factor applied to the amount. As for example 7% provincial 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.

Identifies the different 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.

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. 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 it’s immediate children invoice elements.

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. 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 it’s immediate children invoice elements. The domain is only specified for an intermediate invoice element group (non-root or non-top level) for an Invoice.

Includes coded 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.

No description

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. 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 it’s immediate children invoice elements. Codes from this domain reflect the type of Invoice such as Pharmacy Dispense, Clinical Service and Clinical Product. The domain is only specified for the root (top level) invoice element group for an Invoice.

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

General category of medical service provided to the patient during their encounter.

List of medications.

No description

Identifies types of monitoring programs

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.)

No description

A planned Act for a specific time and place.

A request for the booking of an appointment.

These are moods describing activities as they progress in the business cycle, from defined, through planned and ordered to completed.

A criterion or condition over actual and potential services that must apply for an associated service to be considered. Matches records any ActMoodCompletionTrack moods.

A definition of a service (master). Historical note: in previous RIM versions, the definition mood was captured as a separate class hierarchy, called Master_service.

No description

A criterion or condition over service events that must apply for an associated service to be considered.

A service that actually happens, may be an ongoing service or a documentation of a past service. Historical note: in previous RIM versions, the event mood was captured as a separate class hierarchy, called Patient_service_event, and later Service_event.

Definition:An act that is considered likely to occur in the future. The essential feature of an act expressed in expectation mood is that it is likely to occur. An expectation may be desirable, undesirable or neutral in effect. Examples:Prognosis of a condition, Expected date of discharge from hospital, patient will likely need an emergency decompression of the intracranial pressure by morning. Discussion:INT (intent) reflects a plan for the future, which is a declaration to do something. This contrasts with expectation, which is a prediction that something will happen in the future. GOL (goal) reflects a hope rather than a prediction. RSK (risk) reflects a potential negative event that may or may not be expected to happen.

Definition:An observation that is considered to be desirable to occur in the future. The essential feature of a goal is that if it occurs it would be considered as a marker of a positive outcome or of progress towards a positive outcome. Examples:Target weight below 80Kg, Stop smoking, Regain ability to walk, goal is to administer thrombolytics to candidate patients presenting with acute myocardial infarction. Discussion: INT (intent) reflects a plan for the future, which is a declaration to do something. This contrasts with goal which doesn’t represent an intention to act, merely a hope for an eventual result. A goal is distinct from the intended actions to reach that goal. “I will reduce the dose of drug x to 20mg” is an intent. “I hope to be able to get the patient to the point where I can reduce the dose of drug x to 20mg” is a goal. EXPEC (expectation) reflects a prediction rather than a hope. RSK (risk) reflects a potential negative event rather than a hope.

An intention or plan to perform a service. Historical note: in previous RIM versions, the intent mood was captured as a separate class hierarchy, called Service_intent_or_order.

An option is an alternative set of property-value bindings. Options specify alternative sets of values, typically used in definitions or orders to describe alternatives. An option can only be used as a group, that is, all assigned values must be used together. Historical note: in HL7 v2.x option existed in the special case for alternative medication routes (RXR segment).

A kind of service which is authorized to be performed.

A request for authorization to perform a kind of service. This is distinct from RQO which is a request for an actual act. PERMRQ is merely a request for permission to perform an act.Discussion:

No description

Any of the above service moods (e.g., event, intent, or goal) can be turned into a predicate used as a criterion to express conditionals (or queries.) However, currently we allow only criteria on service events.

An intent to perform a service that has the strength of a commitment, i.e., other parties may rely on the originator of such promise that said originator will see to it that the promised act will be fulfilled. A promise can be either solicited or unsolicited.

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.

A non-mandated intent to perform an act where a level of professional responsibility is being accepted by making the proposal.

A request or order for a service is an intent directed from a placer (request author) to a fulfiller (service performer). Rationale: The concepts of a “request” and an “order” are viewed as different, because there is an implication of a mandate associated with order. In practice, however, this distinction has no general functional value in the inter-operation of health care computing. “Orders” are commonly refused for a variety of clinical and business reasons, and the notion of a “request” obligates the recipient (the fulfiller) to respond to the sender (the author). Indeed, in many regions, including Australia and Europe, the common term used is “request.” Thus, the concept embodies both notions, as there is no useful distinction to be made. If a mandate is to be associated with a request, this will be embodied in the “local” business rules applied to the transactions. Should HL7 desire to provide a distinction between these in the future, the individual concepts could be added as specializations of this concept. The critical distinction here, is the difference between this concept and an “intent”, of which it is a specialization. An intent involves decisions by a single party, the author. A request, however, involves decisions by two parties, the author and the fulfiller, with an obligation on the part of the fulfiller to respond to the request indicating that the fulfiller will indeed fulfill the request.

Periods of time on a schedule for a resource. Appointments occupy sets of one or more booked slots. A slot that is open for appointments is considered available and a slot that is held back for administrative purposes is considered blocked. A Resource slot that is “tentatively” booked is referred to as reserved.

Definition:An act that may occur in the future and which is regarded as undesirable. The essential feature of a risk is that if it occurs this would be regarded as a marker of a negative outcome or of deterioration towards a negative outcome. Recording a risk indicates that it is seen as more likely to occur in the subject than in a general member of the population but does not mean it is expected to occur. Examples:Increased risk of DVT, at risk for sub-acute bacterial endocarditis. Discussion:Note: An observation in RSK mood expresses the undesirable act, and not the underlying risk factor. A risk factor that is present (e.g. obesity, smoking, etc) should be expressed in event mood. INT (intent) reflects a plan for the future, which is a declaration to do something. This contrasts with RSK (risk), which is the potential that something negative will occur that may or may not ever happen. GOL (goal) reflects a hope to achieve something. EXPEC (expectation) is the prediction of a positive or negative event. This contrasts with RSK (risk), which is the potential that something negative will occur that may or may not ever happen, and may not be expected to happen.

A coded description of the reason for why a patient did not receive a scheduled immunization. (important for public health strategy

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

No description

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

1. Verification of eligibility for coverage under a policy or program - aka enrolled/covered by a policy or program
2. Verification of record - e.g., person has record in an immunization registry
3. Verification of enumeration - e.g. NPI
4. Verification of Board Certification - provider specific
5. Verification of Certification - e.g. JAHCO, NCQA, URAC
6. Verification of Conformance - e.g. entity use with HIPAA, conformant to the CCHIT EHR system criteria
7. Verification of Provider Credentials
8. Verification of no adverse findings - e.g. on National Provider Data Bank, Health Integrity Protection Data Base (HIPDB)

Provides a categorization for annotations recorded directly against the patient

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.

Code identifying the method or the movement of payment instructions. Codes are drawn from X12 data element 591 (PaymentMethodCode)

Identifies types of dispensing events

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

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.

Filler should contact the placer (or target) to schedule the service. (Was “C” in HL7 version 2.3’s TQ-priority component.)

ActPrivacyLaw codes may be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialtyCode complies. May be used to further specify rationale for assignment of other ActPrivacyPolicy codes in the US realm, e.g., ETH and 42CFRPart2 can be differentiated from ETH and Title38Part1.

ActPrivacyPolicyType codes support the designation of the 1..* policies that are applicable to an Act such as a Consent Directive, a Role such as a VIP Patient, or an Entity such as a patient who is a minor. 1..* ActPrivacyPolicyType values may be associated with an Act or Role to indicate the policies that govern the assignment of an Act or Role confidentialityCode. Use of multiple ActPrivacyPolicyType values enables fine grain specification of applicable policies, but must be carefully assigned to ensure cogency and avoid creation of conflicting policy mandates. Statutory title may be named in the ActClassPolicy Act Act.title to specify which privacy policy is being referenced.

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

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.

Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element.

Used to convey the relationship between two or more Acts for purpose of tracking provenance relationships such as the following:

• A predecessor Act and a successor Act (e.g., a predecessor Lab Result from which a successor Lab Result in derived)
• A ProvenanceEvent Act and a target Act for which it records the Provenance (e.g., a target Act is an update of a predecessor Act)
• A predecessor ProvenanceEvent Act and a successor ProvenanceEvent Act UsageConstraint: The v:ActRelationshipActProvenance is intended to limit the types of relationships that could be conveyed by the ActRelationshipType codes to a subset that pertains to these provenance relations.

No description

No description

No description

No description

The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act entered into the source Act by means of the target Transportation act.

Used to assign a “name” to a condition thread. Source is a condition node, target can be any service.

A relationship in which the target act authorizes or certifies the source act.

Definition: The source act is performed to block the effects of the target act. This act relationship should be used when describing near miss type incidents where potential harm could have occurred, but the action described in the source act blocked the potential harmful effects of the incident actually occurring.

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.

Condition is tested every time before execution of the service (WHILE condition DO service).

Condition is tested at the end of a repeated service execution. The service is repeated only if the condition is true (DO service WHILE condition).

Condition is tested once before the service is executed (IF condition THEN service).

Condition is a loop checkpoint, i.e. it is a step of an activity plan and, if negative causes the containing loop to exit.

Condition must be true throughout the execution and the service is interrupted (asynchronously) as soon as the condition turns false (asynchronous WHILE loop). The service must be interruptible.

No description

No description

Specifies under what circumstances (target Act) the source-Act may, must, must not or has occurred

No description

No description

No description

No description

Expresses values for describing the relationship relationship between an InvoiceElement or InvoiceElementGroup and a billable act.

A relationship in which the source act is covered by or is under the authority of a target act. A financial instrument such as an Invoice Element is covered by one or more specific instances of an Insurance Policy.

No description

The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act departed from the source Act by means of the target Transportation act.

No description

The reasons that may be used when relating a Quality Measure Document to other document types.

Used to convey the relationship between two or more Documents for purpose of tracking provenance relationships such as a predecessor Document and a successor Document. For example, a predecessor Clinical Summary Document from which a successor Clinical Summary Document is derived.

The source act documents the target act.

No description

No description

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

No description

The source Act ends after the end of the target Act (i.e. if we say “ActOne EBE ActTwo”, it means that ActOne ends before the end of ActTwo, therefore ActOne is the source and ActTwo is the target).

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

No description

No description

The source Act ends when the target act starts (i.e. if we say “ActOne ECWS ActTwo”, it means that ActOne ends when ActTwo starts, therefore ActOne is the source and ActTwo is the target).

No description

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Expresses an association that links two instances of the same act over time, indicating that the instance are part of the same episode, e.g. linking two condition nodes for episode of illness; linking two encounters for episode of encounter.

A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a “goal distance” (e.g., goal to observation) can be “calculated” and need not be sent explicitly.

No description

The source is an excerpt from the target.

The source is a direct quote from the target.

The source act fulfills (in whole or in part) the target act. Source act must be in a mood equal or more actual than the target act.

No description

A specialization of “has support” (SPRT), used to relate a secondary observation to a Region of Interest on a multidimensional observation, if the ROI specifies the true boundaries of the secondary observation as opposed to only marking the approximate area. For example, if the start and end of an ST elevation episode is visible in an EKG, this relation would indicate the ROI bounds the “ST elevation” observation – the ROI defines the true beginning and ending of the episode. Conversely, if a ROI simply contains ST elevation, but it does not define the bounds (start and end) of the episode, the more general “has support” relation is used. Likewise, if a ROI on an image defines the true bounds of a “1st degree burn”, the relation “has bounded support” is used; but if the ROI only points to the approximate area of the burn, the general “has support” relation is used.

A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service. The financial transaction will define the charge (bill) for delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.

A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently.

A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood.

A contraindication is just a negation of a reason, i.e. it gives a condition under which the action is not to be done. Both, source and target can be any kind of service; target service is in criterion mood. How the strength of a contraindication is expressed (e.g., relative, absolute) is left as an open issue. The priorityNumber attribute could be used.

A relationship from an Act to a Control Variable. For example, if a Device makes an Observation, this relates the Observation to its Control Variables documenting the device’s settings that influenced the observation.

A relationship that provides an ability to associate a financial transaction (target) as a cost to a clinical act (source). A clinical act may have an inherit cost associated with the execution or delivery of the service. The financial transaction will define the cost of delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.

A credit relationship ties a financial transaction (target) to an account (source). A credit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account credit will decrease the account balance. A non-asset account credit will decrease the account balance.

A debit relationship ties a financial transaction (target) to an account (source). A debit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account debit will increase the account balance. A non-asset account debit will decrease the account balance.

This is the inversion of support. Used to indicate that a given observation is explained by another observation or condition.

A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention). Target must be an observation in criterion mood.

The generalization relationship can be used to express categorical knowledge about services (e.g., amilorid, triamterene, and spironolactone have the common generalization potassium sparing diuretic).

A goal that one defines given a patient’s health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood.

No description

No description

A relationship between a source Act that provides more detailed properties to the target Act. The source act thus is a specialization of the target act, but instead of mentioning all the inherited properties it only mentions new property bindings or refinements. The typical use case is to specify certain alternative variants of one kind of Act. The priorityNumber attribute is used to weigh refinements as preferred over other alternative refinements. Example: several routing options for a drug are specified as one SubstanceAdministration for the general treatment with attached refinements for the various routing options.

No description

A requirement to be true before a service is performed. The target can be any service in criterion mood. For multiple pre-conditions a conjunction attribute (AND, OR, XOR) is applicable.

A relationship in which the target act is a predecessor instance to the source act. Generally each of these instances is similar, but no identical. In healthcare coverage it is used to link a claim item to a previous claim item that might have claimed for the same set of services.

No description

Reference ranges are essentially descriptors of a class of result values assumed to be “normal”, “abnormal”, or “critical.” Those can vary by sex, age, or any other criterion. Source and target are observations, the target is in criterion mood. This link type can act as a trigger in case of alarms being triggered by critical results.

A noteworthy undesired outcome of a patient’s condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed.

No description

Relates an Act to its subject Act that the first Act is primarily concerned with. Examples

1. The first Act may be a ControlAct manipulating the subject Act
2. The first act is a region of interest (ROI) that defines a region within the subject Act.
3. The first act is a reporting or notification Act, that echos the subject Act for a specific new purpose. Constraints An Act may have multiple subject acts. Rationale The ActRelationshipType “has subject” is similar to the ParticipationType “subject”, Acts that primarily operate on physical subjects use the Participation, those Acts that primarily operate on other Acts (other information) use the ActRelationship.

Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post.)

A pre-condition that if true should result in the source Act being executed. The target is in typically in criterion mood. When reported after the fact (i.e. the criterion has been met) it may be in Event mood. A delay between the trigger and the triggered action can be specified. Discussion: This includes the concept of a required act for a service or financial instrument such as an insurance plan or policy. In such cases, the trigger is the occurrence of a specific condition such as coverage limits being exceeded.

No description

Description: The ways that product safety Investigations, about which information is captured in an Individual Case Safety Report, are related to each other. One investigation may be performed at a patient care institution, and the second by a manufacturer, a third by a regulatory agency. They may all investigate the same case and are thus related. Other kinds of relationships are replacement (if the mode of the Investigation is changed).

No description

No description

Used to capture the link between a potential service (“master” or plan) and an actual service, where the actual service instantiates the potential service. The instantiation may override the master’s defaults.

No description

An addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered.

Associates a derived Act with its input parameters. E.G., an anion-gap observation can be associated as being derived from given sodium-, (potassium-,), chloride-, and bicarbonate-observations. The narrative content (Act.text) of a source act is wholly machine-derived from the collection of target acts.

An assertion that a new observation was assumed to be the cause for another existing observation. The assumption is attributed to the same actor who asserts the observation. This is stronger and more specific than the support link. For example, a growth of Staphylococcus aureus may be considered the cause of an abscess. The source (cause) is typically an observation, but may be any service, while the target must be an observation.

An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation.

Items located

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.

Detach this branch from the other branches so it will not be resynchronized with the other branches.

Wait for any one of the branches in the set of exclusive wait branches to terminate, then discontinue all the other exclusive wait branches.

When all other concurrent branches are terminated, interrupt and discontinue this branch.

Wait for this branch to terminate.

A relationship that limits or restricts the source act by the elements of the target act. For example, an authorization may be limited by a financial amount (up to $500). Target Act must be in EVN.CRIT mood.

No description

A trigger-match links an actual service (e.g., an observation or procedure that took place) with a service in criterion mood. For example if the trigger is “observation of pain” and pain is actually observed, and if that pain-observation caused the trigger to fire, that pain-observation can be linked with the trigger.

The source act removes or lessens the occurrence or effect of the target act.

Definition: Used to link a newer version or ‘snapshot’ of a business object (source) to an older version or ‘snapshot’ of the same business object (target). Usage:The identifier of the Act should be the same for both source and target. If the identifiers are distinct, RPLC should be used instead. Name from source to target = “modifiesPrior” Name from target to source = “modifiesByNew”

The target act is a desired outcome of the source act. Source is any act (typically an intervention). Target must be an observation in criterion mood.

The source act is a single occurrence of a repeatable target act. The source and target act can be in any mood on the “completion track” but the source act must be as far as or further along the track than the target act (i.e., the occurrence of an intent can be an event but not vice versa).

An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called “post-condition”.) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute

No description

No description

No description

This is a very unspecific relationship from one item of clinical information to another. It does not judge about the role the pertinent information plays.

Expresses values for describing the relationship between a FinancialTransaction and an Account.

No description

Indicates that the target Act provides evidence in support of the action represented by the source Act. The target is not a ‘reason’ for the source act, but rather gives supporting information on why the source act is an appropriate course of action. Possible targets might be clinical trial results, journal articles, similar successful therapies, etc. Rationale: Provides a mechanism for conveying clinical justification for non-approved or otherwise non-traditional therapies.

Description:A relationship in which the target act is carried out to determine whether an effect attributed to the source act can be recreated.

The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action. Discussion: In prior releases, the code “SUGG” (suggests) was expressed as “an inversion of the reason link.” That code has been retired in favor of the inversion indicator that is an attribute of ActRelationship.

Definition: The source act is performed to recover from the effects of the target act.

Relates either an appointment request or an appointment to the order for the service being scheduled.

A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee.

No description

A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type.

A relationship between a source Act that seeks to reverse or undo the action of the prior target Act. Example: A posted financial transaction (e.g., a debit transaction) was applied in error and must be reversed (e.g., by a credit transaction) the credit transaction is identified as an undo (or reversal) of the prior target transaction. Constraints: the “completion track” mood of the target Act must be equally or more “actual” than the source act. I.e., when the target act is EVN the source act can be EVN, or any INT. If the target act is INT, the source act can be INT.

Associates a specific time (and associated resources) with a scheduling request or other intent.

An act relationship indicating that the source act follows the target act. The source act should in principle represent the same kind of act as the target. Source and target need not have the same mood code (mood will often differ). The target of a sequel is called antecedent. Examples for sequel relationships are: revision, transformation, derivation from a prototype (as a specialization is a derivation of a generalization), followup, realization, instantiation.

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.

The pre-condition associated with the branch is evaluated once and if true the branch may be entered. All other exclusive branches compete with each other and only one will be selected. This implements a COND, IF and CASE conditionals, or “XOR-split.” The order in which the branches are considered may be specified in the priorityNumber attribute.

A branch is selected as soon as the pre-condition associated with the branch evaluates to true. If the condition is false, the branch may be entered later, when the condition turns true. All other exclusive branches compete with each other and only one will be selected. Each waiting branch executes in parallel with the default join code wait (see below). The order in which the branches are considered may be specified in the Service_relationship.priority_nmb.

A branch is executed if its associated preconditions permit. If associated preconditions do not permit, the branch is dropped. Inclusive branches are not suppressed and do not suppress other branches.

A branch is executed as soon as its associated conditions permit. If the condition is false, the branch may be entered later, when the condition turns true. Inclusive branches are not suppressed and do not suppress other branches. Each waiting branch executes in parallel with the default join code wait (see below).

No description

Description:A relationship in which the target act takes place with a defined temporal relationship with respect to the time at which the source act terminates.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

The source Act starts after the start of the target Act (i.e. if we say “ActOne SAS ActTwo”, it means that ActOne starts after the start of ActTwo, therefore ActOne is the source and ActTwo is the target).

No description

No description

The source Act starts after the end of the target Act (i.e. if we say “ActOne SBE ActTwo”, it means that ActOne starts before the end of ActTwo, therefore ActOne is the source and ActTwo is the target).

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

No description

No description

No description

No description

The source Act starts when the target act ends (i.e. if we say “ActOne SCWE ActTwo”, it means that ActOne starts when ActTwo ends, therefore ActOne is the source and ActTwo is the target).

No description

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

No description

No description

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.

Definition: A new act that carries forward the intention of the original act, but does not completely replace it. The status of the predecessor act must be ‘completed’. The original act is the target act and the successor is the source act.

An act that contains summary values for a list or set of subordinate acts. For example, a summary of transactions for a particular accounting period.

Used in the diagnosis of the indicated disease.

No description

Pro-forma value set for each head code in the ActRelationshipType code system; all codes present and future below the head code.

No description

No description

Used when the target Act is a transformation of the source Act. (For instance, used to show that a CDA document is a transformation of a DICOM SR document.)

No description

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: Deprecation Comment: Was mis-named, and a proper representation has been provided. Replaced by value set ActRelationshipCompliesWith.

A condition thread relationship specifically links condition nodes together to form a condition thread. The source is the new condition node and the target links to the most recent node of the existing condition thread.

No description

Definition: Consent to have healthcare information in an electronic health record accessed for research purposes.

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

Identifies the type of observation that is made about a specimen that may affect its processing, analysis or further result interpretation

An observation that reports the dilution of a sample.

An observation that relates to factors that may potentially cause interference with the observation

An observation that reports the volume of a sample.

Set of codes related to specimen treatments

Contains the names (codes) for each of the states in the state-machine of the RIM Act class.

The Act has been terminated prior to the originally intended completion.

Description: The status of an assessment for indications of an abnormal condition.

The Act can be performed or is being performed

** none supplied **

** none supplied **

The Act has been abandoned before activation.

An Act that has terminated normally after all of its constituents have been performed.

An Act that is still in the preparatory stages has been put aside. No action can occur until the Act is released.

An Act that is in the preparatory stages and may not yet be acted upon

Encompasses the expected states of an Act, but excludes “nullified” and “obsolete” which represent unusual terminal states for the life-cycle.

This Act instance was created in error and has been ‘removed’ and is treated as though it never existed. A record is retained for audit purposes only.

This Act instance has been replaced by a new instance.

An Act that has been activated (actions could or have been performed against it), but has been temporarily disabled. No further action should be taken against it until it is released

No description

Describes the type of substance administration being performed.

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

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

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)

A clinician enters a clinical note about a given patient

A person reviews a clinical note of a given patient.

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

A person reviews a list of medication orders submitted to a given patient

A person reviews a list of microbiology results of a given patient.

No description

A person enters documentation about a given patient.

A person (e.g., clinician, the patient herself) reviews patient information in the electronic medical record.

A person reviews a Risk Assessment Instrument report of a given patient.

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.

Deprecation Comment: Content moved to ActCode, and is now represented in value set ActPrivacyLaw.

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.

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.

Either a practitioner role or a relationship type. Note from UTG import - may have been a temporary entry that subsequently disappeared from the FHIR source; unable to locate. Version set to 0.1.0

The type of action to be performed.

High-level categorization of the type of activity.

This can be a unit designator, such as apartment number, suite number, or floor. There may be several unit designators in an address (e.g., “3rd floor, Appt. 342”.) This can also be a designator pointing away from the location (e.g. Across the street from).

Description: An address line is for either an additional locator, a delivery address or a street address.

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

Description:Identifies the different representations of a Address. The representation may affect how the address is used. (E.g. use of Ideographic for formal communications.)

No description

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).

This value set includes smattering of Adjudication Reason codes.

This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.

This value set includes a smattering of adjudication codes.

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.Usage:

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

A device intended to administer a substance to a subject

A role type that is used to further qualify an entity playing a role where the role class attribute is set to RoleClassCommissioningParty.

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

This value set defines a set of codes that can be used to indicate from where the patient came in.

The player of the role is a child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.

Value set for stating if a suspected entity is Not Related, Unlikely Related, Possibly Related, or Related to the cause of the adverse event. Using NCI codes. The values originate with ICH. For information on ICH see https://admin.ich.org/sites/default/files/inline-files/OID_Information_Paper_1.pdf from the INTERNATIONAL CONFERENCE ON HARMONISATION OF TECHNICAL REQUIREMENTS FOR REGISTRATION OF PHARMACEUTICALS FOR HUMAN USE (ICH) document ICH E2B(R3), the Electronic Transmission of Individual Case Safety Reports (ICSRs) Implementation Guide Data Elements and Message Specification, and ICH M8, the Electronic Common Technical Document

Value set of grades used in Adverse Event Clinical Research, especially in Oncology clinical trials

This value set includes codes that describe the type of outcome from the adverse event as typically used in reporting for Clinical Research, post-market surveillance (e.g. Medwatch forms). NCI codes used here This list originates from the ICH E2B R3 (https://database.ich.org/sites/default/files/E2D_Guideline.pdf), specifically CDISC CL.C66768.OUT. For information on ICH see https://admin.ich.org/sites/default/files/inline-files/OID_Information_Paper_1.pdf from the INTERNATIONAL CONFERENCE ON HARMONISATION OF TECHNICAL REQUIREMENTS FOR REGISTRATION OF PHARMACEUTICALS FOR HUMAN USE (ICH) document ICH E2B(R3), the Electronic Transmission of Individual Case Safety Reports (ICSRs) Implementation Guide Data Elements and Message Specification, and ICH M8, the Electronic Common Technical Document.

Action criteria usually associated with serious events that pose a threat to a patient’s life or functioning. Adverse Events criteria to expand on the seriousness of the adverse event. Typically used in reporting for Clinical Research, post-market surveillance (e.g. Form FDA 3500A MedWatch). The adverse event seriousness criteria value set is based on the ICH E2D Post-Approval Safety Data Management: Definitions and Standards for Expedited Reporting guidance (https://database.ich.org/sites/default/files/E2D_Guideline.pdf). For information on ICH see https://admin.ich.org/sites/default/files/inline-files/OID_Information_Paper_1.pdf from the INTERNATIONAL CONFERENCE ON HARMONISATION OF TECHNICAL REQUIREMENTS FOR REGISTRATION OF PHARMACEUTICALS FOR HUMAN USE (ICH) document ICH E2B(R3), the Electronic Transmission of Individual Case Safety Reports (ICSRs) Implementation Guide Data Elements and Message Specification, and ICH M8, the Electronic Common Technical Document

Overall categorization of the event, e.g. product-related or situational.

Codes for the assessment of whether the entity caused the event.

TODO.

Overall seriousness of this event for the patient.

The severity of the adverse event itself, in direct relation to the subject.

No description

Proposed therapy may be inappropriate or contraindicated due to patient age

Observation values used to indicate the age group of a person in terms of age group concept codes.

No description

No description

No description

Reaching a decision through the application of an algorithm designed to weigh the different factors involved.

The clinical status of an allergy disposition (Clinical Focus) Used in Program: C-CDA, C-CDA R2.1 2017-06-09 using this value set

Preferred value set for AllergyIntolerance Clinical Status.

The verification status to support or decline the clinical status of the allergy or intolerance.

Statement about the degree of clinical certainty that a specific substance was the cause of the manifestation in a reaction event.

The risk of an adverse reaction (allergy or intolerance) for this patient upon exposure to the substance (including pharmaceutical products).

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

Indicates the type of use for which the code is defined.

Indicates the type of use for which the code is defined.

No description

An emergency vehicle used for transporting patients to a health care facility after injury or illness. Types of ambulances used in the United States include ground (surface) ambulance, rotor-wing (helicopter), and fixed-wing aircraft (airplane).

No description

Amniotic fluid sac

No description

No description

Application specific media type.

This example value set defines a set of reasons for the cancellation of an appointment.

The scoring for appropriateness of an action based upon RAND.

No description

No description

No description

Identifier types for an artifact (e.g. version-independent, version-specific, short-name, endorser, publisher)

The versioning policy of an artifact or set of artifacts (metadata or strict)

Artificial dentition, artificial subsitutes for the natural dentition

Information was sought but not found (e.g., patient was asked but didn’t know)

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

No description

No description

Audio media type.

The type of process where the audit event originated from.

The type of process where the audit event originated from.

Code representing the role the entity played in the audit event.

No description

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.

Definition: An insurance policy for losses sustained in an automobile accident that typically covers losses incurred by the named insured and parties who may be claimants for losses, such as pedestrians and passengers.

No description

No description

This value set defines codes for resources not yet supported by (or which will never be supported by) FHIR. Many of the codes listed here will eventually be turned into official resources. However, there is no guarantee that any particular resource will be created nor that the scope will be exactly as defined by the codes presented here. Codes in this set will be deprecated if/when formal resources are defined that encompass these concepts.

This value set includes examples of Benefit Category codes.

This value set includes a smattering of Benefit Term codes.

This value set includes a smattering of Benefit type codes.

Whether the cost applies to in-network or out-of-network providers.

Biliary tract

Description: All coded binding realms for terminology constraint context binding.

Description:Animals, including fish and insects, and microorganisms which may participate as assigned entities in biotherapies.

A bubblepack. Medications sealed individually, separated into doses.

Body surface

A container, typically rounded, either glass or plastic with a narrow neck and capable of storing liquid.

Buccal mucosa

No description

The number of a building, house or lot alongside the street. Also known as “primary street number”. This does not number the street but rather the building.

Access modifiers defined by the Clinical Quality Language (CQL) specification in the Access Modifiers topic.

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. Purpose: Supports the selection of the entire ControlledUnclassifiedInformation value set for e.g., rules engine policy set purposes.

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 Purpose: Supports the selection of ControlledUnclassifiedInformation leaf concepts for use, e.g., in security labels.

A practice setting where cardiovascular diagnostic procedures or therapeutic interventions are performed (e.g., cardiac catheterization lab, echocardiography suite)

No description

No description

No description

No description

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

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

No description

No description

Ability of the primary source to push updates/alerts

A solid dosage form in which the drug is enclosed within either a hard or soft soluble container or “shell” made from a suitable form of gelatin.

No description

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.

The type of catalog.

No description

Cecostomy

No description

No description

No description

No description

Cervix of the uterus

The method used to determine the characteristic(s) of the variable.

Example set of codes that can be used for billing purposes.

Internet Assigned Numbers Authority (IANA) Charset Types

Chew

The player of the role is a child of the scoping entity.

The player of the role is the spouse of scoping person’s child.

No description

No description

No description

Direction in which lists of possible answers should be displayed.

(1) A hospital including a physical plant and personnel that provides multidisciplinary diagnosis and treatment for diseases that have one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alteration; requires special training of the patient for rehabilitation; and/or may be expected to require a long period of supervision or care. In addition, patients require the safety, security, and shelter of these specialized inpatient or partial hospitalization settings. (2) A hospital that provides medical and skilled nursing services to patients with long-term illnesses who are not in an acute phase but who require an intensity of services not available in nursing homes

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

• Full citizen
• Asylum seeker
• Permit card holder

Claim roles of the care team members providing products and services.

This value set includes sample Information Category codes.

This value set includes Claim Type codes.

The type of Claim payee Resource.

DescriptionA role recognized through the eligibility of a party play a claimant for benefits covered or provided under an insurance policy.

Description: Subset of null flavors, used for associations as needed for the ITS, and used in InfrastructureRoot.

This value set defines a set of codes that can be used to where the patient left the hospital. Note that this value set explicitly removes ‘oth’ (Other) to allow the binding strength to be extensible and therefore allow the exchange of additional concepts without requiring mapping to ‘oth.’

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.

No description

No description

Code systems used in HL7 standards.

How a code system is maintained by HL7

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.

Description:Indicates why the prescription should be suspended.

Common Tag Codes defined by FHIR project

Commonly encountered UCUM units (for purposes of helping populate look ups).

Codes for general categories of communications such as alerts, instructions, etc.

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

Codes for the reason why a communication did not happen.

Codes describing the purpose or content of the communication.

A named tag set for metadata used to populate a security category label field that “segments” an IT resource per policy by indicating that access and use is restricted to members of a defined community or project. (HL7 Healthcare Privacy and Security Classification System) Usage Note: 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.”

No description

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

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.

The composite scoring method of the measure.

Observation values that communicate the method used in a quality measure to combine the component measure results that are included in a composite measure. Steward: CQI WG

No description

Property identifiers for a concept code

Preferred value set for Condition Categories.

Preferred value set for Condition Clinical Status.

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

Enumeration indicating whether the condition is currently active, inactive, or has been resolved.

The verification status to support or decline the clinical status of the condition or diagnosis.

Some conditions may be attached to an allowable substitution. An allowable substitution is based on a match to any other attributes that may be specified.

Concepts drawn from the HL7 V3 Confidentiality code system . Used in Version 2 messaging in the Security Classification elements in the Message Header segment (MSH) and the Access Restrictions segment (ARV).

Set of codes used to value Act.Confidentiality and Role.Confidentiality attribute in accordance with the definition for concept domain “Confidentiality”.

Modifiers of role based access rights (multiple allowed) Usage Note: All codes that are referenced by this value set were retired as of the November 2013 Harmonization cycle. Guidance for what to use instead of the v:ConfidentialityModifers leaf concepts: celebrity, sensitive, and taboo: These codes have been revised and are now included under v:ActCode at:

• V:ActInformationSensitivityPolicy:2.16.840.1.113883.1.11.20429 - taboo
• V:InformationSensitivityPolicy:2.16.840.1.113883.1.11.20428 - celebrity/VIP and patient requested sensitivity

Indicates the degree of adherence to a specified behavior or capability expected for a system to be deemed conformant with a specification.

This value set includes sample Consent Action codes.

This value set includes sample Regulatory consent policy types from the US and other regions.

This value set includes the four Consent scope codes.

This value set includes base Consent Verification codes.

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

Consulted prescriber, therapy confirmed

This example value set defines a set of codes that can be used to indicate the purpose for which you would contact a contact party.

Types of contact for Role code “CON”

Color of the container cap.

The type of cap associated with a container

Material intended to hold another material for purpose of storage or transport.

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.

No description

A code that specifies how an ActRelationship or Participation contributes to the context of an Act, and whether it may be propagated to descendent Acts whose association allows such propagation (see also attributes Participation.contextControlCode, ActRelationship.contextControlCode, ActRelationship.contextConductionInd).

The association adds to the existing context associated with the Act. Both this association and any associations propagated from ancestor Acts are interpreted as being related to this Act.

The association adds to the existing context associated with the Act, but will not propagate to any descendant Acts reached by conducting ActRelationships (see contextControlCode). Examples: If an ‘Author’ Participation were marked as “Additive, Non-Propagating” it means that the author will be added to the set of author participations that have propagated from ancestor Acts for the purpose of this Act. However only the previously propagated authors will propagate to any child Acts that allow context to be propagated.

The association adds to the existing context associated with the Act, and will propagate to any descendant Acts reached by conducting ActRelationships (see contextControlCode). Examples: If an ‘Author’ Participation were marked as “Additive, Propagating” it means that the author will be added to the set of author participations that have propagated from ancestor Acts, and will itself propagate with the other authors to any child Acts that allow context to be propagated.

The association applies only to the current Act and will not propagate to any child Acts that are related via a conducting ActRelationship (refer to contextConductionInd).

The association adds to the existing context associated with the Act, but replaces associations propagated from ancestor Acts whose typeCodes are the same.

The association is added to the existing context associated with the Act, but overrides an association with the same typeCode. However, this overriding association will not propagate to any descendant Acts reached by conducting ActRelationships (see contextControlCode). Examples: If an ‘Author’ Participation were marked as “Overriding, Non-Propagating” it means that the author will replace the set of author participations that have propagated from ancestor Acts. Furthermore, no author participations whatsoever will propagate to any child Acts that allow context to be propagated.

The association is added to the existing context associated with the Act, but overrides an association with the same typeCode. This overriding association will propagate to any descendant Acts reached by conducting ActRelationships (see contextControlCode). Examples: If an ‘Author’ Participation were marked as “Overriding, Propagating” it means that the author will replace the set of author participations that have propagated from ancestor Acts, and will itself be the only author to propagate to any child Acts that allow context to be propagated.

The association propagates to any child Acts that are related via a conducting ActRelationship (refer to contextConductionInd).

This value set includes sample Contract Action codes.

This value set includes sample Contract Actor Role codes.

This is an example set of Content Derivative type codes, which represent the minimal content derived from the basal information source at a specific stage in its lifecycle, which is sufficient to manage that source information, for example, in a repository, registry, processes and workflows, for making access control decisions, and providing query responses.

This value set includes sample Contract Signer Type codes.

This value set includes sample Contract Subtype codes.

This value set includes sample Contract Term SubType codes.

This value set includes sample Contract Term Type codes.

This value set includes sample Contract Type codes.

How a resource reference is interpreted when evaluating contract offers.

Description:Identifies reasons for nullifying (retracting) a particular control act. Examples:“Entered in error”, “altered decision”, etc.

No description

Identifies why a specific query, request, or other trigger event occurred.

A monitoring program that focuses on narcotics and/or commonly abused substances that are subject to legal restriction.

No description

Copy Number Event.

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

Countries of the world. ISO 3166, part 1, alpha-2 set.

A set of codes identifying specific countries.

This value set includes Coverage Class codes.

This value set includes sample Coverage Copayment Type codes.

This value set includes Coverage SelfPay codes.

Description:Identifies the reason or rational for why a person is eligible for benefits under an insurance policy or program. Examples: A new employee is eligible for health insurance as an employment benefit. A person meets eligibility criteria for government program coverage based on financial, age or health status.

This value set includes CoverageEligibilityResponse Auth Support codes.

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.

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

Role recognized through the issuance of insurance coverage to an identified covered party who has this relationship with the policy holder such as the policy holder themselves (self), spouse, child, etc

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.

A semisolid dosage form containing one or more drug substances dissolved or dispersed in a suitable base; more recently, the term has been restricted to products consisting of oil-in-water emulsions or aqueous microcrystalline dispersions of long chain fatty acids or alcohols that are water washable and more cosmetically and aesthetically acceptable.

No description

No description

No description

Recommended values for criticality observations > Steward: Security WG

No description

The currency unit as defined in ISO 4217

No description

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

A role of a place that further classifies the clinical setting (e.g., cardiology clinic, primary care clinic, rehabilitation hospital, skilled nursing facility) in which care is delivered during an encounter.

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

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

Codes identifying the lifecycle stage of a definition.

High-level categorization of the definition, used for searching, sorting, and filtering.

No description

A delivery address line is frequently used instead of breaking out delivery mode, delivery installation, etc. An address generally has only a delivery address line or a street address line, but not both.

No description

A dentist is a person qualified by a doctorate in dental surgery (D.D. S.) or dental medicine (D.M.D.). licensed by the state to practice dentistry, and practicing within the scope of that license. Many dentists are general practitioners who handle a wide variety of dental needs. Other dentists practice in one of eight specialty areas recognized by the American Dental Association: oral and maxillofacial surgery, orthodontics, periodontics, prosthodontics, endodontics, public health, oral pathology and pediatric dentistry.

No description

Description: A role recognized through the eligibility of a party to play a dependent for benefits covered or provided under a health insurance policy because of an association with the subscriber that is recognized by the policy underwriter.

Domain values for the Device.Alert_levelCode

Codes identifying groupings of parameters; e.g. Cardiovascular.

Codes used to identify medical devices safety characteristics. These codes are taken from the NCI Thesaurus and are provided here as a suggestive example.

Codes used to identify medical devices.

No description

A practice setting where diagnostic procedures or therapeutic interventions are performed

No description

This value set defines a set of codes that can be used to express the role of a diagnosis on the Encounter or EpisodeOfCare record.

No description

This value set defines a set of codes that can be used to indicate dietary preferences or restrictions a patient may have.

Diffusion

This value set defines a set of codes that can be used to choose digital certification.

This value set defines a set of codes that can be used to where the patient left the hospital.

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.

No description

Dissolve

Identifies the current completion state of a clinical document.

The type of document section. Possible values: review of systems, medical history, family history, microscopic findings, etc.

Identifies the storage status of a document.

A storage status in which a document is available on-line.

No description

Proposed dosage instructions for therapy differ from standard practice.

The kind of dose or rate specified.

Proposed length of therpay differs from standard practice

Proposed length of therapy is longer than standard practice

Proposed length of therapy is shorter than that necessary for therapeutic effect

Proposed dosage exceeds standard practice

Proposed dosage interval/timing differs from standard practice

Proposed dosage is below suggested therapeutic levels

Douche

No description

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

No description

No description

Description: The EPSG (European Petroleum Survey Group) dataset represents all Datums, coordinate references (projected and 2D geographic) and coordinate systems (including Cartesian coordinate systems) used in surveying worldwide. Each record includes a 4-8 digit unique identifier. The current version is available from http://www.epsg.org/. The database contains over 4000 records covering spatial data applications worldwide.

The section of a health care facility for providing rapid treatment to victims of sudden illness or trauma.

No description

No description

No description

No description

Electro-osmosis

Description:Identifies the reason or rational for why a person is eligible for benefits under an insurance policy or program. Examples: A new employee is eligible for health insurance as an employment benefit. A person meets eligibility criteria for government program coverage based on financial, age or health status.

Broad category for individuals who complete additional training and education in the area of pre-hospital emergency services and are licensed and/or practice within the scope of that training.

A supply action where there is no ‘valid’ order for the supplied medication. E.g. Emergency vacation supply, weekend supply (when prescriber is unavailable to provide a renewal prescription)

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

No description

This value set defines a set of codes that can be used to indicate the class of encounter: a specific code indicating class of service provided.

This example value set defines a set of codes that can be used to indicate the status of the subject within the encounter

This example value set defines a set of codes that can be used to indicate the type of encounter: a specific code indicating type of service provided.

No description

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

Endocervical

No description

This is an example value set defined by the FHIR project, that could be used to represent possible connection type profile values.

Enema

EnteralFormulaAdditiveType: Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula. This value set is provided as a suggestive example.

Enteral

No description

No description

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 living subject from the animal kingdom.

A physical artifact that stores information about the granting of authorization.

A substance that is fully defined by an organic or inorganic chemical formula, includes mixtures of other chemical substances. Refine using, e.g., IUPAC codes.

The territory of a city, town or other municipality.

A container of other entities.

The territory of a sovereign nation.

The territory of a county, parish or other division of a state or province.

A subtype of ManufacturedMaterial used in an activity, without being substantially changed through that activity. The kind of device is identified by the code attribute inherited from Entity. Usage: This includes durable (reusable) medical equipment as well as disposable equipment.

Naturally occurring, processed or manufactured entities that are primarily used as food for humans and animals.

A grouping of resources (personnel, material, or places) to be used for scheduling purposes. May be a pool of like-type resources, a team, or combination of personnel, material and places.

A health chart included to serve as a document receiving entity in the management of medical records.

A type of container that can hold other containers or other holders.

Class to contain unique attributes of diagnostic imaging equipment.

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

Corresponds to the ManufacturedMaterial class

Any thing that has extension in space and mass, may be of living or non-living origin.

All single celled living organisms including protozoa, bacteria, yeast, viruses, etc.

A politically organized body of people bonded by territory and known as a nation.

No description

A social or legal structure formed by human beings.

A living subject of the species homo sapiens.

A physicial 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.

A living subject from the order of plants.

An agency of the people of a state often assuming some authority over a certain matter. Includes government, governmental agencies, associations.

Corresponds to the Entity class

A politically organized body of people bonded by territory, culture, or ethnicity, having sovereignty (to a certain extent) granted by other states (enclosing or neighboring states). This includes countries (nations), provinces (e.g., one of the United States of America or a French departement), counties or municipalities. Refine using, e.g., ISO country codes, FIPS-PUB state codes, etc.

The territory of a state, province, department or other division of a sovereign country.

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.

A standard value set allowing reference to all EntityDeterminer codes that are equal to or specializations of GROUPKIND. This is the value set used when a model indicates that the binding is to “<= GROUPKIND”.

The described quantified determiner indicates that the given Entity is taken as a general description of a specific amount of a thing. For example, QUANTIFIED_KIND of syringe (quantity = 3,) stands for exactly three syringes.

The described determiner is used to indicate that the given Entity is taken as a general description of a kind of thing that can be taken in whole, in part, or in multiples.

The specific determiner indicates that the given Entity is taken as one specific thing instance. For example, a human INSTANCE (quantity = 1,) stands for exactly one human being.

A standard value set allowing reference to all EntityDeterminer codes that are equal to or specializations of GROUP. This is the value set used when a model indicates that the binding is to “<= GROUP”.

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.

EntitySensitivity codes are used to convey a policy that is applicable to sensitive information conveyed by an entity attribute. May be used to bind a Role.confidentialityCode associated with an Entity per organizational policy. Role.confidentialityCode is defined in the RIM as “an indication of the appropriate disclosure of information about this Role with respect to the playing Entity.”

No description

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.

No description

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

No description

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

The vocabulary table for the Entity.riskCode attribute

Codes representing the defined possible states of an Entity, as defined by the Entity class state machine.

The state representing the fact that the Entity record is currently active.

Definition: The state representing the fact that the entity is inactive.

The ‘typical’ state. Excludes “nullified” which represents the termination state of an Entity record instance that was created in error.

The state representing the termination of an Entity record instance that was created in error.

Epidural

This example value set defines a set of codes that can be used to express the usage type of an EpisodeOfCare record.

No description

No description

No description

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.

No description

No description

No description

No description

No description

The quality of how direct the match is.

The role that the assertion variable plays.

This value set includes sample Claim SubType codes which are used to distinguish the claim types for example within type institutional there may be subtypes for emergency services, bed stay and transportation.

This value set includes Example Coverage Financial Exception Codes.

This value set includes example Diagnosis Related Group codes.

This value set includes example Diagnosis Type codes.

This value set includes example Diagnosis on Admission codes.

Example Message Reasons. These are the set of codes that might be used an updating an encounter using admin-update.

This value set includes example Payment Type codes.

This value set includes example Procedure Type codes.

This value set includes sample Program Reason Span codes.

This value set includes sample Provider Qualification codes.

This value set includes sample Related Claim Relationship codes.

This value set includes sample Revenue Center codes.

This value set includes a smattering of Service Place codes.

Example use codes for the List resource - typical kinds of use.

This value set includes a smattering of Prescription Product codes.

This value set includes sample Exception codes.

Declares what the source of a parameter is.

Defines how concepts are processed into the expansion when it’s for UI presentation.

An occurrence that is scheduled to occur in the future. An Act whose effective time is greater than ‘now’, where ‘now’ is the time the instance is authored.

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

A solid dosage form in which the drug is enclosed within either a hard or soft soluble container made from a suitable form of gelatin, and which releases a drug (or drugs) in such a manner to allow a reduction in dosing frequency as compared to that drug (or drugs) presented as a conventional dosage form.

No description

A solid dosage form containing a drug which allows at least a reduction in dosing frequency as compared to that drug presented in conventional dosage form.

Extra-amniotic

Extracorporeal circulation

Codes used to identify medical devices. Includes concepts from SNOMED CT (http://www.snomed.org/) where concept is-a 49062001 (Device) and is provided as a suggestive example.

The availability status reason of the device.

The availability status of the device.

The result if validation fails

Codes describing the reason why a family member’s history is not available.

A relationship between two people characterizing their “familial” relationship

This value set includes Financial Task codes.

This value set includes Financial Task Input Type codes.

The initial fill against an order. (This includes initial fills against refill orders.)

Example list of general categories for flagged issues. (Not complete or necessarily appropriate.)

Flush

No description

(abstract) Defines font rendering characteristics

This value set includes a sample set of Forms codes.

The player of the role is a child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.

This value set includes sample funds reservation type codes.

No description

A practice setting where GI procedures (such as endoscopies) are performed

Description:Global Trade Item Number is an identifier for trade items developed by GS1 (comprising the former EAN International and Uniform Code Council).

No description

Description:Basic abbreviations defined for the General timing Specification data type.

Holidays

Christian Holidays (Roman/Gregorian “Western” Tradition.)

United States National Holidays (public holidays for federal employees established by U.S. Federal law 5 U.S.C. 6103.)

Description:Other, more specific, abbreviations defined for the General timing Specification data type, that are specializations of one of the Base concepts.

Any elastic aeriform fluid in which the molecules are separated from one another and have free paths.

No description

No description

Gastric

A semisolid system consisting of either suspensions made up of small inorganic particles or large organic molecules interpenetrated by a liquid.

Codes that indicate a individual’s gender identity. This value set is a minimum set of commonly used values. It is expected and encouraged that specific jurisdictions or communities will use additional gender identity concepts that are relevant within their community.

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

(X12N 282N00000N)

No description

Supports communication of purpose of use at a general level.

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

Codes that specify interpretation of genetic analysis, such as “positive”, “negative”, “carrier”, “responsive”, etc.

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.

Genitourinary

Gingival

Describes the progression, or lack thereof, towards the goal against the target.

Example codes for grouping goals to use for filtering or presentation.

Indicates the level of importance associated with reaching or sustaining a goal.

Codes indicating whether the goal has been accepted by a stakeholder.

Types of relationships between two goals.

The player of the role is a child of the scoping person’s son or daughter.

parent of a parent of the subject

The player of the role is a parent of the scoping person’s grandparent.

No description

Code of parameter that is input to the guide.

Concepts used to specify a state or province. Used in Version 2 messaging in the Extended Composite ID with Check Digit (CX), Performing Person Time Stamp (PPN), and Extended Composite ID Number and Name for Persons (XCN) values as well as the Accident (ACC) segment.

The HL7-FormatCodes value set is defined to be the set of FormatCode(s) defined by implementation guides published by HL7 and other SDOs. The use of a formatCode from the FormatCodes value set specifies the technical format that a document conforms to. The formatCode is a further specialization more detailed than the mime-type. The formatCode provides sufficient information to allow any potential document content consumer to know if it can process and/or display the content of the document based on the document encoding, structure and template conformance indicated by the formatCode. The set of formatCodes is intended to be extensible. The Content Logical Description is defined intentionally to permit formatCodes defined by other Standards Development Organizations to be added by inclusion of additional formatCode Code Systems.

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.

No description

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.

No description

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

An HL7 administrative unit that owns artifacts in the FHIR specification.

Hair

The player of the role is related to the scoping entity by sharing only one biological parent.

Set of handling instructions prior testing of the specimen.

This value set includes all HCPCS Level II codes.

No description

A comprehensive classification of locations and settings where healthcare services are provided. This value set is based on the CMS Place of Service code set NHSN location code system that has been developed over a number of years through CDCaTMs interaction with a variety of healthcare facilities and is intended to serve a variety of reporting needs where coding of healthcare service locations is required. Excluded codes are those that do not represent an actual location where health care services can be delivered, IE: Float, or a location aggregation.

Proposed therapy may be inappropriate based on the patient’s height or body surface area

No description

No description

No description

Definition: Living arrangements lacking a permanent residence.

An acute care institution that provides medical, surgical, or psychiatric care and treatment for the sick or the injured.

No description

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. OpenIssue: This value set was approved for deletion in November 2008, and was deleted at release #762. Subsequently, however, it was found that this deletion caused the legacy software embedded in the RMIM Designer in Visio to fail to show appropriate options for concepts in the subject area of this value set. For that reason, the value set was re-added in releasse 813 and DEPRECATED from general use at the same time. This value set should be deleted as soon as it is no longer required to support of the legacy software.

Codes for the representation of the names of human languages.

The set of body locations to or through which a drug product may be administered.

No description

No description

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.

Image media type.

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why an administered dose has been assigned a particular status. Often, this reason describes why a dose is considered invalid. This value set is provided as a suggestive example.

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the validity of a dose relative to a particular recommended schedule. This value set is provided as a suggestive example.

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the source of the vaccine administered. This value set is provided as a suggestive example.

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the patient’s eligibility for a vaccination program. This value set is provided as a suggestive example.

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the status of the patient towards perceived immunity against a vaccine preventable disease. This value set is provided as a suggestive example.

The value set to instantiate this attribute should be drawn from a terminologically robust code system that consists of or contains concepts to support describing the reason why a dose is considered to be subpotent. This value set is provided as a suggestive example.

Description: Indicates the valid antigen count.

A set codes that define the functional status of an implanted device.

Implantation

No description

All codes from code system ActCode._IndividualCaseSafetyReportType

DescriptionA role recognized through the eligibility of a party to play an individual insured for benefits covered or provided under an insurance policy where the party is also the policy holder.

Container intended to contain sufficient material for only one use.

No description

Value Set of codes that specify the reason for the restricted access. Sensitivity codes are not useful for interoperability outside of a policy domain because sensitivity policies are typically localized and vary drastically across policy domains even for the same information category because of differing organizational business rules, security policies, and jurisdictional requirements. For example, an “employee” sensitivity code would make little sense for use outside of a policy domain. “Taboo” would rarely be useful outside of a policy domain unless there are jurisdictional requirements requiring that a provider disclose sensitive information to a patient directly. Sensitivity codes may be more appropriate in a legacy system’s Master Files in order to notify those who access a patient’s orders and observations about the sensitivity policies that apply. Newer systems may have a security engine that uses a sensitivity policy’s criteria directly. The specializable Sensitivity Act.code may be useful in some scenarious if used in combination with a sensitivity identifier and/or Act.titleValue Set of codes that specify the reason for the restricted access. Note that this resource was created in THO in error due to an oversight in the import processing.

Sensitivity codes are not useful for interoperability outside of a policy domain because sensitivity policies are typically localized and vary drastically across policy domains even for the same information category because of differing organizational business rules, security policies, and jurisdictional requirements. For example, an “employee” sensitivity code would make little sense for use outside of a policy domain. “Taboo” would rarely be useful outside of a policy domain unless there are jurisdictional requirements requiring that a provider disclose sensitive information to a patient directly. Sensitivity codes may be more appropriate in a legacy system’s Master Files in order to notify those who access a patient’s orders and observations about the sensitivity policies that apply. Newer systems may have a security engine that uses a sensitivity policy’s criteria directly. The specializable Sensitivity Act.code may be useful in some scenarious if used in combination with a sensitivity identifier and/or Act.title.

Infusion

No description

Inhalation

A small device used for inhaling medicine in the form of a vapour or gas in order to ease a respiratory condition such as asthma or to relieve nasal congestion.

Injection

A device intended to administer liquid into a subject via a

Insertion

Instillation

Institution

This example value set defines a set of codes that can be used to indicate a type of insurance plan.

No description

No description

Interameningeal

No description

Interstitial

Intra-abdominal

Injection, intraarterial

Intra-arterial

Intraarticular

Intrabronchial

Intrabursal

Injection, intracardiac

Intracardiac

Intracartilaginous

Intracaudal

Intracavernosal

Intracavitary

Intracerebral

Intracervical

Intracisternal

Intracorneal

Intracoronal (dental)

Injection, intracoronary

Intracoronary

Intracorpus cavernosum

Intradermal

Intradiscal

Intraductal

Intraduodenal

Intradural

Intraepidermal

Intraepithelial

Intraesophageal

Intragastric

Intraileal

Intralesional

Intraluminal

Intralymphatic

Intramedullary

Injection, intramuscular

Intramuscular

Intraocular

Intraosseous

Intraovarian

Intrapericardial

Intraperitoneal

Intrapleural

Intraprostatic

Intrapulmonary

Intrasinal

Intraspinal

Intrasternal

Intrasynovial

Intratendinous

Intratesticular

Intrathecal

Intrathoracic

Intratracheal

Intratubular

Intratumor

Intratympanic

Intrauterine

Intravascular

Infusion, intravenous

Injection, intravenous

Intravenous

Intraventricular

Intravesicle

Intravitreal

No description

Total counts and total net amounts adjudicated for all Invoice Groupings that were adjudicated within a time period based on the adjudication date of the Invoice Grouping.

Total counts and total net amounts paid for all Invoice Groupings that were paid within a time period based on the payment date.

Total counts and total net amounts billed for all Invoice Groupings that were submitted within a time period. Adjudicated invoice elements are included.

Iontophoresis

No description

Irrigation

A sterile solution intended to bathe or flush open wounds or body cavities; they’re used topically, never parenterally.

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

Jejunum

This value set defines a base set of codes for country, country subdivision and region for indicating where a resource is intended to be used. Note: The codes for countries and country subdivisions are taken from ISO 3166 while the codes for “supra-national” regions are from UN Standard country or area codes for statistical use (M49).

No description

No description

No description

A container for a diverse collection of products intended to be used together for some purpose (e.g. Medicinal kits often contain a syringe, a needle and the injectable medication).

No description

Observation values used to indicate a knowledge subject of interest for which knowledge content is requested (e.g., a medication, a laboratory test, a medical condition).

No description

Observation values used to indicate a knowledge subtopic of interest for which knowledge content is requested (e.g., treatment, etiology, prognosis).

No description

No description

Identifies a type of observation that captures the age of an entity involved in an act with no implied method of determination.

Definition:The set of LOINC codes for the act of determining the period of time that has elapsed since an entity was born or created.

No description

Description:Trigger Event ID as published in the standard.

No description

Value Set of codes specifying an observation sub-type used with observation type code RSLT (Result).

Lacrimal puncta

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.

Laryngeal

Lavage

No description

The type of knowledge asset this library contains.

Definition: A policy under which the insurer agrees to pay a sum of money upon the occurrence of the covered partys death. In return, the policyholder agrees to pay a stipulated amount called a premium at regular intervals. Life insurance indemnifies the beneficiary for the loss of the insurable interest that a beneficiary has in the life of a covered party. For persons related by blood, a substantial interest established through love and affection, and for all other persons, a lawful and substantial economic interest in having the life of the insured continue. An insurable interest is required when purchasing life insurance on another person. Specific exclusions are often written into the contract to limit the liability of the insurer; for example claims resulting from suicide or relating to war, riot and civil commotion. Discussion:A life insurance policy may be used by the covered party as a source of health care coverage in the case of a viatical settlement, which is the sale of a life insurance policy by the policy owner, before the policy matures. Such a sale, at a price discounted from the face amount of the policy but usually in excess of the premiums paid or current cash surrender value, provides the seller an immediate cash settlement. Generally, viatical settlements involve insured individuals with a life expectancy of less than two years. In countries without state-subsidized healthcare and high healthcare costs (e.g. United States), this is a practical way to pay extremely high health insurance premiums that severely ill people face. Some people are also familiar with life settlements, which are similar transactions but involve insureds with longer life expectancies (two to fifteen years).

A hollow tube used to administer a substance into a vein, artery or body cavity

Lingual

A state of substance that is an intermediate one entered into as matter goes from solid to gas; liquids are also intermediate in that they have neither the orderliness of a crystal nor the randomness of a gas. (Note: This term should not be used to describe solutions, only pure chemicals in their liquid state.)

No description

A two-phase system in which one liquid is dispersed throughout another liquid in the form of small droplets.

A liquid preparation which consists of solid particles dispersed throughout a liquid phase in which the particles are not soluble.

General reasons for a list to be empty. Reasons are either related to a summary list (i.e. problem or medication list) or to a workflow related list (i.e. consultation list).

Base values for the order of the items in a list resource.

Defines list rendering characteristics

A code depicting the living arrangements of a person

Code indicating the primary use for which a living subject is bred or grown

Temporary supply of a product without transfer of ownership for the product.

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.

This example value set defines a set of codes that can be used to indicate the physical form of the Location.

The LOINC database provides a set of universal names and ID codes for identifying laboratory and clinical test results. The purpose is to facilitate the exchange and pooling of results, such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes management, and research. The LOINC codes are not intended to transmit all possible information about a test or observation. They are only intended to identify the test result or clinical observation. http://www.regenstrief.org/LOINC/LOINC.htm

The LOINC Document Ontology constrained for usage in the Universal Realm by removal of “regional” Document Types such as the “VA Compensation and Pension” codes.

The term “lotion” has been used to categorize many topical suspensions, solutions and emulsions intended for application to the skin.

Codes for use in the ext-mif-relationship-relationshipKind to capture V3 Model Interchange Format (MIF) SupportedConceptRelationship.relationshipKind values

Codes for use in the ext-mif-relationship-reflexivity to capture V3 Model Interchange Format (MIF) SupportedConceptRelationship.reflexivity values

Codes for use in the ext-mif-relationship-symmetry to capture V3 Model Interchange Format (MIF) SupportedConceptRelationship.symmetry values

Codes for use in the ext-mif-relationship-transitivity to capture V3 Model Interchange Format (MIF) SupportedConceptRelationship.transitivity values

No description

Definition: Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well. Managed care policies specifically exclude coverage for losses insured under a disability policy, workers’ compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy. Discussion: Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member.

Codes representing the defined possible states of a Managed Participation, as defined by the Managed Participation class state machine.

The state representing the fact that the Participation is in progress.

The terminal state resulting from cancellation of the Participation prior to activation.

The terminal state representing the successful completion of the Participation.

The ‘typical’ state. Excludes “nullified” which represents the termination state of a participation instance that was created in error.

The state representing the termination of a Participation instance that was created in error.

The state representing that fact that the Participation has not yet become active.

An example value set representing the ManufacturerModelName concept domain used to convey a coded name for the software used to author content.

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.

A Master Patient Index (MPI) assessment of whether a candidate patient record is a match or not.

Material known to be infectious with human pathogenic microorganisms. Those who handle this material must take precautions for their protection.

Material is highly inflammable and in certain mixtures (with air) may lead to explosions. Keep away from fire, sparks and excessive heat.

Types of Material for EntityClass “MAT”

Flags an element as having unlimited repetitions.

Aggregation method for a measure (e.g. sum, average, median, minimum, maximum, count)

The intended usage for supplemental data elements in the measure.

Observation values that indicate what change in a measurement value or score is indicative of an improvement in the measured item or scored issue.

The type of population.

The scoring type of the measure.

Supplemental data in a population for measuring purposes.

The type of measure (includes codes from 2.16.840.1.113883.1.11.20368).

No description

Internet Assigned Numbers Authority (IANA) Mime Media Types

A device with direct or indirect therapeutic purpose. Values for EntityCode when EntityClass = “DEV”

MedicationAdministration Performer Function Codes

MedicationDispense Performer Function Codes

MedicationKnowledge Characteristic Codes

MedicationKnowledge Package Type Codes

MedicationKnowledge Status Codes

MedicationRequest Category Codes

MedicationRequest Course of Therapy Codes

MedicationRequest Status Reason Codes

Direction in which lists of possible answers should be displayed.

Cap types for medication containers

Identifies the specific hierarchical relationship between the playing and scoping medications. Examples: Generic, Generic Formulation, Therapeutic Class, etc.

No description

No description

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

Direction in which lists of possible answers should be displayed.

Direction in which lists of possible answers should be displayed.

A role type that is used to further qualify an entity playing a role where the role class attribute is set to RoleClassMember.

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.

A health care facility operated by the Department of Defense or other military operation.

Definition: A person playing the role of program eligible under a program based on military status. Discussion: This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either “program eligible” or “subscriber” and the person’s status as a member of the military meets jurisdictional or program criteria

This value set includes sample Missing Tooth Reason codes.

No description

No description

No description

Location (mobile) where healthcare service was delivered.

No description

Model media type.

This value set includes sample Modifier type codes.

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

Indicates why an existing prescription is changed.

Mucosal absorption

Mucous membrane

A container intended to contain sufficient material for more than one use. (I.e. Material is intended to be removed from the container at more than one discrete time period.)

Multipart Media Type

No description

In the absence of an all-encompassing Provider Classification System, both X12N and the National Provider System Workgroup from the Centers for Medicare and Medicaid Services (CMS) commenced work on identifying and coding an external provider table that would be able to codify provider type and provider area of specialization for all medical related providers. CMS’ intent was to provide a single coding structure to support work on the National Provider System, while X12N needed a single common table for trading partner use. The two projects worked independently to some extent until April 1996 when the lists were coordinated and a single taxonomy was proposed. A sub-group of the X12N TG2 WG 15 was charged with resolving differences in the two proposed taxonomies. Their work resulted in a single taxonomy that both CMS and members of X12N found meaningful, easy to use, and functional for electronic transactions. The sub-group initially started with the CMS draft taxonomy. This list incorporated all types of providers associated with medical care in various ways. Many of the providers listed, such as technologists or technicians, support or repair equipment/machinery. A number of the providers offer medical services, in concert with others, and do not or cannot bill independently for their portion. The amount of research to validate and classify all providers using the proposed hierarchical structure was enormous. The X12N sub-group focused on medical providers who are licensed practitioners, those who bill for health-related services rendered, and those who appeared on the Medicare CMS Provider Specialty listing. This included providers who were licensed to practice medicine via state licensure agencies. In addition, a very broad definition of “areas of specialization” was used, which included nationally recognized specialties, provider self-designated specialties, areas of practice focus, and any request by any agency or trading partner submitted before the first taxonomy release. This level of detail captured specialty information in categories detailed enough to support those trading credentialing information, yet broad enough to support those wishing to trade directory level specialization information. In 2001, ANSI ASC X12N asked the NUCC to become the official maintainer of the Health Care Provider Taxonomy List. The NUCC has a formal operating protocol and its membership includes representation from key provider and payer organizations, as well as state and federal agencies, standard development organizations and the National Uniform Billing Committee (NUBC). Criteria for membership includes a national scope and representation of a unique constituency affected by health care electronic commerce, with an emphasis on maintaining a provider/payer balance.

No description

Nail

No description

Inhalation, nasal

Nasal

Codes identifying nation states. Allows for finer grained specification of Entity with classcode <= NAT Example:ISO3166 country codes.

NATIVE ENTITIES WITHIN THE STATE OF ALASKA RECOGNIZED AND ELIGIBLE TO RECEIVE SERVICES FROM THE UNITED STATES BUREAU OF INDIAN AFFAIRS

NATIVE ENTITIES WITHIN THE CONTIGUOUS 48 STATES

A child as determined by birth.

No description

The player of the role has both biological parents in common with the scoping entity.

Nebulization

Inhalation, nebulization

The frequency with which the target must be validated

No description

This value set includes a smattering of Network type codes.

The player of the role is a child of scoping person’s brother or sister or of the brother or sister of the scoping person’s spouse.

Description:The value is exceptional (missing, omitted, incomplete, improper). No information as to the reason for being an exceptional value is provided. This is the most general exceptional value. It is also the default exceptional value.

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

A container having dimensions that adjust somewhat based on the amount and shape of the material placed within it.

No description

No description

No description

No description

No description

No description

NutritionIntake Category Codes

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

• encrypt Usage Note: 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.

Observation Category codes.

This value set defines a set of codes that can be used to indicate the meaning/use of a reference range for a particular target population.

Identifies a type of observation that captures the age of a person in terms of age group concept codes.

Definition:The ways the age of an entity involved in an act can be measured, calculated or otherwise expressed in order to provide context for another act.

No description

Hypersensitivity to an agent caused by an immunologic response to an initial exposure.

Codes specifying asset indicators used to assess or establish eligibility for coverage under a policy or program.

High level observation categories for the general type of observation being made. Steward: OO WG

No description

No description

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

An observation about the presence (or absence) of a particular disease state in a subject.

Hypersensitivity resulting in an adverse reaction upon exposure to a drug.

Code specifying eligibility indicators used to assess or establish eligibility for coverage under a policy or program eligibility status, e.g., certificates of creditable coverage; student enrollment; adoption, marriage or birth certificate.

Hypersensitivity resulting in an adverse reaction upon exposure to environmental conditions.

Hypersensitivity resulting in an adverse reaction upon exposure to food.

Code specifying non-clinical indicators related to health status used to assess or establish eligibility for coverage under a policy or program, e.g., pregnancy, disability, drug use, mental health issues.

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.

One or more codes providing a rough qualitative interpretation of the observation,such as “normal” / “abnormal”, “low” / “high”, “better” / “worse”, “resistant” / “susceptible”, “expected” / “not expected”. The value set is intended to be for ANY use where coded representation of an interpretation is needed. Usage Note: This is being communicated in v2.x in OBX-8, in v3 in ObservationInterpretation (CWE) in R1 (Representative Realm) and in FHIR Observation.interpretation. Historically these values come from the laboratory domain, and these codes are extensively used.

Interpretations of change of quantity and/or severity, such as “better”, “worse”, “increased”, etc. At most one of B or W and one of U or D allowed.

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, these concepts provide a categorical interpretation of the “meaning” of the quantitative value for the same observation.

Technical exceptions resulting in the inability to provide an interpretation. At most one allowed. Does not imply normality or severity.

Observation interpretation codes for expected results based on additional information (contraindicators) about the patient’s situation.

Interpretation 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.

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

Interpretation of a critical (or “alert”) degree of abnormality. Concepts in this category are mutually exclusive, i.e., at most one is allowed.

Interpretation for a quantitative observation of degree of abnormality (including critical or “alert” level) above the upper limit of the reference range.

Interpretation for a quantitative observation of degree of abnormality (including critical or “alert” level) below the lower limit of the reference range.

The observation/test result is interpreted as being outside the inclusion range for a particular protocol within which the result is being reported. Example: A positive result on a Hepatitis screening test. Open Issue: We are not deprecating this value set at this time, but instead are leaving open the consideration of deprecation in the future. [Note: The concepts included in this value set have also been suggested for future deprecation, and there are no associated concept subdomains or bindings. Note also that the name of the value set appears to have a typo in it from the old cycle when it was originally added.]

The observation/test result is interpreted as being outside the inclusion range for a particular protocol within which the result is being reported. Example: A positive result on a Hepatitis screening test. Open Issue: We are not deprecating this value set at this time, but instead are leaving open the consideration of deprecation in the future. [Note: The concepts included in this value set have also been suggested for future deprecation, and there are no associated concept subdomains or bindings.]

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

Hypersensitivity resulting in an adverse reaction upon exposure to an agent.

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.

Continued living in private residence requires functional and health care assistance from spouse or life partner.

Codes specifying living expense indicators used to assess or establish eligibility for coverage under a policy or program.

Code specifying observations related to living situation for a person in a private residence.

A collection of items that can be counted by a quality measure (e.g., patients, encounters, procedures, etc.) for Observation.value used in the HQMF R2 MeasureAttribute class.

No description

Observation values used to indicate what kind of health quality measure is used.

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.

A set of codes that defines how a set of values are summarized in an aggregated computation, for use with sets of values do describe which aggregated statistic functions are to be applied (e.g., average, mode, min, max, standard deviation, variance).

Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

Observation values used to assert various populations that a subject falls into.

Codes used to define various metadata aspects of a health quality measure.

No description

No description

Code specifying observations or indicators related to socio-economic status used to assess to assess for services, e.g., discharge planning, or to establish eligibility for coverage under a policy or program.

Identifies the kinds of observations that can be performed

An unctuous, combustible substance which is liquid, or easily liquefiable, on warming, and is soluble in ether but insoluble in water. Such substances, depending on their origin, are classified as animal, mineral, or vegetable oils.

A semisolid preparation intended for external application to the skin or mucous membranes.

No description

Ophthalmic

This value set includes a smattering of FDI oral site codes.

No description

Inhalation, oral

Oral

No description

No description

No description

No description

Defines rendering characteristics for ordered lists

No description

This example value set defines a set of codes that can be used to indicate a type of organization.

Further classifies entities of classCode ORG.

No description

No description

No description

Oromucosal

Oropharyngeal

No description

The actual value is not an element in the value domain of a variable. (e.g., concept not provided by required code system).

Order is performed as issued, but other action taken to mitigate potential adverse effects

Otic

No description

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

Value Set of codes that specify the organization that manufactures a vaccine. The values are maintained by the US Centers of Disease Control. Note that the source of truth for these code values are maintained by the CDC, and the code system may be accessed via https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.16.840.1.113883.12.227

This race value set is based upon CDC check-digit codes, but using the HL7 table 0005. HL7 adopted the CDC Race and Ethnicity codes in HL7 Table 0005 in 2005. This value set has been created for backward compatibility and some historic Implementation guides (E.g. Immunization). Recommend using Race Category value set based upon CDC Race & Ethnicity code system.

Value Set of codes that specify the administered vaccines. The values are maintained by the US Centers of Disease Control.. The code system is maintained by the CDC, and may be found at URL; https://phinvads.cdc.gov/vads/ViewCodeSystem.action?id=2.1

No description

A material intended to hold other materials for purposes of storage or transportation

No description

No description

No description

Paranasal sinuses

one that begets or brings forth offspring or a person who brings up and cares for another (Webster’s Collegiate Dictionary)

The player of the role is the parent of scoping person’s husband or wife.

Parenteral

No description

The practitioner who is responsible for admitting a patient to a patient encounter.

No description

Participations related, but not primary to an act. The Referring, Admitting, and Discharging practitioners must be the same person as those authoring the ControlAct event for their respective trigger events.

The practitioner that has responsibility for overseeing a patient’s care during a patient encounter.

A verifier who attests to the accuracy of an act, but who does not have privileges to legally authenticate the act. An example would be a resident physician who sees a patient and dictates a note, then later signs it. Their signature constitutes an authentication.

Definition: A party that originates the Act and therefore has responsibility for the information given in the Act and ownership of this Act. Example: the report writer, the person writing the act definition, the guideline author, the placer of an order, the EKG cart (device) creating a report etc. Every Act should have an author. Authorship is regardless of mood always actual authorship. Examples of such policies might include:

• The author and anyone they explicitly delegate may update the report;
• All administrators within the same clinic may cancel and reschedule appointments created by other administrators within that clinic; A party that is neither an author nor a party who is extended authorship maintenance rights by policy, may only amend, reverse, override, replace, or follow up in other ways on this Act, whereby the Act remains intact and is linked to another Act authored by that other party.

In an obstetric service, the baby.

Target on behalf of whom the service happens, but that is not necessarily present in the service. Can occur together with direct target to indicate that a target is both, as in the case where the patient is the indirect beneficiary of a service rendered to a family member, e.g. counseling or given home care instructions. This concept includes a participant, such as a covered party, who derives benefits from a service act covered by a coverage act. Note that the semantic role of the intended recipient who benefits from the happening denoted by the verb in the clause. Thus, a patient who has no coverage under a policy or program may be a beneficiary of a health service while not being the beneficiary of coverage for that service.

A person or organization who should be contacted for follow-up questions about the act in place of the author.

No description

Definition: A factor, such as a microorganism, chemical substance, or form of radiation, whose presence, excessive presence, or (in deficiency diseases) relative absence is essential, in whole or in part, for the occurrence of a condition. Constraint: The use of this participation is limited to observations.

An advisor participating in the service by performing evaluations and making recommendations.

Target that is taken up, is diminished, and disappears in the service.

The target participation for an individual in a health care coverage act in which the target role is either the policy holder of the coverage, or a covered party under the coverage.

An entity (person, organization or device) that is in charge of maintaining the information of this act (e.g., who maintains the report or the master service catalog item, etc.).

A person entering the data into the originating system. The data entry person is collected optionally for internal quality control purposes. This includes the transcriptionist for dictated text.

The destination for services. May be a static building (or room therein) or a movable facility (e.g., ship).

The practitioner who is responsible for the discharge of a patient from a patient encounter.

Distributes material used in or generated during the act.

In some organ transplantation services and rarely in transfusion services a donor will be a target participant in the service. However, in most cases transplantation is decomposed in three services: explantation, transport, and implantation. The identity of the donor (recipient) is often irrelevant for the explantation (implantation) service.

A location where data about an Act was entered.

Only with Transportation services. A person who escorts the patient.

Description: The entity playing the associated role is the physical (including energy), chemical or biological substance that is participating in the exposure. For example in communicable diseases, the associated playing entity is the disease causing pathogen.

Description:Direct participation in an exposure act where it is unknown that the participant is the source or subject of the exposure. If the participant is known to be the contact of an exposure then the EXPTRGT participation type should be used. If the participant is known to be the source then the EXSRC participation type should be used.

Description:The entity playing the associated role is the source of exposure.

Description: The entity playing the associated role is the target (contact) of exposure.

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).

The target person or organization contractually recognized by the issuer as a participant who has assumed fiscal responsibility for another personaTMs financial obligations by guaranteeing to pay for amounts owed to a particular account Example:The subscriber of the patientaTMs health insurance policy signs a contract with the provider to be fiscally responsible for the patient billing account balance amount owed.

Participant who posses an instrument such as a financial contract (insurance policy) usually based on some agreement with the author.

Target that is not substantially present in the act and which is not directly affected by the act, but which will be a focus of the record or documentation of the act.

A source of reported information (e.g., a next of kin who answers questions about the patient’s history). For history questions, the patient is logically an informant, yet the informant of history questions is implicitly the subject.

Parties that may or should contribute or have contributed information to the Act. Such information includes information leading to the decision to perform the Act and how to perform the Act (e.g., consultant), information that the Act itself seeks to reveal (e.g., informant of clinical history), or information about what Act was performed (e.g., informant witness).

A party, who may or should receive or who has recieved the Act or subsequent or derivative information of that Act. Information recipient is inert, i.e., independent of mood.” Rationale: this is a generalization of a too diverse family that the definition can’t be any more specific, and the concept is abstract so one of the specializations should be used.

An entity entering the data into the originating system. The data entry entity is collected optionally for internal quality control purposes. This includes the transcriptionist for dictated text transcribed into electronic form.

A verifier who legally authenticates the accuracy of an act. An example would be a staff physician who sees a patient and dictates a note, then later signs it. Their signature constitutes a legal authentication.

Identifies the primary means by which an Entity participates in an Act.

Participation by non-human-languaged based electronic signal

Participation by voice communication

Participation by human language recorded on a physical material

A device that changes ownership due to the service, e.g., a pacemaker, a prosthesis, an insulin injection equipment (pen), etc. Such material may need to be restocked after he service.

The location of origin for services. May be a static building (or room therein) or a movable facility (e.g., ship).

Indicates that the target of the participation is involved in some manner in the act, but does not qualify how. This should not be used except when no more specific participation type is known or when the participation type is further clarified elsewhere. It should not be used lightly, and should never be used as a “placeholder” when a more appropriate specific type does not yet exist.

A person who actually and principally carries out the action. Need not be the principal responsible actor, e.g. a surgery resident operating under supervision of attending surgeon, and may be the patient in self-care, e.g. fingerstick blood sugar. The traditional order filler is a performer. This information should accompany every service event.

Information recipient to whom an act statement is primarily directed. E.g., a primary care provider receiving a discharge letter from a hospitalist, a health department receiving information on a suspected case of infectious disease. Multiple of these participations may exist on the same act without requiring that recipients be ranked as primary vs. secondary.

The principal or primary performer of the act.

A material target that is brought forth (produced) in the service (e.g., specimen in a specimen collection, access or drainage in a placement service, medication package in a dispense service). It doesn’t matter whether the material produced had existence prior to the service, or whether it is created in the service (e.g., in supply services the product is taken from a stock).

The person (or organization) who receives the product of an Act.

The record target indicates whose medical record holds the documentation of this act. This is especially important when the subject of a service is not the patient himself.

A participant (e.g. provider) who has referred the subject of an act (e.g. patient). Typically, a referred by participant will provide a report (e.g. referral).

The person who receives the patient

A person having referred the subject of the service to the performer (referring physician). Typically, a referring physician will receive a report.

Some services take place at multiple concurrent locations (e.g., telemedicine, telephone consultation). The location where the principal performing actor is located is taken as the primary location (LOC) while the other location(s) are considered “remote.”

The person or organization that has primary responsibility for the act. The responsible party is not necessarily present in an action, but is accountable for the action through the power to delegate, and the duty to review actions with the performing actor after the fact. This responsibility may be ethical, legal, contractual, fiscal, or fiduciary in nature. Example: A person who is the head of a biochemical laboratory; a sponsor for a policy or government program.

A device that does not change ownership due to the service, i.e., a surgical instrument or tool or an endoscope. The distinction between reuseable and non-reuseable must be made in order to know whether material must be re-stocked.

A person assisting in an act through his substantial presence and involvement This includes: assistants, technicians, associates, or whatever the job titles may be.

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.)

The subject of non-clinical (e.g. laboratory) observation services is a specimen.

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.

Something used in delivering the service without being substantially affected by the service (i.e. durable or inert with respect to that particular service.) Examples are: monitoring equipment, tools, but also access/drainage lines, prostheses, pace maker, etc.

Target that is substantially present in the service and which is directly affected by the service action (includes consumed material, devices, etc.).

The facility where the service is done. May be a static building (or room therein) or a moving location (e.g., ambulance, helicopter, aircraft, train, truck, ship, etc.)

The principle target that the service acts on. E.g. the patient in physical examination, a specimen in a lab observation. May also be a patient’s family member (teaching) or a device or room (cleaning, disinfecting, housekeeping). Note: not all direct targets are subjects, consumables, and devices used as tools for a service are not subjects. However, a device may be a subject of a maintenance service.

A secondary information recipient, who receives copies (e.g., a primary care provider receiving copies of results as ordered by specialist).

A code specifying the meaning and purpose of every Participation instance. Each of its values implies specific constraints on the Roles undertaking the participation.

Identifies the set of participation types context that can be blocked (overridden) at the CDA section or sub-section level of a document.

An information recipient to notify for urgent matters about this Act. (e.g., in a laboratory order, critical results are being called by phone right away, this is the contact to call; or for an inpatient encounter, a next of kin to notify when the patient becomes critically ill).

A person who verifies the correctness and appropriateness of the service (plan, order, event, etc.) and hence takes on accountability.

For services, an intermediate location that specifies a path between origin an destination.

Only with service events. A person witnessing the action happening without doing anything. A witness is not necessarily aware, much less approves of anything stated in the service event. Example for a witness is students watching an operation or an advanced directive witness.

An occurrence that occurred or was scheduled to occur in the past. An Act whose effective time is less than ‘now’. (‘now’ is the time the instance is authored.)

A semisolid dosage form that contains one or more drug substances intended for topical application.

A drug delivery system that contains an adhesived backing and that permits its ingredients to diffuse from some portion of it (e.g., the backing itself, a reservoir, the adhesive, or some other component) into the body from the external site where it is applied.

Description: Reporting codes that are related to an immunization event.

Patient VIP code

No description

Codes indicating the type of party to be reimbursed for cost of the products and service.

The type of payee Resource.

This value set includes smattering of Payment Adjustment Reason codes.

This value set includes a sample set of Payment Status codes.

This value set includes sample Payment Type codes.

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.

No description

No description

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Perianal

Periarticular

Peridural

Perineal

Perineural

Periodontal

Permanent dentition, the natural teeth of adulthood that replace or are added to the deciduous teeth

A code identifying a person’s disability.

A code indicating the type of name (e.g. nickname, alias, maiden name, legal, adopted)

Codes that indicate the pronouns to be used when communicating with or about an individual.

A ‘personal and legal’ relationship records the role of a person in relation to another person, or a person to himself or herself. This value set is to be used when recording relationships based on personal or family ties or through legal assignment of responsibility.

Types of personal relationships between two living subjects. Example:Parent, sibling, unrelated friend, neighbor

An individual who is licensed to prepare and sell or dispense drugs and compounds and to make up prescriptions.

Definition:Identifies why the dispense event was not completed

No description

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

Definition:A collection of concepts that identifies why a renewal prescription has been refused.

No description

A small, round solid dosage form containing a medicinal agent intended for oral administration.

Types of places for EntityClass “PLC”

The type of PlanDefinition.

A bottle made of plastic

No description

Description: A role recognized through the eligibility of an identified party for benefits covered under an insurance policy or a program based on meeting eligibility criteria. Eligibility as a covered party may be conditioned on the party meeting criteria to qualify for coverage under a policy or program, which may be mandated by law. These criteria may be:

1. The sole basis for coverage, e.g., being differently abled may qualify a person for disability coverage
2. May more fully qualify a covered party role e.g, being differently abled may qualify an adult child as a dependent
3. May impact the level of coverage for a covered party under a policy or program, e.g., being differently abled may qualify a program eligible for additional benefits. 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”. These role.codes may only be used with COVPTY to avoid overlapping concepts that would result from using them to specify the specializations of COVPTY, e.g., the role.class DEPEN should not be used with the role.code family dependent because that relationship has overlapping concepts due to the role.code precoodination and is conveyed in FICO with the personal relationship role that has a PART role link to the covered party role. For the same reasons, the role.class DEPEN should not be used with the role.code HANDIC (handicapped dependent); the role.code DIFFABLE (differently abled) should be used instead. In summary, the coded concepts in the Abstract Value Set “CoveredPartyRoleType” can be “post-coordinated” with the “RoleClassCoveredParty” Abstract Value Set. Decoupling these concepts is intended to support an expansive range of covered party concepts and their semantic comparability.

No description

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

No description

An intimate mixture of dry, finely divided drugs and/or chemicals that may be intended for internal or external use.

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.

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

Concepts that describe whether a condition is present when a patient is admitted to a healthcare facility.

Type of the validation primary source

Primary dentition, the first teeth to errupt and usually replaced with permanent dentition

Codes used for human readable marks indicating, e.g., the level of confidentiality protection, an authorized compartment, the integrity, or the handling instruction required by applicable policy. Such markings must be displayed as directed by applicable policy on electronically rendered information content and any electronic transmittal envelope or container; or on hardcopy information and any physical transmittal envelope or container. Purpose: Supports the selection of the entire PrivacyMark value set with head code for e.g., rules engine policy set purposes.

Definition: A living arrangement within a private residence for single family.

No description

This value set includes the financial processing priority codes.

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.

This value set defines an example set of codes that could be can be used to classify groupings of service-types/specialties.

Description:A role recognized through the eligibility of a party to play a program eligible for benefits covered or provided under a program.

The type of participation a provenance participant.

Specifies the state change of a target Act, such as a document or an entry, from its previous state as a predecessor Act. For example, if the target Act is the result of a predecessor Act being “obsoleted” and replaced with the target Act, the source ProvenanceEventCurrentState Act code would be “obsoleted”.

Specifies the state change of a target Act, using ActStatus codes, from its previous state as a predecessor Act. For example, if the target Act is the result of a predecessor Act being “obsoleted” and replaced with the target Act, the source ProvenanceEventCurrentState Act code would be “obsoleted”.

Specifies the state change of a target Act using DocuymentCompletion codes, from its previous state as a predecessor Act. For example, if the target Act is the result of a predecessor Act being “obsoleted” and replaced with the target Act, the source ProvenanceEventCurrentState Act code would be “obsoleted”.

Definition: A a public or governmental health program with an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health and financial status. These programs are established by legislation with provisions for ongoing government oversight. Regulations 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. For example, A Canadian provincial or national health plan such as the BC MSP (British Columbia Medical Services Plan) OHIP (Ontario Health Insurance Plan), NHS (National Health Service). Examples of U.S. government funded health programs include those for maternity case management, behavioral health, and HIV-AIDs, such as the Ryan White program.

Pulmonary

Supports communication of purpose of use at a general level.

Type of alerts/updates the primary source can send

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.

A rating system that describes the quality of evidence such as the GRADE, DynaMed, or Oxford CEBM systems.

A specimen specifically used to verify the sensitivity, specificity, accuracy or other perfomance parameter of a diagnostic test.

Identifies the time frame in which the response is expected.

Definition: The number of matching instances (number of focal classes). The document header class is the focal class of a document, a record would therefore be equal to a document.

A code classifying the general nature of the response to a given query. Includes whether or not data was found, or whether an error occurred.

A code specifying the state of the Query.

Identifies the modes of usage of a questionnaire that should enable a particular questionnaire item.

Shape of the region on the object being referenced

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.

No description

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