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4.4.2.8 HL7 v3 Value Set ActReason

Vocabulary Work Group Maturity Level: 1Draft Use Context: Any

This value set (http://terminology.hl7.org/ValueSet/v3-ActReason) is defined as part of HL7 v3.

Summary

Defining URL:http://terminology.hl7.org/ValueSet/v3-ActReason
Version:2018-08-12
Name:v3.ActReason
Title:v3 Code System ActReason
Definition:

A set of codes specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably represented as an ActRelationship of type "has reason" linking to another Act. Examples: Example reasons that might qualify for being coded in this field might be: "routine requirement", "infectious disease reporting requirement", "on patient request", "required by law".

OID: (for OID based terminology systems)
Source ResourceXML / JSON

This value set is used in the following places:


This value set includes codes from the following code systems:

 

This expansion generated 20 Sep 2019


This value set contains 248 concepts

Expansion based on http://terminology.hl7.org/CodeSystem/v3-ActReason version 2018-08-12

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

LvlCodeDisplayDefinition
0_ActAccommodationReasonActAccommodationReasonIdentifies the reason the patient is assigned to this accommodation type
1  ACCREQNAAccommodation Requested Not AvailableAccommodation requested is not available.
1  FLRCNVFloor ConvenienceAccommodation is assigned for floor convenience.
1  MEDNECMedical NecessityRequired for medical reasons(s).
1  PATPatient requestThe Patient requested the action
0_ActCoverageReasonActCoverageReasonDescription: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.
1  _EligibilityActReasonCodeEligibilityActReasonCodeIdentifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
2    _ActIneligibilityReasonActIneligibilityReasonIdentifies 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.
3      COVSUScoverage suspendedWhen a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc. Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).
3      DECSDdeceasedClient deceased.
3      REGERRregistered in errorClient was registered in error.
2    _CoverageEligibilityReasonCoverageEligibilityReasonDefinition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
3      AGEage eligibilityA person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.
3      CRIMEcrime victimA person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program.
3      DISdisabilityA person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
3      EMPLOYemployment benefitA person becomes eligible for insurance provided as an employment benefit based on employment status.
3      FINANfinancial eligibilityA person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
3      HEALTHhealth statusA person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
3      MULTImultiple criteria eligibilityA person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
3      PNCproperty and casualty conditionA person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
3      STATUTORYstatutory eligibilityA person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
3      VEHICmotor vehicle accident victimA person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
3      WORKwork relatedA person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program.
0_ActInformationManagementReasonActInformationManagementReasonDescription:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.
1  _ActHealthInformationManagementReasonActHealthInformationManagementReasonDescription: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.
2    _ActConsentInformationAccessOverrideReasonActConsentInformationAccessOverrideReasonTo perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety. Usage Notes: Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.
3      OVRERemergency treatment overrideTo perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention. Usage Notes: The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.
3      OVRINCOMPincompetency overrideTo perform one or more operations on information to which the patient has not consented because deemed incompetent to provide consent. Usage Note: Maps to v2 CON-16 Subject Competence Indicator (ID) 01791 Definition: Identifies whether the subject was deemed competent to provide consent. Refer to table HL7 Table 0136 - Yes/No Indicator and CON-23 Non-Subject Consenter Reason User-defined Table 0502 - Non-Subject Consenter Reason code NC "Subject is not competent to consent".
3      OVRPJprofessional judgment overrideTo perform one or more operations on information to which the patient declined to consent for providing health care. Usage Notes: The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.
3      OVRPSpublic safety overrideTo perform one or more operations on information to which the patient has not consented for public safety reasons. Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.
3      OVRTPSthird party safety overrideTo perform one or more operations on information to which the patient has not consented for third party safety. Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.
2    PurposeOfUsepurpose of useReason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives. Usage Notes: The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.
3      HMARKThealthcare marketingTo perform one or more operations on information for marketing services and products related to health care.
3      HOPERAThealthcare operationsTo perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
4        CAREMGTcare managementTo perform analytics, evaluation and other secondary uses of treatment and healthcare related information to manage the quality, efficacy, patient safety, population health, and cost effectiveness of healthcare delivery. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment. Usage Note: The concept of care management is narrower than the list of activities related to more general organizational objectives such as provider profiling, education of healthcare and non-healthcare professionals; insurance underwriting, premium rating, reinsurance; organizational legal, medical review, auditing, compliance and fraud and abuse detection; business planning, development, and restructuring; fund-raising; and customer service. Map: Maps to ISO 14265 Classification Term "Health service management and quality assurance" described as "To inform persons or processes responsible for determining the availability, quality, safety, equity and cost-effectiveness of health care services." There is a semantic gap in concepts. This classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
4        DONATdonationTo perform one or more operations on information used for cadaveric organ, eye or tissue donation.
4        FRAUDfraudTo perform one or more operations on information used for fraud detection and prevention processes.
4        GOVgovernmentTo perform one or more operations on information used within government processes.
4        HACCREDhealth accreditationTo perform one or more operations on information for conducting activities related to meeting accreditation criteria.
4        HCOMPLhealth complianceTo perform one or more operations on information used for conducting activities required to meet a mandate.
4        HDECDdecedentTo perform one or more operations on information used for handling deceased patient matters.
4        HDIRECTdirectoryTo perform one or more operation operations on information used to manage a patient directory. Examples: facility enterprise payer health information exchange patient directory
4        HDMhealthcare delivery managementTo perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment. Usage Note: Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking. Map: Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care." However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.
4        HLEGALlegalTo perform one or more operations on information for conducting activities required by legal proceeding.
4        HOUTCOMShealth outcome measureTo perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
4        HPRGRPhealth program reportingTo perform one or more operations on information used for conducting activities to meet program accounting requirements.
4        HQUALIMPhealth quality improvementTo perform one or more operations on information used for conducting administrative activities to improve health care quality.
4        HSYSADMINhealth system administrationTo perform one or more operations on information to administer the electronic systems used for the delivery of health care.
5          LABELINGlabelingTo perform one or more operations on information to assign, persist, and manage labels to healthcare data to characterize various aspects, such as its security classification, sensitivity, compartment, integrity, and provenance; applicable privacy, consent, security, provenance, and trust policies; and handling caveats such as purpose of use, obligations, and refrain policies. Label management includes classification of target data by constructing and binding of a label set per applicable policies, security policy information file semantics, and classification guides. Label management also includes process and procedures for subsequent revision of a label for, e.g., reclassification, downgrading classification, and declassification. Label revisions may be triggered by, e.g., expiry of classification period; changes in applicable policy, e.g., revocation of a consent directive; or changes in the governing policy domain in which the data is relocated or a copy of the data is sent. If a label is revised, an audit log should be kept and the provenance of the label changes should be tracked.
5          METAMGTmetadata managementTo perform one or more operations on information to assign, persist, and manage metadata to healthcare data to characterize various aspects used for its indexing, discovery, retrieval, and processing by systems, applications, and end users. For example, master index identifier, media type, and location.
4        MEMADMINmember administrationTo perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.
4        MILCDMmilitary commandTo perform one or more operations on information for conducting activities required by military processes, procedures, policies, or law.
4        PATADMINpatient administrationTo perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.
4        PATSFTYpatient safetyTo perform one or more operations on information in processes related to ensuring the safety of health care.
4        PERFMSRperformance measureTo perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.
4        RECORDMGTrecords managementTo perform one or more operations on information used within the health records management process.
4        SYSDEVsystem developmentTo perform one or more operations on information to design, develop, implement, test, or deploy a healthcare system or application.
5          HTESTtest health dataTo perform one or more operations on information that is simulated or synthetic health data used for testing system capabilities outside of a production or operational system environment. Usage Note: Data marked with a HTEST security label enables an access control system to permit interfacing systems or end users provisioned with a clearance, which includes a HTEST purpose of use attribute, to test, verify, or validate that a system or application will operate in production as intended based on design specifications.
4        TRAINtrainingTo perform one or more operations on information used in training and education.
3      HPAYMThealthcare paymentTo perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.
4        CLMATTCHclaim attachmentTo perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
4        COVAUTHcoverage authorizationTo perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
4        COVERAGEcoverage under policy or programTo perform one or more operations on information for conducting activities related to coverage under a program or policy.
5          ELIGDTRMeligibility determinationTo perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.
5          ELIGVEReligibility verificationTo perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.
5          ENROLLMenrollmentTo perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.
5          MILDCRGmilitary dischargeTo perform one or more operations on information for the process of releasing military personnel from their service obligations, which may include determining service merit, discharge benefits, and disability assessment.
4        REMITADVremittance adviceTo perform one or more operations on information about the amount remitted for a health care claim.
3      HRESCHhealthcare researchTo perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data iincludes basic and applied research such as biomedical, population origin or ancestry, translational research, and disease, discipline, specialty specific healthcare research and clinical trial research.
4        BIORCHbiomedical researchTo perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified biomedical basic or applied research. For example, research on rare plants to determine whether biologic properties may be useful for pharmaceutical development. May be used in combination with clinical trial and other healthcare research purposes of use.
4        CLINTRCHclinical trial researchTo perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
5          CLINTRCHNPCclinical trial research without patient careTo perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge without provision of patient care. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, a clinical trial conducted on laboratory specimens collected from a specified patient population.
5          CLINTRCHPCclinical trial research with patient careTo perform one or more operations on information for conducting scientific investigations with patient care in accordance with clinical trial protocols to obtain health care knowledge. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, an "off-label" drug used for cancer therapy administer to a specified patient population.
5          PRECLINTRCHpreclinical trial researchTo perform one or more operations on information in preparation for conducting scientific investigation to obtain health care knowledge, such as research on animals or review of patient health records, to determine the feasibility of a clinical trial study; assist with protocol design; or in preparation for institutional review board or ethics committee approval process. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research.
4        DSRCHdisease specific healthcare researchTo perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified conditions, diagnosis, or disease healthcare research. For example, conducting cancer research by testing reaction of tumor cells to certain biologics. May be used in combination with clinical trial and other healthcare research purposes of use.
4        POARCHpopulation origins or ancestry healthcare researchTo perform one or more operations on information, including genealogical pedigrees, historical records, surveys, family health data, health records, and genetic information, for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to population origins and/or ancestry healthcare research. For example, gathering genetic specimens from a specific population in order to determine the ancestry and population origins of that group. May be used in combination with clinical trial and other healthcare research purposes of use.
4        TRANSRCHtranslational healthcare researchTo perform one or more operations on information for conducting scientific investigations to obtain health care knowledge related to evidence based medicine during the course of providing healthcare treatment. Sometimes referred to as "bench to bedside", which is the iterative feedback loop between healthcare research and clinical trials with input from information collected in the course of routine provision of healthcare. For example, by extending a patient encounter to conduct a survey related to a research topic such as attitudes about use of a wellness device that a patient agreed to use. May be used in combination with clinical trial and other healthcare research purposes of use.
3      PATRQTpatient requestedTo perform one or more operations on information in response to a patient's request.
4        FAMRQTfamily requestedTo perform one or more operations on information in response to a request by a family member authorized by the patient.
4        PWATRNYpower of attorneyTo perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.
4        SUPNWKsupport networkTo perform one or more operations on information in response to a request by a person authorized by the patient.
3      PUBHLTHpublic healthTo perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.
4        DISASTERdisasterTo perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
4        THREATthreatTo perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.
3      TREATtreatmentTo perform one or more operations on information for provision of health care.
4        CLINTRLclinical trialTo perform health care as part of the clinical trial protocol.
4        COCcoordination of careTo perform one or more actions on information in order to organize the provision and case management of an individual’s healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care. Usage Note: Use when describing these functions: 1. Monitoring a person’s goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care. The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment. For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare. Map: Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."
4        ETREATEmergency TreatmentTo perform one or more operations on information for provision of immediately needed health care for an emergent condition.
5          BTGbreak the glassTo perform policy override operations on information for provision of immediately needed health care for an emergent condition affecting potential harm, death or patient safety by end users who are not provisioned for this purpose of use. Includes override of organizational provisioning policies and may include override of subject of care consent directive restricting access. Map: Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care." The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure.
5          ERTREATemergency room treatmentTo perform one or more operations on information for provision of immediately needed health care for an emergent condition in an emergency room or similar emergent care context by end users provisioned for this purpose, which does not constitute as policy override such as in a "Break the Glass" purpose of use. Map:Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care." The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure. There is a semantic gap in concepts. This classification term is described as activities “to inform personsâ€? rather than the rationale for performing actions/operations on information related to the activity.
4        POPHLTHpopulation healthTo perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.
1  _ActInformationPrivacyReasonActInformationPrivacyReasonDescription:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.
2    MARKTmarketingDescription:
2    OPERAToperationsDescription:Administrative and contractual processes required to support an activity, product, or service
3      LEGALsubpoenaDefinition:To provide information as a result of a subpoena.
3      ACCREDaccreditationDescription:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
3      COMPLcomplianceDescription:Operational activities required to meet a mandate related to an activity, product, or service
3      ENADMINentity administrationDescription:Operational activities conducted to administer information relating to entities involves with an activity, product, or service
3      OUTCOMSoutcome measureDescription:Operational activities conducted for the purposes of assessing the results of an activity, product, or service
3      PRGRPTprogram reportingDescription:Operational activities conducted to meet program accounting requirements related to an activity, product, or service
3      QUALIMPquality improvementDescription:Operational activities conducted for the purposes of improving the quality of an activity, product, or service
3      SYSADMNsystem administrationDescription:Operational activities conducted to administer the electronic systems used for an activity, product, or service
2    PAYMTpaymentDescription:Administrative, financial, and contractual processes related to payment for an activity, product, or service
2    RESCHresearchDescription:Investigative activities conducted for the purposes of obtaining knowledge
2    SRVCserviceDescription:Provision of a service, product, or capability to an individual or organization
0_ActInvalidReasonActInvalidReasonDescription: Types of reasons why a substance is invalid for use.
1  ADVSTORAGEadverse storage conditionDescription: Storage conditions caused the substance to be ineffective.
2    COLDCHNBRKcold chain breakDescription: Cold chain was not maintained for the substance.
1  EXPLOTexpired lotDescription: The lot from which the substance was drawn was expired.
1  OUTSIDESCHEDadministered outside recommended schedule or practiceThe substance was administered outside of the recommended schedule or practice.
1  PRODRECALLproduct recallDescription: The substance was recalled by the manufacturer.
0_ActInvoiceCancelReasonActInvoiceCancelReasonDomain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.
1  INCCOVPTYincorrect covered party as patientThe covered party (patient) specified with the Invoice is not correct.
1  INCINVOICEincorrect billingThe billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.
1  INCPOLICYincorrect policyThe policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.
1  INCPROVincorrect providerThe provider specified with the Invoice is not correct.
0_ActNoImmunizationReasonActNoImmunizationReasonA coded description of the reason for why a patient did not receive a scheduled immunization. (important for public health strategy
1  IMMUNEimmunityDefinition:Testing has shown that the patient already has immunity to the agent targeted by the immunization.
1  MEDPRECmedical precautionDefinition:The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.
1  OSTOCKproduct out of stockDefinition:There was no supply of the product on hand to perform the service.
1  PATOBJpatient objectionDefinition:The patient or their guardian objects to receiving the vaccine.
1  PHILISOPphilosophical objectionDefinition:The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.
1  RELIGreligious objectionDefinition:The patient or their guardian objects to receiving the vaccine on religious grounds.
1  VACEFFvaccine efficacy concernsDefinition:The intended vaccine has expired or is otherwise believed to no longer be effective. Example:Due to temperature exposure.
1  VACSAFvaccine safety concernsDefinition:The patient or their guardian objects to receiving the vaccine because of concerns over its safety.
0_ActSupplyFulfillmentRefusalReasonActSupplyFulfillmentRefusalReasonIndicates 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)
1  FRR01order stoppedDefinition:The order has been stopped by the prescriber but this fact has not necessarily captured electronically. Example:A verbal stop, a fax, etc.
1  FRR02stale-dated orderDefinition:Order has not been fulfilled within a reasonable amount of time, and may not be current.
1  FRR03incomplete dataDefinition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available Example:Lab results, diagnostic imaging, etc.
1  FRR04product unavailableDefinition:Product not available or manufactured. Cannot supply.
1  FRR05ethical/religiousDefinition:The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.
1  FRR06unable to provide careDefinition:Fulfiller not able to provide appropriate care associated with fulfilling the order. Example:Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.
0_ClinicalResearchEventReasonClinicalResearchEventReasonDefinition:Specifies the reason that an event occurred in a clinical research study.
1  RETretestDefinition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
1  SCHscheduledDefinition:The event occurred due to it being scheduled in the research protocol.
1  TRMterminationDefinition:The event occurred in order to terminate the subject's participation in the study.
1  UNSunscheduledDefinition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.
0_ClinicalResearchObservationReasonClinicalResearchObservationReasonDefinition: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.
1  NPTnon-protocolDefinition:The observation or test was neither defined or scheduled in the study protocol.
1  PPTper protocolDefinition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
1  UPTper definition:The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.
0_CombinedPharmacyOrderSuspendReasonCodeCombinedPharmacyOrderSuspendReasonCodeDescription:Indicates why the prescription should be suspended.
1  ALTCHOICEtry another treatment firstDescription:This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.
1  CLARIFprescription requires clarificationDescription:Clarification is required before the order can be acted upon.
1  DRUGHIGHdrug level too highDescription:The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.
1  HOSPADMadmission to hospitalDescription:The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.
1  LABINTlab interference issuesDescription:The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.
1  NON-AVAILpatient not-availableDescription:Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.
1  PREGparent is pregnant/breast feedingDescription:The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.
1  SALGallergyDescription:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
1  SDDIdrug interacts with another drugDescription:The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.
1  SDUPTHERduplicate therapyDescription:Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.
1  SINTOLsuspected intoleranceDescription:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
1  SURGpatient scheduled for surgeryDescription:The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.
1  WASHOUTwaiting for old drug to wash outDescription:The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.
0_ControlActNullificationReasonCodeControlActNullificationReasonCodeDescription:Identifies reasons for nullifying (retracting) a particular control act.
1  ALTDaltered decisionDescription:The decision on which the recorded information was based was changed before the decision had an effect. Example:Aborted prescription before patient left office, released prescription before suspend took effect.
1  EIEentered in errorDescription:The information was recorded incorrectly or was recorded in the wrong record.
1  NORECMTCHno record matchDescription: There is no match for the record in the database.
0_ControlActNullificationRefusalReasonTypeControlActNullificationRefusalReasonTypeDescription: Reasons to refuse a transaction to be undone.
1  INRQSTATEin requested stateThe record is already in the requested state.
1  NOMATCHno matchDescription: There is no match.
2    NOPRODMTCHno product matchDescription: There is no match for the product in the master file repository.
2    NOSERMTCHno service matchDescription: There is no match for the service in the master file repository.
2    NOVERMTCHno version matchDescription: There is no match for the record and version.
1  NOPERMno permissionDescription: There is no permission.
2    NOUSERPERMno user permissionDefinition:The user does not have permission
2    NOAGNTPERMno agent permissionDescription: The agent does not have permission.
2    NOUSRPERMno user permissionDescription: The user does not have permission.
1  WRNGVERwrong versionDescription: The record and version requested to update is not the current version.
0_ControlActReasonControlActReasonIdentifies why a specific query, request, or other trigger event occurred.
1  _MedicationOrderAbortReasonCodemedication order abort reasonDescription:Indicates the reason the medication order should be aborted.
2    DISCONTproduct discontinuedDescription:The medication is no longer being manufactured or is otherwise no longer available.
2    INEFFECTineffectiveDescription:The therapy has been found to not have the desired therapeutic benefit on the patient.
2    MONITresponse to monitoringDescription:Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.
2    NOREQno longer required for treatmentDescription:The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.
2    NOTCOVERnot coveredDescription:The product does not have (or no longer has) coverage under the patientaTMs insurance policy.
2    PREFUSpatient refuseDescription:The patient refused to take the product.
2    RECALLproduct recalledDescription:The manufacturer or other agency has requested that stocks of a medication be removed from circulation.
2    REPLACEchange in orderDescription:Item in current order is no longer in use as requested and a new one has/will be created to replace it.
3      DOSECHGchange in medication/doseDescription:The medication is being re-prescribed at a different dosage.
2    REPLACEFIXerror in orderDescription:Current order was issued with incorrect data and a new order has/will be created to replace it.
2    UNABLEunable to useDescription:<The patient is not (or is no longer) able to use the medication in a manner prescribed. Example:CanaTMt swallow.
1  _MedicationOrderReleaseReasonCodemedication order release reasonDefinition:A collection of concepts that indicate why the prescription should be released from suspended state.
2    HOLDDONEsuspend reason no longer appliesDefinition:The original reason for suspending the medication has ended.
2    HOLDINAPsuspend reason inappropriateDefinition:
1  _ModifyPrescriptionReasonTypeModifyPrescriptionReasonTypeTypes of reason why a prescription is being changed.
2    ADMINERRORadministrative error in orderOrder was created with incorrect data and is changed to reflect the intended accuracy of the order.
2    CLINMODclinical modificationOrder is changed based on a clinical reason.
1  _PharmacySupplyEventAbortReasonPharmacySupplyEventAbortReasonDefinition:Identifies why the dispense event was not completed.
2    CONTRAcontraindicationDefinition:Contraindication identified
2    FOABORTorder abortedDefinition:Order to be fulfilled was aborted
2    FOSUSPorder suspendedDefinition:Order to be fulfilled was suspended
2    NOPICKnot picked upDefinition:Patient did not come to get medication
2    PATDECpatient changed mindDefinition:Patient changed their mind regarding obtaining medication
2    QUANTCHGchange supply quantityDefinition:Patient requested a revised quantity of medication
1  _PharmacySupplyEventStockReasonCodepharmacy supply event stock reasonDefinition:A collection of concepts that indicates the reason for a "bulk supply" of medication.
2    FLRSTCKfloor stockDefinition:The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)
2    LTClong term care useDefinition:The bulk supply will be administered within a long term care facility.
2    OFFICEoffice useDefinition:The bulk supply is intended for general clinician office use.
2    PHARMpharmacy transferDefinition:The bulk supply is being transferred to another dispensing facility to. Example:Alleviate a temporary shortage.
2    PROGprogram useDefinition:The bulk supply is intended for dispensing according to a specific program. Example:Mass immunization.
1  _PharmacySupplyRequestRenewalRefusalReasonCodepharmacy supply request renewal refusal reasonDefinition:A collection of concepts that identifies why a renewal prescription has been refused.
2    ALREADYRXnew prescription existsDefinition:Patient has already been given a new (renewal) prescription.
2    FAMPHYSfamily physician must authorize further fillsDefinition:Request for further authorization must be done through patient's family physician.
2    MODIFYmodified prescription existsDefinition:Therapy has been changed and new prescription issued
2    NEEDAPMTpatient must make appointmentDefinition:Patient must see prescriber prior to further fills.
2    NOTAVAILprescriber not availableDefinition:Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.
2    NOTPATpatient no longer in this practiceDefinition:Patient no longer or has never been under this prescribers care.
2    ONHOLDmedication on holdDefinition:This medication is on hold.
2    PRNAproduct not availableDescription:This product is not available or manufactured.
2    STOPMEDprescriber stopped medication for patientRenewing or original prescriber informed patient to stop using the medication.
2    TOOEARLYtoo earlyDefinition:The patient should have medication remaining.
1  _SupplyOrderAbortReasonCodesupply order abort reasonDefinition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
2    IMPROVcondition improvedDefinition:The patient's medical condition has nearly abated.
2    INTOLintoleranceDescription:The patient has an intolerance to the medication.
2    NEWSTRnew strengthDefinition:The current medication will be replaced by a new strength of the same medication.
2    NEWTHERnew therapyDefinition:A new therapy will be commenced when current supply exhausted.
0_GenericUpdateReasonCodeGenericUpdateReasonCodeDescription:Identifies why a change is being made to a record.
1  CHGDATAinformation changeDescription:Information has changed since the record was created.
1  FIXDATAerror correctionDescription:Previously recorded information was erroneous and is being corrected.
1  MDATAmerge dataInformation is combined into the record.
1  NEWDATAnew informationDescription:New information has become available to supplement the record.
1  UMDATAunmerge dataInformation is separated from the record.
0_PatientProfileQueryReasonCodepatient profile query reasonDefinition:A collection of concepts identifying why the patient's profile is being queried.
1  ADMREVadministrative reviewDefinition: To evaluate for service authorization, payment, reporting, or performance/outcome measures.
1  PATCARpatient careDefinition:To obtain records as part of patient care.
1  PATREQpatient request queryDefinition:Patient requests information from their profile.
1  PRCREVpractice reviewDefinition:To evaluate the provider's current practice for professional-improvement reasons.
1  REGULregulatory reviewDescription:Review for the purpose of regulatory compliance.
1  RSRCHresearchDefinition:To provide research data, as authorized by the patient.
1  VALIDATIONvalidation reviewDescription:To validate the patient's record. Example:Merging or unmerging records.
0_PharmacySupplyRequestFulfillerRevisionRefusalReasonCodePharmacySupplyRequestFulfillerRevisionRefusalReasonCodeDefinition:Indicates why the request to transfer a prescription from one dispensing facility to another has been refused.
1  LOCKEDlockedDefinition:The prescription may not be reassigned from the original pharmacy.
1  UNKWNTARGETunknown targetDefinition:The target facility does not recognize the dispensing facility.
0_RefusalReasonCodeRefusalReasonCodeDescription: Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.
0_SchedulingActReasonSchedulingActReasonReasons for cancelling or rescheduling an Appointment
1  BLKUnexpected Block (of Schedule)The time slots previously allocated are now blocked and no longer available for booking Appointments
1  DECPatient DeceasedThe Patient is deceased
1  FINNo Financial BackingPatient unable to pay and not covered by insurance
1  MEDMedical Status AlteredThe medical condition of the Patient has changed
1  MTGIn an outside meetingThe Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment
1  PHYPhysician requestThe Physician requested the action
0_StatusRevisionRefusalReasonCodeStatusRevisionRefusalReasonCodeIndicates why the act revision (status update) is being refused.
1  FILLEDfully filledOrdered quantity has already been completely fulfilled.
0_SubstanceAdministrationPermissionRefusalReasonCodeSubstanceAdministrationPermissionRefusalReasonCodeDefinition:Indicates why the requested authorization to prescribe or dispense a medication has been refused.
1  PATINELIGpatient not eligibleDefinition:Patient not eligible for drug
1  PROTUNMETprotocol not metDefinition:Patient does not meet required protocol
1  PROVUNAUTHprovider not authorizedDefinition:Provider is not authorized to prescribe or dispense
0_SubstanceAdminSubstitutionNotAllowedReasonSubstanceAdminSubstitutionNotAllowedReasonReasons why substitution of a substance administration request is not permitted.
1  ALGINTallergy intoleranceDefinition: Patient has had a prior allergic intolerance response to alternate product or one of its components.
1  COMPCONcompliance concernDefinition: Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.
1  THERCHARtherapeutic characteristicsThe prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.
1  TRIALclinical trial drugDefinition: The specific manufactured drug is part of a clinical trial.
0_SubstanceAdminSubstitutionReasonSubstanceAdminSubstitutionReasonSubstanceAdminSubstitutionReason
1  CTcontinuing therapyIndicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.
1  FPformulary policyIndicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.
1  OSout of stockIn the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.
1  RRregulatory requirementIndicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
0_TransferActReasonTransferActReasonThe explanation for why a patient is moved from one location to another within the organization
1  ERErrorMoved to an error in placing the patient in the original location.
1  RQRequestMoved at the request of the patient.
0_ActBillableServiceReasonActBillableServiceReasonDefinition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
1  _ActBillableClinicalServiceReasonActBillableClinicalServiceReasonReason for Clinical Service being performed. This domain excludes reasons specified by diagnosed conditions. Examples of values from this domain include duplicate therapy and fraudulent prescription.
0BONUS
0CHDChildren onlyDescription:The level of coverage under the policy or program is available only to children
0DEPDependents onlyDescription:The level of coverage under the policy or program is available only to a subscriber's dependents.
0ECHEmployee and childrenDescription:The level of coverage under the policy or program is available to an employee and his or her children.
0EDU
0EMPEmployee onlyDescription:The level of coverage under the policy or program is available only to an employee.
0ESPEmployee and spouseDescription:The level of coverage under the policy or program is available to an employee and his or her spouse.
0FAMFamilyDescription:The level of coverage under the policy or program is available to a subscriber's family.
0INDIndividualDescription:The level of coverage under the policy or program is available to an individual.
0INVOICE
0PROA
0RECOV
0RETRO
0SPCSpouse and childrenDescription:The level of coverage under the policy or program is available to a subscriber's spouse and children
0SPOSpouse onlyDescription:The level of coverage under the policy or program is available only to a subscribers spouse
0TRAN