# Concepts

Code: UPGRDLABEL
Display: upgrade security label
Definition:
Custodian security system must declassify information assigned security labels by instantiating a new version of the classified information so as to break the binding of the classifying security label when assigning a new security label that marks the information as classified at a more protected level in accordance with applicable jurisdictional privacy policies associated with the target information. The system must retain an immutable record of the previous assignment and binding.


Code: PROCESSINLINELABEL
Display: process inline security label
Definition:
Custodian security system must take note that the data object contains inline security labels and process them.


Code: CREACT
Display: common reaction alert
Definition:
**Description:**Proposed therapy may be inappropriate or contraindicated because of a common but non-patient specific reaction to the product.

**Example:**There is no record of a specific sensitivity for the patient, but the presence of the sensitivity is common and therefore caution is warranted.


Code: OrgNSI
Display: organizational non-sensitive information policy
Definition:
Organizational policy on collection, access, use, or disclosure of information deemed non-sensitive by the organization or by applicable jurisdictional law.


Code: OrgUUI
Display: organizational uncontrolled unclassified information policy
Definition:
Organizational policy on collection, access, use, or disclosure of uncontrolled unclassified information as defined by the organization or governing jurisdiction.


Code: CDSREV
Display: clinical decision support intervention review
Definition:
A person reviews a recommendation/assessment provided automatically by a clinical decision support application for a given patient.


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


Code: ControlledUnclassifiedInformation
Display: ControlledUnclassifiedInformation
Definition:
Information the US Government creates or possesses, or that an entity creates or possesses for or on behalf of the Government, that a law, regulation, or Government-wide policy requires or permits an agency to handle using safeguarding or dissemination controls. However, CUI does not include classified information (see definition above) or information a non-executive branch entity possesses and maintains in its own systems that did not come from, or was not created or possessed by or for, an executive branch agency or an entity acting for an agency. Law, regulation, or Government-wide policy may require or permit safeguarding or dissemination controls in three ways: Requiring or permitting agencies to control or protect the information but providing no specific controls, which makes the information CUI Basic; requiring or permitting agencies to control or protect the information and providing specific controls for doing so, which makes the information CUI Specified; or requiring or permitting agencies to control the information and specifying only some of those controls, which makes the information CUI Specified, but with CUI Basic controls where the authority does not specify. Based on CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html .

*Usage Note:* Mandatory control marking, which must be displayed on the top portion of each rendered or printed page containing controlled information. Should be displayed at the bottom of each rendered or printed page containing controlled information. Must be displayed on each portion of controlled information at the portion level if portions are uncontrolled unclassified information. Based on CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf. For definitions of key terms see CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.


Code: SecurityLabelMark
Display: Security Label Mark
Definition:
An abstract code for displayed Security Label tags.

*Usage Note:* These marks may be based on any of the HL7 Security Labeling related codes from various code systems and values sets, which are organized according to the HL7 Privacy and Security Classification System into HL7 Security Observation Type Named Tag Sets and valued with codes associated with the HL7 Security Observation Value Tag Set Names.


Code: CUIMark
Display: CUI Mark
Definition:
An originator must mark, persist, display, and convey computable and renderable Controlled Unclassified Information (CUI) marks as required by policy. A recipient must consume, persist, display, and reconvey CUI marks on information received based on agreements with the originator..

**Examples:** 

 *  As CUI custodians, Federal Agencies and their contractors must mark, persist, display, and convey these marks.
 *  All CUI receivers must consume, persist, display, and reconvey CUI markings on information further disclosed

*Usage Note:* 

In accordance with US 32 CFR Part 2002 and US Executive Order 13556 Controlled Unclassified Information, US Federal Agencies and their contractors are charged with classifying and marking certain information they create as Controlled Unclassified Information (CUI).

The following definitions, which are provided for context, are based on terms defined by the CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html

 *  CUI is defined as "information in any form that the Government creates or possesses, or that an entity creates or possesses for or on behalf of the Government, that a law, regulation, or Government-wide policy requires or permits an agency to handle using safeguarding or dissemination controls"
 *  Designating CUI occurs when an authorized holder, consistent with US 32 CFR Part 2002 and the CUI Registry, determines that a specific item of information falls into a CUI category or subcategory.
 *  The designating agency is the executive branch agency that designates or approves the designation of a specific item of information as CUI.
 *  The authorized holder who designates the CUI must make recipients aware of the information's CUI status when disseminating that information.
 *  Disseminating occurs when authorized holders provide access, transmit, or transfer CUI to other authorized holders through any means, whether internal or external to the agency.

Once designated as CUI, US Federal Agencies and their contractors must assign CUI marks as prescribed by the National Archives and Records Administration (NARA) CUI Registry, and display marks as prescribed by the CUI Marking Handbook.

CUI markings must be displayed on hard copy, on containers, electronic media, and to end users for IT systems.

When HL7 content is designated as CUI, these computable markings can be interoperably conveyed using HL7 security label CUI tags, and may be included in HL7 text and narrative elements as human readable markings.

**Impact of CUI markings:**

CUI Custodians must enforce CUI security controls per applicable CUI policies. Federal agencies and their contractors must adhere to FISMA and NIST SP 800-53 security controls. Custodians, who are not Federal agencies or agency contractors, and are receivers of CUI, must adhere to NIST SP 800-171 security controls and those dictated by the Authorities indicated by the assigned CUI markings.

For most participants in US healthcare information exchange, including Federal Agencies and their contractors, additional controls are required by HIPAA Security standards for health information US 42 USC 1320d-2(d)(2) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf

Federal Agencies and their contractors may be the CUI classifier of original CUI content; or a CUI derivative classifier, which reclassifies CUI content that has been aggregated with other CUI or Unclassified Uncontrolled Information (U) or dissembled from a larger CUI content; or declassifiers, depending on the designating agency's policies.

Applicable CUI policies include the following and any future applicable updates to policies or laws related to CUI:

 *  Executive Order 13556 https://www.federalregister.gov/articles/2010/11/09/2010-28360/controlled-unclassified-information
 *  US 32 CFR Part 2002 https://www.govinfo.gov/content/pkg/CFR-2017-title32-vol6/pdf/CFR-2017-title32-vol6-part2002.pdf
 *  NIST SP 800-171 https://nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-171r1.pdf
 *  NIST SP 800-171A https://doi.org/10.6028/NIST.SP.800-171A
 *  CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf
 *  CUI Registry - Health Information Category https://www.archives.gov/cui/registry/category-detail/health-info
 *  CUI Registry: Limited Dissemination Controls https://www.archives.gov/cui/registry/limited-dissemination
 *  CUI Policy and Guidance https://www.archives.gov/cui/registry/policy-guidance


Code: DENTPRG
Display: dental program
Definition:
**Definition:** A public or government health program that administers and funds coverage for dental care to assist program eligible who meet financial and health status criteria.


Code: MENTPRG
Display: mental health program
Definition:
**Definition:** Government administered and funded mental health program for beneficiaries meeting financial and mental health status criteria. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors.

**Example:** In the U.S., states receive funding for substance use programs from the Substance Abuse Mental Health Administration (SAMHSA).


Code: SAFNET
Display: safety net clinic program
Definition:
**Definition:** Government administered and funded program to support provision of care to underserved populations through safety net clinics.

**Example:** In the U.S., safety net providers such as federally qualified health centers (FQHC) receive funding under PHSA Section 330 grants administered by the Health Resources and Services Administration.


Code: SUBPRG
Display: substance use program
Definition:
**Definition:** Government administered and funded substance use program for beneficiaries meeting financial, substance use behavior, and health status criteria. Beneficiaries may be required to enroll as a result of legal proceedings. Administration, funding levels, eligibility criteria, covered benefits, provider types, and financial participation are typically set by a regulatory process. Payer responsibilities for administering the program may be delegated to contractors.

**Example:** In the U.S., states receive funding for substance use programs from the Substance Abuse Mental Health Administration (SAMHSA).


Code: ALGY
Display: Allergy Alert
Definition:
Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to the proposed product. (Allergies are immune based reactions.)


Code: INT
Display: Intolerance Alert
Definition:
Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to the proposed product. (Intolerances are non-immune based sensitivities.)


Code: NOMOU
Display: no disclosure without MOU
Definition:
Prohibition on disclosure without an interagency service agreement or memorandum of understanding (MOU).


Code: NOPAT
Display: no disclosure to patient, family or caregivers without attending provider's authorization
Definition:
Prohibition on disclosing information to patient, family or caregivers without attending provider's authorization.

*Usage Note:* The information may be labeled with the ActInformationSensitivity TBOO code, triggering application of this RefrainPolicy code as a handling caveat controlling access.

Maps to FHIR NOPAT: Typically, this is used on an Alert resource, when the alert records information on patient abuse or non-compliance.

FHIR print name is "keep information from patient". Maps to the French realm - code: INVISIBLE\_PATIENT.

 *  displayName: Document non visible par le patient
 *  codingScheme: 1.2.250.1.213.1.1.4.13

French use case: A label for documents that the author chose to hide from the patient until the content can be disclose to the patient in a face to face meeting between a healthcare professional and the patient (in French law some results like cancer diagnosis or AIDS diagnosis must be announced to the patient by a healthcare professional and should not be find out by the patient alone).


Code: NOPERSISTP
Display: no collection beyond purpose of use
Definition:
Prohibition on collection of the information beyond time necessary to accomplish authorized purpose of use is prohibited.


Code: NORELINK
Display: no relinking
Definition:
Prohibition on associating de-identified or pseudonymized information with other information in a manner that could or does result in disclosing information intended to be masked.


Code: WELLREMLREV
Display: wellness reminder list review
Definition:
**Description:** A person reviews a list of wellness or preventive care reminders for a given patient.


Code: MAXOCCURS
Display: repetitions above maximum
Definition:
**Description:**The number of repeating elements is above the maximum number of repetitions allowed.


Code: MINOCCURS
Display: repetitions below minimum
Definition:
**Description:**The number of repeating elements is below the minimum number of repetitions allowed.


Code: RSDID
Display: de-identified information access
Definition:
**Definition:** Consent to have de-identified healthcare information in an electronic health record that is accessed for research purposes, but without consent to re-identify the information under any circumstance.


Code: RSREID
Display: re-identifiable information access
Definition:
**Definition:** Consent to have de-identified healthcare information in an electronic health record that is accessed for research purposes re-identified under specific circumstances outlined in the consent.

**Example::** Where there is a need to inform the subject of potential health issues.


Code: RFC
Display: Refill - Complete
Definition:
A refill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets.)


Code: RFP
Display: Refill - Part Fill
Definition:
A refill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.)


Code: RFS
Display: refill partial strength
Definition:
A fill against an order that has already been filled (or partially filled) at least once and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).


Code: RFCS
Display: refill complete partial strength
Definition:
A refill where the quantity supplied is equal to one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a complete fill would be for the full 90 tablets.) and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).


Code: RFFS
Display: refill partial strength (first fill this facility)
Definition:
The first fill against an order that has already been filled at least once at another facility and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).


Code: RFPS
Display: refill part fill partial strength
Definition:
A refill where the quantity supplied is less than one full repetition of the ordered amount. (e.g. If the order was 90 tablets, 3 refills, a partial fill might be for only 30 tablets.) and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).


Code: RALG
Display: Related Allergy Alert
Definition:
Proposed therapy may be inappropriate or contraindicated because of a recorded patient allergy to a cross-sensitivity related product. (Allergies are immune based reactions.)


Code: RAR
Display: Related Prior Reaction Alert
Definition:
Proposed therapy may be inappropriate or contraindicated because of a recorded prior adverse reaction to a cross-sensitivity related product.


Code: RINT
Display: Related Intolerance Alert
Definition:
Proposed therapy may be inappropriate or contraindicated because of a recorded patient intolerance to a cross-sensitivity related product. (Intolerances are non-immune based sensitivities.)


Code: SECALTINTOBS
Display: security alteration integrity observation
Definition:
Type of security metadata observation made about the alteration integrity of an IT resource (data, information object, service, or system capability), which indicates the mechanism used for authorized transformations of the resource.

**Examples:** Types of security alteration integrity observation metadata, which may value the observation with a code used to indicate the mechanism used for authorized transformation of an IT resource, including:

 *  translation
 *  syntactic transformation
 *  semantic mapping
 *  redaction
 *  masking
 *  pseudonymization
 *  anonymization


Code: SECDATINTOBS
Display: security data integrity observation
Definition:
Type of security metadata observation made about the data integrity of an IT resource (data, information object, service, or system capability), which indicates the security mechanism used to preserve resource accuracy and consistency. Data integrity is defined by ISO 22600-23.3.21 as: "The property that data has not been altered or destroyed in an unauthorized manner", and by ISO/IEC 2382-8: The property of data whose accuracy and consistency are preserved regardless of changes made."

**Examples:** Types of security data integrity observation metadata, which may value the observation, include cryptographic hash function and digital signature.


Code: SECINTCONOBS
Display: security integrity confidence observation
Definition:
Type of security metadata observation made about the integrity confidence of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions.

**Examples:** Types of security integrity confidence observation metadata, which may value the observation, include highly reliable, uncertain reliability, and not reliable.

*Usage Note:* A security integrity confidence observation on an Act may indicate that a valued Act.uncertaintycode attribute has been overridden by the entity responsible for ascribing the SecurityIntegrityConfidenceObservationValue. This supports the business requirements for increasing or decreasing the assessment of the reliability or trustworthiness of an IT resource based on parameters beyond the original assignment of an Act statement level of uncertainty.


Code: SECINTPRVOBS
Display: security integrity provenance observation
Definition:
Type of security metadata observation made about the provenance integrity of an IT resource (data, information object, service, or system capability), which indicates the lifecycle completeness of an IT resource in terms of workflow status such as its creation, modification, suspension, and deletion; locations in which the resource has been collected or archived, from which it may be retrieved, and the history of its distribution and disclosure. Integrity provenance metadata about an IT resource may be used to assess its veracity, reliability, and trustworthiness.

**Examples:** Types of security integrity provenance observation metadata, which may value the observation about an IT resource, include:

 *  completeness or workflow status, such as authentication
 *  the entity responsible for original authoring or informing about an IT resource
 *  the entity responsible for a report or assertion about an IT resource relayed "second-hand"
 *  the entity responsible for excerpting, transforming, or compiling an IT resource


Code: SECINTSTOBS
Display: security integrity status observation
Definition:
Type of security metadata observation made about the integrity status of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Indicates the completeness of an IT resource in terms of workflow status, which may impact users that are authorized to access and use the resource.

**Examples:** Types of security integrity status observation metadata, which may value the observation, include codes from the HL7 DocumentCompletion code system such as legally authenticated, in progress, and incomplete.


Code: SECINTPRVABOBS
Display: security integrity provenance asserted by observation
Definition:
Type of security metadata observation made about the integrity provenance of an IT resource (data, information object, service, or system capability), which indicates the entity that made assertions about the resource. The asserting entity may not be the original informant about the resource.

**Examples:** Types of security integrity provenance asserted by observation metadata, which may value the observation, including:

 *  assertions about an IT resource by a patient
 *  assertions about an IT resource by a clinician
 *  assertions about an IT resource by a device


Code: SECINTPRVRBOBS
Display: security integrity provenance reported by observation
Definition:
Type of security metadata observation made about the integrity provenance of an IT resource (data, information object, service, or system capability), which indicates the entity that reported the existence of the resource. The reporting entity may not be the original author of the resource.

**Examples:** Types of security integrity provenance reported by observation metadata, which may value the observation, include:

 *  reports about an IT resource by a patient
 *  reports about an IT resource by a clinician
 *  reports about an IT resource by a device


Code: SECCATOBS
Display: security category observation
Definition:
Type of security metadata observation made about the category of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security category metadata is defined by ISO/IEC 2382-8:1998(E/F)/ T-REC-X.812-1995 as: "A nonhierarchical grouping of sensitive information used to control access to data more finely than with hierarchical security classification alone."

*Rationale:* A security category observation supports requirement to specify the type of IT resource to facilitate application of appropriate levels of information security according to a range of levels of impact or consequences that might result from the unauthorized disclosure, modification, or use of the information or information system. A resource is assigned to a specific category of information (e.g., privacy, medical, proprietary, financial, investigative, contractor sensitive, security management) defined by an organization or in some instances, by a specific law, Executive Order, directive, policy, or regulation. \[FIPS 199\]

**Examples:** Types of security categories include:

 *  Compartment: A division of data into isolated blocks with separate security controls for the purpose of reducing risk. (ISO 2382-8). A security label tag that "segments" an IT resource by indicating that access and use is restricted to members of a defined community or project. (HL7 Healthcare Classification System)
 *  Sensitivity: The characteristic of an IT resource which implies its value or importance and may include its vulnerability. (ISO 7492-2) Privacy metadata for information perceived as undesirable to share. (HL7 Healthcare Classification System)


Code: SECCLASSOBS
Display: security classification observation
Definition:
Type of security metadata observation made about the classification of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security classification is defined by ISO/IEC 2382-8:1998(E/F)/ T-REC-X.812-1995 as: "The determination of which specific degree of protection against access the data or information requires, together with a designation of that degree of protection." Security classification metadata is based on an analysis of applicable policies and the risk of financial, reputational, or other harm that could result from unauthorized disclosure.

*Rationale:* A security classification observation may indicate that the confidentiality level indicated by an Act or Role confidentiality attribute has been overridden by the entity responsible for ascribing the SecurityClassificationObservationValue. This supports the business requirement for increasing or decreasing the level of confidentiality (classification or declassification) based on parameters beyond the original assignment of an Act or Role confidentiality.

**Examples:** Types of security classification include: HL7 Confidentiality Codes such as very restricted, unrestricted, and normal. Intelligence community examples include top secret, secret, and confidential.

*Usage Note:* Security classification observation type codes designate security label field types, which are valued with an applicable SecurityClassificationObservationValue code as the "security label tag".


Code: SECCONOBS
Display: security control observation
Definition:
Type of security metadata observation made about the control of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security control metadata convey instructions to users and receivers for secure distribution, transmission, and storage; dictate obligations or mandated actions; specify any action prohibited by refrain policy such as dissemination controls; and stipulate the permissible purpose of use of an IT resource.

*Rationale:* A security control observation supports requirement to specify applicable management, operational, and technical controls (i.e., safeguards or countermeasures) prescribed for an information system to protect the confidentiality, integrity, and availability of the system and its information. \[FIPS 199\]

**Examples:** Types of security control metadata include:

 *  handling caveats
 *  dissemination controls
 *  obligations
 *  refrain policies
 *  purpose of use constraints


Code: SECINTOBS
Display: security integrity observation
Definition:
Type of security metadata observation made about the integrity of an IT resource (data, information object, service, or system capability), which may be used to make access control decisions.

*Rationale:* A security integrity observation supports the requirement to guard against improper information modification or destruction, and includes ensuring information non-repudiation and authenticity. (44 U.S.C., SEC. 3542)

**Examples:** Types of security integrity metadata include:

 *  Integrity status, which indicates the completeness or workflow status of an IT resource (data, information object, service, or system capability)
 *  Integrity confidence, which indicates the reliability and trustworthiness of an IT resource
 *  Integrity control, which indicates pertinent handling caveats, obligations, refrain policies, and purpose of use for the resource
 *  Data integrity, which indicate the security mechanisms used to ensure that the accuracy and consistency are preserved regardless of changes made (ISO/IEC DIS 2382-8)
 *  Alteration integrity, which indicate the security mechanisms used for authorized transformations of the resource
 *  Integrity provenance, which indicates the entity responsible for a report or assertion relayed "second-hand" about an IT resource


Code: SECTRSTOBS
Display: SECTRSTOBS
Definition:
An observation identifying trust metadata about an IT resource (data, information object, service, or system capability), which may be used as a trust attribute to populate a computable trust policy, trust credential, trust assertion, or trust label field in a security label or trust policy, which are principally used for authentication, authorization, and access control decisions.


Code: TRSTAGREOBS
Display: trust agreement observation
Definition:
Type of security metadata observation made about privacy and security requirements with which a security domain must comply. \[ISO IEC 10181-1\]


Code: TRSTCERTOBS
Display: trust certificate observation
Definition:
Type of security metadata observation made about a set of security-relevant data issued by a security authority or trusted third party, together with security information which is used to provide the integrity and data origin authentication services for an IT resource (data, information object, service, or system capability). \[Based on ISO IEC 10181-1\]

**For example,**

 *  A Certificate Policy (CP), which is a named set of rules that indicates the applicability of a certificate to a particular community and/or class of application with common security requirements. For example, a particular Certificate Policy might indicate the applicability of a type of certificate to the authentication of electronic data interchange transactions for the trading of goods within a given price range. \[Trust Service Principles and Criteria for Certification Authorities Version 2.0 March 2011 Copyright 2011 by Canadian Institute of Chartered Accountants.
 *  A Certificate Practice Statement (CSP), which is a statement of the practices which an Authority employs in issuing and managing certificates. \[Trust Service Principles and Criteria for Certification Authorities Version 2.0 March 2011 Copyright 2011 by Canadian Institute of Chartered Accountants.\]


Code: TRSTFWKOBS
Display: trust framework observation
Definition:
Type of security metadata observation made about a complete set of contracts, regulations or commitments that enable participating actors to rely on certain assertions by other actors to fulfill their information security requirements. \[Kantara Initiative\]


Code: ConfidentialMark
Display: confidential mark
Definition:
A displayed mark rendered as "Confidential", which indicates to end users that the electronic or hardcopy information they are viewing must be protected at a level of protection as dictated by applicable policy.

May be used to indicate proprietary or classified information that is, for example, business, intelligence, or project related, e.g., secret ingredients in a therapeutic substance; location of disaster health facilities and providers, or the name of a manufacturer or project contractor. Example use cases include a display to alert authorized business system users that they are viewing additionally protected proprietary and business confidential information deemed proprietary under an applicable jurisdictional or organizational policy.

*Usage Note:* 

The ConfidentialMark (confidential mark) description is based on the HL7 Confidentiality Concept Domain: Types of privacy metadata classifying an IT resource (data, information object, service, or system capability) according to its level of sensitivity, which is based on an analysis of applicable privacy policies and the risk of financial, reputational, or other harm to an individual or entity that could result if made available or disclosed to unauthorized individuals, entities, or processes.

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

Map: Definition aligns with ISO 7498-2:1989 - Confidentiality is the property that information is not made available or disclosed to unauthorized individuals, entities, or processes.


Code: COPYMark
Display: copy of original mark
Definition:
A displayed mark indicating that the electronic or hardcopy information is a copy of an authoritative source for the information. The copy is not considered authoritative but is a duplicate of the authoritative content.

*Usage Note:* Applicable policy will dictate how the COPY mark will be displayed. Typical renderings include the marking appearing at the top or "banner" of electronic or hardcopy pages, or as watermarks set diagonally across each page.


Code: DeliverToAddresseeOnlyMark
Display: deliver only to addressee mark
Definition:
A displayed mark on an electronic transmission or physical container such as an electronic transmittal wrapper, batch file, message header, or a physical envelop or package indicating that the contents, whether electronic or hardcopy information, must only be delivered to the authorized recipient(s) named in the address.

*Usage Note:* Required by US 32 CRF Part 2002 for container storing or transmitting CUI.


Code: RedisclosureProhibitionMark
Display: prohibition against redisclosure mark
Definition:
A displayed mark rendered to end users as a prescribed text warning that the electronic or hardcopy information shall not be further disclosed without consent of the subject of the information. For example, in order to warn a recipient of 42 CFR Part 2 information of the redisclosure restrictions, the rule mandates that end users receive a written prohibition against redisclosure unless authorized by patient consent or otherwise permitted by Part 2. See 42 CFR §  2.32 Prohibition on re-disclosure. (a)Notice to accompany disclosure. Each disclosure made with the patient's written consent must be accompanied by one of the following written statements: (1) This information has been disclosed to you from records protected by federal confidentiality rules ( 42 CFR part 2). The federal rules prohibit you from making any further disclosure of information in this record that identifies a patient as having or having had a substance use disorder either directly, by reference to publicly available information, or through verification of such identification by another person unless further disclosure is expressly permitted by the written consent of the individual whose information is being disclosed or as otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose (see §  2.31). The federal rules restrict any use of the information to investigate or prosecute with regard to a crime any patient with a substance use disorder, except as provided at § §  2.12(c)(5) and 2.65; or (2) 42 CFR part 2 prohibits unauthorized disclosure of these records. https://www.law.cornell.edu/cfr/text/42/2.32

*Usage Note:* Example of marking requirement from SAMHSA FAQ Response to question 13:

Would a logon or splash page notification on an HIO's portal that contains the Part 2 notice prohibiting redisclosure be sufficient to meet Part 2's requirement that disclosures made with patient consent be accompanied by such a statement?

No. Part 2 requires each disclosure made with written patient consent to be accompanied by a written statement that the information disclosed is protected by federal law and that the recipient cannot make any further disclosure of it unless permitted by the regulations (42 CFR §  2.32). A logon page is the page where a user logs onto a computer system; a splash page is an introductory page to a web site. A logon or splash page notification on a HIO's portal including the statement as required by §  2.32 would not be sufficient notification regarding prohibitions on redisclosure since it would not accompany a specific disclosure. The notification must be tied to the Part 2 information being disclosed in order to ensure that the recipient of that information knows that specific information is protected by Part 2 and cannot be redisclosed except as authorized by the express written consent of the person to whom it pertains or as otherwise permitted by Part 2. https://www.samhsa.gov/about-us/who-we-are/laws-regulations/confidentiality-regulations-faqs


Code: RestrictedConfidentialityMark
Display: restricted confidentiality mark
Definition:
A displayed mark rendered to end users as "Restricted Confidentiality", which indicates that the electronic or hardcopy information they are viewing, must be protected at a restricted level of confidentiality protection as defined by HL7 Confidentiality code "R" (restricted). Examples: Includes information that is additionally protected such as sensitive conditions mental health, HIV, substance abuse, domestic violence, child abuse, genetic disease, and reproductive health; or sensitive demographic information such as a patient's standing as an employee or a celebrity. Use cases include a display to alert authorized EHR users that they are viewing additionally protected health information deemed sensitive by an applicable jurisdictional, organizational, or personal privacy policy.

*Usage Note:* The definition is based on HL7 Confidentiality code "R" (restricted), which is described as:

Privacy metadata indicating highly sensitive, potentially stigmatizing information, which presents a high risk to the information subject if disclosed without authorization. May be pre-empted by jurisdictional law, e.g., for public health reporting or emergency treatment. Foundational definitions of Confidentiality: From HL7 Confidentiality Concept Domain: Types of privacy metadata classifying an IT resource (data, information object, service, or system capability) according to its level of sensitivity, which is based on an analysis of applicable privacy policies and the risk of financial, reputational, or other harm to an individual or entity that could result if made available or disclosed to unauthorized individuals, entities, or processes.

Usage Note from HL7 Confidentiality code "R": Confidentiality codes may be used in security labels and privacy markings to classify IT resources based on sensitivity to indicate the obligation of a custodian or receiver to ensure that the protected resource is not made available or disclosed to individuals, entities, or processes (security principals) unless authorized per applicable policies. Confidentiality codes may also be used in the clearances of initiators requesting access to protected resources.

This metadata indicates that the receiver may be obligated to comply with applicable, prevailing (default) jurisdictional privacy law or disclosure authorization.

Map: Definition aligns with ISO 7498-2:1989 - Confidentiality is the property that information is not made available or disclosed to unauthorized individuals, entities, or processes. Map: Partial Map to ISO 13606-4 Sensitivity Level (3) Clinical Care: Default for normal clinical care access (i.e. most clinical staff directly caring for the patient should be able to access nearly all of the EHR). Maps to normal confidentiality for treatment information but not to ancillary care, payment and operations.


Code: DRAFTMark
Display: Draft Mark
Definition:
A displayed mark indicating that the electronic or hard-copy information is still under development and is not yet considered to be ready for normal use.


Code: AUTHPOL
Display: authorization policy
Definition:
Authorisation policies are essentially security policies related to access-control and specify what activities a subject is permitted or forbidden to do, to a set of target objects. They are designed to protect target objects so are interpreted by access control agents or the run-time systems at the target system.

A positive authorisation policy defines the actions that a subject is permitted to perform on a target. A negative authorisation policy specifies the actions that a subject is forbidden to perform on a target. Positive authorisation policies may also include filters to transform the parameters associated with their actions. (Based on PONDERS)


Code: DELEPOL
Display: delegation policy
Definition:
Delegation policies specify which actions subjects are allowed to delegate to others. A delegation policy thus specifies an authorisation to delegate. Subjects must already possess the access rights to be delegated.

Delegation policies are aimed at subjects delegating rights to servers or third parties to perform actions on their behalf and are not meant to be the means by which security administrators would assign rights to subjects. A negative delegation policy identifies what delegations are forbidden.

A Delegation policy specifies the authorisation policy from which delegated rights are derived, the grantors, which are the entities which can delegate these access rights, and the grantees, which are the entities to which the access rights can be delegated. There are two types of delegation policy, positive and negative. (Based on PONDERS)


Code: ObligationPolicy
Display: obligation policy
Definition:
Conveys the mandated workflow action that an information custodian, receiver, or user must perform.

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


Code: PrivacyMark
Display: privacy mark
Definition:
An abstract code 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.

Examples of protocols for marking displays on electronic or hardcopy rendered content: Across the top or "banner" of each page ; as a watermark placed diagonally cross each page; at the bottom or "footer" of each page; and may be displayed at the beginning of any portion within the content that required markings different than other portions of the content. The banner or top of page marking typically acts as a "high watermark" by including all of the markings made on any marked portions within the entirety of the information content.

*Usage Note:* A "Privacy Mark" is a Security Control Observation (SECCONOBS) named tag set as specified by the HL7 Privacy and Security Classification System (HCS). A Privacy Mark Named Tag Set is valued with a Privacy Mark leaf code "tag", which is a member of the Security Control Observation Value (\_SecurityObservationValue) tag set. Related Security Control Observation named tag sets are Purpose of Use, Obligation Policy, and Refrain Policy, each with their own Security Control Observation Value tag sets.

Foundational standard definitions: ISO 22600-3 Section A.3.4.3 - If present, the privacy-mark is not used for access control. The content of the privacy-mark may be defined by the security policy in force (identified by the security-policy-identifier) which may define a list of values to be used. Alternately, the value may be determined by the originator of the security-label. IEEE Security Glossary Compendium 93- CESG Memorandum No.1 Issue 1.2 Oct 1992 - Human readable word or phrase acting as an indicator of all or part of the security constraints that apply to a document so marked. NOTE: A machine readable representation of a marking.

*Comment:* While policies requiring creators, processors, custodians, senders or recipients apply, enforce, and persist applicable Privacy Marks may be dictated by a jurisdiction, organization or personal privacy, security, or integrity policy, those required to comply may be governed under different policies, so compliance may need to be enforced through trust contracts. For example, information content marked with GDPR related policies may require adherence by processors or recipients outside of the European Union. For this reason, this code system is likely to evolve with the inclusion of multiple policy domains needing to communicate encoded policies in a standard, interoperable manner.


Code: BH
Display: behavioral health information sensitivity
Definition:
Policy for handling information related to behavioral and emotional disturbances affecting social adjustment and physical health, which is afforded heightened confidentiality.

*Usage Note:* If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.


Code: MH
Display: mental health information sensitivity
Definition:
Policy for handling information related to psychological disorders, which is afforded heightened confidentiality. Mental health information may be deemed specifically sensitive and distinct from physical health, substance use disorders, and behavioral disabilities and disorders in some jurisdictions.

*Usage Note:* If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.


Code: PSY
Display: psychiatry disorder information sensitivity
Definition:
Policy for handling psychiatry psychiatric disorder information, which is afforded heightened confidentiality.

*Usage Note:* If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.


Code: PSYTHPN
Display: psychotherapy note information sensitivity
Definition:
Policy for handling psychotherapy note information, which is afforded heightened confidentiality.

*Usage Note:* In some jurisdiction, disclosure of psychotherapy notes requires patient consent.

If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law rather than or in addition to this more generic code.


Code: SUD
Display: substance use disorder information sensitivity
Definition:
Policy for handling information related to alcohol or drug use disorders and conditions caused by these disorders, which is afforded heightened confidentiality.

*Usage Note:* If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.


Code: SUBSIDMC
Display: subsidized managed care program
Definition:
**Definition:** A government health program that provides coverage through managed care contracts for health services to persons meeting eligibility criteria such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds.

*Discussion:* The structure and business processes for underwriting and administering a subsidized managed care program is further specified by the Underwriter and Payer Role.class and Role.code.


Code: SUBSUPP
Display: subsidized supplemental health program
Definition:
**Definition:** A government health program that provides coverage for health services to persons meeting eligibility criteria for a supplemental health policy or program such as income, location of residence, access to other coverages, health condition, and age, the cost of which is to some extent subsidized by public funds.

**Example:** Supplemental health coverage program may cover the cost of a health program or policy financial participations, such as the copays and the premiums, and may provide coverage for services in addition to those covered under the supplemented health program or policy. In the U.S., Medicaid programs may pay the premium for a covered party who is also covered under the Medicare program or a private health policy.

*Discussion:* The structure and business processes for underwriting and administering a subsidized supplemental retiree health program is further specified by the Underwriter and Payer Role.class and Role.code.


Code: ETHUD
Display: alcohol use disorder information sensitivity
Definition:
Policy for handling information related to alcohol use disorders and conditions caused by these disorders, which is afforded heightened confidentiality.

*Usage Note:* If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.


Code: OPIOIDUD
Display: opioid use disorder information sensitivity
Definition:
Policy for handling information related to opioid use disorders and conditions caused by these disorders, which is afforded heightened confidentiality.

*Usage Note:* If there is a jurisdictional mandate, then use the applicable ActPrivacyLaw code system, and specify the law in addition to this more generic code.


Code: TBS
Display: trial balance partial strength
Definition:
A fill where the remainder of a 'complete' fill is provided after a trial fill has been provided and where the strength supplied is less than the ordered strength (e.g. 10mg for an order of 50mg where a subsequent fill will dispense 40mg tablets).


Code: ALRTENDLATE
Display: end too late alert
Definition:
**Definition:**Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy.


Code: ALRTSTRTLATE
Display: start too late alert
Definition:
**Definition:**Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition.


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


Code: MINFREQ
Display: too soon within frequency based on the usage
Definition:
**Definition:**The therapy action is being performed too soon after the previous occurrence based on the requested frequency


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


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


Code: NODUPS
Display: duplicate values are not permitted
Definition:
**Description:**More than one element with the same value exists in the set. Duplicates not permission in this set in a set.


Code: NOPERSIST
Display: element will not be persisted
Definition:
**Description:** Element in submitted message will not persist in data storage based on detected issue.


Code: REP_RANGE
Display: repetitions out of range
Definition:
**Description:**The number of repeating elements falls outside the range of the allowed number of repetitions.


Code: AVAILABLE
Display: Available Volume
Definition:
The available quantity of specimen. This is the current quantity minus any planned consumption (e.g., tests that are planned)


Code: DEF
Display: definition
Definition:
**Definition:** A definition of a kind of act that can occur .

**OpenIssue:** The semantic constructs embodied in DEF and CRT moods seem indistinguishable, and their uses can readily be determined by the context in which these are used. Therefore, this OpenIssue has been created to declare that it is likely that ActMood.DEF will be "retired" in the future in favor of the more general ActMood.CRT.


Code: EVN
Display: event (occurrence)
Definition:
**Definition:** An act that actually happens (may be an ongoing act or a documentation of a past act).


Code: INT
Display: intent
Definition:
**Definition:** An intention or plan for an act.

**>UsageNotes:** The final outcome of the intent, the act that is intended to occur, is always an event. However the final outcome may be reached indirectly via steps through other intents, such as promise, permission request, or an appointment that may lead to an actual event to occur. Alternatively, the intended act may never occur.


Code: _ActMoodActRequest
Display: act request
Definition:
**Definition:** A request (or order) for an act that is part of a defined request/fulfillment cycle.

**UsageNotes:** Use of an HL7 defined request/fulfillment framework is not required to use this mood code.


Code: ARQ
Display: appointment request
Definition:
**Definition:** A request act that is specialized for the appointment scheduling request/fulfillment cycle. An appointment request is fulfilled only and completely by an appointment (APT), i.e., all that the appointment request intends is to create an appointment *(the actual act may well not happen if that is the professional decision during the appointment)*.


Code: PERMRQ
Display: permission request
Definition:
**Definition:** A request for a permission to perform the act. Typically a payer (or possibly a supervisor) is being requested to give permission to perform the act. As opposed to the RQO, the requestee is not asked to perform or cause to perform the act but only to give the permission.


Code: RQO
Display: request
Definition:
**Definition:** A request act that is specialized for an event request/fulfillment cycle.

**UsageNotes:** The fulfillment cycle may involve intermediary fulfilling acts in moods such as PRMS, APT, or even another RQO before being fulfilled by the final event.

**UsageNotes:** 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.


Code: PRP
Display: proposal
Definition:
**Definition:** A suggestion that an act might be performed. Not an explicit request, and professional responsibility may or may not be present.


Code: RMD
Display: recommendation
Definition:
**Definition:** A suggestion that an act should be performed with an acceptance of some degree of professional responsibility for the resulting act. Not an explicit request. .

**UsageNotes:** Where there is no clear definition or applicable concept of "professional responsibility", RMD becomes indistinguishable from PRP. .


Code: PRMS
Display: promise
Definition:
**Definition:** A commitment to perform an act (may be either solicited or unsolicited). The committer becomes responsible to the other party for executing the act, and, as a consequence, the other party may rely on the first party to perform or cause to perform the act.

**UsageNotes:** Commitments may be retracted or cancelled.


Code: CRT
Display: criterion
Definition:
***Deprecation Comment:*** This concept This codes should no longer be used. Instead, set attribute Act.isCriterionInd to "true" and use the desired mood for your criterion.

**Definition:** A condition that must be true for the source act to be considered.


Code: EVN.CRT
Display: event criterion
Definition:
***Deprecation Comment:*** This concept This codes should no longer be used. Instead, set attribute Act.isCriterionInd to "true" and use the desired mood for your criterion.

**Definition:** A criterion (CRT) that has\_match = an event (EVN).


Code: EXPEC
Display: expectation
Definition:
**Definition:** An act that is considered to have some noteworthy likelihood of occurring in the future (has\_match = event).

**Examples:**Prognosis of a condition, Expected date of discharge from hospital, patient will likely need an emergency decompression of the intracranial pressure by morning.

**UsageNotes:**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.


Code: GOL
Display: Goal
Definition:
**Definition:** An expectation that is considered to be desirable to occur in the future

**Examples:**Target weight below 80Kg, Stop smoking, Regain ability to walk, goal is to administer thrombolytics to candidate patients presenting with acute myocardial infarction.

**UsageNotes:** 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.


Code: RSK
Display: risk
Definition:
**Definition:**An act that may occur in the future and which is regarded as undesirable

**Examples:**Increased risk of DVT, at risk for sub-acute bacterial endocarditis.

**UsageNotes:**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.


Code: OPT
Display: option
Definition:
**Definition:** One of a set of acts that specify an option for the property values that the parent act may have. 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. The actual mood of the act is the same as the parent act, and they must be linked by an actrelationship with type = OPTN.


Code: CR
Display: callback results
Definition:
Filler should contact the placer as soon as results are available, even for preliminary results. (Was "C" in HL7 version 2.3's reporting priority.)


Code: CSP
Display: callback placer for scheduling
Definition:
Filler should contact the placer to schedule the service. (Was "C" in HL7 version 2.3's TQ-priority component.)


Code: CSR
Display: contact recipient for scheduling
Definition:
Filler should contact the service recipient (target) to schedule the service. (Was "C" in HL7 version 2.3's TQ-priority component.)


Code: P
Display: preop
Definition:
Used to indicate that a service is to be performed prior to a scheduled surgery. When ordering a service and using the pre-op priority, a check is done to see the amount of time that must be allowed for performance of the service. When the order is placed, a message can be generated indicating the time needed for the service so that it is not ordered in conflict with a scheduled operation.


Code: PRN
Display: as needed
Definition:
An "as needed" order should be accompanied by a description of what constitutes a need. This description is represented by an observation service predicate as a precondition.


Code: T
Display: timing critical
Definition:
It is critical to come as close as possible to the requested time (e.g., for a through antimicrobial level).


Code: _ActInformationManagementReason
Display: ActInformationManagementReason
Definition:
**Description:**The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.


Code: _ActInvoiceCancelReason
Display: ActInvoiceCancelReason
Definition:
Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.


Code: _ActImmunizationReason
Display: ActImmunizationReason
Definition:
**Description:**A coded description of the reason for why a patient was administered an immunization.

**Examples:**Post Exposure - Reason, Universal Immunization Program, Outbreak Control, Universal School Program


Code: _NonPerformanceReasonCode
Display: NonPerformanceReasonCode
Definition:
The reason the action wasn't performed, e.g. why the medication was not taken. If an action wasn"t performed, it is often clinically important to know why the action wasn"t taken.

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


Code: DEP
Display: Dependents only
Definition:
**Description:**The level of coverage under the policy or program is available only to a subscriber's dependents.


Code: ECH
Display: Employee and children
Definition:
**Description:**The level of coverage under the policy or program is available to an employee and his or her children.


Code: ESP
Display: Employee and spouse
Definition:
**Description:**The level of coverage under the policy or program is available to an employee and his or her spouse.


Code: FAM
Display: Family
Definition:
**Description:**The level of coverage under the policy or program is available to a subscriber's family.


Code: SPC
Display: Spouse and children
Definition:
**Description:**The level of coverage under the policy or program is available to a subscriber's spouse and children


Code: SPO
Display: Spouse only
Definition:
**Description:**The level of coverage under the policy or program is available only to a subscribers spouse


Code: _ActBillableClinicalServiceReason
Display: ActBillableClinicalServiceReason
Definition:
Reason for Clinical Service being performed.

This domain excludes reasons specified by diagnosed conditions.

Examples of values from this domain include duplicate therapy and fraudulent prescription.


Code: OVRER
Display: emergency treatment override
Definition:
To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.

*Usage Notes:* The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.


Code: OVRINCOMP
Display: incompetency override
Definition:
To perform one or more operations on information to which the patient has not consented because deemed incompetent to provide consent.

*Usage Note:* Maps to v2 CON-16 Subject Competence Indicator (ID) 01791 Definition: Identifies whether the subject was deemed competent to provide consent. Refer to table HL7 Table 0136 - Yes/No Indicator and CON-23 Non-Subject Consenter Reason User-defined Table 0502 - Non-Subject Consenter Reason code NC "Subject is not competent to consent".


Code: OVRPJ
Display: professional judgment override
Definition:
To perform one or more operations on information to which the patient declined to consent for providing health care.

*Usage Notes:* The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.


Code: OVRPS
Display: public safety override
Definition:
To perform one or more operations on information to which the patient has not consented for public safety reasons.

*Usage Notes:* The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.


Code: OVRTPS
Display: third party safety override
Definition:
To perform one or more operations on information to which the patient has not consented for third party safety.

*Usage Notes:* The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.


Code: _CoverageExclusionReason
Display: CoverageExclusionReason
Definition:
**Definition:** Identifies the reason or rationale for coverage of a service or product based on coverage exclusions related to the risk of adverse selection by covered parties.


Code: _ActHealthInformationPrivacyReason
Display: ActHealthInformationPrivacyReason
Definition:
**Description:**The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.


Code: COVSUS
Display: coverage suspended
Definition:
When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.

Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).


Code: _ActHealthInformationManagementReason
Display: ActHealthInformationManagementReason
Definition:
**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.


Code: _ActInformationPrivacyReason
Display: ActInformationPrivacyReason
Definition:
**Description:**The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.


Code: OPERAT
Display: operations
Definition:
**Description:**Administrative and contractual processes required to support an activity, product, or service


Code: PAYMT
Display: payment
Definition:
**Description:**Administrative, financial, and contractual processes related to payment for an activity, product, or service


Code: INCINVOICE
Display: incorrect billing
Definition:
The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.


Code: INCPOLICY
Display: incorrect policy
Definition:
The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.


Code: IMMUNE
Display: immunity
Definition:
**Definition:**Testing has shown that the patient already has immunity to the agent targeted by the immunization.


Code: MEDPREC
Display: medical precaution
Definition:
**Definition:**The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.


Code: PHILISOP
Display: philosophical objection
Definition:
**Definition:**The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.


Code: VACEFF
Display: vaccine efficacy concerns
Definition:
**Definition:**The intended vaccine has expired or is otherwise believed to no longer be effective.

**Example:**Due to temperature exposure.


Code: VACSAF
Display: vaccine safety concerns
Definition:
**Definition:**The patient or their guardian objects to receiving the vaccine because of concerns over its safety.


Code: FRR01
Display: order stopped
Definition:
**Definition:**The order has been stopped by the prescriber but this fact has not necessarily captured electronically.

**Example:**A verbal stop, a fax, etc.


Code: FRR02
Display: stale-dated order
Definition:
**Definition:**Order has not been fulfilled within a reasonable amount of time, and may not be current.


Code: FRR03
Display: incomplete data
Definition:
**Definition:**Data needed to safely act on the order which was expected to become available independent of the order is not yet available

**Example:**Lab results, diagnostic imaging, etc.


Code: FRR05
Display: ethical/religious
Definition:
**Definition:**The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.


Code: FRR06
Display: unable to provide care
Definition:
**Definition:**Fulfiller not able to provide appropriate care associated with fulfilling the order.

**Example:**Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.


Code: RET
Display: retest
Definition:
**Definition:**The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.


Code: UNS
Display: unscheduled
Definition:
**Definition:**The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.


Code: PPT
Display: per protocol
Definition:
**Definition:**The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.


Code: UPT
Display: per definition
Definition:
**:**The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.


Code: ALTCHOICE
Display: try another treatment first
Definition:
**Description:**This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.


Code: DRUGHIGH
Display: drug level too high
Definition:
**Description:**The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.


Code: HOSPADM
Display: admission to hospital
Definition:
**Description:**The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.


Code: LABINT
Display: lab interference issues
Definition:
**Description:**The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.


Code: NON-AVAIL
Display: patient not-available
Definition:
**Description:**Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.


Code: PREG
Display: parent is pregnant/breast feeding
Definition:
**Description:**The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.


Code: SALG
Display: allergy
Definition:
**Description:**The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.


Code: SDDI
Display: drug interacts with another drug
Definition:
**Description:**The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.


Code: SDUPTHER
Display: duplicate therapy
Definition:
**Description:**Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.


Code: SINTOL
Display: suspected intolerance
Definition:
**Description:**The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.


Code: SURG
Display: patient scheduled for surgery
Definition:
**Description:**The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.


Code: WASHOUT
Display: waiting for old drug to wash out
Definition:
**Description:**The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.


Code: ALTD
Display: altered decision
Definition:
**Description:**The decision on which the recorded information was based was changed before the decision had an effect.

**Example:**Aborted prescription before patient left office, released prescription before suspend took effect.


Code: AGE
Display: age eligibility
Definition:
A person becomes eligible for a program based on age.

*Example:*  In the U.S., a person who is 65 years of age or older is eligible for Medicare.


Code: CRIME
Display: crime victim
Definition:
A person becomes eligible for insurance or a program because of crime related health condition or injury.

*Example:*  A person is a claimant under the U.S. Crime Victims Compensation program.


Code: DIS
Display: disability
Definition:
A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.


Code: EMPLOY
Display: employment benefit
Definition:
A person becomes eligible for insurance provided as an employment benefit based on employment status.


Code: FINAN
Display: financial eligibility
Definition:
A person becomes eligible for a program based on financial criteria.

*Example:*  A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.


Code: HEALTH
Display: health status
Definition:
A person becomes eligible for a program because of a qualifying health condition or injury.

*Examples:*  A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program


Code: MULTI
Display: multiple criteria eligibility
Definition:
A person becomes eligible for a program based on more than one criterion.

*Examples:*  In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.


Code: PNC
Display: property and casualty condition
Definition:
A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.

*Example:*  A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.


Code: STATUTORY
Display: statutory eligibility
Definition:
A person becomes eligible for a program based on statutory criteria.

*Examples:*  A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.


Code: VEHIC
Display: motor vehicle accident victim
Definition:
A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.


Code: WORK
Display: work related
Definition:
A person becomes eligible for insurance or a program because of a work related health condition or injury.

*Example:*  A person is a claimant under the U.S. Black Lung Program.


Code: INEFFECT
Display: ineffective
Definition:
**Description:**The therapy has been found to not have the desired therapeutic benefit on the patient.


Code: MONIT
Display: response to monitoring
Definition:
**Description:**Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.


Code: NOREQ
Display: no longer required for treatment
Definition:
**Description:**The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.


Code: NOTCOVER
Display: not covered
Definition:
**Description:**The product does not have (or no longer has) coverage under the patientaTMs insurance policy.


Code: RECALL
Display: product recalled
Definition:
**Description:**The manufacturer or other agency has requested that stocks of a medication be removed from circulation.


Code: REPLACE
Display: change in order
Definition:
**Description:**Item in current order is no longer in use as requested and a new one has/will be created to replace it.


Code: REPLACEFIX
Display: error in order
Definition:
**Description:**Current order was issued with incorrect data and a new order has/will be created to replace it.


Code: UNABLE
Display: unable to use
Definition:
**Description:**<The patient is not (or is no longer) able to use the medication in a manner prescribed.

**Example:**CanaTMt swallow.


Code: ADMREV
Display: administrative review
Definition:
**Definition:** To evaluate for service authorization, payment, reporting, or performance/outcome measures.


Code: FLRSTCK
Display: floor stock
Definition:
**Definition:**The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)


Code: PHARM
Display: pharmacy transfer
Definition:
**Definition:**The bulk supply is being transferred to another dispensing facility to.

**Example:**Alleviate a temporary shortage.


Code: PROG
Display: program use
Definition:
**Definition:**The bulk supply is intended for dispensing according to a specific program.

**Example:**Mass immunization.


Code: NOTAVAIL
Display: prescriber not available
Definition:
**Definition:**Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.


Code: BLK
Display: Unexpected Block (of Schedule)
Definition:
The time slots previously allocated are now blocked and no longer available for booking Appointments


Code: MTG
Display: In an outside meeting
Definition:
The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment


Code: ALGINT
Display: allergy intolerance
Definition:
**Definition:** Patient has had a prior allergic intolerance response to alternate product or one of its components.


Code: COMPCON
Display: compliance concern
Definition:
**Definition:** Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.


Code: THERCHAR
Display: therapeutic characteristics
Definition:
The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.


Code: CT
Display: continuing therapy
Definition:
Indicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.


Code: FP
Display: formulary policy
Definition:
Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.


Code: OS
Display: out of stock
Definition:
In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.


Code: RR
Display: regulatory requirement
Definition:
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.


Code: CLINTRCHNPC
Display: clinical trial research without patient care
Definition:
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge without provision of patient care. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, a clinical trial conducted on laboratory specimens collected from a specified patient population.


Code: CLINTRCHPC
Display: clinical trial research with patient care
Definition:
To perform one or more operations on information for conducting scientific investigations with patient care in accordance with clinical trial protocols to obtain health care knowledge. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research. For example, an "off-label" drug used for cancer therapy administer to a specified patient population.


Code: PRECLINTRCH
Display: preclinical trial research
Definition:
To perform one or more operations on information in preparation for conducting scientific investigation to obtain health care knowledge, such as research on animals or review of patient health records, to determine the feasibility of a clinical trial study; assist with protocol design; or in preparation for institutional review board or ethics committee approval process. May be post-coordinated or used with other purposes of use such as disease, discipline, specialty, population origins or ancestry, translational healthcare research.


Code: ELIGDTRM
Display: eligibility determination
Definition:
To perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.


Code: ELIGVER
Display: eligibility verification
Definition:
To perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.


Code: ENROLLM
Display: enrollment
Definition:
To perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.


Code: MILDCRG
Display: military discharge
Definition:
To perform one or more operations on information for the process of releasing military personnel from their service obligations, which may include determining service merit, discharge benefits, and disability assessment.


Code: BTG
Display: break the glass
Definition:
To perform policy override operations on information for provision of immediately needed health care for an emergent condition affecting potential harm, death or patient safety by end users who are not provisioned for this purpose of use. Includes override of organizational provisioning policies and may include override of subject of care consent directive restricting access.

*Map:* Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care." The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure.


Code: ERTREAT
Display: emergency room treatment
Definition:
To perform one or more operations on information for provision of immediately needed health care for an emergent condition in an emergency room or similar emergent care context by end users provisioned for this purpose, which does not constitute as policy override such as in a "Break the Glass" purpose of use.

Map:Partially Maps to ISO 14265 Classification Term "Emergency care provision to an individual subject of care" described as "To inform persons needing to provide health care services to the subject of care urgently, possibly needing to over-ride the policies and consents pertaining to Purpose 1 above." Purpose 1 is equivalent to HL7 treatment purpose of use: "Clinical care provision to an individual subject of care" described as "To inform persons or processes responsible for providing health care services to the subject of care."

The ISO description conflates both of the proposed specializations of HL7 ETREAT: break the glass and the typically broader access to health information normally available to providers who are provisioned for emergency workflows on a regular basis, e.g., Emergency Room providers. Examples of greater access than is normally accessible by providers based on the need to know are access to sensitive information for which access typically requires a patient's consent. This is not an override of a patient's dissent to disclose sensitive information in cases where the applicable policy waives the need for that consent to access this information. In US, Title 38 Section 7332 and 42 CFR Part 2 both permit emergency access without the need to override a patient's consent directive; rather, this access is a limitation to the patient's right to dissent from disclosure.

There is a semantic gap in concepts. This classification term is described as activities "to inform persons" rather than the rationale for performing actions/operations on information related to the activity.


Code: CAREMGT
Display: care management
Definition:
To perform analytics, evaluation and other secondary uses of treatment and healthcare related information to manage the quality, efficacy, patient safety, population health, and cost effectiveness of healthcare delivery. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.

*Usage Note:* The concept of care management is narrower than the list of activities related to more general organizational objectives such as provider profiling, education of healthcare and non-healthcare professionals; insurance underwriting, premium rating, reinsurance; organizational legal, medical review, auditing, compliance and fraud and abuse detection; business planning, development, and restructuring; fund-raising; and customer service.

*Map:* Maps to ISO 14265 Classification Term "Health service management and quality assurance" described as "To inform persons or processes responsible for determining the availability, quality, safety, equity and cost-effectiveness of health care services."

There is a semantic gap in concepts. This classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.


Code: HACCRED
Display: health accreditation
Definition:
To perform one or more operations on information for conducting activities related to meeting accreditation criteria.


Code: HCOMPL
Display: health compliance
Definition:
To perform one or more operations on information used for conducting activities required to meet a mandate.


Code: HDIRECT
Display: directory
Definition:
To perform one or more operation operations on information used to manage a patient directory.

**Examples:** 

 *  facility
 *  enterprise
 *  payer
 *  health information exchange patient directory


Code: HDM
Display: healthcare delivery management
Definition:
To perform one or more actions on information used for conducting administrative and contractual activities by or on behalf of organizational entities responsible for delivery of an individual's benefits in a healthcare program, health plan or insurance. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.

*Usage Note:* Examples of activities conducted under this purpose of use: provider profiling, risk adjustment, underwriting, fraud and abuse, quality improvement population health and care management. Aligns with HIPAA Operation POU minus coordination of care or other treatment related activities. Similar to the description in SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking.

*Map:* Maps to ISO 14265 Classification Term "Administration of care for an individual subject of care" described as "To inform persons or processes responsible for enabling the availability of resources or funding or permissions for providing health care services to the subject of care."

However, this classification term is described as activities, i.e., "to inform persons" or "to inform processes" rather than the rationale for performing actions/operations on information related to the activity.


Code: HLEGAL
Display: legal
Definition:
To perform one or more operations on information for conducting activities required by legal proceeding.


Code: HOUTCOMS
Display: health outcome measure
Definition:
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.


Code: HPRGRP
Display: health program reporting
Definition:
To perform one or more operations on information used for conducting activities to meet program accounting requirements.


Code: HQUALIMP
Display: health quality improvement
Definition:
To perform one or more operations on information used for conducting administrative activities to improve health care quality.


Code: HSYSADMIN
Display: health system administration
Definition:
To perform one or more operations on information to administer the electronic systems used for the delivery of health care.


Code: MEMADMIN
Display: member administration
Definition:
To perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.


Code: MILCDM
Display: military command
Definition:
To perform one or more operations on information for conducting activities required by military processes, procedures, policies, or law.


Code: PATADMIN
Display: patient administration
Definition:
To perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.


Code: PATSFTY
Display: patient safety
Definition:
To perform one or more operations on information in processes related to ensuring the safety of health care.


Code: PERFMSR
Display: performance measure
Definition:
To perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.


Code: SYSDEV
Display: system development
Definition:
To perform one or more operations on information to design, develop, implement, test, or deploy a healthcare system or application.


Code: CLMATTCH
Display: claim attachment
Definition:
To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.


Code: COVAUTH
Display: coverage authorization
Definition:
To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.


Code: COVERAGE
Display: coverage under policy or program
Definition:
To perform one or more operations on information for conducting activities related to coverage under a program or policy.


Code: PMTDS
Display: decision support assisted payment decision
Definition:
To apply algorithms (e.g. AI, CDS) to perform one or more operations on information to arrive at decision used in payment for provision of health care.


Code: BIORCH
Display: biomedical research
Definition:
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified biomedical basic or applied research. For example, research on rare plants to determine whether biologic properties may be useful for pharmaceutical development. May be used in combination with clinical trial and other healthcare research purposes of use.


Code: CLINTRCH
Display: clinical trial research
Definition:
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.


Code: DSRCH
Display: disease specific healthcare research
Definition:
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to specified conditions, diagnosis, or disease healthcare research. For example, conducting cancer research by testing reaction of tumor cells to certain biologics. May be used in combination with clinical trial and other healthcare research purposes of use.


Code: POARCH
Display: population origins or ancestry healthcare research
Definition:
To perform one or more operations on information, including genealogical pedigrees, historical records, surveys, family health data, health records, and genetic information, for conducting scientific investigations to obtain health care knowledge. Use of the data must be related to population origins and/or ancestry healthcare research. For example, gathering genetic specimens from a specific population in order to determine the ancestry and population origins of that group. May be used in combination with clinical trial and other healthcare research purposes of use.


Code: TRANSRCH
Display: translational healthcare research
Definition:
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge related to evidence based medicine during the course of providing healthcare treatment. Sometimes referred to as "bench to bedside", which is the iterative feedback loop between healthcare research and clinical trials with input from information collected in the course of routine provision of healthcare. For example, by extending a patient encounter to conduct a survey related to a research topic such as attitudes about use of a wellness device that a patient agreed to use. May be used in combination with clinical trial and other healthcare research purposes of use.


Code: LABELING
Display: labeling
Definition:
To perform one or more operations on information to assign, persist, and manage labels to healthcare data to characterize various aspects, such as its security classification, sensitivity, compartment, integrity, and provenance; applicable privacy, consent, security, provenance, and trust policies; and handling caveats such as purpose of use, obligations, and refrain policies.

Label management includes classification of target data by constructing and binding of a label set per applicable policies, security policy information file semantics, and classification guides. Label management also includes process and procedures for subsequent revision of a label for, e.g., reclassification, downgrading classification, and declassification.

Label revisions may be triggered by, e.g., expiry of classification period; changes in applicable policy, e.g., revocation of a consent directive; or changes in the governing policy domain in which the data is relocated or a copy of the data is sent. If a label is revised, an audit log should be kept and the provenance of the label changes should be tracked.


Code: METAMGT
Display: metadata management
Definition:
To perform one or more operations on information to assign, persist, and manage metadata to healthcare data to characterize various aspects used for its indexing, discovery, retrieval, and processing by systems, applications, and end users. For example, master index identifier, media type, and location.


Code: ACCRED
Display: accreditation
Definition:
**Description:**Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service


Code: COMPL
Display: compliance
Definition:
**Description:**Operational activities required to meet a mandate related to an activity, product, or service


Code: ENADMIN
Display: entity administration
Definition:
**Description:**Operational activities conducted to administer information relating to entities involves with an activity, product, or service


Code: OUTCOMS
Display: outcome measure
Definition:
**Description:**Operational activities conducted for the purposes of assessing the results of an activity, product, or service


Code: PRGRPT
Display: program reporting
Definition:
**Description:**Operational activities conducted to meet program accounting requirements related to an activity, product, or service


Code: QUALIMP
Display: quality improvement
Definition:
**Description:**Operational activities conducted for the purposes of improving the quality of an activity, product, or service


Code: SYSADMN
Display: system administration
Definition:
**Description:**Operational activities conducted to administer the electronic systems used for an activity, product, or service


Code: FAMRQT
Display: family requested
Definition:
To perform one or more operations on information in response to a request by a family member authorized by the patient.


Code: PWATRNY
Display: power of attorney
Definition:
To perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.


Code: SUPNWK
Display: support network
Definition:
To perform one or more operations on information in response to a request by a person authorized by the patient.


Code: DISASTER
Display: disaster
Definition:
To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.


Code: THREAT
Display: threat
Definition:
To perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.


Code: HMARKT
Display: healthcare marketing
Definition:
To perform one or more operations on information for marketing services and products related to health care.


Code: HOPERAT
Display: healthcare operations
Definition:
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.


Code: HPAYMT
Display: healthcare payment
Definition:
To perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.


Code: HRESCH
Display: healthcare research
Definition:
To perform one or more operations on information for conducting scientific investigations to obtain health care knowledge. Use of the data iincludes basic and applied research such as biomedical, population origin or ancestry, translational research, and disease, discipline, specialty specific healthcare research and clinical trial research.


Code: PUBHLTH
Display: public health
Definition:
To perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.


Code: HTEST
Display: test health data
Definition:
To perform one or more operations on information that is simulated or synthetic health data used for testing system capabilities outside of a production or operational system environment.

*Usage Note:* Data marked with a HTEST security label enables an access control system to permit interfacing systems or end users provisioned with a clearance, which includes a HTEST purpose of use attribute, to test, verify, or validate that a system or application will operate in production as intended based on design specifications.


Code: COC
Display: coordination of care
Definition:
To 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."


Code: ETREAT
Display: Emergency Treatment
Definition:
To perform one or more operations on information for provision of immediately needed health care for an emergent condition.


Code: POPHLTH
Display: population health
Definition:
To perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.


Code: TREATDS
Display: decision support assisted treatment decision
Definition:
To apply algorithms (e.g. AI, CDS) to perform one or more operations on information to arrive at decision used in health care treatment.


Code: FUTSUM
Display: future summary
Definition:
Represents a 'summary' of all acts that are scheduled to occur in the future (whose effective time is greater than 'now' where is the time the instance is authored.). The effectiveTime represents the outer boundary of all occurrences, repeatNumber represents the total number of repetitions, etc.


Code: LAST
Display: expected last
Definition:
Restricted to the latest known occurrence that is scheduled to occur. The Act with the highest known effective time.


Code: NEXT
Display: expected next
Definition:
Restricted to the nearest recent known occurrence scheduled to occur in the future. The Act with the lowest effective time, still greater than 'now'. ('now' is the time the instance is authored.)


Code: FIRST
Display: first known
Definition:
Restricted to the earliest known occurrence that occurred or was scheduled to occur in the past. The Act with the lowest effective time. ('now' is the time the instance is authored.)


Code: PREVSUM
Display: previous summary
Definition:
Represents a 'summary' of all acts that previously occurred or were scheduled to occur. The effectiveTime represents the outer boundary of all occurrences, repeatNumber represents the total number of repetitions, etc. ('now' is the time the instance is authored.)


Code: RECENT
Display: most recent
Definition:
Restricted to the most recent known occurrence that occurred or was scheduled to occur in the past. The Act with the most recent effective time, still less than 'now'. ('now' is the time the instance is authored.)


Code: SUM
Display: summary
Definition:
Represents a 'summary' of all acts that have occurred or were scheduled to occur and which are scheduled to occur in the future. The effectiveTime represents the outer boundary of all occurrences, repeatNumber represents the total number of repetitions, etc.


Code: MAX
Display: maximum
Definition:
The occurrence whose value attribute is greater than all other occurrences at the time the instance is created.


Code: MIN
Display: minimum
Definition:
The occurrence whose value attribute is less than all other occurrences at the time the instance is created.


Code: ART
Display: act relationship type
Definition:
**Description:** A directed association between a source Act and a target Act.

**Usage Note:** This code should never be transmitted in an instance as the value of ActRelationship.typeCode (attribute)


Code: _ActRelationshipTemporallyPertainsEnd
Display: ActRelationshipTemporallyPertainsEnd
Definition:
A relationship that defines the relative time of the end source act based on the time of the target act.


Code: _ActRelationshipTemporallyPertainsStart
Display: ActRelationshipTemporallyPertainsStart
Definition:
A relationship that defines the relative time of the start source act based on the time of the target act.


Code: RSON
Display: has reason
Definition:
**Description:** 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. As well as providing various types of information about the rationale for a service, the RSON act relationship is routinely used between a SBADM act and an OBS act to describe the indication for use of a medication. Child concepts may be used to describe types of indication.

*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.


Code: EAS
Display: ends after start of
Definition:
A relationship in which the source act ends after the target act starts.

*UsageNote:* Inverse code is **SBE**


Code: EASORECWS
Display: ends after or concurrent with start of
Definition:
A relationship in which the source act's effective time ends after or concurrent with the start of the target act's effective time.

*Usage Note:* Inverse code is EBSORECWS


Code: INDEPENDENT
Display: independent of time of
Definition:
The source Act is independent of the time of the target Act.

*UsageNote:* This code is reflexive. Therefore its inverse code is itself.


Code: SAEORSCWE
Display: starts after or concurrent with end of
Definition:
A relationship in which the source act's effective time starts after or concurrent with the end of the target act's effective time.

*Usage Note:* Inverse code is SBEORSCWE


Code: SASORSCW
Display: starts after or concurrent with start of
Definition:
A relationship in which the source act's effective time starts after or concurrent with the start of the target act's effective time.

*Usage Note:* Inverse code is SBSORSCW


Code: SBEORSCWE
Display: starts before or concurrent with end of
Definition:
A relationship in which the source act's effective time starts before or concurrent with the end of the target act's effective time.

*Usage Note:* Inverse code is SAEORSCWE


Code: ENE
Display: ends near end
Definition:
A relationship in which the source act's effective time ends near the end of the target act's effective time. Near is defined separately as a time interval.

*Usage Note:* Inverse code is ENS


Code: ENS
Display: ends near start
Definition:
A relationship in which the source act's effective time ends near the start of the target act's effective time. Near is defined separately as a time interval.

*Usage Note:* Inverse code is ENE


Code: SNE
Display: starts near end
Definition:
A relationship in which the source act's effective time starts near the end of the target act's effective time. Near is defined separately as a time interval.

*Usage Note:* Inverse code is SNS


Code: SNS
Display: starts near start
Definition:
A relationship in which the source act's effective time starts near the start of the target act's effective time. Near is defined separately as a time interval.

*Usage Note:* Inverse code is SNE


Code: CAUS
Display: is etiology for
Definition:
**Description:** An assertion that an act was the cause of another act.This is stronger and more specific than the support link. The source (cause) is typically an observation, but may be any act, while the target may be any act.

**Examples:**

 *  a growth of Staphylococcus aureus may be considered the cause of an abscess
 *  contamination of the infusion bag was deemed to be the cause of the infection that the patient experienced
 *  lack of staff on the shift was deemed to be a supporting factor (proximal factor) causing the patient safety incident where the patient fell out of bed because the bed-sides had not been put up which caused the night patient to fall out of bed


Code: COMP
Display: has component
Definition:
The target act is a component of the source act, with no semantics regarding composition or aggregation implied.


Code: EXACBY
Display: exacerbated by
Definition:
**Description:**The source act is aggravated by the target act. (Example "chest pain" EXACBY "exercise")


Code: INTF
Display: interfered by
Definition:
the target act documents a set of circumstances (events, risks) which prevent successful completion, or degradation of quality of, the source Act.

*UsageNote:* This provides the semantics to document barriers to care


Code: META
Display: has metadata
Definition:
**Definition:** Indicates that the attributes and associations of the target act provide metadata (for example, identifiers, authorship, etc.) for the source act.

**Constraint:**  Source act must have either a mood code that is not "EVN" (event) or its "isCriterion" attribute must set to "true". Target act must be an Act with a mood code of EVN and with isCriterionInd attribute set to "true".


Code: OUTC
Display: has outcome
Definition:
An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-conditional".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute (AND, OR, XOR) can be used. An outcome link is often inverted to describe an outcome assessment.


Code: RELVBY
Display: relieved by
Definition:
**Description:**The source act is wholly or partially alleviated by the target act. (Example "chest pain" RELVBY "sublingual nitroglycerin administration")


Code: SPRT
Display: has support
Definition:
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).


Code: VALUE
Display: has value
Definition:
**Description:**Indicates that the target Act represents the result of the source observation Act.

**FormalConstraint:** Source Act must be an Observation or specialization there-of. Source Act must not have the value attribute specified

**UsageNote:** This relationship allows the result of an observation to be fully expressed as RIM acts as opposed to being embedded in the value attribute. For example, sending a Document act as the result of an imaging observation, sending a list of Procedures and/or other acts as the result of a medical history observation.

The valueNegationInd attribute on the source Act has the same semantics of "negated finding" when it applies to the target of a VALUE ActRelationship as it does to the value attribute. On the other hand, if the ActRelationship.negationInd is true for a VALUE ActRelationship, that means the specified observation does not have the indicated value but does not imply a negated finding. Because the semantics are extremely close, it is recommended that Observation.valueNegationInd be used, not ActRelationship.negationInd.

**OpenIssue:** The implications of negationInd on ActRelationship and the valueNegationind on Observation.


Code: MBR
Display: has member
Definition:
The target Acts are aggregated by the source Act. Target Acts may have independent existence, participate in multiple ActRelationships, and do not contribute to the meaning of the source.

**UsageNotes:** This explicitly represents the conventional notion of aggregation. The target Act is part of a collection of Acts (no implication is made of cardinality, a source of Acts may contain zero, one, or more member target Acts).

It is expected that this will be primarily used with \_ActClassRecordOrganizer, BATTERY, and LIST


Code: PART
Display: has part
Definition:
The source Act is a composite of the target Acts. The target Acts do not have an existence independent of the source Act.

*UsageNote:* In UML 1.1, this is a "composition" defined as:  
*"A form of aggregation with strong ownership and coincident lifetime as part of the whole. Parts with non-fixed multiplicity may be created after the composite itself, but once created they live and die with it (i.e., they share lifetimes). Such parts can also be explicitly removed before the death of the composite. Composition may be recursive."*


Code: SASEAE
Display: starts after start of, ends after end of
Definition:
The source Act starts after start of the target Act and ends after end of the target Act.

*UsageNote:* Inverse code is **SBSEBE**


Code: EAE
Display: ends after end of
Definition:
A relationship in which the source act ends after the target act ends.

*UsageNote:* Inverse code is **EBE**


Code: ECW
Display: ends concurrent with
Definition:
A relationship in which the source act's effective time ends with the end of the target act's effective time.

*UsageNote:* This code is reflexive. Therefore its inverse code is itself.


Code: SAS
Display: starts after start of
Definition:
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).

*UsageNote:* Inverse code is **SBS**


Code: EAEORECW
Display: ends after or concurrent with end of
Definition:
A relationship in which the source act's effective time ends after or concurrent with the end of the target act's effective time.

*Usage Note:* Inverse code is EBEORECW


Code: ECWS
Display: ends concurrent with start of
Definition:
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).

*UsageNote:* Inverse code is **SCWE**


Code: SBSEBE
Display: starts before start of, ends before end of
Definition:
The source Act starts before the start of the target Act, and ends before the end of the target Act.

*UsageNote:* Inverse code is **SASEAE**


Code: EBE
Display: ends before end of
Definition:
The source Act ends before 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).

*UsageNote:* Inverse code is **EAE**


Code: EBS
Display: ends before start of
Definition:
A relationship in which the source act ends before the target act starts.

*UsageNote:* Inverse code is **SAE**


Code: CONCURRENT
Display: concurrent with
Definition:
A relationship in which the source act's effective time is the same as the target act's effective time.

*UsageNote:* This code is reflexive. Therefore its inverse code is itself.


Code: SBSECWE
Display: starts before start of, ends with
Definition:
The source Act starts before the start of the target Act, and ends with the target Act.

*UsageNote:* Inverse code is **SASECWE**


Code: SBSEASEBE
Display: contains start of, ends before end of
Definition:
The source Act contains the start of the target Act, and ends before the end of the target Act.

*UsageNote:* Inverse code is **SASSBEEAS**


Code: SCWSEBE
Display: starts with. ends before end of
Definition:
The source Act starts with.the target Act and ends before the end of the target Act.

*UsageNote:* Inverse code is **SCWSEAE**


Code: ACTIMM
Display: active immunization against
Definition:
**Description:** The source act is intended to provide active immunity against the effects of the target act (the target act describes an infectious disease)


Code: PASSIMM
Display: passive immunization against
Definition:
**Description:** The source act is intended to provide passive immunity against the effects of the target act (the target act describes an infectious disease).


Code: STEP
Display: has step
Definition:
A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently.

*UsageNotes:* Sequence of steps may be indicated by use of \_ActRelationshipTemporallyPertains, as well as via ActRelationship.sequenceNumber, ActRelationship.pauseQuantity, Target.priorityCode.

*OpenIssue:* Need Additional guidelines on when each approach should be used.


Code: EDU
Display: ends during
Definition:
A relationship in which the source act ends within the target act's effective time (including end points, as defined in the act's effective times)

*UsageNote:* Inverse code is **SBEEAE**


Code: SCW
Display: starts concurrent with
Definition:
A relationship in which the source act's effective time starts with the start of the target act's effective time.

*UsageNote:* This code is reflexive. Therefore its inverse code is itself.


Code: SCWE
Display: starts concurrent with end of
Definition:
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).

*UsageNote:* Inverse code is **SBSECWS**


Code: SDU
Display: starts during
Definition:
A relationship in which the source act starts within the target act's effective time (including end points, as defined in the act's effective times)

*UsageNote:* Inverse code is **SBSEAS**


Code: USE
Display: uses
Definition:
Indicates that the source act makes use of (or will make use of) the information content of the target act.

*UsageNotes:* A usage relationship only makes sense if the target act is authored and occurs independently of the source act. Otherwise a simpler relationship such as COMP would be appropriate.

*Rationale:* There is a need when defining a clinical trial protocol to indicate that the protocol makes use of other protocol or treatment specifications. This is stronger than the assertion of "references". References may exist without usage, and in a clinical trial protocol is common to assert both: what other specifications does this trial use and what other specifications does it merely reference.


Code: DIAG
Display: diagnoses
Definition:
**Description:** The source act is intended to help establish the presence of a (an adverse) situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.


Code: IMM
Display: immunization against
Definition:
**Description:** The source act is intented to provide immunity against the effects of the target act (the target act describes an infectious disease)


Code: PRYLX
Display: prophylaxis of
Definition:
**Description:** The source act is intended to reduce the risk of of an adverse situation to emerge as described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.


Code: TREAT
Display: treats
Definition:
**Description:** The source act is intended to improve a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.


Code: SAE
Display: starts after end of
Definition:
A relationship in which the source act starts after the target act ends.

*UsageNote:* Inverse code is **EBS**


Code: DURING
Display: occurs during
Definition:
A relationship in which the source act's effective time is wholly within the target act's effective time (including end points, as defined in the act's effective times)

*UsageNote:* Inverse code is **SBSEAE**


Code: SASECWE
Display: starts after start of, ends with
Definition:
The source Act starts after start of the target Act, and ends with the target Act.

*UsageNote:* Inverse code is **SBSECWE**


Code: SASSBEEAS
Display: start after start of, contains end of
Definition:
The source Act start after the start of the target Act, and contains the end of the target Act.

*UsageNote:* Inverse code is **SBSEASEBE**


Code: EBEORECW
Display: ends before or concurrent with end of
Definition:
A relationship in which the source act's effective time ends before or concurrent with the end of the target act's effective time.

*Usage Note:* Inverse code is EAEORECW


Code: SBSORSCW
Display: starts before or concurrent with start of
Definition:
A relationship in which the source act's effective time starts before or concurrent with the start of the target act's effective time.

*Usage Note:* Inverse code is SASORSCW


Code: OVERLAP
Display: overlaps with
Definition:
A relationship in which the source act's effective time overlaps the target act's effective time in any way.

*UsageNote:* This code is reflexive. Therefore its inverse code is itself.


Code: SBE
Display: starts before end of
Definition:
The source Act starts before 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).

*UsageNote:* Inverse code is **EAS**


Code: EBSORECWS
Display: ends before or concurrent with start of
Definition:
A relationship in which the source act's effective time ends before or concurrent with the start of the target act's effective time.

*Usage Note:* Inverse code is EASORECWS


Code: SBS
Display: starts before start of
Definition:
A relationship in which the source act begins before the target act begins.

*UsageNote:* Inverse code is **SAS**


Code: BSLN
Display: has baseline
Definition:
Indicates that the target observation(s) provide an initial reference for the source observation or observation group.

*UsageConstraints:* Both source and target must be Observations or specializations thereof.


Code: COMPLY
Display: complies with
Definition:
**Description:**The source act complies with, adheres to, conforms to, or is permissible under (in whole or in part) the policy, contract, agreement, law, conformance criteria, certification guidelines or requirement conveyed by the target act.

Examples for compliance relationships are: audits of adherence with a security policy, certificate of conformance to system certification requirements, or consent directive in compliance with or permissible under a privacy policy.


Code: QUALF
Display: has qualifier
Definition:
The target observation qualifies (refines) the semantics of the source observation.

*UsageNote:* This is not intended to replace concept refinement and qualification via vocabulary. It is used when there are multiple components which together provide the complete understanding of the source Act.


Code: ADJUNCT
Display: adjunctive treatment
Definition:
**Description:** The source act is intended to offer an additional treatment for the management or cure of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. It is not a requirement that the non-adjunctive treatment is explicitly specified.


Code: MTREAT
Display: maintenance treatment
Definition:
**Description:** The source act is intended to provide long term maintenance improvement or management of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.


Code: PALLTREAT
Display: palliates
Definition:
**Description:** The source act is intended to provide palliation for the effects of the target act.


Code: SYMP
Display: symptomatic relief
Definition:
**Description:** The source act is intented to provide symptomatic relief for the effects of the target act.


Code: 42CFRPart2
Display: 42 CFR Part2
Definition:
42 CFR Part 2 stipulates the right of an individual who has applied for or been given diagnosis or treatment for alcohol or drug abuse at a federally assisted program.

*Definition:* Non-disclosure of health information relating to health care paid for by a federally assisted substance abuse program without patient consent.

*Usage Note:* May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies.


Code: CommonRule
Display: Common Rule
Definition:
U.S. Federal regulations governing the protection of human subjects in research (codified at Subpart A of 45 CFR part 46) that has been adopted by 15 U.S. Federal departments and agencies in an effort to promote uniformity, understanding, and compliance with human subject protections. Existing regulations governing the protection of human subjects in Food and Drug Administration (FDA)-regulated research (21 CFR parts 50, 56, 312, and 812) are separate from the Common Rule but include similar requirements.

*Definition:* U.S. federal laws governing research-related privacy policies.

*Usage Note:* 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.


Code: HIPAANOPP
Display: HIPAA notice of privacy practices
Definition:
The U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Part 164 Subpart E) permits access, use and disclosure of certain personal health information (PHI as defined under the law) for purposes of Treatment, Payment, and Operations, and requires that the provider ask that patients acknowledge the Provider's Notice of Privacy Practices as permitted conduct under the law.

*Definition:* Notification of HIPAA Privacy Practices.

*Usage Note:* 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.


Code: HIPAAPsyNotes
Display: HIPAA psychotherapy notes
Definition:
The U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Part 164 Section 164.508) requires authorization for certain uses and disclosure of psychotherapy notes.

*Definition:* Authorization that must be obtained for disclosure of psychotherapy notes.

*Usage Note:* May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies.


Code: HIPAASelfPay
Display: HIPAA self-pay
Definition:
Section 13405(a) of the Health Information Technology for Economic and Clinical Health Act (HITECH) stipulates the right of an individual to have disclosures regarding certain health care items or services for which the individual pays out of pocket in full restricted from a health plan.

*Definition:* Non-disclosure of health information to a health plan relating to health care items or services for which an individual pays out of pocket in full.

*Usage Note:* May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies.


Code: Title38Section7332
Display: Title 38 Section 7332
Definition:
Title 38 Part 1-protected information may only be disclosed to a third party with the special written consent of the patient except where expressly authorized by 38 USC 7332. VA may disclose this information for specific purposes to: VA employees on a need to know basis - more restrictive than Privacy Act need to know; contractors who need the information in order to perform or fulfill the duties of the contract; and researchers who provide assurances that the information will not be identified in any report. This information may also be disclosed without consent where patient lacks decision-making capacity; in a medical emergency for the purpose of treating a condition which poses an immediate threat to the health of any individual and which requires immediate medical intervention; for eye, tissue, or organ donation purposes; and disclosure of HIV information for public health purposes.

*Definition:* Title 38 Part 1 - Â§1.462 Confidentiality restrictions.

(a) General. The patient records to which Â§Â§1.460 through 1.499 of this part apply may be disclosed or used only as permitted by these regulations and may not otherwise be disclosed or used in any civil, criminal, administrative, or legislative proceedings conducted by any Federal, State, or local authority. Any disclosure made under these regulations must be limited to that information which is necessary to carry out the purpose of the disclosure. SUBCHAPTER III--PROTECTION OF PATIENT RIGHTS Sec. 7332. Confidentiality of certain medical records (a)(1) Records of the identity, diagnosis, prognosis, or treatment of any patient or subject which are maintained in connection with the performance of any program or activity (including education, training, treatment, rehabilitation, or research) relating to drug abuse, alcoholism or alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia which is carried out by or for the Department under this title shall, except as provided in subsections (e) and (f), be confidential, and (section 5701 of this title to the contrary notwithstanding) such records may be disclosed only for the purposes and under the circumstances expressly authorized under subsection (b).

*Usage Note:* May be associated with an Act or a Role to indicate the legal provision to which the assignment of an Act.confidentialityCode or Role.confidentialityCode complies.


Code: N
Display: stated with no assertion of uncertainty
Definition:
Specifies that the act statement is made without explicit tagging of uncertainty. This is the normal statement, meaning that it is not free of errors and uncertainty may still exist.


Code: U
Display: stated with uncertainty
Definition:
Specifies that the originator of the Act statement does not have full confidence in the applicability (i.e., in event mood: factual truth) of the statement.


Code: ADL
Display: additional locator
Definition:
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, rather than specifying a smaller location within some larger one (e.g., Dutch "t.o." means "opposite to" for house boats located across the street facing houses).


Code: SAL
Display: street address line
Definition:
**Description:** A street address line is frequently used instead of breaking out build number, street name, street type, etc. An address generally has only a delivery address line or a street address line, but not both.


Code: BNS
Display: building number suffix
Definition:
Any alphabetic character, fraction or other text that may appear after the numeric portion of a building number


Code: CAR
Display: care of
Definition:
The name of the party who will take receipt at the specified address, and will take on responsibility for ensuring delivery to the target recipient


Code: CPA
Display: county or parish
Definition:
A sub-unit of a state or province. (49 of the United States of America use the term "county;" Louisiana uses the term "parish".)


Code: DEL
Display: delimiter
Definition:
Delimiters are printed without framing white space. If no value component is provided, the delimiter appears as a line break.


Code: DINST
Display: delivery installation type
Definition:
Indicates the type of delivery installation (the facility to which the mail will be delivered prior to final shipping via the delivery mode.) Example: post office, letter carrier depot, community mail center, station, etc.


Code: DINSTA
Display: delivery installation area
Definition:
The location of the delivery installation, usually a town or city, and is only required if the area is different from the municipality. Area to which mail delivery service is provided from any postal facility or service such as an individual letter carrier, rural route, or postal route.


Code: DINSTQ
Display: delivery installation qualifier
Definition:
A number, letter or name identifying a delivery installation. E.g., for Station A, the delivery installation qualifier would be 'A'.


Code: DMOD
Display: delivery mode
Definition:
Indicates the type of service offered, method of delivery. For example: post office box, rural route, general delivery, etc.


Code: DMODID
Display: delivery mode identifier
Definition:
Represents the routing information such as a letter carrier route number. It is the identifying number of the designator (the box number or rural route number).


Code: INT
Display: intersection
Definition:
**Description:**An intersection denotes that the actual address is located AT or CLOSE TO the intersection OF two or more streets.


Code: STB
Display: street name base
Definition:
The base name of a roadway or artery recognized by a municipality (excluding street type and direction)


Code: UNID
Display: unit identifier
Definition:
The number or name of a specific unit contained within a building or complex, as assigned by that building or complex.


Code: CONF
Display: confidential address
Definition:
**Description:** Indicates that the address is considered sensitive and should only be shared or published in accordance with organizational controls governing patient demographic information with increased sensitivity. Uses of Addresses. Lloyd to supply more complete description.


Code: H
Display: home address
Definition:
**Description:** A communication address at a home, attempted contacts for business purposes might intrude privacy and chances are one will contact family or other household members instead of the person one wishes to call. Typically used with urgent cases, or if no other contacts are available.


Code: OLD
Display: no longer in use
Definition:
This address is no longer in use.

*Usage Note:* Address may also carry valid time ranges. This code is used to cover the situations where it is known that the address is no longer valid, but no particular time range for its use is known.


Code: TMP
Display: temporary address
Definition:
**Description:** A temporary address, may be good for visit or mailing. Note that an address history can provide more detailed information.


Code: WP
Display: work place
Definition:
**Description:** An office address. First choice for business related contacts during business hours.


Code: DIR
Display: direct
Definition:
**Description:** Indicates a work place address or telecommunication address that reaches the individual or organization directly without intermediaries. For phones, often referred to as a 'private line'.


Code: PUB
Display: public
Definition:
**Description:** Indicates a work place address or telecommunication address that is a 'standard' address which may reach a reception service, mail-room, or other intermediary prior to the target entity.


Code: AS
Display: answering service
Definition:
**Description:** An automated answering machine used for less urgent cases and if the main purpose of contact is to leave a message or access an automated announcement.


Code: EC
Display: emergency contact
Definition:
**Description:** A contact specifically designated to be used for emergencies. This is the first choice in emergencies, independent of any other use codes.


Code: MC
Display: mobile contact
Definition:
**Description:** A telecommunication device that moves and stays with its owner. May have characteristics of all other use codes, suitable for urgent matters, not the first choice for routine business.


Code: UN
Display: Undifferentiated
Definition:
En: The gender of a person could not be uniquely defined as male or female, such as intersex. Nl: Het geslacht van een persoon kan niet uniek worden gedefinieerd als man of vrouw, zoals een intersekse-conditie.

*Open Issue:* This is a short-term stopgap solution to the definition issue, full solutions are being worked out by the Gender Harmony project launched in 2019.


Code: GREG
Display: Gregorian
Definition:
The Gregorian calendar is the calendar in effect in most countries of Christian influence since approximately 1582. This calendar superceded the Julian calendar.


Code: WM
Display: week of the month
Definition:
The week with the month's first Thursday in it (analagous to the ISO 8601 definition for week of the year).


Code: GREG
Display: Gregorian
Definition:
The Gregorian calendar is in effect in the most countries of Christian influence since approximately 1582. This calendar superceded the Julian calendar.


Code: PR
Display: post-coded and required
Definition:
Post-coded from free text source, required by the specification describing the use of the coded concept.


Code: DF
Display: deflate
Definition:
The deflate compressed data format as specified in RFC 1951 \[http://www.ietf.org/rfc/rfc1951.txt\].


Code: GZ
Display: gzip
Definition:
A compressed data format that is compatible with the widely used GZIP utility as specified in RFC 1952 \[http://www.ietf.org/rfc/rfc1952.txt\] (uses the deflate algorithm).


Code: Z
Display: compress
Definition:
Original UNIX compress algorithm and file format using the LZC algorithm (a variant of LZW). Patent encumbered and less efficient than deflate.


Code: ZL
Display: zlib
Definition:
A compressed data format that also uses the deflate algorithm. Specified as RFC 1950 \[http://www.ietf.org/rfc/rfc1952.txt\]


Code: _Confidentiality
Display: Confidentiality
Definition:
A specializable code and its leaf codes used in Confidentiality value sets to value the Act.Confidentiality and Role.Confidentiality attribute in accordance with the definition for concept domain "Confidentiality".


Code: L
Display: low
Definition:
Privacy metadata indicating that a low level of protection is required to safeguard personal and healthcare information, which has been altered in such a way as to minimize the need for confidentiality protections with some residual risks associated with re-linking. The risk of harm to an individual's reputation and sense of privacy if disclosed without authorization is considered negligible, and mitigations are in place to address reidentification risk.

*Usage Note:* 

The level of protection afforded anonymized and pseudonymized, and non-personally identifiable information (e.g., a limited data set) is dictated by privacy policies and data use agreements intended to engender trust that health information can be used and disclosed with little or no risk of re-identification.

**Example:** Personal and healthcare information, which excludes 16 designated categories of direct identifiers in a HIPAA Limited Data Set. This information may be disclosed by HIPAA Covered Entities without patient authorization for a research, public health, and operations purposes if conditions are met, which includes obtaining a signed data use agreement from the recipient. See 45 CFR Section 164.514.

This metadata indicates that the receiver may have an obligation to comply with a data use agreement with the discloser. The discloser may have obligations to comply with policies dictating the methods for de-identification.

Confidentiality code total order hierarchy: Low (L) is less protective than *V, R, N,* and *M*, and subsumes *U*.


Code: M
Display: moderate
Definition:
Privacy metadata indicating the level of protection required to safeguard personal and healthcare information, which if disclosed without authorization, would present a moderate risk of harm to an individual's reputation and sense of privacy.

*Usage Note:* The level of protection afforded moderately confidential information is dictated by privacy policies intended to engender trust in a service provider. May include publicly available information in jurisdictions that restrict uses of that information without the consent of the data subject.

Privacy policies mandating moderate levels of protection, which preempt less protective privacy policies. "Moderate" confidentiality policies differ from and would be preempted by the prevailing privacy policies mandating the normative level of protection for information used in the delivery and management of healthcare.

Confidentiality code total order hierarchy: Moderate (M) is less protective than *V, R, and N*, and subsumes all other protection levels (i.e., *L* and *U*).

**Examples:** Includes personal and health information that an individual authorizes to be collected, accessed, used or disclosed to a bank for a health credit card or savings account; to health oversight authorities; to a hospital patient directory; to worker compensation, disability, property and casualty or life insurers; and to personal health record systems, consumer-controlled devices, social media accounts and online Apps; or for marketing purposes


Code: N
Display: normal
Definition:
Privacy metadata indicating the level of protection required to safeguard personal and healthcare information, which if disclosed without authorization, would present a considerable risk of harm to an individual's reputation and sense of privacy.

*Usage Note:* The level of protection afforded normatively confidential information is dictated by the prevailing normative privacy policies, which are intended to engender patient trust in their healthcare providers.

Privacy policies mandating normative levels of protection, which preempt less protective privacy policies when the information is used in the delivery and management of healthcare. May be pre-empted by jurisdictional law (e.g., for public health reporting or emergency treatment).

Confidentiality code total order hierarchy: Normal (N) is less protective than *V* and *R*, and subsumes all other protection levels (i.e., *M, L, and U*).

**Map:**Partial Map to ISO 13606-4 Sensitivity Level (3) Clinical Care when purpose of use is treatment: Default for normal clinical care access (i.e., most clinical staff directly caring for the patient should be able to access nearly all of the EHR). Maps to normal confidentiality for treatment information but not to ancillary care, payment and operations.

**Examples:** 

n the US, this includes what HIPAA identifies as protected health information (PHI) under 45 CFR Section 160.103.


Code: R
Display: restricted
Definition:
Privacy metadata indicating the level of protection required to safeguard potentially stigmatizing information, which if disclosed without authorization, would present a high risk of harm to an individual's reputation and sense of privacy.

*Usage Note:* The level of protection afforded restricted confidential information is dictated by specially protective organizational or jurisdictional privacy policies, including at an authorized individual's request, intended to engender patient trust in providers of sensitive services.

Privacy policies mandating additional levels of protection by restricting information access preempt less protective privacy policies when the information is used in the delivery and management of healthcare. May be pre-empted by jurisdictional law (e.g., for public health reporting or emergency treatment).

Confidentiality code total order hierarchy: Restricted (R) is less protective than *V*, and subsumes all other protection levels (i.e., *N, M, L, and U*).

**Examples:** 

Includes information that is additionally protected such as sensitive conditions mental health, HIV, substance abuse, domestic violence, child abuse, genetic disease, and reproductive health; or sensitive demographic information such as a patient's standing as an employee or a celebrity. May be used to indicate proprietary or classified information that is not related to an individual (e.g., secret ingredients in a therapeutic substance; or the name of a manufacturer).


Code: U
Display: unrestricted
Definition:
Privacy metadata indicating that no level of protection is required to safeguard personal and healthcare information that has been disclosed by an authorized individual without restrictions on its use.

**Examples:** Includes publicly available information e.g., business name, phone, email and physical address.

*Usage Note:* The authorization to collect, access, use, and disclose this information may be stipulated in a contract of adhesion by a data user (e.g., via terms of service or data user privacy policies) in exchange for the data subject's use of a service.

This metadata indicates that the receiver has no obligation to consider privacy policies other than its own when making access control decisions.

This metadata indicates that the receiver has no obligation to consider privacy policies other than its own when making access control decisions.

Confidentiality code total order hierarchy: Unrestricted (U) is less protective than *V, R, N, M,* and *L*, and is the lowest protection levels.


Code: V
Display: very restricted
Definition:
Privacy metadata indicating the level of protection required under atypical cicumstances to safeguard potentially damaging or harmful information, which if disclosed without authorization, would (1) present an extremely high risk of harm to an individual's reputation, sense of privacy, and possibly safety; or (2) impact an individual's or organization's legal matters.

*Usage Note:* The level of protection afforded very restricted confidential information is dictated by specially protective privacy or legal policies intended to ensure that under atypical circumstances additional protections limit access to only those with a high 'need to know' and the information is kept in highest confidence..

Privacy and legal policies mandating the highest level of protection by stringently restricting information access, preempt less protective privacy policies when the information is used in the delivery and management of healthcare including legal proceedings related to healthcare. May be pre-empted by jurisdictional law (e.g., for public health reporting or emergency treatment but only under limited circumstances).

Confidentiality code total order hierarchy: Very Restricted (V) is the highest protection level and subsumes all other protection levels s (i.e., *R, N, M, L, and UI*).

**Examples:** 

Includes information about a victim of abuse, patient requested information sensitivity, and taboo subjects relating to health status that must be discussed with the patient by an attending provider before sharing with the patient. May also include information held under a legal hold or attorney-client privilege.


Code: _ConfidentialityByAccessKind
Display: ConfidentialityByAccessKind
Definition:
**Description:** By accessing subject / role and relationship based rights (These concepts are mutually exclusive, one and only one is required for a valid confidentiality coding.)

*Deprecation Comment:*Deprecated due to updated confidentiality codes under ActCode


Code: B
Display: business
Definition:
**Description:** Since the service class can represent knowledge structures that may be considered a trade or business secret, there is sometimes (though rarely) the need to flag those items as of business level confidentiality. However, no patient related information may ever be of this confidentiality level.

*Deprecation Comment:* Replced by ActCode.B


Code: D
Display: clinician
Definition:
**Description:** Only clinicians may see this item, billing and administration persons can not access this item without special permission.

*Deprecation Comment:*Deprecated due to updated confidentiality codes under ActCode


Code: I
Display: individual
Definition:
**Description:** Access only to individual persons who are mentioned explicitly as actors of this service and whose actor type warrants that access (cf. to actor type code).

*Deprecation Comment:*Deprecated due to updated confidentiality codes under ActCode


Code: _ConfidentialityByInfoType
Display: ConfidentialityByInfoType
Definition:
**Description:** By information type, only for service catalog entries (multiples allowed). Not to be used with actual patient data!

*Deprecation Comment:*Deprecated due to updated confidentiality codes under ActCode


Code: SDV
Display: sexual and domestic violence related
Definition:
**Description:** Sexual assault / domestic violence related item

*Deprecation Comment:*Replced by ActCode.SDV


Code: _ConfidentialityModifiers
Display: ConfidentialityModifiers
Definition:
**Description:** Modifiers of role based access rights (multiple allowed)

*Deprecation Comment:*Deprecated due to updated confidentiality codes under ActCode


Code: C
Display: celebrity
Definition:
**Description:** Celebrities are people of public interest (VIP) including employees, whose information require special protection.

*Deprecation Comment:*Replced by ActCode.CEL


Code: S
Display: sensitive
Definition:
**Description:** 

Information for which the patient seeks heightened confidentiality. Sensitive information is not to be shared with family members. Information reported by the patient about family members is sensitive by default. Flag can be set or cleared on patient's request.

*Deprecation Comment:*Deprecated due to updated confidentiality codes under ActCode


Code: T
Display: taboo
Definition:
**Description:** Information not to be disclosed or discussed with patient except through physician assigned to patient in this case. This is usually a temporary constraint only, example use is a new fatal diagnosis or finding, such as malignancy or HIV.

*Deprecation Note:*Replced by ActCode.TBOO


Code: CHILD
Display: ChildProof
Definition:
A cap designed to be difficult to open for children. Generally requires multiple simultaneous actions (e.g. squeeze and twist) to open. Used for products that may be dangerous if ingested or overdosed by children.


Code: EASY
Display: EasyOpen
Definition:
A cap designed to be easily removed. For products intended to be opened by persons with limited strength or dexterity.


Code: PUSH
Display: Push Cap
Definition:
A non-threaded cap that forms a tight-fitting closure on a container by pushing the fitted end into the conatiner opening


Code: _ContextControlOverriding
Display: ContextControlOverriding
Definition:
The association adds to the existing context associated with the Act, but replaces associations propagated from ancestor Acts whose typeCodes are the same or more specific.


Code: CREATE
Display: create
Definition:
Fundamental operation in an Information System (IS) that results only in the act of bringing an object into existence. Note: The preceding definition is taken from the HL7 RBAC specification. There is no restriction on how the operation is invoked, e.g., via a user interface. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: DELETE
Display: delete
Definition:
Fundamental operation in an Information System (IS) that results only in the removal of information about an object from memory or storage. Note: The preceding definition is taken from the HL7 RBAC specification. There is no restriction on how the operation is invoked, e.g., via a user interface.


Code: EXECUTE
Display: execute
Definition:
Fundamental operation in an IS that results only in initiating performance of a single or set of programs (i.e., software objects). Note: The preceding definition is taken from the HL7 RBAC specification. There is no restriction on how the operation is invoked, e.g., via a user interface.


Code: READ
Display: read
Definition:
Fundamental operation in an Information System (IS) that results only in the flow of information about an object to a subject. Note: The preceding definition is taken from the HL7 RBAC specification. There is no restriction on how the operation is invoked, e.g., via a user interface.


Code: UPDATE
Display: revise
Definition:
Fundamental operation in an Information System (IS) that results only in the revision or alteration of an object. Note: The preceding definition is taken from the HL7 RBAC specification. There is no restriction on how the operation is invoked, e.g., via a user interface.


Code: APPEND
Display: append
Definition:
Fundamental operation in an Information System (IS) that results only in the addition of information to an object already in existence. Note: The preceding definition is taken from the HL7 RBAC specification. There is no restriction on how the operation is invoked, e.g., via a user interface.


Code: ABORT
Display: abort
Definition:
Change the status of an object representing an Act to "aborted", i.e., terminated prior to the originally intended completion. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: ACTIVATE
Display: activate
Definition:
Change the status of an object representing an Act to "active", i.e., so it can be performed or is being performed, for the first time. (Contrast with REACTIVATE.) For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: CANCEL
Display: cancel
Definition:
Change the status of an object representing an Act to "cancelled", i.e., abandoned before activation. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: COMPLETE
Display: complete
Definition:
Change the status of an object representing an Act to "completed", i.e., terminated normally after all of its constituents have been performed. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: HOLD
Display: hold
Definition:
Change the status of an object representing an Act to "held", i.e., put aside an Act that is still in preparatory stages. No action can occur until the Act is released. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: JUMP
Display: jump
Definition:
Change the status of an object representing an Act to a normal state. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: NULLIFY
Display: nullify
Definition:
Change the status of an object representing an Act to "nullified", i.e., treat as though it never existed. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: OBSOLETE
Display: obsolete
Definition:
Change the status of an object representing an Act to "obsolete" when it has been replaced by a new instance. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: DEPRECATE
Display: deprecate
Definition:
Fundamental operation in HL7 Standards Governance that results only in the addition of deprecation information to an object already in existence without changing the status of the object.  Operation used internally in the maintenance and recordkeeping of HL7 terminology and standards artifacts.


Code: REACTIVATE
Display: reactivate
Definition:
Change the status of a formerly active object representing an Act to "active", i.e., so it can again be performed or is being performed. (Contrast with ACTIVATE.) For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: RELEASE
Display: release
Definition:
Change the status of an object representing an Act so it is no longer "held", i.e., allow action to occur. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: RESUME
Display: resume
Definition:
Change the status of a suspended object representing an Act to "active", i.e., so it can be performed or is being performed. For an HL7 Act, the state transitions per the HL7 Reference Information Model.


Code: SUSPEND
Display: suspend
Definition:
Change the status of an object representing an Act to **suspended**, i.e., so it is temporarily not in service.


Code: AU
Display: authenticated
Definition:
A completion status in which a document has been signed manually or electronically by one or more individuals who attest to its accuracy. No explicit determination is made that the assigned individual has performed the authentication. While the standard allows multiple instances of authentication, it would be typical to have a single instance of authentication, usually by the assigned individual.


Code: DO
Display: documented
Definition:
A completion status in which document content, other than dictation, has been received but has not been translated into the final electronic format. Examples include paper documents, whether hand-written or typewritten, and intermediate electronic forms, such as voice to text.


Code: IP
Display: in progress
Definition:
A workflow status where the material has been assigned to personnel to perform the task of transcription. The document remains in this state until the document is transcribed.


Code: LA
Display: legally authenticated
Definition:
A completion status in which a document has been signed manually or electronically by the individual who is legally responsible for that document. This is the most mature state in the workflow progression.


Code: NU
Display: nullified document
Definition:
A completion status in which a document was created in error or was placed in the wrong chart. The document is no longer available.


Code: UC
Display: unsigned completed document
Definition:
A completion status where the document is complete and there is no expectation that the document will be signed.


Code: AA
Display: active and archived
Definition:
A storage status in which a document is available on-line and is also stored off-line for long-term access.


Code: FT
Display: full-time
Definition:
Employment in which the employee is expected to work at least a standard work week (defined by the US Bureau of Labor Statistics as 35-44 hours per week)


Code: PT
Display: part-time
Definition:
Employment in which the employee is expected to work less than a standard work week (defined by the US Bureau of Labor Statistics as 35-44 hours per week)


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


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


Code: PMP
Display: Pump
Definition:
A device that is used to raise, compress, or transfer liquids or gases and is operated by a piston or similar mechanism.


Code: _ActiveIngredientDrugEntityType
Display: ActiveIngredientDrugEntityType
Definition:
Any substance which, when combined with other ingredients, delivers all or part of the therapeutic benefit associated with a medication.


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


Code: BLDPRD
Display: Blood Product
Definition:
A manufactured product that is produced from the raw blood oi a donor with the intention of using it in a recipient transfusion.


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

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


Code: _ExposureAgentEntityType
Display: ExposureAgentEntityType
Definition:
Indicates the material to which the patient was exposed which is believed to be related to the adverse reaction


Code: JAR
Display: Jar
Definition:
A container of glass, earthenware, plastic, etc. Top of the container has a diameter of similar size to the diameter of the container as a whole


Code: WING
Display: Wing Location
Definition:
The location of a wing of a building (e.g. East Wing). The same room number for the same floor number can be distinguished by wing number in some situations


Code: ACDA
Display: ACD Solution A
Definition:
ACD Solution A of trisodium citrate, 22.0g/L; citric acid, 8.0 g/L; and dextrose 24.5 g/L. Used in Blood banking and histocompatibilty testing


Code: ACDB
Display: ACD Solution B
Definition:
ACD Solution B of trisodium citrate, 13.2g/L; citric acid, 4.8 g/L; and dextrose 14.7 g/L. Used in Blood banking and histocompatibilty testing.


Code: AMIES
Display: Amies transport medium
Definition:
Sodium Chloride 3.0g, Potassium Chloride 0.2g, Calcium Chloride 0.1g, Magnesium Chloride 0.1g, Monopotassium Phosphate 0.2g, Disodium Phosphate 1.15g, Sodium Thiogly collate 1.0g, Distilled Water 1 liter


Code: BOUIN
Display: Bouin's solution
Definition:
Picric acid, saturated aqueous solution (750.0 ml), 37-40% formalin (250.0 ml), glacial acetic acid (50.0 ml). Tissue preservative.


Code: CARY
Display: Cary Blair Medium
Definition:
Sodium Thioglycollate 1.5 g, Disodium Hydrogen Phosphate 1.1 g, Sodium Chloride 5.0 g, Calcium Chloride 0.09 g, Agar 5.0 g, per Liter of Water


Code: CHLTM
Display: Chlamydia transport medium
Definition:
Any of a number of non-nutritive buffered media used to maintain Chlamydia viability during transportation to the laboratory


Code: ENT
Display: Enteric bacteria transport medium
Definition:
Any of a number of non-nutritive buffered media used to maintain enteric bacterial viability during transportation to the laboratory


Code: F10
Display: 10% Formalin
Definition:
A 10% v/v solution in water of formalin( a 37% solution of formaldehyde and water). Used for tissue preservation.


Code: M4
Display: M4
Definition:
Modified Hank's balanced salt solution supplemented with bovine serum albumin, gelatin, sucrose and glutamic acid. It is buffered to pH 7.3+ or - 0.2 with HEPES buffer. Phenol red is used to indicate pH. Vancomycin, Amphotericin B and Colistin are used to


Code: M4RT
Display: M4-RT
Definition:
Modified Hank's balanced salt solution supplemented with bovine serum albumin, gelatin, sucrose and glutamic acid. It is buffered to pH 7.3+ or - 0.2 with Hepes buffer. Phenol red is used to indicate pH. Gentamicin and amphotericin B are used to inhibit c


Code: M5
Display: M5
Definition:
Modified Hank's balanced salt solution supplemented with protein stabilizers, sucrose and glutamic acid. It is buffered to pH 7.3+ or - 0.2 with Hepes buffer. Phenol red is used to indicate pH. Vancomycin, Amphotericin B and Colistin are used to inhibit c


Code: MICHTM
Display: Michel's transport medium
Definition:
1M potassium citrate, pH 7.0 2.5 ml, 0.1M magnesium sulfate 5.0 ml, 0.1M N-ethyl malemide 5.0 ml, dH2O 87.5 ml, ammonium sulfate 55gm. Preserve antigens for Immunofluorescence procedures


Code: MMDTM
Display: MMD transport medium
Definition:
A buffered medium with ammonium sulfate added to preserve antigens for Immunofluorescence procedures


Code: PAGE
Display: Page's Saline
Definition:
0.12 g NaCl, 0.004 g MgSO, 0.004 g, CaCl, 0.142 g Na2HPO4 and 0.136 g KH2PO4 per liter of distilled water. Maintain Acanthaoemba viability.


Code: SPS
Display: Sodium polyanethol sulfonate 0.35% in 0.85% sodium chloride
Definition:
Sodium polyanethol sulfonate in saline. Anticomplementary and antiphagocytic properties. Used in blood culture collection.


Code: STUTM
Display: Stuart transport medium
Definition:
Sodium Glycerophosphate 10.0g, Calcium Chloride 0.1g, Mercaptoacetic Acid 1.0ml, Distilled Water 1 liter


Code: THYO
Display: Thyoglycolate broth
Definition:
A nutritive medium with a reducing agent (sodium thioglycolate) which, due to a chemical reaction, removes oxygen from the broth.


Code: URETM
Display: Ureaplasma transport medium
Definition:
A buffered salt solution with antifungal agents added for the collection and transport of Ureaplasma specimens.


Code: VIRTM
Display: Viral Transport medium
Definition:
Sucrose 74.6g, Potassium hydrogenphosphate 0.52g, L-glutamic acid 0.72g, Bovine serum albumin 5.0g, Gentamicin 50mg, Potassium dihydrogenphosphate 1.25g, L-15 medium 9.9L, Water to 10L. Maintain Virus viability.


Code: DISK
Display: Disk
Definition:
Object that is thin, flat, and circular. Doses of medication often contained in bubbles on the disk.


Code: STRIP
Display: Strip
Definition:
A continuous strip of plastic sectioned into individual pouches, each one containing the quantity of 1 or more medications intended to be administered at a specific time


Code: INSTANCE
Display: specific
Definition:
**Description:**A determiner that specifies that the Entity object represents a particular physical thing (as opposed to a universal, kind, or class of physical thing).

**Discussion:** It does not matter whether an INSTANCE still exists as a whole at the point in time (or process) when we mention it, for example, a drug product lot is an INSTANCE even though it has been portioned out for retail purpose.


Code: GROUP
Display: specific group
Definition:
A determiner that specifies that the Entity object represents a particular collection of physical things (as opposed to a universal, kind, or class of physical thing). While the collection may resolve to having only a single individual (or even no individuals), the potential should exist for it to cover multiple individuals.


Code: KIND
Display: described
Definition:
**Description:**A determiner that specifies that the Entity object represents a universal, kind or class of physical thing (as opposed to a particular thing).


Code: GROUPKIND
Display: described group
Definition:
A determiner that specifies that the Entity object represents a universal, kind or class of collections physical things. While the collection may resolve to having only a single individual (or even no individuals), the potential should exist for it to cover multiple individuals.


Code: PharmaceuticalEntityNamePartQualifiers
Display: PharmaceuticalEntityNamePartQualifiers
Definition:
**Description:** Medication Name Parts are a means of specifying a range of acceptable "official" forms of the name of a product. They are used as patterns against which input name strings may be matched for automatic identification of products from input text reports. While they cover the concepts held under "doseForm" or "route" or "strength" the name parts are not the same and do not fit into a controlled vocabulary in the same way. By specifying up to 8 name parts a much larger range of possible names can be generated.


Code: BR
Display: birth
Definition:
A name that a person had shortly after being born. Usually for family names but may be used to mark given names at birth that may have changed later.


Code: IN
Display: initial
Definition:
Indicates that a name part is just an initial. Initials do not imply a trailing period since this would not work with non-Latin scripts. Initials may consist of more than one letter, e.g., "Ph." could stand for "Philippe" or "Th." for "Thomas".


Code: LS
Display: Legal status
Definition:
For organizations a suffix indicating the legal status, e.g., "Inc.", "Co.", "AG", "GmbH", "B.V." "S.A.", "Ltd." etc.


Code: NB
Display: nobility
Definition:
In Europe and Asia, there are still people with nobility titles (aristocrats). German "von" is generally a nobility title, not a mere voorvoegsel. Others are "Earl of" or "His Majesty King of..." etc. Rarely used nowadays, but some systems do keep track of this.


Code: PR
Display: professional
Definition:
Primarily in the British Imperial culture people tend to have an abbreviation of their professional organization as part of their credential suffices.


Code: SP
Display: spouse
Definition:
The name assumed from the partner in a marital relationship (hence the "SP"). Usually the spouse's family name. Note that no inference about gender can be made from the existence of spouse names.


Code: TITLE
Display: title
Definition:
Indicates that a prefix or a suffix is a title that applies to the whole name, not just the adjacent name part.


Code: VV
Display: voorvoegsel
Definition:
A Dutch "voorvoegsel" is something like "van" or "de" that might have indicated nobility in the past but no longer so. Similar prefixes exist in other languages such as Spanish, French or Portugese.


Code: CON
Display: container name
Definition:
**Description:** This refers to the container if present in the medicinal product name.

EXAMPLES:

 *  For Optaflu suspension for injection in pre-filled syringe Influenza vaccine (surface antigen, inactivated, prepared in cell culture) (2007/2008 season): pre-filled syringe


Code: DEV
Display: device name
Definition:
**Description:** This refers to the qualifiers in the name for devices and is at the moment mainly applicable to insulins and inhalation products.

EXAMPLES:

 *  For the medicinal product Actrapid FlexPen 100 IU/ml Solution for injection Subcutaneous use: FlexPen.


Code: FLAV
Display: FlavorName
Definition:
**Description:** This refers to a flavor of the medicinal product if present in the medicinal product name.

**Examples:**

 *  For 'CoughCure Linctus Orange Flavor', the flavor part is "Orange"
 *  For 'Wonderdrug Syrup Cherry Flavor', the flavor part is "Cherry"


Code: FORMUL
Display: FormulationPartName
Definition:
**Description:** This refers to the formulation of the medicinal product if present in the medicinal product name.

**Examples:**

 *  For 'SpecialMed Sugar Free Cough Syrup', the formulation name part is "Sugar Free"
 *  For 'QuickCure Gluten-free Bulk Fibre', the formulation name part is "gluten-free"


Code: FRM
Display: form name
Definition:
**Description:** This refers to the pharmaceutical form/ if present in the medicinal product name.

EXAMPLES:

 *  For Agenerase 50 mg soft capsules: Soft Capsules
 *  For Ludiomil 25mg-Filmtabletten: Filmtabletten
 *  For Optaflu suspension for injection in pre-filled syringe Influenza vaccine (surface antigen, inactivated, prepared in cell culture) (2007/2008 season): suspension for injection


Code: INV
Display: invented name
Definition:
**Description:** This refers to the product name without the trademark or the name of the marketing authorization holder or any other descriptor reflected in the product name and, if appropriate, whether it is intended e.g. for babies, children or adults.

EXAMPLES:

 *  Agenerase
 *  Optaflu
 *  Ludiomil


Code: POPUL
Display: TargetPopulationName
Definition:
**Description:** This refers to the target population for the medicinal product if present in the medicinal product name

**Examples:**

 *  For 'Broncho-Drug 3.5 mg-capsules for children', the target population part is "children"
 *  For 'Adult Chesty Cough Syrup', the target population part is "adult"


Code: SCI
Display: scientific name
Definition:
**Description:** This refers to the product common or scientific name without the trademark or the name of the marketing authorization holder or any other descriptor reflected in the product name.

EXAMPLES:

 *  For Agenerase: N/A
 *  For Optaflu: Influenza vaccine (surface antigen, inactivated, prepared in cell culture) (2007/2008 season)
 *  For Ludiomil: N/A


Code: STR
Display: strength name
Definition:
**Description:** This refers to the strength if present in the medicinal product name. The use of decimal points should be accommodated if required.

EXAMPLES:

 *  For Agenerase 50 mg soft capsules: 50mg
 *  For Ludiomil 25mg-Filmtabletten: 25 mg
 *  For Optaflu suspension for injection in pre-filled syringe Influenza vaccine (surface antigen, inactivated, prepared in cell culture) (2007/2008 season): N/A


Code: TIME
Display: TimeOrPeriodName
Definition:
**Description:** This refers to a time or time period that may be specified in the text of the medicinal product name

**Example:**

 *  For an influenza vaccine 'Drug-FLU season 2008/2009', the time/period part is "2008/2009 season"


Code: TMK
Display: trademark name
Definition:
**Description:** This refers to trademark/company element if present in the medicinal product name.

EXAMPLES:

 *  for Insulin Human Winthrop Comb 15: Winthrop


Code: USE
Display: intended use name
Definition:
**Description:** This refers to the intended use if present in the medicinal product name without the trademark or the name of the marketing authorization holder or any other descriptor reflected in the product name.

**Examples:**

 *  For 'Drug-BI Caplets - Heartburn Relief', the intended use part is: "Heartburn Relief"
 *  For 'Medicine Honey Syrup for Soothing Coughs' the intended use part is "Soothing Coughs"


Code: AD
Display: acquired
Definition:
**Description:**A name part a person acquired. The name part may be acquired by adoption, or the person may have chosen to use the name part for some other reason.

**Note:** this differs from an Other/Psuedonym/Alias in that an acquired name part is acquired on a formal basis rather than an informal one (e.g. registered as part of the official name).


Code: SP
Display: spouse
Definition:
**Description:**The name assumed from the partner in a marital relationship. Usually the spouse's family name. Note that no inference about gender can be made from the existence of spouse names.


Code: BR
Display: birth
Definition:
**Description:**A name that a person was given at birth or established as a consequence of adoption.

**Note:** This is not used for temporary names assigned at birth such as "Baby of Smith" a" which is just a name with a use code of "TEMP".


Code: CL
Display: callme
Definition:
**Description:**Used to indicate which of the various name parts is used when interacting with the person.


Code: IN
Display: initial
Definition:
**Description:**Indicates that a name part is just an initial. Initials do not imply a trailing period since this would not work with non-Latin scripts. In some languages, initials may consist of more than one letter, e.g., "Ph" could stand for "Philippe" or "Th" For "Thomas".


Code: LS
Display: legal status
Definition:
**Description:**For organizations a suffix indicating the legal status, e.g., "Inc.", "Co.", "AG", "GmbH", "B.V." "S.A.", "Ltd." etc.


Code: MID
Display: middle name
Definition:
**Description:**Indicates that the name part is a middle name.

**Usage Notes:** In general, the english "middle name" concept is all of the given names after the first. This qualifier may be used to explicitly indicate which given names are considered to be middle names. The middle name qualifier may also be used with family names. This is a Scandinavian use case, matching the concept of "mellomnavn","mellannamn". Note that there are specific rules that indicate what names may be taken as a mellannamn in different Scandinavian countries.


Code: PFX
Display: prefix
Definition:
**Description:**A prefix has a strong association to the immediately following name part. A prefix has no implicit trailing white space (it has implicit leading white space though).


Code: SFX
Display: suffix
Definition:
**Description:**A suffix has a strong association to the immediately preceding name part. A suffix has no implicit leading white space (it has implicit trailing white space though).


Code: PR
Display: professional
Definition:
**Description:**Primarily in the British Imperial culture people tend to have an abbreviation of their professional organization as part of their credential titles.


Code: DEL
Display: delimiter
Definition:
A delimiter has no meaning other than being literally printed in this name representation. A delimiter has no implicit leading and trailing white space.


Code: FAM
Display: family
Definition:
Family name, this is the name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.


Code: PFX
Display: prefix
Definition:
A prefix has a strong association to the immediately following name part. A prefix has no implicit trailing white space (it has implicit leading white space though). Note that prefixes can be inverted.


Code: SFX
Display: suffix
Definition:
**Description:**A suffix has a strong association to the immediately preceding name part. A suffix has no implicit leading white space (it has implicit trailing white space though). Suffices cannot be inverted.


Code: DEL
Display: delimiter
Definition:
**Description:**A delimiter has no meaning other than being literally printed in this name representation. A delimiter has no implicit leading and trailing white space.


Code: FAM
Display: family
Definition:
**Description:**Family name, this is the name that links to the genealogy. In some cultures (e.g. Eritrea) the family name of a son is the first name of his father.


Code: GIV
Display: given
Definition:
**Description:**Given name. Note: don't call it "first name" since the given names do not always come first.


Code: TITLE
Display: title
Definition:
**Description:**Part of the name that is acquired as a title due to academic, legal, employment or nobility status etc.

**Note:**Title name parts include name parts that come after the name such as qualifications, even if they are not always considered to be titles.


Code: _NameRepresentationUse
Display: NameRepresentationUse
Definition:
Identifies the different representations of a name. The representation may affect how the name is used. (E.g. use of Ideographic for formal communications.)


Code: ASGN
Display: assigned
Definition:
A name assigned to a person. Reasons some organizations assign alternate names may include not knowing the person's name, or to maintain anonymity. Some, but not necessarily all, of the name types that people call "alias" may fit into this category.


Code: OR
Display: official registry
Definition:
**Definition:**The formal name as registered in an official (government) registry, but which name might not be commonly used. Particularly used in countries with a law system based on Napoleonic law.


Code: PHON
Display: phonetic
Definition:
A name spelled phonetically.

There are a variety of phonetic spelling algorithms. This code value does not distinguish between these.*Discussion:*


Code: A
Display: business name
Definition:
**Description:**A name used in a Professional or Business context . Examples: Continuing to use a maiden name in a professional context, or using a stage performing name (some of these names are also pseudonyms)


Code: P
Display: Other/Pseudonym/Alias
Definition:
**Description:**A non-official name by which the person is sometimes known. (This may also be used to record informal names such as a nickname)


Code: R
Display: religious
Definition:
**Description:**A name assumed as part of a religious vocation . e.g . Sister Mary Francis, Brother John


Code: M
Display: maiden name
Definition:
**Description:**A name used prior to marriage.Note that marriage naming customs vary greatly around the world. This name use is for use by applications that collect and store maiden names. Though the concept of maiden name is often gender specific, the use of this term is not gender specific. The use of this term does not imply any particular history for a person's name, nor should the maiden name be determined algorithmically


Code: NameRepresentationUse
Display: NameRepresentationUse
Definition:
**Description:**Identifies the different representations of a name . The representation may affect how the name is used . (E.g . use of Ideographic for formal communications.)


Code: OLD
Display: no longer in use
Definition:
**Description:**This name is no longer in use (note: Names may also carry valid time ranges . This code is used to cover the situations where it is known that the name is no longer valid, but no particular time range for its use is known)


Code: DN
Display: do not use
Definition:
**Description:**This name should no longer be used when interacting with the person (i.e . in addition to no longer being used, the name should not be even mentioned when interacting with the person)Note: applications are not required to compare names labeled "Do Not Use" and other names in order to eliminate name parts that are common between the other name and a name labeled "Do Not Use".


Code: OR
Display: official registry name
Definition:
**Description:**The formal name as registered in an official (government) registry, but which name might not be commonly used . May correspond to the concept of legal name


Code: PHON
Display: phonetic
Definition:
**Description:**The name as understood by the data enterer, i.e. a close approximation of a phonetic spelling of the name, not based on a phonetic algorithm.


Code: SRCH
Display: search
Definition:
**Description:**A name intended for use in searching or matching. This is used when the name is incomplete and contains enough details for search matching, but not enough for other uses.


Code: T
Display: temporary
Definition:
**Description:**A temporary name. Note that a name valid time can provide more detailed information. This may also be used for temporary names assigned at birth or in emergency situations.


Code: BIO
Display: Biological
Definition:
The dangers associated with normal biological materials. I.e. potential risk of unknown infections. Routine biological materials from living subjects.


Code: COR
Display: Corrosive
Definition:
Material is corrosive and may cause severe injury to skin, mucous membranes and eyes. Avoid any unprotected contact.


Code: BHZ
Display: biohazard
Definition:
Material contains microorganisms that is an environmental hazard. Must be handled with special care.


Code: POI
Display: poison
Definition:
Material is poisonous to humans and/or animals. Special care must be taken to avoid incorporation, even of small amounts.


Code: RAD
Display: radioactive
Definition:
Material is a source for ionizing radiation and must be handled with special care to avoid injury of those who handle it and to avoid environmental hazards.


Code: 2186-5
Display: Not Hispanic or Latino
Definition:
Note that this term remains in the table for completeness, even though within HL7, the notion of "not otherwise coded" term is deprecated.


Code: AIRBORNE
Display: airborne
Definition:
**Description:** Communication of an agent from a living subject or environmental source to a living subject through indirect contact via oral or nasal inhalation.


Code: CONTACT
Display: contact
Definition:
**Description:** Communication of an agent from a living subject or environmental source to a living subject through direct physical contact.


Code: FOODBORNE
Display: foodborne
Definition:
**Description:** Communication of an agent from a food source to a living subject via oral consumption.


Code: WATERBORNE
Display: waterborne
Definition:
**Description:** Communication of an agent to a living subject by contact and/or consumption via an aqueous medium


Code: JHCHREAS
Display: JHCHREAS
Definition:
Easter Sunday. The Easter date is a rather complex calculation based on Astronomical tables describing full moon dates. Details can be found at \[http://www.assa.org.au/edm.html, and http://aa.usno.navy.mil/AA/faq/docs/easter.html\]. Note that the Christian Orthodox Holidays are based on the Julian calendar.


Code: JHNUS
Display: GTSAbbreviationHolidaysUSNational
Definition:
United States National Holidays (public holidays for federal employees established by U.S. Federal law 5 U.S.C. 6103).


Code: C
Display: conduction-indicator-based
Definition:
*Definition:* Context conduction is defined using the contextConductionCode and contextConductionInd attributes on ActRelationship and Participation.

*UsageNotes:* This approach is deprecated as of March, 2010.


Code: I
Display: inferred
Definition:
*Definition:* Context conduction is not explicitly defined. The recipient of an instance must infer conduction based on the semantics of the model and what is deemed "reasonable".

*UsageNotes:* Because this approach can lead to variation in instance interpretation, its use is discouraged.


Code: V
Display: vocabulary-based
Definition:
*Definition:* Context conduction is defined using the ActRelationship.blockedContextActRelationshipType and blockedContextParticipationType attributes and the "conductible" property on the ActRelationshipType and ParticipationType code systems.


Code: EndState
Display: End state
Definition:
The HL7 MDF says that leaf level use cases should be connected to a state transition of the subject class. The use case diagram provides the link to the subject class. The modeler must use three properties to identify the state transition -- this property and the two following ones named StartState and StateTransition. The first two are, as their names imply, the names of the starting state and ending state of the transition, and the third is the name of the transition.


Code: HMD
Display: HMD identifier
Definition:
The identifier of the HMD from which the message structure for the message transferred by an interaction is drawn.


Code: InstancedDTsymbo
Display: Data type instantiated
Definition:
Holds the data type assigned to the generic type parameter when an instantiation of generic type is recorded.


Code: IsReferenceDT
Display: Reference data type
Definition:
Indicates that the type for a data type component (attribute of a data type stereotype of class) is found by reference.


Code: MandatoryInclusi
Display: Mandatory
Definition:
Indicates with a value of "True" whether the inclusion of an attribute in an HMD and in the messages derived from that HMD is mandatory. The default is not mandatory, and use of mandatory inclusion in the RIM is deprecated.


Code: MayRepeat
Display: Attribute may repeat
Definition:
Indicates with values of "True" or "False" whether an attribute may repeat in an HMD. The default is non-repeating.


Code: MIM_id
Display: MIM Identifier
Definition:
Used in a subject area category that holds a MIM. It provides the unique identifier for the MIM. The first portion of this identifier should be the ModelID of the RIM from which the MIM is derived.


Code: MsgID
Display: Message type identifier
Definition:
The identifier of the message structure within the HMD (above) that defines the message transferred by an interaction.


Code: RcvResp
Display: Receiver responsibility
Definition:
This property holds the identifier of the follow-on interaction, when the receiving application role for an interaction has the responsibility to initiate a follow-on interaction.


Code: StateAttribute
Display: State attribute
Definition:
For classes that are subject classes, this component provides the name of the state attribute for the class. Only one state attribute component may appear for a given class.


Code: V23_Datatype
Display: Version 2 data type
Definition:
This component can document the Version 2.3 datatype for an attribute that is related to or derived from data fields in HL7 Version 2.3.


Code: V23_Fields
Display: Version 2 Field reference
Definition:
This component provides a reference to the source Version 2.x field for an attribute that is related to or derived from data fields in HL7 Version 2.3 standard. Concatenate multiple values with commas, if multiple references to Version 2.x exist for an attribute.


Code: Vocab_domain
Display: Vocabulary domain
Definition:
Captures the identifier (name) of the vocabulary domain that constrains the values of coded attributes. This property is captured both for RIM attributes and in MIMs.


Code: Vocab_strength
Display: Vocabulary strength
Definition:
Captures the strength of encoding for the elements of a coded attribute. This property is captured both for RIM attributes and in MIMs.


Code: zhxID
Display: History identifier
Definition:
This component tracks the version history of each element of the model. It contains the unique element identifier assigned to each model element. The repository assigns values for this element. Modelers should not change these values or assign new ones, but they may copy them to indicate an element's historic predecessor.


Code: Ballot2008Jan
Display: Ballot 2008 January
Definition:
The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in January 2008.


Code: Ballot2008May
Display: Ballot 2008 May
Definition:
The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in May 2008.


Code: Ballot2008Sep
Display: Ballot 2008 September
Definition:
The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in September 2008.


Code: Ballot2009Jan
Display: Ballot 2009 January
Definition:
The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in January 2009.


Code: Ballot2009May
Display: Ballot 2009 May
Definition:
The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in May 2009.


Code: Ballot2009Sep
Display: Ballot 2009 September
Definition:
The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in September 2009.


Code: Ballot2010Jan
Display: Ballot 2010 Jan
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in January 2010.


Code: Ballot2010May
Display: Ballot 2010 May
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in May 2010.


Code: Ballot2010Sep
Display: Ballot 2010 Sep
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in September 2010.


Code: Ballot2011Jan
Display: Ballot 2011 Jan
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in January 2011.


Code: Ballot2011May
Display: Ballot 2011 May
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in May 2011.


Code: Ballot2011Sep
Display: Ballot 2011 Sep
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in September 2011.


Code: Ballot2012Jan
Display: Ballot 2012 Jan
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in January 2012.


Code: Ballot2012May
Display: Ballot 2012 May
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in May 2012.


Code: Ballot2012Sep
Display: Ballot 2012 Sep
Definition:
**Definition:** The complete set of normative, DSTU, proposed (under ballot) and draft artifacts as published in the ballot whose ballot cycle ended in September 2012.


Code: V3-2003-12
Display: HL7 Version V3-2003-12
Definition:
The consistent set of messaging artefacts as published or contained in repositories in December of 2003, based on the latest version of any V3 models or artefacts (RIM, Datatypes, CMETS, Common Messages, Vocabularies) as available in December of 2003. Note: This versioncode does not cover the version of the XML ITS.


Code: V3-2005N
Display: 2005 Normative Edition
Definition:
**Description:**The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2004, based on the latest version of any V3 models or artifacts (RIM, Datatypes, CMETS, Common Messages, Vocabularies) as published under the title of Normative Edition 2005. Note: This versioncode does not cover the version of the XML ITS.


Code: V3-2006N
Display: 2006 Normative Edition
Definition:
**Description:**The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2005, based on the latest version of any V3 models or artifacts (RIM, Datatypes, CMETS, Common Messages, Vocabularies) as published under the title of Normative Edition 2006. Note: This versioncode does not cover the version of the XML ITS.


Code: V3-2008N
Display: 2008 Normative Edition
Definition:
**Definition:** The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2007, based on the latest version of any V3 models or artifacts (RIM, Data Types, CMETS, Common Messages, Vocabularies) published under the title of Normative Edition 2008. Note: This version code does not cover the version of the XML ITS.


Code: V3-2009N
Display: 2009 Normative Edition
Definition:
**Description:** The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2008, based on the latest version of any V3 models or artifacts (RIM, Data Types, CMETS, Common Messages, Vocabularies) published under the title of Normative Edition 2009. Note: This version code does not cover the version of the XML ITS.


Code: V3-2010N
Display: 2010 Normative Edition
Definition:
**Definition:** The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2009, based on the latest version of any V3 models or artifacts (RIM, Data Types, CMETS, Common Messages, Vocabularies) published under the title of Normative Edition 2010. Note: This version code does not cover the version of the XML ITS.


Code: V3-2011N
Display: 2011 Normative Edition
Definition:
**Definition:** The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2010, based on the latest version of any V3 models or artifacts (RIM, Data Types, CMETS, Common Messages, Vocabularies) published under the title of Normative Edition 2011. Note: This version code does not cover the version of the XML ITS.


Code: V3-2012N
Display: 2012 Normative Edition
Definition:
**Definition:** The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2011, based on the latest version of any V3 models or artifacts (RIM, Data Types, CMETS, Common Messages, Vocabularies) published under the title of Normative Edition 2012. Note: This version code does not cover the version of the XML ITS.


Code: V3PR1
Display: Version3 Pre-release #1
Definition:
Includes all material published as part of the ballot package released for vote in July-August 2003.


Code: V3-2007N
Display: 2007 Normative Edition
Definition:
**Description:**The consistent set of normative and DSTU messaging artifacts as published or contained in repositories in December of 2006, based on the latest version of any V3 models or artifacts (RIM, Datatypes, CMETS, Common Messages, Vocabularies) published under the title of Normative Edition 2007. Note: This versioncode does not cover the version of the XML ITS.


Code: A
Display: Add
Definition:
**Description:**The item was (or is to be) added, having not been present immediately before. (If it is already present, this may be treated as an error condition.)


Code: D
Display: Remove
Definition:
**Description:**The item was (or is to be) removed (sometimes referred to as deleted). If the item is part of a collection, delete any matching items.


Code: N
Display: No Change
Definition:
**Description:**There was (or is to be) no change to the item. This is primarily used when this element has not changed, but other attributes in the instance have changed.


Code: R
Display: Replace
Definition:
**Description:**The item existed previously and has (or is to be) revised. (If an item does not already exist, this may be treated as an error condition.)


Code: REF
Display: Reference
Definition:
**Description:**This item provides enough information to allow a processing system to locate the full applicable record by identifying the object.


Code: U
Display: Unknown
Definition:
**Description:**Description:</b>It is not specified whether or what kind of change has occurred to the item, or whether the item is present as a reference or identifying property.


Code: ESA
Display: Set Add
Definition:
Add the message element to the collection of items on the receiving system that correspond to the message element.


Code: ESAC
Display: Set Add or Change
Definition:
Change the item on the receiving system that corresponds to this message element; if a matching element does not exist, add a new one created with the values in the message.


Code: ESC
Display: Set Change
Definition:
Change the item on the receiving system that corresponds to this message element; do not process if a matching element does not exist.


Code: AU
Display: Add or Update
Definition:
**Description:** AU: If this item exists, update it with these values. If it does not exist, create it with these values. If the item is part of the collection, update each item that matches this item, and if no items match, add a new item to the collection.


Code: V
Display: Verify
Definition:
Verify - this message element must match a value already in the receiving systems database in order to process the message.


Code: alternate
Display: alternate
Definition:
Designates substitute versions for the document in which the link occurs. When used together with the lang attribute, it implies a translated version of the document. When used together with the media attribute, it implies a version designed for a different medium (or media).


Code: bookmark
Display: bookmark
Definition:
Refers to a bookmark. A bookmark is a link to a key entry point within an extended document. The title attribute may be used, for example, to label the bookmark. Note that several bookmarks may be defined in each document.


Code: contents
Display: contents
Definition:
Refers to a document serving as a table of contents. Some user agents also support the synonym ToC (from "Table of Contents").


Code: next
Display: next
Definition:
Refers to the next document in a linear sequence of documents. User agents may choose to preload the "next" document, to reduce the perceived load time.


Code: prev
Display: prev
Definition:
Refers to the previous document in an ordered series of documents. Some user agents also support the synonym "Previous".


Code: start
Display: start
Definition:
Refers to the first document in a collection of documents. This link type tells search engines which document is considered by the author to be the starting point of the collection.


Code: stylesheet
Display: stylesheet
Definition:
Refers to an external style sheet. See the section on external style sheets for details. This is used together with the link type "Alternate" for user-selectable alternate style sheets.


Code: UNV
Display: Unverified by system
Definition:
**Description:** The identifier was provided to the system that constructed the instance, but has not been verified. e.g. a Drivers license entered manually into a system by a user.


Code: VRF
Display: Verified by system
Definition:
**Description:** The identifier was not issued by the system responsible for constructing the instance, but the system that captured the id has verified the identifier with the issuing authority, or with another system that has verified the identifier.


Code: BUSN
Display: Business Identifier
Definition:
**Description:** An identifier whose scope is defined by the business practices associated with the object. In contrast to the other scope identifiers, the scope of the use of the id is not necessarily restricted to a single object, but may be reused for other objects closely associated with the object due to business practice.


Code: OBJ
Display: Object Identifier
Definition:
**Description:** The identifier associated with a particular object. It remains consistent as the object undergoes state transitions.


Code: VER
Display: Version Identifier
Definition:
**Description:** An identifier that references a particular object as it existed at a given point in time. The identifier **SHALL** change with each state transition on the object. I.e. The version identifier of an object prior to a 'suspend' state transition is distinct from the identifier of the object after the state transition. Each version identifier can be tied to exactly one ControlAct event which brought that version into being (though the control act may never be instantiated).

 **NOTE:** Applications that do not support versioning of objects must ignore and not persist these ids to avoid confusion resulting from leaving the same identifier on an object that undergoes changes.


Code: VW
Display: View Specific Identifier
Definition:
**Description:** An identifier that references a particular object as it existed at a given point in time. The identifier **SHALL** change with each state transition on the object.

**Example** The version identifier of an object prior to a 'suspend' state transition is distinct from the identifier of the object after the state transition. Each version identifier can be tied to exactly one ControlAct event which brought that version into being (though the control act may never be instantiated).

 **NOTE:** Applications that do not support versioning of objects must ignore and not persist these ids to avoid confusion resulting from leaving the same identifier on an object that undergoes changes.


Code: CS
Display: community shelter
Definition:
**Definition:** A group living arrangement specifically for the care of those in need of temporary and crisis housing assistance. Examples include domestic violence shelters, shelters for displaced or homeless individuals, Salvation Army, Jesus House, etc. Community based services may be provided.


Code: SL
Display: supported living
Definition:
**Definition:** Assisted living in a single family residence for persons with physical, behavioral, or functional health, or socio-economic challenges. There may or may not be on-site supervision but the housing is designed to assist the client with developing independent living skills. Community based services may be provided.


Code: BT
Display: Broader Than
Definition:
The first concept is at a more abstract level than the second concept. For example, Hepatitis is broader than Hepatitis A, and endocrine disease is broader than Diabetes Mellitus. Broader than is the opposite of the narrower than relationship.


Code: NT
Display: Narrower Than
Definition:
The first concept is at a more detailed level than the second concept. For example, Pennicillin G is narrower than Pennicillin, and vellus hair is narrower than hair. Narrower than is the opposite of broader than.


Code: C
Display: Common Law
Definition:
a marriage recognized in some jurisdictions and based on the parties' agreement to consider themselves married and can also be based on documentation of cohabitation.

This definition was based on https://www.merriam-webster.com/dictionary/common-law%20marriage.


Code: NP
Display: not present
Definition:
Value is not present in a message. This is only defined in messages, never in application data! All values not present in the message must be replaced by the applicable default, or no-information (NI) as the default of all defaults.


Code: DER
Display: derived
Definition:
**Description:**An actual value may exist, but it must be derived from the provided information (usually an EXPR generic data type extension will be used to convey the derivation expressionexpression .


Code: OTH
Display: other
Definition:
**Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system).

**Usage Notes**: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to \*any\* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc.

With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE.


Code: UNC
Display: un-encoded
Definition:
**Description:** The actual value has not yet been encoded within the approved value domain.

**Example**: Original text or a local code has been specified but translation or encoding to the approved value set has not yet occurred due to limitations of the sending system. Original text has been captured for a PQ, but not attempt has been made to split the value and unit or to encode the unit in UCUM.

**Usage Notes**: If it is known that it is not possible to encode the concept, OTH should be used instead. However, use of UNC does not necessarily guarantee the concept will be encodable, only that encoding has not been attempted.

Data type properties such as original text and translations may be present when this null flavor is included.


Code: INV
Display: invalid
Definition:
**Description:**The value as represented in the instance is not a member of the set of permitted data values in the constrained value domain of a variable.


Code: MSK
Display: masked
Definition:
There is information on this item available but it has not been provided by the sender due to security, privacy or other reasons. There may be an alternate mechanism for gaining access to this information.

Note: using this null flavor does provide information that may be a breach of confidentiality, even though no detail data is provided. Its primary purpose is for those circumstances where it is necessary to inform the receiver that the information does exist without providing any detail.


Code: UNK
Display: unknown
Definition:
**Description:**A proper value is applicable, but not known.

**Usage Notes**: This means the actual value is not known. If the only thing that is unknown is how to properly express the value in the necessary constraints (value set, datatype, etc.), then the OTH or UNC flavor should be used. No properties should be included for a datatype with this property unless:

1.  Those properties themselves directly translate to a semantic of "unknown". (E.g. a local code sent as a translation that conveys 'unknown')
2.  Those properties further qualify the nature of what is unknown. (E.g. specifying a use code of "H" and a URL prefix of "tel:" to convey that it is the home phone number that is unknown.)


Code: NAVU
Display: Not available
Definition:
Information is not available at this time (with no expectation regarding whether it will or will not be available in the future).


Code: QS
Display: Sufficient Quantity
Definition:
**Description:**The specific quantity is not known, but is known to be non-zero and is not specified because it makes up the bulk of the material. e.g. 'Add 10mg of ingredient X, 50mg of ingredient Y, and sufficient quantity of water to 100mL.' The null flavor would be used to express the quantity of water.


Code: exam
Display: Exam
Definition:
Observations generated by physical exam findings including direct observations made by a clinician and use of simple instruments and the result of simple maneuvers performed directly on the patient's body.


Code: imaging
Display: Imaging
Definition:
Observations generated by imaging. The scope includes observations, plain x-ray, ultrasound, CT, MRI, angiography, echocardiography, nuclear medicine.


Code: laboratory
Display: Laboratory
Definition:
The results of observations generated by laboratories. Laboratory results are typically generated by laboratories providing analytic services in areas such as chemistry, hematology, serology, histology, cytology, anatomic pathology, microbiology, and/or virology. These observations are based on analysis of specimens obtained from the patient and submitted to the laboratory.


Code: procedure
Display: Procedure
Definition:
Observations generated by other procedures. This category includes observations resulting from interventional and non-interventional procedures excluding lab and imaging (e.g. cardiology catheterization, endoscopy, electrodiagnostics, etc.). Procedure results are typically generated by a clinician to provide more granular information about component observations made during a procedure, such as where a gastroenterologist reports the size of a polyp observed during a colonoscopy.


Code: social-history
Display: Social History
Definition:
The Social History Observations define the patient's occupational, personal (e.g. lifestyle), social, and environmental history and health risk factors, as well as administrative data such as marital status, race, ethnicity and religious affiliation.


Code: survey
Display: Survey
Definition:
Assessment tool/survey instrument observations (e.g. Apgar Scores, Montreal Cognitive Assessment (MoCA))


Code: therapy
Display: Therapy
Definition:
Observations generated by non-interventional treatment protocols (e.g. occupational, physical, radiation, nutritional and medication therapy)


Code: vital-signs
Display: Vital Signs
Definition:
Clinical observations measure the body's basic functions such as such as blood pressure, heart rate, respiratory rate, height, weight, body mass index, head circumference, pulse oximetry, temperature, and body surface area.


Code: _ObservationInterpretationChange
Display: ObservationInterpretationChange
Definition:
Interpretations of change of quantity and/or severity. At most one of B or W and one of U or D allowed.


Code: EX
Display: outside threshold
Definition:
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:* EX, HX, LX: These three concepts do not seem to meet a clear need in the vocabulary, and their use in observation interpretation appears likely to be covered by other existing concepts (e.g., A, H, L). The only apparent significant difference is their reference to use in protocols for exclusion of study subjects. These concepts/codes were proposed by RCRIM for use in the CTLaboratory message. They were submitted and approved in the November 2005 Harmonization cycle in proposal "030103C\_VOCAB\_RCRIM\_l\_quade\_RCRIM Obs Interp\_20051028154455". However, this proposal was not fully implemented in the vocabulary. The proposal recommended creation of the x\_ClinicalResearchExclusion domain in ObservationInterpretation with a value set including those three concepts/codes, but there is no subdomain of that name or equivalent with a binding to either of the value sets that contain these concepts/codes. Members of the OO WG have recently attempted to contact members of RCRIM regarding these concepts, both by email and at the recent WGM in Atlanta, without response. It is felt by OO that the best course of action to take at this time is to add this comprehensive Open Issue rather than deprecate these three concepts at this time, until further discussion is held.


Code: HM
Display: Hold for Medical Review
Definition:
Hold for Medical Review

*Usage Note:* This code is not intended for use in V3 artifacts. It is included in the code system to maintain alignment with the V2 Table 0078 "Interpretation Codes."


Code: OBX
Display: Interpretation qualifiers in separate OBX segments
Definition:
Interpretation qualifiers in separate OBX segments

*Usage Note:* This code is not intended for use in V3 artifacts. It is included in the code system to maintain alignment with the V2 Table 0078 "Interpretation Codes."


Code: CAR
Display: Carrier
Definition:
The patient is considered as carrier based on the testing results. A carrier is an individual who carries an altered form of a gene which can lead to having a child or offspring in future generations with a genetic disorder.


Code: Carrier
Display: Carrier
Definition:
The patient is considered as carrier based on the testing results. A carrier is an individual who carries an altered form of a gene which can lead to having a child or offspring in future generations with a genetic disorder.

***Deprecation Comment:*** This code is currently the same string as the print name for this concept and is inconsistent with the conventions being used for the other codes in the coding system, as it is a full word with initial capitalization, rather than an all upper case mnemonic. The recommendation from OO is to deprecate the code "Carrier" and to add "CAR" as the new active code representation for this concept.


Code: B
Display: Better
Definition:
The current result or observation value has improved compared to the previous result or observation value (the change is significant as defined in the respective test procedure).

\[Note: This can be applied to quantitative or qualitative observations.\]


Code: D
Display: Significant change down
Definition:
The current result has decreased from the previous result for a quantitative observation (the change is significant as defined in the respective test procedure).


Code: U
Display: Significant change up
Definition:
The current result has increased from the previous result for a quantitative observation (the change is significant as defined in the respective test procedure).


Code: W
Display: Worse
Definition:
The current result or observation value has degraded compared to the previous result or observation value (the change is significant as defined in the respective test procedure).

\[Note: This can be applied to quantitative or qualitative observations.\]


Code: <
Display: Off scale low
Definition:
The result is below the minimum detection limit (the test procedure or equipment is the limiting factor).

Synonyms: Below analytical limit, low off scale.


Code: >
Display: Off scale high
Definition:
The result is above the maximum quantifiable limit (the test procedure or equipment is the limiting factor).

Synonyms: Above analytical limit, high off scale.


Code: AC
Display: Anti-complementary substances present
Definition:
A valid result cannot be obtained for the specified component / analyte due to the presence of anti-complementary substances in the sample.

***Deprecation Comment:*** This code is being deprecated to match the status in V2 Table 0078 "Interpretation Codes.


Code: IE
Display: Insufficient evidence
Definition:
There is insufficient evidence that the species in question is a good target for therapy with the drug. A categorical interpretation is not possible.

\[Note: A MIC with "IE" and/or a comment may be reported (without an accompanying S, I or R-categorization).\]


Code: QCF
Display: Quality control failure
Definition:
A result cannot be considered valid for the specified component / analyte or organism due to failure in the quality control testing component.

***Deprecation Comment:*** This code is being deprecated to match the status in V2 Table 0078 "Interpretation Codes.


Code: TOX
Display: Cytotoxic substance present
Definition:
A valid result cannot be obtained for the specified organism or cell line due to the presence of cytotoxic substances in the sample or culture.

***Deprecation Comment:*** This code is being deprecated to match the status in V2 Table 0078 "Interpretation Codes.


Code: A
Display: Abnormal
Definition:
The result or observation value is outside the reference range or expected norm (as defined for the respective test procedure).

\[Note: Typically applies to non-numeric results.\]


Code: N
Display: Normal
Definition:
The result or observation value is within the reference range or expected norm (as defined for the respective test procedure).

\[Note: Applies to numeric or non-numeric results.\]


Code: I
Display: Intermediate
Definition:
Bacterial strain inhibited in vitro by a concentration of an antimicrobial agent that is associated with uncertain therapeutic effect. Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized\_Terminolo.htm) Projects: ISO 20776-1, ISO 20776-2

\[Note 1: Bacterial strains are categorized as intermediate by applying the appropriate breakpoints in a defined phenotypic test system.\]

\[Note 2: This class of susceptibility implies that an infection due to the isolate can be appropriately treated in body sites where the drugs are physiologically concentrated or when a high dosage of drug can be used.\]

\[Note 3: This class also indicates a "buffer zone," to prevent small, uncontrolled, technical factors from causing major discrepancies in interpretations.\]

\[Note 4: These breakpoints can be altered due to changes in circumstances (e.g., changes in commonly used drug dosages, emergence of new resistance mechanisms).\]


Code: MS
Display: moderately susceptible
Definition:
The patient is considered as carrier based on the testing results. A carrier is an individual who carries an altered form of a gene which can lead to having a child or offspring in future generations with a genetic disorder.

***Deprecation Comment:*** This antimicrobial susceptibility test interpretation concept is recommended by OO to be deprecated as it is no longer recommended for use in susceptibility testing by CLSI (reference CLSI document M100-S22; Vol. 32 No.3; CLSI Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. Jan 2012).


Code: NCL
Display: No CLSI defined breakpoint
Definition:
Use when not enough clinical trial data published by the Clinical and Laboratory Standards Institutes (CLSI) is available to establish the breakpoints for susceptible / intermediate and resistant.


Code: NS
Display: Non-susceptible
Definition:
A category used for isolates for which only a susceptible interpretive criterion has been designated because of the absence or rare occurrence of resistant strains. Isolates that have MICs above or zone diameters below the value indicated for the susceptible breakpoint should be reported as non-susceptible.

NOTE 1: An isolate that is interpreted as non-susceptible does not necessarily mean that the isolate has a resistance mechanism. It is possible that isolates with MICs above the susceptible breakpoint that lack resistance mechanisms may be encountered within the wild-type distribution subsequent to the time the susceptible-only breakpoint is set.

NOTE 2: For strains yielding results in the "nonsusceptible" category, organism identification and antimicrobial susceptibility test results should be confirmed.

Synonym: decreased susceptibility.


Code: R
Display: Resistant
Definition:
Bacterial strain inhibited in vitro by a concentration of an antimicrobial agent that is associated with a high likelihood of therapeutic failure. Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized\_Terminolo.htm) Projects: ISO 20776-1, ISO 20776-2

\[Note 1: Bacterial strains are categorized as resistant by applying the appropriate breakpoints in a defined phenotypic test system.\]

\[Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes in commonly used drug dosages, emergence of new resistance mechanisms).\]


Code: S
Display: Susceptible
Definition:
Bacterial strain inhibited by in vitro concentration of an antimicrobial agent that is associated with a high likelihood of therapeutic success. Reference: CLSI (http://www.clsi.org/Content/NavigationMenu/Resources/HarmonizedTerminologyDatabase/Harmonized\_Terminolo.htm) Synonym (earlier term): Sensitive Projects: ISO 20776-1, ISO 20776-2

\[Note 1: Bacterial strains are categorized as susceptible by applying the appropriate breakpoints in a defined phenotypic system.\]

\[Note 2: This breakpoint can be altered due to changes in circumstances (e.g., changes in commonly used drug dosages, emergence of new resistance mechanisms).\]


Code: AA
Display: Critical abnormal
Definition:
The result or observation value is outside a reference range or expected norm at a level at which immediate action should be considered for patient safety (as defined for the respective test procedure).

\[Note: Typically applies to non-numeric results. Analogous to critical/panic limits for numeric results.\]


Code: H
Display: High
Definition:
The result for a quantitative observation is above the upper limit of the reference range (as defined for the respective test procedure).

Synonym: Above high normal


Code: L
Display: Low
Definition:
The result for a quantitative observation is below the lower limit of the reference range (as defined for the respective test procedure).

Synonym: Below low normal


Code: HH
Display: Critical high
Definition:
The result for a quantitative observation is above a reference level at which immediate action should be considered for patient safety (as defined for the respective test procedure).

Synonym: Above upper panic limits.


Code: LL
Display: Critical low
Definition:
The result for a quantitative observation is below a reference level at which immediate action should be considered for patient safety (as defined for the respective test procedure).

Synonym: Below lower panic limits.


Code: LX
Display: below low threshold
Definition:
The numeric observation/test result is interpreted as being below the low threshold value for a particular protocol within which the result is being reported.

**Example:** A Total White Blood Cell Count falling below a protocol-defined threshold value of 3000/mm^3

*Open Issue:* EX, HX, LX: These three concepts do not seem to meet a clear need in the vocabulary, and their use in observation interpretation appears likely to be covered by other existing concepts (e.g., A, H, L). The only apparent significant difference is their reference to use in protocols for exclusion of study subjects. These concepts/codes were proposed by RCRIM for use in the CTLaboratory message. They were submitted and approved in the November 2005 Harmonization cycle in proposal "030103C\_VOCAB\_RCRIM\_l\_quade\_RCRIM Obs Interp\_20051028154455". However, this proposal was not fully implemented in the vocabulary. The proposal recommended creation of the x\_ClinicalResearchExclusion domain in ObservationInterpretation with a value set including those three concepts/codes, but there is no subdomain of that name or equivalent with a binding to either of the value sets that contain these concepts/codes. Members of the OO WG have recently attempted to contact members of RCRIM regarding these concepts, both by email and at the recent WGM in Atlanta, without response. It is felt by OO that the best course of action to take at this time is to add this comprehensive Open Issue rather than deprecate these three concepts at this time, until further discussion is held.


Code: H>
Display: Significantly high
Definition:
A test result that is significantly higher than the reference (normal) or therapeutic interval, but has not reached the critically high value and might need special attention, as defined by the laboratory or the clinician.

\[Note: This level is situated between 'H' and 'HH'.\]

*Deprecation Comment:* The code 'H>' is being deprecated in order to align with the use of the code 'HU' for "Very high" in V2 Table 0078 "Interpretation Codes".

\[Note: The use of code 'H>' is non-preferred, as this code is deprecated and on track to be retired; use code 'HU' instead.


Code: HU
Display: Significantly high
Definition:
A test result that is significantly higher than the reference (normal) or therapeutic interval, but has not reached the critically high value and might need special attention, as defined by the laboratory or the clinician.


Code: E
Display: Equivocal
Definition:
The test or procedure was successfully performed, but the results are borderline and can neither be declared positive / negative nor detected / not detected according to the current established criteria.


Code: L<
Display: Significantly low
Definition:
A test result that is significantly lower than the reference (normal) or therapeutic interval, but has not reached the critically low value and might need special attention, as defined by the laboratory or the clinician.

\[Note: This level is situated between 'L' and 'LL'.\]

*Deprecation Comment:* The code 'L<' is being deprecated in order to align with the use of the code 'LU' for "Very low" in V2 Table 0078 "Interpretation Codes".

\[Note: The use of code 'L<' is non-preferred, as this code is deprecated and on track to be retired; use code 'LU' instead.


Code: LU
Display: Significantly low
Definition:
A test result that is significantly lower than the reference (normal) or therapeutic interval, but has not reached the critically low value and might need special attention, as defined by the laboratory or the clinician.


Code: ND
Display: Not detected
Definition:
The presence of the specified component / analyte, organism or clinical sign could not be determined within the limit of detection of the performed test or procedure.


Code: IND
Display: Indeterminate
Definition:
The specified component / analyte, organism or clinical sign could neither be declared positive / negative nor detected / not detected by the performed test or procedure.

*Usage Note:* For example, if the specimen was degraded, poorly processed, or was missing the required anatomic structures, then "indeterminate" (i.e. "cannot be determined") is the appropriate response, not "equivocal".


Code: NEG
Display: Negative
Definition:
An absence finding of the specified component / analyte, organism or clinical sign based on the established threshold of the performed test or procedure.

\[Note: Negative does not necessarily imply the complete absence of the specified item.\]


Code: POS
Display: Positive
Definition:
A presence finding of the specified component / analyte, organism or clinical sign based on the established threshold of the performed test or procedure.


Code: EXP
Display: Expected
Definition:
This result has been evaluated in light of known contraindicators. Once those contraindicators have been taken into account the result is determined to be "Expected" (e.g., presence of drugs in a patient that is taking prescription medication for pain management).


Code: UNE
Display: Unexpected
Definition:
This result has been evaluated in light of known contraindicators. Once those contraindicators have been taken into account the result is determined to be "Unexpected" (e.g., presence of non-prescribed drugs in a patient that is taking prescription medication for pain management).


Code: DET
Display: Detected
Definition:
The measurement of the specified component / analyte, organism or clinical sign above the limit of detection of the performed test or procedure.


Code: SYN-R
Display: Synergy - resistant
Definition:
A category for isolates where the bacteria (e.g. enterococci) are not susceptible in vitro to a combination therapy (e.g., high-level aminoglycoside and cell wall active agent). This is predictive that this combination therapy will not be effective.

*Usage Note:* Since the use of penicillin or ampicillin alone often results in treatment failure of serious enterococcal or other bacterial infections, combination therapy is usually indicated to enhance bactericidal activity. The synergy between a cell wall active agent (such as penicillin, ampicillin, or vancomycin) and an aminoglycoside (such as gentamicin, kanamycin or streptomycin) is best predicted by screening for high-level bacterial resistance to the aminoglycoside.

*Open Issue:* The print name of the code is very general and the description is very specific to a pair of classes of agents, which may lead to confusion of these concepts in the future should other synergies be found.


Code: NR
Display: Non-reactive
Definition:
An absence finding used to indicate that the specified component / analyte did not react measurably with the reagent.


Code: RR
Display: Reactive
Definition:
A presence finding used to indicate that the specified component / analyte reacted with the reagent above the reliably measurable limit of the performed test.


Code: WR
Display: Weakly reactive
Definition:
A weighted presence finding used to indicate that the specified component / analyte reacted with the reagent, but below the reliably measurable limit of the performed test.


Code: SDD
Display: Susceptible-dose dependent
Definition:
A category that includes isolates with antimicrobial agent minimum inhibitory concentrations (MICs) that approach usually attainable blood and tissue levels and for which response rates may be lower than for susceptible isolates.

Reference: CLSI document M44-A2 2009 "Method for antifungal disk diffusion susceptibility testing of yeasts; approved guideline - second edition" - page 2.


Code: SYN-S
Display: Synergy - susceptible
Definition:
A category for isolates where the bacteria (e.g. enterococci) are susceptible in vitro to a combination therapy (e.g., high-level aminoglycoside and cell wall active agent). This is predictive that this combination therapy will be effective.

*Usage Note:* Since the use of penicillin or ampicillin alone often results in treatment failure of serious enterococcal or other bacterial infections, combination therapy is usually indicated to enhance bactericidal activity. The synergy between a cell wall active agent (such as penicillin, ampicillin, or vancomycin) and an aminoglycoside (such as gentamicin, kanamycin or streptomycin) is best predicted by screening for high-level bacterial resistance to the aminoglycoside.

*Open Issue:* The print name of the code is very general and the description is very specific to a pair of classes of agents, which may lead to confusion of these concepts in the future should other synergies be found.


Code: GINT
Display: global introspection
Definition:
Reaching a decision by consideration of the totality of factors involved in order to reach a judgement.


Code: _ObservationMethodAggregate
Display: observation method aggregate
Definition:
Provides additional detail about the aggregation methods used to compute the aggregated values for an observation. This is an abstract code.


Code: STDEV.S
Display: sample standard deviation
Definition:
Standard Deviation of the values in the referenced set of values, computed over a sample of the population.


Code: VREG
Display: registry verification
Definition:
verification by means of a response to an electronic query

*Example:* query message to a Covered Party registry application or Coverage Administrator.


Code: VTOKEN
Display: electronic token verification
Definition:
Verification by means of electronic token.

*Example:* smartcard, magnetic swipe card, RFID device.


Code: VVOICE
Display: voice-based verification
Definition:
Verification by means of voice.

*Example:* By speaking with or calling the Coverage Administrator or Covered Party


Code: 0128
Display: Nucleic acid probe with amplification
Definition:
Molecular, Nucleic acid probe with amplification

*Rationale:* Duplicate of code 0126. Use code 0126 instead.


Code: INCOME
Display: income
Definition:
Code specifying income indicators used to assess or establish eligibility for coverage under a policy or program; e.g., pay or pension check, child support payments received or provided, and taxes paid.


Code: INVEST
Display: investment income
Definition:
Indicator of investment income, e.g., dividend check, annuity payment; real estate rent, investment divestiture proceeds; trust or endowment check.


Code: PAY
Display: paid employment
Definition:
Indicator of paid employment, e.g., letter of hire, contract, employer letter; copy of pay check or pay stub.


Code: SPOUSAL
Display: spousal or partner support
Definition:
Indicator of spousal or partner support payments received or provided; e.g., alimony payment; support stipulations in a divorce settlement.


Code: HEALTH
Display: health expense
Definition:
Indicator of health expenses; including medication costs, health service costs, financial participations, and health coverage premiums.


Code: HOUSE
Display: household expense
Definition:
Indicator of housing expense, e.g., household appliances, fixtures, furnishings, and maintenance and repairs.


Code: TRANS
Display: transportation expense
Definition:
Indicator of transportation expenses, e.g., vehicle payments, vehicle insurance, vehicle fuel, and vehicle maintenance and repairs.


Code: MEMBER
Display: program or policy member
Definition:
Indicator of status as covered member under a policy or program, e.g., member id card or coverage document.


Code: LIVDEP
Display: living dependency
Definition:
Code specifying observations related to living dependency, such as dependent upon spouse for activities of daily living.


Code: RELDEP
Display: relative dependent
Definition:
Continued living in private residence requires functional and health care assistance from one or more relatives.


Code: URELDEP
Display: unrelated person dependent
Definition:
Continued living in private residence requires functional and health care assistance from one or more unrelated persons.


Code: _CompositeMeasureScoring
Display: CompositeMeasureScoring
Definition:
Observation values that communicate the method used in a quality measure to combine the component measure results included in an composite measure.


Code: ALLORNONESCR
Display: All-or-nothing Scoring
Definition:
Code specifying that the measure uses all-or-nothing scoring. All-or-nothing scoring places an individual in the numerator of the composite measure if and only if they are in the numerator of all component measures in which they are in the denominator.


Code: LINEARSCR
Display: Linear Scoring
Definition:
Code specifying that the measure uses linear scoring. Linear scoring computes the fraction of component measures in which the individual appears in the numerator, giving equal weight to each component measure.


Code: OPPORSCR
Display: Opportunity Scoring
Definition:
Code specifying that the measure uses opportunity-based scoring. In opportunity-based scoring the measure score is determined by combining the denominator and numerator of each component measure to determine an overall composite score.


Code: WEIGHTSCR
Display: Weighted Scoring
Definition:
Code specifying that the measure uses weighted scoring. Weighted scoring assigns a factor to each component measure to weight that measure's contribution to the overall score.


Code: ADC
Display: adult child
Definition:
**Description:**Child over an age as specified by coverage policy or program, e.g., student, differently abled, and income dependent.


Code: CHD
Display: child
Definition:
**Description:**Dependent biological, adopted, foster child as specified by coverage policy or program.


Code: DEP
Display: dependent
Definition:
**Description:**Person requiring functional and/or financial assistance from another person as specified by coverage policy or program.


Code: DP
Display: domestic partner
Definition:
**Description:**Persons registered as a family unit in a domestic partner registry as specified by law and by coverage policy or program.


Code: ECH
Display: employee
Definition:
**Description:**An individual employed by an employer who receive remuneration in wages, salary, commission, tips, piece-rates, or pay-in-kind through the employeraTMs payment system (i.e., not a contractor) as specified by coverage policy or program.


Code: SSP
Display: same sex partner
Definition:
**Description:**A pair of people of the same gender who live together as a family as specified by coverage policy or program, e.g., Naomi and Ruth from the Book of Ruth; Socrates and Alcibiades


Code: CRITH
Display: high criticality
Definition:
Worst case result of a future exposure is assessed to be life-threatening or having high potential for organ system failure.


Code: CRITL
Display: low criticality
Definition:
Worst case result of a future exposure is not assessed to be life-threatening or having high potential for organ system failure.


Code: Employed
Display: Employed
Definition:
Individuals who, during the last week: a) did any work for at least 1 hour as paid or unpaid employees of a business or government organization; worked in their own businesses, professions, or on their own farms; or b) were not working, but who have a job or business from which the individual was temporarily absent because of vacation, illness, bad weather, childcare problems, maternity or paternity leave, labor-management dispute, job training, or other family or personal reasons, regardless of whether or not they were paid for the time off or were seeking other jobs.


Code: NotInLaborForce
Display: Not In Labor Force
Definition:
Persons not classified as employed or unemployed, meaning those who have no job and are not looking for one.


Code: Unemployed
Display: Unemployed
Definition:
Persons who currently have no employment, but are available for work and have made specific efforts to find employment.


Code: Homozygote
Display: HOMO
Definition:
**Description:** An individual having different alleles at one or more loci regarding a specific character


Code: DecrIsImp
Display: Decreased score indicates improvement
Definition:
Improvement is indicated as a decrease in the score or measurement (e.g. Lower score indicates better quality)


Code: IncrIsImp
Display: Increased score indicates improvement
Definition:
Improvement is indicated as an increase in the score or measurement (e.g. Higher score indicates better quality)


Code: COHORT
Display: cohort measure scoring
Definition:
A measure in which either short-term cross-section or long-term longitudinal analysis is performed over a group of subjects defined by a set of common properties or defining characteristics (e.g., Male smokers between the ages of 40 and 50 years, exposure to treatment, exposure duration).


Code: CONTVAR
Display: continuous variable measure scoring
Definition:
A measure score in which each individual value for the measure can fall anywhere along a continuous scale (e.g., mean time to thrombolytics which aggregates the time in minutes from a case presenting with chest pain to the time of administration of thrombolytics).


Code: PROPOR
Display: proportion measure scoring
Definition:
A score derived by dividing the number of cases that meet a criterion for quality (the numerator) by the number of eligible cases within a given time frame (the denominator) where the numerator cases are a subset of the denominator cases (e.g., percentage of eligible women with a mammogram performed in the last year).


Code: RATIO
Display: ratio measure scoring
Definition:
A score that may have a value of zero or greater that is derived by dividing a count of one type of data by a count of another type of data (e.g., the number of patients with central lines who develop infection divided by the number of central line days).


Code: COMPOSITE
Display: composite measure type
Definition:
A measure that is composed from one or more other measures and indicates an overall summary of those measures.


Code: INTERM-OM
Display: intermediate outcome measure type
Definition:
A measure that evaluates the change over time of a physiologic state observable that is associated with a specific long-term health outcome.


Code: PRO-PM
Display: patient reported outcome measure type
Definition:
A measure that is a comparison of patient reported outcomes for a single or multiple patients collected via an instrument specifically designed to obtain input directly from patients.


Code: APPROPRIATE
Display: appropriate use process measure
Definition:
A measure that assesses the use of one or more processes where the expected health benefit exceeds the expected negative consequences.


Code: DENEX
Display: denominator exclusions
Definition:
Patients who should be removed from the eMeasure population and denominator before determining if numerator criteria are met. Denominator exclusions are used in proportion and ratio measures to help narrow the denominator.


Code: DENEXCEP
Display: denominator exceptions
Definition:
Denominator exceptions are those conditions that should remove a patient, procedure or unit of measurement from the denominator only if the numerator criteria are not met. Denominator exceptions allow for adjustment of the calculated score for those providers with higher risk populations. Denominator exceptions are used only in proportion eMeasures. They are not appropriate for ratio or continuous variable eMeasures. Denominator exceptions allow for the exercise of clinical judgment and should be specifically defined where capturing the information in a structured manner fits the clinical workflow. Generic denominator exception reasons used in proportion eMeasures fall into three general categories:

 *  Medical reasons
 *  Patient reasons
 *  System reasons


Code: DENOM
Display: denominator
Definition:
It can be the same as the initial patient population or a subset of the initial patient population to further constrain the population for the purpose of the eMeasure. Different measures within an eMeasure set may have different Denominators. Continuous Variable eMeasures do not have a Denominator, but instead define a Measure Population.


Code: IP
Display: initial population
Definition:
The initial population refers to all entities to be evaluated by a specific quality measure who share a common set of specified characteristics within a specific measurement set to which a given measure belongs.


Code: IPP
Display: initial patient population
Definition:
The initial patient population refers to all patients to be evaluated by a specific quality measure who share a common set of specified characteristics within a specific measurement set to which a given measure belongs. Details often include information based upon specific age groups, diagnoses, diagnostic and procedure codes, and enrollment periods.


Code: MSRPOPL
Display: measure population
Definition:
Measure population is used only in continuous variable eMeasures. It is a narrative description of the eMeasure population. (e.g., all patients seen in the Emergency Department during the measurement period).


Code: NUMER
Display: numerator
Definition:
Numerators are used in proportion and ratio eMeasures. In proportion measures the numerator criteria are the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator. In ratio measures the numerator is related, but not directly derived from the denominator (e.g., a numerator listing the number of central line blood stream infections and a denominator indicating the days per thousand of central line usage in a specific time period).


Code: NUMEX
Display: numerator exclusions
Definition:
Numerator Exclusions are used only in ratio eMeasures to define instances that should not be included in the numerator data. (e.g., if the number of central line blood stream infections per 1000 catheter days were to exclude infections with a specific bacterium, that bacterium would be listed as a numerator exclusion.)


Code: _SECCATOBV
Display: security category
Definition:
Abstract security observation values used to indicate security category metadata.

**Examples:** Codes conveying:

 *  privacy law
 *  information sensitivity
 *  consent directive types


Code: _SECCLASSOBV
Display: security classification
Definition:
Abstract security observation values used to indicate security classification metadata.

**Examples:** Confidentiality Codes


Code: _SECCONOBV
Display: security control
Definition:
Abstract security observation values used to indicate security control metadata.

**Examples:** Codes conveying dissemination controls, information handling caveats, purpose of use, refrain policies, and obligations to which custodians and information receivers must comply.


Code: _SECINTOBV
Display: security integrity
Definition:
Abstract security observation values used to indicate security integrity metadata.

**Examples:** Codes conveying integrity status, integrity confidence, and provenance.


Code: _SECALTINTOBV
Display: alteration integrity
Definition:
Abstract security metadata observation values used to indicate mechanism used for authorized alteration of an IT resource (data, information object, service, or system capability)


Code: ABSTRED
Display: abstracted
Definition:
Security metadata observation values used to indicate the use of a more abstract version of the content, e.g., replacing exact value of an age or date field with a range, or remove the left digits of a credit card number or SSN.


Code: AGGRED
Display: aggregated
Definition:
Security metadata observation values used to indicate the use of an algorithmic combination of actual values with the result of an aggregate function, e.g., average, sum, or count in order to limit disclosure of an IT resource (data, information object, service, or system capability) to the minimum necessary.


Code: ANONYED
Display: anonymized
Definition:
Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability) by used to indicate the mechanism by which software systems can strip portions of the resource that could allow the identification of the source of the information or the information subject. No key to relink the data is retained.


Code: MAPPED
Display: mapped
Definition:
Security metadata observation value used to indicate that the IT resource semantic content has been transformed from one encoding to another.

*Usage Note:* "MAP" code does not indicate the semantic fidelity of the transformed content.

To indicate semantic fidelity for maps of HL7 to other code systems, this security alteration integrity observation may be further specified using an Act valued with Value Set: MapRelationship (2.16.840.1.113883.1.11.11052).

Semantic fidelity of the mapped IT Resource may also be indicated using a SecurityIntegrityConfidenceObservation.


Code: MASKED
Display: masked
Definition:
Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability) by indicating the mechanism by which software systems can make data unintelligible (that is, as unreadable and unusable by algorithmically transforming plaintext into ciphertext) such that it can only be accessed or used by authorized users. An authorized user may be provided a key to decrypt per license or "shared secret".

*Usage Note:* "MASKED" may be used, per applicable policy, as a flag to indicate to a user or receiver that some portion of an IT resource has been further encrypted, and may be accessed only by an authorized user or receiver to which a decryption key is provided.


Code: PSEUDED
Display: pseudonymized
Definition:
Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability), by indicating the mechanism by which software systems can strip portions of the resource that could allow the identification of the source of the information or the information subject. Custodian may retain a key to relink data necessary to reidentify the information subject.

*Rationale:* Personal data which has been processed to make it impossible to know whose data it is. Used particularly for secondary use of health data. In some cases, it may be possible for authorized individuals to restore the identity of the individual, e.g.,for public health case management. Based on ISO/TS 25237:2008 Health informatics-Pseudonymization


Code: REDACTED
Display: redacted
Definition:
Security metadata observation value used to indicate the mechanism by which software systems can filter an IT resource (data, information object, service, or system capability) to remove any portion of the resource that is not authorized to be access, used, or disclosed.

*Usage Note:* "REDACTED" may be used, per applicable policy, as a flag to indicate to a user or receiver that some portion of an IT resource has filtered and not included in the content accessed or received.


Code: SUBSETTED
Display: subsetted
Definition:
Metadata observation used to indicate that some information has been removed from the source object when the view this object contains was constructed because of configuration options when the view was created. The content may not be suitable for use as the basis of a record update

*Usage Note:* This is not suitable to be used when information is removed for security reasons - see the code REDACTED for this use.


Code: SYNTAC
Display: syntactic transform
Definition:
Security metadata observation value used to indicate that the IT resource syntax has been transformed from one syntactical representation to another.

*Usage Note:* "SYNTAC" code does not indicate the syntactical correctness of the syntactically transformed IT resource.


Code: TRSLT
Display: translated
Definition:
Security metadata observation value used to indicate that the IT resource has been translated from one human language to another.

*Usage Note:* "TRSLT" does not indicate the fidelity of the translation or the languages translated.

The fidelity of the IT Resource translation may be indicated using a SecurityIntegrityConfidenceObservation.

To indicate languages, use the Value Set:HumanLanguage (2.16.840.1.113883.1.11.11526)


Code: VERSIONED
Display: versioned
Definition:
Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability) which indicates that the resource only retains versions of an IT resource for access and use per applicable policy

*Usage Note:* When this code is used, expectation is that the system has removed historical versions of the data that falls outside the time period deemed to be the effective time of the applicable version.


Code: _SECDATINTOBV
Display: data integrity
Definition:
Abstract security observation values used to indicate data integrity metadata.

**Examples:** Codes conveying the mechanism used to preserve the accuracy and consistency of an IT resource such as a digital signature and a cryptographic hash function.


Code: CRYTOHASH
Display: cryptographic hash function
Definition:
Security metadata observation value used to indicate the mechanism by which software systems can establish that data was not modified in transit.

*Rationale:* This definition is intended to align with the ISO 22600-2 3.3.19 definition of cryptographic checkvalue: Information which is derived by performing a cryptographic transformation (see cryptography) on the data unit. The derivation of the checkvalue may be performed in one or more steps and is a result of a mathematical function of the key and a data unit. It is usually used to check the integrity of a data unit.

**Examples:** 

 *  SHA-1
 *  SHA-2 (Secure Hash Algorithm)


Code: DIGSIG
Display: digital signature
Definition:
Security metadata observation value used to indicate the mechanism by which software systems use digital signature to establish that data has not been modified.

*Rationale:* This definition is intended to align with the ISO 22600-2 3.3.26 definition of digital signature: Data appended to, or a cryptographic transformation (see cryptography) of, a data unit that allows a recipient of the data unit to prove the source and integrity of the data unit and protect against forgery e.g., by the recipient.


Code: _SECINTCONOBV
Display: integrity confidence
Definition:
Abstract security observation value used to indicate integrity confidence metadata.

**Examples:** Codes conveying the level of reliability and trustworthiness of an IT resource.


Code: HRELIABLE
Display: highly reliable
Definition:
Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be very high.


Code: RELIABLE
Display: reliable
Definition:
Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be adequate.


Code: UNCERTREL
Display: uncertain reliability
Definition:
Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be uncertain.


Code: UNRELIABLE
Display: unreliable
Definition:
Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be inadequate.


Code: _SECINTPRVOBV
Display: provenance
Definition:
Abstract security metadata observation value used to indicate the provenance of an IT resource (data, information object, service, or system capability).

**Examples:** Codes conveying the provenance metadata about the entity reporting an IT resource.


Code: _SECINTPRVABOBV
Display: provenance asserted by
Definition:
Abstract security provenance metadata observation value used to indicate the entity that asserted an IT resource (data, information object, service, or system capability).

**Examples:** Codes conveying the provenance metadata about the entity asserting the resource.


Code: CLINAST
Display: clinician asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a clinician.


Code: DEVAST
Display: device asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a device.


Code: HCPAST
Display: healthcare professional asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a healthcare professional.


Code: PACQAST
Display: patient acquaintance asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a patient acquaintance.


Code: PATAST
Display: patient asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a patient.


Code: PAYAST
Display: payer asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a payer.


Code: PROAST
Display: professional asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a professional.


Code: SDMAST
Display: substitute decision maker asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a substitute decision maker.


Code: AIAST
Display: Artificial Intelligence asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, or information object) was asserted by a Artificial Intelligence (e.g. Clinical Decision Support, Machine Learning, Algorithm).


Code: DICTAST
Display: Dictation asserted
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, or information object) was asserted by a Dictation algorithm transforming human communications (e.g. speech).


Code: _SECINTPRVRBOBV
Display: provenance reported by
Definition:
Abstract security provenance metadata observation value used to indicate the entity that reported the resource (data, information object, service, or system capability).

**Examples:** Codes conveying the provenance metadata about the entity reporting an IT resource.


Code: CLINRPT
Display: clinician reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a clinician.


Code: DEVRPT
Display: device reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a device.


Code: HCPRPT
Display: healthcare professional reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a healthcare professional.


Code: PACQRPT
Display: patient acquaintance reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a patient acquaintance.


Code: PATRPT
Display: patient reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a patient.


Code: PAYRPT
Display: payer reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a payer.


Code: PRORPT
Display: professional reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a professional.


Code: SDMRPT
Display: substitute decision maker reported
Definition:
Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a substitute decision maker.


Code: _SECINTSTOBV
Display: integrity status
Definition:
Abstract security observation values used to indicate integrity status metadata.

**Examples:** Codes, such as those in the HL7 DocumentClassification code system conveying the workflow status of resource as authenticated, legally authenticated, and in progress.


Code: SECTRSTOBV
Display: security trust observation
Definition:
Observation value used to indicate aspects of trust applicable to an IT resource (data, information object, service, or system capability).


Code: TRSTACCRDOBV
Display: trust accreditation observation
Definition:
Values for security trust accreditation metadata observation made about the formal declaration by an authority or neutral third party that validates the technical, security, trust, and business practice conformance of Trust Agents to facilitate security, interoperability, and trust among participants within a security domain or trust framework.


Code: TRSTAGREOBV
Display: trust agreement observation
Definition:
Values for security trust agreement metadata observation made about privacy and security requirements with which a security domain must comply. \[ISO IEC 10181-1\] \[ISO IEC 10181-1\]


Code: TRSTCERTOBV
Display: trust certificate observation
Definition:
Values for security trust certificate metadata observation made about a set of security-relevant data issued by a security authority or trusted third party, together with security information which is used to provide the integrity and data origin authentication services for an IT resource (data, information object, service, or system capability). \[Based on ISO IEC 10181-1\]

For example, a Certificate Policy (CP), which is a named set of rules that indicates the applicability of a certificate to a particular community and/or class of application with common security requirements. A particular Certificate Policy might indicate the applicability of a type of certificate to the authentication of electronic data interchange transactions for the trading of goods within a given price range. Another example is Cross Certification with Federal Bridge.


Code: TRSTFWKOBV
Display: none supplied 5
Definition:
Values for security trust framework metadata observation made about a complete set of contracts, regulations or commitments that enable participating actors to rely on certain assertions by other actors to fulfill their information security requirements. \[Kantara Initiative\]


Code: TRSTLOAOBV
Display: trust assurance observation
Definition:
Values for security trust assurance metadata observation made about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.


Code: LOAAN
Display: authentication level of assurance value
Definition:
The value assigned as the indicator of the digital quality or reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. \[Based on ISO 7498-2\]

For example, the degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. \[OMB M-04-04 E-Authentication Guidance for Federal Agencies\]


Code: LOAAN1
Display: low authentication level of assurance
Definition:
Indicator of low digital quality or reliability of the digital reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. \[Based on ISO 7498-2\]

The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. \[OMB M-04-04 E-Authentication Guidance for Federal Agencies\]

Low authentication level of assurance indicates that the relying party may have little or no confidence in the asserted identity's validity. Level 1 requires little or no confidence in the asserted identity. No identity proofing is required at this level, but the authentication mechanism should provide some assurance that the same claimant is accessing the protected transaction or data. A wide range of available authentication technologies can be employed and any of the token methods of Levels 2, 3, or 4, including Personal Identification Numbers (PINs), may be used. To be authenticated, the claimant must prove control of the token through a secure authentication protocol. At Level 1, long-term shared authentication secrets may be revealed to verifiers. Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAN2
Display: basic authentication level of assurance
Definition:
Indicator of basic digital quality or reliability of the digital reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. \[Based on ISO 7498-2\]

The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. \[OMB M-04-04 E-Authentication Guidance for Federal Agencies\]

Basic authentication level of assurance indicates that the relying party may have some confidence in the asserted identity's validity. Level 2 requires confidence that the asserted identity is accurate. Level 2 provides for single-factor remote network authentication, including identity-proofing requirements for presentation of identifying materials or information. A wide range of available authentication technologies can be employed, including any of the token methods of Levels 3 or 4, as well as passwords. Successful authentication requires that the claimant prove through a secure authentication protocol that the claimant controls the token. Eavesdropper, replay, and online guessing attacks are prevented. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Approved cryptographic techniques are required. Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAN3
Display: medium authentication level of assurance
Definition:
Indicator of medium digital quality or reliability of the digital reliability of verification and validation of the process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. \[Based on ISO 7498-2\]

The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. \[OMB M-04-04 E-Authentication Guidance for Federal Agencies\]

Medium authentication level of assurance indicates that the relying party may have high confidence in the asserted identity's validity. Level 3 is appropriate for transactions that need high confidence in the accuracy of the asserted identity. Level 3 provides multifactor remote network authentication. At this level, identity-proofing procedures require verification of identifying materials and information. Authentication is based on proof of possession of a key or password through a cryptographic protocol. Cryptographic strength mechanisms should protect the primary authentication token (a cryptographic key) against compromise by the protocol threats, including eavesdropper, replay, online guessing, verifier impersonation, and man-in-the-middle attacks. A minimum of two authentication factors is required. Three kinds of tokens may be used:

 *  "soft" cryptographic token, which has the key stored on a general-purpose computer,
 *  "hard" cryptographic token, which has the key stored on a special hardware device, and
 *  "one-time password" device token, which has symmetric key stored on a personal hardware device that is a cryptographic module validated at FIPS 140-2 Level 1 or higher. Validation testing of cryptographic modules and algorithms for conformance to Federal Information Processing Standard (FIPS) 140-2, Security Requirements for Cryptographic Modules, is managed by NIST.

Authentication requires that the claimant prove control of the token through a secure authentication protocol. The token must be unlocked with a password or biometric representation, or a password must be used in a secure authentication protocol, to establish two-factor authentication. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Approved cryptographic techniques are used for all operations. Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAN4
Display: high authentication level of assurance
Definition:
Indicator of high digital quality or reliability of the digital reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. \[Based on ISO 7498-2\]

The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. \[OMB M-04-04 E-Authentication Guidance for Federal Agencies\]

High authentication level of assurance indicates that the relying party may have very high confidence in the asserted identity's validity. Level 4 is for transactions that need very high confidence in the accuracy of the asserted identity. Level 4 provides the highest practical assurance of remote network authentication. Authentication is based on proof of possession of a key through a cryptographic protocol. This level is similar to Level 3 except that only â€œhardâ€? cryptographic tokens are allowed, cryptographic module validation requirements are strengthened, and subsequent critical data transfers must be authenticated via a key that is bound to the authentication process. The token should be a hardware cryptographic module validated at FIPS 140-2 Level 2 or higher overall with at least FIPS 140-2 Level 3 physical security. This level requires a physical token, which cannot readily be copied, and operator authentication at Level 2 and higher, and ensures good, two-factor remote authentication.

Level 4 requires strong cryptographic authentication of all parties and all sensitive data transfers between the parties. Either public key or symmetric key technology may be used. Authentication requires that the claimant prove through a secure authentication protocol that the claimant controls the token. Eavesdropper, replay, online guessing, verifier impersonation, and man-in-the-middle attacks are prevented. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Strong approved cryptographic techniques are used for all operations. All sensitive data transfers are cryptographically authenticated using keys bound to the authentication process. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAP
Display: authentication process level of assurance value
Definition:
The value assigned as the indicator of the digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. \[Based on NIST SP 800-63-2\]


Code: LOAAP1
Display: low authentication process level of assurance
Definition:
Indicator of the low digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. \[Based on NIST SP 800-63-2\]

Low authentication process level of assurance indicates that (1) long-term shared authentication secrets may be revealed to verifiers; and (2) assertions and assertion references require protection from manufacture/modification and reuse attacks. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAP2
Display: basic authentication process level of assurance
Definition:
Indicator of the basic digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. \[Based on NIST SP 800-63-2\]

Basic authentication process level of assurance indicates that long-term shared authentication secrets are never revealed to any other party except Credential Service Provider (CSP). Sessions (temporary) shared secrets may be provided to independent verifiers by CSP. Long-term shared authentication secrets, if used, are never revealed to any other party except Verifiers operated by the Credential Service Provider (CSP); however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. In addition to Level 1 requirements, assertions are resistant to disclosure, redirection, capture and substitution attacks. Approved cryptographic techniques are required. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAP3
Display: medium authentication process level of assurance
Definition:
Indicator of the medium digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. \[Based on NIST SP 800-63-2\]

Medium authentication process level of assurance indicates that the token can be unlocked with password, biometric, or uses a secure multi-token authentication protocol to establish two-factor authentication. Long-term shared authentication secrets are never revealed to any party except the Claimant and Credential Service Provider (CSP).

Authentication requires that the Claimant prove, through a secure authentication protocol, that he or she controls the token. The Claimant unlocks the token with a password or biometric, or uses a secure multi-token authentication protocol to establish two-factor authentication (through proof of possession of a physical or software token in combination with some memorized secret knowledge). Long-term shared authentication secrets, if used, are never revealed to any party except the Claimant and Verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. In addition to Level 2 requirements, assertions are protected against repudiation by the Verifier.


Code: LOAAP4
Display: high authentication process level of assurance
Definition:
Indicator of the high digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. \[Based on NIST SP 800-63-2\]

High authentication process level of assurance indicates all sensitive data transfer are cryptographically authenticated using keys bound to the authentication process. Level 4 requires strong cryptographic authentication of all communicating parties and all sensitive data transfers between the parties. Either public key or symmetric key technology may be used. Authentication requires that the Claimant prove through a secure authentication protocol that he or she controls the token. All protocol threats at Level 3 are required to be prevented at Level 4. Protocols shall also be strongly resistant to man-in-the-middle attacks. Long-term shared authentication secrets, if used, are never revealed to any party except the Claimant and Verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. Approved cryptographic techniques are used for all operations. All sensitive data transfers are cryptographically authenticated using keys bound to the authentication process. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAS
Display: assertion level of assurance value
Definition:
The value assigned as the indicator of the high quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes.


Code: LOAAS1
Display: low assertion level of assurance
Definition:
Indicator of the low quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes.

Assertions and assertion references require protection from modification and reuse attacks. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAS2
Display: basic assertion level of assurance
Definition:
Indicator of the basic quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes.

Assertions are resistant to disclosure, redirection, capture and substitution attacks. Approved cryptographic techniques are required for all assertion protocols. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAS3
Display: medium assertion level of assurance
Definition:
Indicator of the medium quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes.

Assertions are protected against repudiation by the verifier. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOAAS4
Display: high assertion level of assurance
Definition:
Indicator of the high quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes.

Strongly resistant to man-in-the-middle attacks. "Bearer" assertions are not used. "Holder-of-key" assertions may be used. RP maintains records of the assertions. \[Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.\]


Code: LOACM
Display: token and credential management level of assurance value)
Definition:
Indicator of the digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and its binding to an identity. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOACM1
Display: low token and credential management level of assurance
Definition:
Indicator of the low digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and its binding to an identity. Little or no confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include weak identity binding to tokens and plaintext passwords or secrets not transmitted across a network. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOACM2
Display: basic token and credential management level of assurance
Definition:
Indicator of the basic digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and its binding to an identity. Some confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include: Verification must prove claimant controls the token; token resists online guessing, replay, session hijacking, and eavesdropping attacks; and token is at least weakly resistant to man-in-the middle attacks. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOACM3
Display: medium token and credential management level of assurance
Definition:
Indicator of the medium digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and it's binding to an identity. High confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include: Ownership of token verifiable through security authentication protocol and credential management protects against verifier impersonation attacks. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOACM4
Display: high token and credential management level of assurance
Definition:
Indicator of the high digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and it's binding to an identity. Very high confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include: Verifier can prove control of token through a secure protocol; credential management supports strong cryptographic authentication of all communication parties. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOAID
Display: identity proofing level of assurance
Definition:
Indicator of the quality or reliability in the process of ascertaining that an individual is who he or she claims to be.


Code: LOAID1
Display: low identity proofing level of assurance
Definition:
Indicator of low digital quality or reliability in the process of ascertaining that an individual is who he or she claims to be. Requires that a continuity of identity be maintained but does not require identity proofing. \[Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOAID2
Display: basic identity proofing level of assurance
Definition:
Indicator of some digital quality or reliability in the process of ascertaining that that an individual is who he or she claims to be. Requires identity proofing via presentation of identifying material or information. \[Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOAID3
Display: medium identity proofing level of assurance
Definition:
Indicator of high digital quality or reliability in the process of ascertaining that an individual is who he or she claims to be. Requires identity proofing procedures for verification of identifying materials and information. \[Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOANR
Display: non-repudiation level of assurance value
Definition:
Indicator of the digital quality or reliability in the process of establishing proof of delivery and proof of origin. \[Based on ISO 7498-2\]


Code: LOANR1
Display: low non-repudiation level of assurance
Definition:
Indicator of low digital quality or reliability in the process of establishing proof of delivery and proof of origin. \[Based on ISO 7498-2\]


Code: LOANR2
Display: basic non-repudiation level of assurance
Definition:
Indicator of basic digital quality or reliability in the process of establishing proof of delivery and proof of origin. \[Based on ISO 7498-2\]


Code: LOANR3
Display: medium non-repudiation level of assurance
Definition:
Indicator of medium digital quality or reliability in the process of establishing proof of delivery and proof of origin. \[Based on ISO 7498-2\]


Code: LOANR4
Display: high non-repudiation level of assurance
Definition:
Indicator of high digital quality or reliability in the process of establishing proof of delivery and proof of origin. \[Based on ISO 7498-2\]


Code: LOARA
Display: remote access level of assurance value
Definition:
Indicator of the digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization's security controls. \[Based on NIST SP 800-63-2\]


Code: LOARA1
Display: low remote access level of assurance
Definition:
Indicator of low digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization's security controls. \[Based on NIST SP 800-63-2\]


Code: LOARA2
Display: basic remote access level of assurance
Definition:
Indicator of basic digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization's security controls. \[Based on NIST SP 800-63-2\]


Code: LOARA3
Display: medium remote access level of assurance
Definition:
Indicator of medium digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization's security controls. \[Based on NIST SP 800-63-2\]


Code: LOARA4
Display: high remote access level of assurance
Definition:
Indicator of high digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization's security controls. \[Based on NIST SP 800-63-2\]


Code: LOATK
Display: token level of assurance value
Definition:
Indicator of the digital quality or reliability of single and multi-token authentication. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOATK1
Display: low token level of assurance
Definition:
Indicator of the low digital quality or reliability of single and multi-token authentication. Permits the use of any of the token methods of Levels 2, 3, or 4. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOATK2
Display: basic token level of assurance
Definition:
Indicator of the basic digital quality or reliability of single and multi-token authentication. Requires single factor authentication using memorized secret tokens, pre-registered knowledge tokens, look-up secret tokens, out of band tokens, or single factor one-time password devices. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOATK3
Display: medium token level of assurance
Definition:
Indicator of the medium digital quality or reliability of single and multi-token authentication. Requires two authentication factors. Provides multi-factor remote network authentication. Permits multi-factor software cryptographic token. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: LOATK4
Display: high token level of assurance
Definition:
Indicator of the high digital quality or reliability of single and multi-token authentication. Requires token that is a hardware cryptographic module validated at validated at Federal Information Processing Standard (FIPS) 140-2 Level 2 or higher overall with at least FIPS 140-2 Level 3 physical security. Level 4 token requirements can be met by using the PIV authentication key of a FIPS 201 compliant Personal Identity Verification (PIV) Card. \[Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011\]


Code: TRSTMECOBV
Display: none supplied 6
Definition:
Values for security trust mechanism metadata observation made about a security architecture system component that supports enforcement of security policies.


Code: L
Display: Low
Definition:
Indicates the condition may result in some adverse consequences but is unlikely to substantially affect the situation of the subject.


Code: M
Display: Moderate
Definition:
Indicates the condition may result in noticable adverse adverse consequences but is unlikely to be life-threatening or cause permanent injury.


Code: RTRD
Display: reverse trendelenburg
Definition:
Lying on the back, on an inclined plane, typically about 30-45 degrees with head raised and feet lowered.


Code: TRD
Display: trendelenburg
Definition:
Lying on the back, on an inclined plane, typically about 30-45 degrees, with head lowered and feet raised.


Code: ACTPEND
Display: active - pending investigation
Definition:
**Definition:** Coverage is in effect for healthcare service(s) and/or product(s) - Pending Investigation


Code: INPNDINV
Display: inactive - pending investigation
Definition:
**Definition:** Coverage is not in effect for healthcare service(s) and/or product(s) - Pending Investigation.


Code: INPNDUPD
Display: inactive - pending eligibility update
Definition:
**Definition:** Coverage is not in effect for healthcare service(s) and/or product(s) - Pending Eligibility Update.


Code: NELG
Display: not eligible
Definition:
**Definition:** Coverage is not in effect for healthcare service(s) and/or product(s). May optionally include reasons for the ineligibility.


Code: DS
Display: daytime shift
Definition:
A person who is scheduled for work during daytime hours (for example between 6am and 6pm) on a regular basis.


Code: ES
Display: evening shift
Definition:
A person who is scheduled for work during evening hours (for example between 2pm and midnight) on a regular basis.


Code: RSWN
Display: rotating shift with nights
Definition:
Scheduled for work times that change periodically between days, and/or evenings, and includes some night shifts.


Code: RSWON
Display: rotating shift without nights
Definition:
Scheduled for work days/times that change periodically between days, but does not include night or evening work.


Code: SS
Display: split shift
Definition:
Shift consisting of two distinct work periods each day that are separated by a break of a few hours (for example 2 to 4 hours)


Code: VS
Display: variable shift
Definition:
Irregular, unpredictable hours scheduled on a short notice (for example, less than 2 day notice): inconsistent schedule, on-call, as needed, as available.


Code: _ReactionActionTaken
Display: ReactionActionTaken
Definition:
Code used to indicate the action taken by practitioner in response to the problem (whether drug or device related) that is reported in the ICSR.

Examples include: failing device replaced, medication stopped, medication dose adjusted.


Code: AULR
Display: legitimate relationship information receiver
Definition:
**Description:**Provider with legitimate relationship authorized to receive patient health information.


Code: AUWA
Display: work area information receiver
Definition:
**Description:**Entities within specified work area authorized to receive patient health information.


Code: GRDCON
Display: legal guardian consent author
Definition:
**Description:**Legal guardian of the subject of consent authorized to author a consent directive for the subject of consent.


Code: POACON
Display: healthcare power of attorney consent author
Definition:
**Description:**Person authorized with healthcare power of attorney to author a consent directive for the subject of consent.


Code: PRCON
Display: personal representative consent author
Definition:
**Description:**Personal representative of the subject of consent authorized to author a consent directive for the subject of consent.


Code: PROMSK
Display: authorized provider masking author
Definition:
**Definition:**Provider authorized to mask information to protect the patient, a third party, or to ensure that the provider has consulted with the patient prior to release of this information.


Code: AUEMROV
Display: emergency overrider
Definition:
**Description:**Entity authorized to override a consent directive or privacy policy in an emergency.


Code: CLMADJ
Display: claims adjudication
Definition:
**Definition:** Manages all operations required to adjudicate fee for service claims or managed care encounter reports.


Code: FFSMGT
Display: ffs management
Definition:
**Definition:** Managing all operations required to administer a fee for service or indemnity health plan including enrolling covered parties and providing customer service, provider contracting, claims payment, care management and utilization review.


Code: MCMGT
Display: managed care management
Definition:
**Definition:** Managing all operations required to administer a managed care plan including enrolling covered parties and providing customer service,, provider contracting, claims payment, care management and utilization review.


Code: PROVMGT
Display: provider management
Definition:
**Definition:** Managing provider contracting, provider services, credentialing, profiling, performance measures, and ensuring network adequacy.


Code: UMGT
Display: utilization management
Definition:
**Definition:** Managing utilization of services by ensuring that providers adhere to, e.g., payeraTMs clinical protocols for medical appropriateness and standards of medical necessity. May include management of authorizations for services and referrals.


Code: FULINRD
Display: fully insured
Definition:
**Definition:** Responsibility taken by a sponsor to contract with one or more underwriters for the assumption of full responsibility for the risk and administration of a policy or program.


Code: SELFINRD
Display: self insured
Definition:
**Definition:** Responsibility taken by a sponsor to organize the underwriting of risk and administration of a policy or program.


Code: PAYORCNTR
Display: payor contracting
Definition:
**Definition:** Contracting for the provision and administration of health services to payors while retaining the risk for coverage. Contracting may be for all provision and administration; or for provision of certain types of services; for provision of services by region; and by types of administration, e.g., claims adjudication, enrollment, provider management, and utilization management. Typically done by underwriters for sponsors who need coverage provided to covered parties in multiple regions. The underwriter may act as the payor in some, but not all of the regions in which coverage is provided.


Code: SUBCTRT
Display: subcontracting risk
Definition:
**Definition:** Delegating risk for a policy or program to one or more subcontracting underwriters, e.g., a major health insurer may delegate risk for provision of coverage under a national health plan to other underwriters by region .


Code: UNDERWRTNG
Display: underwriting
Definition:
**Definition:** Provision of underwriting analysis for another underwriter without assumption of risk.


Code: ADMPHYS
Display: admitting physician
Definition:
A physician who admitted a patient to a hospital or other care unit that is the context of this service.


Code: ANEST
Display: anesthesist
Definition:
In a typical anesthesia setting an anesthesiologist or anesthesia resident in charge of the anesthesia and life support, but only a witness to the surgical procedure itself. To clarify responsibilities anesthesia should always be represented as a separate service related to the surgery.


Code: ANRS
Display: anesthesia nurse
Definition:
In a typical anesthesia setting the nurse principally assisting the anesthesiologist during the critical periods.


Code: ASSEMBLER
Display: assembly software
Definition:
A device that operates independently of an author on custodian's algorithms for data extraction of existing information for purpose of generating a new artifact.

*UsageConstraint:* ASSEMBLER ParticipationFunction should be used with DEV (device) ParticipationType.


Code: ATTPHYS
Display: attending physician
Definition:
A physician who is primarily responsible for a patient during the hospitalization, which is the context of the service.


Code: COMPOSER
Display: composer software
Definition:
A device used by an author to record new information, which may also be used by the author to select existing information for aggregation with newly recorded information for the purpose of generating a new artifact.

*UsageConstraint:* COMPOSER ParticipationFunction should be used with DEV (device) ParticipationType.

*Usage Note:* This code will enable implementers to more specifically represent the manner in which a Device participated in and facilitated the generation of a CDA Clinical Document or a CDA Entry by the responsible Author, which is comprised of the Author's newly entered content, and may include the pre-existing content selected by the Author, for the purpose of establishing the provenance and accountability for these acts.


Code: DISPHYS
Display: discharging physician
Definition:
A physician who discharged a patient from a hospital or other care unit that is the context of this service.


Code: FASST
Display: first assistant surgeon
Definition:
In a typical surgery setting the assistant facing the primary surgeon. The first assistant performs parts of the operation and assists in others (e.g., incision, approach, electrocoutering, ligatures, sutures).


Code: MDWF
Display: midwife
Definition:
A person (usually female) helping a woman deliver a baby. Responsibilities vary locally, ranging from a mere optional assistant to a full required participant, responsible for (normal) births and pre- and post-natal care for both mother and baby.


Code: NASST
Display: nurse assistant
Definition:
In a typical surgery setting the non-sterile nurse handles material supply from the stock, forwards specimen to pathology, and helps with other non-sterile tasks (e.g., phone calls, etc.).


Code: REVIEWER
Display: reviewer
Definition:
A verifier who is accountable for reviewing and asserting that the verification of an Act complies with jurisdictional or organizational policy.

*UsageConstraint:* UsageConstraint: Specifies the exact function that an actor is authorized to have as a verifier of an Act. Connotes that a specialized verifier asserts compliance for veracity of the review per jurisdictional or organizational policy. E.g., The Provider who takes responsibility for authenticity of a record submitted to a payer.

REVIEW ParticipationFunction should be used with VFR (verifier)


Code: TASST
Display: third assistant
Definition:
In a typical surgery setting there is rarely a third assistant (e.g., in some Hip operations the third assistant postures the affected leg).


Code: PHYSICAL
Display: physical presence
Definition:
Participation by direct action where subject and actor are in the same location. (The participation involves more than communication.)


Code: REMOTE
Display: remote presence
Definition:
Participation by direct action where subject and actor are in separate locations, and the actions of the actor are transmitted by electronic or mechanical means. (The participation involves more than communication.)


Code: DICTATE
Display: dictated
Definition:
Participation by pre-recorded voice. Communication is limited to one direction (from the recorder to recipient).


Code: PHONE
Display: telephone
Definition:
Participation by voice communication where the voices of the communicating parties are transported over an electronic medium


Code: VIDEOCONF
Display: videoconferencing
Definition:
Participation by voice and visual communication where the voices and images of the communicating parties are transported over an electronic medium


Code: MAILWRIT
Display: mail
Definition:
Participation by text or diagrams printed on paper transmitted physically (e.g. by courier service, postal service).


Code: TYPEWRIT
Display: typewritten
Definition:
Participation by text or diagrams printed on paper or other recording medium where the recording was performed using a typewriter, typesetter, computer or similar mechanism.


Code: MSGWRIT
Display: messaging
Definition:
Participation by messaging typically from a mobile phone or mobile device through a cellular network or Internet. Includes secured or unsecured messaging transmission and includes online chat. Also includes submission of photos or other images.


Code: APPWRIT
Display: messaging app
Definition:
Participation by text or diagrams transmitted over an online app, e.g. Facebook Messenger, WhatsApp, or similar web app.


Code: S
Display: signed
Definition:
Signature has been affixed, either written on file, or electronic (incl. digital) signature in Participation.signatureText.


Code: PART
Display: Participation
Definition:
Indicates that the target of the participation is involved in some manner in the act, but does not qualify how.


Code: NOTARY
Display: notary
Definition:
The entity (person or organization) who legally attests that the information present in the Act is a true replica of an original.


Code: DIR
Display: direct target
Definition:
Target participant that is substantially present in the act and which is directly involved in the action (includes consumed material, devices, etc.).


Code: ALY
Display: analyte
Definition:
The target of an Observation action. Links an observation to a Role whose player is the substance or most specific component entity (material, micro-organism, etc.) being measured within the subject.

*Examples:* A "plasma porcelain substance concentration" has analyte a Role with player substance Entity "porcelain".

*UsageNotes:* The Role that this participation connects to may be any Role whose player is that substance measured. Very often, the scoper may indicate the system in which the component is being measured. E.g., for "plasma porcelain" the scoper could be "Plasma".


Code: CAT
Display: catalyst
Definition:
The catalyst of a chemical reaction, such as an enzyme or a platinum surface. In biochemical reactions, connects the enzyme with the molecular interaction


Code: TPA
Display: therapeutic agent
Definition:
Something incorporated in the subject of a therapy service to achieve a physiologic effect (e.g., heal, relieve, provoke a condition, etc.) on the subject. In an administration service the therapeutic agent is a consumable, in a preparation or dispense service, it is a product. Thus, consumable or product must be specified in accordance with the kind of service.


Code: DEV
Display: device
Definition:
Participant used in performing the act without being substantially affected by the act (i.e. durable or inert with respect to that particular service).

*Examples:* monitoring equipment, tools, but also access/drainage lines, prostheses, pace maker, etc.


Code: EXPART
Display: ExposureParticipation
Definition:
**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 SBJ participation type should be used. If the participant is known to be the source then the EXSRC participation type should be used.


Code: PRD
Display: product
Definition:
Participant material that is brought forth (produced) in the act (e.g., specimen in a specimen collection, access or drainage in a placement service, medication package in a dispense service). It does not 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).


Code: SBJ
Display: subject
Definition:
The principle target on which the action happens.

*Examples:* 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).

*UsageNotes:* Not all direct targets are subjects. Consumables and devices used as tools for an act are not subjects. However, a device may be a subject of a maintenance action.


Code: PRF
Display: performer
Definition:
**Definition:** A person, non-person living subject, organization or device that who actually and principally carries out the action. Device should only be assigned as a performer in circumstances where the device is performing independent of human intervention. Need not be the principal responsible actor.

**Exampe:** A surgery resident operating under supervision of attending surgeon, a search and rescue dog locating survivors, an electronic laboratory analyzer or the laboratory discipline requested to perform a laboratory test. The performer may also 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.

**Note:** that existing HL7 designs assign an organization as the playing entity of the Role that is the performer. These designs should be revised in subsequent releases to make this the scooping entity for the role involved.


Code: COD
Display: Cash on Delivery
Definition:
Payment in full for products and/or services is required as soon as the service is performed or goods delivered.


Code: N30
Display: Net 30 days
Definition:
Payment in full for products and/or services is required 30 days from the time the service is performed or goods delivered.


Code: N60
Display: Net 60 days
Definition:
Payment in full for products and/or services is required 60 days from the time the service is performed or goods delivered.


Code: N90
Display: Net 90 days
Definition:
Payment in full for products and/or services is required 90 days from the time the service is performed or goods delivered.


Code: B
Display: beta
Definition:
The beta-distribution is used for data that is bounded on both sides and may or may not be skewed (e.g., occurs when probabilities are estimated.) Two parameters a and b are available to adjust the curve. The mean m and variance s2 relate as follows: m = a/ (a + b) and s2 = ab/((a + b)2 (a + b + 1)).


Code: E
Display: exponential
Definition:
Used for data that describes extinction. The exponential distribution is a special form of g-distribution where a = 1, hence, the relationship to mean m and variance s2 are m = b and s2 = b2.


Code: F
Display: F
Definition:
Used to describe the quotient of two c2 random variables. The F-distribution has two parameters n1 and n2, which are the numbers of degrees of freedom of the numerator and denominator variable respectively. The relationship to mean m and variance s2 are: m = n2 / (n2 - 2) and s2 = (2 n2 (n2 + n1 - 2)) / (n1 (n2 - 2)2 (n2 - 4)).


Code: G
Display: (gamma)
Definition:
The gamma-distribution used for data that is skewed and bounded to the right, i.e. where the maximum of the distribution curve is located near the origin. The g-distribution has a two parameters a and b. The relationship to mean m and variance s2 is m = a b and s2 = a b2.


Code: LN
Display: log-normal
Definition:
The logarithmic normal distribution is used to transform skewed random variable X into a normally distributed random variable U = log X. The log-normal distribution can be specified with the properties mean m and standard deviation s. Note however that mean m and standard deviation s are the parameters of the raw value distribution, not the transformed parameters of the lognormal distribution that are conventionally referred to by the same letters. Those log-normal parameters mlog and slog relate to the mean m and standard deviation s of the data value through slog2 = log (s2/m2 + 1) and mlog = log m - slog2/2.


Code: N
Display: normal (Gaussian)
Definition:
This is the well-known bell-shaped normal distribution. Because of the central limit theorem, the normal distribution is the distribution of choice for an unbounded random variable that is an outcome of a combination of many stochastic processes. Even for values bounded on a single side (i.e. greater than 0) the normal distribution may be accurate enough if the mean is "far away" from the bound of the scale measured in terms of standard deviations.


Code: T
Display: T
Definition:
Used to describe the quotient of a normal random variable and the square root of a c2 random variable. The t-distribution has one parameter n, the number of degrees of freedom. The relationship to mean m and variance s2 are: m = 0 and s2 = n / (n - 2)


Code: U
Display: uniform
Definition:
The uniform distribution assigns a constant probability over the entire interval of possible outcomes, while all outcomes outside this interval are assumed to have zero probability. The width of this interval is 2s sqrt(3). Thus, the uniform distribution assigns the probability densities f(x) = sqrt(2 s sqrt(3)) to values m - s sqrt(3) >= x <= m + s sqrt(3) and f(x) = 0 otherwise.


Code: X2
Display: chi square
Definition:
Used to describe the sum of squares of random variables which occurs when a variance is estimated (rather than presumed) from the sample. The only parameter of the c2-distribution is n, so called the number of degrees of freedom (which is the number of independent parts in the sum). The c2-distribution is a special type of g-distribution with parameter a = n /2 and b = 2. Hence, m = n and s2 = 2 n.


Code: _DispenseQueryFilterCode
Display: dispense query filter code
Definition:
**Description:**Filter codes used to manage volume of dispenses returned by a parameter-based queries.


Code: C
Display: Completely dispensed
Definition:
Filter to only include SubstanceAdministration orders which have no remaining quantity authorized to be dispensed.


Code: N
Display: Never Dispensed
Definition:
Filter to only include SubstanceAdministration orders which have no fulfilling supply events performed.


Code: R
Display: Dispensed with remaining fills
Definition:
Filter to only include SubstanceAdministration orders which have had at least one fulfilling supply event, but which still have outstanding quantity remaining to be authorized.


Code: ISSFU
Display: with unmanaged issues
Definition:
**Description:**Result set should be filtered to only include records with associated unmanaged issues.


Code: 2500-7
Display: Other Pacific Islander
Definition:
Note that this term remains in the table for completeness, even though within HL7, the notion of Other code is deprecated.


Code: GN
Display: Generic
Definition:
A generic comparison selects a record for inclusion in the response if the beginning of the designated element value matches the select string.


Code: D
Display: detail
Definition:
Respond with exceptions, completion, modifications and include more detail information (if applicable)


Code: F
Display: confirmation
Definition:
Respond with exceptions, completion, and modification with detail (as above), and send positive confirmations even if no modifications are being made.


Code: N
Display: message-control
Definition:
Respond only with message level acknowledgements, i.e., only notify acceptance or rejection of the message, do not include any application-level detail


Code: T
Display: Bolus
Definition:
Query response to sent as a series of responses at the same time without the use of batch formatting.


Code: I
Display: immediate
Definition:
The receiver is required to assume that the sender is blocking and behave appropriately by sending an immediate response.


Code: Q
Display: queue
Definition:
The receiver shall keep any application responses in a queue until such time as the queue is polled.


Code: COVPTY
Display: covered party
Definition:
A role class played by a person who receives benefit coverage under the terms of a particular insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy.

*Discussion:*This reason for coverage is captured in 'Role.code' and a relationship link with type code of indirect authority should be included using the policy holder role as the source, and the covered party role as the target.

Note that a particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.


Code: LIC
Display: licensed entity
Definition:
A relationship in which the scoper certifies the player ( e. g. a medical care giver, a medical device or a provider organization) to perform certain activities that fall under the jurisdiction of the scoper (e.g., a health authority licensing healthcare providers, a medical quality authority certifying healthcare professionals).


Code: PAT
Display: patient
Definition:
A Role of a LivingSubject (player) as an actual or potential recipient of health care services from a healthcare provider organization (scoper).

*Usage Note:* Communication about relationships between patients and specific healthcare practitioners (people) is not done via scoper. Instead this is generally done using the CareProvision act. This allows linkage between patient and a particular healthcare practitioner role and also allows description of the type of care involved in the relationship.


Code: PRS
Display: personal relationship
Definition:
Links two entities with classCode PSN (person) in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.


Code: ADJY
Display: adjacency
Definition:
A physical association whereby two Entities are in some (even lose) spatial relationship with each other such that they touch each other in some way.

*Examples:* the colon is connected (and therefore adjacent) to the jejunum; the colon is adjacent to the liver (even if not actually connected.)

*UsageConstraints:* Adjacency is in principle a symmetrical connection, but scoper and player of the role should, where applicable, be assigned to have scoper be the larger, more central Entity and player the smaller, more distant, appendage.


Code: CONC
Display: connection
Definition:
An adjacency of two Entities held together by a bond which attaches to each of the two entities.

*Examples:* biceps brachii muscle connected to the radius bone, port 3 on a network switch connected to port 5 on a patch panel.

*UsageConstraints:* See Adjacency for the assignment of scoper (larger, more central) and player (smaller, more distant).


Code: BOND
Display: molecular bond
Definition:
A connection between two atoms of a molecule.

*Examples:* double bond between first and second C in ethane, peptide bond between two amino-acid, disulfide bridge between two proteins, chelate and ion associations, even the much weaker van-der-Waals bonds can be considered molecular bonds.

*UsageConstraints:* See connection and adjacency for the assignment of player and scoper.


Code: CONY
Display: continuity
Definition:
A connection between two regional parts.

*Examples:*  the connection between ascending aorta and the aortic arc, connection between descending colon and sigmoid.

*UsageConstraints:* See connection and adjacency for the assignment of player and scoper.


Code: EQUIV
Display: equivalent entity
Definition:
**Description:** Specifies the player Entity (the equivalent Entity) as an Entity that is considered to be equivalent to a reference Entity (scoper). The equivalence is in principle a symmetric relationship, however, it is expected that the scoper is a reference entity which serves as reference entity for multiple different equivalent entities.

**Examples:** An innovator's medicine formulation is the reference for "generics", i.e., formulations manufactured differently but having been proven to be biologically equivalent to the reference medicine. Another example is a reference ingredient that serves as basis for quantity specifications (basis of strength, e.g., metoprolol succinate specified in terms of metoprolol tartrate.)


Code: SAME
Display: same
Definition:
The "same" role asserts an identity between playing and scoping entities, i.e., that they are in fact two records of the same entity instance, and, in the case of discrepancies (e.g different DOB, gender), that one or both are in error.

*Usage:*

playing and scoping entities must have same classCode, but need not have identical attributes or values.

*Example:* 

a provider registry maintains sets of conflicting demographic data for what is reported to be the same individual.


Code: ACTI
Display: active ingredient
Definition:
**Definition:** a therapeutically active ingredient (player) in a mixture (scoper), where the mixture is typically a manufactured pharmaceutical. It is unknown if the quantity of such an ingredient is expressed precisely in terms of the playing ingredient substance, or, if it is specified in terms of a closely related substance (active moiety or reference substance).


Code: ACTIB
Display: active ingredient - basis of strength
Definition:
**Description:**  Active ingredient, where the ingredient substance (player) is itself the "basis of strength", i.e., where the Role.quantity specifies exactly the quantity of the player substance in the medicine formulation.

**Examples:** Lopressor 50 mg actually contains 50 mg of metoprolol succinate, even though the active moiety is metoprolol, but also: Tenormin 50 mg contain 50 mg of atenolol, as free base, i.e., where the active ingredient atenolol is also the active moiety.


Code: ACTIM
Display: active ingredient - moiety is basis of strength
Definition:
**Description:** Active ingredient, where not the ingredient substance (player), but itaTMs active moiety is the "basis of strength", i.e., where the Role.quantity specifies the quantity of the player substance's active moiety in the medicine formulation.

**Examples:** 1 mL of Betopic 5mg/mL eye drops contains 5.6 mg betaxolol hydrochloride equivalent to betaxolol base 5 mg.


Code: ACTIR
Display: active ingredient - reference substance is basis of strength
Definition:
**Description:** Active ingredient, where not the ingredient substance (player) but another reference substance with the same active moiety, is the "basis of strength", i.e., where the Role.quantity specifies the quantity of a reference substance, similar but different from the player substance's in the medicine formulation.

**Examples:** Toprol-XL 50 mg contains 47.5 mg of metoprolol succinate equivalent to 50 mg of metoprolol tartrate.


Code: ADJV
Display: adjuvant
Definition:
A component (player) added to enhance the action of an active ingredient (scoper) (in the manner of a catalyst) but which has no active effect in and of itself. Such ingredients are significant in defining equivalence of products in a way that inactive ingredients are not.


Code: CNTM
Display: contaminant ingredient
Definition:
An ingredient whose presence is not intended but may not be reasonably avoided given the circumstances of the mixture's nature or origin.


Code: IACT
Display: inactive ingredient
Definition:
An ingredient which is not considered therapeutically active, e.g., colors, flavors, stabilizers, or preservatives, fillers, or structural components added to an active ingredient in order to facilitate administration of the active ingredient but without being considered therapeutically active. An inactive ingredient need not be biologically inert, e.g., might be active as an allergen or might have a pleasant taste, but is not an essential constituent delivering the therapeutic effect.


Code: MECH
Display: mechanical ingredient
Definition:
An ingredient (player) of a medication (scoper) that is inseparable from the active ingredients, but has no intended chemical or pharmaceutical effect itself, but which may have some systemic effect on the patient.

An example is a collagen matrix used as a base for transplanting skin cells. The collagen matrix can be left permanently in the graft site. Because it is of bovine origin, the patient may exhibit allergies or may have cultural objections to its use.


Code: PART
Display: part
Definition:
**Definition:**  an association between two Entities where the playing Entity (the part) is a component of the whole (scoper) in the sense of an integral structural component, that is distinct from other parts in the same whole, has a distinct function in the whole, and, as an effect, the full integrity of the whole depends (to some degree) on the presence of this part, even though the part may often be separable from the whole.

**Discussion:** Part is defined in opposition to (a) ingredient (not separable), (b) content (not a functional component), and (c) member (not functionally distinct from other members).


Code: GT
Display: Guarantor
Definition:
An individual or organization that makes or gives a promise, assurance, pledge to pay or has paid the healthcare service provider.


Code: FM
Display: Family Member
Definition:
A member of the covered party's family. This could be the spouse, a parent, a grand parent, a sibling, etc.


Code: NAMED
Display: named insured
Definition:
A party to an insurance policy to whom the insurer agrees to indemnify for losses, provides benefits for, or renders services.


Code: SUBSCR
Display: subscriber
Definition:
A party covered under a policy based on association with a sponsor who is the policy holder, and whose association may provide for the eligibility of dependents for coverage


Code: BILL
Display: Billing Contact
Definition:
A contact role used to identify a person within a Provider organization that can be contacted for billing purposes (e.g. about the content of the Invoice).


Code: ORG
Display: organizational contact
Definition:
A contact for an organization for administrative purposes. Contact role specifies a person acting as a liason for the organization.

Example: HR Department representative.


Code: PAYOR
Display: Payor Contact
Definition:
A contact role used to identify a person within a Payor organization to whom this communication is addressed.


Code: CLASSIFIER
Display: classifier
Definition:
An individual authorized to assign an original classification to information, including compilations of unclassified information, based on a determination that the information requires protection against unauthorized disclosure. The individual marks the information with immutable, computable, and human readable security labels in accordance with applicable security labeling policies. The labeling policies provide instructions on whether and if so how the security labels may be later reclassified \[i.e., upgraded, downgraded, used in derivative classification, or declassified\] in a manner that preserves the overridden original classification binding and provenance.


Code: CONSENTER
Display: consenter
Definition:
An entity or an entity's delegatee who is the grantee in an agreement such as a consent for services, advanced directive, or a privacy consent directive in accordance with jurisdictional, organizational, or patient policy.


Code: CONSWIT
Display: consent witness
Definition:
An entity which has witnessed and attests to observing another entity being counseled about an agreement such as a consent for services, advanced directive, or a privacy consent directive.


Code: COPART
Display: co-participant
Definition:
An entity which participates in the generation of and attest to veracity of content, but is not an author or coauthor. For example a surgeon who is required by institutional, regulatory, or legal rules to sign an operative report, but who was not involved in the authorship of that report.


Code: DECLASSIFIER
Display: declassifier
Definition:
An individual which is authorized to declassify information based on a determination that the information no longer requires protection against unauthorized disclosure. The individual marks the information being declassified using computable and human readable security labels indicating that this is copy of previously classified information is unclassified in accordance with applicable security labeling policies. The labeling policies provide instructions on whether and if so how the security labels may be later reclassified \[i.e., upgraded or used in derivative classification\] in a manner that preserves the overridden original classification binding and provenance.


Code: DOWNGRDER
Display: downgrader
Definition:
An individual authorized to lower the classification level of labeled content and provide rationale for doing so as directed by a classification guide.


Code: DRIVCLASSIFIER
Display: derivative classifier
Definition:
An individual who is only authorized to classify reproduced, extracted, or summarized classified information, or compile classified and unclassified information by applying classification markings derived from source material or as directed by a classification guide.


Code: INTPRTER
Display: interpreter
Definition:
An entity which converts spoken or written language into the language of key participants in an event such as when a provider is obtaining a patient's consent to treatment or permission to disclose information.


Code: UPGRDER
Display: upgrader
Definition:
An individual authorized to raise the classification level of labeled content and provide rationale for doing so as directed by a classification guide.


Code: CCO
Display: Clinical Companion
Definition:
**Description:**Companion animals, such as dogs, cats, and rabbits, which may be provided to patients to improve general mood, decrease depression and loneliness, and distract from stress-inducing concerns to improve quality of life.


Code: SNIFF
Display: Sniffing
Definition:
**Description:**Dogs trained or having the ability to detect imminent seizures or cancers in humans, probably as a result of volatile chemical (odors) given off by the malignancy of the host.


Code: CN
Display: national
Definition:
A person who is legally recognized as a member of a nation or country, with associated rights and obligations.


Code: CNRP
Display: non-country member without residence permit
Definition:
A foreigner who is present in a country (which is foreign to him/her) unlawfully or without the country's authorization (may be called an illegal alien).


Code: CPCA
Display: permit card applicant
Definition:
A non-country member admitted to the territory of a nation or country as a non-resident for an explicit purpose.


Code: CRIMEVIC
Display: crime victim
Definition:
**Description:** A person playing the role of program eligible under a program based on allegations of being the victim of a crime.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a crime victim meets jurisdictional or program criteria.


Code: INJWKR
Display: injured worker
Definition:
**Description:** A person playing the role of program eligible under a workers compensation program based on the filing of work-related injury claim.

**Discussion:** This CoveredPartyRoleType.code is used when the CoveredPartyRole class code is either "program eligible", a "named insured", and "individual insured", or "dependent", and the person's status as differently abled or "handicapped" meets jurisdictional, policy, or program criteria.


Code: NOK
Display: next of kin
Definition:
Played by an individual who is designated as the next of kin for another individual which scopes the role.


Code: HANDIC
Display: handicapped dependent
Definition:
Covered party is a dependent of the policy holder with a physical or mental disability causing a disadvantage that makes independent achievement unusually difficult.


Code: INJ
Display: injured plaintiff
Definition:
Covered party is an injured party with a legal claim for compensation against a policy holder under an insurance policy.


Code: SPON
Display: sponsored dependent
Definition:
Covered party is an individual that the policy holder has assumed responsibility for, such as foster child or legal ward.


Code: PARNT
Display: parent
Definition:
One that begets or brings forth offspring or a person who brings up and cares for for another (Webster's Collegiate Dictionary)


Code: STEP
Display: step child
Definition:
A child receiving parental care and nurture from a person who is related to them through marriage to their parent.


Code: FULLINS
Display: Fully insured coverage sponsor
Definition:
**Description:**An employer or organization that contracts with an underwriter to assumes the financial risk and administrative responsibility for coverage of health services for covered parties.


Code: SELFINS
Display: Self insured coverage sponsor
Definition:
**Description:**An employer or organization that assumes the financial risk and administrative responsibility for coverage of health services for covered parties.


Code: _IndividualInsuredPartyRoleType
Display: IndividualInsuredPartyRoleType
Definition:
A 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.


Code: COCBEN
Display: continuity of coverage beneficiary
Definition:
**Description:** A person playing the role of an individual insured with continuity of coverage under a policy which is being terminated based on loss of original status that was the basis for coverage. Criteria for qualifying for continuity of coverage may be set by law.

**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 continuity of coverage beneficiary meets jurisdictional or policy criteria.


Code: DIFFABL
Display: differently abled
Definition:
**Description:** A person playing the role of program eligible under a program based on meeting criteria for health or functional limitation set by law or by the program.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible", "named insured", "individual insured", or "dependent", and the person's status as differently abled meets jurisdictional, policy, or program criteria.


Code: WARD
Display: ward
Definition:
**Description:** A person, who is a minor or is deemed incompetent, who plays the role of a program eligible where eligibility for coverage is based on meeting program eligibility criteria for status as a ward of a court or jurisdiction.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is a "claimant", "program eligible", a "named insured", an "individual Insured" or a "dependent", and the person's status as a ward meets program or policy criteria. In the case of a ward covered under a program providing financial or health benefits, a governmental agency may take temporary custody of a minor or incompetent for his/her protection and care, e.g., if the ward is suffering from neglect or abuse, or has been in trouble with the law.


Code: UPC
Display: underage protection center
Definition:
**Description:** A location that plays the role of delivering services which may include: social emergency services required for a young person as required under any jurisdictional youth laws, child placement, and family mediation in the defined geographical area the SDL is responsible for. It may provide expertise in a judiciary setting on child custody, adoption and biological history research.


Code: RETIREE
Display: retiree
Definition:
**Description:** A person playing the role of an individual insured under a policy based on meeting criteria for the employment status of retired set by law or the policy.

**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 retiree meets jurisdictional or policy criteria.


Code: ACHFID
Display: accreditation location identifier
Definition:
**Description:**Identifier assigned to a location by the organization responsible for accrediting the location.


Code: LOCHFID
Display: local location identifier
Definition:
**Description:**Identifier assigned to a location by a local party (which could be the facility itself or organization overseeing a group of facilities).


Code: DC
Display: therapeutic class
Definition:
**Description:**A categorization of medicinal products by their therapeutic properties and/or main therapeutic use.


Code: GD
Display: generic drug
Definition:
Relates a manufactured drug product to the non-proprietary (generic) representation of its ingredients independent of strength, and form.

The scoping entity identifies a unique combination of medicine ingredients; sometimes referred to as "ingredient set".


Code: MGDSF
Display: manufactured drug strength form
Definition:
Relates a manufactured drug product to the non-proprietary (generic) representation of its ingredients with their strength in a specific dose form. The scoping entity identifies a unique combination of medicine ingredients with their strength in a single dose form.


Code: ENROLBKR
Display: Enrollment Broker
Definition:
**Description:**A payor that is responsible for functions related to the enrollment of covered parties.


Code: TPA
Display: Third party administrator
Definition:
**Description:**Third party administrator (TPA) is a payor organization that processes health care claims without carrying insurance risk. Third party administrators are prominent players in the managed care industry and have the expertise and capability to administer all or a portion of the claims process. They are normally contracted by a health insurer or self-insuring companies to administer services, including claims administration, premium collection, enrollment and other administrative activities.

Self-insured employers often contract with third party administrator to handle their insurance functions. Insurance companies oftentimes outsource the claims, utilization review or membership functions to a TPA. Sometimes TPAs only manage provider networks, only claims or only utilization review.

While some third-party administrators may operate as units of insurance companies, they are often independent. However, hospitals or provider organizations desiring to set up their own health plans will often outsource certain responsibilities to TPAs. TPAs may perform one or several payor functions, specified by the PayorParticipationFunction value set, such as provider management, enrollment, utilization management, and fee for service claims adjudication management.


Code: UMO
Display: Utilization management organization
Definition:
**Description:**A payor that is responsible for review and case management of health services covered under a policy or program.


Code: INDIG
Display: member of an indigenous people
Definition:
**Description:** A person playing the role of program eligible under a program based on aboriginal ancestry or as a member of an aboriginal community.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is "program eligible" and the person's status as a member of an indigenous people meets jurisdictional or program criteria.


Code: ERL
Display: enrollment
Definition:
**Definition:**The specific role being played by a research subject participating in the active treatment or primary data collection portion of a research study.


Code: SCN
Display: screening
Definition:
**Definition:**The specific role being played by a research subject participating in the pre-enrollment evaluation portion of a research study.


Code: L
Display: Pool
Definition:
Aliquots of individual specimens combined to form a single specimen representing all of the included individuals.


Code: ADOPTF
Display: adoptive father
Definition:
The player of the role (father) is a male who has taken the scoper (child) into their family through legal means and raises them as his own child.


Code: ADOPTM
Display: adoptive mother
Definition:
The player of the role (father) is a female who has taken the scoper (child) into their family through legal means and raises them as her own child.


Code: MAUNT
Display: maternal aunt
Definition:
**Description:**The player of the role is a biological sister of the scoping person's biological mother.


Code: PAUNT
Display: paternal aunt
Definition:
**Description:**The player of the role is a biological sister of the scoping person's biological father.


Code: ANTIBIOT
Display: Antibiotic
Definition:
**Description:**Non-person living subject used as antibiotic.

**Examples:**Bacteriophage, is a virus that infects bacteria.


Code: DEBR
Display: Debridement
Definition:
**Description:**Maggots raised for biodebridement.

**Discussion:** Maggot Debridement Therapy is the medical use of live maggots for cleaning non-healing wounds.

**Examples:**Removal of burnt skin.


Code: HBRO
Display: half-brother
Definition:
The player of the role is a male related to the scoping entity by sharing only one biological parent.


Code: CASM
Display: single minor asylum seeker
Definition:
A person who is someone of below legal age who has fled his or her home country, *without his or her parents*, to find a safe place elsewhere at time of categorization.


Code: DAUADOPT
Display: adopted daughter
Definition:
The player of the role is a female child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.


Code: SONADOPT
Display: adopted son
Definition:
The player of the role is a male child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.


Code: DAUFOST
Display: foster daughter
Definition:
The player of the role is a female child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.


Code: SONFOST
Display: foster son
Definition:
The player of the role is a male child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.


Code: CNRPM
Display: non-country member minor without residence permit
Definition:
A person who is below legal age present in a country, *without his or her parents*, (which is foreign to him/her) unlawfully or without the country's authorization.


Code: CSC
Display: community service center
Definition:
**Description:** A location that plays the role of delivering services which may include providing front-line services to the population of a defined geographic area such as: healthcare services and social services, preventive or curative, rehabilitation or reintegration.


Code: MCOUSN
Display: maternal cousin
Definition:
**Description:**The player of the role is a biological relative of the scoping person descended from a common ancestor on the player's mother's side, such as a grandparent, by two or more steps in a diverging line.


Code: PCOUSN
Display: paternal cousin
Definition:
**Description:**The player of the role is a biological relative of the scoping person descended from a common ancestor on the player's father's side, such as a grandparent, by two or more steps in a diverging line.


Code: CRPM
Display: non-country member minor with residence permit
Definition:
A person who is a resident below legal age of the country *without his or her parents* and does not have citizenship.


Code: COUSN
Display: cousin
Definition:
The player of the role is a relative of the scoping person descended from a common ancestor, such as a grandparent, by two or more steps in a diverging line.


Code: EXT
Display: extended family member
Definition:
**Description:** A family member not having an immediate genetic or legal relationship e.g. Aunt, cousin, great grandparent, grandchild, grandparent, niece, nephew or uncle.


Code: PRN
Display: parent
Definition:
The player of the role is one who begets, gives birth to, or nurtures and raises the scoping entity (child).


Code: FTHFOST
Display: foster father
Definition:
The player of the role (parent) who is a male state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary.

The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.


Code: STPFTH
Display: stepfather
Definition:
The player of the role is the husband of scoping person's mother and not the scoping person's natural father.


Code: FTWINBRO
Display: fraternal twin brother
Definition:
The scoper was carried in the same womb as the male player and shares common biological parents but is the product of a distinct egg/sperm pair.


Code: FTWINSIS
Display: fraternal twin sister
Definition:
The scoper was carried in the same womb as the female player and shares common biological parents but is the product of a distinct egg/sperm pair.


Code: GDF
Display: generic drug form
Definition:
Relates a manufactured drug product to the non-proprietary (generic) representation of its ingredients and dose form, independent of strength of the ingredients. The scoping entity identifies a unique combination of medicine ingredients in a specific dose form.


Code: GDS
Display: generic drug strength
Definition:
Relates a manufactured drug product to the non-proprietary (generic) representation of is ingredients with their strength. The scoping entity identifies a unique combination of medicine ingredients with their strength.


Code: MGGRFTH
Display: maternal great-grandfather
Definition:
**Description:**The player of the role is the biological father of the scoping person's biological mother's parent.


Code: PGGRFTH
Display: paternal great-grandfather
Definition:
**Description:**The player of the role is the biological father of the scoping person's biological father's parent.


Code: MGGRMTH
Display: maternal great-grandmother
Definition:
**Description:**The player of the role is the biological mother of the scoping person's biological mother's parent.


Code: PGGRMTH
Display: paternal great-grandmother
Definition:
**Description:**The player of the role is the biological mother of the scoping person's biological father's parent.


Code: MGGRPRN
Display: maternal great-grandparent
Definition:
**Description:**The player of the role is a biological parent of the scoping person's biological mother's parent.


Code: PGGRPRN
Display: paternal great-grandparent
Definition:
**Description:**The player of the role is a biological parent of the scoping person's biological father's parent.


Code: MGRFTH
Display: maternal grandfather
Definition:
**Description:**The player of the role is the biological father of the scoping person's biological mother.


Code: PGRFTH
Display: paternal grandfather
Definition:
**Description:**The player of the role is the biological father of the scoping person's biological father.


Code: MGRMTH
Display: maternal grandmother
Definition:
**Description:**The player of the role is the biological mother of the scoping person's biological mother.


Code: PGRMTH
Display: paternal grandmother
Definition:
**Description:**The player of the role is the biological mother of the scoping person's biological father.


Code: MGRPRN
Display: maternal grandparent
Definition:
**Description:**The player of the role is the biological parent of the scoping person's biological mother.


Code: PGRPRN
Display: paternal grandparent
Definition:
**Description:**The player of the role is the biological parent of the scoping person's biological father.


Code: INLAB
Display: inpatient laboratory
Definition:
**Description:** A location that plays the role of delivering services which may include tests are done on clinical specimens to get health information about a patient pertaining to the diagnosis, treatment, and prevention of disease for a hospital visit longer than one day.


Code: OUTLAB
Display: outpatient laboratory
Definition:
**Description:** A location that plays the role of delivering services which may include tests are done on clinical specimens to get health information about a patient pertaining to the diagnosis, treatment, and prevention of disease for same day visits.


Code: HSIS
Display: half-sister
Definition:
The player of the role is a female related to the scoping entity by sharing only one biological parent.


Code: HLAB
Display: hospital laboratory
Definition:
**Description:** A location that plays the role of delivering services which may include tests done based on clinical specimens to get health information about a patient as pertaining to the diagnosis, treatment and prevention of disease. Hospital laboratories may be further divided into specialized units such as Anatomic Pathology, Microbiology, and Biochemistry.


Code: HRAD
Display: radiology unit
Definition:
**Description:** A location that plays the role of delivering services which may include the branch of medicine that uses ionizing and non-ionizing radiation to diagnose and treat diseases. The radiology unit may be further divided into subspecialties such as Imaging, Cardiovascular, Thoracic, and Ultrasound.


Code: HUSCS
Display: specimen collection site
Definition:
**Description:** A location that plays the role of delivering services which may include collecting specimens and/or samples from patients for laboratory testing purposes, but does not perform any tests or analysis functions.


Code: INPHARM
Display: inpatient pharmacy
Definition:
**Description:** A location that plays the role of delivering services which may include providing judicious, safe, efficacious, appropriate and cost effective use of medicines for treatment of patients for visits longer than one day. The distinction between inpatient pharmacies and retail (or outpatient) pharmacies is that they are part of a patient's continuity of care while staying in the hospital.


Code: MBL
Display: medical laboratory
Definition:
**Description:** A location that plays the role of delivering services which include biochemistry, hematology, microbiology, immunochemistry, and toxicology.


Code: OUTPHARM
Display: outpatient pharmacy
Definition:
**Description:** A location that plays the role of delivering services which may include providing judicious, safe, efficacious, appropriate and cost effective use of medicines for treatment of patients for outpatient visits and may also be used for discharge prescriptions.


Code: ACTMIL
Display: active duty military
Definition:
**Description:** A person playing the role of program eligible under a program based on active military status.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as active duty military meets jurisdictional or program criteria.


Code: RETMIL
Display: retired military
Definition:
**Description:** A person playing the role of program eligible under a program based on retired military status.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as retired military meets jurisdictional or program criteria.


Code: VET
Display: veteran
Definition:
**Description:** A person playing the role of program eligible under a program based on status as a military veteran.

**Discussion:** This CoveredPartyRoleType.code is typically used when the CoveredPartyRole class code is either "program eligible" or "subscriber" and the persons status as a veteran meets jurisdictional or program criteria.


Code: GESTM
Display: gestational mother
Definition:
The player is a female whose womb carries the fetus of the scoper. Generally used when the gestational mother and natural mother are not the same.


Code: MTHFOST
Display: foster mother
Definition:
The player of the role (parent) who is a female state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary.

The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.


Code: STPMTH
Display: stepmother
Definition:
The player of the role is the wife of scoping person's father and not the scoping person's natural mother.


Code: NEPHEW
Display: nephew
Definition:
The player of the role is a son of the scoping person's brother or sister or of the brother or sister of the scoping person's spouse.


Code: NIECE
Display: niece
Definition:
The player of the role is a daughter of the scoping person's brother or sister or of the brother or sister of the scoping person's spouse.


Code: OPTC
Display: optometry clinic
Definition:
**Description:** A location that plays the role of delivering services which may include examination, diagnosis, treatment, management, and prevention of diseases and disorders of the eye as well as prescribing and fitting appropriate corrective lenses (glasses or contact lenses) as needed. Optometry clinics may also provide tests for visual field screening, measuring intra-ocular pressure and ophthalmoscopy, as and when required.


Code: PROFF
Display: Provider's Office
Definition:
Location where healthcare service was delivered, identified as the healthcare provider's practice office.


Code: DPOWATT
Display: durable power of attorney
Definition:
A relationship between two people in which one person authorizes another, usually a family member or relative, to act for him or her 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 that is often limited in the kinds of powers that can be assigned. Unlike ordinary powers of attorney, durable powers can survive for long periods of time, and again, unlike standard powers of attorney, durable powers can continue after incompetency.


Code: HPOWATT
Display: healthcare power of attorney
Definition:
A relationship between two people in which one person authorizes another to act for him or her 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 that continues (by its terms) to be effective even though the grantor has become mentally incompetent after signing the document.


Code: SPOWATT
Display: special power of attorney
Definition:
A relationship between two people in which one person authorizes another to act for him or her 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 that is often limited in the kinds of powers that can be assigned.


Code: ADOPTP
Display: adoptive parent
Definition:
The player of the role (parent) has taken the scoper (child) into their family through legal means and raises them as his or her own child.


Code: MTH
Display: mother
Definition:
The player of the role is a female who conceives, gives birth to, or raises and nurtures the scoping entity (child).


Code: PRNFOST
Display: foster parent
Definition:
The player of the role (parent) who is a state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary.

The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.


Code: B
Display: Blind
Definition:
Quality Control specimen submitted to the lab whose identity and composition is not known to the lab.


Code: F
Display: Filler Proficiency
Definition:
Specimen used for testing proficiency of an organization performing testing (how does this differ from O?)


Code: EXCEST
Display: executor of estate
Definition:
The role played by a person acting as the estate executor for a deceased subscriber or policyholder who was the responsible party


Code: GUADLTM
Display: guardian ad lidem
Definition:
The role played by a person appointed by the court to look out for the best interests of a minor child during the course of legal proceedings.


Code: GUARD
Display: guardian
Definition:
The role played by a person or institution legally empowered with responsibility for the care of a ward.


Code: RHAT
Display: addiction treatment center
Definition:
**Description:** A location that plays the role of delivering services which may include life training and/or social support to people with addictions.


Code: RHII
Display: intellectual impairment center
Definition:
**Description:** A location that plays the role of delivering services which may include adaptation, rehabilitation and social integration services for people with intellectual and/or pervasive development disorders such as autism or severe behaviour disorder.


Code: RHMAD
Display: parents with adjustment difficulties center
Definition:
**Description:** A location that plays the role of delivering services which may social support services for adolescents who are pregnant or have child and are experiencing adaptation issues/difficulties in their current or eventual parenting role.


Code: RHPI
Display: physical impairment center
Definition:
**Description:** A location that plays the role of delivering services which may include adaptation, rehabilitation and social integration services for people with physical impairments.


Code: RHYAD
Display: youths with adjustment difficulties center
Definition:
**Description:** A location that plays the role of delivering services which may include life training and/or social support services for the adaption, rehabilitation and social integration of youths with adjustment difficulties.


Code: RHPIH
Display: physical impairment - hearing center
Definition:
**Description:** A location that plays the role of delivering services for people with hearing impairments.


Code: RHPIMS
Display: physical impairment - motor skills center
Definition:
**Description:** A location that plays the role of delivering services for people with motor skill impairments.


Code: RHPIVS
Display: physical impairment - visual skills center
Definition:
**Description:** A location that plays the role of delivering services for people with visual skill impairments.


Code: BROINLAW
Display: brother-in-law
Definition:
The player of the role is: (1) a brother of the scoping person's spouse, or (2) the husband of the scoping person's sister, or (3) the husband of a sister of the scoping person's spouse.


Code: SISINLAW
Display: sister-in-law
Definition:
The player of the role is: (1) a sister of the scoping person's spouse, or (2) the wife of the scoping person's brother, or (3) the wife of a brother of the scoping person's spouse.


Code: FMRSPS
Display: former spouse
Definition:
Player of the role was previously joined to the scoping person in marriage and this marriage is now dissolved and inactive.

*Usage Note:* This is significant to indicate as some jurisdictions have different legal requirements for former spouse to access the patient's record, from a general friend.


Code: FSTUD
Display: full-time student
Definition:
Covered party to an insurance policy has coverage through full-time attendance at a recognized educational institution as defined by a particular insurance policy.


Code: PSTUD
Display: part-time student
Definition:
Covered party to an insurance policy has coverage through part-time attendance at a recognized educational institution as defined by a particular insurance policy.


Code: FTWIN
Display: fraternal twin
Definition:
The scoper and player were carried in the same womb and share common biological parents but are the product of distinct egg/sperm pairs.


Code: MUNCLE
Display: maternal uncle
Definition:
**Description:**The player of the role is a biological brother of the scoping person's biological mother.


Code: PUNCLE
Display: paternal uncle
Definition:
**Description:**The player of the role is a biological brother of the scoping person's biological father.


Code: NORMAL
Display: normal
Definition:
**Description:** The 'typical' state. Excludes "nullified" which represents the termination state of a RoleLink instance that was created in error.


Code: CANCELLED
Display: cancelled
Definition:
**Description:** The terminal state resulting from abandoning the RoleLink prior to or after activation.


Code: NULLIFIED
Display: nullified
Definition:
**Description:** The state representing the termination of a RoleLink instance that was created in error.


Code: CONT
Display: has contact
Definition:
This relationship indicates the target Role provides or receives information regarding the target role. For example, AssignedEntity is a contact for a ServiceDeliveryLocation.


Code: IDENT
Display: Identification
Definition:
**Description:** The source role provides identification for the target role. The source role must be IDENT. The player entity of the source role is constrained to be the same as (i.e. the equivalent of, or equal to) the player of the target role if present. If the player is absent from the source role, then it is assumed to be the same as the player of the target role.


Code: H
Display: convex hull
Definition:
Form the convex hull with the value. The convex hull is defined over ordered domains and is the smallest contiguous superset (interval) that of all the operand sets.


Code: P
Display: periodic hull
Definition:
Form the periodic hull with the value. The periodic hull is defined over ordered domains and is the periodic set that contains all contiguous supersets of pairs of intervals generated by the operand periodic intervals.


Code: NOTIFY
Display: Notify first
Definition:
Notification to the Contact Person, prior to substitution and through normal institutional procedures, has or will be made.


Code: voice
Display: voice
Definition:
**Description:** This device can receive voice calls (i.e. talking to another person, or a recording device, or a voice activated computer).


Code: HS
Display: HS
Definition:
**Description:** Prior to beginning a regular period of extended sleep (this would exclude naps). Note that this might occur at different times of day depending on a person's regular sleep schedule.


Code: WAKE
Display: WAKE
Definition:
**Description:** Upon waking up from a regular period of sleep, in order to start regular activities (this would exclude waking up from a nap or temporarily waking up during a period of sleep)

**Usage Notes:** e.g.

Take pulse rate on waking in management of thyrotoxicosis.

Take BP on waking in management of hypertension

Take basal body temperature on waking in establishing date of ovulation


Code: SEQL
Display: sequence
Definition:
**Description:**A transmission relationship indicating that the source transmission follows the target transmission.


Code: 512
Display:
Pribilof Islands Aleut Communities of St. Paul & St. George Islands (Saint George Island and Saint Paul Island)


Code: 12
Display:
Bad River Band of the Lake Superior Tribe of Chippewa Indians of the Bad River Reservation, Wisconsin


Code: 26
Display:
Cachil DeHe Band of Wintun Indians of the Colusa Indian Community of the Colusa Rancheria, California


Code: 32
Display: Capitan Grande Band of Diegueno Mission Indians of California
Definition:
Capitan Grande Band of Diegueno Mission Indians of California (Barona Group of Capitan Grande Band of Mission Indians of the Barona Reservation, California; Viejas (Baron Long) Group of Capitan Grande Band of Mission Indians of the Viejas Reservation, California)


Code: 88
Display:
Fort Independence Indian Community of Paiute Indians of the Fort Independence Reservation, California


Code: 89
Display:
Fort McDermitt Paiute and Shoshone Tribes of the Fort McDermitt Indian Reservation, Nevada and Oregon


Code: 134
Display:
Lac du Flambeau Band of Lake Superior Chippewa Indians of the Lac du Flambeau Reservation of Wisconsin


Code: 159
Display:
Minnesota Chippewa Tribe, Minnesota (Six component reservations: Bois Forte Band (Nett Lake); Fond du Lac Band; Grand Portage Band; Leech Lake Band; Mille Lacs Band; White Earth Band)


Code: 185
Display:
Paiute Indian Tribe of Utah (Cedar Band of Paiutes, Kanosh Band of Paiutes, Koosharem Band of Paiutes, Indian Peaks Band of Paiutes, and Shivwits Band of Paiutes)


Code: 200
Display:
Pit River Tribe, California (includes XL Ranch, Big Bend, Likely, Lookout, Montgomery Creek, and Roaring Creek Rancherias)


Code: 299
Display:
Te-Moak Tribe of Western Shoshone Indians of Nevada (Four constituent bands: Battle Mountain Band; Elko Band; South Fork Band; and Wells Band)


Code: 324
Display:
Washoe Tribe of Nevada & California (Carson Colony, Dresslerville Colony, Woodfords Community, Stewart Community, & Washoe Ranches)


Code: cid
Display: Content ID
Definition:
**Description:** cid: is the most common mechanism used in webservices. A cid: reference points from the SOAP body to other content in the mime package in which the SOAP envelope is wrapped


Code: file
Display: File
Definition:
Host-specific local file names \[RCF 1738\]. Note that the file scheme works only for local files. There is little use for exchanging local file names between systems, since the receiving system likely will not be able to access the file.


Code: hl7-att
Display: HL7 Attachment
Definition:
**Description:** A reference to an HL7 attachment by it's identifier, which takes the form hl7-att:\[II.literal\], such as hl7-att:2.1.16.3.9.12345.2.39.3:ABC123


Code: mllp
Display: MLLP
Definition:
**Description:** Mimimal Lower Layer Protocol. See Transport Specification: MLLP, Release 2 (HL7 V3 Transport specification).


Code: nfs
Display: NFS
Definition:
Network File System protocol \[RFC 2224\]. Some sites use NFS servers to share data files.

http://www.ietf.org/rfc/rfc2224.txt


Code: tel
Display: Telephone
Definition:
A voice telephone number \[http://www.ietf.org/rfc/rfc3966.txt and http://www.ietf.org/rfc/rfc2806.txt\].


Code: telnet
Display: Telnet
Definition:
Reference to interactive sessions \[RFC 1738\]. Some sites, (e.g., laboratories) have TTY based remote query sessions that can be accessed through telnet.

http://www.ietf.org/rfc/rfc1738.txt


Code: fax
Display: Fax
Definition:
A telephone number served by a fax device \[http://www.ietf.org/rfc/rfc3966.txt and http://www.ietf.org/rfc/rfc2806.txt\].


Code: modem
Display: Modem
Definition:
A telephone number served by a modem device \[http://www.ietf.org/rfc/rfc3966.txt and http://www.ietf.org/rfc/rfc2806.txt\].


Code: x-text-fax
Display: Fax
Definition:
**Description:** A telephone number served by a fax device \[http://www.ietf.org/rfc/rfc3966.txt and http://www.ietf.org/rfc/rfc2806.txt\]


Code: x-text-tel
Display: Text Telephone
Definition:
**Description:** A text telephone - a telephone which is designed for use by the hearing-impaired

**Notes:**

 *  x-text-fax is required to replace fax, since this has been deprecated by W3C.
 *  hl7-att is associated with a series of rules that must be followed. These rules are documented in Datatypes R2
 *  This domain is external and extensible, so documenting this simply clarifies consistent usage for these use cases.


Code: PMC
Display:
Aventis Pasteur Inc. (formerly Pasteur Merieux Connaught; includes Connaught Laboratories and Pasteur Merieux)

Definition:
Aventis Pasteur Inc. (formerly Pasteur Merieux Connaught; includes Connaught Laboratories and Pasteur Merieux)


Code: WAL
Display:
Wyeth-Ayerst (includes Wyeth-Lederle Vaccines and Pediatrics, Wyeth Laboratories, Lederle Laboratories, and Praxis Biologics)

Definition:
Wyeth-Ayerst (includes Wyeth-Lederle Vaccines and Pediatrics, Wyeth Laboratories, Lederle Laboratories, and Praxis Biologics)


Code: PWFG
Display: Paid work, national government, not armed forces
Definition:
A situation in which an individual works for a national government organization, not including armed forces, and receives a paid salary or wage.


Code: PWLG
Display: Paid work, local government, not armed forces
Definition:
A situation in which an individual works for a government organization with jurisdiction below the level of state/provincial/territorial/tribal government (e.g., city, town, township), not armed forces, and receives a paid salary or wage.


Code: PWNSE
Display: Paid non-governmental work, not self-employed
Definition:
A situation in which an individual works for a business (not government) that they do not own and receives a paid salary or wage.


Code: PWSE
Display: Paid work, self-employed
Definition:
A situation in which an individual earns a salary or wage working for himself or herself instead of working for an employer.


Code: PWSG
Display: Paid work, state government, not armed forces
Definition:
A situation in which an individual works for a government organization with jurisdiction immediately below the level of national government (between national government and local government), not armed forces and receives a paid salary or wage. Often called a state, provincial, territorial, or tribal government.


Code: UWNSE
Display: Unpaid non-governmental work, not self-employed
Definition:
A situation in which an individual works for a business (not government) that they do not own without receiving a paid salary or wage.


Code: UWSE
Display: Unpaid work, self-employed
Definition:
A situation in which an individual works for himself or herself without receiving a paid salary or wage.


Code: VW
Display: Volunteer work (20 or more hours/week and not Disaster Response/ First Responder)
Definition:
A situation in which an individual chooses to do something, especially for other people or for an organization, willingly and without being forced or compensated to do it. This can include formal activity undertaken through public, private and voluntary organizations as well as informal community participation.


Code: VWDR
Display: Voluntary Disaster Response/First Responder
Definition:
A situation in which an individual chooses to donate their time to perform activities (work) in disaster response or as a first responder, without being forced and with no expectation of compensation. This can include formal activity undertaken through a government agency or a public or private organization, as well as informal community participation.


Code: affd
Display: affiliate ballot - DSTU
Definition:
**Description:** Content that is being presented to an international affiliate for consideration as a realm-specific draft standard for trial use.


Code: affi
Display: affiliate ballot - informative
Definition:
**Description:** Content that is being presented to an international affiliate for consideration as a realm-specific informative standard.


Code: affn
Display: affiliate ballot - normative
Definition:
**Description:** Content that is being presented to an international affiliate for consideration as a realm-specific normative standard.


Code: comi
Display: committee ballot - informative
Definition:
**Description:** Content prepared by a committee and submitted for internal consideration as an informative standard.

***Deprecation Comment*** No longer supported as ballot statuses within the HL7 Governance and Operations Manual. Use normative or informative variants instead.


Code: loc
Display: localized adaptation
Definition:
**Description:** Content that represents an adaption of a implementable balloted material to represent the needs or capabilities of a particular installation.


Code: memd
Display: membership ballot - DSTU
Definition:
**Description:** Content prepared by a committee and submitted for membership consideration as a draft standard for trial use.


Code: memi
Display: membership ballot - informative
Definition:
**Description:** Content prepared by a committee and submitted for membership consideration as an informative standard.


Code: memn
Display: membership ballot - normative
Definition:
**Description:** Content prepared by a committee and submitted for membership consideration as a normative standard.


Code: ns
Display: non-standard - available for use
Definition:
**Description:** Content developed independently by an organization or individual that is declared to be 'usable' but for which there is no present intention to submit through the standards submission and review process.


Code: prop
Display: proposal
Definition:
**Description:** Content submitted to a committee for consideration for future inclusion in the standard.


Code: ref
Display: reference
Definition:
**Description:** Content intended to support other content that is subject to approval, but which is not itself subject to formal approval.


Code: wd
Display: withdrawn
Definition:
**Description:** Content that represents an item that was at one point a normative or informative standard, but was subsequently withdrawn.


Code: contact
Display: contact
Definition:
**Description:** Provides sufficient information to allow the object identified to be contacted. This is likely to have the content of identified and confirmable plus telephone number.


Code: identified
Display: identified
Definition:
**Description:** This variant is a proper subset of universal and is intended to provide sufficient information to identify the object(s) modeled by the CMET. This variant is only suitable for use within TIGHTLY COUPLED SYSTEMS ONLY. This variant provides ONLY the ID (and code where applicable) and Name. Other variants may not be substituted at runtime.


Code: identified-confirmable
Display: identified-confirmable
Definition:
**Description:** This extends the identified variant by adding just sufficient additional information to allow the identity of object modeled to be confirmed by a number of corroborating items of data; for instance a patient's date of birth and current address. However, specific contact information, such as telephone number, are not viewed as confirming information.


Code: identified-informational
Display: identified-informational
Definition:
**Description:** Generally the same information content as "contactable" but using new "informational" CMETs as dependant CMETs. This flavor allows expression of the CMET when non-focal class information is not known.


Code: informational
Display: informational
Definition:
**Description:** Generally the same information content as "contactable", but with required (not mandatory) ids on entry point class. This flavor allows expression of the CMET even when mandatory information is not known.


Code: minimal
Display: minimal
Definition:
**Description:** Provides more than identified, but not as much as universal. There are not expected to be many of these.


Code: universal
Display: universal
Definition:
**Description:** This variant includes all attributes and associations present in the R-MIM. Any of non-mandatory and non-required attributes and/or associations may be present or absent, as permitted in the cardinality constraints.


Code: AB
Display: accounting & billing
Definition:
**Description:** Represents the HL7 content "domain" that supports accounting and billing functions - and "provides support for the creation and management of patient billing accounts and the post of financial transactions against patient billing accounts for the purpose of aggregating financial transactions that will be submitted as claims or invoices for reimbursemen"

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: AI
Display: trigger event control act infrastructure
Definition:
**Description:** Represents the HL7 content "domain" that supports trigger event control act infrastructure - and "covers the alternate structures of the message Trigger Event Control Acts in the HL7 Composite Message."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: AL
Display: artificial listing for test purposes - faux Domain for testing
Definition:
**Description:** Represents the HL7 content "domain" that was defined as an "artificial listing" domain to support publication testing.


Code: BB
Display: blood tissue and organ
Definition:
**Description:** Represents the HL7 content "domain" that supports blood tissue and organ domain - and "comprises the models, messages, and other artIfacts that are needed to support messaging related to the process of blood, tissue, and organ banking operations such as donations, eligibility, storage, dispense, administration/transfusion, explantation, and implantation. "

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CD
Display: clinical document architecture
Definition:
**Description:** Represents the HL7 content "domain" that supports the clinical document architecture.

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CG
Display: clinical genomics
Definition:
**Description:** Represents the HL7 content "domain" that supports clinical genomics - and includes " standards to enable the exchange of interrelated clinical and personalized genomic data between interested parties."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CI
Display: transmission infrastructure
Definition:
**Description:** Represents the HL7 content "domain" that supports transmission infrastructure - and " is primarily concerned with the data content of exchanges between healthcare applications, the sequence or interrelationships in the flow of messages and the communication of significant application level exceptions or error conditions."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CO
Display: coverage
Definition:
**Description:** Represents the HL7 content "domain" that supports Coverage - and provides support for managing health care coverage in the reimbursement system(s).

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CP
Display: common product model
Definition:
**Description:** Represents the HL7 content "domain" that supports the common product model - which "is used to improve the alignment between the different representations of products used within the body of HL7 Version 3 models."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CR
Display: claims and reimbursement
Definition:
**Description:** Represents the HL7 content "domain" that supports Claims and Reimbursement - and "provides support for Generic, Pharmacy, Preferred Accommodation, Physician, Oral Health Vision Care and Hospital claims for eligibility, authorization, coverage extension, pre-determination, invoice adjudication, payment advice and Statement of Financial Activity (SOFA) Release 3 of this document adds claims messaging support for Physician, Oral Health Vision Care and Hospital claims."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CS
Display: clinical statement
Definition:
**Description:** Represents the HL7 content "domain" that supports a common clinical statement pattern - and "is a 'pattern' designed to be used within multiple HL7 Version 3 domain models. This pattern is intended to facilitate the consistent design of communications that convey clinical information to meet specific use cases."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: CT
Display: common types
Definition:
**Description:** Represents the HL7 content "domain" that supports common model types - and "are a work product produced by a particular committee for expressing a common, useful and reusable concept."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: DD
Display: dummy domain
Definition:
**Description:** Represents the HL7 content "domain" that was created to support testing and initial set-up functions.


Code: DS
Display: decision support
Definition:
**Description:** Represents the HL7 content "domain" that provides decision support.

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: EM
Display: emergency medical services
Definition:
**Description:** Represents the HL7 content "domain" that supports Emergency Medical Services.

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: II
Display: imaging integration
Definition:
**Description:** Represents the HL7 content "domain" that supports imaging integration - and is "comprises the models, implementation guides, sample documents and images that are needed to illustrate the transformation of DICOM structured reports to CDA Release 2 as well as the creation of CDA diagnostic imaging reports."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: IZ
Display: immunization
Definition:
**Description:** Represents the HL7 content "domain" that supports immunization - and "describes communication of information about immunization: the administration of vaccines (and/or antisera) to individuals to prevent infectious disease."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: LB
Display: laboratory
Definition:
**Description:** Represents the HL7 content "domain" that supports clinical laboratory functions - and is "comprises the models, messages, and other artifacts that are needed to support messaging related to laboratory tests or observations. "

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: ME
Display: medication
Definition:
**Description:** Represents the HL7 content "domain" that supports medication - and "deals with the description of a medicine for the purposes of messaging information about medicines" and the applications of these descriptions.

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: MI
Display: masterfile infrastructure
Definition:
**Description:** Represents the HL7 content "domain" that supports master file infrastructure - and is "comprises the classes and attributes needed to support Master Files and Registries."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: MM
Display: materials management
Definition:
**Description:** Represents the HL7 content "domain" that supports Materials Management - and is "supports the simple scenario of a Materials Management application sending requests, notifications and queries to an auxiliary application. The intent is to establish a standard for the minimum functionality that is useful and comprehensive enough to explore the important concepts relative to inventory management."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: MR
Display: medical records
Definition:
**Description:** Represents the HL7 content "domain" that supports medical records - and is "supports clinical document management, and document querying."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: MT
Display: shared messages
Definition:
**Description:** Represents the HL7 content "domain" that supports shared messages - and "are a work product produced for expressing common, useful and reusable message types."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: OB
Display: observations
Definition:
**Description:** Represents the HL7 content "domain" that supports observations - and is "comprises the models, messages, and other artifacts that are needed to support messaging related to resulting basic healthcare diagnostic services. "

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: OO
Display: orders & observations
Definition:
**Description:** Represents the HL7 content "domain" that supports orders and observations - and will provide over-arching support information for the "Orders" (OR) and "Observations" (OB) domains.

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: OR
Display: orders
Definition:
**Description:** Represents the HL7 content "domain" that supports orders - and "comprises the models, messages, and other artifacts that are needed to support messaging related to ordering basic healthcare services."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: PA
Display: patient administration
Definition:
**Description:** Represents the HL7 content "domain" that supports Patient Administration - and "defines person and patient demographics and visit information about patients"

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: PC
Display: care provision
Definition:
**Description:** Represents the HL7 content "domain" that supports Care Provision - and "addresses the information that is needed for the ongoing care of individuals, populations, and other targets of care."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: PH
Display: public health
Definition:
**Description:** Represents the HL7 content "domain" that supports public health - and is "the source of a number of Common Model Element Types (CMET) designed to meet the needs of public health data exchange."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: PM
Display: personnel management
Definition:
**Description:** Represents the HL7 content "domain" that supports Personnel Management - and "spans a variety of clinical-administrative information functions associated with the organizations, individuals, animals and devices involved in the delivery and support of healthcare services."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: QI
Display: query infrastructure
Definition:
**Description:** Represents the HL7 content "domain" that supports query infrastructure - and "specifies the formation of information queries and the responses to these queries to meet the needs of healthcare applications using the HL7 version 3 messaging standard."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: QM
Display: quality measures
Definition:
**Description:** Represents the HL7 content "domain" that supports Quality Measures - and "is a standard for representing a health quality measure as an electronic document."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: RG
Display: registries
Definition:
**Description:** Represents the HL7 content "domain" that supports Registries - and "collects HL7 artifacts for administrative registries."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: RI
Display: informative public health
Definition:
**Description:** Represents the HL7 content "domain" that supports Informative Public Health.

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: RP
Display: regulated products
Definition:
**Description:** Represents the HL7 content "domain" that supports Regulated Products - and "includes standards developed as part of the family of messages targeted for the exchange of information about regulated products and the exchange of the data needed to provide approval for such products."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: RR
Display: public health reporting
Definition:
**Description:** Represents the HL7 content "domain" that supports Public Health Reporting - and "includes messages and documents that are specifically designed to support managment, reporting and investigation in the public health context."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: RT
Display: regulated studies
Definition:
**Description:** Represents the HL7 content "domain" that supports Regulated Studies - and is "includes standards developed as part of the family of messages targeted for the exchange of information about the conduct of regulated studies, and the exchange of the data collected during those studies."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


Code: RX
Display: pharmacy
Definition:
**Description:** Represents the HL7 content "domain" that supports pharmacy - and is a "model used to derive message patterns to describe and communicate processes related to medication."

*UsageNote:* V3 Specifications are published in a set of "domains", which contain interactions and related specifications for a single area of health care within which can be supported by a single, coherent set of interoperability specifications.


