# text.div
Generated Narrative: CodeSystem v3-ActCode

Language: en

Properties

This code system defines the following properties for its concepts

Name | Code | URI | Type | Description
Concept Domain that classifies a RIM Class Code | rim-ClassifiesClassCode | http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-ClassifiesClassCode | Coding | The child code is a classification of the particular class group identified by the 'classCode' in a RIM class as the parent code. Used only in RIM backbone classes to link the code and classCode values.
Status | status | http://hl7.org/fhir/concept-properties#status | code | A property that indicates the status of the concept. One of active, experimental, deprecated, or retired.
Deprecation Date | deprecationDate | http://hl7.org/fhir/concept-properties#deprecationDate | dateTime | The date at which a concept was deprecated. Concepts that are deprecated but not inactive can still be used, but their use is discouraged.
Not Selectable | notSelectable | http://hl7.org/fhir/concept-properties#notSelectable | boolean | Indicates that the code is abstract - only intended to be used as a selector for other concepts
HL7 Concept Usage Notes | HL7usageNotes | http://terminology.hl7.org/CodeSystem/utg-concept-properties#HL7usageNotes | string | HL7 Concept Usage Notes
Synonym | synonymCode | http://hl7.org/fhir/concept-properties#synonym | code | An additional concept code that was also attributed to a concept
Parent | subsumedBy | http://hl7.org/fhir/concept-properties#parent | code | The concept code of a parent concept

Concepts

This case-sensitive code system http://terminology.hl7.org/CodeSystem/v3-ActCode defines the following codes in a Is-A hierarchy:

Lvl | Code | Display | Definition | Concept Domain that classifies a RIM Class Code | Status | Not Selectable | HL7 Concept Usage Notes | Synonym | Parent

1

_ActAccountCode

ActAccountCode

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

account

active

true

2

ACCTRECEIVABLE

account receivable

An account for collecting charges, reversals, adjustments and payments, including deductibles, copayments, coinsurance (financial transactions) credited or debited to the account receivable account for a patient's encounter.

active

_ActAccountCode

2 | CASH | Cash | | | active | | | | _ActAccountCode

2

CC

credit card

Description: Types of advance payment to be made on a plastic card usually issued by a financial institution used of purchasing services and/or products.

active

_ActAccountCode

3 | AE | American Express | | | active | | | | CC
3 | DN | Diner's Club | | | active | | | | CC
3 | DV | Discover Card | | | active | | | | CC
3 | MC | Master Card | | | active | | | | CC
3 | V | Visa | | | active | | | | CC

2

PBILLACCT

patient billing account

An account representing charges and credits (financial transactions) for a patient's encounter.

active

_ActAccountCode

2 | _CreditCard | CreditCard | | | retired | true | | | _ActAccountCode

1

_ActAdjudicationCode

ActAdjudicationCode

Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

financial adjudication

active

true

2

_ActAdjudicationGroupCode

ActAdjudicationGroupCode

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

financial adjudication

active

true

_ActAdjudicationCode

3

CONT

contract

Transaction counts and value totals by Contract Identifier.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

DAY

day

Transaction counts and value totals for each calendar day within the date range specified.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

LOC

location

Transaction counts and value totals by service location (e.g clinic).

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

MONTH

month

Transaction counts and value totals for each calendar month within the date range specified.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

PERIOD

period

Transaction counts and value totals for the date range specified.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

PROV

provider

Transaction counts and value totals by Provider Identifier.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

WEEK

week

Transaction counts and value totals for each calendar week within the date range specified.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

3

YEAR

year

Transaction counts and value totals for each calendar year within the date range specified.

active

_ActAdjudicationGroupCode, _ActInvoiceAdjudicationPaymentSummaryCode

2

AA

adjudicated with adjustments

The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges).

Also includes the concept 'Adjudicate as zero' and items not covered under a particular Policy.

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

active

_ActAdjudicationCode

3

ANF

adjudicated with adjustments and no financial impact

The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges) without changing the amount.

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

active

AA

2

AR

adjudicated as refused

The invoice element has passed through the adjudication process but payment is refused due to one or more reasons.

Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late').

If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected.

A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer.

Invoice element cannot be reversed (nullified) as there is nothing to reverse.

Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting).

active

_ActAdjudicationCode

2

AS

adjudicated as submitted

The invoice element was/will be paid exactly as submitted, without financial adjustment(s).

If the dollar amount stays the same, but the billing codes have been amended or financial adjustments have been applied through the adjudication process, the invoice element is treated as "Adjudicated with Adjustment".

If information items are included in the adjudication results that do not affect the monetary amounts paid, then this is still Adjudicated as Submitted (e.g. 'reached Plan Maximum on this Claim').

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

active

_ActAdjudicationCode

1

_ActAdjudicationResultActionCode

ActAdjudicationResultActionCode

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

active

true

2

DISPLAY

Display

The adjudication result associated is to be displayed to the receiver of the adjudication result.

active

_ActAdjudicationResultActionCode

2

FORM

Print on Form

The adjudication result associated is to be printed on the specified form, which is then provided to the covered party.

active

_ActAdjudicationResultActionCode

1

_ActBillableModifierCode

ActBillableModifierCode

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

active

true

2

CPTM

CPT modifier codes

**Description:**CPT modifier codes are found in Appendix A of CPT 2000 Standard Edition.

active

_ActBillableModifierCode

2

HCPCSA

HCPCS Level II and Carrier-assigned

**Description:**HCPCS Level II (HCFA-assigned) and Carrier-assigned (Level III) modifiers are reported in Appendix A of CPT 2000 Standard Edition and in the Medicare Bulletin.

active

_ActBillableModifierCode

1

_ActBillingArrangementCode

ActBillingArrangementCode

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

active

true

2

BLK

block funding

A billing arrangement where a Provider charges a lump sum to provide a prescribed group (volume) of services to a single patient which occur over a period of time. Services included in the block may vary.

This billing arrangement is also known as Program of Care for some specific Payors and Program Fees for other Payors.

active

_ActBillingArrangementCode

2

CAP

capitation funding

A billing arrangement where the payment made to a Provider is determined by analyzing one or more demographic attributes about the persons/patients who are enrolled with the Provider (in their practice).

active

_ActBillingArrangementCode

2

CONTF

contract funding

A billing arrangement where a Provider charges a lump sum to provide a particular volume of one or more interventions/procedures or groups of interventions/procedures.

active

_ActBillingArrangementCode

2

FINBILL

financial

A billing arrangement where a Provider charges for non-clinical items. This includes interest in arrears, mileage, etc. Clinical content is not included in Invoices submitted with this type of billing arrangement.

active

_ActBillingArrangementCode

2

ROST

roster funding

A billing arrangement where funding is based on a list of individuals registered as patients of the Provider.

active

_ActBillingArrangementCode

2

SESS

sessional funding

A billing arrangement where a Provider charges a sum to provide a group (volume) of interventions/procedures to one or more patients within a defined period of time, typically on the same date. Interventions/procedures included in the session may vary.

active

_ActBillingArrangementCode

2

FFS

fee for service

A billing arrangement where a Provider charges a separate fee for each intervention/procedure/event or product.

Fee for Service is used when an individual intervention/procedure/event is used for billing purposes. In other words, fees are associated with the intervention/procedure/event. For example, a specific CCI (Canadian Classification of Interventions) code has an associated fee and is used for billing purposes.

retired

_ActBillingArrangementCode, FF

3

FFPS

first fill, part fill, partial strength

A first fill 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 also 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)

active

FF, FFS, FFSS

3

FFCS

first fill complete, partial strength

A first fill 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 also 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).

active

FFC, FFS, FFSS

3

TFS

trial fill partial strength

A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance and also 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).

active

FFS, FFSS, TF

1

_ActBoundedROICode

ActBoundedROICode

Type of bounded ROI.

bounded ROI

active

true

2

ROIFS

fully specified ROI

A fully specified bounded Region of Interest (ROI) delineates a ROI in which only those dimensions participate that are specified by boundary criteria, whereas all other dimensions are excluded. For example a ROI to mark an episode of "ST elevation" in a subset of the EKG leads V2, V3, and V4 would include 4 boundaries, one each for time, V2, V3, and V4.

active

_ActBoundedROICode

2

ROIPS

partially specified ROI

A partially specified bounded Region of Interest (ROI) specifies a ROI in which at least all values in the dimensions specified by the boundary criteria participate. For example, if an episode of ventricular fibrillations (VFib) is observed, it usually doesn't make sense to exclude any EKG leads from the observation and the partially specified ROI would contain only one boundary for time indicating the time interval where VFib was observed.

active

_ActBoundedROICode

1

_ActCareProvisionCode

act care provision

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

care provision

active

true

2

_ActCredentialedCareCode

act credentialed care

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by a credentialing agency, i.e. government or non-government agency. Failure in executing this Act may result in loss of credential to the person or organization who participates as performer of the Act. Excludes employment agreements.

**Example:**Hospital license; physician license; clinic accreditation.

care provision

active

true

_ActCareProvisionCode

3

_ActCredentialedCareProvisionPersonCode

act credentialed care provision peron

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing individuals.

care provision

active

true

_ActCredentialedCareCode

4

CACC

certified anatomic pathology and clinical pathology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CAIC

certified allergy and immunology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CAMC

certified aerospace medicine care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CANC

certified anesthesiology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CAPC

certified anatomic pathology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CBGC

certified clinical biochemical genetics care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CCCC

certified clinical cytogenetics care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CCGC

certified clinical genetics (M.D.) care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CCPC

certified clinical pathology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CCSC

certified colon and rectal surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CDEC

certified dermatology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CDRC

certified diagnostic radiology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CEMC

certified emergency medicine care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CFPC

certified family practice care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CIMC

certified internal medicine care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CMGC

certified clinical molecular genetics care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CNEC

certified neurology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board

active

_ActCredentialedCareProvisionPersonCode

4

CNMC

certified nuclear medicine care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CNQC

certified neurology with special qualifications in child neurology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CNSC

certified neurological surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

COGC

certified obstetrics and gynecology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

COMC

certified occupational medicine care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

COPC

certified ophthalmology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

COSC

certified orthopaedic surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

COTC

certified otolaryngology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CPEC

certified pediatrics care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CPGC

certified Ph.D. medical genetics care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CPHC

certified public health and general preventive medicine care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CPRC

certified physical medicine and rehabilitation care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CPSC

certified plastic surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CPYC

certified psychiatry care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CROC

certified radiation oncology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CRPC

certified radiological physics care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CSUC

certified surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CTSC

certified thoracic surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CURC

certified urology care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

CVSC

certified vascular surgery care

**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

active

_ActCredentialedCareProvisionPersonCode

4

LGPC

licensed general physician care

**Description:**Scope of responsibility taken-on for physician care of a patient as defined by a governmental licensing agency.

active

_ActCredentialedCareProvisionPersonCode

3

_ActCredentialedCareProvisionProgramCode

act credentialed care provision program

**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing programs within organizations.

care provision

active

true

_ActCredentialedCareCode

4

AALC

accredited assisted living care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

AAMC

accredited ambulatory care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

ABHC

accredited behavioral health care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

ACAC

accredited critical access hospital care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

ACHC

accredited hospital care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

AHOC

accredited home care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

ALTC

accredited long term care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

AOSC

accredited office-based surgery care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

active

_ActCredentialedCareProvisionProgramCode

4

CACS

certified acute coronary syndrome care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CAMI

certified acute myocardial infarction care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CAST

certified asthma care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CBAR

certified bariatric surgery care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CCAD

certified coronary artery disease care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CCAR

certified cardiac care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CDEP

certified depression care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CDGD

certified digestive/gastrointestinal disorders care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CDIA

certified diabetes care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CEPI

certified epilepsy care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CFEL

certified frail elderly care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CHFC

certified heart failure care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CHRO

certified high risk obstetrics care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CHYP

certified hyperlipidemia care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CMIH

certified migraine headache care

Description:.

active

_ActCredentialedCareProvisionProgramCode

4

CMSC

certified multiple sclerosis care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

COJR

certified orthopedic joint replacement care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CONC

certified oncology care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

COPD

certified chronic obstructive pulmonary disease care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CORT

certified organ transplant care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CPAD

certified parkinsons disease care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CPND

certified pneumonia disease care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CPST

certified primary stroke center care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CSDM

certified stroke disease management care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CSIC

certified sickle cell care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CSLD

certified sleep disorders care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CSPT

certified spine treatment care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CTBU

certified trauma/burn center care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CVDC

certified vascular diseases care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CWMA

certified wound management care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

4

CWOH

certified women's health care

**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

active

_ActCredentialedCareProvisionProgramCode

2

_ActEncounterCode

ActEncounterCode

Domain provides codes that qualify the ActEncounterClass (ENC)

encounter

active

true

_ActCareProvisionCode

3

AMB

ambulatory

A comprehensive term for health care provided in a healthcare facility (e.g. a practitioneraTMs office, clinic setting, or hospital) on a nonresident basis. The term ambulatory usually implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter.

active

_ActEncounterCode

3

EMER

emergency

A patient encounter that takes place at a dedicated healthcare service delivery location where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an inpatient or transferred to another facility.)

active

_ActEncounterCode

3

FLD

field

A patient encounter that takes place both outside a dedicated service delivery location and outside a patient's residence. Example locations might include an accident site and at a supermarket.

active

_ActEncounterCode

3

HH

home health

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

active

_ActEncounterCode

3

IMP

inpatient encounter

A patient encounter where a patient is admitted by a hospital or equivalent facility, assigned to a location where patients generally stay at least overnight and provided with room, board, and continuous nursing service.

active

_ActEncounterCode

4

ACUTE

inpatient acute

An acute inpatient encounter.

active

IMP

4

NONAC

inpatient non-acute

Any category of inpatient encounter except 'acute'

active

IMP

3

OBSENC

observation encounter

An encounter where the patient usually will start in different encounter, such as one in the emergency department (EMER) but then transition to this type of encounter because they require a significant period of treatment and monitoring to determine whether or not their condition warrants an inpatient admission or discharge. In the majority of cases the decision about admission or discharge will occur within a time period determined by local, regional or national regulation, often between 24 and 48 hours.

active

_ActEncounterCode

3

PRENC

pre-admission

A patient encounter where patient is scheduled or planned to receive service delivery in the future, and the patient is given a pre-admission account number. When the patient comes back for subsequent service, the pre-admission encounter is selected and is encapsulated into the service registration, and a new account number is generated.

Usage Note: This is intended to be used in advance of encounter types such as ambulatory, inpatient encounter, virtual, etc.

active

_ActEncounterCode

3

SS

short stay

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

active

_ActEncounterCode

3

VR

virtual

A patient encounter where the patient and the practitioner(s) are not in the same physical location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference.

active

_ActEncounterCode

2

_ActMedicalServiceCode

ActMedicalServiceCode

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

active

true

_ActCareProvisionCode

3

ALC

Alternative Level of Care

Provision of Alternate Level of Care to a patient in an acute bed. Patient is waiting for placement in a long-term care facility and is unable to return home.

active

_ActMedicalServiceCode

3

CARD

Cardiology

Provision of diagnosis and treatment of diseases and disorders affecting the heart

active

_ActMedicalServiceCode

3

CHR

Chronic

Provision of recurring care for chronic illness.

active

_ActMedicalServiceCode

3

DNTL

Dental

Provision of treatment for oral health and/or dental surgery.

active

_ActMedicalServiceCode

3

DRGRHB

Drug Rehab

Provision of treatment for drug abuse.

active

_ActMedicalServiceCode

3

GENRL

General

General care performed by a general practitioner or family doctor as a responsible provider for a patient.

active

_ActMedicalServiceCode

3

MED

Medical

Provision of diagnostic and/or therapeutic treatment.

active

_ActMedicalServiceCode

3

OBS

Obstetrics

Provision of care of women during pregnancy, childbirth and immediate postpartum period. Also known as Maternity.

active

_ActMedicalServiceCode

3

ONC

Oncology

Provision of treatment and/or diagnosis related to tumors and/or cancer.

active

_ActMedicalServiceCode

3

PALL

Palliative

Provision of care for patients who are living or dying from an advanced illness.

active

_ActMedicalServiceCode

3

PED

Pediatrics

Provision of diagnosis and treatment of diseases and disorders affecting children.

active

_ActMedicalServiceCode

3

PHAR

Pharmaceutical

Pharmaceutical care performed by a pharmacist.

active

_ActMedicalServiceCode

3

PHYRHB

Physical Rehab

Provision of treatment for physical injury.

active

_ActMedicalServiceCode

3

PSYCH

Psychiatric

Provision of treatment of psychiatric disorder relating to mental illness.

active

_ActMedicalServiceCode

3

SURG

Surgical

Provision of surgical treatment.

active

_ActMedicalServiceCode

1

_ActClaimAttachmentCategoryCode

ActClaimAttachmentCategoryCode

Description: Coded types of attachments included to support a healthcare claim.

category

active

true

2

AUTOATTCH

auto attachment

Description: Automobile Information Attachment

active

_ActClaimAttachmentCategoryCode

2

DOCUMENT

document

Description: Document Attachment

active

_ActClaimAttachmentCategoryCode

2

HEALTHREC

health record

Description: Health Record Attachment

active

_ActClaimAttachmentCategoryCode

2

IMG

image attachment

Description: Image Attachment

active

_ActClaimAttachmentCategoryCode

2

LABRESULTS

lab results

Description: Lab Results Attachment

active

_ActClaimAttachmentCategoryCode

2

MODEL

model

Description: Digital Model Attachment

active

_ActClaimAttachmentCategoryCode

2

WIATTCH

work injury report attachment

Description: Work Injury related additional Information Attachment

active

_ActClaimAttachmentCategoryCode

2

XRAY

x-ray

Description: Digital X-Ray Attachment

active

_ActClaimAttachmentCategoryCode

1

_ActConsentType

ActConsentType

Definition: The type of consent directive, e.g., to consent or dissent to collect, access, or use in specific ways within an EHRS or for health information exchange; or to disclose health information for purposes such as research.

consent

active

true

2

ICOL

information collection

Definition: Consent to have healthcare information collected in an electronic health record. This entails that the information may be used in analysis, modified, updated.

active

_ActConsentType

2

IDSCL

information disclosure

Definition: Consent to have collected healthcare information disclosed.

active

_ActConsentType

2

INFA

information access

Definition: Consent to access healthcare information.

active

_ActConsentType

3

INFAO

access only

Definition: Consent to access or "read" only, which entails that the information is not to be copied, screen printed, saved, emailed, stored, re-disclosed or altered in any way. This level ensures that data which is masked or to which access is restricted will not be.

Example: Opened and then emailed or screen printed for use outside of the consent directive purpose.

active

INFA

3

INFASO

access and save only

Definition: Consent to access and save only, which entails that access to the saved copy will remain locked.

active

INFA

2

IRDSCL

information redisclosure

Definition: Information re-disclosed without the patient's consent.

active

_ActConsentType

2

RESEARCH

research information access

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

active

_ActConsentType

3

RSDID

de-identified information access

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.

active

RESEARCH

3

RSREID

re-identifiable information access

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.

active

RESEARCH

1

_ActContainerRegistrationCode

ActContainerRegistrationCode

Constrains the ActCode to the domain of Container Registration

container registration

active

true

2

ID

Identified

Used by one system to inform another that it has received a container.

active

_ActContainerRegistrationCode

2

IP

In Position

Used by one system to inform another that the container is in position for specimen transfer (e.g., container removal from track, pipetting, etc.).

active

_ActContainerRegistrationCode

2

L

Left Equipment

Used by one system to inform another that the container has been released from that system.

active

_ActContainerRegistrationCode

2

M

Missing

Used by one system to inform another that the container did not arrive at its next expected location.

active

_ActContainerRegistrationCode

2

O

In Process

Used by one system to inform another that the specific container is being processed by the equipment. It is useful as a response to a query about Container Status, when the specific step of the process is not relevant.

active

_ActContainerRegistrationCode

2

R

Process Completed

Status is used by one system to inform another that the processing has been completed, but the container has not been released from that system.

active

_ActContainerRegistrationCode

2

X

Container Unavailable

Used by one system to inform another that the container is no longer available within the scope of the system (e.g., tube broken or discarded).

active

_ActContainerRegistrationCode

1

_ActControlVariable

ActControlVariable

An observation form that determines parameters or attributes of an Act. Examples are the settings of a ventilator machine as parameters of a ventilator treatment act; the controls on dillution factors of a chemical analyzer as a parameter of a laboratory observation act; the settings of a physiologic measurement assembly (e.g., time skew) or the position of the body while measuring blood pressure.

Control variables are forms of observations because just as with clinical observations, the Observation.code determines the parameter and the Observation.value assigns the value. While control variables sometimes can be observed (by noting the control settings or an actually measured feedback loop) they are not primary observations, in the sense that a control variable without a primary act is of no use (e.g., it makes no sense to record a blood pressure position without recording a blood pressure, whereas it does make sense to record a systolic blood pressure without a diastolic blood pressure).

observation

active

true

2

AUTO

auto-repeat permission

Specifies whether or not automatic repeat testing is to be initiated on specimens.

active

_ActControlVariable

2

ENDC

endogenous content

A baseline value for the measured test that is inherently contained in the diluent. In the calculation of the actual result for the measured test, this baseline value is normally considered.

active

_ActControlVariable

2

REFLEX

reflex permission

Specifies whether or not further testing may be automatically or manually initiated on specimens.

active

_ActControlVariable

2 | _ECGControlVariable | ECGControlVariable | | | retired | true | | | _ActControlVariable

1

_ActCoverageConfirmationCode

ActCoverageConfirmationCode

Response to an insurance coverage eligibility query or authorization request.

coverage

active

true

2

_ActCoverageAuthorizationConfirmationCode

ActCoverageAuthorizationConfirmationCode

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

coverage

active

true

_ActCoverageConfirmationCode

3

AUTH

Authorized

Authorization approved and funds have been set aside to pay for specified healthcare service(s) and/or product(s) within defined criteria for the authorization.

active

_ActCoverageAuthorizationConfirmationCode

3

NAUTH

Not Authorized

Authorization for specified healthcare service(s) and/or product(s) denied.

active

_ActCoverageAuthorizationConfirmationCode

2

_ActCoverageEligibilityConfirmationCode

ActCoverageEligibilityConfirmationCode

Indication of eligibility coverage for healthcare service(s) and/or product(s).

retired

true

_ActCoverageConfirmationCode

3

ELG

Eligible

Insurance coverage is in effect for healthcare service(s) and/or product(s).

retired

_ActCoverageEligibilityConfirmationCode

3

NELG

Not Eligible

Insurance coverage is not in effect for healthcare service(s) and/or product(s). May optionally include reasons for the ineligibility.

retired

_ActCoverageEligibilityConfirmationCode

1

_ActCoverageLimitCode

ActCoverageLimitCode

Criteria that are applicable to the authorized coverage.

coverage

active

true

2

_ActCoverageQuantityLimitCode

ActCoverageQuantityLimitCode

Maximum amount paid or maximum number of services/products covered; or maximum amount or number covered during a specified time period under the policy or program.

coverage

active

true

_ActCoverageLimitCode

3

COVPRD

coverage period

Codes representing the time period during which coverage is available; or financial participation requirements are in effect.

active

_ActCoverageQuantityLimitCode

3

LFEMX

life time maximum

Definition: Maximum amount paid by payer or covered party; or maximum number of services or products covered under the policy or program during a covered party's lifetime.

active

_ActCoverageQuantityLimitCode, COVMX

3

NETAMT

Net Amount

Maximum net amount that will be covered for the product or service specified.

active

_ActCoverageQuantityLimitCode

3

PRDMX

period maximum

Definition: Maximum amount paid by payer or covered party; or maximum number of services/products covered under the policy or program by time period specified by the effective time on the act.

active

_ActCoverageQuantityLimitCode, COVMX

3

UNITPRICE

Unit Price

Maximum unit price that will be covered for the authorized product or service.

active

_ActCoverageQuantityLimitCode

3

UNITQTY

Unit Quantity

Maximum number of items that will be covered of the product or service specified.

active

_ActCoverageQuantityLimitCode

2

COVMX

coverage maximum

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

active

_ActCoverageLimitCode

3 | LFEMX | life time maximum |
3 | PRDMX | period maximum |

2

_ActCoveredPartyLimitCode

ActCoveredPartyLimitCode

Codes representing the types of covered parties that may receive covered benefits under a policy or program.

retired

true

_ActCoverageLimitCode

3

_ActCoveragePartyLimitGroupCode

ActCoveragePartyLimitGroupCode

Codes representing the level of coverage provided under the policy or program in terms of the types of entities that may play covered parties based on their personal relationships or employment status.

retired

true

_ActCoveredPartyLimitCode

1

_ActCoverageTypeCode

ActCoverageTypeCode

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

coverage

active

true

2

_ActInsurancePolicyCode

ActInsurancePolicyCode

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

policy

active

true

_ActCoverageTypeCode

3

EHCPOL

extended healthcare

Private insurance policy that provides coverage in addition to other policies (e.g. in addition to a Public Healthcare insurance policy).

active

_ActHealthInsuranceTypeCode, _ActInsurancePolicyCode

3

HSAPOL

health spending account

Insurance policy that provides for an allotment of funds replenished on a periodic (e.g. annual) basis. The use of the funds under this policy is at the discretion of the covered party.

active

_ActHealthInsuranceTypeCode, _ActInsurancePolicyCode

3

AUTOPOL

automobile

Insurance policy for injuries sustained in an automobile accident. Will also typically covered non-named parties to the policy, such as pedestrians and passengers.

active

_ActInsurancePolicyCode, _ActInsuranceTypeCode

4

COL

collision coverage policy

Definition: An automobile insurance policy under which the insurance company will cover the cost of damages to an automobile owned by the named insured that are caused by accident or intentionally by another party.

active

AUTOPOL

4

UNINSMOT

uninsured motorist policy

Definition: An automobile insurance policy under which the insurance company will indemnify a loss for which another motorist is liable if that motorist is unable to pay because he or she is uninsured. Coverage under the policy applies to bodily injury damages only. Injuries to the covered party caused by a hit-and-run driver are also covered.

active

AUTOPOL

3

PUBLICPOL

public healthcare

Insurance policy funded by a public health system such as a provincial or national health plan. Examples include BC MSP (British Columbia Medical Services Plan) OHIP (Ontario Health Insurance Plan), NHS (National Health Service).

active

_ActInsurancePolicyCode, _ActProgramTypeCode

4

DENTPRG

dental program

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.

active

PUBLICPOL

4

DISEASEPRG

public health program

Definition: A public or government health program that administers and funds coverage for health and social services to assist program eligible who meet financial and health status criteria related to a particular disease.

Example: Reproductive health, sexually transmitted disease, and end renal disease programs.

active

PUBLICPOL

5

CANPRG

women's cancer detection program

Definition: A program that provides low-income, uninsured, and underserved women access to timely, high-quality screening and diagnostic services, to detect breast and cervical cancer at the earliest stages.

Example: To improve women's access to screening for breast and cervical cancers, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which guided CDC in creating the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides access to critical breast and cervical cancer screening services for underserved women in the United States. An estimated 7 to 10% of U.S. women of screening age are eligible to receive NBCCEDP services. Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250% of federal poverty level; ages 18 to 64 for cervical screening; ages 40 to 64 for breast screening.

active

DISEASEPRG

5

ENDRENAL

end renal program

Definition: A public or government program that administers publicly funded coverage of kidney dialysis and kidney transplant services.

Example: In the U.S., the Medicare End-stage Renal Disease program (ESRD), the National Kidney Foundation (NKF) American Kidney Fund (AKF) The Organ Transplant Fund.

active

DISEASEPRG

5

HIVAIDS

HIV-AIDS program

Definition: Government administered and funded HIV-AIDS program for beneficiaries meeting financial and 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., the Ryan White program, which is administered by the Health Resources and Services Administration.

active

DISEASEPRG

4 | MANDPOL | mandatory health program | | | active | | | | PUBLICPOL

4

MENTPRG

mental health program

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).

active

PUBLICPOL

4

SAFNET

safety net clinic program

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.

active

PUBLICPOL

4

SUBPRG

substance use program

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).

active

PUBLICPOL

4

SUBSIDIZ

subsidized health program

Definition: A government health program that provides coverage 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.

active

PUBLICPOL

5

SUBSIDMC

subsidized managed care program

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.

active

SUBSIDIZ

5

SUBSUPP

subsidized supplemental health program

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.

active

SUBSIDIZ

3

WCBPOL

worker's compensation

Insurance policy for injuries sustained in the work place or in the course of employment.

active

_ActInsurancePolicyCode, _ActProgramTypeCode

2

_ActInsuranceTypeCode

ActInsuranceTypeCode

Definition: Set of codes indicating the type of insurance policy. Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of potential financial loss. Insurance is defined as the equitable transfer of the risk of a potential loss, from one entity to another, in exchange for a premium and duty of care. A policy holder is an individual or an organization enters into a contract with an underwriter which stipulates that, in exchange for payment of a sum of money (a premium), one or more covered parties (insureds) is guaranteed compensation for losses resulting from certain perils under specified conditions. The underwriter analyzes the risk of loss, makes a decision as to whether the risk is insurable, and prices the premium accordingly. A policy provides benefits that indemnify or cover the cost of a loss incurred by a covered party, and may include coverage for services required to remediate a loss. An insurance policy contains pertinent facts about the policy holder, the insurance coverage, the covered parties, and the insurer. A policy may include exemptions and provisions specifying the extent to which the indemnification clause cannot be enforced for intentional tortious conduct of a covered party, e.g., whether the covered parties are jointly or severably insured.

Discussion: In contrast to programs, an insurance policy has one or more policy holders, who own the policy. The policy holder may be the covered party, a relative of the covered party, a partnership, or a corporation, e.g., an employer. A subscriber of a self-insured health insurance policy is a policy holder. A subscriber of an employer sponsored health insurance policy is holds a certificate of coverage, but is not a policy holder; the policy holder is the employer. See CoveredRoleType.

active

true

_ActCoverageTypeCode

3

_ActHealthInsuranceTypeCode

ActHealthInsuranceTypeCode

Definition: Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement).

active

true

_ActInsuranceTypeCode

4

DENTAL

dental care policy

Definition: A health insurance policy that that covers benefits for dental services.

active

_ActHealthInsuranceTypeCode

4

DISEASE

disease specific policy

Definition: A health insurance policy that covers benefits for healthcare services provided for named conditions under the policy, e.g., cancer, diabetes, or HIV-AIDS.

active

_ActHealthInsuranceTypeCode

4

DRUGPOL

drug policy

Definition: A health insurance policy that covers benefits for prescription drugs, pharmaceuticals, and supplies.

active

_ActHealthInsuranceTypeCode

4

HIP

health insurance plan policy

Definition: A health insurance policy that covers healthcare benefits by protecting covered parties from medical expenses arising from health conditions, sickness, or accidental injury as well as preventive care. Health insurance policies explicitly exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.

Discussion: Health insurance policies are offered by health insurance plans that typically reimburse providers for covered services on a fee-for-service basis, that is, a fee that is the allowable amount that a provider may charge. This is in contrast to managed care plans, which typically prepay providers a per-member/per-month amount or capitation as reimbursement for all covered services rendered. Health insurance plans include indemnity and healthcare services plans.

active

_ActHealthInsuranceTypeCode

4

LTC

long term care policy

Definition: An insurance policy that covers benefits for long-term care services people need when they no longer can care for themselves. This may be due to an accident, disability, prolonged illness or the simple process of aging. Long-term care services assist with activities of daily living including:

Help at home with day-to-day activities, such as cooking, cleaning, bathing and dressing

Care in the community, such as in an adult day care facility

Supervised care provided in an assisted living facility

Skilled care provided in a nursing home

active

_ActHealthInsuranceTypeCode

4

MCPOL

managed care policy

Definition: Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

Managed care policies specifically exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.

Discussion: Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member.

active

_ActHealthInsuranceTypeCode

5

HMO

health maintenance organization policy

Definition: A policy for a health plan that provides coverage for health care only through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Eligibility to enroll in an HMO is determined by where a covered party lives or works.

active

MCPOL

5

PPO

preferred provider organization policy

Definition: A network-based, managed care plan that allows a covered party to choose any health care provider. However, if care is received from a "preferred" (participating in-network) provider, there are generally higher benefit coverage and lower deductibles.

active

MCPOL

5 | POS | point of service policy |

4

MENTPOL

mental health policy

Definition: A health insurance policy that covers benefits for mental health services and prescriptions.

active

_ActHealthInsuranceTypeCode

4

POS

point of service policy

Definition: A policy for a health plan that has features of both an HMO and a FFS plan. Like an HMO, a POS plan encourages the use its HMO network to maintain discounted fees with participating providers, but recognizes that sometimes covered parties want to choose their own provider. The POS plan allows a covered party to use providers who are not part of the HMO network (non-participating providers). However, there is a greater cost associated with choosing these non-network providers. A covered party will usually pay deductibles and coinsurances that are substantially higher than the payments when he or she uses a plan provider. Use of non-participating providers often requires the covered party to pay the provider directly and then to file a claim for reimbursement, like in an FFS plan.

active

_ActHealthInsuranceTypeCode, MCPOL

4

SUBPOL

substance use policy

Definition: A health insurance policy that covers benefits for substance use services.

active

_ActHealthInsuranceTypeCode

4

VISPOL

vision care policy

Definition: Set of codes for a policy that provides coverage for health care expenses arising from vision services.

A health insurance policy that covers benefits for vision care services, prescriptions, and products.

active

_ActHealthInsuranceTypeCode

4 | EHCPOL | extended healthcare |
4 | HSAPOL | health spending account |

3

DIS

disability insurance policy

Definition: An insurance policy that provides a regular payment to compensate for income lost due to the covered party's inability to work because of illness or injury.

active

_ActInsuranceTypeCode

3

EWB

employee welfare benefit plan policy

Definition: An insurance policy under a benefit plan run by an employer or employee organization for the purpose of providing benefits other than pension-related to employees and their families. Typically provides health-related benefits, benefits for disability, disease or unemployment, or day care and scholarship benefits, among others. An employer sponsored health policy includes coverage of health care expenses arising from sickness or accidental injury, coverage for on-site medical clinics or for dental or vision benefits, which are typically provided under a separate policy. Coverage excludes health care expenses covered by accident or disability, workers' compensation, liability or automobile insurance.

active

_ActInsuranceTypeCode

3

FLEXP

flexible benefit plan policy

Definition: An insurance policy that covers qualified benefits under a Flexible Benefit plan such as group medical insurance, long and short term disability income insurance, group term life insurance for employees only up to $50,000 face amount, specified disease coverage such as a cancer policy, dental and/or vision insurance, hospital indemnity insurance, accidental death and dismemberment insurance, a medical expense reimbursement plan and a dependent care reimbursement plan.

Discussion: See UnderwriterRoleTypeCode flexible benefit plan which is defined as a benefit plan that allows employees to choose from several life, health, disability, dental, and other insurance plans according to their individual needs. Also known as cafeteria plans. Authorized under Section 125 of the Revenue Act of 1978.

active

_ActInsuranceTypeCode

3

LIFE

life insurance policy

Definition: A policy under which the insurer agrees to pay a sum of money upon the occurrence of the covered partys death. In return, the policyholder agrees to pay a stipulated amount called a premium at regular intervals. Life insurance indemnifies the beneficiary for the loss of the insurable interest that a beneficiary has in the life of a covered party. For persons related by blood, a substantial interest established through love and affection, and for all other persons, a lawful and substantial economic interest in having the life of the insured continue. An insurable interest is required when purchasing life insurance on another person. Specific exclusions are often written into the contract to limit the liability of the insurer; for example claims resulting from suicide or relating to war, riot and civil commotion.

*Discussion:*A life insurance policy may be used by the covered party as a source of health care coverage in the case of a viatical settlement, which is the sale of a life insurance policy by the policy owner, before the policy matures. Such a sale, at a price discounted from the face amount of the policy but usually in excess of the premiums paid or current cash surrender value, provides the seller an immediate cash settlement. Generally, viatical settlements involve insured individuals with a life expectancy of less than two years. In countries without state-subsidized healthcare and high healthcare costs (e.g. United States), this is a practical way to pay extremely high health insurance premiums that severely ill people face. Some people are also familiar with life settlements, which are similar transactions but involve insureds with longer life expectancies (two to fifteen years).

active

_ActInsuranceTypeCode

4

ANNU

annuity policy

Definition: A policy that, after an initial premium or premiums, pays out a sum at pre-determined intervals.

For example, a policy holder may pay $10,000, and in return receive $150 each month until he dies; or $1,000 for each of 14 years or death benefits if he dies before the full term of the annuity has elapsed.

active

LIFE

4

TLIFE

term life insurance policy

Definition: Life insurance under which the benefit is payable only if the insured dies during a specified period. If an insured dies during that period, the beneficiary receives the death payments. If the insured survives, the policy ends and the beneficiary receives nothing.

active

LIFE

4

ULIFE

universal life insurance policy

Definition: Life insurance under which the benefit is payable upon the insuredaTMs death or diagnosis of a terminal illness. If an insured dies during that period, the beneficiary receives the death payments. If the insured survives, the policy ends and the beneficiary receives nothing

active

LIFE

3

PNC

property and casualty insurance policy

Definition: A type of insurance that covers damage to or loss of the policyholderaTMs property by providing payments for damages to property damage or the injury or death of living subjects. The terms "casualty" and "liability" insurance are often used interchangeably. Both cover the policyholder's legal liability for damages caused to other persons and/or their property.

active

_ActInsuranceTypeCode

3

REI

reinsurance policy

Definition: An agreement between two or more insurance companies by which the risk of loss is proportioned. Thus the risk of loss is spread and a disproportionately large loss under a single policy does not fall on one insurance company. Acceptance by an insurer, called a reinsurer, of all or part of the risk of loss of another insurance company.

Discussion: Reinsurance is a means by which an insurance company can protect itself against the risk of losses with other insurance companies. Individuals and corporations obtain insurance policies to provide protection for various risks (hurricanes, earthquakes, lawsuits, collisions, sickness and death, etc.). Reinsurers, in turn, provide insurance to insurance companies.

For example, an HMO may purchase a reinsurance policy to protect itself from losing too much money from one insured's particularly expensive health care costs. An insurance company issuing an automobile liability policy, with a limit of $100,000 per accident may reinsure its liability in excess of $10,000. A fire insurance company which issues a large policy generally reinsures a portion of the risk with one or several other companies. Also called risk control insurance or stop-loss insurance.

active

_ActInsuranceTypeCode

3

SURPL

surplus line insurance policy

Definition:

1. A risk or part of a risk for which there is no normal insurance market available.

2. Insurance written by unauthorized insurance companies. Surplus lines insurance is insurance placed with unauthorized insurance companies through licensed surplus lines agents or brokers.

active

_ActInsuranceTypeCode

3

UMBRL

umbrella liability insurance policy

Definition: A form of insurance protection that provides additional liability coverage after the limits of your underlying policy are reached. An umbrella liability policy also protects you (the insured) in many situations not covered by the usual liability policies.

active

_ActInsuranceTypeCode

3 | AUTOPOL | automobile |

2

_ActProgramTypeCode

ActProgramTypeCode

Definition: A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds.

Discussion: Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

active

true

_ActCoverageTypeCode

3

CHAR

charity program

Definition: A program that covers the cost of services provided directly to a beneficiary who typically has no other source of coverage without charge.

active

_ActProgramTypeCode

3

CRIME

crime victim program

Definition: A program that covers the cost of services provided to crime victims for injuries or losses related to the occurrence of a crime.

active

_ActProgramTypeCode

3

EAP

employee assistance program

Definition: An employee assistance program is run by an employer or employee organization for the purpose of providing benefits and covering all or part of the cost for employees to receive counseling, referrals, and advice in dealing with stressful issues in their lives. These may include substance abuse, bereavement, marital problems, weight issues, or general wellness issues. The services are usually provided by a third-party, rather than the company itself, and the company receives only summary statistical data from the service provider. Employee's names and services received are kept confidential.

active

_ActProgramTypeCode

3

GOVEMP

government employee health program

Definition: A set of codes used to indicate a government program that is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health and financial status. Government programs are established or permitted by legislation with provisions for ongoing government oversight. Regulation mandates the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency is charged with implementing the program in accordance to the regulation

Example: Federal employee health benefit program in the U.S.

active

_ActProgramTypeCode

3

HIRISK

high risk pool program

Definition: A government program that provides health coverage to individuals who are considered medically uninsurable or high risk, and who have been denied health insurance due to a serious health condition. In certain cases, it also applies to those who have been quoted very high premiums a" again, due to a serious health condition. The pool charges premiums for coverage. Because the pool covers high-risk people, it incurs a higher level of claims than premiums can cover. The insurance industry pays into the pool to make up the difference and help it remain viable.

active

_ActProgramTypeCode

3

IND

indigenous peoples health program

Definition: Services provided directly and through contracted and operated indigenous peoples health programs.

Example: Indian Health Service in the U.S.

active

_ActProgramTypeCode

3

MILITARY

military health program

Definition: A government program that provides coverage for health services to military personnel, retirees, and dependents. A covered party who is a subscriber can choose from among Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Plans offering a Point of Service (POS) Product, or Health Maintenance Organizations.

Example: In the U.S., TRICARE, CHAMPUS.

active

_ActProgramTypeCode

3

RETIRE

retiree health program

Definition: A government mandated program with specific eligibility requirements based on premium contributions made during employment, length of employment, age, and employment status, e.g., being retired, disabled, or a dependent of a covered party under this program. Benefits typically include ambulatory, inpatient, and long-term care, such as hospice care, home health care and respite care.

active

_ActProgramTypeCode

3

SOCIAL

social service program

Definition: A social service program funded by a public or governmental entity.

Example: Programs providing habilitation, food, lodging, medicine, transportation, equipment, devices, products, education, training, counseling, alteration of living or work space, and other resources to persons meeting eligibility criteria.

active

_ActProgramTypeCode

3

VET

veteran health program

Definition: Services provided directly and through contracted and operated veteran health programs.

active

_ActProgramTypeCode

3 | PUBLICPOL | public healthcare |
3 | WCBPOL | worker's compensation |

1

_ActDetectedIssueManagementCode

ActDetectedIssueManagementCode

Codes dealing with the management of Detected Issue observations

detected issue

active

true

2

_ActAdministrativeDetectedIssueManagementCode

ActAdministrativeDetectedIssueManagementCode

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

active

true

_ActDetectedIssueManagementCode

3 | _AuthorizationIssueManagementCode | Authorization Issue Management Code | | detected issue | active | true | | | _ActAdministrativeDetectedIssueManagementCode

4

EMAUTH

emergency authorization override

Used to temporarily override normal authorization rules to gain access to data in a case of emergency. Use of this override code will typically be monitored, and a procedure to verify its proper use may be triggered when used.

active

_AuthorizationIssueManagementCode

5

21

authorization confirmed

Description: Indicates that the permissions have been externally verified and the request should be processed.

active

EMAUTH

2

1

Therapy Appropriate

Confirmed drug therapy appropriate

active

_ActDetectedIssueManagementCode

3

19

Consulted Supplier

Consulted other supplier/pharmacy, therapy confirmed

active

1

3

2

Assessed Patient

Assessed patient, therapy is appropriate

active

1

3

22

appropriate indication or diagnosis

Description: The patient has the appropriate indication or diagnosis for the action to be taken.

active

1

3

23

prior therapy documented

Description: It has been confirmed that the appropriate pre-requisite therapy has been tried.

active

1

3

3

Patient Explanation

Patient gave adequate explanation

active

1

3

4

Consulted Other Source

Consulted other supply source, therapy still appropriate

active

1

3

5

Consulted Prescriber

Consulted prescriber, therapy confirmed

active

1

4

6

Prescriber Declined Change

Consulted prescriber and recommended change, prescriber declined

active

5

3

7

Interacting Therapy No Longer Active/Planned

Concurrent therapy triggering alert is no longer on-going or planned

active

1

2

14

Supply Appropriate

Confirmed supply action appropriate

active

_ActDetectedIssueManagementCode

3

15

Replacement

Patient's existing supply was lost/wasted

active

14

3

16

Vacation Supply

Supply date is due to patient vacation

active

14

3

17

Weekend Supply

Supply date is intended to carry patient over weekend

active

14

3

18

Leave of Absence

Supply is intended for use during a leave of absence from an institution.

active

14

3

20

additional quantity on separate dispense

Description: Supply is different than expected as an additional quantity has been supplied in a separate dispense.

active

14

2

8

Other Action Taken

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

active

_ActDetectedIssueManagementCode

3

10

Provided Patient Education

Provided education or training to the patient on appropriate therapy use

active

8

3

11

Added Concurrent Therapy

Instituted an additional therapy to mitigate potential negative effects

active

8

3

12

Temporarily Suspended Concurrent Therapy

Suspended existing therapy that triggered interaction for the duration of this therapy

active

8

3

13

Stopped Concurrent Therapy

Aborted existing therapy that triggered interaction.

active

8

3

9

Instituted Ongoing Monitoring Program

Arranged to monitor patient for adverse effects

active

8

2

_ActFinancialDetectedIssueManagementCode

ActFinancialDetectedIssueManagementCode

Codes dealing with the management of Detected Issue observations for the financial acts domain.

retired

true

_ActDetectedIssueManagementCode

1

_ActExposureCode

ActExposureCode

Concepts that identify the type or nature of exposure interaction. Examples include "household", "care giver", "intimate partner", "common space", "common substance", etc. to further describe the nature of interaction.

exposure

active

true

2

CHLDCARE

Day care - Child care Interaction

Description: Exposure participants' interaction occurred in a child care setting

active

_ActExposureCode

2

CONVEYNC

Common Conveyance Interaction

Description: An interaction where the exposure participants traveled in/on the same vehicle (not necessarily concurrently, e.g. both are passengers of the same plane, but on different flights of that plane).

active

_ActExposureCode

2

HLTHCARE

Health Care Interaction - Not Patient Care

Description: Exposure participants' interaction occurred during the course of health care delivery or in a health care delivery setting, but did not involve the direct provision of care (e.g. a janitor cleaning a patient's hospital room).

active

_ActExposureCode

2

HOMECARE

Care Giver Interaction

Description: Exposure interaction occurred in context of one providing care for the other, i.e. a babysitter providing care for a child, a home-care aide providing assistance to a paraplegic.

active

_ActExposureCode

2

HOSPPTNT

Hospital Patient Interaction

Description: Exposure participants' interaction occurred when both were patients being treated in the same (acute) health care delivery facility.

active

_ActExposureCode

2

HOSPVSTR

Hospital Visitor Interaction

Description: Exposure participants' interaction occurred when one visited the other who was a patient being treated in a health care delivery facility.

active

_ActExposureCode

2

HOUSEHLD

Household Interaction

Description: Exposure interaction occurred in context of domestic interaction, i.e. both participants reside in the same household.

active

_ActExposureCode

2

INMATE

Inmate Interaction

Description: Exposure participants' interaction occurred in the course of one or both participants being incarcerated at a correctional facility

active

_ActExposureCode

2

INTIMATE

Intimate Interaction

Description: Exposure interaction was intimate, i.e. participants are intimate companions (e.g. spouses, domestic partners).

active

_ActExposureCode

2

LTRMCARE

Long Term Care Facility Interaction

Description: Exposure participants' interaction occurred in the course of one or both participants being resident at a long term care facility (second participant may be a visitor, worker, resident or a physical place or object within the facility).

active

_ActExposureCode

2

PLACE

Common Space Interaction

Description: An interaction where the exposure participants were both present in the same location/place/space.

active

_ActExposureCode

2

PTNTCARE

Health Care Interaction - Patient Care

Description: Exposure participants' interaction occurred during the course of health care delivery by a provider (e.g. a physician treating a patient in her office).

active

_ActExposureCode

2

SCHOOL2

School Interaction

Description: Exposure participants' interaction occurred in an academic setting (e.g., participants are fellow students, or student and teacher).

active

_ActExposureCode

2

SOCIAL2

Social/Extended Family Interaction

Description: An interaction where the exposure participants are social associates or members of the same extended family

active

_ActExposureCode

2

SUBSTNCE

Common Substance Interaction

Description: An interaction where the exposure participants shared or co-used a common substance (e.g. drugs, needles, or common food item).

active

_ActExposureCode

2

TRAVINT

Common Travel Interaction

Description: An interaction where the exposure participants traveled together in/on the same vehicle/trip (e.g. concurrent co-passengers).

active

_ActExposureCode

2

WORK2

Work Interaction

Description: Exposure interaction occurred in a work setting, i.e. participants are co-workers.

active

_ActExposureCode

1 | _ActFinancialTransactionCode | ActFinancialTransactionCode | | financial transaction | active | true | | |

2

CHRG

Standard Charge

A type of transaction that represents a charge for a service or product. Expressed in monetary terms.

active

_ActFinancialTransactionCode

2

REV

Standard Charge Reversal

A type of transaction that represents a reversal of a previous charge for a service or product. Expressed in monetary terms. It has the opposite effect of a standard charge.

active

_ActFinancialTransactionCode

1

_ActIncidentCode

ActIncidentCode

Set of codes indicating the type of incident or accident.

incident

active

true

2

MVA

Motor vehicle accident

Incident or accident as the result of a motor vehicle accident

active

_ActIncidentCode

2

SCHOOL

School Accident

Incident or accident is the result of a school place accident.

active

_ActIncidentCode

2

SPT

Sporting Accident

Incident or accident is the result of a sporting accident.

active

_ActIncidentCode

2

WPA

Workplace accident

Incident or accident is the result of a work place accident

active

_ActIncidentCode

2

_ActPatientSafetyIncidentCode

ActPatientSafetyIncidentCode

Definition: A code specifying the particular kind of Patient Safety Incident that the Incident class instance represents.

Examples:"Medication incident", "slips, trips and falls incident".The actual value set for the domain will be determined by each (realm) implementation, whose Patient Safety terminology will be specific, although probably linked to the WHO Patient Safety Taxonomy that is currently under development

retired

true

_ActIncidentCode

1

_ActInformationAccessCode

ActInformationAccessCode

Description: The type of health information to which the subject of the information or the subject's delegate consents or dissents.

active

true

2

ACADR

adverse drug reaction access

Description: Provide consent to collect, use, disclose, or access adverse drug reaction information for a patient.

active

_ActInformationAccessCode

2

ACALL

all access

Description: Provide consent to collect, use, disclose, or access all information for a patient.

active

_ActInformationAccessCode

2

ACALLG

allergy access

Description: Provide consent to collect, use, disclose, or access allergy information for a patient.

active

_ActInformationAccessCode

2

ACCONS

informational consent access

Description: Provide consent to collect, use, disclose, or access informational consent information for a patient.

active

_ActInformationAccessCode

2

ACDEMO

demographics access

Description: Provide consent to collect, use, disclose, or access demographics information for a patient.

active

_ActInformationAccessCode

2

ACDI

diagnostic imaging access

Description: Provide consent to collect, use, disclose, or access diagnostic imaging information for a patient.

active

_ActInformationAccessCode

2

ACIMMUN

immunization access

Description: Provide consent to collect, use, disclose, or access immunization information for a patient.

active

_ActInformationAccessCode

2

ACLAB

lab test result access

Description: Provide consent to collect, use, disclose, or access lab test result information for a patient.

active

_ActInformationAccessCode

2

ACMED

medication access

Description: Provide consent to collect, use, disclose, or access medical condition information for a patient.

active

_ActInformationAccessCode

2

ACMEDC

medical condition access

Definition: Provide consent to view or access medical condition information for a patient.

active

_ActInformationAccessCode

2

ACMEN

mental health access

**Description:**Provide consent to collect, use, disclose, or access mental health information for a patient.

active

_ActInformationAccessCode

2

ACOBS

common observations access

Description: Provide consent to collect, use, disclose, or access common observation information for a patient.

active

_ActInformationAccessCode

2

ACPOLPRG

policy or program information access

Description: Provide consent to collect, use, disclose, or access coverage policy or program for a patient.

active

_ActInformationAccessCode

2

ACPROV

provider information access

Description: Provide consent to collect, use, disclose, or access provider information for a patient.

active

_ActInformationAccessCode

2

ACPSERV

professional service access

Description: Provide consent to collect, use, disclose, or access professional service information for a patient.

active

_ActInformationAccessCode

2

ACSUBSTAB

substance abuse access

**Description:**Provide consent to collect, use, disclose, or access substance abuse information for a patient.

active

_ActInformationAccessCode

1

_ActInformationAccessContextCode

ActInformationAccessContextCode

Concepts conveying the context in which authorization given under jurisdictional law, by organizational policy, or by a patient consent directive permits the collection, access, use or disclosure of specified patient health information.

active

true

2

INFAUT

authorized information transfer

Authorization to collect, access, use, or disclose specified patient health information in accordance with jurisdictional law, organizational policy, or a patient's consent directive, which may be implied, deemed, opt-in, opt-out, or explicit.

active

_ActInformationAccessContextCode

3

INFCON

after explicit consent

Authorization to collect, access, use, or disclose specified patient health information as explicitly consented to by the subject of the information or the subject's representative.

active

INFAUT

2

INFCRT

only on court order

Authorization to collect, access, use, or disclose specified patient health information in accordance with judicial system protocol, such as in the case of a subpoena or court order.

active

_ActInformationAccessContextCode

2

INFDNG

only if danger to others

Authorization to collect, access, use, or disclose specified patient health information where deemed necessary to avert potential danger to other persons in accordance with jurisdictional law, organizational policy, or standards of practice. For example, disclosure about a person threatening violence.

active

_ActInformationAccessContextCode

2

INFEMER

only in an emergency

Authorization to collect, access, use, or disclose specified patient health information in accordance with emergency information transfer protocol dictated by jurisdictional law, organization policy, or standards of practice. For example, sharing of health information during disaster response.

active

_ActInformationAccessContextCode

2

INFPWR

only if public welfare risk

Authorization to collect, access, use, or disclose specified patient health information necessary to avert potential public welfare risk in accordance with jurisdictional law, organizational policy, or standards of practice. For example, reporting that a person is a victim of abuse or demonstrating suicidal tendencies.

active

_ActInformationAccessContextCode

2

INFREG

regulatory information transfer

Authorization to collect, access, use, or disclose specified patient health information for public health, welfare, and safety purposes in accordance with jurisdictional law, organizational policy, or standards of practice. For example, public health reporting of notifiable conditions.

active

_ActInformationAccessContextCode

1

_ActInformationCategoryCode

ActInformationCategoryCode

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

document

active

true

2

ALLCAT

all categories

Description: All patient information.

active

_ActInformationCategoryCode

2

ALLGCAT

allergy category

**Definition:**All information pertaining to a patient's allergy and intolerance records.

active

_ActInformationCategoryCode

2

ARCAT

adverse drug reaction category

Description: All information pertaining to a patient's adverse drug reactions.

active

_ActInformationCategoryCode

2

COBSCAT

common observation category

**Definition:**All information pertaining to a patient's common observation records (height, weight, blood pressure, temperature, etc.).

active

_ActInformationCategoryCode

2

DEMOCAT

demographics category

**Definition:**All information pertaining to a patient's demographics (such as name, date of birth, gender, address, etc).

active

_ActInformationCategoryCode

2

DICAT

diagnostic image category

**Definition:**All information pertaining to a patient's diagnostic image records (orders & results).

active

_ActInformationCategoryCode

2

IMMUCAT

immunization category

**Definition:**All information pertaining to a patient's vaccination records.

active

_ActInformationCategoryCode

2

LABCAT

lab test category

Description: All information pertaining to a patient's lab test records (orders & results)

active

_ActInformationCategoryCode

2

MEDCCAT

medical condition category

**Definition:**All information pertaining to a patient's medical condition records.

active

_ActInformationCategoryCode

2

MENCAT

mental health category

Description: All information pertaining to a patient's mental health records.

active

_ActInformationCategoryCode

2

PSVCCAT

professional service category

**Definition:**All information pertaining to a patient's professional service records (such as smoking cessation, counseling, medication review, mental health).

active

_ActInformationCategoryCode

2

RXCAT

medication category

**Definition:**All information pertaining to a patient's medication records (orders, dispenses and other active medications).

active

_ActInformationCategoryCode

1

_ActInvoiceElementCode

ActInvoiceElementCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

invoice element

active

true

2

_ActInvoiceAdjudicationPaymentCode

ActInvoiceAdjudicationPaymentCode

Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

active

true

_ActInvoiceElementCode

3

_ActInvoiceAdjudicationPaymentGroupCode

ActInvoiceAdjudicationPaymentGroupCode

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

active

true

_ActInvoicePaymentCode

_ActInvoiceAdjudicationPaymentCode

4

ALEC

alternate electronic

Payment initiated by the payor as the result of adjudicating a submitted invoice that arrived to the payor from an electronic source that did not provide a conformant set of HL7 messages (e.g. web claim submission).

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

BONUS

bonus

Bonus payments based on performance, volume, etc. as agreed to by the payor.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

CFWD

carry forward adjusment

An amount still owing to the payor but the payment is 0$ and this cannot be settled until a future payment is made.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

EDU

education fees

Fees deducted on behalf of a payee for tuition and continuing education.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

EPYMT

early payment fee

Fees deducted on behalf of a payee for charges based on a shorter payment frequency (i.e. next day versus biweekly payments.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

GARN

garnishee

Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

INVOICE

submitted invoice

Payment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results..

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

PINV

paper invoice

Payment initiated by the payor as the result of adjudicating a paper (original, may have been faxed) invoice.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

PPRD

prior period adjustment

An amount that was owed to the payor as indicated, by a carry forward adjusment, in a previous payment advice

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

PROA

professional association deduction

Professional association fee that is collected by the payor from the practitioner/provider on behalf of the association

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

RECOV

recovery

Retroactive adjustment such as fee rate adjustment due to contract negotiations.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

RETRO

retro adjustment

Bonus payments based on performance, volume, etc. as agreed to by the payor.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

4

TRAN

transaction fee

Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

active

_ActInvoiceAdjudicationPaymentGroupCode, _ActInvoicePaymentCode

3

_ActInvoicePaymentCode

ActInvoiceAdjudicationPaymentGroupCode

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

retired

true

_ActInvoiceAdjudicationPaymentGroupCode

_ActInvoiceAdjudicationPaymentCode

4 | ALEC | alternate electronic |
4 | BONUS | bonus |
4 | CFWD | carry forward adjusment |
4 | EDU | education fees |
4 | EPYMT | early payment fee |
4 | GARN | garnishee |
4 | INVOICE | submitted invoice |
4 | PINV | paper invoice |
4 | PPRD | prior period adjustment |
4 | PROA | professional association deduction |
4 | RECOV | recovery |
4 | RETRO | retro adjustment |
4 | TRAN | transaction fee |

3

_ActInvoiceAdjudicationPaymentSummaryCode

ActInvoiceAdjudicationPaymentSummaryCode

Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee, etc.

active

true

_ActInvoiceAdjudicationPaymentCode

4

INVTYPE

invoice type

Transaction counts and value totals by invoice type (e.g. RXDINV - Pharmacy Dispense)

active

_ActInvoiceAdjudicationPaymentSummaryCode

4

PAYEE

payee

Transaction counts and value totals by each instance of an invoice payee.

active

_ActInvoiceAdjudicationPaymentSummaryCode

4

PAYOR

payor

Transaction counts and value totals by each instance of an invoice payor.

active

_ActInvoiceAdjudicationPaymentSummaryCode

4

SENDAPP

sending application

Transaction counts and value totals by each instance of a messaging application on a single processor. It is a registered identifier known to the receivers.

active

_ActInvoiceAdjudicationPaymentSummaryCode

4 | CONT | contract |
4 | DAY | day |
4 | LOC | location |
4 | MONTH | month |
4 | PERIOD | period |
4 | PROV | provider |
4 | WEEK | week |
4 | YEAR | year |

2

_ActInvoiceDetailCode

ActInvoiceDetailCode

Codes representing a service or product that is being invoiced (billed). The code can represent such concepts as "office visit", "drug X", "wheelchair" and other billable items such as taxes, service charges and discounts.

active

true

_ActInvoiceElementCode

3

_ActInvoiceDetailClinicalProductCode

ActInvoiceDetailClinicalProductCode

An identifying data string for healthcare products.

active

true

_ActInvoiceDetailCode

4

UNSPSC

United Nations Standard Products and Services Classification

**Description:**United Nations Standard Products and Services Classification, managed by Uniform Code Council (UCC): www.unspsc.org

active

_ActInvoiceDetailClinicalProductCode

3

_ActInvoiceDetailDrugProductCode

ActInvoiceDetailDrugProductCode

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

active

true

_ActInvoiceDetailCode

4

GTIN

Global Trade Item Number

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

active

_ActInvoiceDetailDrugProductCode

4

UPC

Universal Product Code

**Description:**Universal Product Code is one of a wide variety of bar code languages widely used in the United States and Canada for items in stores.

active

_ActInvoiceDetailDrugProductCode

3

_ActInvoiceDetailGenericCode

ActInvoiceDetailGenericCode

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

active

true

_ActInvoiceDetailCode

4

_ActInvoiceDetailGenericAdjudicatorCode

ActInvoiceDetailGenericAdjudicatorCode

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

active

true

_ActInvoiceDetailGenericCode

5

COIN

coinsurance

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

active

_ActInvoiceDetailGenericAdjudicatorCode

5

COPAYMENT

patient co-pay

That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

active

_ActInvoiceDetailGenericAdjudicatorCode

5

DEDUCTIBLE

deductible

That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

active

_ActInvoiceDetailGenericAdjudicatorCode

5

PAY

payment

The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.

active

_ActInvoiceDetailGenericAdjudicatorCode

5

SPEND

spend down

That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results

active

_ActInvoiceDetailGenericAdjudicatorCode

5

COINS

co-insurance

The covered party pays a percentage of the cost of covered services.

retired

_ActInvoiceDetailGenericAdjudicatorCode

4

_ActInvoiceDetailGenericModifierCode

ActInvoiceDetailGenericModifierCode

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

active

true

_ActInvoiceDetailGenericCode

5

AFTHRS

non-normal hours

Premium paid on service fees in compensation for practicing outside of normal working hours.

active

_ActInvoiceDetailGenericModifierCode

5

ISOL

isolation allowance

Premium paid on service fees in compensation for practicing in a remote location.

active

_ActInvoiceDetailGenericModifierCode

5

OOO

out of office

Premium paid on service fees in compensation for practicing at a location other than normal working location.

active

_ActInvoiceDetailGenericModifierCode

4

_ActInvoiceDetailGenericProviderCode

ActInvoiceDetailGenericProviderCode

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

active

true

_ActInvoiceDetailGenericCode

5

CANCAPT

cancelled appointment

A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.

active

_ActInvoiceDetailGenericProviderCode

5

DSC

discount

A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.

active

_ActInvoiceDetailGenericProviderCode

5

ESA

extraordinary service assessment

A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.

active

_ActInvoiceDetailGenericProviderCode

5

FFSTOP

fee for service top off

Under agreement between the parties (payor and provider), a guaranteed level of income is established for the provider over a specific, pre-determined period of time. The normal course of business for the provider is submission of fee-for-service claims. Should the fee-for-service income during the specified period of time be less than the agreed to amount, a top-up amount is paid to the provider equal to the difference between the fee-for-service total and the guaranteed income amount for that period of time. The details of the agreement may specify (or not) a requirement for repayment to the payor in the event that the fee-for-service income exceeds the guaranteed amount.

active

_ActInvoiceDetailGenericProviderCode

5

FNLFEE

final fee

Anticipated or actual final fee associated with treating a patient.

active

_ActInvoiceDetailGenericProviderCode

5

FRSTFEE

first fee

Anticipated or actual initial fee associated with treating a patient.

active

_ActInvoiceDetailGenericProviderCode

5

MARKUP

markup or up-charge

An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.

active

_ActInvoiceDetailGenericProviderCode

5

MISSAPT

missed appointment

A charge to compensate the provider when a patient does not show for an appointment.

active

_ActInvoiceDetailGenericProviderCode

5

PERFEE

periodic fee

Anticipated or actual periodic fee associated with treating a patient. For example, expected billing cycle such as monthly, quarterly. The actual period (e.g. monthly, quarterly) is specified in the unit quantity of the Invoice Element.

active

_ActInvoiceDetailGenericProviderCode

5

PERMBNS

performance bonus

The amount for a performance bonus that is being requested from a payor for the performance of certain services (childhood immunizations, influenza immunizations, mammograms, pap smears) on a sliding scale. That is, for 90% of childhood immunizations to a maximum of $2200/yr. An invoice is created at the end of the service period (one year) and a code is submitted indicating the percentage achieved and the dollar amount claimed.

active

_ActInvoiceDetailGenericProviderCode

5

RESTOCK

restocking fee

A charge is requested because the patient failed to pick up the item and it took an amount of time to return it to stock for future use.

active

_ActInvoiceDetailGenericProviderCode

5

TRAVEL

travel

A charge to cover the cost of travel time and/or cost in conjuction with providing a service or product. It may be charged per kilometer or per hour based on the effective agreement.

active

_ActInvoiceDetailGenericProviderCode

5

URGENT

urgent

Premium paid on service fees in compensation for providing an expedited response to an urgent situation.

active

_ActInvoiceDetailGenericProviderCode

4

_ActInvoiceDetailTaxCode

ActInvoiceDetailTaxCode

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

active

true

_ActInvoiceDetailGenericCode

5

FST

federal sales tax

Federal tax on transactions such as the Goods and Services Tax (GST)

active

_ActInvoiceDetailTaxCode

5

HST

harmonized sales Tax

Joint Federal/Provincial Sales Tax

active

_ActInvoiceDetailTaxCode

5

PST

provincial/state sales tax

Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax

active

_ActInvoiceDetailTaxCode

3

_ActInvoiceDetailPreferredAccommodationCode

ActInvoiceDetailPreferredAccommodationCode

An identifying data string for medical facility accommodations.

active

true

_ActInvoiceDetailCode

4

_ActEncounterAccommodationCode

ActEncounterAccommodationCode

Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

accommodation

active

true

_ActInvoiceDetailPreferredAccommodationCode

5

_HL7AccommodationCode

HL7AccommodationCode

**Description:**Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

accommodation

active

true

_ActEncounterAccommodationCode

6

I

Isolation

Accommodations used in the care of diseases that are transmitted through casual contact or respiratory transmission.

active

_HL7AccommodationCode

6

P

Private

Accommodations in which there is only 1 bed.

active

_HL7AccommodationCode

6

S

Suite

Uniquely designed and elegantly decorated accommodations with many amenities available for an additional charge.

active

_HL7AccommodationCode

6

SP

Semi-private

Accommodations in which there are 2 beds.

active

_HL7AccommodationCode

6

W

Ward

Accommodations in which there are 3 or more beds.

active

_HL7AccommodationCode

5

_HCPCSAccommodationCode

HCPCSAccommodationCode

**Description:**External value set for accommodation types used in the U.S. Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

retired

true

_ActEncounterAccommodationCode

3

_ActInvoiceDetailClinicalServiceCode

ActInvoiceDetailClinicalServiceCode

An identifying data string for healthcare procedures.

retired

true

_ActInvoiceDetailCode

4

_CPT5

CPT5

**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

retired

true

_ActInvoiceDetailClinicalServiceCode, _ActProcedureCode

4

_HCPCS

HCPCS

**Description:**Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes are procedure identifying codes. HCPCS is Health Care Finance AdministrationaTMs (HFCA) coding scheme to group procedures performed for payment to providers. contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

retired

true

_ActInvoiceDetailClinicalServiceCode, _ActProcedureCode

4

_ICD10PCS

ICD10PCS

**Description:**International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) are procedure identifying codes. ICD-10-PCS describes the classification of inpatient procedures for statistical purposes.

retired

true

_ActInvoiceDetailClinicalServiceCode, _ActProcedureCode

4

_ICD9PCS

ICD9PCS

**Description:**International Classification of Diseases, 9th Revision, Procedure Coding System (ICD-9-PCS) are procedure identifying codes. ICD-9-PCS describes the classification of inpatient procedures for statistical purposes.

retired

true

_ActInvoiceDetailClinicalServiceCode, _ActProcedureCode

3

_ActInvoiceDetailOralHealthProcedureCode

ActInvoiceDetailOralHealthProcedureCode

An identifying data string for oral health procedure codes, e.g. extract tooth.

retired

true

_ActInvoiceDetailCode

2

_ActInvoiceGroupCode

ActInvoiceGroupCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

invoice element

active

true

_ActInvoiceElementCode

3

_ActInvoiceInterGroupCode

ActInvoiceInterGroupCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

The domain is only specified for an intermediate invoice element group (non-root or non-top level) for an Invoice.

invoice element

active

true

_ActInvoiceGroupCode

4

CPNDDRGING

compound drug invoice group

A grouping of invoice element groups and details including the ones specifying the compound ingredients being invoiced. It may also contain generic detail items such as markup.

active

_ActInvoiceInterGroupCode

4

CPNDINDING

compound ingredient invoice group

A grouping of invoice element details including the one specifying an ingredient drug being invoiced. It may also contain generic detail items such as tax or markup.

active

_ActInvoiceInterGroupCode

4

CPNDSUPING

compound supply invoice group

A grouping of invoice element groups and details including the ones specifying the compound supplies being invoiced. It may also contain generic detail items such as markup.

active

_ActInvoiceInterGroupCode

4

DRUGING

drug invoice group

A grouping of invoice element details including the one specifying the drug being invoiced. It may also contain generic detail items such as markup.

active

_ActInvoiceInterGroupCode

4

FRAMEING

frame invoice group

A grouping of invoice element details including the ones specifying the frame fee and the frame dispensing cost that are being invoiced.

active

_ActInvoiceInterGroupCode

4

LENSING

lens invoice group

A grouping of invoice element details including the ones specifying the lens fee and the lens dispensing cost that are being invoiced.

active

_ActInvoiceInterGroupCode

4

PRDING

product invoice group

A grouping of invoice element details including the one specifying the product (good or supply) being invoiced. It may also contain generic detail items such as tax or discount.

active

_ActInvoiceInterGroupCode

3

_ActInvoiceRootGroupCode

ActInvoiceRootGroupCode

Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

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

invoice element

active

true

_ActInvoiceGroupCode

4

CPINV

clinical product invoice

Clinical product invoice where the Invoice Grouping contains one or more billable item and is supported by clinical product(s).

For example, a crutch or a wheelchair.

active

CP

_ActInvoiceRootGroupCode

4

CP

clinical product invoice

Clinical product invoice where the Invoice Grouping contains one or more billable item and is supported by clinical product(s).

For example, a crutch or a wheelchair.

retired

CPINV

_ActInvoiceRootGroupCode

4

CSINV

clinical service invoice

Clinical Services Invoice which can be used to describe a single service, multiple services or repeated services.

[1] Single Clinical services invoice where the Invoice Grouping contains one billable item and is supported by one clinical service.

For example, a single service for an office visit or simple clinical procedure (e.g. knee mobilization).

[2] Multiple Clinical services invoice where the Invoice Grouping contains more than one billable item, supported by one or more clinical services. The services can be distinct and over multiple dates, but for the same patient. This type of invoice includes a series of treatments which must be adjudicated together.

For example, an adjustment and ultrasound for a chiropractic session where fees are associated for each of the services and adjudicated (invoiced) together.

[3] Repeated Clinical services invoice where the Invoice Grouping contains one or more billable item, supported by the same clinical service repeated over a period of time.

For example, the same Chiropractic adjustment (service or treatment) delivered on 3 separate occasions over a period of time at the discretion of the provider (e.g. month).

active

CS

_ActInvoiceRootGroupCode

4

CS

clinical service invoice

Clinical Services Invoice which can be used to describe a single service, multiple services or repeated services.

[1] Single Clinical services invoice where the Invoice Grouping contains one billable item and is supported by one clinical service.

For example, a single service for an office visit or simple clinical procedure (e.g. knee mobilization).

[2] Multiple Clinical services invoice where the Invoice Grouping contains more than one billable item, supported by one or more clinical services. The services can be distinct and over multiple dates, but for the same patient. This type of invoice includes a series of treatments which must be adjudicated together.

For example, an adjustment and ultrasound for a chiropractic session where fees are associated for each of the services and adjudicated (invoiced) together.

[3] Repeated Clinical services invoice where the Invoice Grouping contains one or more billable item, supported by the same clinical service repeated over a period of time.

For example, the same Chiropractic adjustment (service or treatment) delivered on 3 separate occasions over a period of time at the discretion of the provider (e.g. month).

retired

CSINV

_ActInvoiceRootGroupCode

4

CSPINV

clinical service and product

A clinical Invoice Grouping consisting of one or more services and one or more product. Billing for these service(s) and product(s) are supported by multiple clinical billable events (acts).

All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator.

For example , a brace (product) invoiced together with the fitting (service).

active

_ActInvoiceRootGroupCode

4

FININV

financial invoice

Invoice Grouping without clinical justification. These will not require identification of participants and associations from a clinical context such as patient and provider.

Examples are interest charges and mileage.

active

_ActInvoiceRootGroupCode

4

OHSINV

oral health service

A clinical Invoice Grouping consisting of one or more oral health services. Billing for these service(s) are supported by multiple clinical billable events (acts).

All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator.

active

_ActInvoiceRootGroupCode

4

PAINV

preferred accommodation invoice

HealthCare facility preferred accommodation invoice.

active

PA

_ActInvoiceRootGroupCode

4

PA

preferred accommodation invoice

HealthCare facility preferred accommodation invoice.

retired

PAINV

_ActInvoiceRootGroupCode

4

RXCINV

Rx compound invoice

Pharmacy dispense invoice for a compound.

active

RXC

_ActInvoiceRootGroupCode

4

RXC

Rx compound invoice

Pharmacy dispense invoice for a compound.

retired

RXCINV

_ActInvoiceRootGroupCode

4

RXDINV

Rx dispense invoice

Pharmacy dispense invoice not involving a compound

active

RXD

_ActInvoiceRootGroupCode

4

RXD

Rx dispense invoice

Pharmacy dispense invoice not involving a compound

retired

RXDINV

_ActInvoiceRootGroupCode

4

SBFINV

sessional or block fee invoice

Clinical services invoice where the Invoice Group contains one billable item for multiple clinical services in one or more sessions.

active

_ActInvoiceRootGroupCode

4

VRXINV

vision dispense invoice

Vision dispense invoice for up to 2 lens (left and right), frame and optional discount. Eye exams are invoiced as a clinical service invoice.

active

_ActInvoiceRootGroupCode

1

_ActInvoiceElementSummaryCode

ActInvoiceElementSummaryCode

Identifies the different types of summary information that can be reported by queries dealing with Statement of Financial Activity (SOFA). The summary information is generally used to help resolve balance discrepancies between providers and payors.

invoice element

active

true

2

_InvoiceElementAdjudicated

InvoiceElementAdjudicated

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

invoice element

active

true

_ActInvoiceElementSummaryCode

3

ADNFPPELAT

adjud. nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

active

ADCNPPELAT

_InvoiceElementAdjudicated

3

ADCNPPELAT

adjud. nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

retired

ADNFPPELAT

_InvoiceElementAdjudicated

3

ADNFPPELCT

adjud. nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

active

ADCNPPELCT

_InvoiceElementAdjudicated

3

ADCNPPELCT

adjud. nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

retired

ADNFPPELCT

_InvoiceElementAdjudicated

3

ADNFPPMNAT

adjud. nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

active

ADCNPPMNAT

_InvoiceElementAdjudicated

3

ADCNPPMNAT

adjud. nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

retired

ADNFPPMNAT

_InvoiceElementAdjudicated

3

ADNFPPMNCT

adjud. nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

active

ADCNPPMNCT

_InvoiceElementAdjudicated

3

ADCNPPMNCT

adjud. nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

retired

ADNFPPMNCT

_InvoiceElementAdjudicated

3

ADNFSPELAT

adjud. nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

active

ADCNSPELAT

_InvoiceElementAdjudicated

3

ADCNSPELAT

adjud. nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

retired

ADNFSPELAT

_InvoiceElementAdjudicated

3

ADNFSPELCT

adjud. nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

active

ADCNSPELCT

_InvoiceElementAdjudicated

3

ADCNSPELCT

adjud. nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

retired

ADNFSPELCT

_InvoiceElementAdjudicated

3

ADNFSPMNAT

adjud. nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

active

ADCNSPMNAT

_InvoiceElementAdjudicated

3

ADCNSPMNAT

adjud. nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

retired

ADNFSPMNAT

_InvoiceElementAdjudicated

3

ADNFSPMNCT

adjud. nullified same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

active

ADCNSPMNCT

_InvoiceElementAdjudicated

3

ADCNSPMNCT

adjud. nullified same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

retired

ADNFSPMNCT

_InvoiceElementAdjudicated

3

ADNPPPELAT

adjud. non-payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADNPPPELCT

adjud. non-payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADNPPPMNAT

adjud. non-payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADNPPPMNCT

adjud. non-payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADNPSPELAT

adjud. non-payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADNPSPELCT

adjud. non-payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADNPSPMNAT

adjud. non-payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADNPSPMNCT

adjud. non-payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADPPPPELAT

adjud. payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADPPPPELCT

adjud. payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADPPPPMNAT

adjud. payee payable prior-period manual amout

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADPPPPMNCT

adjud. payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADPPSPELAT

adjud. payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADPPSPELCT

adjud. payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADPPSPMNAT

adjud. payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADPPSPMNCT

adjud. payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADRFPPELAT

adjud. refused prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADRFPPELCT

adjud. refused prior-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADRFPPMNAT

adjud. refused prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADRFPPMNCT

adjud. refused prior-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADRFSPELAT

adjud. refused same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADRFSPELCT

adjud. refused same-period electronic count

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

active

_InvoiceElementAdjudicated

3

ADRFSPMNAT

adjud. refused same-period manual amount

Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

active

_InvoiceElementAdjudicated

3

ADRFSPMNCT

adjud. refused same-period manual count

Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

active

_InvoiceElementAdjudicated

2

_InvoiceElementPaid

InvoiceElementPaid

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

invoice element

active

true

_ActInvoiceElementSummaryCode

3

PDNFPPELAT

paid nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

active

PDCNPPELAT

_InvoiceElementPaid

3

PDCNPPELAT

paid nullified prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

retired

PDNFPPELAT

_InvoiceElementPaid

3

PDNFPPELCT

paid nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

active

PDCNPPELCT

_InvoiceElementPaid

3

PDCNPPELCT

paid nullified prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

retired

PDNFPPELCT

_InvoiceElementPaid

3

PDNFPPMNAT

paid nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

active

PDCNPPMNAT

_InvoiceElementPaid

3

PDCNPPMNAT

paid nullified prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

retired

PDNFPPMNAT

_InvoiceElementPaid

3

PDNFPPMNCT

paid nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

active

PDCNPPMNCT

_InvoiceElementPaid

3

PDCNPPMNCT

paid nullified prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

retired

PDNFPPMNCT

_InvoiceElementPaid

3

PDNFSPELAT

paid nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

active

PDCNSPELAT

_InvoiceElementPaid

3

PDCNSPELAT

paid nullified same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

retired

PDNFSPELAT

_InvoiceElementPaid

3

PDNFSPELCT

paid nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently cancelled in the specified period and submitted electronically.

active

PDCNSPELCT

_InvoiceElementPaid

3

PDCNSPELCT

paid nullified same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently cancelled in the specified period and submitted electronically.

retired

PDNFSPELCT

_InvoiceElementPaid

3

PDNFSPMNAT

paid nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

active

PDCNSPMNAT

_InvoiceElementPaid

3

PDCNSPMNAT

paid nullified same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

retired

PDNFSPMNAT

_InvoiceElementPaid

3

PDNFSPMNCT

paid nullified same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

active

PDCNSPMNCT

_InvoiceElementPaid

3

PDCNSPMNCT

paid nullified same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

retired

PDNFSPMNCT

_InvoiceElementPaid

3

PDNPPPELAT

paid non-payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementPaid

3

PDNPPPELCT

paid non-payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementPaid

3

PDNPPPMNAT

paid non-payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementPaid

3

PDNPPPMNCT

paid non-payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementPaid

3

PDNPSPELAT

paid non-payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementPaid

3

PDNPSPELCT

paid non-payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

active

_InvoiceElementPaid

3

PDNPSPMNAT

paid non-payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementPaid

3

PDNPSPMNCT

paid non-payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

active

_InvoiceElementPaid

3

PDPPPPELAT

paid payee payable prior-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementPaid

3

PDPPPPELCT

paid payee payable prior-period electronic count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementPaid

3

PDPPPPMNAT

paid payee payable prior-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementPaid

3

PDPPPPMNCT

paid payee payable prior-period manual count

Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementPaid

3

PDPPSPELAT

paid payee payable same-period electronic amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementPaid

3

PDPPSPELCT

paid payee payable same-period electronic count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

active

_InvoiceElementPaid

3

PDPPSPMNAT

paid payee payable same-period manual amount

Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementPaid

3

PDPPSPMNCT

paid payee payable same-period manual count

Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

active

_InvoiceElementPaid

2

_InvoiceElementSubmitted

InvoiceElementSubmitted

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

invoice element

active

true

_ActInvoiceElementSummaryCode

3

SBBLELAT

submitted billed electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

active

SBBLAT

_InvoiceElementSubmitted

3

SBBLAT

submitted billed electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

retired

SBBLELAT

_InvoiceElementSubmitted

3

SBBLELCT

submitted billed electronic count

Identifies the total number of submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

active

SBBLCT

_InvoiceElementSubmitted

3

SBBLCT

submitted billed electronic count

Identifies the total number of submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

retired

SBBLELCT

_InvoiceElementSubmitted

3

SBNFELAT

submitted nullified electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

active

SBCNAT

_InvoiceElementSubmitted

3

SBCNAT

submitted nullified electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

retired

SBNFELAT

_InvoiceElementSubmitted

3

SBNFELCT

submitted cancelled electronic count

Identifies the total number of submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

active

SBCNCT

_InvoiceElementSubmitted

3

SBCNCT

submitted cancelled electronic count

Identifies the total number of submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

retired

SBNFELCT

_InvoiceElementSubmitted

3

SBPDELAT

submitted pending electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

active

SBPDAT

_InvoiceElementSubmitted

3

SBPDAT

submitted pending electronic amount

Identifies the total net amount billed for all submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

retired

SBPDELAT

_InvoiceElementSubmitted

3

SBPDELCT

submitted pending electronic count

Identifies the total number of submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

active

SBPDCT

_InvoiceElementSubmitted

3

SBPDCT

submitted pending electronic count

Identifies the total number of submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

retired

SBPDELCT

_InvoiceElementSubmitted

1

_ActInvoiceOverrideCode

ActInvoiceOverrideCode

Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

invoice element

active

true

2

COVGE

coverage problem

Insurance coverage problems have been encountered. Additional explanation information to be supplied.

active

_ActInvoiceOverrideCode

2

EFORM

electronic form to follow

Electronic form with supporting or additional information to follow.

active

_ActInvoiceOverrideCode

2

FAX

fax to follow

Fax with supporting or additional information to follow.

active

_ActInvoiceOverrideCode

2

GFTH

good faith indicator

The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered.

active

_ActInvoiceOverrideCode

2

LATE

late invoice

Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied.

active

_ActInvoiceOverrideCode

2

MANUAL

manual review

Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.

active

_ActInvoiceOverrideCode

2

OOJ

out of jurisdiction

The medical service and/or product was provided to a patient that has coverage in another jurisdiction.

active

_ActInvoiceOverrideCode

2

ORTHO

orthodontic service

The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.

active

_ActInvoiceOverrideCode

2

PAPER

paper documentation to follow

Paper documentation (or other physical format) with supporting or additional information to follow.

active

_ActInvoiceOverrideCode

2

PIE

public insurance exhausted

Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission.

active

_ActInvoiceOverrideCode

2

PYRDELAY

delayed by a previous payor

Allows provider to explain lateness of invoice to a subsequent payor.

active

_ActInvoiceOverrideCode

2

REFNR

referral not required

Rules of practice do not require a physician's referral for the provider to perform a billable service.

active

_ActInvoiceOverrideCode

2

REPSERV

repeated service

The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate.

active

_ActInvoiceOverrideCode

2

UNRELAT

unrelated service

The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items.

active

_ActInvoiceOverrideCode

2

VERBAUTH

verbal authorization

The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.

active

_ActInvoiceOverrideCode

1

_ActListCode

ActListCode

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

working list

active

true

2 | _ActObservationList | ActObservationList | | working list | active | true | | | _ActListCode

3

CARELIST

care plan

List of acts representing a care plan. The acts can be in a varierty of moods including event (EVN) to record acts that have been carried out as part of the care plan.

active

_ActObservationList

3

CONDLIST

condition list

List of condition observations.

active

_ActObservationList

4

INTOLIST

intolerance list

List of intolerance observations.

active

CONDLIST

4

PROBLIST

problem list

List of problem observations.

active

CONDLIST

4

RISKLIST

risk factors

List of risk factor observations.

active

CONDLIST

3

GOALLIST

goal list

List of observations in goal mood.

active

_ActObservationList

2

_ActTherapyDurationWorkingListCode

ActTherapyDurationWorkingListCode

Codes used to identify different types of 'duration-based' working lists. Examples include "Continuous/Chronic", "Short-Term" and "As-Needed".

working list

active

true

_ActListCode

3

_ActMedicationTherapyDurationWorkingListCode

act medication therapy duration working list

**Definition:**A collection of concepts that identifies different types of 'duration-based' mediation working lists.

Examples:"Continuous/Chronic" "Short-Term" and "As Needed"

working list

active

true

_ActTherapyDurationWorkingListCode

4

ACU

short term/acute

**Definition:**A list of medications which the patient is only expected to consume for the duration of the current order or limited set of orders and which is not expected to be renewed.

active

_ActMedicationTherapyDurationWorkingListCode

4

CHRON

continuous/chronic

**Definition:**A list of medications which are expected to be continued beyond the present order and which the patient should be assumed to be taking unless explicitly stopped.

active

_ActMedicationTherapyDurationWorkingListCode

4

ONET

one time

**Definition:**A list of medications which the patient is intended to be administered only once.

active

_ActMedicationTherapyDurationWorkingListCode

4

PRN

as needed

**Definition:**A list of medications which the patient will consume intermittently based on the behavior of the condition for which the medication is indicated.

active

_ActMedicationTherapyDurationWorkingListCode

2

MEDLIST

medication list

List of medications.

active

_ActListCode

3

CURMEDLIST

current medication list

List of current medications.

active

MEDLIST

3

DISCMEDLIST

discharge medication list

List of discharge medications.

active

MEDLIST

3

HISTMEDLIST

medication history

Historical list of medications.

active

MEDLIST

2

_ActProcedureCategoryList

ActProcedureCategoryList

**Description:**Describes the high level classification of professional services for grouping.

**Examples:**Education, Counseling, Surgery, etc.

retired

true

_ActListCode

1

_ActMonitoringProtocolCode

ActMonitoringProtocolCode

Identifies types of monitoring programs

monitoring program

active

true

2

CTLSUB

Controlled Substance

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

active

_ActMonitoringProtocolCode

3

_DEADrugSchedule

DEADrugSchedule

DEA schedule for a drug.

retired

true

CTLSUB

2

INV

investigational

**Definition:**A monitoring program that focuses on a drug which is under investigation and has not received regulatory approval for the condition being investigated

active

_ActMonitoringProtocolCode

2

LU

limited use

**Description:**A drug that can be prescribed (and reimbursed) only if it meets certain criteria.

active

_ActMonitoringProtocolCode

2

OTC

non prescription medicine

Medicines designated in this way may be supplied for patient use without a prescription. The exact form of categorisation will vary in different realms.

active

_ActMonitoringProtocolCode

2

RX

prescription only medicine

Some form of prescription is required before the related medicine can be supplied for a patient. The exact form of regulation will vary in different realms.

active

_ActMonitoringProtocolCode

2

SA

special authorization

**Definition:**A drug that requires prior approval (to be reimbursed) before being dispensed

active

_ActMonitoringProtocolCode

2

SAC

special access

**Description:**A drug that requires special access permission to be prescribed and dispensed.

active

_ActMonitoringProtocolCode

1

_ActNonObservationIndicationCode

ActNonObservationIndicationCode

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

act

active

true

2

IND01

imaging study requiring contrast

**Description:**Contrast agent required for imaging study.

active

_ActNonObservationIndicationCode

2

IND02

colonoscopy prep

**Description:**Provision of prescription or direction to consume a product for purposes of bowel clearance in preparation for a colonoscopy.

active

_ActNonObservationIndicationCode

2

IND03

prophylaxis

**Description:**Provision of medication as a preventative measure during a treatment or other period of increased risk.

active

_ActNonObservationIndicationCode

2

IND04

surgical prophylaxis

**Description:**Provision of medication during pre-operative phase; e.g., antibiotics before dental surgery or bowel prep before colon surgery.

active

_ActNonObservationIndicationCode

2

IND05

pregnancy prophylaxis

**Description:**Provision of medication for pregnancy --e.g., vitamins, antibiotic treatments for vaginal tract colonization, etc.

active

_ActNonObservationIndicationCode

1

_ActObservationVerificationType

act observation verification

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

Examples:

1. Verification of eligibility for coverage under a policy or program - aka enrolled/covered by a policy or program

2. Verification of record - e.g., person has record in an immunization registry

3. Verification of enumeration - e.g. NPI

4. Verification of Board Certification - provider specific

5. Verification of Certification - e.g. JAHCO, NCQA, URAC

6. Verification of Conformance - e.g. entity use with HIPAA, conformant to the CCHIT EHR system criteria

7. Verification of Provider Credentials

8. Verification of no adverse findings - e.g. on National Provider Data Bank, Health Integrity Protection Data Base (HIPDB)

Verification

active

true

2

VFPAPER

verify paper

**Definition:**Indicates that the paper version of the record has, should be or is being verified against the electronic version.

active

VRFPAPER

_ActObservationVerificationType

2

VRFPAPER

verify paper

**Definition:**Indicates that the paper version of the record has, should be or is being verified against the electronic version.

active

VFPAPER

_ActObservationVerificationType

1

_ActPaymentCode

ActPaymentCode

Code identifying the method or the movement of payment instructions.

Codes are drawn from X12 data element 591 (PaymentMethodCode)

financial transaction

active

true

2

ACH

Automated Clearing House

Automated Clearing House (ACH).

active

_ActPaymentCode

2

CHK

Cheque

A written order to a bank to pay the amount specified from funds on deposit.

active

_ActPaymentCode

2

DDP

Direct Deposit

Electronic Funds Transfer (EFT) deposit into the payee's bank account

active

_ActPaymentCode

2

NON

Non-Payment Data

Non-Payment Data.

active

_ActPaymentCode

1

_ActPharmacySupplyType

ActPharmacySupplyType

Identifies types of dispensing events

supply

active

true

2

DF

Daily Fill

A fill providing sufficient supply for one day

active

_ActPharmacySupplyType, RF

2

EM

Emergency Supply

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

active

_ActPharmacySupplyType

3

SO

Script Owing

An emergency supply where the expectation is that a formal order authorizing the supply will be provided at a later date.

active

EM

2

FF

First Fill

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

active

_ActPharmacySupplyType

3

FFC

First Fill - Complete

A first fill 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).

active

FF

4 | FFCS | first fill complete, partial strength |

3

FFP

First Fill - Part Fill

A first fill 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.)

active

FF

3

FFSS

first fill, partial strength

A first fill 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).

active

FF

4 | FFPS | first fill, part fill, partial strength |
4 | FFCS | first fill complete, partial strength |
4 | TFS | trial fill partial strength |

3

TF

Trial Fill

A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance.

active

FF

4 | TFS | trial fill partial strength |
3 | FFS | fee for service |
3 | FFPS | first fill, part fill, partial strength |

2

FS

Floor stock

A supply action to restock a smaller more local dispensary.

active

_ActPharmacySupplyType

2

MS

Manufacturer Sample

A supply of a manufacturer sample

active

_ActPharmacySupplyType

2

RF

Refill

A fill against an order that has already been filled (or partially filled) at least once.

active

_ActPharmacySupplyType

3

RFC

Refill - Complete

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.)

active

RF

4

RFCS

refill complete partial strength

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).

active

RFC

3

RFF

Refill (First fill this facility)

The first fill against an order that has already been filled at least once at another facility.

active

RF

4

RFFS

refill partial strength (first fill this facility)

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).

active

RFF

3

RFP

Refill - Part Fill

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.)

active

RF

4

RFPS

refill part fill partial strength

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).

active

RFP

3

RFS

refill partial strength

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).

active

RF

3

TB

Trial Balance

A fill where the remainder of a 'complete' fill is provided after a trial fill has been provided.

active

RF

4

TBS

trial balance partial strength

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).

active

TB

3 | DF | Daily Fill |
3 | UD | Unit Dose |

2

UD

Unit Dose

A supply action that provides sufficient material for a single dose.

active

_ActPharmacySupplyType, RF

2

UDE

unit dose equivalent

A supply action that provides sufficient material for a single dose via multiple products. E.g. 2 50mg tablets for a 100mg unit dose.

active

_ActPharmacySupplyType

1

_ActPolicyType

ActPolicyType

A mandate, regulation, obligation, principle, requirement, rule, or expectation of how an entity is to conduct itself or execute an activity, which may be dictated and enforced by an authority of competent jurisdiction.

policy

active

true

2

_ActConsent

_ActConsent

Specifies the type or actual definition of a contractually binding agreement or a non-binding representation of that agreement between a grantor and a grantee as to the exchange of the grantee's considerations in return for the grantor's control of certain assets. The type of assets exchanged include rights, license, terms of service, valued items, information and real property assets and control over such assets such as physical and locatable property; intellectual property; biospecimen; genomic and genetic information related to an individual including that disclosed by genetically related individuals with or without the individual's consent; personal identifiable, pseudonymized, anonymized, de-identified per some rubric, and relinkable variants.

Usage Note: Types or actual definitions of a contractually binding agreement or a non-binding representation of that agreement include:

_ActDecision (formally ActConsentDirective), which specifies the type of decision made by the grantor. The decision types are mapped to ISO/TS 17975 Health informatics - Principles and data requirements for consent in the Collection, Use or Disclosure of personal health information;

_ActPrivacyConsentDirective, which is the parent of types of registry participation consent directives, and of realm specific privacy consent directive policies such as _USPrivacyConsentDirective and _GDPRPrivacyConsentDirective.

active

_ActPolicyType

3

_ActDecision

_ActDecision

Specifies the type of agreement between one or more grantor and grantee in which rights and obligations related to one or more shared items of interest are allocated.

Usage Note: Such agreements may be considered "consent directives" or "contracts" depending on the context, and are considered closely related or synonymous from a legal perspective.

Examples:

Healthcare Privacy Consent Directive permitting or restricting in whole or part the collection, access, use, and disclosure of health information, and any associated handling caveats.

Healthcare Medical Consent Directive to receive medical procedures after being informed of risks and benefits, thereby reducing the grantee's liability.

Research Informed Consent for participation in clinical trials and disclosure of health information after being informed of risks and benefits, thereby reducing the grantee's liability.

Substitute decision maker delegation in which the grantee assumes responsibility to act on behalf of the grantor.

Contracts in which the agreement requires assent/dissent by the grantor of terms offered by a grantee, a consumer opts out of an "award" system for use of a retailer's marketing or credit card vendor's point collection cards in exchange for allowing purchase tracking and profiling.

A mobile device or App privacy policy and terms of service to which a user must agree in whole or in part in order to utilize the service.

Agreements between a client and an authorization server or between an authorization server and a resource operator and/or resource owner permitting or restricting e.g., collection, access, use, and disclosure of information, and any associated handling caveats.

active

true

_ActConsent

4

GRANTORCHOICE

grantor choice

A grantor's terms of agreement to which a grantee may assent or dissent, and which may include an opportunity for a grantee to request restrictions or extensions.

Comment: A grantor typically is able to stipulate preferred terms of agreement when the grantor has control over the topic of the agreement, which a grantee must accept in full or may be offered an opportunity to extend or restrict certain terms.

Usage Note: If the grantor's term of agreement must be accepted in full, then this is considered "basic consent". If a grantee is offered an opportunity to extend or restrict certain terms, then the agreement is considered "granular consent".

Examples:

Healthcare: A PHR account holder [grantor] may require any PHR user [grantee] to accept the terms of agreement in full, or may permit a PHR user to extend or restrict terms selected by the account holder or requested by the PHR user.

Non-healthcare: The owner of a resource server [grantor] may require any authorization server [grantee] to meet authorization requirements stipulated in the grantor's terms of agreement.

active

_ActConsentDirective, _ActDecision

4

IMPLIED

implied consent

A grantor's presumed assent to the grantee's terms of agreement is based on the grantor's behavior, which may result from not expressly assenting to the consent directive offered, or from having no right to assent or dissent offered by the grantee.

Comment: Implied or "implicit" consent occurs when the behavior of the grantor is understood by a reasonable person to signal agreement to the grantee's terms.

Usage Note: Implied consent with no opportunity to assent or dissent to certain terms is considered "basic consent".

Examples:

Healthcare: A patient schedules an appointment with a provider, and either does not take the opportunity to expressly assent or dissent to the provider's consent directive, does not have an opportunity to do so, as in the case where emergency care is required, or simply behaves as though the patient [grantor] agrees to the rights granted to the provider [grantee] in an implicit consent directive.

An injured and unconscious patient is deemed to have assented to emergency treatment by those permitted to do so under jurisdictional laws, e.g., Good Samaritan laws.

Non-healthcare: Upon receiving a driver's license, the driver is deemed to have assented without explicitly consenting to undergoing field sobriety tests.

A corporation that does business in a foreign nation is deemed to have deemed to have assented without explicitly consenting to abide by that nation's laws.

active

_ActConsentDirective, _ActDecision

4

IMPLIEDD

implied consent with opportunity to dissent

A grantor's presumed assent to the grantee's terms of agreement, which is based on the grantor's behavior, and includes a right to dissent to certain terms.

Comment: A grantor assenting to the grantee's terms of agreement may or may not exercise a right to dissent to grantor selected terms or to grantee's selected terms to which a grantor may dissent.

Usage Note: Implied or "implicit" consent with an "opportunity to dissent" occurs when the grantor's behavior is understood by a reasonable person to signal assent to the grantee's terms of agreement whether the grantor requests or the grantee approves further restrictions, is considered "granular consent".

Examples:

Healthcare Examples: A healthcare provider deems a patient's assent to disclosure of health information to family members and friends, but offers an opportunity or permits the patient to dissent to such disclosures.

A health information exchanges deems a patient to have assented to disclosure of health information for treatment purposes, but offers the patient an opportunity to dissents to disclosure to particular provider organizations.

Non-healthcare Examples: A bank deems a banking customer's assent to specified collection, access, use, or disclosure of financial information as a requirement of holding a bank account, but provides the user an opportunity to limit third-party collection, access, use or disclosure of that information for marketing purposes.

active

_ActConsentDirective, _ActDecision

4

NOCONSENT

no consent

No notification or opportunity is provided for a grantor to assent or dissent to a grantee's terms of agreement.

Comment: A "No Consent" policy scheme provides no opportunity for accommodation of an individual's preferences, and may not comply with Fair Information Practice Principles [FIPP] by enabling the data subject to object, access collected information, correct errors, or have accounting of disclosures.

Usage Note: The grantee's terms of agreement, may be available to the grantor by reviewing the grantee's privacy policies, but there is no notice by which a grantor is apprised of the policy directly or able to acknowledge.

Examples:

Healthcare: Without notification or an opportunity to assent or dissent, a patient's health information is automatically included in and available (often according to certain rules) through a health information exchange. Note that this differs from implied consent, where the patient is assumed to have consented.

Without notification or an opportunity to assent or dissent, a patient's health information is collected, accessed, used, or disclosed for research, public health, security, fraud prevention, court order, or law enforcement.

Non-healthcare: Without notification or an opportunity to assent or dissent, a consumer's healthcare or non-healthcare internet searches are aggregated for secondary uses such as behavioral tracking and profiling.

Without notification or an opportunity to assent or dissent, a consumer's location and activities in a shopping mall are tracked by RFID tags on purchased items.

active

_ActConsentDirective, _ActDecision

4

OPTIN

opt-in

A grantor's assent to the terms of an agreement offered by a grantee without an opportunity for to dissent to any terms.

Comment: Acceptance of a grantee's terms pertaining, for example, to permissible activities, purposes of use, handling caveats, expiry date, and revocation policies.

Usage Note: Opt-in with no opportunity for a grantor to restrict certain permissions sought by the grantee is considered "basic consent".

Examples:

Healthcare: A patient [grantor] signs a provider's [grantee's] consent directive form, which lists permissible collection, access, use, or disclosure activities, purposes of use, handling caveats, and revocation policies.

Non-healthcare: An employee [grantor] signs an employer's [grantee's] non-disclosure and non-compete agreement.

active

_ActConsentDirective, _ActDecision

4

OPTINR

opt-in with restrictions

A grantor's assent to the grantee's terms of an agreement with an opportunity for to dissent to certain grantor or grantee selected terms.

Comment: A grantor dissenting to the grantee's terms of agreement may or may not exercise a right to assent to grantor's pre-approved restrictions or to grantee's selected terms to which a grantor may dissent.

Usage Note: Opt-in with restrictions is considered "granular consent" because the grantor has an opportunity to narrow the permissions sought by the grantee.

Examples:

Healthcare: A patient assent to grantee's consent directive terms for collection, access, use, or disclosure of health information, and dissents to disclosure to certain recipients as allowed by the provider's pre-approved restriction list.

Non-Healthcare: A cell phone user assents to the cell phone's privacy practices and terms of use, but dissents from location tracking by turning off the cell phone's tracking capability.

active

_ActConsentDirective, _ActDecision

4

OPTOUT

op-out

A grantor's dissent to the terms of agreement offered by a grantee without an opportunity for to assent to any terms.

Comment: Rejection of a grantee's terms of agreement pertaining, for example, to permissible activities, purposes of use, handling caveats, expiry date, and revocation policies.

Usage Note: Opt-out with no opportunity for a grantor to permit certain permissions sought by the grantee is considered "basic consent".

Examples:

Healthcare: A patient [grantor] declines to sign a provider's [grantee's] consent directive form, which lists permissible collection, access, use, or disclosure activities, purposes of use, handling caveats, revocation policies, and consequences of not assenting.

Non-healthcare: An employee [grantor] refuses to sign an employer's [grantee's] agreement not to join unions or participate in a strike where state law protects employee's collective bargaining rights.

A citizen [grantor] refuses to enroll in mandatory government [grantee] health insurance based on religious beliefs, which is an exemption.

active

_ActConsentDirective, _ActDecision

4

OPTOUTE

opt-out with exceptions

A grantor's dissent to the grantee's terms of agreement except for certain grantor or grantee selected terms.

Comment: A rejection of a grantee's terms of agreement while assenting to certain permissions sought by the grantee or requesting approval of additional grantor terms.

Usage Note: Opt-out with exceptions is considered a "granular consent" because the grantor has an opportunity to accept certain permissions sought by the grantee or request additional grantor terms, while rejecting other grantee terms.

Examples:

Healthcare: A patient [grantor] dissents to a health information exchange consent directive with the exception of disclosure based on a limited "time to live" shared secret [e.g., a token or password], which the patient can give to a provider when seeking care.

Non-healthcare: A social media user [grantor] dissents from public access to their account, but assents to access to a circle of friends.

active

_ActConsentDirective, _ActDecision

3

_ActPrivacyConsentDirective

_ActPrivacyConsentDirective

Specifies types of consent directives governing the collection, access, use, or disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual.

active

true

_ActConsent

4

_ActGDPRConsentDirective

_ActGDPRConsentDirective

European Union General Data Protection Regulation (GDPR) consent directives.

active

true

_ActPrivacyConsentDirective

5

GDPRCD

GDPR Consent Directive

A consent directive compliant with the European Union General Data Protection Regulation (GDPR) definition: Consent of the data subject means any freely given, specific, informed and unambiguous indication of the data subject's wishes by which he or she, by a statement or by a clear affirmative action, signifies agreement to the processing of personal data relating to him or her.

Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Consent should be given by a clear affirmative act establishing a freely given, specific, informed and unambiguous indication of the data subject's agreement to the processing of personal data relating to him or her, such as by a written statement, including by electronic means, or an oral statement. This could include ticking a box when visiting an internet website, choosing technical settings for information society services or another statement or conduct which clearly indicates in this context the data subject's acceptance of the proposed processing of his or her personal data. Silence, pre-ticked boxes or inactivity should not therefore constitute consent. Consent should cover all processing activities carried out for the same purpose or purposes. When the processing has multiple purposes, consent should be given for all of them. If the data subject's consent is to be given following a request by electronic means, the request must be clear, concise and not unnecessarily disruptive to the use of the service for which it is provided.

Usage Note: Article 4.11 GDPR Definitions https://gdpr-info.eu/art-4-gdpr/ 11) 'Consent' of the data subject means any freely given, specific, informed and unambiguous indication of the data subject's wishes by which he or she, by a statement or by a clear affirmative action, signifies agreement to the processing of personal data relating to him or her. Article 7 GDPR Conditions for consent https://gdpr-info.eu/art-7-gdpr Recital 32 Conditions for consent* https://gdpr-info.eu/recitals/no-32 Recital 42 Burden of proof and requirements for consent* https://gdpr-info.eu/recitals/no-42/> Recital 43 Freely given consent* https://gdpr-info.eu/recitals/no-43 GDPR Consent Brief https://gdpr-info.eu/issues/consent/ Art. 4 GDPR Definitions Art. 6 GDPR Lawfulness of processing Art. 7 GDPR Conditions for consent Art. 8 GDPR Conditions applicable to child's consent in relation to information society services Art. 9 GDPR Processing of special categories of personal data Art. 22 GDPR Automated individual decision-making, including profiling Art. 49 GDPR Derogations for specific situations

Relevant GDPR Recitals: (32) Conditions for consent (33) Consent to certain areas of scientific research (38) Special protection of children's personal data (40) Lawfulness of data processing (42) Burden of proof and requirements for consent (43) Freely given consent (50) Further processing of personal data (51) Protecting sensitive personal data (54) Processing of sensitive data in public health sector (71) Profiling (111) Exceptions for certain cases of international transfers (155) Processing in the employment context (161) Consenting to the participation in clinical trials (171) Repeal of Directive 95/46/EC and transitional provisions

active

_ActGDPRConsentDirective

5

GDPRResearchCD

GDPR Research Consent Directive

A consent directive that complies with regulatory requirements for a consent directive compliant with the European Union General Data Protection Regulation (GDPR) definition: Consent of the data subject means any freely given, specific, informed and unambiguous indication of the data subject's wishes by which he or she, by a statement or by a clear affirmative action, signifies agreement to the processing of personal data relating to him or her.

GDPR research consent directive has the additional caveat that it is often not possible to fully identify the purpose of personal data processing for scientific research purposes at the time of data collection. Therefore, data subjects should be allowed to give their consent to certain areas of scientific research when in keeping with recognized ethical standards for scientific research. Data subjects should have the opportunity to give their consent only to certain areas of research or parts of research projects to the extent allowed by the intended purpose.

Usage Note: HL7 Purpose of Use codes include specialize research purposes of use, which could be used to convey a data subject's purpose of use restrictions related to areas of research or parts of research projects. See citations for GDPRResearchCD and below: Recital 33 Consent to certain areas of scientific research https://gdpr-info.eu/recitals/no-33/> Recital 157 Information from registries and scientific research https://gdpr-info.eu/recitals/no-157 Recital 159 Processing for scientific research purposes* https://gdpr-info.eu/recitals/no-159/

active

_ActGDPRConsentDirective

4

_ActGenericConsentDirective

_ActGenericConsentDirective

Specifies types of consent directives authorizing a registry or repository to collect and, under certain terms, manage the access, use, and disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual.

Registries governed by registry consent directives are data management systems, which use metadata to support the collection, access, use, and disclosure of personal information or effects as well as observational or analytic information generated about personal information or effects stored in federated repositories. Such registries are used for a variety of purposes by federated health information exchanges, health information systems, personal record systems, and research organizations to locate and retrieve personal information or effects as well as observational or analytic information generated about personal information stored externally to their systems.

Repositories governed by registry consent directives are data stores used to collect, access, use, and disclose personal information or effects as well as observational or analytic information generated about personal information or effects and metadata used to manage the repository contents. Such repositories are used for a variety of purposes by centralized health information exchanges, health information systems used by providers and payers, personal record systems, and research organizations. A repository typically includes a registry component that provides the data store with content management capabilities for internal purposes. A repository may also interface with one or more external registries, which provide federated content management.

active

true

_ActPrivacyConsentDirective

5

OIC

opt-in to personal information or effect collection in a registry or repository

An expressed privacy consent directive permitting the collection of a some or all personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

Usage Note: Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-in to collection of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" consent directive maps to ISO/TS 17975:2015(E) definitions for "Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care" and "Opt-in".

active

_ActGenericConsentDirective

5

OIS

opt-in to personal information or effect sharing via a registry or repository

An expressed privacy consent directive permitting access, use, or disclosure of a some or all personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

Usage Note: Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-in to access, use, or disclosure of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" consent directive maps to ISO/TS 17975:2015(E) Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care and "Opt-in".

active

_ActGenericConsentDirective

5

OOC

opt-out of personal information or effect collection in a registry or repository

An expressed privacy consent directive restricting or prohibiting collection of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

Usage Note: Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-out of access, use, or disclosure of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" opt-out to collection consent directive maps to ISO/TS 17975:2015(E) definitions for "Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care" and "Express or Expressed (and Informed) Denial".

active

_ActGenericConsentDirective

5

OOS

opt-out of personal information or effect sharing via a registry or repository

An expressed privacy consent directive restricting or prohibiting access, use, or disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

Usage Note: Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-out of access, use, or disclosure of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" opt-out to sharing consent directive maps to ISO/TS 17975:2015(E) definitions for "Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care" and "Express or Expressed (and Informed) Denial".

active

_ActGenericConsentDirective

4

_ActUSPrivacyConsentDirective

_ActUSPrivacyConsentDirective

Specific US privacy consent directives in accordance with US federal, state, regional, organizational, or personal privacy policies.

active

true

_ActPrivacyConsentDirective

5

42CFRPart2CD

42 CFR Part 2 consent directive

A code representing an individual's privacy consent directive that complies with 42 CFR Part 2.31 Consent requirements https://www.gpo.gov/fdsys/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-31.pdf, which is a US Federal law stipulating the policy elements of a written consent to a disclosure under the regulations in Part 2.

(1) The name of the patient. (2) The specific name(s) or general designation(s) of the part 2 program(s), entity(ies), or individual(s) permitted to make the disclosure. (3) How much and what kind of information is to be disclosed, including an explicit description of the substance use disorder information that may be disclosed. (4) (i) The name(s) of the individual(s) to whom a disclosure is to be made; or (ii)Entities with a treating provider relationship with the patient. If the recipient entity has a treating provider relationship with the patient whose information is being disclosed, such as a hospital, a health care clinic, or a private practice, the name of that entity; or (iii)Entities without a treating provider relationship with the patient. (A) If the recipient entity does not have a treating provider relationship with the patient whose information is being disclosed and is a third-party payer, the name of the entity; or (B) If the recipient entity does not have a treating provider relationship with the patient whose information is being disclosed and is not covered by paragraph (a)(4)(iii)(A) of this section, such as an entity that facilitates the exchange of health information or a research institution, the name(s) of the entity(-ies); and (1) The name(s) of an individual participant(s); or (2) The name(s) of an entity participant(s) that has a treating provider relationship with the patient whose information is being disclosed; or (3) A general designation of an individual or entity participant(s) or class of participants that must be limited to a participant(s) who has a treating provider relationship with the patient whose information is being disclosed. (i) When using a general designation, a statement must be included on the consent form that the patient (or other individual authorized to sign in lieu of the patient), confirms their understanding that, upon their request and consistent with this part, they must be provided a list of entities to which their information has been disclosed pursuant to the general designation (see Section 2.13(d)). (ii) [Reserved] (5) The purpose of the disclosure. In accordance with Section 2.13(a), the disclosure must be limited to that information which is necessary to carry out the stated purpose. (6) A statement that the consent is subject to revocation at any time except to the extent that the part 2 program or other lawful holder of patient identifying information that is permitted to make the disclosure has already acted in reliance on it. Acting in reliance includes the provision of treatment services in reliance on a valid consent to disclose information to a third-party payer (7) The date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must ensure that the consent will last no longer than reasonably necessary to serve the purpose for which it is provided. (8) The signature of the patient and, when required for a patient who is a minor, the signature of an individual authorized to give consent under Section 2.14; or, when required for a patient who is incompetent or deceased, the signature of an individual authorized to sign under Section 2.15. Electronic signatures are permitted to the extent that they are not prohibited by any applicable law. (9) The date on which the consent is signed.

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's 42 CFR Part 2.31 consent directive, "42CFRPart2CD" as the security label policy code.

Since information governed by an individual's 42 CFR Part 2.31 consent directive has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Â§ 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

active

_ActUSPrivacyConsentDirective

5

CompoundResearchCD

Compound HIPAA Research Authorization and Informed Consent for Research

A code representing an individual's consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section specific to disclosures for purposes of research when combined with a Common Rule or Federal Drug Administration consent to participate in research also known as a compound authorization.

Usage Note: The Agency for Healthcare Research and Quality (AHRQ) has developed the Informed Consent and Authorization Toolkit for Minimal Risk Research to facilitate the process of obtaining informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization from potential research subjects. This toolkit contains information for people responsible for ensuring that potential research subjects are informed in a manner that is consistent with medical ethics and regulatory guidelines. From https://www.ahrq.gov/sites/default/files/publications/files/ictoolkit.pdf.

Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's right of access directive under 45 CFR Section 164.508 use "CompoundResearchCD" as the security label policy code.

Information or biospecimen disclosed under the Common Rule are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code "M" (moderate).

See ActCode._ActPolicyType._ActPrivacyPolicy._ActPrivacyLaw._ActUSPrivacyLaw.HIPAAAuth (HIPAA Authorization for Disclosure). See: HIPAAAuth and NIH Sample Authorization Language for Research Uses and Disclosures of Individually Identifiable Health Information by a Covered Health Care Provider https://privacyruleandresearch.nih.gov/authorization.asp

active

_ActUSPrivacyConsentDirective

5

HIPAAAuthCD

HIPAA Authorization Consent Directive

A code representing an individual's consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section.

An "authorization" is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. Where the Privacy Rule requires patient authorization, voluntary consent is not sufficient to permit a use or disclosure of protected health information unless it also satisfies the requirements of a valid authorization. An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization. https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html

A HIPAA Authorization must comply with 45 CFR Section164.508(c) Implementation specifications: Core elements and requirements - (1) Core elements. A valid authorization under this Section must contain at least the following elements: (i) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion. (ii) The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure. (iii) The name or other specific identification of the person(s), or class of persons, to whom the covered entity may make the requested use or disclosure. (iv) A description of each purpose of the requested use or disclosure. The statement "at the request of the individual" is a sufficient description of the purpose when an individual initiates the authorization and does not, or elects not to, provide a statement of the purpose. (v) An expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure. The statement "end of the research study," "none," or similar language is sufficient if the authorization is for a use or disclosure of protected health information for research, including for the creation and maintenance of a research database or research repository. (vi) Signature of the individual and date. If the authorization is signed by a personal representative of the individual, a description of such representative's authority to act for the individual must also be provided. (2)Required statements. In addition to the core elements, the authorization must contain statements adequate to place the individual on notice of all of the following: (i) The individual's right to revoke the authorization in writing, and either: (A) The exceptions to the right to revoke and a description of how the individual may revoke the authorization; or (B) To the extent that the information in paragraph (c)(2)(i)(A) of this section is included in the notice required by Section 164.520, a reference to the covered entity's notice. https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf

Usage Note: Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by a an individual's HIPAA Authorization for Disclosure, use "HIPAAAuthCD" as the security label policy code.

Information governed under a HIPAA Authorization for Disclosure has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, which is considered the "norm", assign the HL7 Confidentiality code "N" (normal).

active

_ActUSPrivacyConsentDirective

5

HIPAAConsentCD

HIPAA Consent Directive

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule 45 CFR Section 164.522 Rights to request privacy protection for protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf, which stipulates the process by which a covered entity seeks agreement from an individual regarding how it will use and disclose the individual's protected health information for treatment, payment, and health care operations is termed a "consent."

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's consent directive under 45 CFR Section 164.522 use "HIPAAConsentCD" as the security label policy code.

Since information governed by a 45 CFR Section 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

active

_ActUSPrivacyConsentDirective

5

HIPAAResearchAuthCD

HIPAA Authorization for Disclosure for Research Consent Directive

A code representing an individual's consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section specific to disclosures for purposes of research.

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's HIPAA Authorization for Disclosure for Research under 45 CFR Section 164.508 use "HIPAAResearchAuthCD" as the security label policy code.

Information disclosed under an individual's HIPAA Authorization for Disclosure for Research are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code "M" (moderate).

See ActCode._ActPolicyType._ActPrivacyPolicy._ActPrivacyLaw._ActUSPrivacyLaw.HIPAAAuth (HIPAA Authorization for Disclosure). See: HIPAAAuth and NIH Sample Authorization Language for Research Uses and Disclosures of Individually Identifiable Health Information by a Covered Health Care Provider https://privacyruleandresearch.nih.gov/authorization.asp

active

_ActUSPrivacyConsentDirective

5

HIPAAROAD

HIPAA Right of Access Directive

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule 45 CFR Section 164.524 Access of individuals to protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-524.pdf, stipulating the policy elements of an individual's written and signed right of access directive requesting that a covered entity send the individual's protected health information (PHI) to a third party.

See 45 CFR 164.524(c)(3)(ii) If an individual's request for access directs the covered entity to transmit the copy of protected health information directly to another person designated by the individual, the covered entity must provide the copy to the person designated by the individual. The individual's request must be in writing, signed by the individual, and clearly identify the designated person and where to send the copy of protected health information. https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-524.pdf

This right applies to PHI in a designated record set, which is defined as "Designated record set means: (1) A group of records maintained by or for a covered entity that is: (i) The medical records and billing records about individuals maintained by or for a covered health care provider; (ii) The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (iii) Used, in whole or in part, by or for the covered entity to make decisions about individuals. [https://www.law.cornell.edu/cfr/text/45/164.501]. Also see HHS Individuals' Right under HIPAA to Access their Health Information 45 CFR Section 164.524 [https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html#maximumflatfee].

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's right of access directive under 45 CFR Section 164.524 use "HIPAAROAD" as the security label policy code.

Information disclosed under a HIPAA 42 CFR Section 164.524 no longer has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is considered the "norm", assign the HL7 Confidentiality code "M" (moderate), which may be protected under other laws such as the Federal Trade Commission privacy and security regulations.

active

_ActUSPrivacyConsentDirective

5

MDHHS-5515

Michigan Consent to Share Behavioral Health Information for Care Coordination Purposes

The State of Michigan standard privacy consent form for sharing of health information specific to behavioral health and substance use treatment in accordance with Public Act 129 of 2014. In Michigan, while providers are not required to use this new standard form (MDHHS-5515), they are required to accept it.

Usage Note: For legislative background, current MDHHS-5515 consent directive form, and provider and patient FAQs see http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_58005-343686--,00.html

active

_ActUSPrivacyConsentDirective

6

MDHHS-5515MMHC

Michigan Consent to Share Behavioral Health Information for Care Coordination Purposes-Michigan Mental Health Code

The State of Michigan standard privacy consent form for sharing of health information specific to behavioral health governed by the Michigan Mental Health Code Act 258 of 1974, which require patient authorization for purposes other than treatment, payment, and coordination of care, in accordance with Public Act 129 of 2014.

Usage Note: For legislative background, current MDHHS-5515 consent directive form, and provider and patient FAQs see http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_58005-343686--,00.html

active

MDHHS-5515

6

MDHHS-5515Part2

Michigan Consent to Share Behavioral Health Information for Care Coordination Purposes-US 42 CFR Part 2

The State of Michigan standard privacy consent form for sharing of health information specific to substance use information governed under US 42 CFR Part 2 in accordance with Public Act 129 of 2014.

Usage Note: For legislative background, current MDHHS-5515 consent directive form, and provider and patient FAQs see http://www.michigan.gov/mdhhs/0,5885,7-339-71550_2941_58005-343686--,00.html

active

MDHHS-5515

5

USResearchInformedAssent

Informed Assent for Research

An informed assertion by a minor who is a candidate research subject, of the individual's willingness to participate in research. Assent means a child's affirmative agreement to participate in a clinical investigation. Mere failure to object should not, absent affirmative agreement, be construed as assent. The minor's assent must be accompanied by parental or guardian consent that the minor participate in a specified research. The assent is not legally binding, however, the accompanying consent is legally binding. Background: In the US, informed assent is governed under 21 CFR Part 50, Subpart D - Additional Safeguards for Children in Clinical Investigations. Available at https://www.law.cornell.edu/cfr/text/21/part-50/subpart-D

active

_ActUSPrivacyConsentDirective

5

USResearchInformedConsent

Informed Consent for Research

An informed assertion by an adult, or the parent/guardian of a minor who is a candidate research subject, of the individual's willingness to participate in a specified research study. The consent is legally binding. Background: In the US, informed assent is governed under 49 CFR § 11.116 - General Requirements for Informed Consent. Available at https://www.law.cornell.edu/cfr/text/49/11.116

active

_ActUSPrivacyConsentDirective

5

USBroadResearchConsent

Broad Consent for Research

An informed assertion by an adult, or the parent/guardian of a minor who is a candidate research subject, of the individual's willingness to participate in unspecified research studies, including storage, maintenance, and secondary research use of identifiable biospecimens and data. If broad consent is obtained, any subsequent storage, maintenance, and secondary research uses of the individual’s identifiable biospecimens and data consistent with the broad consent would not require additional consent, so long as additional conditions are met, including limited review by an IRB. The consent is legally binding. Background: In the US, informed assent is governed under 49 CFR § 11.116 - General Requirements for Informed Consent. Available at https://www.law.cornell.edu/cfr/text/49/11.116

active

_ActUSPrivacyConsentDirective

2

_ActInformationActionPolicy

_ActInformationActionPolicy

The type of action permitted on information by jurisdictional, organizational, or personal policy.

active

true

_ActPolicyType

3

INFOACCESS

access information

Authorization to obtain information with no further permission to collect and store it.

active

_ActInformationActionPolicy

3

INFOCOLLECT

collect information

Authorization to gather and store information.

active

_ActInformationActionPolicy

3

INFODEIDENTIFIY

deidentify information

Authorization to alter or remove identifying characteristics of an entity or individual that is a subject of the information.

active

_ActInformationActionPolicy

3

INFODISCLOSE

disclose information

Authorization to make information known to another party.

active

_ActInformationActionPolicy

3

INFOMASK

mask information

Authorization to alter information in order to conceal it from unauthorized recipients.

active

_ActInformationActionPolicy

3

INFOREADONLY

read only information

Authorization to access information within a specific context for communication purposes only. Storing, manipulating, and further disclosure are prohibited and may be technically disabled.

active

_ActInformationActionPolicy

3

INFOREDACT

redact information

Authorization to remove information that a recipient is not authorized to access.

active

_ActInformationActionPolicy

3

INFOREDISCLOSE

redisclose information

Authorization to make disclosed information known to another party.

active

_ActInformationActionPolicy

3

INFOREIDENTIFY

reidentify information

Authorization to alter or relink deidentified information so that an entity or individual that is the subject of that information identifiable.

active

_ActInformationActionPolicy

3

INFOUSE

use information

Authorization to employ or alter information.

active

_ActInformationActionPolicy

2

_ActInformationPolicy

_ActInformationPolicy

Information management directives related to privacy, security, integrity, and control concerns, which may be governed by specific laws; based on private sector self-governance; adopted "best practices" recognized by a community of interest; or terms of license, participation, or service as implemented in jurisdictional, organizational, or personal policies.

active

true

_ActPolicyType

3

JurisIP

jurisdictional information policy

Jurisdictional policy on collection, access, use, or disclosure of information as defined by applicable jurisdictional law.

active

_ActInformationPolicy

4

JurisCUI

jurisdictional controlled unclassified information policy

Jurisdictional policy on collection, access, use, or disclosure of controlled unclassified information as defined by applicable jurisdictional law.

active

JurisIP

4

JurisDEID

jurisdictional de-identified information policy

Jurisdictional policy on collection, access, use, or disclosure of de-identified information as defined by applicable jurisdictional law.

active

JurisIP

4

JurisLDS

jurisdictional limited data set

Jurisdictional policy on collection, access, use, or disclosure of information in a limited data set as defined by applicable jurisdictional law.

active

JurisIP

4

JurisNSI

jurisdictional non-sensitive information policy

Jurisdictional policy on collection, access, use, or disclosure of information deemed non-sensitive by applicable jurisdiction law.

active

JurisIP

4

JurisPI

jurisdictional public information policy

Jurisdictional policy on collection, access, use, or disclosure of information deemed public by applicable jurisdiction law.

active

JurisIP

4

JurisSP-CUI

jurisdictional specified controlled unclassified information policy

Jurisdictional policy on collection, access, use, or disclosure of specified controlled unclassified information as defined by applicable jurisdictional policy.

active

JurisIP

4

JurisUUI

jurisdictional uncontrolled unclassified information policy

Jurisdictional policy on collection, access, use, or disclosure of uncontrolled unclassified information as defined by applicable jurisdictional policy.

active

JurisIP

3

OrgIP

organizational information policy

Organizational policy on collection, access, use, or disclosure of information, which does not conflict with jurisdictional law.

active

_ActInformationPolicy

4

OrgCUI

organizational basic controlled unclassified information policy

Organizational policy on collection, access, use, or disclosure of basic controlled unclassified information as defined by the organization or by applicable jurisdictional law.

active

OrgIP

4

OrgDEID

organizational de-identified informati)on policy

Organizational policy on collection, access, use, or disclosure of de-identified information as defined by the organization or by applicable jurisdictional law.

active

OrgIP

4

OrgLDS

organizational limited data set information policy

Organizational policy on collection, access, use, or disclosure of information in a limited data set as defined by the organization or by applicable jurisdictional law.

active

OrgIP

4

OrgNSI

organizational non-sensitive information policy

Organizational policy on collection, access, use, or disclosure of information deemed non-sensitive by the organization or by applicable jurisdictional law.

active

OrgIP

4

OrgPI

organizational public information policy

Organizational policy on collection, access, use, or disclosure of public information as defined by the organization or by applicable jurisdictional law.

active

OrgIP

4

OrgSP-CUI

organizational specified controlled unclassified information policy

Organizational policy on collection, access, use, or disclosure of specified controlled unclassified information as defined by the organization or by applicable jurisdictional law.

active

OrgIP

4

OrgUUI

organizational uncontrolled unclassified information policy

Organizational policy on collection, access, use, or disclosure of uncontrolled unclassified information as defined by the organization or governing jurisdiction.

active

OrgIP

3

PersIP

personal information policy

Personal policy on collection, access, use, or disclosure of information.

active

_ActInformationPolicy

4

PersDEID

personal de-identified information policy

Personal policy on collection, access, use, or disclosure of de-identified information as defined by the information subject or by applicable jurisdictional law.

active

PersIP

4

PersLDS

personal limited data set information policy

Personal policy personal policy on collection, access, use, or disclosure of information in a limited data set by the information subject.

active

PersIP

4

PersNSI

personal non-sensitive information policy

Personal policy on collection, access, use, or disclosure of information deemed non-sensitive by the information subject.

active

PersIP

4

PersPI

personal public information policy

Personal policy on collection, access, use, or disclosure of information deemed public by the information subject.

active

PersIP

2

_ActPrivacyPolicy

ActPrivacyPolicy

A policy deeming certain information to be private to an individual or organization.

Definition: A mandate, obligation, requirement, rule, or expectation relating to privacy.

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

Usage Note: Statutory title may be named in the ActClassPolicy Act Act.title to specify which privacy policy is being referenced.

active

true

_ActPolicyType

3

_ActConsentDirective

ActConsentDirective

Specifies the type of agreement between one or more grantor and grantee in which rights and obligations related to one or more shared items of interest are allocated.

Usage Note: Such agreements may be considered "consent directives" or "contracts" depending on the context, and are considered closely related or synonymous from a legal perspective.

Examples:

Healthcare Privacy Consent Directive permitting or restricting in whole or part the collection, access, use, and disclosure of health information, and any associated handling caveats.

Healthcare Medical Consent Directive to receive medical procedures after being informed of risks and benefits, thereby reducing the grantee's liability.

Research Informed Consent for participation in clinical trials and disclosure of health information after being informed of risks and benefits, thereby reducing the grantee's liability.

Substitute decision maker delegation in which the grantee assumes responsibility to act on behalf of the grantor.

Contracts in which the agreement requires assent/dissent by the grantor of terms offered by a grantee, a consumer opts out of an "award" system for use of a retailer's marketing or credit card vendor's point collection cards in exchange for allowing purchase tracking and profiling.

A mobile device or App privacy policy and terms of service to which a user must agree in whole or in part in order to utilize the service.

Agreements between a client and an authorization server or between an authorization server and a resource operator and/or resource owner permitting or restricting e.g., collection, access, use, and disclosure of information, and any associated handling caveats.

active

true

_ActPrivacyPolicy

4

EMRGONLY

emergency only

Privacy consent directive restricting or prohibiting access, use, or disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for all purposes except for emergency treatment generally, which may include treatment during a disaster, a threat, in an emergency department and for break the glass purposes of use as specified by applicable domain policy.

Usage Note: To specify the scope of an "EMRGONLY" consent directive within a policy domain, use one or more of the following Purpose of Use codes in the ActReason code system OID: 2.16.840.1.113883.5.8.

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

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

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

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

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

Map: An "emergency only" consent directive maps to ISO/TS 17975:2015(E) 5.13 Exceptional access

active

_ActConsentDirective

4

NOPP

notice of privacy practices

An implied privacy consent directive or notification, which the data subject may or may not acknowledge. The notification specifies permitted actions, which may include access, use, or disclosure of any and all personal information. The notification specifies the scope of personal information, which may include de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, that may be used to identify an individual in a registry or repository. The notification specifies the purposes for which personal information may be used such as treatment, payment, operations, research, information exchange, public health, disaster, quality and safety reporting; as required by law including court order, law enforcement, national security, military authorities; and for data analytics, marketing, and profiling.

Usage Notes: Map: An "implied" consent directive maps to ISO/TS 17975:2015(E) definition forImplied: Consent to Collect, Use and Disclose personal health information is implied by the actions or inactions of the individual and the circumstances under which it was implied".

active

Map: An "implied" consent directive maps to ISO/TS 17975:2015(E) definition forImplied: Consent to Collect, Use and Disclose personal health information is implied by the actions or inactions of the individual and the circumstances under which it was implied".

_ActConsentDirective

4 | GRANTORCHOICE | grantor choice |
4 | IMPLIED | implied consent |
4 | IMPLIEDD | implied consent with opportunity to dissent |
4 | NOCONSENT | no consent |
4 | OPTIN | opt-in |
4 | OPTINR | opt-in with restrictions |
4 | OPTOUT | op-out |
4 | OPTOUTE | opt-out with exceptions |

3

_ActPrivacyLaw

ActPrivacyLaw

A jurisdictional mandate, regulation, obligation, requirement, rule, or expectation deeming certain information to be private to an individual or organization, which is imposed on:

The activity of a governed party

The behavior of a governed party

The manner in which an act is executed by a governed party

active

true

_ActPrivacyPolicy

4

_ActGDPRPrivacyLaw

General Data Protection Regulation

GDPR is a regulation on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (Data Protection Directive). Promulgated by the European Parliament and Council of the European Union. Regulation available at L119, 4 May 2016, p. 1-88.

GDPR privacy policies specifying types of lawful personal data processing based on a controller meeting one or more processing condition such as specified by law, compliance with data controller legal obligations, protection of data subject's vital interests, perform tasks in the public interest, related to legal claims, research and statistics, management of health or social care systems, legitimate interests of controller or third party. Processing sensitive personal data, including genetic, biometric and health data, as well as personal data from which racial and ethnic origin, political opinions, religious or ideological convictions or membership in a union can be attributed to a person, requires meeting at least one sensitive personal processing condition.

GDPR 'processing' means any operation or set of operations which is performed on personal data or on sets of personal data, whether or not by automated means, such as collection, recording, organisation, structuring, storage, adaptation or alteration, retrieval, consultation, use, disclosure by transmission, dissemination or otherwise making available, alignment or combination, restriction, erasure or destruction. Article 4 https://gdpr-info.eu/art-4-gdpr/

Usage Note:

Confidentiality: e.g., U (unrestricted) for anonymized personal information; L (low) for pseudonymized U (unrestricted) for anonymized personal information; M (moderate) for indirectly identifiable information such as test scores and work times; N (normal) for personal information; and R (restricted) for sensitive personal information

DPR sensitivity [personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation, some of which are defined at Article 4 https://gdpr-info.eu/art-4-gdpr/

GDPR processing policies and GDPR ConsentDirectiveTypes, such as data subject consent and research consent.

Other security category codes, such as compartment codes for legitimate relationship,

Handling instructions including

Purpose of use stipulated in a GDPR consent or contract restricting processing or related to the scope of the processing policy such as public health, research, and legal obligations

Obligation policies such as GDPR Information Obligations https://gdpr-info.eu/issues/information-obligations, data minimization and deleting when processing is complete

Refrain policies such as no relinking

See Intersoft GDPR at https://gdpr-info.eu/issues/personal-data/ Art. 4 GDPR Definitions https://gdpr-info.eu/art-4-gdpr/ Art. 9 GDPR Processing of special categories of personal data https://gdpr-info.eu/art-9-gdpr/ Relevant Recitals (26) Not applicable to anonymous data (30) Online identifiers for profiling and identification (34) Genetic data (35) Health data (51) Protecting sensitive personal data at Intersoft GDPR briefing papers and navigating tool https://gdpr-info.eu/

Authorities

European Data Protection Supervisor - Security Measures for Personal Data Processing (Link)

Data Protection Authority Isle of Man - Know your data - Mapping the 5 W's (Link)

Data Protection Authority UK - Key definitions (Link)

European Commission - What is personal data? (Link)

European Commission - What personal data is considered sensitive? (Link)

EU publications - Handbook on European data protection law - Personal data, page 83 (Link)

Expert contribution A&L Goodbody - The GDPR: A Guide for Businesses - Definition of Personal & Sensitive Data, Page 8 (Link) Bird & Bird - Sensitive data and lawful processing (Link) https://ec.europa.eu/commission/priorities/justice-and-fundamental-rights/data-protection/2018-reform-eu-data-protection-rules_en General Data Protection Regulation https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1528874672298&uri=CELEX%3A32016R0679 Communication on data protection - guidance on direct application of the GDPR http://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1517578296944&uri=CELEX%3A52018DC0043 Intersoft GDPR briefing papers and navigating tool https://gdpr-info.eu/

active

true

_ActPrivacyLaw

5

GDPRCONSENT

GDPR Consent

Processing of personal data, inclusive of the special categories of data, is lawful only if the data subject has given explicit consent to the processing of his or her personal data, inclusive of the special categories of data, for one or more specific purposes, except where Union or Member State law provide that the prohibition to use the data may not be lifted by the data subject; and for personal data which are manifestly made public by the data subject.

Usage Note: The description is based on the following GDPR provisions: Article 6.1.a https://gdpr-info.eu/art-6-gdpr/ 1Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes. Article 9.1, 9.2a., 9.2.e https://gdpr-info.eu/art-9-gdpr/ 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; and (e) processing relates to personal data which are manifestly made public by the data subject.

active

_ActGDPRPrivacyLaw

4

_ActUSPrivacyLaw

_ActUSPrivacyLaw

Definition: A jurisdictional mandate in the U.S. relating to privacy.

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

active

_ActPrivacyLaw

5

42CFRPart2

42 CFR Part2

A code representing 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records. 42 CFR Part 2 stipulates the privacy rights of an individual who has applied for or been given diagnosis or treatment for alcohol or drug abuse at a federally assisted program, which includes non-disclosure of health information relating to health care paid for by a federally assisted substance use disorder program without patient consent. https://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-part2.pdf

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, the collection, access, use, and disclosure of healthcare information is governed by 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records https://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-part2.pdf use "42CFRPart2" as the security label policy code.

Since information governed by a 42 CFR Part 2 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf assign the HL7 Confidentiality code "R" (restricted).

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CommonRule

Common Rule

A code representing U.S. Federal laws governing research-related privacy policies known as the "Common Rule". The Common Rule is the U.S. Federal regulations governing the protection of human subjects in research (codified at Subpart A of 45 CFR part 46), which 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.

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information or biospecimen is governed by the Common Rule use "COMMONRULE" as the security label policy code. Information or biospecimen disclosed under the Common Rule are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code "M" (moderate).

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_ActUSPrivacyLaw

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HIPAAAuth

HIPAA Authorization for Disclosure

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.508) Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which stipulates the process by which a covered entity seeks agreement from an individual to use or disclose protected health information for other purposes, or to authorize another covered entity to disclose protected health information to the requesting covered entity, are termed "authorizations".

An "authorization" is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. Where the Privacy Rule requires patient authorization, voluntary consent is not sufficient to permit a use or disclosure of protected health information unless it also satisfies the requirements of a valid authorization. An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization. https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html

Usage Note: Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, where use or disclosure of healthcare information is governed by a covered entity's HIPAA Authorization for Disclosure, use "HIPAAAuth" as the security label policy code.

Information disclosed under a HIPAA Authorization for Disclosure no longer has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is considered the "norm", assign the HL7 Confidentiality code "M" (moderate), which may be protected under other laws such as the Federal Trade Commission privacy and security regulations.

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HIPAAConsent

HIPAA Consent

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.522), which stipulates the process by which a covered entity seeks agreement from an individual regarding how it will use and disclose the individual's protected health information for treatment, payment, and health care operations is termed a "consent".

The Privacy Rule permits, but does not require, a covered entity to voluntarily obtain patient consent for uses and disclosures of protected health information for treatment, payment, and health care operations. Covered entities that do so have complete discretion to design a process that best suits their needs. From https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html. The provisions relating to consent are largely contained in Section 164.522 Rights to request privacy protection for protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf.

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by 45 CFR Section 164.522 use 'HIPAAConsent' as the security label policy code.

Since information governed by a 45 CFR Section 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code 'R' (restricted).

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HIPAANOPP

HIPAA notice of privacy practices

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.520), which stipulates an individual's right to adequate notice of the uses and disclosures of protected health information that may be made by the covered entity, and of the individual's rights and the covered entity's legal duties with respect to protected health information. Relevant HIPAA Privacy Rule provisions are at Section 164.520 (a) Standard: Notice of privacy practices. https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-520.pdf

Usage Note: Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, if collection, access, use, or disclosure of healthcare information is governed by a covered entity's HIPAA Notice of Privacy Practices, use "HIPAANOPP" as the security label policy code.

Information governed under a HIPAA Notice of Privacy Practices has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf , which is considered the "norm", assign the HL7 Confidentiality code "N" (normal).

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_ActUSPrivacyLaw

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HIPAAPsyNotes

HIPAA psychotherapy notes

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.508), which stipulates the privacy rights of an individual who is the subject of psychotherapy notes, and requires authorization for certain uses and disclosure of that information.

Definition of Psychotherapy notes 45 CFR Section 164.501 https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-501.pdf: Psychotherapy notes means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

See Section 164.508 Uses and disclosures for which an authorization is required. (2)Authorization required: Psychotherapy notes https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf: Notwithstanding any provision of this subpart, other than the transition provisions in Section 164.532, a covered entity must obtain an authorization for any use or disclosure of psychotherapy notes, except: (i) To carry out the following treatment, payment, or health care operations: (A) Use by the originator of the psychotherapy notes for treatment; (B) Use or disclosure by the covered entity for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; or (C) Use or disclosure by the covered entity to defend itself in a legal action or other proceeding brought by the individual; and (ii) A use or disclosure that is required by Section 164.502(a)(2)(ii) or permitted by Section 164.512(a); Section 164.512(d) with respect to the oversight of the originator of the psychotherapy notes; Section 164.512(g)(1); Section 164.512(j)(1)(i).

Usage Note: Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, the collection, access, use, or disclosure of healthcare information is governed by HIPAA 45 CFR 164.508 (2) Authorization required: Psychotherapy notes https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf , use "HIPAAPsyNotes" as the security label policy code.

Since information governed by a HIPAA 45 CFR 164.508 (2) has a level of confidentiality protection that is more stringent than the normal level of protection under 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

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HIPAAROA

HIPAA Right of Access

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule 45 CFR Section 164.524 Access of individuals to protected health information https://www.govinfo.gov/app/details/CFR-2017-title45-vol1/CFR-2017-title45-vol1-sec164-524, which stipulates that an individual has a right of access to inspect and obtain a copy of protected health information about the individual in a designated record set, for as long as the protected health information is maintained in the designated record set with exceptions stipulated in HIPAA Privacy Rule Section 164.524. Exceptions include psychotherapy notes and information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.

If an individual's request for access directs the covered entity to transmit the copy of protected health information directly to another person designated by the individual, the covered entity must provide the copy to the person designated by the individual. The individual's request must be in writing, signed by the individual, and clearly identify the designated person and where to send the copy of protected health information.

For discussion on extent of right, grounds for denial, and documentation requirements see: HHS Individuals' Right under HIPAA to Access their Health Information 45 CFR Section 164.524 https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html and HHS FAQ on Right of Access vs. HIPAA Authorization https://www.hhs.gov/hipaa/for-professionals/faq/2041/why-depend-on-the-individuals-right/index.html

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed under 45 CFR Section 164.5224 use "HIPAAROA" as the security label policy code.

Information disclosed under a HIPAA 42 CFR Section 164.524 no longer has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is considered the "norm", assign the HL7 Confidentiality code "M" (moderate), which may be protected under other laws such as the Federal Trade Commission privacy and security regulations.

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_ActUSPrivacyLaw

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HIPAASelfPay

HIPAA self-pay

A code representing 45 CFR 164.522 Rights to request privacy protection for protected health information, which is a US Federal law stipulating the privacy rights of an individual to restrict disclosure of information related to health care items or services for which the individual pays out of pocket in full to a health plan or payer.

See 45 CFR 164.522 https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf. (vi) A covered entity must agree to the request of an individual to restrict disclosure of protected health information about the individual to a health plan if: (A) The disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (B) The protected health information pertains solely to a health care item or service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.

Usage Note: Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, the collection, access, use, or disclosure of healthcare information is governed by HIPAA 45 CFR 164.522 https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf use "HIPAASelfPay" as the security label policy code.

Since information governed by a HIPAA 45 CFR 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

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Title38Section7332

Title 38 Section 7332

A code representing Title 38 Section 7332, which is a US Federal law stipulating the privacy rights of veterans diagnosed and treated for substance use disorders, infection with the human immunodeficiency virus, or sickle cell anemia.

https://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html . (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). (2) Paragraph (1) prohibits the disclosure to any person or entity other than the patient or subject concerned of the fact that a special written consent is required in order for such records to be disclosed. (b) (1) The content of any record referred to in subsection (a) may be disclosed by the Secretary in accordance with the prior written consent of the patient or subject with respect to whom such record is maintained, but only to such extent, under such circumstances, and for such purposes as may be allowed in regulations prescribed by the Secretary. (2) Whether or not any patient or subject, with respect to whom any given record referred to in subsection (a) is maintained, gives written consent, the content of such record may be disclosed by the Secretary as follows: (A) To medical personnel to the extent necessary to meet a bona fide medical emergency. (B) To qualified personnel for the purpose of conducting scientific research, management audits, financial audits, or program evaluation, but such personnel may not identify, directly or indirectly, any individual patient or subject in any report of such research, audit, or evaluation, or otherwise disclose patient or subject identities in any manner. (C) (i) In the case of any record which is maintained in connection with the performance of any program or activity relating to infection with the human immunodeficiency virus, to a Federal, State, or local public-health authority charged under Federal or State law with the protection of the public health, and to which Federal or State law requires disclosure of such record, if a qualified representative of such authority has made a written request that such record be provided as required pursuant to such law for a purpose authorized by such law. (ii) A person to whom a record is disclosed under this paragraph may not redisclose or use such record for a purpose other than that for which the disclosure was made. (D) If authorized by an appropriate order of a court of competent jurisdiction granted after application showing good cause therefor. In assessing good cause the court shall weigh the public interest and the need for disclosure against the injury to the patient or subject, to the physician-patient relationship, and to the treatment services. Upon the granting of such order, the court, in determining the extent to which any disclosure of all or any part of any record is necessary, shall impose appropriate safeguards against unauthorized disclosure. (E) To an entity described in paragraph (1)(B) of section 5701(k) of this title, but only to the extent authorized by such section. (F) (i) To a representative of a patient who lacks decision-making capacity, when a practitioner deems the content of the given record necessary for that representative to make an informed decision regarding the patient's treatment. (ii) In this subparagraph, the term "representative" means an individual, organization, or other body authorized under section 7331 of this title and its implementing regulations to give informed consent on behalf of a patient who lacks decision-making capacity. (G) To a State controlled substance monitoring program, including a program approved by the Secretary of Health and Human Services under section 399O of the Public Health Service Act (42 U.S.C. 280g-3), to the extent necessary to prevent misuse and diversion of prescription medicines. (H) (i) To a non-Department entity (including private entities and other Federal agencies) for purposes of providing health care, including hospital care, medical services, and extended care services, to Veterans or performing other health care-related activities or functions. (ii) An entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made or as permitted by law. (I) To a third party in order to recover or collect reasonable charges for care furnished to, or paid on behalf of, a Veteran in connection with a non-service connected disability as permitted by section 1729 of this title or for a condition for which recovery is authorized or with respect to which the United States is deemed to be a third party beneficiary under the Act entitled 'An Act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the United States' (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as the 'Federal Medical Care Recovery Act').

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by 38 U.S. Code Section 7332 - Confidentiality of certain medical records https://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html use "Title38Section7332" as the security label policy code.

Since information governed by a Title 38 Section 7332 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

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a) HIPAAConsent

HIPAA Consent

Code retired in December 2019 and replaced by code HIPAAConsent. Originally entered with copy/paste error in code value.

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.522), which stipulates the process by which a covered entity seeks agreement from an individual regarding how it will use and disclose the individual's protected health information for treatment, payment, and health care operations is termed a "consent." The Privacy Rule permits, but does not require, a covered entity to voluntarily obtain patient consent for uses and disclosures of protected health information for treatment, payment, and health care operations. Covered entities that do so have complete discretion to design a process that best suits their needs. From https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html. The provisions relating to consent are largely contained in Section 164.522 Rights to request privacy protection for protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf.

Usage Note: Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by 45 CFR Section 164.522 use "HIPAAConsent" as the security label policy code.

Since information governed by a 45 CFR Section 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

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_InformationSensitivityPolicy

InformationSensitivityPolicy

A mandate, obligation, requirement, rule, or expectation characterizing the value or importance of a resource and may include its vulnerability. (Based on ISO7498-2:1989. Note: The vulnerability of personally identifiable sensitive information may be based on concerns that the unauthorized disclosure may result in social stigmatization or discrimination.) Description: Types of Sensitivity policy that apply to Acts or Roles. A sensitivity policy is adopted by an enterprise or group of enterprises (a 'policy domain') through a formal data use agreement that stipulates the value, importance, and vulnerability of information. A sensitivity code representing a sensitivity policy may be associated with criteria such as categories of information or sets of information identifiers (e.g., a value set of clinical codes or branch in a code system hierarchy). These criteria may in turn be used for the Policy Decision Point in a Security Engine. A sensitivity code may be used to set the confidentiality code used on information about Acts and Roles to trigger the security mechanisms required to control how security principals (i.e., a person, a machine, a software application) may act on the information (e.g., collection, access, use, or disclosure). Sensitivity codes are never assigned to the transport or business envelope containing patient specific information being exchanged outside of a policy domain as this would disclose the information intended to be protected by the policy. When sensitive information is exchanged with others outside of a policy domain, the confidentiality code on the transport or business envelope conveys the receiver's responsibilities and indicates the how the information is to be safeguarded without unauthorized disclosure of the sensitive information. This ensures that sensitive information is treated by receivers as the sender intends, accomplishing interoperability without point to point negotiations.

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

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true

_ActPrivacyPolicy

4

_ActInformationSensitivityPolicy

ActInformationSensitivityPolicy

Types of sensitivity policies that apply to Acts. Act.confidentialityCode is defined in the RIM as "constraints around appropriate disclosure of information about this Act, regardless of mood."

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

active

true

_InformationSensitivityPolicy

5

ETH

substance abuse information sensitivity

Policy for handling alcohol or drug-abuse information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to alcohol or drug-abuse information that is deemed sensitive.

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.

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_ActInformationSensitivityPolicy

5

GDIS

genetic disease information sensitivity

Policy for handling genetic disease information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to genetic disease information that is deemed sensitive.

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.

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_ActInformationSensitivityPolicy

5

HIV

HIV/AIDS information sensitivity

Policy for handling HIV or AIDS information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to HIV or AIDS information that is deemed sensitive.

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.

active

_ActInformationSensitivityPolicy

5

MST

military sexual trauma information sensitivity

Policy for handling information related to sexual assault or repeated, threatening sexual harassment that occurred while the patient was in the military, which is afforded heightened confidentiality.

Access control concerns for military sexual trauma is based on the patient being subject to control by a higher ranking military perpetrator and/or censure by others within the military unit. Due to the relatively unfettered access to healthcare information by higher ranking military personnel and those who have command over the patient, there is a need to sequester this information outside of the typical controls on access to military health records.

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.

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_ActInformationSensitivityPolicy

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PREGNANT

pregnancy information sensitivity

Policy for handling information about an individual's current or past pregnancy status, deemed sensitive by the individual or by policy, which may be afforded heightened confidentiality.

Usage Note:

Information about a patient's current or past pregnancy status may be considered sensitive in circumstances in which that status could result in discrimination or stigmatization.

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_ActInformationSensitivityPolicy

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SCA

sickle cell anemia information sensitivity

Policy for handling sickle cell disease information, which is afforded heightened confidentiality. Information handling protocols are based on organizational policies related to sickle cell disease information, which is deemed sensitive.

Usage Note: If there is a jurisdictional mandate, then the Act valued with this ActCode should be associated with an Act valued with any applicable laws from the ActPrivacyLaw code system.

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_ActInformationSensitivityPolicy

5

SDV

sexual assault, abuse, or domestic violence information sensitivity

Policy for handling sexual assault, abuse, or domestic violence information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexual assault, abuse, or domestic violence information that is deemed sensitive.

SDV code covers violence perpetrated by related and non-related persons. This code should be specific to physical and mental trauma caused by a related person only. The access control concerns are keeping the patient safe from the perpetrator who may have an abusive psychological control over the patient, may be stalking the patient, or may try to manipulate care givers into allowing the perpetrator to make contact with the patient. The definition needs to be clarified.

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.

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_ActInformationSensitivityPolicy

5

SEX

sexuality and reproductive health information sensitivity

Policy for handling sexuality and reproductive health information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexuality and reproductive health information that is deemed sensitive.

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.

active

_ActInformationSensitivityPolicy

5

SPI

specially protected information sensitivity

Policy for handling information deemed specially protected by law or policy including substance abuse, substance use, psychiatric, mental health, behavioral health, and cognitive 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.

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_ActInformationSensitivityPolicy

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BH

behavioral health information sensitivity

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.

active

SPI

7

COGN

cognitive disability information sensitivity

Policy for handling information related to cognitive disability disorders and conditions caused by these disorders, which are 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.

Examples may include dementia, traumatic brain injury, attention deficit, hearing and visual disability such as dyslexia and other disorders and related conditions which impair learning and self-sufficiency. However, the cognitive disabilities to which this term may apply versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used.

active

BH

7

DVD

developmental disability information sensitivity

Policy for handling information related to developmental disability 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.

A diverse group of chronic conditions that are due to mental or physical impairments impacting activities of daily living, self-care, language acuity, learning, mobility, independent living and economic self-sufficiency. Examples may include Down syndrome and Autism spectrum. However, the developmental disabilities to which this term applies versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used.

active

BH

7

EMOTDIS

emotional disturbance information sensitivity

Policy for handling information related to emotional disturbance 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.

Typical used to characterize behavioral and mental health issues of adolescents where the disorder may be temporarily diagnosed in order to avoid the potential and unnecessary stigmatizing diagnoses of disorder long term.

active

BH

6

MH

mental health information sensitivity

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.

active

SPI

6

PSY

psychiatry disorder information sensitivity

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.

active

SPI

6

PSYTHPN

psychotherapy note information sensitivity

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.

active

SPI

6

SUD

substance use disorder information sensitivity

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.

active

SPI

7

ETHUD

alcohol use disorder information sensitivity

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.

active

SUD

7

OPIOIDUD

opioid use disorder information sensitivity

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.

active

SUD

5

STD

sexually transmitted disease information sensitivity

Policy for handling sexually transmitted disease information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexually transmitted disease information that is deemed sensitive.

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.

active

_ActInformationSensitivityPolicy

5

TBOO

taboo

Policy for handling information not to be initially disclosed or discussed with patient except by a physician assigned to patient in this case. Information handling protocols based on organizational policies related to sensitive patient information that must be initially discussed with the patient by an attending physician before being disclosed to the patient.

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.

Open Issue: This definition conflates a rule and a characteristic, and there may be a similar issue with ts sibling codes.

active

_ActInformationSensitivityPolicy

5

VIO

violence information sensitivity

Policy for handling information related to harm by violence, which is afforded heightened confidentiality. Harm by violence is perpetrated by an unrelated person.

Access control concerns for information about mental or physical harm resulting from violence caused by an unrelated person may include manipulation of care givers or access to records that enable the perpetrator contact or locate the patient, but the perpetrator will likely not have established abusive psychological control over the patient.

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.

active

_ActInformationSensitivityPolicy

5

IDS

Identifier Sensitivity

Policy for handling information related to an identifier of an information subject, which will be afforded heightened confidentiality. Usage Note: Such policies may govern the sensitivity of information related to an identifier of an act, such as the identifier of a contract; a role, such as a citizen, a patient, a practitioner, or an organization; or an entity such as a medical device due to potential impact on the privacy, well-being, safety or integrity of an information subject. For example, protection against identity fraud or counterfeit.

active

_ActInformationSensitivityPolicy

5

SICKLE

sickle cell

Types of sensitivity policies that apply to Acts. Act.confidentialityCode is defined in the RIM as "constraints around appropriate disclosure of information about this Act, regardless of mood."

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

retired

_ActInformationSensitivityPolicy

4

_EntitySensitivityPolicyType

EntityInformationSensitivityPolicy

Types of sensitivity policies that may apply to a sensitive attribute on an Entity.

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

active

true

_InformationSensitivityPolicy

5

DEMO

all demographic information sensitivity

Policy for handling all demographic information about an information subject, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to all demographic about an information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject.

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.

active

_EntitySensitivityPolicyType

5

DOB

date of birth information sensitivity

Policy for handling information related to an information subject's date of birth, which will be afforded heightened confidentiality.Policies may govern sensitivity of information related to an information subject's date of birth, the disclosure of which could impact the privacy, well-being, or safety of that subject.

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.

active

_EntitySensitivityPolicyType

5

GENDER

gender and sexual orientation information sensitivity

Policy for handling information related to an information subject's gender and sexual orientation, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's gender and sexual orientation, the disclosure of which could impact the privacy, well-being, or safety of that subject.

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.

active

_EntitySensitivityPolicyType

5

LIVARG

living arrangement information sensitivity

Policy for handling information related to an information subject's living arrangement, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's living arrangement, the disclosure of which could impact the privacy, well-being, or safety of that subject.

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.

active

_EntitySensitivityPolicyType

5

MARST

marital status information sensitivity

Policy for handling information related to an information subject's marital status, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's marital status, the disclosure of which could impact the privacy, well-being, or safety of that subject.

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.

active

_EntitySensitivityPolicyType

5

PATLOC

patient location

Policy for handling information related to an individual's location, which is deemed sensitive when the disclosure could impact the privacy, well-being, or safety of that subject, and requires additional protection.

Usage Note: If there is a jurisdictional, organizational, or individual mandate, then use the applicable ActPrivacyLaw or ActConsentDirective code from the ActCode system to and specify the law in addition to this more generic code.

active

_EntitySensitivityPolicyType

5

RACE

race information sensitivity

Policy for handling information related to an information subject's race, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's race, the disclosure of which could impact the privacy, well-being, or safety of that subject.

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.

active

_EntitySensitivityPolicyType

5

REL

religion information sensitivity

Policy for handling information related to an information subject's religious affiliation, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's religion, the disclosure of which could impact the privacy, well-being, or safety of that subject.

Usage Notes: 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.

active

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.

_EntitySensitivityPolicyType

4

_RoleInformationSensitivityPolicy

RoleInformationSensitivityPolicy

Types of sensitivity policies that apply to Roles.

Usage Notes: RoleSensitivity codes are used to bind information to a Role.confidentialityCode per organizational policy. Role.confidentialityCode is defined in the RIM as "an indication of the appropriate disclosure of information about this Role with respect to the playing Entity."

active

true

RoleSensitivity codes are used to bind information to a Role.confidentialityCode per organizational policy. Role.confidentialityCode is defined in the RIM as "an indication of the appropriate disclosure of information about this Role with respect to the playing Entity."

_InformationSensitivityPolicy

5

B

business information sensitivity

Policy for handling trade secrets such as financial information or intellectual property, which will be afforded heightened confidentiality. 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.

Usage Notes: No patient related information may ever be of this confidentiality level. 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.

active

No patient related information may ever be of this confidentiality level. 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.

_RoleInformationSensitivityPolicy

5

EMPL

employer information sensitivity

Policy for handling information related to an employer which is deemed classified to protect an employee who is the information subject, and which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to an employer, such as law enforcement or national security, the identity of which could impact the privacy, well-being, or safety of an information subject who is an employee.

Usage Notes: 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.

active

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.

_RoleInformationSensitivityPolicy

5

LOCIS

location information sensitivity

Policy for handling information related to the location of the information subject, which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to the location of the information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject.

Usage Notes: 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.

active

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.

_RoleInformationSensitivityPolicy

5

SSP

sensitive service provider information sensitivity

Policy for handling information related to a provider of sensitive services, which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to providers who deliver sensitive healthcare services in order to protect the privacy, well-being, and safety of the provider and of patients receiving sensitive services.

Usage Notes: 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.

active

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.

_RoleInformationSensitivityPolicy

4

ADOL

adolescent information sensitivity

Policy for handling information related to an adolescent, which will be afforded heightened confidentiality per applicable organizational or jurisdictional policy. An enterprise may have a policy that requires that adolescent patient information be provided heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

Usage Note: For use within an enterprise in which an adolescent is the information subject. 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.

active

_InformationSensitivityPolicy

4

CEL

celebrity information sensitivity

Policy for handling information related to a celebrity (people of public interest (VIP), which will be afforded heightened confidentiality. Celebrities are people of public interest (VIP) about whose information an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive may include health information and patient role information including patient status, demographics, next of kin, and location.

Usage Note: For use within an enterprise in which the information subject is deemed a celebrity or very important person. 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.

active

VIP

_InformationSensitivityPolicy

4

VIP

celebrity information sensitivity

Policy for handling information related to a celebrity (people of public interest (VIP), which will be afforded heightened confidentiality. Celebrities are people of public interest (VIP) about whose information an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive may include health information and patient role information including patient status, demographics, next of kin, and location.

Usage Note: For use within an enterprise in which the information subject is deemed a celebrity or very important person. 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.

active

CEL

_InformationSensitivityPolicy

4

DIA

diagnosis information sensitivity

Policy for handling information related to a diagnosis, health condition or health problem, which will be afforded heightened confidentiality. Diagnostic, health condition or health problem related information may be deemed sensitive by organizational policy, and require heightened confidentiality.

Usage Note: For use within an enterprise that provides heightened confidentiality to diagnostic, health condition or health problem related information deemed sensitive. 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.

active

_InformationSensitivityPolicy

4

DRGIS

drug information sensitivity

Policy for handling information related to a drug, which will be afforded heightened confidentiality. Drug information may be deemed sensitive by organizational policy, and require heightened confidentiality.

Usage Note: For use within an enterprise that provides heightened confidentiality to drug information deemed sensitive. 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.

active

_InformationSensitivityPolicy

4

EMP

employee information sensitivity

Policy for handling information related to an employee, which will be afforded heightened confidentiality. When a patient is an employee, an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

Usage Note: Policy for handling information related to an employee, which will be afforded heightened confidentiality. Description: When a patient is an employee, an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

active

_InformationSensitivityPolicy

4

PDS

patient default information sensitivity

Policy for specially protecting information reported by or about a patient, which is deemed sensitive within the enterprise (i.e., by default regardless of whether the patient requested that the information be deemed sensitive for another reason.) For example information reported by the patient about another person, e.g., a family member, may be deemed sensitive by default. Organizational policy may allow the sensitivity tag to be cleared on patient's request.

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.

For example, VA deems employee information sensitive by default. Information about a patient who is being stalked or a victim of abuse or violence may be deemed sensitive by default per a provider organization's policies.

active

_InformationSensitivityPolicy

4

PHY

physician requested information sensitivity

Policy for handling information about a patient, which a physician or other licensed healthcare provider deems sensitive. Once tagged by the provider, this may trigger alerts for follow up actions according to organizational policy or jurisdictional law.

Usage Note: For use within an enterprise that provides heightened confidentiality to certain types of information designated by a physician as sensitive. 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.

Use cases in which this code could be used are, e.g., in systems that lack the ability to automatically detect sensitive information and must rely on manual tagging; a system that lacks an applicable sensitivity tag, or for ad hoc situations where criticality of the situation requires that the tagging be done immediately by the provider before coding or transcription of consult notes can be completed, e.g., upon detection of a patient with suicidal tendencies or potential for violence.

active

_InformationSensitivityPolicy

4

PRS

patient requested information sensitivity

Policy for specially protecting information reported by or about a patient, which the patient deems sensitive, and the patient requests that collection, access, use, or disclosure of that information be restricted. For example, a minor patient may request that information about reproductive health not be disclosed to the patient's family or to particular providers and payers.

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.

active

_InformationSensitivityPolicy

3

COMPT

compartment

This is the healthcare analog to the US Intelligence Community's concept of a Special Access Program. Compartment codes may be used in as a field value in an initiator's clearance to indicate permission to access and use an IT Resource with a security label having the same compartment value in security category label field.

Map: Aligns with ISO 2382-8 definition of Compartment - "A division of data into isolated blocks with separate security controls for the purpose of reducing risk."

active

_ActPrivacyPolicy

4

ACOCOMPT

accountable care organization compartment

A group of health care entities, which may include health care providers, care givers, hospitals, facilities, health plans, and other health care constituents who coordinate care for reimbursement based on quality metrics for improving outcomes and lowering costs, and may be authorized to access the consumer's health information because of membership in that group.

Security Compartment Labels assigned to a consumer's information use in accountable care workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a an accountable care workflow who is requesting access to that information

active

COMPT

4

CDSSCOMPT

CDS system compartment

This compartment code may be used as a field value in an initiator's clearance to indicate permission for its Clinical Decision Support system (CDSS) to access and use an IT Resource with a security label having the same compartment value in the security category label field.

This code permits a CDS system to algorithmically process information with this compartment tag for the purpose of alerting an unauthorized end user that masked information is needed to address an emergency or a patient safety issue, such as a contraindicated medication. The alert would advise the end user to "break the glass", to access the masked information in an accountable manner, or to ask the patient about possibly masked information.

For example, releasing a list of sensitive medications with this compartment tag means that while the CDS system is permitted to use this list in its contraindication analysis, this sensitive information should not be shared directly with unauthorized end-users or end-user-facing Apps. Based on the results of the CDS system analysis (e.g., warnings about prescriptions) the end-user (e.g., a clinician) may still have the ability to access to the sensitive information by invoking "break-the-glass protocol".

Usage Note: A security label with the CDS system compartment may be used in conjunction with other security labels, e.g., a label authorizing an end user with adequate clearance to access the same CDS system compartment tagged information. For example, a patient may restrict sharing sensitive information with most care team members except in an emergency or to prevent an adverse event, and may consent to sharing with their sensitive service care team providers, e.g., for mental health or substance abuse.

active

COMPT

4

CTCOMPT

care team compartment

Care coordination across participants in a care plan requires sharing of a healthcare consumer's information specific to that workflow. A care team member should only have access to that information while participating in that workflow or for other authorized uses.

Security Compartment Labels assigned to a consumer's information use in care coordination workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a care team member workflow who is requesting access to that information

active

COMPT

4

FMCOMPT

financial management compartment

Financial management department members who have access to healthcare consumer information as part of a patient account, billing and claims workflows.

Security Compartment Labels assigned to consumer information used in these workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a financial management workflow who is requesting access to that information.

active

COMPT

4

HRCOMPT

human resource compartment

A security category label field value, which indicates that access and use of an IT resource is restricted to members of human resources department or workflow.

active

COMPT

4

LRCOMPT

legitimate relationship compartment

Providers and care givers who have an established relationship per criteria determined by policy are considered to have an established care provision relations with a healthcare consumer, and may be authorized to access the consumer's health information because of that relationship. Providers and care givers should only have access to that information while participating in legitimate relationship workflows or for other authorized uses.

Security Compartment Labels assigned to a consumer's information use in legitimate relationship workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a legitimate relationship workflow who is requesting access to that information.

active

COMPT

4

PACOMPT

patient administration compartment

Patient administration members who have access to healthcare consumer information as part of a patient administration workflows.

Security Compartment Labels assigned to consumer information used in these workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a patient administration workflow who is requesting access to that information.

active

COMPT

4

RESCOMPT

research project compartment

A security category label field value, which indicates that access and use of an IT resource is restricted to members of a research project.

active

COMPT

4

RMGTCOMPT

records management compartment

A security category label field value, which indicates that access and use of an IT resource is restricted to members of records management department or workflow.

active

COMPT

2

ActTrustPolicyType

trust policy

A mandate, obligation, requirement, rule, or expectation conveyed as security metadata between senders and receivers required to establish the reliability, authenticity, and trustworthiness of their transactions.

Trust security metadata are observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability).

Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. [Based on ISO IEC 10181-1 and NIST SP 800-63-2]

For example, identity proofing , level of assurance, and Trust Framework.

active

true

_ActPolicyType

3

TRSTACCRD

trust accreditation

Type of security metadata 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.

active

ActTrustPolicyType

3

TRSTAGRE

trust agreement

Type of security metadata about privacy and security requirements with which a security domain must comply. [ISO IEC 10181-1]

active

ActTrustPolicyType

3

TRSTASSUR

trust assurance

Type of security metadata about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.

active

ActTrustPolicyType

3

TRSTCERT

trust certificate

Type of security metadata 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]

active

ActTrustPolicyType

3

TRSTFWK

trust framework

Type of security metadata 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]

active

ActTrustPolicyType

3

TRSTMEC

trust mechanism

Type of security metadata about a security architecture system component that supports enforcement of security policies.

active

ActTrustPolicyType

2

COVPOL

benefit policy

**Description:**A mandate, obligation, requirement, rule, or expectation unilaterally imposed on benefit coverage under a policy or program by a sponsor, underwriter or payor on:

The activity of another party

The behavior of another party

The manner in which an act is executed

**Examples:**A clinical protocol imposed by a payer to which a provider must adhere in order to be paid for providing the service. A formulary from which a provider must select prescribed drugs in order for the patient to incur a lower copay.

active

_ActPolicyType

2

SecurityPolicy

security policy

Types of security policies that further specify the ActClassPolicy value set.

Examples:

obligation to encrypt

refrain from redisclosure without consent

active

_ActPolicyType

3

AUTHPOL

authorization policy

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)

active

SecurityPolicy

4

ACCESSCONSCHEME

access control scheme

An access control policy specific to the type of access control scheme, which is used to enforce one or more authorization policies.

Usage Note: Access control schemes are the type of access control policy, which is comprised of access control policy rules concerning the provision of the access control service.

There are two categories of access control policies, rule-based and identity-based, which are identified in CCITT Rec. X.800 aka ISO 7498-2. Rule-based access control policies are intended to apply to all access requests by any initiator on any target in a security domain. Identity-based access control policies are based on rules specific to an individual initiator, a group of initiators, entities acting on behalf of initiators, or originators acting in a specific role. Context can modify rule-based or identity-based access control policies. Context rules may define the entire policy in effect. Real systems will usually employ a combination of these policy types; if a rule-based policy is used, then an identity-based policy is usually in effect also.

An access control scheme may be based on access control lists, capabilities, labels, and context or a combination of these. An access control scheme is a component of an access control mechanism or "service") along with the supporting mechanisms required by that scheme to provide access control decision information (ADI) supplied by the scheme to the access decision facility (ADF also known as a PDP). (Based on ISO/IEC 10181-3:1996)

Examples:

Attribute Based Access Control (ABAC)

Discretionary Access Control (DAC)

History Based Access Control (HBAC)

Identity Based Access Control (IBAC)

Mandatory Access Control (MAC)

Organization Based Access Control (OrBAC)

Relationship Based Access Control (RelBac)

Responsibility Based Access Control (RespBAC)

Risk Adaptable Access Control (RAdAC)

active

AUTHPOL

3

DELEPOL

delegation policy

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)

active

SecurityPolicy

3

ObligationPolicy

obligation policy

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.

active

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.

SecurityPolicy

4

ANONY

anonymize

Custodian system must remove any information that could result in identifying the information subject.

active

ObligationPolicy

4

AOD

accounting of disclosure

Custodian system must make available to an information subject upon request an accounting of certain disclosures of the individual's protected health information over a period of time. Policy may dictate that the accounting include information about the information disclosed, the date of disclosure, the identification of the receiver, the purpose of the disclosure, the time in which the disclosing entity must provide a response and the time period for which accountings of disclosure can be requested.

active

ObligationPolicy

4

AUDIT

audit

Custodian system must monitor systems to ensure that all users are authorized to operate on information objects.

active

ObligationPolicy

4

AUDTR

audit trail

Custodian system must monitor and maintain retrievable log for each user and operation on information.

active

ObligationPolicy

4

CPLYPOL

comply with policy

Custodian security system must retrieve, evaluate, and comply with applicable policies associated with the target information.

Usage Note: CPLYPOL may be used as a security label code to inform senders and receivers of the tagged information to comply with applicable policy without specifying the specific policy type(s).

active

ObligationPolicy

5

CPLYCC

comply with confidentiality code

Custodian security system must retrieve, evaluate, and comply with the information handling directions of the Confidentiality Code associated with an information target.

Usage Note: CPLYCC may be used as a security label code to inform senders and receivers of information tagged with a Confidentiality Code to comply with applicable level of protection required by the assigned confidentiality code.

active

CPLYPOL

5

CPLYCD

comply with consent directive

Custodian security system must retrieve, evaluate, and comply with applicable information subject consent directives.

Usage Note: CPLYCD may be used as a security label code to inform senders and receivers of information tagged with an ActCode_ActPolicyType_ActConsent code or an ActCode_ActPolicyType_ActPrivacyPolicy_ActConsentDirective code to comply with applicable consent directives.

active

CPLYPOL

5

CPLYCUI

comply with controlled unclassified information policy

Custodian security system must retrieve, evaluate, and comply with applicable Controlled Unclassified Information (CUI) policies associated with the target information.

Usage Note: In the US, CPLYCUI may be used as a security label code to inform recipients of information designated by a US Federal Agency as Controlled Unclassified Information (CUI) to comply with the applicable laws, regulations, executive orders, and other guidances, such as included in DURSAs, to persist, mark, and enforce required CUI controls

Background:

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 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

active

CPLYPOL

5

CPLYJPP

comply with jurisdictional privacy policy

Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional privacy policies associated with the target information.

Usage Note: CPLYJPP may be used as a security label code to inform senders and receivers of information tagged with an ActCode_ActPolicyType_ActPrivacyPolicy_ActPrivacyLaw code or an ActCode_ActPolicyType_ActInformationPolicy.JurisIP code to comply with applicable jurisdictional privacy policy.

active

CPLYPOL

5

CPLYJSP

comply with jurisdictional security policy

Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional security policies associated with the target information.

Usage Note: CPLYJSP may be used as a security label code to inform senders and receivers of information tagged with an ActCode_ActPolicyType.SecurityPolicy code to comply with applicable jurisdictional security policy.

active

CPLYPOL

5

CPLYOPP

comply with organizational privacy policy

Custodian security system must retrieve, evaluate, and comply with applicable organizational privacy policies associated with the target information.

Usage Note: CPLYOPP may be used as a security label code to inform senders and receivers of information tagged with an ActCode_ActPolicyType_ActInformationPolicy.OrgIP code to comply with applicable organizational privacy policy.

active

CPLYPOL

5

CPLYOSP

comply with organizational security policy

Custodian security system must retrieve, evaluate, and comply with the organizational security policies associated with the target information.

Usage Note: CPLYOSP may be used as a security label code to inform senders and receivers of information tagged with an ActCode_ActPolicyType.SecurityPolicy code to comply with applicable organizational security policy.

active

CPLYPOL

4

DECLASSIFYLABEL

declassify security label

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 unclassified 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.

active

ObligationPolicy

4

DEID

deidentify

Custodian system must strip information of data that would allow the identification of the source of the information or the information subject.

active

ObligationPolicy

4

DELAU

delete after use

Custodian system must remove target information from access after use.

active

ObligationPolicy

4

DOWNGRDLABEL

downgrade security label

Custodian security system must downgrade 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 less 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.

active

ObligationPolicy

4

DRIVLABEL

derive security label

Custodian security system must assign and bind security labels derived from compilations of information by aggregation or disaggregation in order to classify information compiled in the information systems under its control for collection, access, use and disclosure 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.

active

ObligationPolicy

4

ENCRYPT

encrypt

Custodian system must render information unreadable by algorithmically transforming plaintext into ciphertext.

Usage Notes: A mathematical transposition of a file or data stream so that it cannot be deciphered at the receiving end without the proper key. Encryption is a security feature that assures that only the parties who are supposed to be participating in a videoconference or data transfer are able to do so. It can include a password, public and private keys, or a complex combination of all. (Per Infoway.)

active

A mathematical transposition of a file or data stream so that it cannot be deciphered at the receiving end without the proper key. Encryption is a security feature that assures that only the parties who are supposed to be participating in a videoconference or data transfer are able to do so. It can include a password, public and private keys, or a complex combination of all. (Per Infoway.)

ObligationPolicy

5

ENCRYPTR

encrypt at rest

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext when "at rest" or in storage.

active

ENCRYPT

5

ENCRYPTT

encrypt in transit

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext while "in transit" or being transported by any means.

active

ENCRYPT

5

ENCRYPTU

encrypt in use

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext while in use such that operations permitted on the target information are limited by the license granted to the end user.

active

ENCRYPT

4

HUAPRV

human approval

Custodian system must require human review and approval for permission requested.

active

ObligationPolicy

4

LABEL

assign security label

Custodian security system must assign and bind security labels in order to classify information created in the information systems under its control for collection, access, use and disclosure in accordance with applicable jurisdictional privacy policies associated with the target information. The system must retain an immutable record of the assignment and binding.

Usage Note: In security systems, security policy label assignments do not change, they may supersede prior assignments, and such reassignments are always tracked for auditing and other purposes.

active

ObligationPolicy

4

MASK

mask

Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext. User may be provided a key to decrypt per license or "shared secret".

active

ObligationPolicy

4

MINEC

minimum necessary

Custodian must limit access and disclosure to the minimum information required to support an authorized user's purpose of use.

Usage Note: Limiting the information available for access and disclosure to that an authorized user or receiver "needs to know" in order to perform permitted workflow or purpose of use.

active

ObligationPolicy

4

PERSISTLABEL

persist security label

Custodian security system must persist the binding of security labels to classify information received or imported by information systems under its control for collection, access, use and disclosure in accordance with applicable jurisdictional privacy policies associated with the target information. The system must retain an immutable record of the assignment and binding.

active

ObligationPolicy

4

PRIVMARK

privacy mark

Custodian must create and/or maintain human readable security label tags as required by policy.

Map: Aligns with ISO 22600-3 Section A.3.4.3 description of privacy mark: "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."

active

ObligationPolicy

5

CUIMark

CUI Mark

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

active

PRIVMARK

4

PSEUD

pseudonymize

Custodian system must strip information of data that would 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.

active

ObligationPolicy

4

REDACT

redact

Custodian system must remove information, which is not authorized to be access, used, or disclosed from records made available to otherwise authorized users.

active

ObligationPolicy

4

UPGRDLABEL

upgrade security label

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.

active

ObligationPolicy

4

PROCESSINLINELABEL

process inline security label

Custodian security system must take note that the data object contains inline security labels and process them.

active

ObligationPolicy

3

PrivacyMark

privacy mark

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.

active

true

SecurityPolicy

4

ControlledUnclassifiedInformation

ControlledUnclassifiedInformation

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.

active

true

PrivacyMark

5

CONTROLLED

CONTROLLED

A displayed mark, required to be rendered as "CONTROLLED", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From 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.

active

ControlledUnclassifiedInformation

5

CUI

CUI

A displayed mark, required to be rendered as "CUI", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From 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.

active

ControlledUnclassifiedInformation

5

CUIHLTH

CUI//HLTH

A displayed mark, required to be rendered as "CUI//HLTH", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

active

ControlledUnclassifiedInformation

5

CUIHLTHP

(CUI//HLTH)

A displayed mark, required to be rendered as "(CUI//HLTH)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

active

ControlledUnclassifiedInformation

5

CUIP

(CUI)

A displayed mark, required to be rendered as "(CUI)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

active

ControlledUnclassifiedInformation

5

CUIPRVCY

CUI//PRVCY

A displayed mark, required to be rendered as "CUI//PRVCY", indicating that the electronic or hardcopy controlled unclassified basic privacy information is private and must be protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of privacy regulation governing CUI Basic marking include 20 CFR 401.100 related to SSA disclosure of personal, program, and non-program information. https://www.govinfo.gov/content/pkg/CFR-2017-title20-vol2/pdf/CFR-2017-title20-vol2-sec401-100.pdf.

active

ControlledUnclassifiedInformation

5

CUIPRVCYP

(CUI//PRVCY)

A displayed mark, required to be rendered as "(CUI//PRVCY)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of privacy regulation governing CUI Basic marking include 20 CFR 401.100 related to SSA disclosure of personal, program, and non-program information. https://www.govinfo.gov/content/pkg/CFR-2017-title20-vol2/pdf/CFR-2017-title20-vol2-sec401-100.pdf.

active

ControlledUnclassifiedInformation

5

CUISP-HLTH

CUI//SP-HLTH

A displayed mark, required to be rendered as "CUI//SP-HLTH", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI in which the authorizing law, regulation, or Government-wide policy contains specific handling controls that it requires or permits agencies to use that differ from those for CUI Basic. The CUI Registry indicates which laws, regulations, and Government-wide policies include such specific requirements. CUI Specified controls may be more stringent than, or may simply differ from, those required by CUI Basic; the distinction is that the underlying authority spells out the controls for CUI Specified information and does not for CUI Basic information. CUI Basic controls apply to those aspects of CUI Specified where the authorizing laws, regulations, and Government-wide policies do not provide specific guidance. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of healthcare regulation governing CUI Specified marking include HIPAA Transaction and Code Sets and references the Congressional requirement that HHS promulgate Privacy, and Security rules https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf.

active

ControlledUnclassifiedInformation

5

CUISP-HLTHP

(CUI//SP-HLTH)

A displayed mark, required to be rendered as "(CUI//SP-HLTH)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of healthcare regulation governing CUI Specified marking include HIPAA Transaction and Code Sets and references the Congressional requirement that HHS promulgate Privacy, and Security rules https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf

active

ControlledUnclassifiedInformation

5

CUISP-PRVCY

CUI//SP-PRVCY

A displayed mark, required to be rendered as "CUI//SP-PRVCY", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of privacy regulation governing CUI Specified marking is OMB M-17-12ï‡? This Memorandum sets forth the policy for Federal agencies to prepare for and respond to a breach of personally identifiable information (PII). It includes a framework for assessing and mitigating the risk of harm to individuals potentially affected by a breach, as well as guidance on whether and how to provide notification and services to those individuals. https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2017/m-17-12_0.pdf.

active

ControlledUnclassifiedInformation

5

CUISP-PRVCYP

(CUI//SP-PRVCY)

A displayed mark, required to be rendered as "(CUI//SP-PRVCY)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

Usage Note: Examples of privacy regulation governing CUI Specified marking is OMB M-17-12ï‡? This Memorandum sets forth the policy for Federal agencies to prepare for and respond to a breach of personally identifiable information (PII). It includes a framework for assessing and mitigating the risk of harm to individuals potentially affected by a breach, as well as guidance on whether and how to provide notification and services to those individuals. https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2017/m-17-12_0.pdf.

active

ControlledUnclassifiedInformation

5

UUI

(U)

A displayed mark, required to be rendered as "(U)", indicating that a portion of an electronic or hardcopy information is neither Executive Order 13556 nor classified information authorities cover as protected. Although this information is not controlled or classified, agencies must still handle it in accordance with Federal Information Security Modernization Act (FISMA) requirements. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html

Usage Note: Regulatory Source: 32 CFR § 2002.20 Marking. Federal Register Page 63344 63344 (ii) Authorized holders permitted to designate CUI must portion mark both CUI and uncontrolled unclassified portions.

CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf

CUI Portion Marking: Portion marking of CUI is optional in a fully unclassified document, but is permitted and encouraged to facilitate information sharing and proper handling of the information. Agency heads may approve the required use of CUI Portion marking on all CUI generated within their agency. As such, users should consult their agency CUI policy when creating CUI documents. When CUI Portion Markings are used and a portion does not contain CUI a "U" is placed in parentheses to indicate that the portion contains Uncontrolled Unclassified Information. (Page 14)

CUI Portion Markings are placed at the beginning of the portion to which they apply and must be used throughout the entire document. They are presented in all capital letters and separated as indicated in this handbook and the CUI Registry. The presence of EVEN ONE item of CUI in a document requires CUI marking of that document. Because of this, CUI Portion Markings can be of great assistance in determining if a document contains CUI and therefore must be marked as such. Remember: When portion markings are used and any portion does not contain CUI, a "(U)" is placed in front of that portion to indicate that it contains Uncontrolled - or non-CUI - Unclassified Information. (Page 15)

active

ControlledUnclassifiedInformation

4

SecurityLabelMark

Security Label Mark

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.

active

true

PrivacyMark

5

ConfidentialMark

confidential mark

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.

active

SecurityLabelMark

5

COPYMark

copy of original mark

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.

active

SecurityLabelMark

5

DeliverToAddresseeOnlyMark

deliver only to addressee mark

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.

active

SecurityLabelMark

5

RedisclosureProhibitionMark

prohibition against redisclosure mark

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

active

SecurityLabelMark

5

RestrictedConfidentialityMark

restricted confidentiality mark

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.

active

SecurityLabelMark

5

DRAFTMark

Draft Mark

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.

active

SecurityLabelMark

3

RefrainPolicy

refrain policy

Conveys prohibited actions which an information custodian, receiver, or user is not permitted to perform unless otherwise authorized or permitted under specified circumstances.

Usage Notes: ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

active

ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

SecurityPolicy

4

NOAUTH

no disclosure without subject authorization

Prohibition on disclosure without information subject's authorization.

active

RefrainPolicy

4

NOCOLLECT

no collection

Prohibition on collection or storage of the information.

active

RefrainPolicy

4

NODSCLCD

no disclosure without consent directive

Prohibition on disclosure without organizational approved patient restriction.

active

RefrainPolicy

4

NODSCLCDS

no disclosure without information subject's consent directive

Prohibition on disclosure without a consent directive from the information subject.

active

RefrainPolicy

4

NOINTEGRATE

no integration

Prohibition on Integration into other records.

active

RefrainPolicy

4

NOLIST

no unlisted entity disclosure

Prohibition on disclosure except to entities on specific access list.

active

RefrainPolicy

4

NOMOU

no disclosure without MOU

Prohibition on disclosure without an interagency service agreement or memorandum of understanding (MOU).

active

RefrainPolicy

4

NOORGPOL

no disclosure without organizational authorization

Prohibition on disclosure without organizational authorization.

active

RefrainPolicy

4

NOPAT

no disclosure to patient, family or caregivers without attending provider's authorization

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).

active

RefrainPolicy

4

NOPERSISTP

no collection beyond purpose of use

Prohibition on collection of the information beyond time necessary to accomplish authorized purpose of use is prohibited.

active

RefrainPolicy

4

NORDSCLCD

no redisclosure without consent directive

Prohibition on redisclosure without patient consent directive.

active

NORDSLCD

RefrainPolicy

4

NORDSLCD

no redisclosure without consent directive

Prohibition on redisclosure without patient consent directive.

retired

NORDSCLCD

RefrainPolicy

4

NORDSCLCDS

no redisclosure without information subject's consent directive

Prohibition on redisclosure without a consent directive from the information subject.

active

RefrainPolicy

4

NORDSCLW

no disclosure without jurisdictional authorization

Prohibition on disclosure without authorization under jurisdictional law.

active

RefrainPolicy

4

NORELINK

no relinking

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.

active

RefrainPolicy

4

NOREUSE

no reuse beyond purpose of use

Prohibition on use of the information beyond the purpose of use initially authorized.

active

RefrainPolicy

4

NOVIP

no unauthorized VIP disclosure

Prohibition on disclosure except to principals with access permission to specific VIP information.

active

RefrainPolicy

4

ORCON

no disclosure without originator authorization

Prohibition on disclosure except as permitted by the information originator.

active

RefrainPolicy

1

_ActProductAcquisitionCode

ActProductAcquisitionCode

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

supply

active

true

2

LOAN

Loan

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

active

_ActProductAcquisitionCode

3

RENT

Rent

Temporary supply of a product with financial compensation, without transfer of ownership for the product.

active

LOAN

2

TRANSFER

Transfer

Transfer of ownership for a product.

active

_ActProductAcquisitionCode

3

SALE

Sale

Transfer of ownership for a product for financial compensation.

active

TRANSFER

1

_ActSpecimenTransportCode

ActSpecimenTransportCode

Transportation of a specimen.

transportation

active

true

2

SREC

specimen received

**Description:**Specimen has been received by the participating organization/department.

active

_ActSpecimenTransportCode

2

SSTOR

specimen in storage

**Description:**Specimen has been placed into storage at a participating location.

active

_ActSpecimenTransportCode

2

STRAN

specimen in transit

**Description:**Specimen has been put in transit to a participating receiver.

active

_ActSpecimenTransportCode

1

_ActSpecimenTreatmentCode

ActSpecimenTreatmentCode

Set of codes related to specimen treatments

specimen treatment

active

true

2

ACID

Acidification

The lowering of specimen pH through the addition of an acid

active

_ActSpecimenTreatmentCode

2

ALK

Alkalization

The act rendering alkaline by impregnating with an alkali; a conferring of alkaline qualities.

active

_ActSpecimenTreatmentCode

2

DEFB

Defibrination

The removal of fibrin from whole blood or plasma through physical or chemical means

active

_ActSpecimenTreatmentCode

2

FILT

Filtration

The passage of a liquid through a filter, accomplished by gravity, pressure or vacuum (suction).

active

_ActSpecimenTreatmentCode

2 | LDLP | LDL Precipitation | | | active | | | | _ActSpecimenTreatmentCode

2

NEUT

Neutralization

The act or process by which an acid and a base are combined in such proportions that the resulting compound is neutral.

active

_ActSpecimenTreatmentCode

2

RECA

Recalcification

The addition of calcium back to a specimen after it was removed by chelating agents

active

_ActSpecimenTreatmentCode

2

UFIL

Ultrafiltration

The filtration of a colloidal substance through a semipermeable medium that allows only the passage of small molecules.

active

_ActSpecimenTreatmentCode

1

_ActSubstanceAdministrationCode

ActSubstanceAdministrationCode

Description: Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information.

substance administration

active

true

2

DRUG

Drug therapy

The introduction of a drug into a subject with the intention of altering its biologic state with the intent of improving its health status.

active

_ActSubstanceAdministrationCode

2

FD

food

Description: The introduction of material into a subject with the intent of providing nutrition or other dietary supplements (e.g. minerals or vitamins).

active

_ActSubstanceAdministrationCode

2

IMMUNIZ

Immunization

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

active

_ActSubstanceAdministrationCode

3

BOOSTER

Booster Immunization

An additional immunization administration within a series intended to bolster or enhance immunity.

retired

IMMUNIZ

3

INITIMMUNIZ

Initial Immunization

The first immunization administration in a series intended to produce immunity

retired

IMMUNIZ

1

_ActTaskCode

ActTaskCode

Description: A task or action that a user may perform in a clinical information system (e.g., medication order entry, laboratory test results review, problem list entry).

act

active

true

2

OE

order entry task

A clinician creates a request for a service to be performed for a given patient.

active

_ActTaskCode

3

LABOE

laboratory test order entry task

A clinician creates a request for a laboratory test to be done for a given patient.

active

OE

3

MEDOE

medication order entry task

A clinician creates a request for the administration of one or more medications to a given patient.

active

OE

2

PATDOC

patient documentation task

A person enters documentation about a given patient.

active

_ActTaskCode

3

ALLERLREV

allergy list review

Description: A person reviews a list of known allergies of a given patient.

active

PATDOC

3

CLINNOTEE

clinical note entry task

A clinician enters a clinical note about a given patient

active

PATDOC

4

DIAGLISTE

diagnosis list entry task

A clinician enters a diagnosis for a given patient.

active

CLINNOTEE

4

DISCHINSTE

discharge instruction entry

A person provides a discharge instruction to a patient.

active

CLINNOTEE

4

DISCHSUME

discharge summary entry task

A clinician enters a discharge summary for a given patient.

active

CLINNOTEE

4

PATEDUE

patient education entry

A person provides a patient-specific education handout to a patient.

active

CLINNOTEE

4

PATREPE

pathology report entry task

A pathologist enters a report for a given patient.

active

CLINNOTEE

4

PROBLISTE

problem list entry task

A clinician enters a problem for a given patient.

active

CLINNOTEE

4

RADREPE

radiology report entry task

A radiologist enters a report for a given patient.

active

CLINNOTEE

3

IMMLREV

immunization list review

Description: A person reviews a list of immunizations due or received for a given patient.

active

PATDOC

3

REMLREV

reminder list review

Description: A person reviews a list of health care reminders for a given patient.

active

PATDOC

4

WELLREMLREV

wellness reminder list review

Description: A person reviews a list of wellness or preventive care reminders for a given patient.

active

REMLREV

2

PATINFO

patient information review task

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

active

_ActTaskCode

3

ALLERLE

allergy list entry

Description: A person enters a known allergy for a given patient.

active

PATINFO

3

CDSREV

clinical decision support intervention review

A person reviews a recommendation/assessment provided automatically by a clinical decision support application for a given patient.

active

PATINFO

3

CLINNOTEREV

clinical note review task

A person reviews a clinical note of a given patient.

active

PATINFO

4

DISCHSUMREV

discharge summary review task

A person reviews a discharge summary of a given patient.

active

CLINNOTEREV

3

DIAGLISTREV

diagnosis list review task

A person reviews a list of diagnoses of a given patient.

active

PATINFO

3

IMMLE

immunization list entry

Description: A person enters an immunization due or received for a given patient.

active

PATINFO

3

LABRREV

laboratory results review task

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

active

PATINFO

3

MICRORREV

microbiology results review task

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

active

PATINFO

4

MICROORGRREV

microbiology organisms results review task

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

active

MICRORREV

4

MICROSENSRREV

microbiology sensitivity test results review task

A person reviews the sensitivity test of microbiology results of a given patient.

active

MICRORREV

3

MLREV

medication list review task

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

active

PATINFO

4

MARWLREV

medication administration record work list review task

A clinician reviews a work list of medications to be administered to a given patient.

active

MLREV

3

OREV

orders review task

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

active

PATINFO

3

PATREPREV

pathology report review task

A person reviews a pathology report of a given patient.

active

PATINFO

3

PROBLISTREV

problem list review task

A person reviews a list of problems of a given patient.

active

PATINFO

3

RADREPREV

radiology report review task

A person reviews a radiology report of a given patient.

active

PATINFO

3

REMLE

reminder list entry

Description: A person enters a health care reminder for a given patient.

active

PATINFO

4

WELLREMLE

wellness reminder list entry

Description: A person enters a wellness or preventive care reminder for a given patient.

active

REMLE

3

RISKASSESS

risk assessment instrument task

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

active

PATINFO

4

FALLRISK

falls risk assessment instrument task

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

active

RISKASSESS

1

_ActTransportationModeCode

ActTransportationModeCode

Characterizes how a transportation act was or will be carried out.

Examples: Via private transport, via public transit, via courier.

transportation

active

true

2

_ActPatientTransportationModeCode

ActPatientTransportationModeCode

Definition: Characterizes how a patient was or will be transported to the site of a patient encounter.

Examples: Via ambulance, via public transit, on foot.

transportation

active

true

_ActTransportationModeCode

3 | AFOOT | pedestrian transport | | | active | | | OnFoot | _ActPatientTransportationModeCode
3 | OnFoot | pedestrian transport | | | retired | | | AFOOT | _ActPatientTransportationModeCode
3 | AMBT | ambulance transport | | | active | | | Ambulance | _ActPatientTransportationModeCode
4 | AMBAIR | fixed-wing ambulance transport | | | active | | | Fixed-wingAmbulance | AMBT, Ambulance
4 | Fixed-wingAmbulance | fixed-wing ambulance transport | | | retired | | | AMBAIR | AMBT, Ambulance
4 | AMBGRND | ground ambulance transport | | | active | | | GroundAmbulance | AMBT, Ambulance
4 | GroundAmbulance | ground ambulance transport | | | retired | | | AMBGRND | AMBT, Ambulance
4 | AMBHELO | helicopter ambulance transport | | | active | | | HelicopterAmbulance | AMBT, Ambulance
4 | HelicopterAmbulance | helicopter ambulance transport | | | retired | | | AMBHELO | AMBT, Ambulance
3 | Ambulance | ambulance transport | | | retired | | | AMBT | _ActPatientTransportationModeCode
4 | AMBAIR | fixed-wing ambulance transport |
4 | Fixed-wingAmbulance | fixed-wing ambulance transport |
4 | AMBGRND | ground ambulance transport |
4 | GroundAmbulance | ground ambulance transport |
4 | AMBHELO | helicopter ambulance transport |
4 | HelicopterAmbulance | helicopter ambulance transport |
3 | LAWENF | law enforcement transport | | | active | | | LawEnforcementVehicle | _ActPatientTransportationModeCode
3 | LawEnforcementVehicle | law enforcement transport | | | retired | | | LAWENF | _ActPatientTransportationModeCode
3 | PRVTRN | private transport | | | active | | | PrivateTransport | _ActPatientTransportationModeCode
3 | PrivateTransport | private transport | | | retired | | | PRVTRN | _ActPatientTransportationModeCode
3 | PUBTRN | public transport | | | active | | | PublicTransport | _ActPatientTransportationModeCode
3 | PublicTransport | public transport | | | retired | | | PUBTRN | _ActPatientTransportationModeCode

1

_ObservationType

ObservationType

Identifies the kinds of observations that can be performed

observation

active

true

2

_ActSpecObsCode

ActSpecObsCode

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

specimen observation

active

true

_ObservationType

3

ARTBLD

ActSpecObsArtBldCode

Describes the artificial blood identifier that is associated with the specimen.

active

_ActSpecObsCode

3

DILUTION

ActSpecObsDilutionCode

An observation that reports the dilution of a sample.

active

_ActSpecObsCode

4

AUTO-HIGH

Auto-High Dilution

The dilution of a sample performed by automated equipment. The value is specified by the equipment

active

DILUTION

4

AUTO-LOW

Auto-Low Dilution

The dilution of a sample performed by automated equipment. The value is specified by the equipment

active

DILUTION

4

PRE

Pre-Dilution

The dilution of the specimen made prior to being loaded onto analytical equipment

active

DILUTION

4

RERUN

Rerun Dilution

The value of the dilution of a sample after it had been analyzed at a prior dilution value

active

DILUTION

3

EVNFCTS

ActSpecObsEvntfctsCode

Domain provides codes that qualify the ActLabObsEnvfctsCode domain. (Environmental Factors)

active

_ActSpecObsCode

3

INTFR

ActSpecObsInterferenceCode

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

active

_ActSpecObsCode

4

FIBRIN

Fibrin

The Fibrin Index of the specimen. In the case of only differentiating between Absent and Present, recommend using 0 and 1

active

INTFR

4

HEMOLYSIS

Hemolysis

An observation of the hemolysis index of the specimen in g/L

active

INTFR

4

ICTERUS

Icterus

An observation that describes the icterus index of the specimen. It is recommended to use mMol/L of bilirubin

active

INTFR

4

LIPEMIA

Lipemia

An observation used to describe the Lipemia Index of the specimen. It is recommended to use the optical turbidity at 600 nm (in absorbance units).

active

INTFR

3

VOLUME

ActSpecObsVolumeCode

An observation that reports the volume of a sample.

active

_ActSpecObsCode

4

AVAILABLE

Available Volume

The available quantity of specimen. This is the current quantity minus any planned consumption (e.g., tests that are planned)

active

VOLUME

4

CONSUMPTION

Consumption Volume

The quantity of specimen that is used each time the equipment uses this substance

active

VOLUME

4

CURRENT

Current Volume

The current quantity of the specimen, i.e., initial quantity minus what has been actually used.

active

VOLUME

4

INITIAL

Initial Volume

The initial quantity of the specimen in inventory

active

VOLUME

2 | _AnnotationType | AnnotationType | | | active | true | | | _ObservationType

3

_ActPatientAnnotationType

ActPatientAnnotationType

**Description:**Provides a categorization for annotations recorded directly against the patient .

active

_AnnotationType

4

ANNDI

diagnostic image note

**Description:**A note that is specific to a patient's diagnostic images, either historical, current or planned.

active

_ActPatientAnnotationType

4

ANNGEN

general note

**Description:**A general or uncategorized note.

active

_ActPatientAnnotationType

4

ANNIMM

immunization note

A note that is specific to a patient's immunizations, either historical, current or planned.

active

_ActPatientAnnotationType

4

ANNLAB

laboratory note

**Description:**A note that is specific to a patient's laboratory results, either historical, current or planned.

active

_ActPatientAnnotationType

4

ANNMED

medication note

**Description:**A note that is specific to a patient's medications, either historical, current or planned.

active

_ActPatientAnnotationType

3 | _ECGAnnotationType | ECGAnnotationType | | | retired | true | | | _AnnotationType

2

_GeneticObservationType

GeneticObservationType

Description: None provided

observation

active

true

_ObservationType

3

GENE

gene

Description: A DNA segment that contributes to phenotype/function. In the absence of demonstrated function a gene may be characterized by sequence, transcription or homology

active

_GeneticObservationType

2

_ImmunizationObservationType

ImmunizationObservationType

Description: Observation codes which describe characteristics of the immunization material.

active

_ObservationType

3

OBSANTC

antigen count

Description: Indicates the valid antigen count.

active

_ImmunizationObservationType

3

OBSANTV

antigen validity

Description: Indicates whether an antigen is valid or invalid.

active

_ImmunizationObservationType

2

_IndividualCaseSafetyReportType

Individual Case Safety Report Type

A code that is used to indicate the type of case safety report received from sender. The current code example reference is from the International Conference on Harmonisation (ICH) Expert Workgroup guideline on Clinical Safety Data Management: Data Elements for Transmission of Individual Case Safety Reports. The unknown/unavailable option allows the transmission of information from a secondary sender where the initial sender did not specify the type of report.

Example concepts include: Spontaneous, Report from study, Other.

active

true

_ObservationType

3

PAT_ADV_EVNT

patient adverse event

Indicates that the ICSR is describing problems that a patient experienced after receiving a vaccine product.

active

_IndividualCaseSafetyReportType

3

VAC_PROBLEM

vaccine product problem

Indicates that the ICSR is describing a problem with the actual vaccine product such as physical defects (cloudy, particulate matter) or inability to confer immunity.

active

_IndividualCaseSafetyReportType

2

_LOINCObservationActContextAgeType

LOINCObservationActContextAgeType

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

observation

active

true

_ObservationType

3

21611-9

age patient qn est

**Definition:**Estimated age.

active

_LOINCObservationActContextAgeType

3

21612-7

age patient qn reported

**Definition:**Reported age.

active

_LOINCObservationActContextAgeType

3

29553-5

age patient qn calc

**Definition:**Calculated age.

active

_LOINCObservationActContextAgeType

3

30525-0

age patient qn definition

**Definition:**General specification of age with no implied method of determination.

active

_LOINCObservationActContextAgeType

3

30972-4

age at onset of adverse event

**Definition:**Age at onset of associated adverse event; no implied method of determination.

active

_LOINCObservationActContextAgeType

2 | _MedicationObservationType | MedicationObservationType | | observation | active | true | | | _ObservationType

3

REP_HALF_LIFE

representative half-life

**Description:**This observation represents an 'average' or 'expected' half-life typical of the product.

active

_MedicationObservationType

3

SPLCOATING

coating

Definition: A characteristic of an oral solid dosage form of a medicinal product, indicating whether it has one or more coatings such as sugar coating, film coating, or enteric coating. Only coatings to the external surface or the dosage form should be considered (for example, coatings to individual pellets or granules inside a capsule or tablet are excluded from consideration).

Constraints: The Observation.value must be a Boolean (BL) with true for the presence or false for the absence of one or more coatings on a solid dosage form.

active

_MedicationObservationType

3

SPLCOLOR

color

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the color or colors that most predominantly define the appearance of the dose form. SPLCOLOR is not an FDA specification for the actual color of solid dosage forms or the names of colors that can appear in labeling.

Constraints: The Observation.value must be a single coded value or a list of multiple coded values, specifying one or more distinct colors that approximate of the color(s) of distinct areas of the solid dosage form, such as the different sides of a tablet or one-part capsule, or the different halves of a two-part capsule. Bands on banded capsules, regardless of the color, are not considered when assigning an SPLCOLOR. Imprints on the dosage form, regardless of their color are not considered when assigning an SPLCOLOR. If more than one color exists on a particular side or half, then the most predominant color on that side or half is recorded. If the gelatin capsule shell is colorless and transparent, use the predominant color of the contents that appears through the colorless and transparent capsule shell. Colors can include: Black;Gray;White;Red;Pink;Purple;Green;Yellow;Orange;Brown;Blue;Turquoise.

active

_MedicationObservationType

3

SPLIMAGE

image

Description: A characteristic representing a single file reference that contains two or more views of the same dosage form of the product; in most cases this should represent front and back views of the dosage form, but occasionally additional views might be needed in order to capture all of the important physical characteristics of the dosage form. Any imprint and/or symbol should be clearly identifiable, and the viewer should not normally need to rotate the image in order to read it. Images that are submitted with SPL should be included in the same directory as the SPL file.

active

_MedicationObservationType

3

SPLIMPRINT

imprint

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the alphanumeric text that appears on the solid dosage form, including text that is embossed, debossed, engraved or printed with ink. The presence of other non-textual distinguishing marks or symbols is recorded by SPLSYMBOL.

Examples: Included in SPLIMPRINT are alphanumeric text that appears on the bands of banded capsules and logos and other symbols that can be interpreted as letters or numbers.

Constraints: The Observation.value must be of type Character String (ST). Excluded from SPLIMPRINT are internal and external cut-outs in the form of alphanumeric text and the letter 'R' with a circle around it (when referring to a registered trademark) and the letters 'TM' (when referring to a 'trade mark'). To record text, begin on either side or part of the dosage form. Start at the top left and progress as one would normally read a book. Enter a semicolon to show separation between words or line divisions.

active

_MedicationObservationType

3

SPLSCORING

scoring

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the number of equal pieces that the solid dosage form can be divided into using score line(s).

Example: One score line creating two equal pieces is given a value of 2, two parallel score lines creating three equal pieces is given a value of 3.

Constraints: Whether three parallel score lines create four equal pieces or two intersecting score lines create two equal pieces using one score line and four equal pieces using both score lines, both have the scoring value of 4. Solid dosage forms that are not scored are given a value of 1. Solid dosage forms that can only be divided into unequal pieces are given a null-value with nullFlavor other (OTH).

active

_MedicationObservationType

3

SPLSHAPE

shape

Description: A characteristic of an oral solid dosage form of a medicinal product, specifying the two dimensional representation of the solid dose form, in terms of the outside perimeter of a solid dosage form when the dosage form, resting on a flat surface, is viewed from directly above, including slight rounding of corners. SPLSHAPE does not include embossing, scoring, debossing, or internal cut-outs. SPLSHAPE is independent of the orientation of the imprint and logo. Shapes can include: Triangle (3 sided); Square; Round; Semicircle; Pentagon (5 sided); Diamond; Double circle; Bullet; Hexagon (6 sided); Rectangle; Gear; Capsule; Heptagon (7 sided); Trapezoid; Oval; Clover; Octagon (8 sided); Tear; Freeform.

active

_MedicationObservationType

3

SPLSIZE

size

Definition: A characteristic of an oral solid dosage form of a medicinal product, specifying the longest single dimension of the solid dosage form as a physical quantity in the dimension of length (e.g., 3 mm). The length is should be specified in millimeters and should be rounded to the nearest whole millimeter.

Example: SPLSIZE for a rectangular shaped tablet is the length and SPLSIZE for a round shaped tablet is the diameter.

active

_MedicationObservationType

3

SPLSYMBOL

symbol

Definition: A characteristic of an oral solid dosage form of a medicinal product, to describe whether or not the medicinal product has a mark or symbol appearing on it for easy and definite recognition. Score lines, letters, numbers, and internal and external cut-outs are not considered marks or symbols. See SPLSCORING and SPLIMPRINT for these characteristics.

Constraints: The Observation.value must be a Boolean (BL) with <u>true</u> indicating the presence and <u>false</u> for the absence of marks or symbols.

Example:

active

_MedicationObservationType

2

_ObservationIssueTriggerCodedObservationType

ObservationIssueTriggerCodedObservationType

Distinguishes the kinds of coded observations that could be the trigger for clinical issue detection. These are observations that are not measurable, but instead can be defined with codes. Coded observation types include: Allergy, Intolerance, Medical Condition, Pregnancy status, etc.

active

true

_ObservationType

3

_CaseTransmissionMode

case transmission mode

Code for the mechanism by which disease was acquired by the living subject involved in the public health case. Includes sexually transmitted, airborne, bloodborne, vectorborne, foodborne, zoonotic, nosocomial, mechanical, dermal, congenital, environmental exposure, indeterminate.

active

true

_ObservationIssueTriggerCodedObservationType

4

AIRTRNS

airborne transmission

Communication of an agent from a living subject or environmental source to a living subject through indirect contact via oral or nasal inhalation.

active

_CaseTransmissionMode

4

ANANTRNS

animal to animal transmission

Communication of an agent from one animal to another proximate animal.

active

_CaseTransmissionMode

4

ANHUMTRNS

animal to human transmission

Communication of an agent from an animal to a proximate person.

active

_CaseTransmissionMode

4

BDYFLDTRNS

body fluid contact transmission

Communication of an agent from one living subject to another living subject through direct contact with any body fluid.

active

_CaseTransmissionMode

4

BLDTRNS

blood borne transmission

Communication of an agent to a living subject through direct contact with blood or blood products whether the contact with blood is part of a therapeutic procedure or not.

active

_CaseTransmissionMode

4

DERMTRNS

transdermal transmission

Communication of an agent from a living subject or environmental source to a living subject via agent migration through intact skin.

active

_CaseTransmissionMode

4

ENVTRNS

environmental exposure transmission

Communication of an agent from an environmental surface or source to a living subject by direct contact.

active

_CaseTransmissionMode

4

FECTRNS

fecal-oral transmission

Communication of an agent from a living subject or environmental source to a living subject through oral contact with material contaminated by person or animal fecal material.

active

_CaseTransmissionMode

4

FOMTRNS

fomite transmission

Communication of an agent from an non-living material to a living subject through direct contact.

active

_CaseTransmissionMode

4

FOODTRNS

food-borne transmission

Communication of an agent from a food source to a living subject via oral consumption.

active

_CaseTransmissionMode

4

HUMHUMTRNS

human to human transmission

Communication of an agent from a person to a proximate person.

active

_CaseTransmissionMode

4

INDTRNS

indeterminate disease transmission mode

Communication of an agent to a living subject via an undetermined route.

active

_CaseTransmissionMode

4

LACTTRNS

lactation transmission

Communication of an agent from one living subject to another living subject through direct contact with mammalian milk or colostrum.

active

_CaseTransmissionMode

4

NOSTRNS

nosocomial transmission

Communication of an agent from any entity to a living subject while the living subject is in the patient role in a healthcare facility.

active

_CaseTransmissionMode

4

PARTRNS

parenteral transmission

Communication of an agent from a living subject or environmental source to a living subject where the acquisition of the agent is not via the alimentary canal.

active

_CaseTransmissionMode

4

PLACTRNS

transplacental transmission

Communication of an agent from a living subject to the progeny of that living subject via agent migration across the maternal-fetal placental membranes while in utero.

active

_CaseTransmissionMode

4

SEXTRNS

sexual transmission

Communication of an agent from one living subject to another living subject through direct contact with genital or oral tissues as part of a sexual act.

active

_CaseTransmissionMode

4

TRNSFTRNS

transfusion transmission

Communication of an agent from one living subject to another living subject through direct contact with blood or blood products where the contact with blood is part of a therapeutic procedure.

active

_CaseTransmissionMode

4

VECTRNS

vector-borne transmission

Communication of an agent from a living subject acting as a required intermediary in the agent transmission process to a recipient living subject via direct contact.

active

_CaseTransmissionMode

4

WATTRNS

water-borne transmission

Communication of an agent from a contaminated water source to a living subject whether the water is ingested as a food or not. The route of entry of the water may be through any bodily orifice.

active

_CaseTransmissionMode

2

_ObservationQualityMeasureAttribute

ObservationQualityMeasureAttribute

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

active

_ObservationType

3

AGGREGATE

aggregate measure observation

Indicates that the observation is carrying out an aggregation calculation, contained in the value element.

active

_ObservationQualityMeasureAttribute

3

CMPMSRMTH

composite measure method

Indicates what method is used in a quality measure to combine the component measure results included in an composite measure.

active

_ObservationQualityMeasureAttribute

3

CMPMSRSCRWGHT

component measure scoring weight

An attribute of a quality measure describing the weight this component measure score is to carry in determining the overall composite measure final score. The value is real value greater than 0 and less than 1.0. Each component measure score will be multiplied by its CMPMSRSCRWGHT and then summed with the other component measures to determine the final overall composite measure score. The sum across all CMPMSRSCRWGHT values within a single composite measure SHALL be 1.0. The value assigned is scoped to the composite measure referencing this component measure only.

active

_ObservationQualityMeasureAttribute

3

COPY

copyright

Identifies the organization(s) who own the intellectual property represented by the eMeasure.

active

_ObservationQualityMeasureAttribute

3

CRS

clinical recommendation statement

Summary of relevant clinical guidelines or other clinical recommendations supporting this eMeasure.

active

_ObservationQualityMeasureAttribute

3

DEF

definition

Description of individual terms, provided as needed.

active

_ObservationQualityMeasureAttribute

3

DISC

disclaimer

Disclaimer information for the eMeasure.

active

_ObservationQualityMeasureAttribute

3

FINALDT

finalized date/time

The timestamp when the eMeasure was last packaged in the Measure Authoring Tool.

active

_ObservationQualityMeasureAttribute

3

GUIDE

guidance

Used to allow measure developers to provide additional guidance for implementers to understand greater specificity than could be provided in the logic for data criteria.

active

_ObservationQualityMeasureAttribute

3

IDUR

improvement notation

Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

active

_ObservationQualityMeasureAttribute

3

ITMCNT

items counted

Describes the items counted by the measure (e.g., patients, encounters, procedures, etc.)

active

_ObservationQualityMeasureAttribute

3

KEY

keyword

A significant word that aids in discoverability.

active

_ObservationQualityMeasureAttribute

3

MEDT

measurement end date

The end date of the measurement period.

active

_ObservationQualityMeasureAttribute

3

MSD

measurement start date

The start date of the measurement period.

active

_ObservationQualityMeasureAttribute

3

MSRADJ

risk adjustment

The method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether an eMeasure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow more useful comparisons.

active

_ObservationQualityMeasureAttribute

3

MSRAGG

rate aggregation

Describes how to combine information calculated based on logic in each of several populations into one summarized result. It can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure. (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two).

Open Issue: The description does NOT align well with the definition used in the HQMF specfication; correct the MSGAGG definition, and the possible distinction of MSRAGG as a child of AGGREGATE.

active

_ObservationQualityMeasureAttribute

3

MSRIMPROV

health quality measure improvement notation

Information on whether an increase or decrease in score is the preferred result. This should reflect information on which way is better, an increase or decrease in score.

active

_ObservationQualityMeasureAttribute

3

MSRJUR

jurisdiction

The list of jurisdiction(s) for which the measure applies.

active

_ObservationQualityMeasureAttribute

3

MSRRPTR

reporter type

Type of person or organization that is expected to report the issue.

active

_ObservationQualityMeasureAttribute

3

MSRRPTTIME

timeframe for reporting

The maximum time that may elapse following completion of the measure until the measure report must be sent to the receiver.

active

_ObservationQualityMeasureAttribute

3

MSRSCORE

measure scoring

Indicates how the calculation is performed for the eMeasure (e.g., proportion, continuous variable, ratio)

active

_ObservationQualityMeasureAttribute

3

MSRSET

health quality measure care setting

Location(s) in which care being measured is rendered

Usage Note: MSRSET is used rather than RoleCode because the setting applies to what is being measured, as opposed to participating directly in the health quality measure documantion itself).

active

_ObservationQualityMeasureAttribute

3 | MSRTOPIC | health quality measure topic type | | | active | | | | _ObservationQualityMeasureAttribute

3

MSRTP

measurement period

The time period for which the eMeasure applies.

active

_ObservationQualityMeasureAttribute

3

MSRTYPE

measure type

Indicates whether the eMeasure is used to examine a process or an outcome over time (e.g., Structure, Process, Outcome).

active

_ObservationQualityMeasureAttribute

3

RAT

rationale

Succinct statement of the need for the measure. Usually includes statements pertaining to Importance criterion: impact, gap in care and evidence.

active

_ObservationQualityMeasureAttribute

3

REF

reference

Identifies bibliographic citations or references to clinical practice guidelines, sources of evidence, or other relevant materials supporting the intent and rationale of the eMeasure.

active

_ObservationQualityMeasureAttribute

3

SDE

supplemental data elements

Comparison of results across strata can be used to show where disparities exist or where there is a need to expose differences in results. For example, Centers for Medicare & Medicaid Services (CMS) in the U.S. defines four required Supplemental Data Elements (payer, ethnicity, race, and gender), which are variables used to aggregate data into various subgroups. Additional supplemental data elements required for risk adjustment or other purposes of data aggregation can be included in the Supplemental Data Element section.

active

_ObservationQualityMeasureAttribute

3

STRAT

stratification

Describes the strata for which the measure is to be evaluated. There are three examples of reasons for stratification based on existing work. These include: (1) evaluate the measure based on different age groupings within the population described in the measure (e.g., evaluate the whole [age 14-25] and each sub-stratum [14-19] and [20-25]); (2) evaluate the eMeasure based on either a specific condition, a specific discharge location, or both; (3) evaluate the eMeasure based on different locations within a facility (e.g., evaluate the overall rate for all intensive care units and also some strata include additional findings [specific birth weights for neonatal intensive care units]).

active

_ObservationQualityMeasureAttribute

3

TRANF

transmission format

Can be a URL or hyperlinks that link to the transmission formats that are specified for a particular reporting program.

active

_ObservationQualityMeasureAttribute

3

USE

notice of use

Usage notes.

active

_ObservationQualityMeasureAttribute

2 | _ObservationSequenceType | ObservationSequenceType | | | active | true | | | _ObservationType

3

TIME_ABSOLUTE

absolute time sequence

A sequence of values in the "absolute" time domain. This is the same time domain that all HL7 timestamps use. It is time as measured by the Gregorian calendar

active

_ObservationSequenceType

3

TIME_RELATIVE

relative time sequence

A sequence of values in a "relative" time domain. The time is measured relative to the earliest effective time in the Observation Series containing this sequence.

active

_ObservationSequenceType

3 | _ECGObservationSequenceType | ECGObservationSequenceType | | | retired | true | | | _ObservationSequenceType
2 | _ObservationSeriesType | ObservationSeriesType | | | active | true | | | _ObservationType
3 | _ECGObservationSeriesType | ECGObservationSeriesType | | observation series | active | true | | | _ObservationSeriesType

4

REPRESENTATIVE_BEAT

ECG representative beat waveforms

This Observation Series type contains waveforms of a "representative beat" (a.k.a. "median beat" or "average beat"). The waveform samples are measured in relative time, relative to the beginning of the beat as defined by the Observation Series effective time. The waveforms are not directly acquired from the subject, but rather algorithmically derived from the "rhythm" waveforms.

active

_ECGObservationSeriesType

4

RHYTHM

ECG rhythm waveforms

This Observation type contains ECG "rhythm" waveforms. The waveform samples are measured in absolute time (a.k.a. "subject time" or "effective time"). These waveforms are usually "raw" with some minimal amount of noise reduction and baseline filtering applied.

active

_ECGObservationSeriesType

2

_PatientImmunizationRelatedObservationType

PatientImmunizationRelatedObservationType

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

active

_ObservationType

3

CLSSRM

classroom

Description: The class room associated with the patient during the immunization event.

active

_PatientImmunizationRelatedObservationType

3

GRADE

grade

Description: The school grade or level the patient was in when immunized.

active

_PatientImmunizationRelatedObservationType

3

SCHL

school

Description: The school the patient attended when immunized.

active

_PatientImmunizationRelatedObservationType

3

SCHLDIV

school division

Description: The school division or district associated with the patient during the immunization event.

active

_PatientImmunizationRelatedObservationType

3

TEACHER

teacher

Description: The patient's teacher when immunized.

active

_PatientImmunizationRelatedObservationType

2

_PopulationInclusionObservationType

PopulationInclusionObservationType

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

active

true

_ObservationType

3

DENEX

denominator exclusions

Criteria which specify subjects 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.

active

_PopulationInclusionObservationType

3

DENEXCEP

denominator exceptions

Criteria which specify the removal of a subject, 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 (or subject) reasons

System reasons

active

_PopulationInclusionObservationType

3

DENOM

denominator

Criteria for specifying the entities to be evaluated by a specific quality measure, based on a shared common set of characteristics (within a specific measurement set to which a given measure belongs). The denominator can be the same as the initial population, or it may be a subset of the initial population to further constrain it 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.

active

_PopulationInclusionObservationType

3

IPOP

initial population

Criteria for specifying the entities to be evaluated by a specific quality measure, based on a shared common set of characteristics (within a specific measurement set to which a given measure belongs).

active

_PopulationInclusionObservationType

4

IPPOP

initial patient population

Criteria for specifying the patients to be evaluated by a specific quality measure, based on a shared common set of 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.

active

IPOP

3

MSROBS

measure observation

Defines the observation to be performed for each patient or event in the measure population. Measure observations for each case in the population are aggregated to determine the overall measure score for the population.

Examples:

the median time from arrival in the Emergency Room to departure

the median time from decision to admit to a hospital to the actual admission for Emergency Room patients

active

_PopulationInclusionObservationType

3

MSRPOPL

measure population

Criteria for specifying the measure population as a narrative description (e.g., all patients seen in the Emergency Department during the measurement period). This is used only in continuous variable eMeasures.

active

_PopulationInclusionObservationType

3

MSRPOPLEX

measure population exclusions

Criteria for specifying subjects who should be removed from the eMeasure's Initial Population and Measure Population. Measure Population Exclusions are used in Continuous Variable measures to help narrow the Measure Population before determining the value(s) of the continuous variable(s).

active

_PopulationInclusionObservationType

3

NUMER

numerator

Criteria for specifying the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator for proportion measures, or related to (but not directly derived from) the denominator for ratio measures (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).

active

_PopulationInclusionObservationType

3

NUMEX

numerator exclusions

Criteria for specifying 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). Numerator Exclusions are used only in ratio eMeasures.

active

_PopulationInclusionObservationType

2

_PreferenceObservationType

_PreferenceObservationType

Types of observations that can be made about Preferences.

active

true

_ObservationType

3

PREFSTRENGTH

preference strength

An observation about how important a preference is to the target of the preference.

active

_PreferenceObservationType

2

ADVERSE_REACTION

Adverse Reaction

Indicates that the observation is of an unexpected negative occurrence in the subject suspected to result from the subject's exposure to one or more agents. Observation values would be the symptom resulting from the reaction.

active

_ObservationType

2

ASSERTION

Assertion

**Description:**Refines classCode OBS to indicate an observation in which observation.value contains a finding or other nominalized statement, where the encoded information in Observation.value is not altered by Observation.code. For instance, observation.code="ASSERTION" and observation.value="fracture of femur present" is an assertion of a clinical finding of femur fracture.

active

_ObservationType

2

CASESER

case seriousness criteria

**Definition:**An observation that provides a characterization of the level of harm to an investigation subject as a result of a reaction or event.

active

_ObservationType

2

CDIO

case disease imported observation

An observation that states whether the disease was likely acquired outside the jurisdiction of observation, and if so, the nature of the inter-jurisdictional relationship.

OpenIssue: This code could be moved to LOINC if it can be done before there are significant implemenations using it.

active

_ObservationType

2

CRIT

criticality

A clinical judgment as to the worst case result of a future exposure (including substance administration). When the worst case result is assessed to have a life-threatening or organ system threatening potential, it is considered to be of high criticality.

active

_ObservationType

2

CTMO

case transmission mode observation

An observation that states the mechanism by which disease was acquired by the living subject involved in the public health case.

OpenIssue: This code could be moved to LOINC if it can be done before there are significant implemenations using it.

active

_ObservationType

2

DX

ObservationDiagnosisTypes

Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests.

active

_ObservationDiagnosisTypes

_ObservationType

3

ADMDX

admitting diagnosis

Admitting diagnosis are the diagnoses documented for administrative purposes as the basis for a hospital admission.

active

_ObservationDiagnosisTypes, DX

3

DISDX

discharge diagnosis

Discharge diagnosis are the diagnoses documented for administrative purposes as the time of hospital discharge.

active

_ObservationDiagnosisTypes, DX

3

INTDX

intermediate diagnosis

Intermediate diagnoses are those diagnoses documented for administrative purposes during the course of a hospital stay.

active

_ObservationDiagnosisTypes, DX

3

NOI

nature of injury

The type of injury that the injury coding specifies.

active

_ObservationDiagnosisTypes, DX

2

_ObservationDiagnosisTypes

ObservationDiagnosisTypes

Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests.

retired

DX

_ObservationType

3 | ADMDX | admitting diagnosis |
3 | DISDX | discharge diagnosis |
3 | INTDX | intermediate diagnosis |
3 | NOI | nature of injury |

2

GISTIER

GIS tier

Description: Accuracy determined as per the GIS tier code system.

active

_ObservationType

2

HHOBS

household situation observation

Indicates that the observation is of a person’s living situation in a household including the household composition and circumstances.

active

_ObservationType

2

ISSUE

detected issue

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

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

active

_ObservationType

3

_ActAdministrativeDetectedIssueCode

ActAdministrativeDetectedIssueCode

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

detected issue

active

true

ISSUE

4 | _ActAdministrativeAuthorizationDetectedIssueCode | ActAdministrativeAuthorizationDetectedIssueCode | | | active | true | | | _ActAdministrativeDetectedIssueCode

5

NAT

Insufficient authorization

The requesting party has insufficient authorization to invoke the interaction.

active

_ActAdministrativeAuthorizationDetectedIssueCode

5

SUPPRESSED

record suppressed

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

active

_ActAdministrativeAuthorizationDetectedIssueCode

5

VALIDAT

validation issue

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

active

_ActAdministrativeAuthorizationDetectedIssueCode

6

KEY204

Unknown key identifier

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

active

_ActAdministrativeRuleDetectedIssueCode, VALIDAT

6

KEY205

Duplicate key identifier

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

active

_ActAdministrativeRuleDetectedIssueCode, VALIDAT

6

COMPLY

Compliance Alert

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

active

_AdministrationDetectedIssueCode, VALIDAT

7

DUPTHPY

Duplicate Therapy Alert

The proposed therapy appears to duplicate an existing therapy

active

_AdministrationDetectedIssueCode, COMPLY

8

DUPTHPCLS

duplicate therapeutic alass alert

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

active

DUPTHPY

8

DUPTHPGEN

duplicate generic alert

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

active

DUPTHPY

7

ABUSE

commonly abused/misused alert

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

active

COMPLY

7

FRAUD

potential fraud

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

active

COMPLY

7

PLYDOC

Poly-orderer Alert

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

active

COMPLY

7

PLYPHRM

Poly-supplier Alert

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

active

COMPLY

6

DOSE

Dosage problem

Proposed dosage instructions for therapy differ from standard practice.

active

_AdministrationDetectedIssueCode, VALIDAT

7

DOSECOND

dosage-condition alert

**Description:**Proposed dosage is inappropriate due to patient's medical condition.

active

DOSE

7

DOSEDUR

Dose-Duration Alert

Proposed length of therapy differs from standard practice.

active

DOSE

8

DOSEDURH

Dose-Duration High Alert

Proposed length of therapy is longer than standard practice

active

DOSEDUR

9

DOSEDURHIND

Dose-Duration High for Indication Alert

Proposed length of therapy is longer than standard practice for the identified indication or diagnosis

active

DOSEDURH

8

DOSEDURL

Dose-Duration Low Alert

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

active

DOSEDUR

9

DOSEDURLIND

Dose-Duration Low for Indication Alert

Proposed length of therapy is shorter than standard practice for the identified indication or diagnosis

active

DOSEDURL

7

DOSEH

High Dose Alert

Proposed dosage exceeds standard practice

active

DOSE

8

DOSEHINDA

High Dose for Age Alert

Proposed dosage exceeds standard practice for the patient's age

active

AGE, DOSEH

8 | DOSEHIND | High Dose for Indication Alert | | | active | | | | DOSEH

8

DOSEHINDSA

High Dose for Height/Surface Area Alert

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

active

DOSEH

8

DOSEHINDW

High Dose for Weight Alert

Proposed dosage exceeds standard practice for the patient's weight

active

DOSEH

7

DOSEIVL

Dose-Interval Alert

Proposed dosage interval/timing differs from standard practice

active

DOSE

8

DOSEIVLIND

Dose-Interval for Indication Alert

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

active

DOSEIVL

7

DOSEL

Low Dose Alert

Proposed dosage is below suggested therapeutic levels

active

DOSE

8

DOSELINDA

Low Dose for Age Alert

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

active

AGE, DOSEL

8 | DOSELIND | Low Dose for Indication Alert | | | active | | | | DOSEL

8

DOSELINDSA

Low Dose for Height/Surface Area Alert

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

active

DOSEL

8

DOSELINDW

Low Dose for Weight Alert

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

active

DOSEL

7

MDOSE

maximum dosage reached

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

active

DOSE

6

OBSA

Observation Alert

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

active

_AppropriatenessDetectedIssueCode, VALIDAT

7

AGE

Age Alert

Proposed therapy may be inappropriate or contraindicated due to patient age

active

OBSA

8

ADALRT

adult alert

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

active

AGE

8

GEALRT

geriatric alert

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

active

AGE

8

PEALRT

pediatric alert

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

active

AGE

8 | DOSEHINDA | High Dose for Age Alert |
8 | DOSELINDA | Low Dose for Age Alert |

7

COND

Condition Alert

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

active

OBSA

8 | HGHT | | | | active | | | | COND

8

LACT

Lactation Alert

Proposed therapy may be inappropriate or contraindicated when breast-feeding

active

COND

8

PREG

Pregnancy Alert

Proposed therapy may be inappropriate or contraindicated during pregnancy

active

COND

8 | WGHT | | | | active | | | | COND

7

CREACT

common reaction alert

**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.

active

OBSA

7

GEN

Genetic Alert

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

active

OBSA

7

GEND

Gender Alert

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

active

OBSA

7

LAB

Lab Alert

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

active

OBSA

7

REACT

Reaction Alert

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

active

OBSA

8

ALGY

Allergy Alert

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

active

REACT

8

INT

Intolerance Alert

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

active

REACT

7

RREACT

Related Reaction Alert

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

active

OBSA

8

RALG

Related Allergy Alert

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

active

RREACT

8

RAR

Related Prior Reaction Alert

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

active

RREACT

8

RINT

Related Intolerance Alert

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.)

active

RREACT

6

BUS

business constraint violation

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

active

VALIDAT

6

CODE_INVAL

code is not valid

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

active

VALIDAT

7

CODE_DEPREC

code has been deprecated

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

active

CODE_INVAL

6

FORMAT

invalid format

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

active

VALIDAT

6

ILLEGAL

illegal

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

active

VALIDAT

6

LEN_RANGE

length out of range

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

active

VALIDAT

7

LEN_LONG

length is too long

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

active

LEN_RANGE

7

LEN_SHORT

length is too short

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

active

LEN_RANGE

6

MISSCOND

conditional element missing

**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.

active

VALIDAT

6

MISSMAND

mandatory element missing

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

active

VALIDAT

6

NODUPS

duplicate values are not permitted

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

active

VALIDAT

6

NOPERSIST

element will not be persisted

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

active

VALIDAT

6

REP_RANGE

repetitions out of range

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

active

VALIDAT

7

MAXOCCURS

repetitions above maximum

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

active

REP_RANGE

7

MINOCCURS

repetitions below minimum

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

active

REP_RANGE

4 | _ActAdministrativeRuleDetectedIssueCode | ActAdministrativeRuleDetectedIssueCode | | | active | true | | | _ActAdministrativeDetectedIssueCode

5

KEY206

non-matching identification

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

active

_ActAdministrativeRuleDetectedIssueCode

5

OBSOLETE

obsolete record returned

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

active

_ActAdministrativeRuleDetectedIssueCode

5 | KEY204 | Unknown key identifier |
5 | KEY205 | Duplicate key identifier |

3

_ActSuppliedItemDetectedIssueCode

ActSuppliedItemDetectedIssueCode

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

detected issue

active

true

ISSUE

4

_AdministrationDetectedIssueCode

AdministrationDetectedIssueCode

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

detected issue

active

true

_ActSuppliedItemDetectedIssueCode

5 | _AppropriatenessDetectedIssueCode | AppropriatenessDetectedIssueCode | | detected issue | active | true | | | _AdministrationDetectedIssueCode
6 | _InteractionDetectedIssueCode | InteractionDetectedIssueCode | | detected issue | active | true | | | _AppropriatenessDetectedIssueCode

7

FOOD

Food Interaction Alert

Proposed therapy may interact with certain foods

active

_InteractionDetectedIssueCode

7

TPROD

Therapeutic Product Alert

Proposed therapy may interact with an existing or recent therapeutic product

active

_InteractionDetectedIssueCode

8

DRG

Drug Interaction Alert

Proposed therapy may interact with an existing or recent drug therapy

active

TPROD

8

NHP

Natural Health Product Alert

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

active

TPROD

8

NONRX

Non-Prescription Interaction Alert

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

active

TPROD

6

PREVINEF

previously ineffective

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

active

_AppropriatenessDetectedIssueCode

6 | OBSA | Observation Alert |

5

DACT

drug action detected issue

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

active

_AdministrationDetectedIssueCode

5

TIME

timing detected issue

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

active

_AdministrationDetectedIssueCode

6

ALRTENDLATE

end too late alert

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

active

TIME

6

ALRTSTRTLATE

start too late alert

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

active

TIME

5

_DrugActionDetectedIssueCode

DrugActionDetectedIssueCode

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

retired

true

_AdministrationDetectedIssueCode

5

_TimingDetectedIssueCode

TimingDetectedIssueCode

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

retired

true

_AdministrationDetectedIssueCode

6

ENDLATE

End Too Late Alert

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

active

_TimingDetectedIssueCode

6

STRTLATE

Start Too Late Alert

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

active

_TimingDetectedIssueCode

5 | COMPLY | Compliance Alert |
5 | DOSE | Dosage problem |
5 | DUPTHPY | Duplicate Therapy Alert |

4

_SupplyDetectedIssueCode

SupplyDetectedIssueCode

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

active

true

_ActSuppliedItemDetectedIssueCode

5

ALLDONE

already performed

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

active

_SupplyDetectedIssueCode

5

FULFIL

fulfillment alert

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

active

_SupplyDetectedIssueCode

6

NOTACTN

no longer actionable

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

active

FULFIL

6

NOTEQUIV

not equivalent alert

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

active

FULFIL

7

NOTEQUIVGEN

not generically equivalent alert

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

active

NOTEQUIV

7

NOTEQUIVTHER

not therapeutically equivalent alert

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

active

NOTEQUIV

6

TIMING

event timing incorrect alert

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

active

FULFIL

7

INTERVAL

outside requested time

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

active

TIMING

7

MINFREQ

too soon within frequency based on the usage

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

active

TIMING

5

HELD

held/suspended alert

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

active

_SupplyDetectedIssueCode

5

TOOLATE

Refill Too Late Alert

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

active

_SupplyDetectedIssueCode

5

TOOSOON

Refill Too Soon Alert

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

active

_SupplyDetectedIssueCode

4

HISTORIC

record recorded as historical

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

active

_ActSuppliedItemDetectedIssueCode

4

PATPREF

violates stated preferences

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

active

_ActSuppliedItemDetectedIssueCode

5

PATPREFALT

violates stated preferences, alternate available

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

active

PATPREF

3

_ActFinancialDetectedIssueCode

ActFinancialDetectedIssueCode

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

retired

true

ISSUE

3

_ClinicalActionDetectedIssueCode

ClinicalActionDetectedIssueCode

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

active

true

ISSUE

4

CAREGAP

Caregap

Identifies the type of detected issue is a care gap

active

_ClinicalActionDetectedIssueCode

4

CODINGGAP

Codinggap

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

active

_ClinicalActionDetectedIssueCode

2

KSUBJ

knowledge subject

Categorization of types of observation that capture the main clinical knowledge subject which may be a medication, a laboratory test, a disease.

active

_ObservationType

2

KSUBT

knowledge subtopic

Categorization of types of observation that capture a knowledge subtopic which might be treatment, etiology, or prognosis.

active

_ObservationType

2

OINT

intolerance

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

active

_ObservationType

3

ALG

Allergy

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

active

OINT

4

DALG

Drug Allergy

An allergy to a pharmaceutical product.

active

ALG, DINT

4

EALG

Environmental Allergy

An allergy to a substance other than a drug or a food. E.g. Latex, pollen, etc.

active

ALG, EINT

4

FALG

Food Allergy

An allergy to a substance generally consumed for nutritional purposes.

active

ALG, FINT

3

DINT

Drug Intolerance

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

active

OINT

4

DNAINT

Drug Non-Allergy Intolerance

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

active

DINT, NAINT

4 | DALG | Drug Allergy |

3

EINT

Environmental Intolerance

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

active

OINT

4

ENAINT

Environmental Non-Allergy Intolerance

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

active

EINT, NAINT

4 | EALG | Environmental Allergy |

3

FINT

Food Intolerance

Hypersensitivity resulting in an adverse reaction upon exposure to food.

active

OINT

4

FNAINT

Food Non-Allergy Intolerance

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

active

FINT, NAINT

4 | FALG | Food Allergy |

3

NAINT

Non-Allergy Intolerance

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

active

OINT

4 | DNAINT | Drug Non-Allergy Intolerance |
4 | ENAINT | Environmental Non-Allergy Intolerance |
4 | FNAINT | Food Non-Allergy Intolerance |

2

SEV

Severity Observation

A subjective evaluation of the seriousness or intensity associated with another observation.

active

_ObservationType

2

_ActPrivilegeCategorizationType

ActPrivilegeCategorizationType

This domain includes observations used to characterize a privilege, under which this additional information is classified.

*Examples:*A privilege to prescribe drugs has a RESTRICTION that excludes prescribing narcotics; a surgical procedure privilege has a PRE-CONDITION that it requires prior Board approval.

retired

true

_ObservationType

2

_AdverseSubstanceAdministrationEventActionTakenType

AdverseSubstanceAdministrationEventActionTakenType

Definition: Indicates the class of actions taken with regard to a substance administration related adverse event. This characterization offers a judgment of the practitioner's response to the patient's problem.

Examples: Example values include dose withdrawn, dose reduced, dose not changed.

NOTE: The concept domain is currently supported by a value set created by the International Conference on Harmonization

retired

true

_ObservationType

2

_CommonClinicalObservationType

CommonClinicalObservationType

Used in a patient care message to report and query simple clinical (non-lab) observations.

retired

true

_ObservationType

2

_FDALabelData

FDALabelData

FDA label data

retired

true

_ObservationType

3

FDACOATING

coating

FDA label coating

retired

_FDALabelData

3

FDACOLOR

color

FDA label color

retired

_FDALabelData

3

FDAIMPRINTCD

imprint code

FDA label imprint code

retired

_FDALabelData

3

FDALOGO

logo

FDA label logo

retired

_FDALabelData

3

FDASCORING

scoring

FDA label scoring

retired

_FDALabelData

3

FDASHAPE

shape

FDA label shape

retired

_FDALabelData

3

FDASIZE

size

FDA label size

retired

_FDALabelData

2

_ObservationAllergyTestCode

observation allergy test

**Description:**Dianostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge actiivities.

**Example:**Skin tests and eosinophilia evaluations.

retired

true

_ObservationType

2

_ObservationAllergyTestType

ObservationAllergyTestType

Indicates the type of allergy test performed or to be performed. E.g. the specific antibody or skin test performed

retired

true

_ObservationType

2

_ObservationCausalityAssessmentType

observation causality assessment

**Description:**A kind of observation that allows a Secondary Observation (source act) to assert (at various levels of probability) that the target act of the association (which may be of any type of act) is implicated in the etiology of another observation that is named as the subject of the Secondary Observation

**Example:**Causality assertions where an accident is the cause of a symptom; predisposition assertions where the genetic state plus environmental factors are implicated in the development of a disease; reaction assertions where a substance exposure is associated with a finding of wheezing.

retired

true

_ObservationType

2

_ObservationDosageDefinitionPreconditionType

observation dosage definition precondition type

Definition:

The set of observation type concepts that can be used to express pre-conditions to a particular dosage definition.

Rationale: Used to constrain the set of observations to those related to the applicability of a dosage, such as height, weight, age, pregnancy, liver function, kidney function, etc. For example, in drug master-file type records indicating when a specified dose is applicable.

retired

true

_ObservationType

2 | _ObservationGenomicFamilyHistoryType | ObservationGenomicFamilyHistoryType | | | retired | true | | | _ObservationType

2

_ObservationIndicationType

ObservationIndicationType

Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests

retired

true

_ObservationType

2

_ObservationIssueTriggerMeasuredObservationType

ObservationIssueTriggerMeasuredObservationType

Distinguishes between the kinds of measurable observations that could be the trigger for clinical issue detection. Measurable observation types include: Lab Results, Height, Weight.

retired

true

_ObservationType

2

_ObservationQueryMatchType

ObservationQueryMatchType

Definition: An observation related to a query response.

**Example:**The degree of match or match weight returned by a matching algorithm in a response to a query.

retired

true

_ObservationType

2

_ObservationVisionPrescriptionType

ObservationVisionPrescriptionType

Definition: Identifies the type of Vision Prescription Observation that is being described.

retired

true

_ObservationType

2

_PatientCharacteristicObservationType

PatientCharacteristicObservationType

Indicates the type of characteristics a patient should have for a given therapy to be appropriate. E.g. Weight, Age, certain lab values, etc.

retired

true

_ObservationType

2

_SimpleMeasurableClinicalObservationType

SimpleMeasurableClinicalObservationType

Types of measurement observations typically performed in a clinical (non-lab) setting. E.g. Height, Weight, Blood-pressure

retired

true

_ObservationType

1

_ROIOverlayShape

ROIOverlayShape

Shape of the region on the object being referenced

active

true

2

CIRCLE

circle

A circle defined by two (column,row) pairs. The first point is the center of the circle and the second point is a point on the perimeter of the circle.

active

_ROIOverlayShape

2

ELLIPSE

ellipse

An ellipse defined by four (column,row) pairs, the first two points specifying the endpoints of the major axis and the second two points specifying the endpoints of the minor axis.

active

_ROIOverlayShape

2

POINT

point

A single point denoted by a single (column,row) pair, or multiple points each denoted by a (column,row) pair.

active

_ROIOverlayShape

2

POLY

polyline

A series of connected line segments with ordered vertices denoted by (column,row) pairs; if the first and last vertices are the same, it is a closed polygon.

active

_ROIOverlayShape

1

C

corrected

**Description:**Indicates that result data has been corrected.

active

1

DIET

Diet

Code set to define specialized/allowed diets

active

2

BR

breikost (GE)

A diet exclusively composed of oatmeal, semolina, or rice, to be extremely easy to eat and digest.

active

DIET

2

DM

diabetes mellitus diet

A diet that uses carbohydrates sparingly. Typically with a restriction in daily energy content (e.g. 1600-2000 kcal).

active

DIET

2

FAST

fasting

No enteral intake of foot or liquids whatsoever, no smoking. Typically 6 to 8 hours before anesthesia.

active

DIET

2

FORMULA

formula diet

A diet consisting of a formula feeding, either for an infant or an adult, to provide nutrition either orally or through the gastrointestinal tract via tube, catheter or stoma.

active

DIET

2

GF

gluten free

Gluten free diet for celiac disease.

active

DIET

2

LF

low fat

A diet low in fat, particularly to patients with hepatic diseases.

active

DIET

2

LP

low protein

A low protein diet for patients with renal failure.

active

DIET

2

LQ

liquid

A strictly liquid diet, that can be fully absorbed in the intestine, and therefore may not contain fiber. Used before enteral surgeries.

active

DIET

2

LS

low sodium

A diet low in sodium for patients with congestive heart failure and/or renal failure.

active

DIET

2

N

normal diet

A normal diet, i.e. no special preparations or restrictions for medical reasons. This is notwithstanding any preferences the patient might have regarding special foods, such as vegetarian, kosher, etc.

active

DIET

2

NF

no fat

A no fat diet for acute hepatic diseases.

active

DIET

2

PAF

phenylalanine free

Phenylketonuria diet.

active

DIET

2

PAR

parenteral

Patient is supplied with parenteral nutrition, typically described in terms of i.v. medications.

active

DIET

2

RD

reduction diet

A diet that seeks to reduce body fat, typically low energy content (800-1600 kcal).

active

DIET

2

SCH

schonkost (GE)

A diet that avoids ingredients that might cause digestion problems, e.g., avoid excessive fat, avoid too much fiber (cabbage, peas, beans).

active

DIET

2

SUPPLEMENT

nutritional supplement

A diet that is not intended to be complete but is added to other diets.

active

DIET

2

T

tea only

This is not really a diet, since it contains little nutritional value, but is essentially just water. Used before coloscopy examinations.

active

DIET

2

VLI

low valin, leucin, isoleucin

Diet with low content of the amino-acids valin, leucin, and isoleucin, for "maple syrup disease."

active

DIET

1

DRUGPRG

drug program

Definition: A public or government health program that administers and funds coverage for prescription drugs to assist program eligible who meet financial and health status criteria.

active

1

F

final

**Description:**Indicates that a result is complete. No further results are to come. This maps to the 'complete' state in the observation result status code.

active

1

PRLMN

preliminary

**Description:**Indicates that a result is incomplete. There are further results to come. This maps to the 'active' state in the observation result status code.

active

1

SECOBS

SecurityObservationType

An observation identifying security metadata about an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security metadata are used to name security labels.

Rationale: According to ISO/TS 22600-3:2009(E) A.9.1.7 SECURITY LABEL MATCHING, Security label matching compares the initiator's clearance to the target's security label. All of the following must be true for authorization to be granted:

The security policy identifiers shall be identical

The classification level of the initiator shall be greater than or equal to that of the target (that is, there shall be at least one value in the classification list of the clearance greater than or equal to the classification of the target), and

For each security category in the target label, there shall be a security category of the same type in the initiator's clearance and the initiator's classification level shall dominate that of the target.

Examples: SecurityObservationType security label fields include:

Confidentiality classification

Compartment category

Sensitivity category

Security mechanisms used to ensure data integrity or to perform authorized data transformation

Indicators of an IT resource completeness, veracity, reliability, trustworthiness, or provenance.

Usage Note: SecurityObservationType codes designate security label field types, which are valued with an applicable SecurityObservationValue code as the "security label tag".

active

true

2

SECCATOBS

security category observation

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)

active

SECOBS

2

SECCLASSOBS

security classification observation

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".

active

SECOBS

2

SECCONOBS

security control observation

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

active

SECOBS

2

SECINTOBS

security integrity observation

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

active

SECOBS

3

SECALTINTOBS

security alteration integrity observation

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

active

SECINTOBS

3

SECDATINTOBS

security data integrity observation

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.

active

SECINTOBS

3

SECINTCONOBS

security integrity confidence observation

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.

active

SECINTOBS

3

SECINTPRVOBS

security integrity provenance observation

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

active

true

SECINTOBS

4

SECINTPRVABOBS

security integrity provenance asserted by observation

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

active

SECINTPRVOBS

4

SECINTPRVRBOBS

security integrity provenance reported by observation

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

active

SECINTPRVOBS

3

SECINTSTOBS

security integrity status observation

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.

active

SECINTOBS

2

SECTRSTOBS

SECTRSTOBS

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.

active

true

SECOBS

3

TRSTACCRDOBS

trust accreditation observation

Type of security 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.

active

SECTRSTOBS

3

TRSTAGREOBS

trust agreement observation

Type of security metadata observation made about privacy and security requirements with which a security domain must comply. [ISO IEC 10181-1]

active

SECTRSTOBS

3

TRSTCERTOBS

trust certificate observation

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.]

active

SECTRSTOBS

3

TRSTFWKOBS

trust framework observation

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]

active

SECTRSTOBS

3

TRSTLOAOBS

trust assurance observation

Type of security metadata observation made about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.

active

SECTRSTOBS

3

TRSTMECOBS

trust mechanism observation

Type of security metadata observation made about a security architecture system component that supports enforcement of security policies.

active

SECTRSTOBS

1

SUBSIDFFS

subsidized fee for service program

Definition: A government health program that provides coverage on a fee for service basis 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 fee for service program is further specified by the Underwriter and Payer Role.class and Role.code.

active

1

WRKCOMP

(workers compensation program

Definition: Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

active

1

_ActAdjudicationInformationCode

ActAdjudicationInformationCode

Explanatory codes that provide information derived by an Adjudicator during the course of adjudicating an invoice.

Codes from this domain are purely informational and do not materially affect the adjudicated invoice. That is, these codes do not impact or explain financial adjustments to an invoice. A companion domain (ActAdjudicationReasonCode) includes reasons which have a financial impact on an Invoice (claim).

Example adjudication information code is 54540 - Patient has reached Plan Maximum for current year.

retired

true

1 | _ActBillableTreatmentPlanCode | ActBillableTreatmentPlanCode | | | retired | true | | |

1

_ActCognitiveProfessionalServiceCode

ActCognitiveProfessionalServiceCode

Denotes the specific service that has been performed. This is obtained from the professional service catalog pertaining to the discipline of the health service provider. Professional services are generally cognitive in nature and exclude surgical procedures. E.g. Provided training, Provided drug therapy review, Gave smoking-cessation counseling, etc.

retired

true

1

_ActIdentityDocumentCode

ActIdentityDocumentCode

Code identifying the type of identification document (e.g. passport, drivers license)

**Implementation Note:**The proposal called for a domain, but a code was also provided. When codes are available for the value set the code IDENTDOC (identity document) will be used as the headcode for the specializable value set.

retired

true

1

_ActOrderCode

ActOrderCode

The type of order that was fulfilled by the clinical service

retired

true

1

_ActPrivilegeCategorization

ActPrivilegeCategorization

An Act which characterizes a Privilege can have additional observations to provide a finer definition of the requested or conferred privilege. This domain describes the categories under which this additional information is classified.

retired

true

1

_ActProcedureCode

ActProcedureCode

An identifying code for healthcare interventions/procedures.

retired

true

2

_ActBillableServiceCode

ActBillableServiceCode

Definition: An identifying code for billable services, as opposed to codes for similar services used to identify them for functional purposes.

retired

true

_ActProcedureCode

3

_ActMedicalBillableServiceCode

ActMedicalBillableServiceCode

Definition: An identifying code for billable medical services, as opposed to codes for similar services to identify them for clinical purposes.

retired

true

_ActBillableServiceCode

3

_ActNonMedicalBillableServiceCode

ActNonMedicalBillableServiceCode

Definition: An identifying code for billable services that are not medical procedures, such as social services or governmental program services.

Example: Building a wheelchair ramp, help with groceries, giving someone a ride, etc.

retired

true

_ActBillableServiceCode

2

_ActOralHealthProcedureCode

ActOralHealthProcedureCode

**Description:**An identifying code for oral health interventions/procedures.

retired

true

_ActProcedureCode

2 | _CPT5 | CPT5 |
2 | _HCPCS | HCPCS |
2 | _ICD10PCS | ICD10PCS |
2 | _ICD9PCS | ICD9PCS |

1

_ActRegistryCode

ActRegistryCode

This is the domain of registry types. Examples include Master Patient Registry, Staff Registry, Employee Registry, Tumor Registry.

retired

true

1

_ActSecurityObjectCode

ActSecurityObjectCode

**Description:**An access control object used to manage permissions and capabilities of users within information systems. (See HL7 RBAC specification fo examples of thes objects.)

retired

true

1

_AdvanceBeneficiaryNoticeType

AdvanceBeneficiaryNoticeType

Description:

Represents types of consent that patient must sign prior to receipt of service, which is required for billing purposes.

Examples:

Advanced beneficiary medically necessity notice.

Advanced beneficiary agreement to pay notice.

Advanced beneficiary requests payer billed.

retired

true

1

_CPT4

CPT4

**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

retired

true

1 | _ExternallyDefinedActCodes | ExternallyDefinedActCodes | | | retired | true | | |

1

_HL7DefinedActCodes

HL7DefinedActCodes

Domain provides the root for HL7-defined detailed or rich codes for the Act classes.

retired

true

2

_ActDetectedIssueCode

ActDetectedIssueCode

Identifies types of detected issues for Act class "ALRT"

retired

true

_HL7DefinedActCodes

2

_HL7TriggerEventCode

HL7TriggerEventCode

The trigger event referenced by the Control Act instance. Values are drawn from the available trigger events used in the release of HL7 identified by the versionCode.

retired

true

_HL7DefinedActCodes

2

_SubstanceAdministrationActCode

SubstanceAdministrationActCode

The specific chemical or radiological substance administered or to be administered into the body for therapeutic effect.

retired

true

_HL7DefinedActCodes

1

_IndividualCaseSafetyReportCriteria

IndividualCaseSafetyReportCriteria

Description: Includes those concepts that are provided to justify the fact that an adverse event or product problem is required to be reported in an expedited fashion.

retired

true

1

_IndividualCaseSafetyReportProductCharacteristic

IndividualCaseSafetyReportProductCharacteristic

Description: Includes relevant pieces of information about a product or its process of creation. The vocabulary domain is used to characterize products when they are cited in adverse event or product problem reports.

**Examples:**Weight, color, dimensions.

retired

true

1

_ObservationActAgeGroupType

ObservationActAgeGroupType

**Description:**To allow queries to specify useful information about the age of the patient without disclosing possible protected health information.

retired

true

1 | COPAY | | | | retired | | | |
1 | DEDUCT | | | | retired | | | |
1 | DOSEIND | | | | retired | | | |
1 | PRA | | | | retired | | | |

1

STORE

Storage

The act of putting something away for safe keeping. The "something" may be physical object such as a specimen, or information, such as observations regarding a specimen.

retired

# description
A code specifying the particular kind of Act that the Act-instance represents within its class.

*Constraints:* The kind of Act (e.g. physical examination, serum potassium, inpatient encounter, charge financial transaction, etc.) is specified with a code from one of several, typically external, coding systems. The coding system will depend on the class of Act, such as LOINC for observations, etc.

Conceptually, the Act.code must be a specialization of the Act.classCode. This is why the structure of ActClass domain should be reflected in the superstructure of the ActCode domain and then individual codes or externally referenced vocabularies subordinated under these domains that reflect the ActClass structure.

Act.classCode and Act.code are not modifiers of each other but the Act.code concept should really imply the Act.classCode concept. For a negative example, it is not appropriate to use an Act.code "potassium" together with and Act.classCode for "laboratory observation" to somehow mean "potassium laboratory observation" and then use the same Act.code for "potassium" together with Act.classCode for "medication" to mean "substitution of potassium". This mutually modifying use of Act.code and Act.classCode is not permitted.

# copyright
This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html

# property[].description
The child code is a classification of the particular class group identified by the 'classCode' in a RIM class as the parent code.  Used only in RIM backbone classes to link the code and classCode values.

# property[].description
A property that indicates the status of the concept. One of active, experimental, deprecated, or retired.

# property[].description
The date at which a concept was deprecated. Concepts that are deprecated but not inactive can still be used, but their use is discouraged.

# property[].description
Indicates that the code is abstract - only intended to be used as a selector for other concepts

# property[].description
An additional concept code that was also attributed to a concept

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

# concept[].definition
Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

# concept[].definition
Actions to be carried out by the recipient of the Adjudication Result information.

# concept[].definition
**Definition:**An identifying modifier code for healthcare interventions or procedures.

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

# concept[].definition
**Description:**The type and scope of responsibility taken-on by the performer of the Act for a specific subject of care.

# concept[].definition
**Description:** Coded types of attachments included to support a healthcare claim.

# concept[].definition
**Definition:** The type of consent directive, e.g., to consent or dissent to collect, access, or use in specific ways within an EHRS or for health information exchange; or to disclose health information for purposes such as research.

# concept[].definition
Constrains the ActCode to the domain of Container Registration

# concept[].definition
An observation form that determines parameters or attributes of an Act. Examples are the settings of a ventilator machine as parameters of a ventilator treatment act; the controls on dillution factors of a chemical analyzer as a parameter of a laboratory observation act; the settings of a physiologic measurement assembly (e.g., time skew) or the position of the body while measuring blood pressure.

Control variables are forms of observations because just as with clinical observations, the Observation.code determines the parameter and the Observation.value assigns the value. While control variables sometimes can be observed (by noting the control settings or an actually measured feedback loop) they are not primary observations, in the sense that a control variable without a primary act is of no use (e.g., it makes no sense to record a blood pressure position without recording a blood pressure, whereas it does make sense to record a systolic blood pressure without a diastolic blood pressure).

# concept[].definition
Response to an insurance coverage eligibility query or authorization request.

# concept[].definition
Criteria that are applicable to the authorized coverage.

# concept[].definition
**Definition:** Set of codes indicating the type of insurance policy or program that pays for the cost of benefits provided to covered parties.

# concept[].definition
Codes dealing with the management of Detected Issue observations

# concept[].definition
Concepts that identify the type or nature of exposure interaction. Examples include "household", "care giver", "intimate partner", "common space", "common substance", etc. to further describe the nature of interaction.

# concept[].definition
Set of codes indicating the type of incident or accident.

# concept[].definition
**Description:** The type of health information to which the subject of the information or the subject's delegate consents or dissents.

# concept[].definition
Concepts conveying the context in which authorization given under jurisdictional law, by organizational policy, or by a patient consent directive permits the collection, access, use or disclosure of specified patient health information.

# concept[].definition
**Definition:**Indicates the set of information types which may be manipulated or referenced, such as for recommending access restrictions.

# concept[].definition
Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

# concept[].definition
Identifies the different types of summary information that can be reported by queries dealing with Statement of Financial Activity (SOFA). The summary information is generally used to help resolve balance discrepancies between providers and payors.

# concept[].definition
Includes coded responses that will occur as a result of the adjudication of an electronic invoice at a summary level and provides guidance on interpretation of the referenced adjudication results.

# concept[].definition
Provides codes associated with ActClass value of LIST (working list)

# concept[].definition
**Description:**Concepts representing indications (reasons for clinical action) other than diagnosis and symptoms.

# concept[].definition
Identifies the type of verification investigation being undertaken with respect to the subject of the verification activity.

**Examples:**

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

# concept[].definition
Code identifying the method or the movement of payment instructions.

Codes are drawn from X12 data element 591 (PaymentMethodCode)

# concept[].definition
A mandate, regulation, obligation, principle, requirement, rule, or expectation of how an entity is to conduct itself or execute an activity, which may be dictated and enforced by an authority of competent jurisdiction.

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

# concept[].definition
Set of codes related to specimen treatments

# concept[].definition
**Description:** Describes the type of substance administration being performed. This should not be used to carry codes for identification of products. Use an associated role or entity to carry such information.

# concept[].definition
**Description:** A task or action that a user may perform in a clinical information system (e.g., medication order entry, laboratory test results review, problem list entry).

# concept[].definition
Characterizes how a transportation act was or will be carried out.

*Examples:* Via private transport, via public transit, via courier.

# concept[].definition
Identifies the kinds of observations that can be performed

# concept[].definition
Shape of the region on the object being referenced

# concept[].definition
**Description:**Indicates that result data has been corrected.

# concept[].definition
Code set to define specialized/allowed diets

# concept[].definition
**Definition:** A public or government health program that administers and funds coverage for prescription drugs to assist program eligible who meet financial and health status criteria.

# concept[].definition
**Description:**Indicates that a result is complete. No further results are to come. This maps to the 'complete' state in the observation result status code.

# concept[].definition
**Description:**Indicates that a result is incomplete. There are further results to come. This maps to the 'active' state in the observation result status code.

# concept[].definition
An observation identifying security metadata about an IT resource (data, information object, service, or system capability), which may be used to make access control decisions. Security metadata are used to name security labels.

*Rationale:* According to ISO/TS 22600-3:2009(E) A.9.1.7 SECURITY LABEL MATCHING, Security label matching compares the initiator's clearance to the target's security label. All of the following must be true for authorization to be granted:

 *  The security policy identifiers shall be identical
 *  The classification level of the initiator shall be greater than or equal to that of the target (that is, there shall be at least one value in the classification list of the clearance greater than or equal to the classification of the target), and
 *  For each security category in the target label, there shall be a security category of the same type in the initiator's clearance and the initiator's classification level shall dominate that of the target.

**Examples:** SecurityObservationType security label fields include:

 *  Confidentiality classification
 *  Compartment category
 *  Sensitivity category
 *  Security mechanisms used to ensure data integrity or to perform authorized data transformation
 *  Indicators of an IT resource completeness, veracity, reliability, trustworthiness, or provenance.

*Usage Note:* SecurityObservationType codes designate security label field types, which are valued with an applicable SecurityObservationValue code as the "security label tag".

# concept[].definition
**Definition:** A government health program that provides coverage on a fee for service basis 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 fee for service program is further specified by the Underwriter and Payer Role.class and Role.code.

# concept[].definition
**Definition:** Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

# concept[].definition
Explanatory codes that provide information derived by an Adjudicator during the course of adjudicating an invoice.

Codes from this domain are purely informational and do not materially affect the adjudicated invoice. That is, these codes do not impact or explain financial adjustments to an invoice. A companion domain (ActAdjudicationReasonCode) includes reasons which have a financial impact on an Invoice (claim).

Example adjudication information code is 54540 - Patient has reached Plan Maximum for current year.

# concept[].definition
Denotes the specific service that has been performed. This is obtained from the professional service catalog pertaining to the discipline of the health service provider. Professional services are generally cognitive in nature and exclude surgical procedures. E.g. Provided training, Provided drug therapy review, Gave smoking-cessation counseling, etc.

# concept[].definition
Code identifying the type of identification document (e.g. passport, drivers license)

**Implementation Note:**The proposal called for a domain, but a code was also provided. When codes are available for the value set the code IDENTDOC (identity document) will be used as the headcode for the specializable value set.

# concept[].definition
The type of order that was fulfilled by the clinical service

# concept[].definition
An Act which characterizes a Privilege can have additional observations to provide a finer definition of the requested or conferred privilege. This domain describes the categories under which this additional information is classified.

# concept[].definition
An identifying code for healthcare interventions/procedures.

# concept[].definition
This is the domain of registry types. Examples include Master Patient Registry, Staff Registry, Employee Registry, Tumor Registry.

# concept[].definition
**Description:**An access control object used to manage permissions and capabilities of users within information systems. (See HL7 RBAC specification fo examples of thes objects.)

# concept[].definition
**Description:**

Represents types of consent that patient must sign prior to receipt of service, which is required for billing purposes.

**Examples:**

 *  Advanced beneficiary medically necessity notice.
 *  Advanced beneficiary agreement to pay notice.
 *  Advanced beneficiary requests payer billed.

# concept[].definition
**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

# concept[].definition
Domain provides the root for HL7-defined detailed or rich codes for the Act classes.

# concept[].definition
**Description:** Includes those concepts that are provided to justify the fact that an adverse event or product problem is required to be reported in an expedited fashion.

# concept[].definition
**Description:** Includes relevant pieces of information about a product or its process of creation. The vocabulary domain is used to characterize products when they are cited in adverse event or product problem reports.

**Examples:**Weight, color, dimensions.

# concept[].definition
**Description:**To allow queries to specify useful information about the age of the patient without disclosing possible protected health information.

# concept[].definition
The act of putting something away for safe keeping. The "something" may be physical object such as a specimen, or information, such as observations regarding a specimen.

# concept[].definition
An account for collecting charges, reversals, adjustments and payments, including deductibles, copayments, coinsurance (financial transactions) credited or debited to the account receivable account for a patient's encounter.

# concept[].definition
**Description:** Types of advance payment to be made on a plastic card usually issued by a financial institution used of purchasing services and/or products.

# concept[].definition
An account representing charges and credits (financial transactions) for a patient's encounter.

# concept[].definition
Catagorization of grouping criteria for the associated transactions and/or summary (totals, subtotals).

# concept[].definition
The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges).

Also includes the concept 'Adjudicate as zero' and items not covered under a particular Policy.

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

# concept[].definition
The invoice element has passed through the adjudication process but payment is refused due to one or more reasons.

Includes items such as patient not covered, or invoice element is not constructed according to payer rules (e.g. 'invoice submitted too late').

If one invoice element line item in the invoice element structure is rejected, the remaining line items may not be adjudicated and the complete group is treated as rejected.

A refused invoice element can be forwarded to the next payer (for Coordination of Benefits) or modified and resubmitted to refusing payer.

Invoice element cannot be reversed (nullified) as there is nothing to reverse.

Recommend that the invoice element is not saved for DUR (Drug Utilization Reporting).

# concept[].definition
The invoice element was/will be paid exactly as submitted, without financial adjustment(s).

If the dollar amount stays the same, but the billing codes have been amended or financial adjustments have been applied through the adjudication process, the invoice element is treated as "Adjudicated with Adjustment".

If information items are included in the adjudication results that do not affect the monetary amounts paid, then this is still Adjudicated as Submitted (e.g. 'reached Plan Maximum on this Claim').

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

# concept[].definition
Transaction counts and value totals by Contract Identifier.

# concept[].definition
Transaction counts and value totals for each calendar day within the date range specified.

# concept[].definition
Transaction counts and value totals by service location (e.g clinic).

# concept[].definition
Transaction counts and value totals for each calendar month within the date range specified.

# concept[].definition
Transaction counts and value totals for the date range specified.

# concept[].definition
Transaction counts and value totals by Provider Identifier.

# concept[].definition
Transaction counts and value totals for each calendar week within the date range specified.

# concept[].definition
Transaction counts and value totals for each calendar year within the date range specified.

# concept[].definition
The adjudication result associated is to be displayed to the receiver of the adjudication result.

# concept[].definition
The adjudication result associated is to be printed on the specified form, which is then provided to the covered party.

# concept[].definition
The requesting party has insufficient authorization to invoke the interaction.

# concept[].definition
**Description:** One or more records in the query response have been suppressed due to consent or privacy restrictions.

# concept[].definition
**Description:**The specified element did not pass business-rule validation.

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

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

# concept[].definition
**Description:** Metadata associated with the identification (e.g. name or gender) does not match the identification being verified.

# concept[].definition
**Description:** One or more records in the query response have a status of 'obsolete'.

# concept[].definition
**Description:**CPT modifier codes are found in Appendix A of CPT 2000 Standard Edition.

# concept[].definition
**Description:**HCPCS Level II (HCFA-assigned) and Carrier-assigned (Level III) modifiers are reported in Appendix A of CPT 2000 Standard Edition and in the Medicare Bulletin.

# concept[].definition
**Definition:** An identifying code for billable medical services, as opposed to codes for similar services to identify them for clinical purposes.

# concept[].definition
**Definition:** An identifying code for billable services that are not medical procedures, such as social services or governmental program services.

**Example:** Building a wheelchair ramp, help with groceries, giving someone a ride, etc.

# concept[].definition
A billing arrangement where a Provider charges a lump sum to provide a prescribed group (volume) of services to a single patient which occur over a period of time. Services included in the block may vary.

This billing arrangement is also known as Program of Care for some specific Payors and Program Fees for other Payors.

# concept[].definition
A billing arrangement where the payment made to a Provider is determined by analyzing one or more demographic attributes about the persons/patients who are enrolled with the Provider (in their practice).

# concept[].definition
A billing arrangement where a Provider charges a lump sum to provide a particular volume of one or more interventions/procedures or groups of interventions/procedures.

# concept[].definition
A billing arrangement where a Provider charges for non-clinical items. This includes interest in arrears, mileage, etc. Clinical content is not included in Invoices submitted with this type of billing arrangement.

# concept[].definition
A billing arrangement where funding is based on a list of individuals registered as patients of the Provider.

# concept[].definition
A billing arrangement where a Provider charges a sum to provide a group (volume) of interventions/procedures to one or more patients within a defined period of time, typically on the same date. Interventions/procedures included in the session may vary.

# concept[].definition
A billing arrangement where a Provider charges a separate fee for each intervention/procedure/event or product.

Fee for Service is used when an individual intervention/procedure/event is used for billing purposes. In other words, fees are associated with the intervention/procedure/event. For example, a specific CCI (Canadian Classification of Interventions) code has an associated fee and is used for billing purposes.

# concept[].definition
A fully specified bounded Region of Interest (ROI) delineates a ROI in which only those dimensions participate that are specified by boundary criteria, whereas all other dimensions are excluded. For example a ROI to mark an episode of "ST elevation" in a subset of the EKG leads V2, V3, and V4 would include 4 boundaries, one each for time, V2, V3, and V4.

# concept[].definition
A partially specified bounded Region of Interest (ROI) specifies a ROI in which at least all values in the dimensions specified by the boundary criteria participate. For example, if an episode of ventricular fibrillations (VFib) is observed, it usually doesn't make sense to exclude any EKG leads from the observation and the partially specified ROI would contain only one boundary for time indicating the time interval where VFib was observed.

# concept[].definition
**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by a credentialing agency, i.e. government or non-government agency. Failure in executing this Act may result in loss of credential to the person or organization who participates as performer of the Act. Excludes employment agreements.

**Example:**Hospital license; physician license; clinic accreditation.

# concept[].definition
Domain provides codes that qualify the ActEncounterClass (ENC)

# concept[].definition
General category of medical service provided to the patient during their encounter.

# concept[].definition
**Description:** Work Injury related additional Information Attachment

# concept[].definition
Specifies the type of agreement between one or more grantor and grantee in which rights and obligations related to one or more shared items of interest are allocated.

*Usage Note:* Such agreements may be considered "consent directives" or "contracts" depending on the context, and are considered closely related or synonymous from a legal perspective.

**Examples:** 

 *  Healthcare Privacy Consent Directive permitting or restricting in whole or part the collection, access, use, and disclosure of health information, and any associated handling caveats.
 *  Healthcare Medical Consent Directive to receive medical procedures after being informed of risks and benefits, thereby reducing the grantee's liability.
 *  Research Informed Consent for participation in clinical trials and disclosure of health information after being informed of risks and benefits, thereby reducing the grantee's liability.
 *  Substitute decision maker delegation in which the grantee assumes responsibility to act on behalf of the grantor.
 *  Contracts in which the agreement requires assent/dissent by the grantor of terms offered by a grantee, a consumer opts out of an "award" system for use of a retailer's marketing or credit card vendor's point collection cards in exchange for allowing purchase tracking and profiling.
 *  A mobile device or App privacy policy and terms of service to which a user must agree in whole or in part in order to utilize the service.
 *  Agreements between a client and an authorization server or between an authorization server and a resource operator and/or resource owner permitting or restricting e.g., collection, access, use, and disclosure of information, and any associated handling caveats.

# concept[].definition
Specifies types of consent directives governing the collection, access, use, or disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual.

# concept[].definition
Privacy consent directive restricting or prohibiting access, use, or disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for all purposes except for emergency treatment generally, which may include treatment during a disaster, a threat, in an emergency department and for break the glass purposes of use as specified by applicable domain policy.

*Usage Note:* To specify the scope of an "EMRGONLY" consent directive within a policy domain, use one or more of the following Purpose of Use codes in the ActReason code system OID: 2.16.840.1.113883.5.8.

 *  ETREAT (Emergency Treatment): To perform one or more operations on information for provision of immediately needed health care for an emergent condition.
 *  BTG (break the glass): To perform policy override operations on information for provision of immediately needed health care for an emergent condition affecting potential harm, death or patient safety by end users who are not provisioned for this purpose of use. Includes override of organizational provisioning policies and may include override of subject of care consent directive restricting access.
 *  ERTREAT (emergency room treatment): To perform one or more operations on information for provision of immediately needed health care for an emergent condition in an emergency room or similar emergent care context by end users provisioned for this purpose, which does not constitute as policy override such as in a "Break the Glass" purpose of use.
 *  THREAT (threat): To perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.
 *  DISASTER (disaster): To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.

Map: An "emergency only" consent directive maps to ISO/TS 17975:2015(E) 5.13 Exceptional access

# concept[].definition
A grantor's terms of agreement to which a grantee may assent or dissent, and which may include an opportunity for a grantee to request restrictions or extensions.

*Comment:* A grantor typically is able to stipulate preferred terms of agreement when the grantor has control over the topic of the agreement, which a grantee must accept in full or may be offered an opportunity to extend or restrict certain terms.

*Usage Note:* If the grantor's term of agreement must be accepted in full, then this is considered "basic consent". If a grantee is offered an opportunity to extend or restrict certain terms, then the agreement is considered "granular consent".

**Examples:** 

 *  Healthcare: A PHR account holder \[grantor\] may require any PHR user \[grantee\] to accept the terms of agreement in full, or may permit a PHR user to extend or restrict terms selected by the account holder or requested by the PHR user.
 *  Non-healthcare: The owner of a resource server \[grantor\] may require any authorization server \[grantee\] to meet authorization requirements stipulated in the grantor's terms of agreement.

# concept[].definition
A grantor's presumed assent to the grantee's terms of agreement is based on the grantor's behavior, which may result from not expressly assenting to the consent directive offered, or from having no right to assent or dissent offered by the grantee.

*Comment:* Implied or "implicit" consent occurs when the behavior of the grantor is understood by a reasonable person to signal agreement to the grantee's terms.

*Usage Note:* Implied consent with no opportunity to assent or dissent to certain terms is considered "basic consent".

**Examples:** 

 *  Healthcare: A patient schedules an appointment with a provider, and either does not take the opportunity to expressly assent or dissent to the provider's consent directive, does not have an opportunity to do so, as in the case where emergency care is required, or simply behaves as though the patient \[grantor\] agrees to the rights granted to the provider \[grantee\] in an implicit consent directive.
 *  An injured and unconscious patient is deemed to have assented to emergency treatment by those permitted to do so under jurisdictional laws, e.g., Good Samaritan laws.
 *  Non-healthcare: Upon receiving a driver's license, the driver is deemed to have assented without explicitly consenting to undergoing field sobriety tests.
 *  A corporation that does business in a foreign nation is deemed to have deemed to have assented without explicitly consenting to abide by that nation's laws.

# concept[].display
implied consent with opportunity to dissent

# concept[].definition
A grantor's presumed assent to the grantee's terms of agreement, which is based on the grantor's behavior, and includes a right to dissent to certain terms.

*Comment:* A grantor assenting to the grantee's terms of agreement may or may not exercise a right to dissent to grantor selected terms or to grantee's selected terms to which a grantor may dissent.

*Usage Note:* Implied or "implicit" consent with an "opportunity to dissent" occurs when the grantor's behavior is understood by a reasonable person to signal assent to the grantee's terms of agreement whether the grantor requests or the grantee approves further restrictions, is considered "granular consent".

**Examples:** 

 *  Healthcare Examples: A healthcare provider deems a patient's assent to disclosure of health information to family members and friends, but offers an opportunity or permits the patient to dissent to such disclosures.
 *  A health information exchanges deems a patient to have assented to disclosure of health information for treatment purposes, but offers the patient an opportunity to dissents to disclosure to particular provider organizations.
 *  Non-healthcare Examples: A bank deems a banking customer's assent to specified collection, access, use, or disclosure of financial information as a requirement of holding a bank account, but provides the user an opportunity to limit third-party collection, access, use or disclosure of that information for marketing purposes.

# concept[].definition
No notification or opportunity is provided for a grantor to assent or dissent to a grantee's terms of agreement.

*Comment:* A "No Consent" policy scheme provides no opportunity for accommodation of an individual's preferences, and may not comply with Fair Information Practice Principles \[FIPP\] by enabling the data subject to object, access collected information, correct errors, or have accounting of disclosures.

*Usage Note:* The grantee's terms of agreement, may be available to the grantor by reviewing the grantee's privacy policies, but there is no notice by which a grantor is apprised of the policy directly or able to acknowledge.

**Examples:** 

 *  Healthcare: Without notification or an opportunity to assent or dissent, a patient's health information is automatically included in and available (often according to certain rules) through a health information exchange. Note that this differs from implied consent, where the patient is assumed to have consented.
 *  Without notification or an opportunity to assent or dissent, a patient's health information is collected, accessed, used, or disclosed for research, public health, security, fraud prevention, court order, or law enforcement.
 *  Non-healthcare: Without notification or an opportunity to assent or dissent, a consumer's healthcare or non-healthcare internet searches are aggregated for secondary uses such as behavioral tracking and profiling.
 *  Without notification or an opportunity to assent or dissent, a consumer's location and activities in a shopping mall are tracked by RFID tags on purchased items.

# concept[].definition
An implied privacy consent directive or notification, which the data subject may or may not acknowledge. The notification specifies permitted actions, which may include access, use, or disclosure of any and all personal information. The notification specifies the scope of personal information, which may include de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, that may be used to identify an individual in a registry or repository. The notification specifies the purposes for which personal information may be used such as treatment, payment, operations, research, information exchange, public health, disaster, quality and safety reporting; as required by law including court order, law enforcement, national security, military authorities; and for data analytics, marketing, and profiling.

*Usage Notes:* Map: An "implied" consent directive maps to ISO/TS 17975:2015(E) definition forImplied: Consent to Collect, Use and Disclose personal health information is implied by the actions or inactions of the individual and the circumstances under which it was implied".

# concept[].property[].valueString
Map: An "implied" consent directive maps to ISO/TS 17975:2015(E) definition forImplied: Consent to Collect, Use and Disclose personal health information is implied by the actions or inactions of the individual and the circumstances under which it was implied".

# concept[].definition
A grantor's assent to the terms of an agreement offered by a grantee without an opportunity for to dissent to any terms.

*Comment:* Acceptance of a grantee's terms pertaining, for example, to permissible activities, purposes of use, handling caveats, expiry date, and revocation policies.

*Usage Note:* Opt-in with no opportunity for a grantor to restrict certain permissions sought by the grantee is considered "basic consent".

**Examples:** 

 *  Healthcare: A patient \[grantor\] signs a provider's \[grantee's\] consent directive form, which lists permissible collection, access, use, or disclosure activities, purposes of use, handling caveats, and revocation policies.
 *  Non-healthcare: An employee \[grantor\] signs an employer's \[grantee's\] non-disclosure and non-compete agreement.

# concept[].definition
A grantor's assent to the grantee's terms of an agreement with an opportunity for to dissent to certain grantor or grantee selected terms.

*Comment:* A grantor dissenting to the grantee's terms of agreement may or may not exercise a right to assent to grantor's pre-approved restrictions or to grantee's selected terms to which a grantor may dissent.

*Usage Note:* Opt-in with restrictions is considered "granular consent" because the grantor has an opportunity to narrow the permissions sought by the grantee.

**Examples:** 

 *  Healthcare: A patient assent to grantee's consent directive terms for collection, access, use, or disclosure of health information, and dissents to disclosure to certain recipients as allowed by the provider's pre-approved restriction list.
 *  Non-Healthcare: A cell phone user assents to the cell phone's privacy practices and terms of use, but dissents from location tracking by turning off the cell phone's tracking capability.

# concept[].definition
A grantor's dissent to the terms of agreement offered by a grantee without an opportunity for to assent to any terms.

*Comment:* Rejection of a grantee's terms of agreement pertaining, for example, to permissible activities, purposes of use, handling caveats, expiry date, and revocation policies.

*Usage Note:* Opt-out with no opportunity for a grantor to permit certain permissions sought by the grantee is considered "basic consent".

**Examples:** 

 *  Healthcare: A patient \[grantor\] declines to sign a provider's \[grantee's\] consent directive form, which lists permissible collection, access, use, or disclosure activities, purposes of use, handling caveats, revocation policies, and consequences of not assenting.
 *  Non-healthcare: An employee \[grantor\] refuses to sign an employer's \[grantee's\] agreement not to join unions or participate in a strike where state law protects employee's collective bargaining rights.
 *  A citizen \[grantor\] refuses to enroll in mandatory government \[grantee\] health insurance based on religious beliefs, which is an exemption.

# concept[].definition
A grantor's dissent to the grantee's terms of agreement except for certain grantor or grantee selected terms.

*Comment:* A rejection of a grantee's terms of agreement while assenting to certain permissions sought by the grantee or requesting approval of additional grantor terms.

*Usage Note:* Opt-out with exceptions is considered a "granular consent" because the grantor has an opportunity to accept certain permissions sought by the grantee or request additional grantor terms, while rejecting other grantee terms.

**Examples:** 

 *  Healthcare: A patient \[grantor\] dissents to a health information exchange consent directive with the exception of disclosure based on a limited "time to live" shared secret \[e.g., a token or password\], which the patient can give to a provider when seeking care.
 *  Non-healthcare: A social media user \[grantor\] dissents from public access to their account, but assents to access to a circle of friends.

# concept[].definition
**Definition:** Consent to have healthcare information collected in an electronic health record. This entails that the information may be used in analysis, modified, updated.

# concept[].definition
**Definition:** Consent to have collected healthcare information disclosed.

# concept[].definition
**Definition:** Consent to access healthcare information.

# concept[].definition
**Definition:** Information re-disclosed without the patient's consent.

# concept[].definition
**Definition:** Consent to have healthcare information in an electronic health record accessed for research purposes.

# concept[].definition
Used by one system to inform another that it has received a container.

# concept[].definition
Used by one system to inform another that the container is in position for specimen transfer (e.g., container removal from track, pipetting, etc.).

# concept[].definition
Used by one system to inform another that the container has been released from that system.

# concept[].definition
Used by one system to inform another that the container did not arrive at its next expected location.

# concept[].definition
Used by one system to inform another that the specific container is being processed by the equipment. It is useful as a response to a query about Container Status, when the specific step of the process is not relevant.

# concept[].definition
Status is used by one system to inform another that the processing has been completed, but the container has not been released from that system.

# concept[].definition
Used by one system to inform another that the container is no longer available within the scope of the system (e.g., tube broken or discarded).

# concept[].definition
Specifies whether or not automatic repeat testing is to be initiated on specimens.

# concept[].definition
A baseline value for the measured test that is inherently contained in the diluent. In the calculation of the actual result for the measured test, this baseline value is normally considered.

# concept[].definition
Specifies whether or not further testing may be automatically or manually initiated on specimens.

# concept[].definition
Authorization approved and funds have been set aside to pay for specified healthcare service(s) and/or product(s) within defined criteria for the authorization.

# concept[].definition
Authorization for specified healthcare service(s) and/or product(s) denied.

# concept[].definition
Indication of authorization for healthcare service(s) and/or product(s). If authorization is approved, funds are set aside.

# concept[].definition
Indication of eligibility coverage for healthcare service(s) and/or product(s).

# concept[].definition
Insurance coverage is in effect for healthcare service(s) and/or product(s).

# concept[].definition
Insurance coverage is not in effect for healthcare service(s) and/or product(s). May optionally include reasons for the ineligibility.

# concept[].definition
Maximum amount paid or maximum number of services/products covered; or maximum amount or number covered during a specified time period under the policy or program.

# concept[].definition
**Definition:** Codes representing the maximum coverate or financial participation requirements.

# concept[].definition
Codes representing the types of covered parties that may receive covered benefits under a policy or program.

# concept[].definition
Codes representing the time period during which coverage is available; or financial participation requirements are in effect.

# concept[].definition
**Definition:** Maximum amount paid by payer or covered party; or maximum number of services or products covered under the policy or program during a covered party's lifetime.

# concept[].definition
Maximum net amount that will be covered for the product or service specified.

# concept[].definition
**Definition:** Maximum amount paid by payer or covered party; or maximum number of services/products covered under the policy or program by time period specified by the effective time on the act.

# concept[].definition
Maximum unit price that will be covered for the authorized product or service.

# concept[].definition
Maximum number of items that will be covered of the product or service specified.

# concept[].definition
Set of codes indicating the type of insurance policy or other source of funds to cover healthcare costs.

# concept[].definition
**Definition:** Set of codes indicating the type of insurance policy. Insurance, in law and economics, is a form of risk management primarily used to hedge against the risk of potential financial loss. Insurance is defined as the equitable transfer of the risk of a potential loss, from one entity to another, in exchange for a premium and duty of care. A policy holder is an individual or an organization enters into a contract with an underwriter which stipulates that, in exchange for payment of a sum of money (a premium), one or more covered parties (insureds) is guaranteed compensation for losses resulting from certain perils under specified conditions. The underwriter analyzes the risk of loss, makes a decision as to whether the risk is insurable, and prices the premium accordingly. A policy provides benefits that indemnify or cover the cost of a loss incurred by a covered party, and may include coverage for services required to remediate a loss. An insurance policy contains pertinent facts about the policy holder, the insurance coverage, the covered parties, and the insurer. A policy may include exemptions and provisions specifying the extent to which the indemnification clause cannot be enforced for intentional tortious conduct of a covered party, e.g., whether the covered parties are jointly or severably insured.

*Discussion:* In contrast to programs, an insurance policy has one or more policy holders, who own the policy. The policy holder may be the covered party, a relative of the covered party, a partnership, or a corporation, e.g., an employer. A subscriber of a self-insured health insurance policy is a policy holder. A subscriber of an employer sponsored health insurance policy is holds a certificate of coverage, but is not a policy holder; the policy holder is the employer. See CoveredRoleType.

# concept[].definition
**Definition:** A set of codes used to indicate coverage under a program. A program is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health, financial, and demographic status. Programs are typically established or permitted by legislation with provisions for ongoing government oversight. Regulations may mandate the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency may be charged with implementing the program in accordance to the regulation. Risk of loss under a program in most cases would not meet what an underwriter would consider an insurable risk, i.e., the risk is not random in nature, not financially measurable, and likely requires subsidization with government funds.

*Discussion:* Programs do not have policy holders or subscribers. Program eligibles are enrolled based on health status, statutory eligibility, financial status, or age. Program eligibles who are covered parties under the program may be referred to as members, beneficiaries, eligibles, or recipients. Programs risk are underwritten by not for profit organizations such as governmental entities, and the beneficiaries typically do not pay for any or some portion of the cost of coverage. See CoveredPartyRoleType.

# concept[].definition
Codes representing the level of coverage provided under the policy or program in terms of the types of entities that may play covered parties based on their personal relationships or employment status.

# concept[].definition
**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing individuals.

# concept[].definition
**Description:**The type and scope of legal and/or professional responsibility taken-on by the performer of the Act for a specific subject of care as described by an agency for credentialing programs within organizations.

# concept[].display
certified anatomic pathology and clinical pathology care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].display
certified clinical biochemical genetics care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].display
certified clinical molecular genetics care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].display
certified neurology with special qualifications in child neurology care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].display
certified obstetrics and gynecology care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].display
certified public health and general preventive medicine care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].display
certified physical medicine and rehabilitation care

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken on for specialty care as defined by the respective Specialty Board.

# concept[].definition
**Description:**Scope of responsibility taken-on for physician care of a patient as defined by a governmental licensing agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].display
accredited critical access hospital care

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the respective accreditation agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].display
certified acute myocardial infarction care

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].display
certified orthopedic joint replacement care

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].display
certified chronic obstructive pulmonary disease care

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].display
certified stroke disease management care

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
**Description:**Scope of responsibility taken on by an organization for care of a patient as defined by the disease management certification agency.

# concept[].definition
Codes dealing with the management of Detected Issue observations for the administrative and patient administrative acts domains.

# concept[].definition
Order is performed as issued, but other action taken to mitigate potential adverse effects

# concept[].definition
Codes dealing with the management of Detected Issue observations for the financial acts domain.

# concept[].definition
**Description:**Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

# concept[].definition
**Description:**External value set for accommodation types used in the U.S. Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

# concept[].definition
A comprehensive term for health care provided in a healthcare facility (e.g. a practitioneraTMs office, clinic setting, or hospital) on a nonresident basis. The term ambulatory usually implies that the patient has come to the location and is not assigned to a bed. Sometimes referred to as an outpatient encounter.

# concept[].definition
A patient encounter that takes place at a dedicated healthcare service delivery location where the patient receives immediate evaluation and treatment, provided until the patient can be discharged or responsibility for the patient's care is transferred elsewhere (for example, the patient could be admitted as an inpatient or transferred to another facility.)

# concept[].definition
A patient encounter that takes place both outside a dedicated service delivery location and outside a patient's residence. Example locations might include an accident site and at a supermarket.

# concept[].definition
Healthcare encounter that takes place in the residence of the patient or a designee

# concept[].definition
A patient encounter where a patient is admitted by a hospital or equivalent facility, assigned to a location where patients generally stay at least overnight and provided with room, board, and continuous nursing service.

# concept[].definition
An encounter where the patient usually will start in different encounter, such as one in the emergency department (EMER) but then transition to this type of encounter because they require a significant period of treatment and monitoring to determine whether or not their condition warrants an inpatient admission or discharge. In the majority of cases the decision about admission or discharge will occur within a time period determined by local, regional or national regulation, often between 24 and 48 hours.

# concept[].definition
A patient encounter where patient is scheduled or planned to receive service delivery in the future, and the patient is given a pre-admission account number. When the patient comes back for subsequent service, the pre-admission encounter is selected and is encapsulated into the service registration, and a new account number is generated.

*Usage Note:* This is intended to be used in advance of encounter types such as ambulatory, inpatient encounter, virtual, etc.

# concept[].definition
An encounter where the patient is admitted to a health care facility for a predetermined length of time, usually less than 24 hours.

# concept[].definition
A patient encounter where the patient and the practitioner(s) are not in the same physical location. Examples include telephone conference, email exchange, robotic surgery, and televideo conference.

# concept[].definition
**Description:** Exposure participants' interaction occurred in a child care setting

# concept[].definition
**Description:** An interaction where the exposure participants traveled in/on the same vehicle (not necessarily concurrently, e.g. both are passengers of the same plane, but on different flights of that plane).

# concept[].display
Health Care Interaction - Not Patient Care

# concept[].definition
**Description:** Exposure participants' interaction occurred during the course of health care delivery or in a health care delivery setting, but did not involve the direct provision of care (e.g. a janitor cleaning a patient's hospital room).

# concept[].definition
**Description:** Exposure interaction occurred in context of one providing care for the other, i.e. a babysitter providing care for a child, a home-care aide providing assistance to a paraplegic.

# concept[].definition
**Description:** Exposure participants' interaction occurred when both were patients being treated in the same (acute) health care delivery facility.

# concept[].definition
**Description:** Exposure participants' interaction occurred when one visited the other who was a patient being treated in a health care delivery facility.

# concept[].definition
**Description:** Exposure interaction occurred in context of domestic interaction, i.e. both participants reside in the same household.

# concept[].definition
**Description:** Exposure participants' interaction occurred in the course of one or both participants being incarcerated at a correctional facility

# concept[].definition
**Description:** Exposure interaction was intimate, i.e. participants are intimate companions (e.g. spouses, domestic partners).

# concept[].definition
**Description:** Exposure participants' interaction occurred in the course of one or both participants being resident at a long term care facility (second participant may be a visitor, worker, resident or a physical place or object within the facility).

# concept[].definition
**Description:** An interaction where the exposure participants were both present in the same location/place/space.

# concept[].definition
**Description:** Exposure participants' interaction occurred during the course of health care delivery by a provider (e.g. a physician treating a patient in her office).

# concept[].definition
**Description:** Exposure participants' interaction occurred in an academic setting (e.g., participants are fellow students, or student and teacher).

# concept[].definition
**Description:** An interaction where the exposure participants are social associates or members of the same extended family

# concept[].definition
**Description:** An interaction where the exposure participants shared or co-used a common substance (e.g. drugs, needles, or common food item).

# concept[].definition
**Description:** An interaction where the exposure participants traveled together in/on the same vehicle/trip (e.g. concurrent co-passengers).

# concept[].definition
**Description:** Exposure interaction occurred in a work setting, i.e. participants are co-workers.

# concept[].definition
A type of transaction that represents a charge for a service or product. Expressed in monetary terms.

# concept[].definition
A type of transaction that represents a reversal of a previous charge for a service or product. Expressed in monetary terms. It has the opposite effect of a standard charge.

# concept[].definition
A consent directive compliant with the European Union General Data Protection Regulation (GDPR) definition: Consent of the data subject means any freely given, specific, informed and unambiguous indication of the data subject's wishes by which he or she, by a statement or by a clear affirmative action, signifies agreement to the processing of personal data relating to him or her.

Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Consent should be given by a clear affirmative act establishing a freely given, specific, informed and unambiguous indication of the data subject's agreement to the processing of personal data relating to him or her, such as by a written statement, including by electronic means, or an oral statement. This could include ticking a box when visiting an internet website, choosing technical settings for information society services or another statement or conduct which clearly indicates in this context the data subject's acceptance of the proposed processing of his or her personal data. Silence, pre-ticked boxes or inactivity should not therefore constitute consent. Consent should cover all processing activities carried out for the same purpose or purposes. When the processing has multiple purposes, consent should be given for all of them. If the data subject's consent is to be given following a request by electronic means, the request must be clear, concise and not unnecessarily disruptive to the use of the service for which it is provided.

*Usage Note:* Article 4.11 GDPR Definitions https://gdpr-info.eu/art-4-gdpr/ 11) 'Consent' of the data subject means any freely given, specific, informed and unambiguous indication of the data subject's wishes by which he or she, by a statement or by a clear affirmative action, signifies agreement to the processing of personal data relating to him or her. Article 7 GDPR Conditions for consent https://gdpr-info.eu/art-7-gdpr Recital 32 Conditions for consent\* https://gdpr-info.eu/recitals/no-32 Recital 42 Burden of proof and requirements for consent\* https://gdpr-info.eu/recitals/no-42/> Recital 43 Freely given consent\* https://gdpr-info.eu/recitals/no-43 GDPR Consent Brief https://gdpr-info.eu/issues/consent/ Art. 4 GDPR Definitions Art. 6 GDPR Lawfulness of processing Art. 7 GDPR Conditions for consent Art. 8 GDPR Conditions applicable to child's consent in relation to information society services Art. 9 GDPR Processing of special categories of personal data Art. 22 GDPR Automated individual decision-making, including profiling Art. 49 GDPR Derogations for specific situations

Relevant GDPR Recitals: (32) Conditions for consent (33) Consent to certain areas of scientific research (38) Special protection of children's personal data (40) Lawfulness of data processing (42) Burden of proof and requirements for consent (43) Freely given consent (50) Further processing of personal data (51) Protecting sensitive personal data (54) Processing of sensitive data in public health sector (71) Profiling (111) Exceptions for certain cases of international transfers (155) Processing in the employment context (161) Consenting to the participation in clinical trials (171) Repeal of Directive 95/46/EC and transitional provisions

# concept[].definition
A consent directive that complies with regulatory requirements for a consent directive compliant with the European Union General Data Protection Regulation (GDPR) definition: Consent of the data subject means any freely given, specific, informed and unambiguous indication of the data subject's wishes by which he or she, by a statement or by a clear affirmative action, signifies agreement to the processing of personal data relating to him or her.

GDPR research consent directive has the additional caveat that it is often not possible to fully identify the purpose of personal data processing for scientific research purposes at the time of data collection. Therefore, data subjects should be allowed to give their consent to certain areas of scientific research when in keeping with recognized ethical standards for scientific research. Data subjects should have the opportunity to give their consent only to certain areas of research or parts of research projects to the extent allowed by the intended purpose.

*Usage Note:* HL7 Purpose of Use codes include specialize research purposes of use, which could be used to convey a data subject's purpose of use restrictions related to areas of research or parts of research projects. See citations for GDPRResearchCD and below: Recital 33 Consent to certain areas of scientific research https://gdpr-info.eu/recitals/no-33/> Recital 157 Information from registries and scientific research https://gdpr-info.eu/recitals/no-157 Recital 159 Processing for scientific research purposes\* https://gdpr-info.eu/recitals/no-159/

# concept[].definition
Processing of personal data, inclusive of the special categories of data, is lawful only if the data subject has given explicit consent to the processing of his or her personal data, inclusive of the special categories of data, for one or more specific purposes, except where Union or Member State law provide that the prohibition to use the data may not be lifted by the data subject; and for personal data which are manifestly made public by the data subject.

*Usage Note:* The description is based on the following GDPR provisions: Article 6.1.a https://gdpr-info.eu/art-6-gdpr/ 1Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes. Article 9.1, 9.2a., 9.2.e https://gdpr-info.eu/art-9-gdpr/ 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; and (e) processing relates to personal data which are manifestly made public by the data subject.

# concept[].display
opt-in to personal information or effect collection in a registry or repository

# concept[].definition
An expressed privacy consent directive permitting the collection of a some or all personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

*Usage Note:* Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-in to collection of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" consent directive maps to ISO/TS 17975:2015(E) definitions for "Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care" and "Opt-in".

# concept[].display
opt-in to personal information or effect sharing via a registry or repository

# concept[].definition
An expressed privacy consent directive permitting access, use, or disclosure of a some or all personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

*Usage Note:* Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-in to access, use, or disclosure of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" consent directive maps to ISO/TS 17975:2015(E) Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care and "Opt-in".

# concept[].display
opt-out of personal information or effect collection in a registry or repository

# concept[].definition
An expressed privacy consent directive restricting or prohibiting collection of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

*Usage Note:* Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-out of access, use, or disclosure of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" opt-out to collection consent directive maps to ISO/TS 17975:2015(E) definitions for "Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care" and "Express or Expressed (and Informed) Denial".

# concept[].display
opt-out of personal information or effect sharing via a registry or repository

# concept[].definition
An expressed privacy consent directive restricting or prohibiting access, use, or disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual in a registry or repository for purposes such as treatment, payment, operations, research, information exchange, public health, data analytics, marketing, and profiling.

*Usage Note:* Useful when a more specific jurisdictional or organizational consent directive policy or form is not specified, available, or known, for example, where an individual wishes to opt-out of access, use, or disclosure of some or all of the individual's information by multiple registries and repositories.

Map: An "expressed" opt-out to sharing consent directive maps to ISO/TS 17975:2015(E) definitions for "Express or Expressed: Consent to Collect, Use and Disclose personal health information is expressly given by the subject of care" and "Express or Expressed (and Informed) Denial".

# concept[].definition
**Definition:** A health insurance policy that that covers benefits for dental services.

# concept[].definition
**Definition:** A health insurance policy that covers benefits for healthcare services provided for named conditions under the policy, e.g., cancer, diabetes, or HIV-AIDS.

# concept[].definition
**Definition:** A health insurance policy that covers benefits for prescription drugs, pharmaceuticals, and supplies.

# concept[].definition
Private insurance policy that provides coverage in addition to other policies (e.g. in addition to a Public Healthcare insurance policy).

# concept[].definition
**Definition:** A health insurance policy that covers healthcare benefits by protecting covered parties from medical expenses arising from health conditions, sickness, or accidental injury as well as preventive care. Health insurance policies explicitly exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.

*Discussion:* Health insurance policies are offered by health insurance plans that typically reimburse providers for covered services on a fee-for-service basis, that is, a fee that is the allowable amount that a provider may charge. This is in contrast to managed care plans, which typically prepay providers a per-member/per-month amount or capitation as reimbursement for all covered services rendered. Health insurance plans include indemnity and healthcare services plans.

# concept[].definition
Insurance policy that provides for an allotment of funds replenished on a periodic (e.g. annual) basis. The use of the funds under this policy is at the discretion of the covered party.

# concept[].definition
**Definition:** An insurance policy that covers benefits for long-term care services people need when they no longer can care for themselves. This may be due to an accident, disability, prolonged illness or the simple process of aging. Long-term care services assist with activities of daily living including:

 *  Help at home with day-to-day activities, such as cooking, cleaning, bathing and dressing
 *  Care in the community, such as in an adult day care facility
 *  Supervised care provided in an assisted living facility
 *  Skilled care provided in a nursing home

# concept[].definition
**Definition:** Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

Managed care policies specifically exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.

*Discussion:* Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member.

# concept[].definition
**Definition:** A health insurance policy that covers benefits for mental health services and prescriptions.

# concept[].definition
**Definition:** A policy for a health plan that has features of both an HMO and a FFS plan. Like an HMO, a POS plan encourages the use its HMO network to maintain discounted fees with participating providers, but recognizes that sometimes covered parties want to choose their own provider. The POS plan allows a covered party to use providers who are not part of the HMO network (non-participating providers). However, there is a greater cost associated with choosing these non-network providers. A covered party will usually pay deductibles and coinsurances that are substantially higher than the payments when he or she uses a plan provider. Use of non-participating providers often requires the covered party to pay the provider directly and then to file a claim for reimbursement, like in an FFS plan.

# concept[].definition
**Definition:** A health insurance policy that covers benefits for substance use services.

# concept[].definition
**Definition:** Set of codes for a policy that provides coverage for health care expenses arising from vision services.

A health insurance policy that covers benefits for vision care services, prescriptions, and products.

# concept[].definition
Incident or accident as the result of a motor vehicle accident

# concept[].definition
Incident or accident is the result of a school place accident.

# concept[].definition
Incident or accident is the result of a sporting accident.

# concept[].definition
Incident or accident is the result of a work place accident

# concept[].definition
**Definition:** A code specifying the particular kind of Patient Safety Incident that the Incident class instance represents.

**Examples:**"Medication incident", "slips, trips and falls incident".The actual value set for the domain will be determined by each (realm) implementation, whose Patient Safety terminology will be specific, although probably linked to the WHO Patient Safety Taxonomy that is currently under development

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access adverse drug reaction information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access all information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access allergy information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access informational consent information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access demographics information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access diagnostic imaging information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access immunization information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access lab test result information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access medical condition information for a patient.

# concept[].definition
**Definition:** Provide consent to view or access medical condition information for a patient.

# concept[].definition
**Description:**Provide consent to collect, use, disclose, or access mental health information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access common observation information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access coverage policy or program for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access provider information for a patient.

# concept[].definition
**Description:** Provide consent to collect, use, disclose, or access professional service information for a patient.

# concept[].definition
**Description:**Provide consent to collect, use, disclose, or access substance abuse information for a patient.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information in accordance with jurisdictional law, organizational policy, or a patient's consent directive, which may be implied, deemed, opt-in, opt-out, or explicit.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information in accordance with judicial system protocol, such as in the case of a subpoena or court order.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information where deemed necessary to avert potential danger to other persons in accordance with jurisdictional law, organizational policy, or standards of practice. For example, disclosure about a person threatening violence.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information in accordance with emergency information transfer protocol dictated by jurisdictional law, organization policy, or standards of practice. For example, sharing of health information during disaster response.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information necessary to avert potential public welfare risk in accordance with jurisdictional law, organizational policy, or standards of practice. For example, reporting that a person is a victim of abuse or demonstrating suicidal tendencies.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information for public health, welfare, and safety purposes in accordance with jurisdictional law, organizational policy, or standards of practice. For example, public health reporting of notifiable conditions.

# concept[].definition
Authorization to obtain information with no further permission to collect and store it.

# concept[].definition
Authorization to gather and store information.

# concept[].definition
Authorization to alter or remove identifying characteristics of an entity or individual that is a subject of the information.

# concept[].definition
Authorization to make information known to another party.

# concept[].definition
Authorization to alter information in order to conceal it from unauthorized recipients.

# concept[].definition
Authorization to access information within a specific context for communication purposes only. Storing, manipulating, and further disclosure are prohibited and may be technically disabled.

# concept[].definition
Authorization to remove information that a recipient is not authorized to access.

# concept[].definition
Authorization to make disclosed information known to another party.

# concept[].definition
Authorization to alter or relink deidentified information so that an entity or individual that is the subject of that information identifiable.

# concept[].definition
Authorization to employ or alter information.

# concept[].definition
**Definition:**All information pertaining to a patient's allergy and intolerance records.

# concept[].definition
**Description:** All information pertaining to a patient's adverse drug reactions.

# concept[].definition
**Definition:**All information pertaining to a patient's common observation records (height, weight, blood pressure, temperature, etc.).

# concept[].definition
**Definition:**All information pertaining to a patient's demographics (such as name, date of birth, gender, address, etc).

# concept[].definition
**Definition:**All information pertaining to a patient's diagnostic image records (orders & results).

# concept[].definition
**Definition:**All information pertaining to a patient's vaccination records.

# concept[].definition
**Description:** All information pertaining to a patient's lab test records (orders & results)

# concept[].definition
**Definition:**All information pertaining to a patient's medical condition records.

# concept[].definition
**Description:** All information pertaining to a patient's mental health records.

# concept[].definition
**Definition:**All information pertaining to a patient's professional service records (such as smoking cessation, counseling, medication review, mental health).

# concept[].definition
**Definition:**All information pertaining to a patient's medication records (orders, dispenses and other active medications).

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of information as defined by applicable jurisdictional law.

# concept[].definition
Organizational policy on collection, access, use, or disclosure of information, which does not conflict with jurisdictional law.

# concept[].definition
Personal policy on collection, access, use, or disclosure of information.

# concept[].definition
Policy for handling alcohol or drug-abuse information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to alcohol or drug-abuse information that is deemed sensitive.

*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.

# concept[].definition
Policy for handling genetic disease information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to genetic disease information that is deemed sensitive.

*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.

# concept[].definition
Policy for handling HIV or AIDS information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to HIV or AIDS information that is deemed sensitive.

*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.

# concept[].display
military sexual trauma information sensitivity

# concept[].definition
Policy for handling information related to sexual assault or repeated, threatening sexual harassment that occurred while the patient was in the military, which is afforded heightened confidentiality.

Access control concerns for military sexual trauma is based on the patient being subject to control by a higher ranking military perpetrator and/or censure by others within the military unit. Due to the relatively unfettered access to healthcare information by higher ranking military personnel and those who have command over the patient, there is a need to sequester this information outside of the typical controls on access to military health records.

*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.

# concept[].definition
Policy for handling information about an individual's current or past pregnancy status, deemed sensitive by the individual or by policy, which may be afforded heightened confidentiality.

*Usage Note:* 

Information about a patient's current or past pregnancy status may be considered sensitive in circumstances in which that status could result in discrimination or stigmatization.

# concept[].display
sickle cell anemia information sensitivity

# concept[].definition
Policy for handling sickle cell disease information, which is afforded heightened confidentiality. Information handling protocols are based on organizational policies related to sickle cell disease information, which is deemed sensitive.

*Usage Note:* If there is a jurisdictional mandate, then the Act valued with this ActCode should be associated with an Act valued with any applicable laws from the ActPrivacyLaw code system.

# concept[].display
sexual assault, abuse, or domestic violence information sensitivity

# concept[].definition
Policy for handling sexual assault, abuse, or domestic violence information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexual assault, abuse, or domestic violence information that is deemed sensitive.

SDV code covers violence perpetrated by related and non-related persons. This code should be specific to physical and mental trauma caused by a related person only. The access control concerns are keeping the patient safe from the perpetrator who may have an abusive psychological control over the patient, may be stalking the patient, or may try to manipulate care givers into allowing the perpetrator to make contact with the patient. The definition needs to be clarified.

*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.

# concept[].display
sexuality and reproductive health information sensitivity

# concept[].definition
Policy for handling sexuality and reproductive health information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexuality and reproductive health information that is deemed sensitive.

*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.

# concept[].definition
Policy for handling information deemed specially protected by law or policy including substance abuse, substance use, psychiatric, mental health, behavioral health, and cognitive 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.

# concept[].definition
Policy for handling sexually transmitted disease information, which will be afforded heightened confidentiality. Information handling protocols based on organizational policies related to sexually transmitted disease information that is deemed sensitive.

*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.

# concept[].definition
Policy for handling information not to be initially disclosed or discussed with patient except by a physician assigned to patient in this case. Information handling protocols based on organizational policies related to sensitive patient information that must be initially discussed with the patient by an attending physician before being disclosed to the patient.

*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.

*Open Issue:* This definition conflates a rule and a characteristic, and there may be a similar issue with ts sibling codes.

# concept[].definition
Policy for handling information related to harm by violence, which is afforded heightened confidentiality. Harm by violence is perpetrated by an unrelated person.

Access control concerns for information about mental or physical harm resulting from violence caused by an unrelated person may include manipulation of care givers or access to records that enable the perpetrator contact or locate the patient, but the perpetrator will likely not have established abusive psychological control over the patient.

*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.

# concept[].definition
Policy for handling information related to an identifier of an information subject, which will be afforded heightened confidentiality. Usage Note: Such policies may govern the sensitivity of information related to an identifier of an act, such as the identifier of a contract; a role, such as a citizen, a patient, a practitioner, or an organization; or an entity such as a medical device due to potential impact on the privacy, well-being, safety or integrity of an information subject. For example, protection against identity fraud or counterfeit.

# concept[].definition
Types of sensitivity policies that apply to Acts. Act.confidentialityCode is defined in the RIM as "constraints around appropriate disclosure of information about this Act, regardless of mood."

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

# concept[].definition
Insurance policy for injuries sustained in an automobile accident. Will also typically covered non-named parties to the policy, such as pedestrians and passengers.

# concept[].definition
Insurance policy funded by a public health system such as a provincial or national health plan. Examples include BC MSP (British Columbia Medical Services Plan) OHIP (Ontario Health Insurance Plan), NHS (National Health Service).

# concept[].definition
Insurance policy for injuries sustained in the work place or in the course of employment.

# concept[].definition
**Definition:** Set of codes indicating the type of health insurance policy that covers health services provided to covered parties. A health insurance policy is a written contract for insurance between the insurance company and the policyholder, and contains pertinent facts about the policy owner (the policy holder), the health insurance coverage, the insured subscribers and dependents, and the insurer. Health insurance is typically administered in accordance with a plan, which specifies (1) the type of health services and health conditions that will be covered under what circumstances (e.g., exclusion of a pre-existing condition, service must be deemed medically necessary; service must not be experimental; service must provided in accordance with a protocol; drug must be on a formulary; service must be prior authorized; or be a referral from a primary care provider); (2) the type and affiliation of providers (e.g., only allopathic physicians, only in network, only providers employed by an HMO); (3) financial participations required of covered parties (e.g., co-pays, coinsurance, deductibles, out-of-pocket); and (4) the manner in which services will be paid (e.g., under indemnity or fee-for-service health plans, the covered party typically pays out-of-pocket and then file a claim for reimbursement, while health plans that have contractual relationships with providers, i.e., network providers, typically do not allow the providers to bill the covered party for the cost of the service until after filing a claim with the payer and receiving reimbursement).

# concept[].definition
**Definition:** An insurance policy that provides a regular payment to compensate for income lost due to the covered party's inability to work because of illness or injury.

# concept[].definition
**Definition:** An insurance policy under a benefit plan run by an employer or employee organization for the purpose of providing benefits other than pension-related to employees and their families. Typically provides health-related benefits, benefits for disability, disease or unemployment, or day care and scholarship benefits, among others. An employer sponsored health policy includes coverage of health care expenses arising from sickness or accidental injury, coverage for on-site medical clinics or for dental or vision benefits, which are typically provided under a separate policy. Coverage excludes health care expenses covered by accident or disability, workers' compensation, liability or automobile insurance.

# concept[].definition
**Definition:**  An insurance policy that covers qualified benefits under a Flexible Benefit plan such as group medical insurance, long and short term disability income insurance, group term life insurance for employees only up to $50,000 face amount, specified disease coverage such as a cancer policy, dental and/or vision insurance, hospital indemnity insurance, accidental death and dismemberment insurance, a medical expense reimbursement plan and a dependent care reimbursement plan.

 *Discussion:* See UnderwriterRoleTypeCode flexible benefit plan which is defined as a benefit plan that allows employees to choose from several life, health, disability, dental, and other insurance plans according to their individual needs. Also known as cafeteria plans. Authorized under Section 125 of the Revenue Act of 1978.

# concept[].definition
**Definition:** A policy under which the insurer agrees to pay a sum of money upon the occurrence of the covered partys death. In return, the policyholder agrees to pay a stipulated amount called a premium at regular intervals. Life insurance indemnifies the beneficiary for the loss of the insurable interest that a beneficiary has in the life of a covered party. For persons related by blood, a substantial interest established through love and affection, and for all other persons, a lawful and substantial economic interest in having the life of the insured continue. An insurable interest is required when purchasing life insurance on another person. Specific exclusions are often written into the contract to limit the liability of the insurer; for example claims resulting from suicide or relating to war, riot and civil commotion.

*Discussion:*A life insurance policy may be used by the covered party as a source of health care coverage in the case of a viatical settlement, which is the sale of a life insurance policy by the policy owner, before the policy matures. Such a sale, at a price discounted from the face amount of the policy but usually in excess of the premiums paid or current cash surrender value, provides the seller an immediate cash settlement. Generally, viatical settlements involve insured individuals with a life expectancy of less than two years. In countries without state-subsidized healthcare and high healthcare costs (e.g. United States), this is a practical way to pay extremely high health insurance premiums that severely ill people face. Some people are also familiar with life settlements, which are similar transactions but involve insureds with longer life expectancies (two to fifteen years).

# concept[].definition
**Definition:** A type of insurance that covers damage to or loss of the policyholderaTMs property by providing payments for damages to property damage or the injury or death of living subjects. The terms "casualty" and "liability" insurance are often used interchangeably. Both cover the policyholder's legal liability for damages caused to other persons and/or their property.

# concept[].definition
**Definition:** An agreement between two or more insurance companies by which the risk of loss is proportioned. Thus the risk of loss is spread and a disproportionately large loss under a single policy does not fall on one insurance company. Acceptance by an insurer, called a reinsurer, of all or part of the risk of loss of another insurance company.

**Discussion:** Reinsurance is a means by which an insurance company can protect itself against the risk of losses with other insurance companies. Individuals and corporations obtain insurance policies to provide protection for various risks (hurricanes, earthquakes, lawsuits, collisions, sickness and death, etc.). Reinsurers, in turn, provide insurance to insurance companies.

For example, an HMO may purchase a reinsurance policy to protect itself from losing too much money from one insured's particularly expensive health care costs. An insurance company issuing an automobile liability policy, with a limit of $100,000 per accident may reinsure its liability in excess of $10,000. A fire insurance company which issues a large policy generally reinsures a portion of the risk with one or several other companies. Also called *risk control insurance or stop-loss insurance.*

# concept[].definition
**Definition:** 

1.  A risk or part of a risk for which there is no normal insurance market available.
2.  Insurance written by unauthorized insurance companies. Surplus lines insurance is insurance placed with unauthorized insurance companies through licensed surplus lines agents or brokers.

# concept[].definition
**Definition:** A form of insurance protection that provides additional liability coverage after the limits of your underlying policy are reached. An umbrella liability policy also protects you (the insured) in many situations not covered by the usual liability policies.

# concept[].definition
Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.

# concept[].definition
Codes representing adjustments to a Payment Advice such as retroactive, clawback, garnishee, etc.

# concept[].definition
Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee, etc.

# concept[].definition
Payment initiated by the payor as the result of adjudicating a submitted invoice that arrived to the payor from an electronic source that did not provide a conformant set of HL7 messages (e.g. web claim submission).

# concept[].definition
Bonus payments based on performance, volume, etc. as agreed to by the payor.

# concept[].definition
An amount still owing to the payor but the payment is 0$ and this cannot be settled until a future payment is made.

# concept[].definition
Fees deducted on behalf of a payee for tuition and continuing education.

# concept[].definition
Fees deducted on behalf of a payee for charges based on a shorter payment frequency (i.e. next day versus biweekly payments.

# concept[].definition
Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

# concept[].definition
Payment is based on a payment intent for a previously submitted Invoice, based on formal adjudication results..

# concept[].definition
Payment initiated by the payor as the result of adjudicating a paper (original, may have been faxed) invoice.

# concept[].definition
An amount that was owed to the payor as indicated, by a carry forward adjusment, in a previous payment advice

# concept[].definition
Professional association fee that is collected by the payor from the practitioner/provider on behalf of the association

# concept[].definition
Retroactive adjustment such as fee rate adjustment due to contract negotiations.

# concept[].definition
Bonus payments based on performance, volume, etc. as agreed to by the payor.

# concept[].definition
Fees deducted on behalf of a payee for charges based on a per-transaction or time-period (e.g. monthly) fee.

# concept[].definition
Transaction counts and value totals by invoice type (e.g. RXDINV - Pharmacy Dispense)

# concept[].definition
Transaction counts and value totals by each instance of an invoice payee.

# concept[].definition
Transaction counts and value totals by each instance of an invoice payor.

# concept[].definition
Transaction counts and value totals by each instance of a messaging application on a single processor. It is a registered identifier known to the receivers.

# concept[].display
United Nations Standard Products and Services Classification

# concept[].definition
**Description:**United Nations Standard Products and Services Classification, managed by Uniform Code Council (UCC): www.unspsc.org

# concept[].definition
**Description:**Physicians Current Procedural Terminology (CPT) Manual is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

# concept[].definition
**Description:**Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes are procedure identifying codes. HCPCS is Health Care Finance AdministrationaTMs (HFCA) coding scheme to group procedures performed for payment to providers. contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

# concept[].definition
**Description:**International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) are procedure identifying codes. ICD-10-PCS describes the classification of inpatient procedures for statistical purposes.

# concept[].definition
**Description:**International Classification of Diseases, 9th Revision, Procedure Coding System (ICD-9-PCS) are procedure identifying codes. ICD-9-PCS describes the classification of inpatient procedures for statistical purposes.

# concept[].definition
An identifying data string for healthcare products.

# concept[].definition
An identifying data string for A substance used as a medication or in the preparation of medication.

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

# concept[].definition
An identifying data string for medical facility accommodations.

# concept[].definition
An identifying data string for healthcare procedures.

# concept[].definition
An identifying data string for oral health procedure codes, e.g. extract tooth.

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

# concept[].definition
**Description:**Universal Product Code is one of a wide variety of bar code languages widely used in the United States and Canada for items in stores.

# concept[].definition
That portion of the eligible charges which a covered party must pay for each service and/or product. It is a percentage of the eligible amount for the service/product that is typically charged after the covered party has met the policy deductible. This amount represents the covered party's coinsurance that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

# concept[].definition
That portion of the eligible charges which a covered party must pay for each service and/or product. It is a defined amount per service/product of the eligible amount for the service/product. This amount represents the covered party's copayment that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

# concept[].definition
That portion of the eligible charges which a covered party must pay in a particular period (e.g. annual) before the benefits are payable by the adjudicator. This amount represents the covered party's deductible that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results.

# concept[].definition
The guarantor, who may be the patient, pays the entire charge for a service. Reasons for such action may include: there is no insurance coverage for the service (e.g. cosmetic surgery); the patient wishes to self-pay for the service; or the insurer denies payment for the service due to contractual provisions such as the need for prior authorization.

# concept[].definition
That total amount of the eligible charges which a covered party must periodically pay for services and/or products prior to the Medicaid program providing any coverage. This amount represents the covered party's spend down that is applied to a particular adjudication result. It is expressed as a negative dollar amount in adjudication results

# concept[].definition
The covered party pays a percentage of the cost of covered services.

# concept[].definition
The billable item codes to identify adjudicator specified components to the total billing of a claim.

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

# concept[].definition
The billable item codes to identify provider supplied charges or changes to the total billing of a claim.

# concept[].definition
The billable item codes to identify modifications to a billable item charge by a tax factor applied to the amount. As for example 7% provincial sales tax.

# concept[].definition
Premium paid on service fees in compensation for practicing outside of normal working hours.

# concept[].definition
Premium paid on service fees in compensation for practicing in a remote location.

# concept[].definition
Premium paid on service fees in compensation for practicing at a location other than normal working location.

# concept[].definition
A charge to compensate the provider when a patient cancels an appointment with insufficient time for the provider to make another appointment with another patient.

# concept[].definition
A reduction in the amount charged as a percentage of the amount. For example a 5% discount for volume purchase.

# concept[].definition
A premium on a service fee is requested because, due to extenuating circumstances, the service took an extraordinary amount of time or supplies.

# concept[].definition
Under agreement between the parties (payor and provider), a guaranteed level of income is established for the provider over a specific, pre-determined period of time. The normal course of business for the provider is submission of fee-for-service claims. Should the fee-for-service income during the specified period of time be less than the agreed to amount, a top-up amount is paid to the provider equal to the difference between the fee-for-service total and the guaranteed income amount for that period of time. The details of the agreement may specify (or not) a requirement for repayment to the payor in the event that the fee-for-service income exceeds the guaranteed amount.

# concept[].definition
Anticipated or actual final fee associated with treating a patient.

# concept[].definition
Anticipated or actual initial fee associated with treating a patient.

# concept[].definition
An increase in the amount charged as a percentage of the amount. For example, 12% markup on product cost.

# concept[].definition
A charge to compensate the provider when a patient does not show for an appointment.

# concept[].definition
Anticipated or actual periodic fee associated with treating a patient. For example, expected billing cycle such as monthly, quarterly. The actual period (e.g. monthly, quarterly) is specified in the unit quantity of the Invoice Element.

# concept[].definition
The amount for a performance bonus that is being requested from a payor for the performance of certain services (childhood immunizations, influenza immunizations, mammograms, pap smears) on a sliding scale. That is, for 90% of childhood immunizations to a maximum of $2200/yr. An invoice is created at the end of the service period (one year) and a code is submitted indicating the percentage achieved and the dollar amount claimed.

# concept[].definition
A charge is requested because the patient failed to pick up the item and it took an amount of time to return it to stock for future use.

# concept[].definition
A charge to cover the cost of travel time and/or cost in conjuction with providing a service or product. It may be charged per kilometer or per hour based on the effective agreement.

# concept[].definition
Premium paid on service fees in compensation for providing an expedited response to an urgent situation.

# concept[].definition
Accommodation type. In Intent mood, represents the accommodation type requested. In Event mood, represents accommodation assigned/used. In Definition mood, represents the available accommodation type.

# concept[].definition
Federal tax on transactions such as the Goods and Services Tax (GST)

# concept[].definition
Tax levied by the provincial or state jurisdiction such as Provincial Sales Tax

# concept[].definition
Codes representing a grouping of invoice elements (totals, sub-totals), reported through a Payment Advice or a Statement of Financial Activity (SOFA). The code can represent summaries by day, location, payee and other cost elements such as bonus, retroactive adjustment and transaction fees.

# concept[].definition
Codes representing a service or product that is being invoiced (billed). The code can represent such concepts as "office visit", "drug X", "wheelchair" and other billable items such as taxes, service charges and discounts.

# concept[].definition
Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

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

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

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

# concept[].definition
Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

The domain is only specified for an intermediate invoice element group (non-root or non-top level) for an Invoice.

# concept[].definition
Type of invoice element that is used to assist in describing an Invoice that is either submitted for adjudication or for which is returned on adjudication results.

Invoice elements of this type signify a grouping of one or more children (detail) invoice elements. They do not have intrinsic costing associated with them, but merely reflect the sum of all costing for it's immediate children invoice elements.

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

# concept[].definition
A grouping of invoice element groups and details including the ones specifying the compound ingredients being invoiced. It may also contain generic detail items such as markup.

# concept[].definition
A grouping of invoice element details including the one specifying an ingredient drug being invoiced. It may also contain generic detail items such as tax or markup.

# concept[].definition
A grouping of invoice element groups and details including the ones specifying the compound supplies being invoiced. It may also contain generic detail items such as markup.

# concept[].definition
A grouping of invoice element details including the one specifying the drug being invoiced. It may also contain generic detail items such as markup.

# concept[].definition
A grouping of invoice element details including the ones specifying the frame fee and the frame dispensing cost that are being invoiced.

# concept[].definition
A grouping of invoice element details including the ones specifying the lens fee and the lens dispensing cost that are being invoiced.

# concept[].definition
A grouping of invoice element details including the one specifying the product (good or supply) being invoiced. It may also contain generic detail items such as tax or discount.

# concept[].definition
Insurance coverage problems have been encountered. Additional explanation information to be supplied.

# concept[].definition
Electronic form with supporting or additional information to follow.

# concept[].definition
Fax with supporting or additional information to follow.

# concept[].definition
The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered.

# concept[].definition
Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied.

# concept[].definition
Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.

# concept[].definition
The medical service and/or product was provided to a patient that has coverage in another jurisdiction.

# concept[].definition
The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.

# concept[].definition
Paper documentation (or other physical format) with supporting or additional information to follow.

# concept[].definition
Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission.

# concept[].definition
Allows provider to explain lateness of invoice to a subsequent payor.

# concept[].definition
Rules of practice do not require a physician's referral for the provider to perform a billable service.

# concept[].definition
The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate.

# concept[].definition
The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items.

# concept[].definition
The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.

# concept[].definition
Clinical product invoice where the Invoice Grouping contains one or more billable item and is supported by clinical product(s).

For example, a crutch or a wheelchair.

# concept[].definition
Clinical product invoice where the Invoice Grouping contains one or more billable item and is supported by clinical product(s).

For example, a crutch or a wheelchair.

# concept[].definition
Clinical Services Invoice which can be used to describe a single service, multiple services or repeated services.

\[1\] Single Clinical services invoice where the Invoice Grouping contains one billable item and is supported by one clinical service.

For example, a single service for an office visit or simple clinical procedure (e.g. knee mobilization).

\[2\] Multiple Clinical services invoice where the Invoice Grouping contains more than one billable item, supported by one or more clinical services. The services can be distinct and over multiple dates, but for the same patient. This type of invoice includes a series of treatments which must be adjudicated together.

For example, an adjustment and ultrasound for a chiropractic session where fees are associated for each of the services and adjudicated (invoiced) together.

\[3\] Repeated Clinical services invoice where the Invoice Grouping contains one or more billable item, supported by the same clinical service repeated over a period of time.

For example, the same Chiropractic adjustment (service or treatment) delivered on 3 separate occasions over a period of time at the discretion of the provider (e.g. month).

# concept[].definition
Clinical Services Invoice which can be used to describe a single service, multiple services or repeated services.

\[1\] Single Clinical services invoice where the Invoice Grouping contains one billable item and is supported by one clinical service.

For example, a single service for an office visit or simple clinical procedure (e.g. knee mobilization).

\[2\] Multiple Clinical services invoice where the Invoice Grouping contains more than one billable item, supported by one or more clinical services. The services can be distinct and over multiple dates, but for the same patient. This type of invoice includes a series of treatments which must be adjudicated together.

For example, an adjustment and ultrasound for a chiropractic session where fees are associated for each of the services and adjudicated (invoiced) together.

\[3\] Repeated Clinical services invoice where the Invoice Grouping contains one or more billable item, supported by the same clinical service repeated over a period of time.

For example, the same Chiropractic adjustment (service or treatment) delivered on 3 separate occasions over a period of time at the discretion of the provider (e.g. month).

# concept[].definition
A clinical Invoice Grouping consisting of one or more services and one or more product. Billing for these service(s) and product(s) are supported by multiple clinical billable events (acts).

All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator.

For example , a brace (product) invoiced together with the fitting (service).

# concept[].definition
Invoice Grouping without clinical justification. These will not require identification of participants and associations from a clinical context such as patient and provider.

Examples are interest charges and mileage.

# concept[].definition
A clinical Invoice Grouping consisting of one or more oral health services. Billing for these service(s) are supported by multiple clinical billable events (acts).

All items in the Invoice Grouping must be adjudicated together to be acceptable to the Adjudicator.

# concept[].definition
Pharmacy dispense invoice for a compound.

# concept[].definition
Pharmacy dispense invoice for a compound.

# concept[].definition
Pharmacy dispense invoice not involving a compound

# concept[].definition
Pharmacy dispense invoice not involving a compound

# concept[].definition
Clinical services invoice where the Invoice Group contains one billable item for multiple clinical services in one or more sessions.

# concept[].definition
Vision dispense invoice for up to 2 lens (left and right), frame and optional discount. Eye exams are invoiced as a clinical service invoice.

# concept[].definition
Codes used to identify different types of 'duration-based' working lists. Examples include "Continuous/Chronic", "Short-Term" and "As-Needed".

# concept[].definition
**Description:**Describes the high level classification of professional services for grouping.

**Examples:**Education, Counseling, Surgery, etc.

# concept[].definition
Provision of Alternate Level of Care to a patient in an acute bed. Patient is waiting for placement in a long-term care facility and is unable to return home.

# concept[].definition
Provision of diagnosis and treatment of diseases and disorders affecting the heart

# concept[].definition
Provision of recurring care for chronic illness.

# concept[].definition
Provision of treatment for oral health and/or dental surgery.

# concept[].definition
General care performed by a general practitioner or family doctor as a responsible provider for a patient.

# concept[].definition
Provision of diagnostic and/or therapeutic treatment.

# concept[].definition
Provision of care of women during pregnancy, childbirth and immediate postpartum period. Also known as Maternity.

# concept[].definition
Provision of treatment and/or diagnosis related to tumors and/or cancer.

# concept[].definition
Provision of care for patients who are living or dying from an advanced illness.

# concept[].definition
Provision of diagnosis and treatment of diseases and disorders affecting children.

# concept[].definition
Pharmaceutical care performed by a pharmacist.

# concept[].definition
Provision of treatment for physical injury.

# concept[].definition
Provision of treatment of psychiatric disorder relating to mental illness.

# concept[].definition
**Definition:**A list of medications which the patient is only expected to consume for the duration of the current order or limited set of orders and which is not expected to be renewed.

# concept[].definition
**Definition:**A list of medications which are expected to be continued beyond the present order and which the patient should be assumed to be taking unless explicitly stopped.

# concept[].definition
**Definition:**A list of medications which the patient is intended to be administered only once.

# concept[].definition
**Definition:**A list of medications which the patient will consume intermittently based on the behavior of the condition for which the medication is indicated.

# concept[].definition
A monitoring program that focuses on narcotics and/or commonly abused substances that are subject to legal restriction.

# concept[].definition
**Definition:**A monitoring program that focuses on a drug which is under investigation and has not received regulatory approval for the condition being investigated

# concept[].definition
**Description:**A drug that can be prescribed (and reimbursed) only if it meets certain criteria.

# concept[].definition
Medicines designated in this way may be supplied for patient use without a prescription. The exact form of categorisation will vary in different realms.

# concept[].definition
Some form of prescription is required before the related medicine can be supplied for a patient. The exact form of regulation will vary in different realms.

# concept[].definition
**Definition:**A drug that requires prior approval (to be reimbursed) before being dispensed

# concept[].definition
**Description:**A drug that requires special access permission to be prescribed and dispensed.

# concept[].definition
**Description:**Contrast agent required for imaging study.

# concept[].definition
**Description:**Provision of prescription or direction to consume a product for purposes of bowel clearance in preparation for a colonoscopy.

# concept[].definition
**Description:**Provision of medication as a preventative measure during a treatment or other period of increased risk.

# concept[].definition
**Description:**Provision of medication during pre-operative phase; e.g., antibiotics before dental surgery or bowel prep before colon surgery.

# concept[].definition
**Description:**Provision of medication for pregnancy --e.g., vitamins, antibiotic treatments for vaginal tract colonization, etc.

# concept[].definition
List of acts representing a care plan. The acts can be in a varierty of moods including event (EVN) to record acts that have been carried out as part of the care plan.

# concept[].definition
**Definition:**Indicates that the paper version of the record has, should be or is being verified against the electronic version.

# concept[].definition
**Definition:**Indicates that the paper version of the record has, should be or is being verified against the electronic version.

# concept[].definition
**Description:**A note that is specific to a patient's diagnostic images, either historical, current or planned.

# concept[].definition
**Description:**A general or uncategorized note.

# concept[].definition
A note that is specific to a patient's immunizations, either historical, current or planned.

# concept[].definition
**Description:**A note that is specific to a patient's laboratory results, either historical, current or planned.

# concept[].definition
**Description:**A note that is specific to a patient's medications, either historical, current or planned.

# concept[].definition
A written order to a bank to pay the amount specified from funds on deposit.

# concept[].definition
Electronic Funds Transfer (EFT) deposit into the payee's bank account

# concept[].definition
A fill providing sufficient supply for one day

# concept[].definition
A supply action where there is no 'valid' order for the supplied medication. E.g. Emergency vacation supply, weekend supply (when prescriber is unavailable to provide a renewal prescription)

# concept[].definition
The initial fill against an order. (This includes initial fills against refill orders.)

# concept[].definition
A supply action to restock a smaller more local dispensary.

# concept[].definition
A fill against an order that has already been filled (or partially filled) at least once.

# concept[].definition
A supply action that provides sufficient material for a single dose.

# concept[].definition
A supply action that provides sufficient material for a single dose via multiple products. E.g. 2 50mg tablets for a 100mg unit dose.

# concept[].definition
Specifies the type or actual definition of a contractually binding agreement or a non-binding representation of that agreement between a grantor and a grantee as to the exchange of the grantee's considerations in return for the grantor's control of certain assets. The type of assets exchanged include rights, license, terms of service, valued items, information and real property assets and control over such assets such as physical and locatable property; intellectual property; biospecimen; genomic and genetic information related to an individual including that disclosed by genetically related individuals with or without the individual's consent; personal identifiable, pseudonymized, anonymized, de-identified per some rubric, and relinkable variants.

*Usage Note:* Types or actual definitions of a contractually binding agreement or a non-binding representation of that agreement include:

 *  \_ActDecision (formally ActConsentDirective), which specifies the type of decision made by the grantor. The decision types are mapped to ISO/TS 17975 Health informatics - Principles and data requirements for consent in the Collection, Use or Disclosure of personal health information;
 *  \_ActPrivacyConsentDirective, which is the parent of types of registry participation consent directives, and of realm specific privacy consent directive policies such as \_USPrivacyConsentDirective and \_GDPRPrivacyConsentDirective.

# concept[].definition
The type of action permitted on information by jurisdictional, organizational, or personal policy.

# concept[].definition
Information management directives related to privacy, security, integrity, and control concerns, which may be governed by specific laws; based on private sector self-governance; adopted "best practices" recognized by a community of interest; or terms of license, participation, or service as implemented in jurisdictional, organizational, or personal policies.

# concept[].definition
A policy deeming certain information to be private to an individual or organization.

*Definition:* A mandate, obligation, requirement, rule, or expectation relating to privacy.

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

*Usage Note:* Statutory title may be named in the ActClassPolicy Act Act.title to specify which privacy policy is being referenced.

# concept[].definition
A mandate, obligation, requirement, rule, or expectation conveyed as security metadata between senders and receivers required to establish the reliability, authenticity, and trustworthiness of their transactions.

Trust security metadata are observation made about aspects of trust applicable to an IT resource (data, information object, service, or system capability).

Trust applicable to IT resources is established and maintained in and among security domains, and may be comprised of observations about the domain's trust authority, trust framework, trust policy, trust interaction rules, means for assessing and monitoring adherence to trust policies, mechanisms that enforce trust, and quality and reliability measures of assurance in those mechanisms. \[Based on ISO IEC 10181-1 and NIST SP 800-63-2\]

For example, identity proofing , level of assurance, and Trust Framework.

# concept[].definition
**Description:**A mandate, obligation, requirement, rule, or expectation unilaterally imposed on benefit coverage under a policy or program by a sponsor, underwriter or payor on:

 *  The activity of another party
 *  The behavior of another party
 *  The manner in which an act is executed

**Examples:**A clinical protocol imposed by a payer to which a provider must adhere in order to be paid for providing the service. A formulary from which a provider must select prescribed drugs in order for the patient to incur a lower copay.

# concept[].definition
Types of security policies that further specify the ActClassPolicy value set.

**Examples:**

 *  obligation to encrypt
 *  refrain from redisclosure without consent

# concept[].definition
European Union General Data Protection Regulation (GDPR) consent directives.

# concept[].definition
Specifies types of consent directives authorizing a registry or repository to collect and, under certain terms, manage the access, use, and disclosure of personal information, including de-identified information, and personal effects, such as biometrics, biospecimen or genetic material, which may be used to identify an individual.

Registries governed by registry consent directives are data management systems, which use metadata to support the collection, access, use, and disclosure of personal information or effects as well as observational or analytic information generated about personal information or effects stored in federated repositories. Such registries are used for a variety of purposes by federated health information exchanges, health information systems, personal record systems, and research organizations to locate and retrieve personal information or effects as well as observational or analytic information generated about personal information stored externally to their systems.

Repositories governed by registry consent directives are data stores used to collect, access, use, and disclose personal information or effects as well as observational or analytic information generated about personal information or effects and metadata used to manage the repository contents. Such repositories are used for a variety of purposes by centralized health information exchanges, health information systems used by providers and payers, personal record systems, and research organizations. A repository typically includes a registry component that provides the data store with content management capabilities for internal purposes. A repository may also interface with one or more external registries, which provide federated content management.

# concept[].definition
Specific US privacy consent directives in accordance with US federal, state, regional, organizational, or personal privacy policies.

# concept[].definition
GDPR is a regulation on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (Data Protection Directive). Promulgated by the European Parliament and Council of the European Union. Regulation available at L119, 4 May 2016, p. 1-88.

GDPR privacy policies specifying types of lawful personal data processing based on a controller meeting one or more processing condition such as specified by law, compliance with data controller legal obligations, protection of data subject's vital interests, perform tasks in the public interest, related to legal claims, research and statistics, management of health or social care systems, legitimate interests of controller or third party. Processing sensitive personal data, including genetic, biometric and health data, as well as personal data from which racial and ethnic origin, political opinions, religious or ideological convictions or membership in a union can be attributed to a person, requires meeting at least one sensitive personal processing condition.

GDPR 'processing' means any operation or set of operations which is performed on personal data or on sets of personal data, whether or not by automated means, such as collection, recording, organisation, structuring, storage, adaptation or alteration, retrieval, consultation, use, disclosure by transmission, dissemination or otherwise making available, alignment or combination, restriction, erasure or destruction. Article 4 https://gdpr-info.eu/art-4-gdpr/

*Usage Note:* 

 *  Confidentiality: e.g., U (unrestricted) for anonymized personal information; L (low) for pseudonymized U (unrestricted) for anonymized personal information; M (moderate) for indirectly identifiable information such as test scores and work times; N (normal) for personal information; and R (restricted) for sensitive personal information
 *  DPR sensitivity \[personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation, some of which are defined at Article 4 https://gdpr-info.eu/art-4-gdpr/
 *  GDPR processing policies and GDPR ConsentDirectiveTypes, such as data subject consent and research consent.
 *  Other security category codes, such as compartment codes for legitimate relationship,
 *  Handling instructions including
 *  Purpose of use stipulated in a GDPR consent or contract restricting processing or related to the scope of the processing policy such as public health, research, and legal obligations
 *  Obligation policies such as GDPR Information Obligations https://gdpr-info.eu/issues/information-obligations, data minimization and deleting when processing is complete
 *  Refrain policies such as no relinking

See Intersoft GDPR at https://gdpr-info.eu/issues/personal-data/ Art. 4 GDPR Definitions https://gdpr-info.eu/art-4-gdpr/ Art. 9 GDPR Processing of special categories of personal data https://gdpr-info.eu/art-9-gdpr/ Relevant Recitals (26) Not applicable to anonymous data (30) Online identifiers for profiling and identification (34) Genetic data (35) Health data (51) Protecting sensitive personal data at Intersoft GDPR briefing papers and navigating tool https://gdpr-info.eu/

Authorities

 *  European Data Protection Supervisor - Security Measures for Personal Data Processing (Link)
 *  Data Protection Authority Isle of Man - Know your data - Mapping the 5 W's (Link)
 *  Data Protection Authority UK - Key definitions (Link)
 *  European Commission - What is personal data? (Link)
 *  European Commission - What personal data is considered sensitive? (Link)
 *  EU publications - Handbook on European data protection law - Personal data, page 83 (Link)

Expert contribution A&L Goodbody - The GDPR: A Guide for Businesses - Definition of Personal & Sensitive Data, Page 8 (Link) Bird & Bird - Sensitive data and lawful processing (Link) https://ec.europa.eu/commission/priorities/justice-and-fundamental-rights/data-protection/2018-reform-eu-data-protection-rules\_en General Data Protection Regulation https://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1528874672298&uri=CELEX%3A32016R0679 Communication on data protection - guidance on direct application of the GDPR http://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1517578296944&uri=CELEX%3A52018DC0043 Intersoft GDPR briefing papers and navigating tool https://gdpr-info.eu/

# concept[].definition
*Definition:* A jurisdictional mandate in the U.S. relating to privacy.

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

# concept[].definition
Specifies the type of agreement between one or more grantor and grantee in which rights and obligations related to one or more shared items of interest are allocated.

*Usage Note:* Such agreements may be considered "consent directives" or "contracts" depending on the context, and are considered closely related or synonymous from a legal perspective.

**Examples:** 

 *  Healthcare Privacy Consent Directive permitting or restricting in whole or part the collection, access, use, and disclosure of health information, and any associated handling caveats.
 *  Healthcare Medical Consent Directive to receive medical procedures after being informed of risks and benefits, thereby reducing the grantee's liability.
 *  Research Informed Consent for participation in clinical trials and disclosure of health information after being informed of risks and benefits, thereby reducing the grantee's liability.
 *  Substitute decision maker delegation in which the grantee assumes responsibility to act on behalf of the grantor.
 *  Contracts in which the agreement requires assent/dissent by the grantor of terms offered by a grantee, a consumer opts out of an "award" system for use of a retailer's marketing or credit card vendor's point collection cards in exchange for allowing purchase tracking and profiling.
 *  A mobile device or App privacy policy and terms of service to which a user must agree in whole or in part in order to utilize the service.
 *  Agreements between a client and an authorization server or between an authorization server and a resource operator and/or resource owner permitting or restricting e.g., collection, access, use, and disclosure of information, and any associated handling caveats.

# concept[].definition
A jurisdictional mandate, regulation, obligation, requirement, rule, or expectation deeming certain information to be private to an individual or organization, which is imposed on:

 *  The activity of a governed party
 *  The behavior of a governed party
 *  The manner in which an act is executed by a governed party

# concept[].definition
A mandate, obligation, requirement, rule, or expectation characterizing the value or importance of a resource and may include its vulnerability. (Based on ISO7498-2:1989. Note: The vulnerability of personally identifiable sensitive information may be based on concerns that the unauthorized disclosure may result in social stigmatization or discrimination.) Description: Types of Sensitivity policy that apply to Acts or Roles. A sensitivity policy is adopted by an enterprise or group of enterprises (a 'policy domain') through a formal data use agreement that stipulates the value, importance, and vulnerability of information. A sensitivity code representing a sensitivity policy may be associated with criteria such as categories of information or sets of information identifiers (e.g., a value set of clinical codes or branch in a code system hierarchy). These criteria may in turn be used for the Policy Decision Point in a Security Engine. A sensitivity code may be used to set the confidentiality code used on information about Acts and Roles to trigger the security mechanisms required to control how security principals (i.e., a person, a machine, a software application) may act on the information (e.g., collection, access, use, or disclosure). Sensitivity codes are never assigned to the transport or business envelope containing patient specific information being exchanged outside of a policy domain as this would disclose the information intended to be protected by the policy. When sensitive information is exchanged with others outside of a policy domain, the confidentiality code on the transport or business envelope conveys the receiver's responsibilities and indicates the how the information is to be safeguarded without unauthorized disclosure of the sensitive information. This ensures that sensitive information is treated by receivers as the sender intends, accomplishing interoperability without point to point negotiations.

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

# concept[].definition
This is the healthcare analog to the US Intelligence Community's concept of a Special Access Program. Compartment codes may be used in as a field value in an initiator's clearance to indicate permission to access and use an IT Resource with a security label having the same compartment value in security category label field.

Map: Aligns with ISO 2382-8 definition of Compartment - "A division of data into isolated blocks with separate security controls for the purpose of reducing risk."

# concept[].definition
**Definition:** An identifying code for billable services, as opposed to codes for similar services used to identify them for functional purposes.

# concept[].definition
Temporary supply of a product without transfer of ownership for the product.

# concept[].definition
**Definition:** A program that covers the cost of services provided directly to a beneficiary who typically has no other source of coverage without charge.

# concept[].definition
**Definition:** A program that covers the cost of services provided to crime victims for injuries or losses related to the occurrence of a crime.

# concept[].definition
**Definition:** An employee assistance program is run by an employer or employee organization for the purpose of providing benefits and covering all or part of the cost for employees to receive counseling, referrals, and advice in dealing with stressful issues in their lives. These may include substance abuse, bereavement, marital problems, weight issues, or general wellness issues. The services are usually provided by a third-party, rather than the company itself, and the company receives only summary statistical data from the service provider. Employee's names and services received are kept confidential.

# concept[].definition
**Definition:** A set of codes used to indicate a government program that is an organized structure for administering and funding coverage of a benefit package for covered parties meeting eligibility criteria, typically related to employment, health and financial status. Government programs are established or permitted by legislation with provisions for ongoing government oversight. Regulation mandates the structure of the program, the manner in which it is funded and administered, covered benefits, provider types, eligibility criteria and financial participation. A government agency is charged with implementing the program in accordance to the regulation

**Example:** Federal employee health benefit program in the U.S.

# concept[].definition
**Definition:** A government program that provides health coverage to individuals who are considered medically uninsurable or high risk, and who have been denied health insurance due to a serious health condition. In certain cases, it also applies to those who have been quoted very high premiums a" again, due to a serious health condition. The pool charges premiums for coverage. Because the pool covers high-risk people, it incurs a higher level of claims than premiums can cover. The insurance industry pays into the pool to make up the difference and help it remain viable.

# concept[].definition
**Definition:** Services provided directly and through contracted and operated indigenous peoples health programs.

**Example:** Indian Health Service in the U.S.

# concept[].definition
**Definition:** A government program that provides coverage for health services to military personnel, retirees, and dependents. A covered party who is a subscriber can choose from among Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Plans offering a Point of Service (POS) Product, or Health Maintenance Organizations.

**Example:** In the U.S., TRICARE, CHAMPUS.

# concept[].definition
**Definition:** A government mandated program with specific eligibility requirements based on premium contributions made during employment, length of employment, age, and employment status, e.g., being retired, disabled, or a dependent of a covered party under this program. Benefits typically include ambulatory, inpatient, and long-term care, such as hospice care, home health care and respite care.

# concept[].definition
**Definition:** A social service program funded by a public or governmental entity.

**Example:** Programs providing habilitation, food, lodging, medicine, transportation, equipment, devices, products, education, training, counseling, alteration of living or work space, and other resources to persons meeting eligibility criteria.

# concept[].definition
**Definition:** Services provided directly and through contracted and operated veteran health programs.

# concept[].definition
**Description:**Specimen has been placed into storage at a participating location.

# concept[].definition
**Description:**Specimen has been put in transit to a participating receiver.

# concept[].definition
The lowering of specimen pH through the addition of an acid

# concept[].definition
The act rendering alkaline by impregnating with an alkali; a conferring of alkaline qualities.

# concept[].definition
The removal of fibrin from whole blood or plasma through physical or chemical means

# concept[].definition
The passage of a liquid through a filter, accomplished by gravity, pressure or vacuum (suction).

# concept[].definition
The act or process by which an acid and a base are combined in such proportions that the resulting compound is neutral.

# concept[].definition
The addition of calcium back to a specimen after it was removed by chelating agents

# concept[].definition
The filtration of a colloidal substance through a semipermeable medium that allows only the passage of small molecules.

# concept[].definition
Describes the artificial blood identifier that is associated with the specimen.

# concept[].definition
An observation that reports the dilution of a sample.

# concept[].definition
Domain provides codes that qualify the ActLabObsEnvfctsCode domain. (Environmental Factors)

# concept[].definition
An observation that relates to factors that may potentially cause interference with the observation

# concept[].definition
An observation that reports the volume of a sample.

# concept[].definition
The introduction of a drug into a subject with the intention of altering its biologic state with the intent of improving its health status.

# concept[].definition
**Description:** The introduction of material into a subject with the intent of providing nutrition or other dietary supplements (e.g. minerals or vitamins).

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

# concept[].definition
Administration of the proposed therapy may be inappropriate or contraindicated as proposed

# concept[].definition
Supplying the product at this time may be inappropriate or indicate compliance issues with the associated therapy

# concept[].definition
**Description:** While the record was accepted in the repository, there is a more recent version of a record of this type.

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

# concept[].definition
A clinician creates a request for a service to be performed for a given patient.

# concept[].definition
A person enters documentation about a given patient.

# concept[].definition
A person (e.g., clinician, the patient herself) reviews patient information in the electronic medical record.

# concept[].display
act medication therapy duration working list

# concept[].definition
**Definition:**A collection of concepts that identifies different types of 'duration-based' mediation working lists.

**Examples:**"Continuous/Chronic" "Short-Term" and "As Needed"

# concept[].definition
Definition: Characterizes how a patient was or will be transported to the site of a patient encounter.

*Examples:* Via ambulance, via public transit, on foot.

# concept[].definition
A code representing an individual's privacy consent directive that complies with 42 CFR Part 2.31 Consent requirements https://www.gpo.gov/fdsys/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-31.pdf, which is a US Federal law stipulating the policy elements of a written consent to a disclosure under the regulations in Part 2.

(1) The name of the patient. (2) The specific name(s) or general designation(s) of the part 2 program(s), entity(ies), or individual(s) permitted to make the disclosure. (3) How much and what kind of information is to be disclosed, including an explicit description of the substance use disorder information that may be disclosed. (4) (i) The name(s) of the individual(s) to whom a disclosure is to be made; or (ii)Entities with a treating provider relationship with the patient. If the recipient entity has a treating provider relationship with the patient whose information is being disclosed, such as a hospital, a health care clinic, or a private practice, the name of that entity; or (iii)Entities without a treating provider relationship with the patient. (A) If the recipient entity does not have a treating provider relationship with the patient whose information is being disclosed and is a third-party payer, the name of the entity; or (B) If the recipient entity does not have a treating provider relationship with the patient whose information is being disclosed and is not covered by paragraph (a)(4)(iii)(A) of this section, such as an entity that facilitates the exchange of health information or a research institution, the name(s) of the entity(-ies); and (1) The name(s) of an individual participant(s); or (2) The name(s) of an entity participant(s) that has a treating provider relationship with the patient whose information is being disclosed; or (3) A general designation of an individual or entity participant(s) or class of participants that must be limited to a participant(s) who has a treating provider relationship with the patient whose information is being disclosed. (i) When using a general designation, a statement must be included on the consent form that the patient (or other individual authorized to sign in lieu of the patient), confirms their understanding that, upon their request and consistent with this part, they must be provided a list of entities to which their information has been disclosed pursuant to the general designation (see Section 2.13(d)). (ii) \[Reserved\] (5) The purpose of the disclosure. In accordance with Section 2.13(a), the disclosure must be limited to that information which is necessary to carry out the stated purpose. (6) A statement that the consent is subject to revocation at any time except to the extent that the part 2 program or other lawful holder of patient identifying information that is permitted to make the disclosure has already acted in reliance on it. Acting in reliance includes the provision of treatment services in reliance on a valid consent to disclose information to a third-party payer (7) The date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must ensure that the consent will last no longer than reasonably necessary to serve the purpose for which it is provided. (8) The signature of the patient and, when required for a patient who is a minor, the signature of an individual authorized to give consent under Section 2.14; or, when required for a patient who is incompetent or deceased, the signature of an individual authorized to sign under Section 2.15. Electronic signatures are permitted to the extent that they are not prohibited by any applicable law. (9) The date on which the consent is signed.

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's 42 CFR Part 2.31 consent directive, "42CFRPart2CD" as the security label policy code.

Since information governed by an individual's 42 CFR Part 2.31 consent directive has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Â§ 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

# concept[].display
Compound HIPAA Research Authorization and Informed Consent for Research

# concept[].definition
A code representing an individual's consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section specific to disclosures for purposes of research when combined with a Common Rule or Federal Drug Administration consent to participate in research also known as a compound authorization.

*Usage Note:* The Agency for Healthcare Research and Quality (AHRQ) has developed the Informed Consent and Authorization Toolkit for Minimal Risk Research to facilitate the process of obtaining informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization from potential research subjects. This toolkit contains information for people responsible for ensuring that potential research subjects are informed in a manner that is consistent with medical ethics and regulatory guidelines. From https://www.ahrq.gov/sites/default/files/publications/files/ictoolkit.pdf.

Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's right of access directive under 45 CFR Section 164.508 use "CompoundResearchCD" as the security label policy code.

Information or biospecimen disclosed under the Common Rule are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code "M" (moderate).

See ActCode.\_ActPolicyType.\_ActPrivacyPolicy.\_ActPrivacyLaw.\_ActUSPrivacyLaw.HIPAAAuth (HIPAA Authorization for Disclosure). See: HIPAAAuth and NIH Sample Authorization Language for Research Uses and Disclosures of Individually Identifiable Health Information by a Covered Health Care Provider https://privacyruleandresearch.nih.gov/authorization.asp

# concept[].definition
A code representing an individual's consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section.

An "authorization" is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. Where the Privacy Rule requires patient authorization, voluntary consent is not sufficient to permit a use or disclosure of protected health information unless it also satisfies the requirements of a valid authorization. An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization. https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html

A HIPAA Authorization must comply with 45 CFR Section164.508(c) Implementation specifications: Core elements and requirements - (1) Core elements. A valid authorization under this Section must contain at least the following elements: (i) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion. (ii) The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure. (iii) The name or other specific identification of the person(s), or class of persons, to whom the covered entity may make the requested use or disclosure. (iv) A description of each purpose of the requested use or disclosure. The statement "at the request of the individual" is a sufficient description of the purpose when an individual initiates the authorization and does not, or elects not to, provide a statement of the purpose. (v) An expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure. The statement "end of the research study," "none," or similar language is sufficient if the authorization is for a use or disclosure of protected health information for research, including for the creation and maintenance of a research database or research repository. (vi) Signature of the individual and date. If the authorization is signed by a personal representative of the individual, a description of such representative's authority to act for the individual must also be provided. (2)Required statements. In addition to the core elements, the authorization must contain statements adequate to place the individual on notice of all of the following: (i) The individual's right to revoke the authorization in writing, and either: (A) The exceptions to the right to revoke and a description of how the individual may revoke the authorization; or (B) To the extent that the information in paragraph (c)(2)(i)(A) of this section is included in the notice required by Section 164.520, a reference to the covered entity's notice. https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf

*Usage Note:* Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by a an individual's HIPAA Authorization for Disclosure, use "HIPAAAuthCD" as the security label policy code.

Information governed under a HIPAA Authorization for Disclosure has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, which is considered the "norm", assign the HL7 Confidentiality code "N" (normal).

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule 45 CFR Section 164.522 Rights to request privacy protection for protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf, which stipulates the process by which a covered entity seeks agreement from an individual regarding how it will use and disclose the individual's protected health information for treatment, payment, and health care operations is termed a "consent."

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's consent directive under 45 CFR Section 164.522 use "HIPAAConsentCD" as the security label policy code.

Since information governed by a 45 CFR Section 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

# concept[].display
HIPAA Authorization for Disclosure for Research Consent Directive

# concept[].definition
A code representing an individual's consent directive that complies with HIPAA Privacy rule 45 CFR Section 164.508 Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is a US Federal law stipulating the policy elements of a valid authorization under this Section specific to disclosures for purposes of research.

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's HIPAA Authorization for Disclosure for Research under 45 CFR Section 164.508 use "HIPAAResearchAuthCD" as the security label policy code.

Information disclosed under an individual's HIPAA Authorization for Disclosure for Research are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code "M" (moderate).

See ActCode.\_ActPolicyType.\_ActPrivacyPolicy.\_ActPrivacyLaw.\_ActUSPrivacyLaw.HIPAAAuth (HIPAA Authorization for Disclosure). See: HIPAAAuth and NIH Sample Authorization Language for Research Uses and Disclosures of Individually Identifiable Health Information by a Covered Health Care Provider https://privacyruleandresearch.nih.gov/authorization.asp

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule 45 CFR Section 164.524 Access of individuals to protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-524.pdf, stipulating the policy elements of an individual's written and signed right of access directive requesting that a covered entity send the individual's protected health information (PHI) to a third party.

See 45 CFR 164.524(c)(3)(ii) If an individual's request for access directs the covered entity to transmit the copy of protected health information directly to another person designated by the individual, the covered entity must provide the copy to the person designated by the individual. The individual's request must be in writing, signed by the individual, and clearly identify the designated person and where to send the copy of protected health information. https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-524.pdf

This right applies to PHI in a designated record set, which is defined as "Designated record set means: (1) A group of records maintained by or for a covered entity that is: (i) The medical records and billing records about individuals maintained by or for a covered health care provider; (ii) The enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (iii) Used, in whole or in part, by or for the covered entity to make decisions about individuals. \[https://www.law.cornell.edu/cfr/text/45/164.501\]. Also see HHS Individuals' Right under HIPAA to Access their Health Information 45 CFR Section 164.524 \[https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html\#maximumflatfee\].

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by an individual's right of access directive under 45 CFR Section 164.524 use "HIPAAROAD" as the security label policy code.

Information disclosed under a HIPAA 42 CFR Section 164.524 no longer has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is considered the "norm", assign the HL7 Confidentiality code "M" (moderate), which may be protected under other laws such as the Federal Trade Commission privacy and security regulations.

# concept[].display
Michigan Consent to Share Behavioral Health Information for Care Coordination Purposes

# concept[].definition
The State of Michigan standard privacy consent form for sharing of health information specific to behavioral health and substance use treatment in accordance with Public Act 129 of 2014. In Michigan, while providers are not required to use this new standard form (MDHHS-5515), they are required to accept it.

*Usage Note:* For legislative background, current MDHHS-5515 consent directive form, and provider and patient FAQs see http://www.michigan.gov/mdhhs/0,5885,7-339-71550\_2941\_58005-343686--,00.html

# concept[].definition
A code representing 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records. 42 CFR Part 2 stipulates the privacy rights of an individual who has applied for or been given diagnosis or treatment for alcohol or drug abuse at a federally assisted program, which includes non-disclosure of health information relating to health care paid for by a federally assisted substance use disorder program without patient consent. https://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-part2.pdf

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, the collection, access, use, and disclosure of healthcare information is governed by 42 CFR Part 2 Confidentiality of Substance Use Disorder Patient Records https://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol1/pdf/CFR-2010-title42-vol1-part2.pdf use "42CFRPart2" as the security label policy code.

Since information governed by a 42 CFR Part 2 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf assign the HL7 Confidentiality code "R" (restricted).

# concept[].definition
A code representing U.S. Federal laws governing research-related privacy policies known as the "Common Rule". The Common Rule is the U.S. Federal regulations governing the protection of human subjects in research (codified at Subpart A of 45 CFR part 46), which 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.

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information or biospecimen is governed by the Common Rule use "COMMONRULE" as the security label policy code. Information or biospecimen disclosed under the Common Rule are not protected by the HIPAA Privacy Rule. If protected under other laws such as confidentiality provisions under the Common Rule, assign the HL7 Confidentiality code "M" (moderate).

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.508) Uses and disclosures for which an authorization is required https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which stipulates the process by which a covered entity seeks agreement from an individual to use or disclose protected health information for other purposes, or to authorize another covered entity to disclose protected health information to the requesting covered entity, are termed "authorizations".

An "authorization" is required by the Privacy Rule for uses and disclosures of protected health information not otherwise allowed by the Rule. Where the Privacy Rule requires patient authorization, voluntary consent is not sufficient to permit a use or disclosure of protected health information unless it also satisfies the requirements of a valid authorization. An authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, which are generally other than treatment, payment, or health care operations, or to disclose protected health information to a third party specified by the individual.

An authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization. https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html

*Usage Note:* Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, where use or disclosure of healthcare information is governed by a covered entity's HIPAA Authorization for Disclosure, use "HIPAAAuth" as the security label policy code.

Information disclosed under a HIPAA Authorization for Disclosure no longer has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is considered the "norm", assign the HL7 Confidentiality code "M" (moderate), which may be protected under other laws such as the Federal Trade Commission privacy and security regulations.

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.522), which stipulates the process by which a covered entity seeks agreement from an individual regarding how it will use and disclose the individual's protected health information for treatment, payment, and health care operations is termed a "consent".

The Privacy Rule permits, but does not require, a covered entity to voluntarily obtain patient consent for uses and disclosures of protected health information for treatment, payment, and health care operations. Covered entities that do so have complete discretion to design a process that best suits their needs. From https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html. The provisions relating to consent are largely contained in Section 164.522 Rights to request privacy protection for protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf.

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by 45 CFR Section 164.522 use 'HIPAAConsent' as the security label policy code.

Since information governed by a 45 CFR Section 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code 'R' (restricted).

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.520), which stipulates an individual's right to adequate notice of the uses and disclosures of protected health information that may be made by the covered entity, and of the individual's rights and the covered entity's legal duties with respect to protected health information. Relevant HIPAA Privacy Rule provisions are at Section 164.520 (a) Standard: Notice of privacy practices. https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-520.pdf

*Usage Note:* Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, if collection, access, use, or disclosure of healthcare information is governed by a covered entity's HIPAA Notice of Privacy Practices, use "HIPAANOPP" as the security label policy code.

Information governed under a HIPAA Notice of Privacy Practices has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf , which is considered the "norm", assign the HL7 Confidentiality code "N" (normal).

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.508), which stipulates the privacy rights of an individual who is the subject of psychotherapy notes, and requires authorization for certain uses and disclosure of that information.

Definition of Psychotherapy notes 45 CFR Section 164.501 https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-501.pdf: Psychotherapy notes means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

See Section 164.508 Uses and disclosures for which an authorization is required. (2)Authorization required: Psychotherapy notes https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf: Notwithstanding any provision of this subpart, other than the transition provisions in Section 164.532, a covered entity must obtain an authorization for any use or disclosure of psychotherapy notes, except: (i) To carry out the following treatment, payment, or health care operations: (A) Use by the originator of the psychotherapy notes for treatment; (B) Use or disclosure by the covered entity for its own training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family, or individual counseling; or (C) Use or disclosure by the covered entity to defend itself in a legal action or other proceeding brought by the individual; and (ii) A use or disclosure that is required by Section 164.502(a)(2)(ii) or permitted by Section 164.512(a); Section 164.512(d) with respect to the oversight of the originator of the psychotherapy notes; Section 164.512(g)(1); Section 164.512(j)(1)(i).

*Usage Note:* Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, the collection, access, use, or disclosure of healthcare information is governed by HIPAA 45 CFR 164.508 (2) Authorization required: Psychotherapy notes https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf , use "HIPAAPsyNotes" as the security label policy code.

Since information governed by a HIPAA 45 CFR 164.508 (2) has a level of confidentiality protection that is more stringent than the normal level of protection under 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

# concept[].definition
A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule 45 CFR Section 164.524 Access of individuals to protected health information https://www.govinfo.gov/app/details/CFR-2017-title45-vol1/CFR-2017-title45-vol1-sec164-524, which stipulates that an individual has a right of access to inspect and obtain a copy of protected health information about the individual in a designated record set, for as long as the protected health information is maintained in the designated record set with exceptions stipulated in HIPAA Privacy Rule Section 164.524. Exceptions include psychotherapy notes and information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.

If an individual's request for access directs the covered entity to transmit the copy of protected health information directly to another person designated by the individual, the covered entity must provide the copy to the person designated by the individual. The individual's request must be in writing, signed by the individual, and clearly identify the designated person and where to send the copy of protected health information.

For discussion on extent of right, grounds for denial, and documentation requirements see: HHS Individuals' Right under HIPAA to Access their Health Information 45 CFR Section 164.524 https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html and HHS FAQ on Right of Access vs. HIPAA Authorization https://www.hhs.gov/hipaa/for-professionals/faq/2041/why-depend-on-the-individuals-right/index.html

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed under 45 CFR Section 164.5224 use "HIPAAROA" as the security label policy code.

Information disclosed under a HIPAA 42 CFR Section 164.524 no longer has the level of confidentiality protection afforded under the 45 CFR Section 164.506 - Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-508.pdf, which is considered the "norm", assign the HL7 Confidentiality code "M" (moderate), which may be protected under other laws such as the Federal Trade Commission privacy and security regulations.

# concept[].definition
A code representing 45 CFR 164.522 Rights to request privacy protection for protected health information, which is a US Federal law stipulating the privacy rights of an individual to restrict disclosure of information related to health care items or services for which the individual pays out of pocket in full to a health plan or payer.

See 45 CFR 164.522 https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf. (vi) A covered entity must agree to the request of an individual to restrict disclosure of protected health information about the individual to a health plan if: (A) The disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (B) The protected health information pertains solely to a health care item or service for which the individual, or person other than the health plan on behalf of the individual, has paid the covered entity in full.

*Usage Note:* Used to indicate the legal authority for assigning security labels to HIPAA governed information. In this case, the collection, access, use, or disclosure of healthcare information is governed by HIPAA 45 CFR 164.522 https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf use "HIPAASelfPay" as the security label policy code.

Since information governed by a HIPAA 45 CFR 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

# concept[].definition
A code representing Title 38 Section 7332, which is a US Federal law stipulating the privacy rights of veterans diagnosed and treated for substance use disorders, infection with the human immunodeficiency virus, or sickle cell anemia.

https://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html . (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). (2) Paragraph (1) prohibits the disclosure to any person or entity other than the patient or subject concerned of the fact that a special written consent is required in order for such records to be disclosed. (b) (1) The content of any record referred to in subsection (a) may be disclosed by the Secretary in accordance with the prior written consent of the patient or subject with respect to whom such record is maintained, but only to such extent, under such circumstances, and for such purposes as may be allowed in regulations prescribed by the Secretary. (2) Whether or not any patient or subject, with respect to whom any given record referred to in subsection (a) is maintained, gives written consent, the content of such record may be disclosed by the Secretary as follows: (A) To medical personnel to the extent necessary to meet a bona fide medical emergency. (B) To qualified personnel for the purpose of conducting scientific research, management audits, financial audits, or program evaluation, but such personnel may not identify, directly or indirectly, any individual patient or subject in any report of such research, audit, or evaluation, or otherwise disclose patient or subject identities in any manner. (C) (i) In the case of any record which is maintained in connection with the performance of any program or activity relating to infection with the human immunodeficiency virus, to a Federal, State, or local public-health authority charged under Federal or State law with the protection of the public health, and to which Federal or State law requires disclosure of such record, if a qualified representative of such authority has made a written request that such record be provided as required pursuant to such law for a purpose authorized by such law. (ii) A person to whom a record is disclosed under this paragraph may not redisclose or use such record for a purpose other than that for which the disclosure was made. (D) If authorized by an appropriate order of a court of competent jurisdiction granted after application showing good cause therefor. In assessing good cause the court shall weigh the public interest and the need for disclosure against the injury to the patient or subject, to the physician-patient relationship, and to the treatment services. Upon the granting of such order, the court, in determining the extent to which any disclosure of all or any part of any record is necessary, shall impose appropriate safeguards against unauthorized disclosure. (E) To an entity described in paragraph (1)(B) of section 5701(k) of this title, but only to the extent authorized by such section. (F) (i) To a representative of a patient who lacks decision-making capacity, when a practitioner deems the content of the given record necessary for that representative to make an informed decision regarding the patient's treatment. (ii) In this subparagraph, the term "representative" means an individual, organization, or other body authorized under section 7331 of this title and its implementing regulations to give informed consent on behalf of a patient who lacks decision-making capacity. (G) To a State controlled substance monitoring program, including a program approved by the Secretary of Health and Human Services under section 399O of the Public Health Service Act (42 U.S.C. 280g-3), to the extent necessary to prevent misuse and diversion of prescription medicines. (H) (i) To a non-Department entity (including private entities and other Federal agencies) for purposes of providing health care, including hospital care, medical services, and extended care services, to Veterans or performing other health care-related activities or functions. (ii) An entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made or as permitted by law. (I) To a third party in order to recover or collect reasonable charges for care furnished to, or paid on behalf of, a Veteran in connection with a non-service connected disability as permitted by section 1729 of this title or for a condition for which recovery is authorized or with respect to which the United States is deemed to be a third party beneficiary under the Act entitled 'An Act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the United States' (Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as the 'Federal Medical Care Recovery Act').

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by 38 U.S. Code Section 7332 - Confidentiality of certain medical records https://www.gpo.gov/fdsys/granule/USCODE-2011-title38/USCODE-2011-title38-partV-chap73-subchapIII-sec7332/content-detail.html use "Title38Section7332" as the security label policy code.

Since information governed by a Title 38 Section 7332 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

# concept[].definition
Code retired in December 2019 and replaced by code HIPAAConsent. Originally entered with copy/paste error in code value.

A code representing U.S. Public Law 104-191 Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (45 CFR Section 164.522), which stipulates the process by which a covered entity seeks agreement from an individual regarding how it will use and disclose the individual's protected health information for treatment, payment, and health care operations is termed a "consent." The Privacy Rule permits, but does not require, a covered entity to voluntarily obtain patient consent for uses and disclosures of protected health information for treatment, payment, and health care operations. Covered entities that do so have complete discretion to design a process that best suits their needs. From https://www.hhs.gov/hipaa/for-professionals/faq/264/what-is-the-difference-between-consent-and-authorization/index.html. The provisions relating to consent are largely contained in Section 164.522 Rights to request privacy protection for protected health information https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-522.pdf.

*Usage Note:* Used to indicate the legal authority for assigning security labels to governed information. In this case, where collection, access, use, or disclosure of healthcare information is governed by 45 CFR Section 164.522 use "HIPAAConsent" as the security label policy code.

Since information governed by a 45 CFR Section 164.522 has a level of confidentiality protection that is more stringent than the normal level of protection under HIPAA 45 CFR Section 164.506 Uses and disclosures to carry out treatment, payment, or health care operations https://www.gpo.gov/fdsys/pkg/CFR-2017-title45-vol1/pdf/CFR-2017-title45-vol1-sec164-506.pdf, assign the HL7 Confidentiality code "R" (restricted).

# concept[].definition
An informed assertion by a minor who is a candidate research subject, of the individual's willingness to participate in research. Assent means a child's affirmative agreement to participate in a clinical investigation. Mere failure to object should not, absent affirmative agreement, be construed as assent. The minor's assent must be accompanied by parental or guardian consent that the minor participate in a specified research. The assent is not legally binding, however, the accompanying consent is legally binding. Background: In the US, informed assent is governed under 21 CFR Part 50, Subpart D - Additional Safeguards for Children in Clinical Investigations. Available at https://www.law.cornell.edu/cfr/text/21/part-50/subpart-D

# concept[].definition
An informed assertion by an adult, or the parent/guardian of a minor who is a candidate research subject, of the individual's willingness to participate in a specified research study. The consent is legally binding. Background: In the US, informed assent is governed under 49 CFR § 11.116 - General Requirements for Informed Consent. Available at https://www.law.cornell.edu/cfr/text/49/11.116

# concept[].definition
An informed assertion by an adult, or the parent/guardian of a minor who is a candidate research subject, of the individual's willingness to participate in unspecified research studies, including storage, maintenance, and secondary research use of identifiable biospecimens and data.  If broad consent is obtained, any subsequent storage, maintenance, and secondary research uses of the individual’s identifiable biospecimens and data consistent with the broad consent would not require additional consent, so long as additional conditions are met, including limited review by an IRB. The consent is legally binding. Background: In the US, informed assent is governed under 49 CFR § 11.116 - General Requirements for Informed Consent. Available at https://www.law.cornell.edu/cfr/text/49/11.116

# concept[].definition
There may be an issue with the patient complying with the intentions of the proposed therapy

# concept[].definition
**Description:**Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy.

# concept[].definition
Proposed dosage instructions for therapy differ from standard practice.

# concept[].definition
The proposed therapy appears to duplicate an existing therapy

# concept[].definition
**Description:**Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

# concept[].definition
Proposed therapy may be contraindicated or ineffective based on an existing or recent drug therapy

# concept[].definition
Proposed therapy may be inappropriate or ineffective based on the proposed start or end time.

# concept[].definition
**Description:**Provides a categorization for annotations recorded directly against the patient .

# concept[].definition
Proposed therapy may be inappropriate or contraindicated due to conditions or characteristics of the patient

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

# concept[].definition
Used to temporarily override normal authorization rules to gain access to data in a case of emergency. Use of this override code will typically be monitored, and a procedure to verify its proper use may be triggered when used.

# concept[].definition
Communication of an agent from a living subject or environmental source to a living subject through indirect contact via oral or nasal inhalation.

# concept[].definition
Communication of an agent from one animal to another proximate animal.

# concept[].definition
Communication of an agent from an animal to a proximate person.

# concept[].definition
Communication of an agent from one living subject to another living subject through direct contact with any body fluid.

# concept[].definition
Communication of an agent to a living subject through direct contact with blood or blood products whether the contact with blood is part of a therapeutic procedure or not.

# concept[].definition
Communication of an agent from a living subject or environmental source to a living subject via agent migration through intact skin.

# concept[].definition
Communication of an agent from an environmental surface or source to a living subject by direct contact.

# concept[].definition
Communication of an agent from a living subject or environmental source to a living subject through oral contact with material contaminated by person or animal fecal material.

# concept[].definition
Communication of an agent from an non-living material to a living subject through direct contact.

# concept[].definition
Communication of an agent from a food source to a living subject via oral consumption.

# concept[].definition
Communication of an agent from a person to a proximate person.

# concept[].definition
Communication of an agent to a living subject via an undetermined route.

# concept[].definition
Communication of an agent from one living subject to another living subject through direct contact with mammalian milk or colostrum.

# concept[].definition
Communication of an agent from any entity to a living subject while the living subject is in the patient role in a healthcare facility.

# concept[].definition
Communication of an agent from a living subject or environmental source to a living subject where the acquisition of the agent is not via the alimentary canal.

# concept[].definition
Communication of an agent from a living subject to the progeny of that living subject via agent migration across the maternal-fetal placental membranes while in utero.

# concept[].definition
Communication of an agent from one living subject to another living subject through direct contact with genital or oral tissues as part of a sexual act.

# concept[].definition
Communication of an agent from one living subject to another living subject through direct contact with blood or blood products where the contact with blood is part of a therapeutic procedure.

# concept[].definition
Communication of an agent from a living subject acting as a required intermediary in the agent transmission process to a recipient living subject via direct contact.

# concept[].definition
Communication of an agent from a contaminated water source to a living subject whether the water is ingested as a food or not. The route of entry of the water may be through any bodily orifice.

# concept[].definition
This Observation Series type contains waveforms of a "representative beat" (a.k.a. "median beat" or "average beat"). The waveform samples are measured in relative time, relative to the beginning of the beat as defined by the Observation Series effective time. The waveforms are not directly acquired from the subject, but rather algorithmically derived from the "rhythm" waveforms.

# concept[].definition
This Observation type contains ECG "rhythm" waveforms. The waveform samples are measured in absolute time (a.k.a. "subject time" or "effective time"). These waveforms are usually "raw" with some minimal amount of noise reduction and baseline filtering applied.

# concept[].definition
Policy for handling all demographic information about an information subject, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to all demographic about an information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*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.

# concept[].definition
Policy for handling information related to an information subject's date of birth, which will be afforded heightened confidentiality.Policies may govern sensitivity of information related to an information subject's date of birth, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*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.

# concept[].display
gender and sexual orientation information sensitivity

# concept[].definition
Policy for handling information related to an information subject's gender and sexual orientation, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's gender and sexual orientation, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*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.

# concept[].definition
Policy for handling information related to an information subject's living arrangement, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's living arrangement, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*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.

# concept[].definition
Policy for handling information related to an information subject's marital status, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's marital status, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*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.

# concept[].definition
Policy for handling information related to an individual's location, which is deemed sensitive when the disclosure could impact the privacy, well-being, or safety of that subject, and requires additional protection.

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

# concept[].definition
Policy for handling information related to an information subject's race, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's race, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*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.

# concept[].definition
Policy for handling information related to an information subject's religious affiliation, which will be afforded heightened confidentiality. Policies may govern sensitivity of information related to an information subject's religion, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*Usage Notes:* 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.

# concept[].property[].valueString
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.

# concept[].definition
**Description:** A DNA segment that contributes to phenotype/function. In the absence of demonstrated function a gene may be characterized by sequence, transcription or homology

# concept[].definition
Accommodations used in the care of diseases that are transmitted through casual contact or respiratory transmission.

# concept[].definition
Accommodations in which there is only 1 bed.

# concept[].definition
Uniquely designed and elegantly decorated accommodations with many amenities available for an additional charge.

# concept[].definition
Accommodations in which there are 2 beds.

# concept[].definition
Accommodations in which there are 3 or more beds.

# concept[].definition
Identifies types of detected issues for Act class "ALRT"

# concept[].definition
The trigger event referenced by the Control Act instance. Values are drawn from the available trigger events used in the release of HL7 identified by the versionCode.

# concept[].definition
The specific chemical or radiological substance administered or to be administered into the body for therapeutic effect.

# concept[].definition
**Description:** Indicates the valid antigen count.

# concept[].definition
**Description:** Indicates whether an antigen is valid or invalid.

# concept[].definition
Indicates that the ICSR is describing problems that a patient experienced after receiving a vaccine product.

# concept[].definition
Indicates that the ICSR is describing a problem with the actual vaccine product such as physical defects (cloudy, particulate matter) or inability to confer immunity.

# concept[].definition
Types of sensitivity policies that apply to Acts. Act.confidentialityCode is defined in the RIM as "constraints around appropriate disclosure of information about this Act, regardless of mood."

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

# concept[].definition
Types of sensitivity policies that may apply to a sensitive attribute on an Entity.

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

# concept[].definition
Types of sensitivity policies that apply to Roles.

*Usage Notes:* RoleSensitivity codes are used to bind information to a Role.confidentialityCode per organizational policy. Role.confidentialityCode is defined in the RIM as "an indication of the appropriate disclosure of information about this Role with respect to the playing Entity."

# concept[].property[].valueString
RoleSensitivity codes are used to bind information to a Role.confidentialityCode per organizational policy.  Role.confidentialityCode is defined in the RIM as "an indication of the appropriate disclosure of information about this Role with respect to the playing Entity."

# concept[].definition
Policy for handling information related to an adolescent, which will be afforded heightened confidentiality per applicable organizational or jurisdictional policy. An enterprise may have a policy that requires that adolescent patient information be provided heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

*Usage Note:* For use within an enterprise in which an adolescent is the information subject. 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.

# concept[].definition
Policy for handling information related to a celebrity (people of public interest (VIP), which will be afforded heightened confidentiality. Celebrities are people of public interest (VIP) about whose information an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive may include health information and patient role information including patient status, demographics, next of kin, and location.

*Usage Note:*  For use within an enterprise in which the information subject is deemed a celebrity or very important person. 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.

# concept[].definition
Policy for handling information related to a celebrity (people of public interest (VIP), which will be afforded heightened confidentiality. Celebrities are people of public interest (VIP) about whose information an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive may include health information and patient role information including patient status, demographics, next of kin, and location.

*Usage Note:*  For use within an enterprise in which the information subject is deemed a celebrity or very important person. 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.

# concept[].definition
Policy for handling information related to a diagnosis, health condition or health problem, which will be afforded heightened confidentiality. Diagnostic, health condition or health problem related information may be deemed sensitive by organizational policy, and require heightened confidentiality.

*Usage Note:* For use within an enterprise that provides heightened confidentiality to diagnostic, health condition or health problem related information deemed sensitive. 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.

# concept[].definition
Policy for handling information related to a drug, which will be afforded heightened confidentiality. Drug information may be deemed sensitive by organizational policy, and require heightened confidentiality.

*Usage Note:* For use within an enterprise that provides heightened confidentiality to drug information deemed sensitive. 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.

# concept[].definition
Policy for handling information related to an employee, which will be afforded heightened confidentiality. When a patient is an employee, an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

*Usage Note:* Policy for handling information related to an employee, which will be afforded heightened confidentiality. Description: When a patient is an employee, an enterprise may have a policy that requires heightened confidentiality. Information deemed sensitive typically includes health information and patient role information including patient status, demographics, next of kin, and location.

# concept[].definition
Policy for specially protecting information reported by or about a patient, which is deemed sensitive within the enterprise (i.e., by default regardless of whether the patient requested that the information be deemed sensitive for another reason.) For example information reported by the patient about another person, e.g., a family member, may be deemed sensitive by default. Organizational policy may allow the sensitivity tag to be cleared on patient's request.

*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.

For example, VA deems employee information sensitive by default. Information about a patient who is being stalked or a victim of abuse or violence may be deemed sensitive by default per a provider organization's policies.

# concept[].definition
Policy for handling information about a patient, which a physician or other licensed healthcare provider deems sensitive. Once tagged by the provider, this may trigger alerts for follow up actions according to organizational policy or jurisdictional law.

*Usage Note:* For use within an enterprise that provides heightened confidentiality to certain types of information designated by a physician as sensitive. 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.

Use cases in which this code could be used are, e.g., in systems that lack the ability to automatically detect sensitive information and must rely on manual tagging; a system that lacks an applicable sensitivity tag, or for ad hoc situations where criticality of the situation requires that the tagging be done immediately by the provider before coding or transcription of consult notes can be completed, e.g., upon detection of a patient with suicidal tendencies or potential for violence.

# concept[].definition
Policy for specially protecting information reported by or about a patient, which the patient deems sensitive, and the patient requests that collection, access, use, or disclosure of that information be restricted. For example, a minor patient may request that information about reproductive health not be disclosed to the patient's family or to particular providers and payers.

*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.

# concept[].definition
Proposed therapy may interact with certain foods

# concept[].definition
Proposed therapy may interact with an existing or recent therapeutic product

# concept[].display
adjud. nullified prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

# concept[].display
adjud. nullified prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

# concept[].display
adjud. nullified prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

# concept[].display
adjud. nullified prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted electronically.

# concept[].display
adjud. nullified prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
adjud. nullified same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
adjud. nullified same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
adjud. nullified same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
adjud. nullified same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified same-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. nullified same-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date), subsequently cancelled in the specified period and submitted manually.

# concept[].display
adjud. non-payee payable prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
adjud. non-payee payable prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
adjud. non-payee payable prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
adjud. non-payee payable prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
adjud. non-payee payable same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
adjud. non-payee payable same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
adjud. non-payee payable same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
adjud. non-payee payable same-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
adjud. payee payable prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
adjud. payee payable prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
adjud. payee payable prior-period manual amout

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
adjud. payee payable prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable prior to the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
adjud. payee payable same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
adjud. payee payable same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
adjud. payee payable same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
adjud. payee payable same-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as payable during the specified time period (based on adjudication date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
adjud. refused prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

# concept[].display
adjud. refused prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted electronically.

# concept[].display
adjud. refused prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

# concept[].display
adjud. refused prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as refused prior to the specified time period (based on adjudication date) and submitted manually.

# concept[].display
adjud. refused same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

# concept[].display
adjud. refused same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted electronically.

# concept[].display
adjud. refused same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

# concept[].definition
Identifies the total number of all Invoice Groupings that were adjudicated as refused during the specified time period (based on adjudication date) and submitted manually.

# concept[].display
paid nullified prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
paid nullified prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
paid nullified prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
paid nullified prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
paid nullified prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].display
paid nullified prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].display
paid nullified prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].display
paid nullified prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].display
paid nullified same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
paid nullified same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted electronically.

# concept[].display
paid nullified same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently cancelled in the specified period and submitted electronically.

# concept[].display
paid nullified same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently cancelled in the specified period and submitted electronically.

# concept[].display
paid nullified same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].display
paid nullified same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date), subsequently nullified in the specified period and submitted manually.

# concept[].display
paid non-payee payable prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
paid non-payee payable prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
paid non-payee payable prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
paid non-payee payable prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
paid non-payee payable same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
paid non-payee payable same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted electronically.

# concept[].display
paid non-payee payable same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
paid non-payee payable same-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that do not match a specified payee (e.g. pay patient) and submitted manually.

# concept[].display
paid payee payable prior-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
paid payee payable prior-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
paid payee payable prior-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
paid payee payable prior-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid prior to the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
paid payee payable same-period electronic amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
paid payee payable same-period electronic count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted electronically.

# concept[].display
paid payee payable same-period manual amount

# concept[].definition
Identifies the total net amount of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].display
paid payee payable same-period manual count

# concept[].definition
Identifies the total number of all Invoice Groupings that were paid during the specified time period (based on payment date) that match a specified payee (e.g. pay provider) and submitted manually.

# concept[].definition
Identifies the total net amount billed for all submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total net amount billed for all submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total number of submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total number of submitted Invoice Groupings within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total net amount billed for all submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total net amount billed for all submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total number of submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total number of submitted Invoice Groupings that were nullified within a time period and submitted electronically. Adjudicated invoice elements are included.

# concept[].definition
Identifies the total net amount billed for all submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

# concept[].definition
Identifies the total net amount billed for all submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

# concept[].definition
Identifies the total number of submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

# concept[].definition
Identifies the total number of submitted Invoice Groupings that are pended or held by the payor, within a time period and submitted electronically. Adjudicated invoice elements are not included.

# concept[].definition
**Definition:**General specification of age with no implied method of determination.

# concept[].definition
**Definition:**Age at onset of associated adverse event; no implied method of determination.

# concept[].definition
**Description:**This observation represents an 'average' or 'expected' half-life typical of the product.

# concept[].definition
**Definition:** A characteristic of an oral solid dosage form of a medicinal product, indicating whether it has one or more coatings such as sugar coating, film coating, or enteric coating. Only coatings to the external surface or the dosage form should be considered (for example, coatings to individual pellets or granules inside a capsule or tablet are excluded from consideration).

**Constraints:** The Observation.value must be a Boolean (BL) with true for the presence or false for the absence of one or more coatings on a solid dosage form.

# concept[].definition
**Definition:** A characteristic of an oral solid dosage form of a medicinal product, specifying the color or colors that most predominantly define the appearance of the dose form. SPLCOLOR is not an FDA specification for the actual color of solid dosage forms or the names of colors that can appear in labeling.

**Constraints:** The Observation.value must be a single coded value or a list of multiple coded values, specifying one or more distinct colors that approximate of the color(s) of distinct areas of the solid dosage form, such as the different sides of a tablet or one-part capsule, or the different halves of a two-part capsule. Bands on banded capsules, regardless of the color, are not considered when assigning an SPLCOLOR. Imprints on the dosage form, regardless of their color are not considered when assigning an SPLCOLOR. If more than one color exists on a particular side or half, then the most predominant color on that side or half is recorded. If the gelatin capsule shell is colorless and transparent, use the predominant color of the contents that appears through the colorless and transparent capsule shell. Colors can include: Black;Gray;White;Red;Pink;Purple;Green;Yellow;Orange;Brown;Blue;Turquoise.

# concept[].definition
**Description:** A characteristic representing a single file reference that contains two or more views of the same dosage form of the product; in most cases this should represent front and back views of the dosage form, but occasionally additional views might be needed in order to capture all of the important physical characteristics of the dosage form. Any imprint and/or symbol should be clearly identifiable, and the viewer should not normally need to rotate the image in order to read it. Images that are submitted with SPL should be included in the same directory as the SPL file.

# concept[].definition
**Definition:** A characteristic of an oral solid dosage form of a medicinal product, specifying the alphanumeric text that appears on the solid dosage form, including text that is embossed, debossed, engraved or printed with ink. The presence of other non-textual distinguishing marks or symbols is recorded by SPLSYMBOL.

**Examples:** Included in SPLIMPRINT are alphanumeric text that appears on the bands of banded capsules and logos and other symbols that can be interpreted as letters or numbers.

**Constraints:** The Observation.value must be of type Character String (ST). Excluded from SPLIMPRINT are internal and external cut-outs in the form of alphanumeric text and the letter 'R' with a circle around it (when referring to a registered trademark) and the letters 'TM' (when referring to a 'trade mark'). To record text, begin on either side or part of the dosage form. Start at the top left and progress as one would normally read a book. Enter a semicolon to show separation between words or line divisions.

# concept[].definition
**Definition:** A characteristic of an oral solid dosage form of a medicinal product, specifying the number of equal pieces that the solid dosage form can be divided into using score line(s).

**Example:** One score line creating two equal pieces is given a value of 2, two parallel score lines creating three equal pieces is given a value of 3.

**Constraints:** Whether three parallel score lines create four equal pieces or two intersecting score lines create two equal pieces using one score line and four equal pieces using both score lines, both have the scoring value of 4. Solid dosage forms that are not scored are given a value of 1. Solid dosage forms that can only be divided into unequal pieces are given a null-value with nullFlavor other (OTH).

# concept[].definition
**Description:** A characteristic of an oral solid dosage form of a medicinal product, specifying the two dimensional representation of the solid dose form, in terms of the outside perimeter of a solid dosage form when the dosage form, resting on a flat surface, is viewed from directly above, including slight rounding of corners. SPLSHAPE does not include embossing, scoring, debossing, or internal cut-outs. SPLSHAPE is independent of the orientation of the imprint and logo. Shapes can include: Triangle (3 sided); Square; Round; Semicircle; Pentagon (5 sided); Diamond; Double circle; Bullet; Hexagon (6 sided); Rectangle; Gear; Capsule; Heptagon (7 sided); Trapezoid; Oval; Clover; Octagon (8 sided); Tear; Freeform.

# concept[].definition
**Definition:** A characteristic of an oral solid dosage form of a medicinal product, specifying the longest single dimension of the solid dosage form as a physical quantity in the dimension of length (e.g., 3 mm). The length is should be specified in millimeters and should be rounded to the nearest whole millimeter.

**Example:** SPLSIZE for a rectangular shaped tablet is the length and SPLSIZE for a round shaped tablet is the diameter.

# concept[].definition
**Definition:** A characteristic of an oral solid dosage form of a medicinal product, to describe whether or not the medicinal product has a mark or symbol appearing on it for easy and definite recognition. Score lines, letters, numbers, and internal and external cut-outs are not considered marks or symbols. See SPLSCORING and SPLIMPRINT for these characteristics.

**Constraints:** The Observation.value must be a Boolean (BL) with true indicating the presence and false for the absence of marks or symbols.

**Example:**

# concept[].definition
Admitting diagnosis are the diagnoses documented for administrative purposes as the basis for a hospital admission.

# concept[].definition
Discharge diagnosis are the diagnoses documented for administrative purposes as the time of hospital discharge.

# concept[].definition
Intermediate diagnoses are those diagnoses documented for administrative purposes during the course of a hospital stay.

# concept[].definition
The type of injury that the injury coding specifies.

# concept[].definition
Code for the mechanism by which disease was acquired by the living subject involved in the public health case. Includes sexually transmitted, airborne, bloodborne, vectorborne, foodborne, zoonotic, nosocomial, mechanical, dermal, congenital, environmental exposure, indeterminate.

# concept[].definition
Indicates that the observation is carrying out an aggregation calculation, contained in the value element.

# concept[].definition
Indicates what method is used in a quality measure to combine the component measure results included in an composite measure.

# concept[].definition
An attribute of a quality measure describing the weight this component measure score is to carry in determining the overall composite measure final score. The value is real value greater than 0 and less than 1.0. Each component measure score will be multiplied by its CMPMSRSCRWGHT and then summed with the other component measures to determine the final overall composite measure score. The sum across all CMPMSRSCRWGHT values within a single composite measure SHALL be 1.0. The value assigned is scoped to the composite measure referencing this component measure only.

# concept[].definition
Identifies the organization(s) who own the intellectual property represented by the eMeasure.

# concept[].definition
Summary of relevant clinical guidelines or other clinical recommendations supporting this eMeasure.

# concept[].definition
Description of individual terms, provided as needed.

# concept[].definition
Disclaimer information for the eMeasure.

# concept[].definition
The timestamp when the eMeasure was last packaged in the Measure Authoring Tool.

# concept[].definition
Used to allow measure developers to provide additional guidance for implementers to understand greater specificity than could be provided in the logic for data criteria.

# concept[].definition
Information on whether an increase or decrease in score is the preferred result (e.g., a higher score indicates better quality OR a lower score indicates better quality OR quality is within a range).

# concept[].definition
Describes the items counted by the measure (e.g., patients, encounters, procedures, etc.)

# concept[].definition
A significant word that aids in discoverability.

# concept[].definition
The start date of the measurement period.

# concept[].definition
The method of adjusting for clinical severity and conditions present at the start of care that can influence patient outcomes for making valid comparisons of outcome measures across providers. Indicates whether an eMeasure is subject to the statistical process for reducing, removing, or clarifying the influences of confounding factors to allow more useful comparisons.

# concept[].definition
Describes how to combine information calculated based on logic in each of several populations into one summarized result. It can also be used to describe how to risk adjust the data based on supplemental data elements described in the eMeasure. (e.g., pneumonia hospital measures antibiotic selection in the ICU versus non-ICU and then the roll-up of the two).

*Open Issue:* The description does NOT align well with the definition used in the HQMF specfication; correct the MSGAGG definition, and the possible distinction of MSRAGG as a child of AGGREGATE.

# concept[].display
health quality measure improvement notation

# concept[].definition
Information on whether an increase or decrease in score is the preferred result. This should reflect information on which way is better, an increase or decrease in score.

# concept[].definition
The list of jurisdiction(s) for which the measure applies.

# concept[].definition
Type of person or organization that is expected to report the issue.

# concept[].definition
The maximum time that may elapse following completion of the measure until the measure report must be sent to the receiver.

# concept[].definition
Indicates how the calculation is performed for the eMeasure (e.g., proportion, continuous variable, ratio)

# concept[].definition
Location(s) in which care being measured is rendered

Usage Note: MSRSET is used rather than RoleCode because the setting applies to what is being measured, as opposed to participating directly in the health quality measure documantion itself).

# concept[].definition
The time period for which the eMeasure applies.

# concept[].definition
Indicates whether the eMeasure is used to examine a process or an outcome over time (e.g., Structure, Process, Outcome).

# concept[].definition
Succinct statement of the need for the measure. Usually includes statements pertaining to Importance criterion: impact, gap in care and evidence.

# concept[].definition
Identifies bibliographic citations or references to clinical practice guidelines, sources of evidence, or other relevant materials supporting the intent and rationale of the eMeasure.

# concept[].definition
Comparison of results across strata can be used to show where disparities exist or where there is a need to expose differences in results. For example, Centers for Medicare & Medicaid Services (CMS) in the U.S. defines four required Supplemental Data Elements (payer, ethnicity, race, and gender), which are variables used to aggregate data into various subgroups. Additional supplemental data elements required for risk adjustment or other purposes of data aggregation can be included in the Supplemental Data Element section.

# concept[].definition
Describes the strata for which the measure is to be evaluated. There are three examples of reasons for stratification based on existing work. These include: (1) evaluate the measure based on different age groupings within the population described in the measure (e.g., evaluate the whole \[age 14-25\] and each sub-stratum \[14-19\] and \[20-25\]); (2) evaluate the eMeasure based on either a specific condition, a specific discharge location, or both; (3) evaluate the eMeasure based on different locations within a facility (e.g., evaluate the overall rate for all intensive care units and also some strata include additional findings \[specific birth weights for neonatal intensive care units\]).

# concept[].definition
Can be a URL or hyperlinks that link to the transmission formats that are specified for a particular reporting program.

# concept[].definition
A sequence of values in the "absolute" time domain. This is the same time domain that all HL7 timestamps use. It is time as measured by the Gregorian calendar

# concept[].definition
A sequence of values in a "relative" time domain. The time is measured relative to the earliest effective time in the Observation Series containing this sequence.

# concept[].definition
Identifies the type of observation that is made about a specimen that may affect its processing, analysis or further result interpretation

# concept[].definition
**Description:** Observation codes which describe characteristics of the immunization material.

# concept[].definition
A code that is used to indicate the type of case safety report received from sender. The current code example reference is from the International Conference on Harmonisation (ICH) Expert Workgroup guideline on Clinical Safety Data Management: Data Elements for Transmission of Individual Case Safety Reports. The unknown/unavailable option allows the transmission of information from a secondary sender where the initial sender did not specify the type of report.

Example concepts include: Spontaneous, Report from study, Other.

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

# concept[].definition
Distinguishes the kinds of coded observations that could be the trigger for clinical issue detection. These are observations that are not measurable, but instead can be defined with codes. Coded observation types include: Allergy, Intolerance, Medical Condition, Pregnancy status, etc.

# concept[].definition
Codes used to define various metadata aspects of a health quality measure.

# concept[].definition
**Description:** Reporting codes that are related to an immunization event.

# concept[].definition
Observation types for specifying criteria used to assert that a subject is included in a particular population.

# concept[].definition
Types of observations that can be made about Preferences.

# concept[].definition
Indicates that the observation is of an unexpected negative occurrence in the subject suspected to result from the subject's exposure to one or more agents. Observation values would be the symptom resulting from the reaction.

# concept[].definition
**Description:**Refines classCode OBS to indicate an observation in which observation.value contains a finding or other nominalized statement, where the encoded information in Observation.value is not altered by Observation.code. For instance, observation.code="ASSERTION" and observation.value="fracture of femur present" is an assertion of a clinical finding of femur fracture.

# concept[].definition
**Definition:**An observation that provides a characterization of the level of harm to an investigation subject as a result of a reaction or event.

# concept[].definition
An observation that states whether the disease was likely acquired outside the jurisdiction of observation, and if so, the nature of the inter-jurisdictional relationship.

**OpenIssue:** This code could be moved to LOINC if it can be done before there are significant implemenations using it.

# concept[].definition
A clinical judgment as to the worst case result of a future exposure (including substance administration). When the worst case result is assessed to have a life-threatening or organ system threatening potential, it is considered to be of high criticality.

# concept[].definition
An observation that states the mechanism by which disease was acquired by the living subject involved in the public health case.

**OpenIssue:** This code could be moved to LOINC if it can be done before there are significant implemenations using it.

# concept[].definition
Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests.

# concept[].definition
Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests.

# concept[].definition
**Description:** Accuracy determined as per the GIS tier code system.

# concept[].definition
Indicates that the observation is of a person’s living situation in a household including the household composition and circumstances.

# concept[].definition
There is a clinical issue for the therapy that makes continuation of the therapy inappropriate.

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

# concept[].definition
Categorization of types of observation that capture the main clinical knowledge subject which may be a medication, a laboratory test, a disease.

# concept[].definition
Categorization of types of observation that capture a knowledge subtopic which might be treatment, etiology, or prognosis.

# concept[].definition
Hypersensitivity resulting in an adverse reaction upon exposure to an agent.

# concept[].definition
A subjective evaluation of the seriousness or intensity associated with another observation.

# concept[].definition
This domain includes observations used to characterize a privilege, under which this additional information is classified.

*Examples:*A privilege to prescribe drugs has a RESTRICTION that excludes prescribing narcotics; a surgical procedure privilege has a PRE-CONDITION that it requires prior Board approval.

# concept[].definition
**Definition:** Indicates the class of actions taken with regard to a substance administration related adverse event. This characterization offers a judgment of the practitioner's response to the patient's problem.

**Examples:** Example values include dose withdrawn, dose reduced, dose not changed.

**NOTE:** The concept domain is currently supported by a value set created by the International Conference on Harmonization

# concept[].definition
Used in a patient care message to report and query simple clinical (non-lab) observations.

# concept[].definition
**Description:**Dianostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge actiivities.

**Example:**Skin tests and eosinophilia evaluations.

# concept[].definition
Indicates the type of allergy test performed or to be performed. E.g. the specific antibody or skin test performed

# concept[].definition
**Description:**A kind of observation that allows a Secondary Observation (source act) to assert (at various levels of probability) that the target act of the association (which may be of any type of act) is implicated in the etiology of another observation that is named as the subject of the Secondary Observation

**Example:**Causality assertions where an accident is the cause of a symptom; predisposition assertions where the genetic state plus environmental factors are implicated in the development of a disease; reaction assertions where a substance exposure is associated with a finding of wheezing.

# concept[].display
observation dosage definition precondition type

# concept[].definition
**Definition:**

The set of observation type concepts that can be used to express pre-conditions to a particular dosage definition.

Rationale: Used to constrain the set of observations to those related to the applicability of a dosage, such as height, weight, age, pregnancy, liver function, kidney function, etc. For example, in drug master-file type records indicating when a specified dose is applicable.

# concept[].definition
Includes all codes defining types of indications such as diagnosis, symptom and other indications such as contrast agents for lab tests

# concept[].definition
Distinguishes between the kinds of measurable observations that could be the trigger for clinical issue detection. Measurable observation types include: Lab Results, Height, Weight.

# concept[].definition
**Definition:** An observation related to a query response.

**Example:**The degree of match or match weight returned by a matching algorithm in a response to a query.

# concept[].definition
**Definition:** Identifies the type of Vision Prescription Observation that is being described.

# concept[].definition
Indicates the type of characteristics a patient should have for a given therapy to be appropriate. E.g. Weight, Age, certain lab values, etc.

# concept[].definition
Types of measurement observations typically performed in a clinical (non-lab) setting. E.g. Height, Weight, Blood-pressure

# concept[].definition
**Description:** The class room associated with the patient during the immunization event.

# concept[].definition
**Description:** The school grade or level the patient was in when immunized.

# concept[].definition
**Description:** The school the patient attended when immunized.

# concept[].definition
**Description:** The school division or district associated with the patient during the immunization event.

# concept[].definition
**Description:** The patient's teacher when immunized.

# concept[].definition
Criteria which specify subjects 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.

# concept[].definition
Criteria which specify the removal of a subject, 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 (or subject) reasons
 *  System reasons

# concept[].definition
Criteria for specifying the entities to be evaluated by a specific quality measure, based on a shared common set of characteristics (within a specific measurement set to which a given measure belongs). The denominator can be the same as the initial population, or it may be a subset of the initial population to further constrain it 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.

# concept[].definition
Criteria for specifying the entities to be evaluated by a specific quality measure, based on a shared common set of characteristics (within a specific measurement set to which a given measure belongs).

# concept[].definition
Defines the observation to be performed for each patient or event in the measure population. Measure observations for each case in the population are aggregated to determine the overall measure score for the population.

**Examples:** 

 *  the median time from arrival in the Emergency Room to departure
 *  the median time from decision to admit to a hospital to the actual admission for Emergency Room patients

# concept[].definition
Criteria for specifying the measure population as a narrative description (e.g., all patients seen in the Emergency Department during the measurement period). This is used only in continuous variable eMeasures.

# concept[].definition
Criteria for specifying subjects who should be removed from the eMeasure's Initial Population and Measure Population. Measure Population Exclusions are used in Continuous Variable measures to help narrow the Measure Population before determining the value(s) of the continuous variable(s).

# concept[].definition
Criteria for specifying the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator for proportion measures, or related to (but not directly derived from) the denominator for ratio measures (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).

# concept[].definition
Criteria for specifying 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). Numerator Exclusions are used only in ratio eMeasures.

# concept[].definition
An observation about how important a preference is to the target of the preference.

# concept[].definition
A circle defined by two (column,row) pairs. The first point is the center of the circle and the second point is a point on the perimeter of the circle.

# concept[].definition
An ellipse defined by four (column,row) pairs, the first two points specifying the endpoints of the major axis and the second two points specifying the endpoints of the minor axis.

# concept[].definition
A single point denoted by a single (column,row) pair, or multiple points each denoted by a (column,row) pair.

# concept[].definition
A series of connected line segments with ordered vertices denoted by (column,row) pairs; if the first and last vertices are the same, it is a closed polygon.

# concept[].definition
Policy for handling trade secrets such as financial information or intellectual property, which will be afforded heightened confidentiality. 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.

*Usage Notes:* No patient related information may ever be of this confidentiality level. 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.

# concept[].property[].valueString
No patient related information may ever be of this confidentiality level.   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.

# concept[].definition
Policy for handling information related to an employer which is deemed classified to protect an employee who is the information subject, and which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to an employer, such as law enforcement or national security, the identity of which could impact the privacy, well-being, or safety of an information subject who is an employee.

*Usage Notes:* 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.

# concept[].property[].valueString
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.

# concept[].definition
Policy for handling information related to the location of the information subject, which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to the location of the information subject, the disclosure of which could impact the privacy, well-being, or safety of that subject.

*Usage Notes:* 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.

# concept[].property[].valueString
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.

# concept[].definition
Policy for handling information related to a provider of sensitive services, which will be afforded heightened confidentiality. Description: Policies may govern sensitivity of information related to providers who deliver sensitive healthcare services in order to protect the privacy, well-being, and safety of the provider and of patients receiving sensitive services.

*Usage Notes:* 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.

# concept[].property[].valueString
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.

# concept[].definition
**Definition:**The requested action has already been performed and so this request has no effect

# concept[].definition
**Definition:**The therapy being performed is in some way out of alignment with the requested therapy.

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

# concept[].definition
The patient is receiving a subsequent fill significantly later than would be expected based on the amount previously supplied and the therapy dosage instructions

# concept[].definition
The patient is receiving a subsequent fill significantly earlier than would be expected based on the amount previously supplied and the therapy dosage instructions

# concept[].definition
Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy

# concept[].definition
Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition

# concept[].definition
Assessed patient, therapy is appropriate

# concept[].definition
**Description:** The patient has the appropriate indication or diagnosis for the action to be taken.

# concept[].definition
**Description:** It has been confirmed that the appropriate pre-requisite therapy has been tried.

# concept[].definition
Consulted other supply source, therapy still appropriate

# concept[].display
Interacting Therapy No Longer Active/Planned

# concept[].definition
Concurrent therapy triggering alert is no longer on-going or planned

# concept[].definition
Patient's existing supply was lost/wasted

# concept[].definition
Supply date is intended to carry patient over weekend

# concept[].definition
Supply is intended for use during a leave of absence from an institution.

# concept[].display
additional quantity on separate dispense

# concept[].definition
**Description:** Supply is different than expected as an additional quantity has been supplied in a separate dispense.

# concept[].definition
Consulted prescriber and recommended change, prescriber declined

# concept[].definition
Provided education or training to the patient on appropriate therapy use

# concept[].definition
Instituted an additional therapy to mitigate potential negative effects

# concept[].definition
Suspended existing therapy that triggered interaction for the duration of this therapy

# concept[].definition
Aborted existing therapy that triggered interaction.

# concept[].definition
Arranged to monitor patient for adverse effects

# concept[].display
adjudicated with adjustments and no financial impact

# concept[].definition
The invoice element has been accepted for payment but one or more adjustment(s) have been made to one or more invoice element line items (component charges) without changing the amount.

Invoice element can be reversed (nullified).

Recommend that the invoice element is saved for DUR (Drug Utilization Reporting).

# concept[].definition
Type of security metadata 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.

# concept[].definition
Type of security metadata about privacy and security requirements with which a security domain must comply. \[ISO IEC 10181-1\]

# concept[].definition
Type of security metadata about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.

# concept[].definition
Type of security metadata 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). \[Based on ISO IEC 10181-1\]

# concept[].definition
Type of security metadata 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. \[Kantara Initiative\]

# concept[].definition
Type of security metadata about a security architecture system component that supports enforcement of security policies.

# concept[].definition
Proposed therapy is outside of the standard practice for an adult patient.

# concept[].definition
Proposed dosage exceeds standard practice for the patient's age

# concept[].definition
Proposed dosage is below suggested therapeutic levels for the patient's age

# concept[].definition
Proposed therapy is outside of standard practice for a geriatric patient.

# concept[].definition
Proposed therapy is outside of the standard practice for a pediatric patient.

# concept[].definition
An allergy to a substance other than a drug or a food. E.g. Latex, pollen, etc.

# concept[].definition
An allergy to a substance generally consumed for nutritional purposes.

# concept[].definition
An access control policy specific to the type of access control scheme, which is used to enforce one or more authorization policies.

*Usage Note:* Access control schemes are the type of access control policy, which is comprised of access control policy rules concerning the provision of the access control service.

There are two categories of access control policies, rule-based and identity-based, which are identified in CCITT Rec. X.800 aka ISO 7498-2. Rule-based access control policies are intended to apply to all access requests by any initiator on any target in a security domain. Identity-based access control policies are based on rules specific to an individual initiator, a group of initiators, entities acting on behalf of initiators, or originators acting in a specific role. Context can modify rule-based or identity-based access control policies. Context rules may define the entire policy in effect. Real systems will usually employ a combination of these policy types; if a rule-based policy is used, then an identity-based policy is usually in effect also.

An access control scheme may be based on access control lists, capabilities, labels, and context or a combination of these. An access control scheme is a component of an access control mechanism or "service") along with the supporting mechanisms required by that scheme to provide access control decision information (ADI) supplied by the scheme to the access decision facility (ADF also known as a PDP). (Based on ISO/IEC 10181-3:1996)

**Examples:** 

 *  Attribute Based Access Control (ABAC)
 *  Discretionary Access Control (DAC)
 *  History Based Access Control (HBAC)
 *  Identity Based Access Control (IBAC)
 *  Mandatory Access Control (MAC)
 *  Organization Based Access Control (OrBAC)
 *  Relationship Based Access Control (RelBac)
 *  Responsibility Based Access Control (RespBAC)
 *  Risk Adaptable Access Control (RAdAC)

>

# concept[].definition
**Definition:** An automobile insurance policy under which the insurance company will cover the cost of damages to an automobile owned by the named insured that are caused by accident or intentionally by another party.

# concept[].definition
**Definition:** An automobile insurance policy under which the insurance company will indemnify a loss for which another motorist is liable if that motorist is unable to pay because he or she is uninsured. Coverage under the policy applies to bodily injury damages only. Injuries to the covered party caused by a hit-and-run driver are also covered.

# concept[].definition
Policy for handling information related to cognitive disability disorders and conditions caused by these disorders, which are 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.

Examples may include dementia, traumatic brain injury, attention deficit, hearing and visual disability such as dyslexia and other disorders and related conditions which impair learning and self-sufficiency. However, the cognitive disabilities to which this term may apply versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used.

# concept[].definition
Policy for handling information related to developmental disability 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.

A diverse group of chronic conditions that are due to mental or physical impairments impacting activities of daily living, self-care, language acuity, learning, mobility, independent living and economic self-sufficiency. Examples may include Down syndrome and Autism spectrum. However, the developmental disabilities to which this term applies versus other behavioral health categories varies by jurisdiction and organizational policy in part due to overlap with other behavioral health conditions. Implementers should constrain to those diagnoses applicable in the domain in which this code is used.

# concept[].definition
Policy for handling information related to emotional disturbance 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.

Typical used to characterize behavioral and mental health issues of adolescents where the disorder may be temporarily diagnosed in order to avoid the potential and unnecessary stigmatizing diagnoses of disorder long term.

# concept[].definition
A clinician enters a diagnosis for a given patient.

# concept[].definition
A person provides a discharge instruction to a patient.

# concept[].definition
A clinician enters a discharge summary for a given patient.

# concept[].definition
A person provides a patient-specific education handout to a patient.

# concept[].definition
A pathologist enters a report for a given patient.

# concept[].definition
A clinician enters a problem for a given patient.

# concept[].definition
A radiologist enters a report for a given patient.

# concept[].definition
A person reviews a discharge summary of a given patient.

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

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

# concept[].definition
**Description:**The request is suspected to have a fraudulent basis.

# concept[].definition
A similar or identical therapy was recently ordered by a different practitioner.

# concept[].definition
This patient was recently supplied a similar or identical therapy from a different pharmacy or supplier.

# concept[].definition
A group of health care entities, which may include health care providers, care givers, hospitals, facilities, health plans, and other health care constituents who coordinate care for reimbursement based on quality metrics for improving outcomes and lowering costs, and may be authorized to access the consumer's health information because of membership in that group.

Security Compartment Labels assigned to a consumer's information use in accountable care workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a an accountable care workflow who is requesting access to that information

# concept[].definition
This compartment code may be used as a field value in an initiator's clearance to indicate permission for its Clinical Decision Support system (CDSS) to access and use an IT Resource with a security label having the same compartment value in the security category label field.

This code permits a CDS system to algorithmically process information with this compartment tag for the purpose of alerting an unauthorized end user that masked information is needed to address an emergency or a patient safety issue, such as a contraindicated medication. The alert would advise the end user to "break the glass", to access the masked information in an accountable manner, or to ask the patient about possibly masked information.

For example, releasing a list of sensitive medications with this compartment tag means that while the CDS system is permitted to use this list in its contraindication analysis, this sensitive information should not be shared directly with unauthorized end-users or end-user-facing Apps. Based on the results of the CDS system analysis (e.g., warnings about prescriptions) the end-user (e.g., a clinician) may still have the ability to access to the sensitive information by invoking "break-the-glass protocol".

*Usage Note:* A security label with the CDS system compartment may be used in conjunction with other security labels, e.g., a label authorizing an end user with adequate clearance to access the same CDS system compartment tagged information. For example, a patient may restrict sharing sensitive information with most care team members except in an emergency or to prevent an adverse event, and may consent to sharing with their sensitive service care team providers, e.g., for mental health or substance abuse.

# concept[].definition
Care coordination across participants in a care plan requires sharing of a healthcare consumer's information specific to that workflow. A care team member should only have access to that information while participating in that workflow or for other authorized uses.

Security Compartment Labels assigned to a consumer's information use in care coordination workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a care team member workflow who is requesting access to that information

# concept[].definition
Financial management department members who have access to healthcare consumer information as part of a patient account, billing and claims workflows.

Security Compartment Labels assigned to consumer information used in these workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a financial management workflow who is requesting access to that information.

# concept[].definition
A security category label field value, which indicates that access and use of an IT resource is restricted to members of human resources department or workflow.

# concept[].definition
Providers and care givers who have an established relationship per criteria determined by policy are considered to have an established care provision relations with a healthcare consumer, and may be authorized to access the consumer's health information because of that relationship. Providers and care givers should only have access to that information while participating in legitimate relationship workflows or for other authorized uses.

Security Compartment Labels assigned to a consumer's information use in legitimate relationship workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a legitimate relationship workflow who is requesting access to that information.

# concept[].definition
Patient administration members who have access to healthcare consumer information as part of a patient administration workflows.

Security Compartment Labels assigned to consumer information used in these workflows should be met or exceeded by the Security Compartment attribute claimed by a participant in a patient administration workflow who is requesting access to that information.

# concept[].definition
A security category label field value, which indicates that access and use of an IT resource is restricted to members of a research project.

# concept[].definition
A security category label field value, which indicates that access and use of an IT resource is restricted to members of records management department or workflow.

# concept[].definition
Proposed therapy may be inappropriate or contraindicated when breast-feeding

# concept[].definition
Proposed therapy may be inappropriate or contraindicated during pregnancy

# concept[].definition
A displayed mark, required to be rendered as "CONTROLLED", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From 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.

# concept[].definition
A displayed mark, required to be rendered as "CUI", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From 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.

# concept[].definition
A displayed mark, required to be rendered as "CUI//HLTH", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

# concept[].definition
A displayed mark, required to be rendered as "(CUI//HLTH)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

# concept[].definition
A displayed mark, required to be rendered as "(CUI)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of healthcare regulation governing CUI Basic marking include HIPAA Unique Identifier provisions 42 USC 1320d-2 note(b) https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf; Title 38 Section 7332 https://www.govinfo.gov/content/pkg/USCODE-2016-title38/pdf/USCODE-2016-title38-partV-chap73-subchapIII-sec7332.pdf; and several sections of 42 CFR Part 2.related to consent and confidentiality, e.g., https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol1/pdf/CFR-2017-title42-vol1-sec2-12.pdf

# concept[].definition
A displayed mark, required to be rendered as "CUI//PRVCY", indicating that the electronic or hardcopy controlled unclassified basic privacy information is private and must be protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of privacy regulation governing CUI Basic marking include 20 CFR 401.100 related to SSA disclosure of personal, program, and non-program information. https://www.govinfo.gov/content/pkg/CFR-2017-title20-vol2/pdf/CFR-2017-title20-vol2-sec401-100.pdf.

# concept[].definition
A displayed mark, required to be rendered as "(CUI//PRVCY)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of privacy regulation governing CUI Basic marking include 20 CFR 401.100 related to SSA disclosure of personal, program, and non-program information. https://www.govinfo.gov/content/pkg/CFR-2017-title20-vol2/pdf/CFR-2017-title20-vol2-sec401-100.pdf.

# concept[].definition
A displayed mark, required to be rendered as "CUI//SP-HLTH", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI in which the authorizing law, regulation, or Government-wide policy contains specific handling controls that it requires or permits agencies to use that differ from those for CUI Basic. The CUI Registry indicates which laws, regulations, and Government-wide policies include such specific requirements. CUI Specified controls may be more stringent than, or may simply differ from, those required by CUI Basic; the distinction is that the underlying authority spells out the controls for CUI Specified information and does not for CUI Basic information. CUI Basic controls apply to those aspects of CUI Specified where the authorizing laws, regulations, and Government-wide policies do not provide specific guidance. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of healthcare regulation governing CUI Specified marking include HIPAA Transaction and Code Sets and references the Congressional requirement that HHS promulgate Privacy, and Security rules https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf.

# concept[].definition
A displayed mark, required to be rendered as "(CUI//SP-HLTH)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of healthcare regulation governing CUI Specified marking include HIPAA Transaction and Code Sets and references the Congressional requirement that HHS promulgate Privacy, and Security rules https://www.govinfo.gov/content/pkg/USCODE-2016-title42/pdf/USCODE-2016-title42-chap7-subchapXI-partC-sec1320d-2.pdf

# concept[].definition
A displayed mark, required to be rendered as "CUI//SP-PRVCY", indicating that the electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of privacy regulation governing CUI Specified marking is OMB M-17-12ï‡? This Memorandum sets forth the policy for Federal agencies to prepare for and respond to a breach of personally identifiable information (PII). It includes a framework for assessing and mitigating the risk of harm to individuals potentially affected by a breach, as well as guidance on whether and how to provide notification and services to those individuals. https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2017/m-17-12\_0.pdf.

# concept[].definition
A displayed mark, required to be rendered as "(CUI//SP-PRVCY)", indicating that a portion of an electronic or hardcopy information is protected at the level of the subset of CUI for which the authorizing law, regulation, or Government-wide policy does not set out specific handling or dissemination controls. Agencies handle CUI Basic according to the uniform set of controls set forth in this part and the CUI Registry. CUI Basic differs from CUI Specified (see definition for CUI Specified), and CUI Basic controls apply whenever CUI Specified ones do not cover the involved CUI. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html.

*Usage Note:* Examples of privacy regulation governing CUI Specified marking is OMB M-17-12ï‡? This Memorandum sets forth the policy for Federal agencies to prepare for and respond to a breach of personally identifiable information (PII). It includes a framework for assessing and mitigating the risk of harm to individuals potentially affected by a breach, as well as guidance on whether and how to provide notification and services to those individuals. https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/memoranda/2017/m-17-12\_0.pdf.

# concept[].definition
A displayed mark, required to be rendered as "(U)", indicating that a portion of an electronic or hardcopy information is neither Executive Order 13556 nor classified information authorities cover as protected. Although this information is not controlled or classified, agencies must still handle it in accordance with Federal Information Security Modernization Act (FISMA) requirements. From CUI Glossary https://www.archives.gov/cui/registry/cui-glossary.html

*Usage Note:* Regulatory Source: 32 CFR §  2002.20 Marking. Federal Register Page 63344 63344 (ii) Authorized holders permitted to designate CUI must portion mark both CUI and uncontrolled unclassified portions.

CUI Marking Handbook https://www.archives.gov/files/cui/20161206-cui-marking-handbook-v1-1.pdf

CUI Portion Marking: Portion marking of CUI is optional in a fully unclassified document, but is permitted and encouraged to facilitate information sharing and proper handling of the information. Agency heads may approve the required use of CUI Portion marking on all CUI generated within their agency. As such, users should consult their agency CUI policy when creating CUI documents. When CUI Portion Markings are used and a portion does not contain CUI a "U" is placed in parentheses to indicate that the portion contains Uncontrolled Unclassified Information. (Page 14)

CUI Portion Markings are placed at the beginning of the portion to which they apply and must be used throughout the entire document. They are presented in all capital letters and separated as indicated in this handbook and the CUI Registry. The presence of EVEN ONE item of CUI in a document requires CUI marking of that document. Because of this, CUI Portion Markings can be of great assistance in determining if a document contains CUI and therefore must be marked as such. Remember: When portion markings are used and any portion does not contain CUI, a "(U)" is placed in front of that portion to indicate that it contains Uncontrolled - or non-CUI - Unclassified Information. (Page 15)

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with the information handling directions of the Confidentiality Code associated with an information target.

*Usage Note:* CPLYCC may be used as a security label code to inform senders and receivers of information tagged with a Confidentiality Code to comply with applicable level of protection required by the assigned confidentiality code.

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with applicable information subject consent directives.

*Usage Note:* CPLYCD may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType\_ActConsent code or an ActCode\_ActPolicyType\_ActPrivacyPolicy\_ActConsentDirective code to comply with applicable consent directives.

# concept[].display
comply with controlled unclassified information policy

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with applicable Controlled Unclassified Information (CUI) policies associated with the target information.

*Usage Note:* In the US, CPLYCUI may be used as a security label code to inform recipients of information designated by a US Federal Agency as Controlled Unclassified Information (CUI) to comply with the applicable laws, regulations, executive orders, and other guidances, such as included in DURSAs, to persist, mark, and enforce required CUI controls

Background:

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 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

# concept[].display
comply with jurisdictional privacy policy

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional privacy policies associated with the target information.

*Usage Note:* CPLYJPP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType\_ActPrivacyPolicy\_ActPrivacyLaw code or an ActCode\_ActPolicyType\_ActInformationPolicy.JurisIP code to comply with applicable jurisdictional privacy policy.

# concept[].display
comply with jurisdictional security policy

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with applicable jurisdictional security policies associated with the target information.

*Usage Note:* CPLYJSP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType.SecurityPolicy code to comply with applicable jurisdictional security policy.

# concept[].display
comply with organizational privacy policy

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with applicable organizational privacy policies associated with the target information.

*Usage Note:* CPLYOPP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType\_ActInformationPolicy.OrgIP code to comply with applicable organizational privacy policy.

# concept[].display
comply with organizational security policy

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with the organizational security policies associated with the target information.

*Usage Note:* CPLYOSP may be used as a security label code to inform senders and receivers of information tagged with an ActCode\_ActPolicyType.SecurityPolicy code to comply with applicable organizational security policy.

# concept[].definition
A diet exclusively composed of oatmeal, semolina, or rice, to be extremely easy to eat and digest.

# concept[].definition
A diet that uses carbohydrates sparingly. Typically with a restriction in daily energy content (e.g. 1600-2000 kcal).

# concept[].definition
No enteral intake of foot or liquids whatsoever, no smoking. Typically 6 to 8 hours before anesthesia.

# concept[].definition
A diet consisting of a formula feeding, either for an infant or an adult, to provide nutrition either orally or through the gastrointestinal tract via tube, catheter or stoma.

# concept[].definition
A diet low in fat, particularly to patients with hepatic diseases.

# concept[].definition
A low protein diet for patients with renal failure.

# concept[].definition
A strictly liquid diet, that can be fully absorbed in the intestine, and therefore may not contain fiber. Used before enteral surgeries.

# concept[].definition
A diet low in sodium for patients with congestive heart failure and/or renal failure.

# concept[].definition
A normal diet, i.e. no special preparations or restrictions for medical reasons. This is notwithstanding any preferences the patient might have regarding special foods, such as vegetarian, kosher, etc.

# concept[].definition
A no fat diet for acute hepatic diseases.

# concept[].definition
Patient is supplied with parenteral nutrition, typically described in terms of i.v. medications.

# concept[].definition
A diet that seeks to reduce body fat, typically low energy content (800-1600 kcal).

# concept[].definition
A diet that avoids ingredients that might cause digestion problems, e.g., avoid excessive fat, avoid too much fiber (cabbage, peas, beans).

# concept[].definition
A diet that is not intended to be complete but is added to other diets.

# concept[].definition
This is not really a diet, since it contains little nutritional value, but is essentially just water. Used before coloscopy examinations.

# concept[].definition
Diet with low content of the amino-acids valin, leucin, and isoleucin, for "maple syrup disease."

# concept[].definition
The dilution of a sample performed by automated equipment. The value is specified by the equipment

# concept[].definition
The dilution of a sample performed by automated equipment. The value is specified by the equipment

# concept[].definition
The dilution of the specimen made prior to being loaded onto analytical equipment

# concept[].definition
The value of the dilution of a sample after it had been analyzed at a prior dilution value

# concept[].definition
Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

# concept[].definition
**Definition:** A program that provides low-income, uninsured, and underserved women access to timely, high-quality screening and diagnostic services, to detect breast and cervical cancer at the earliest stages.

**Example:** To improve women's access to screening for breast and cervical cancers, Congress passed the Breast and Cervical Cancer Mortality Prevention Act of 1990, which guided CDC in creating the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which provides access to critical breast and cervical cancer screening services for underserved women in the United States. An estimated 7 to 10% of U.S. women of screening age are eligible to receive NBCCEDP services. Federal guidelines establish an eligibility baseline to direct services to uninsured and underinsured women at or below 250% of federal poverty level; ages 18 to 64 for cervical screening; ages 40 to 64 for breast screening.

# concept[].definition
**Definition:** A public or government program that administers publicly funded coverage of kidney dialysis and kidney transplant services.

Example: In the U.S., the Medicare End-stage Renal Disease program (ESRD), the National Kidney Foundation (NKF) American Kidney Fund (AKF) The Organ Transplant Fund.

# concept[].definition
**Definition:** Government administered and funded HIV-AIDS program for beneficiaries meeting financial and 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., the Ryan White program, which is administered by the Health Resources and Services Administration.

# concept[].definition
**Description:**Proposed dosage is inappropriate due to patient's medical condition.

# concept[].definition
Proposed length of therapy differs from standard practice.

# concept[].definition
Proposed dosage exceeds standard practice

# concept[].definition
Proposed dosage interval/timing differs from standard practice

# concept[].definition
Proposed dosage is below suggested therapeutic levels

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

# concept[].definition
Proposed length of therapy is longer than standard practice

# concept[].definition
Proposed length of therapy is shorter than that necessary for therapeutic effect

# concept[].definition
Proposed length of therapy is longer than standard practice for the identified indication or diagnosis

# concept[].definition
Proposed length of therapy is shorter than standard practice for the identified indication or diagnosis

# concept[].definition
Proposed dosage exceeds standard practice for the patient's height or body surface area

# concept[].definition
Proposed dosage exceeds standard practice for the patient's weight

# concept[].definition
Proposed dosage interval/timing differs from standard practice for the identified indication or diagnosis

# concept[].definition
Proposed dosage is below suggested therapeutic levels for the patient's height or body surface area

# concept[].definition
Proposed dosage is below suggested therapeutic levels for the patient's weight

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

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

# concept[].definition
Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

# concept[].definition
An emergency supply where the expectation is that a formal order authorizing the supply will be provided at a later date.

# concept[].definition
**Description:** Indicates that the permissions have been externally verified and the request should be processed.

# concept[].definition
Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext when "at rest" or in storage.

# concept[].definition
Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext while "in transit" or being transported by any means.

# concept[].definition
Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext while in use such that operations permitted on the target information are limited by the license granted to the end user.

# concept[].definition
A first fill 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).

# concept[].definition
A first fill 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.)

# concept[].definition
A first fill 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 also 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)

# concept[].definition
A first fill 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).

# concept[].definition
A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance.

# concept[].definition
A first fill 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 also 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).

# concept[].definition
A fill where a small portion is provided to allow for determination of the therapy effectiveness and patient tolerance and also 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).

# concept[].definition
Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

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

# concept[].definition
**Definition:**The therapy being performed is not sufficiently equivalent to the therapy which was requested.

# concept[].definition
**Definition:**The therapy is being performed at a time which diverges from the time the therapy was requested

# concept[].definition
An additional immunization administration within a series intended to bolster or enhance immunity.

# concept[].definition
The first immunization administration in a series intended to produce immunity

# concept[].definition
Any category of inpatient encounter except 'acute'

# concept[].definition
**Definition:** Consent to access or "read" only, which entails that the information is not to be copied, screen printed, saved, emailed, stored, re-disclosed or altered in any way. This level ensures that data which is masked or to which access is restricted will not be.

**Example:** Opened and then emailed or screen printed for use outside of the consent directive purpose.

# concept[].definition
**Definition:** Consent to access and save only, which entails that access to the saved copy will remain locked.

# concept[].definition
Authorization to collect, access, use, or disclose specified patient health information as explicitly consented to by the subject of the information or the subject's representative.

# concept[].definition
The Fibrin Index of the specimen. In the case of only differentiating between Absent and Present, recommend using 0 and 1

# concept[].definition
An observation of the hemolysis index of the specimen in g/L

# concept[].definition
An observation that describes the icterus index of the specimen. It is recommended to use mMol/L of bilirubin

# concept[].definition
An observation used to describe the Lipemia Index of the specimen. It is recommended to use the optical turbidity at 600 nm (in absorbance units).

# concept[].definition
Criteria for specifying the patients to be evaluated by a specific quality measure, based on a shared common set of 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.

# concept[].definition
Identifies types of detectyed issues for Act class "ALRT" for the administrative and patient administrative acts domains.

# concept[].definition
Identifies types of detected issues regarding the administration or supply of an item to a patient.

# concept[].definition
Identifies types of detected issues for Act class "ALRT" for the financial acts domain.

# concept[].definition
Identifies types of issues detected regarding the performance of a clinical action on a patient.

# concept[].concept[].definition
Identifies the type of detected issue is a care gap

# concept[].concept[].definition
Identifies the type of detected issue is a risk adjustment coding gap

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of controlled unclassified information as defined by applicable jurisdictional law.

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of de-identified information as defined by applicable jurisdictional law.

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of information in a limited data set as defined by applicable jurisdictional law.

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of information deemed non-sensitive by applicable jurisdiction law.

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of information deemed public by applicable jurisdiction law.

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of specified controlled unclassified information as defined by applicable jurisdictional policy.

# concept[].definition
Jurisdictional policy on collection, access, use, or disclosure of uncontrolled unclassified information as defined by applicable jurisdictional policy.

# concept[].definition
**Description:**The length of the data specified is greater than the maximum length defined for the element.

# concept[].definition
**Description:**The length of the data specified is less than the minimum length defined for the element.

# concept[].definition
**Definition:** A policy that, after an initial premium or premiums, pays out a sum at pre-determined intervals.

For example, a policy holder may pay $10,000, and in return receive $150 each month until he dies; or $1,000 for each of 14 years or death benefits if he dies before the full term of the annuity has elapsed.

# concept[].definition
**Definition:** Life insurance under which the benefit is payable only if the insured dies during a specified period. If an insured dies during that period, the beneficiary receives the death payments. If the insured survives, the policy ends and the beneficiary receives nothing.

# concept[].definition
**Definition:** Life insurance under which the benefit is payable upon the insuredaTMs death or diagnosis of a terminal illness. If an insured dies during that period, the beneficiary receives the death payments. If the insured survives, the policy ends and the beneficiary receives nothing

# concept[].definition
Temporary supply of a product with financial compensation, without transfer of ownership for the product.

# concept[].definition
**Definition:** A policy for a health plan that provides coverage for health care only through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Eligibility to enroll in an HMO is determined by where a covered party lives or works.

# concept[].definition
**Definition:** A network-based, managed care plan that allows a covered party to choose any health care provider. However, if care is received from a "preferred" (participating in-network) provider, there are generally higher benefit coverage and lower deductibles.

# concept[].display
Michigan Consent to Share Behavioral Health Information for Care Coordination Purposes-Michigan Mental Health Code

# concept[].definition
The State of Michigan standard privacy consent form for sharing of health information specific to behavioral health governed by the Michigan Mental Health Code Act 258 of 1974, which require patient authorization for purposes other than treatment, payment, and coordination of care, in accordance with Public Act 129 of 2014.

*Usage Note:* For legislative background, current MDHHS-5515 consent directive form, and provider and patient FAQs see http://www.michigan.gov/mdhhs/0,5885,7-339-71550\_2941\_58005-343686--,00.html

# concept[].display
Michigan Consent to Share Behavioral Health Information for Care Coordination Purposes-US 42 CFR Part 2

# concept[].definition
The State of Michigan standard privacy consent form for sharing of health information specific to substance use information governed under US 42 CFR Part 2 in accordance with Public Act 129 of 2014.

*Usage Note:* For legislative background, current MDHHS-5515 consent directive form, and provider and patient FAQs see http://www.michigan.gov/mdhhs/0,5885,7-339-71550\_2941\_58005-343686--,00.html

# concept[].display
microbiology organisms results review task

# concept[].definition
A person reviews organisms of microbiology results of a given patient.

# concept[].display
microbiology sensitivity test results review task

# concept[].definition
A person reviews the sensitivity test of microbiology results of a given patient.

# concept[].display
medication administration record work list review task

# concept[].definition
A clinician reviews a work list of medications to be administered to a given patient.

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

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

# concept[].definition
Custodian system must remove any information that could result in identifying the information subject.

# concept[].definition
Custodian system must make available to an information subject upon request an accounting of certain disclosures of the individual's protected health information over a period of time. Policy may dictate that the accounting include information about the information disclosed, the date of disclosure, the identification of the receiver, the purpose of the disclosure, the time in which the disclosing entity must provide a response and the time period for which accountings of disclosure can be requested.

# concept[].definition
Custodian system must monitor systems to ensure that all users are authorized to operate on information objects.

# concept[].definition
Custodian system must monitor and maintain retrievable log for each user and operation on information.

# concept[].definition
Custodian security system must retrieve, evaluate, and comply with applicable policies associated with the target information.

*Usage Note:* CPLYPOL may be used as a security label code to inform senders and receivers of the tagged information to comply with applicable policy without specifying the specific policy type(s).

# concept[].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 unclassified 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.

# concept[].definition
Custodian system must strip information of data that would allow the identification of the source of the information or the information subject.

# concept[].definition
Custodian system must remove target information from access after use.

# concept[].definition
Custodian security system must downgrade 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 less 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.

# concept[].definition
Custodian security system must assign and bind security labels derived from compilations of information by aggregation or disaggregation in order to classify information compiled in the information systems under its control for collection, access, use and disclosure 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.

# concept[].definition
Custodian system must render information unreadable by algorithmically transforming plaintext into ciphertext.

*Usage Notes:* A mathematical transposition of a file or data stream so that it cannot be deciphered at the receiving end without the proper key. Encryption is a security feature that assures that only the parties who are supposed to be participating in a videoconference or data transfer are able to do so. It can include a password, public and private keys, or a complex combination of all. (Per Infoway.)

# concept[].property[].valueString
A mathematical transposition of a file or data stream so that it cannot be deciphered at the receiving end without the proper key. Encryption is a security feature that assures that only the parties who are supposed to be participating in a videoconference or data transfer are able to do so. It can include a password, public and private keys, or a complex combination of all.  (Per Infoway.)

# concept[].definition
Custodian system must require human review and approval for permission requested.

# concept[].definition
Custodian security system must assign and bind security labels in order to classify information created in the information systems under its control for collection, access, use and disclosure in accordance with applicable jurisdictional privacy policies associated with the target information. The system must retain an immutable record of the assignment and binding.

*Usage Note:* In security systems, security policy label assignments do not change, they may supersede prior assignments, and such reassignments are always tracked for auditing and other purposes.

# concept[].definition
Custodian system must render information unreadable and unusable by algorithmically transforming plaintext into ciphertext. User may be provided a key to decrypt per license or "shared secret".

# concept[].definition
Custodian must limit access and disclosure to the minimum information required to support an authorized user's purpose of use.

*Usage Note:* Limiting the information available for access and disclosure to that an authorized user or receiver "needs to know" in order to perform permitted workflow or purpose of use.

# concept[].definition
Custodian security system must persist the binding of security labels to classify information received or imported by information systems under its control for collection, access, use and disclosure in accordance with applicable jurisdictional privacy policies associated with the target information. The system must retain an immutable record of the assignment and binding.

# concept[].definition
Custodian must create and/or maintain human readable security label tags as required by policy.

Map: Aligns with ISO 22600-3 Section A.3.4.3 description of privacy mark: "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."

# concept[].definition
Custodian system must strip information of data that would 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.

# concept[].definition
Custodian system must remove information, which is not authorized to be access, used, or disclosed from records made available to otherwise authorized users.

# concept[].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.

# concept[].definition
Custodian security system must take note that the data object contains inline security labels and process them.

# concept[].definition
Proposed therapy may be inappropriate or contraindicated due to patient age

# concept[].definition
Proposed therapy may be inappropriate or contraindicated due to an existing/recent patient condition or diagnosis

# concept[].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.

# concept[].definition
Proposed therapy may be inappropriate or contraindicated due to patient genetic indicators.

# concept[].definition
Proposed therapy may be inappropriate or contraindicated due to patient gender.

# concept[].definition
Proposed therapy may be inappropriate or contraindicated due to recent lab test results

# concept[].definition
Proposed therapy may be inappropriate or contraindicated based on the potential for a patient reaction to the proposed product

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

# concept[].definition
A clinician creates a request for a laboratory test to be done for a given patient.

# concept[].definition
A clinician creates a request for the administration of one or more medications to a given patient.

# concept[].definition
Hypersensitivity to an agent caused by an immunologic response to an initial exposure

# concept[].definition
Hypersensitivity resulting in an adverse reaction upon exposure to a drug.

# concept[].definition
Hypersensitivity resulting in an adverse reaction upon exposure to environmental conditions.

# concept[].definition
Hypersensitivity resulting in an adverse reaction upon exposure to food.

# concept[].definition
Hypersensitivity to an agent caused by a mechanism other than an immunologic response to an initial exposure

# concept[].definition
Organizational policy on collection, access, use, or disclosure of basic controlled unclassified information as defined by the organization or by applicable jurisdictional law.

# concept[].definition
Organizational policy on collection, access, use, or disclosure of de-identified information as defined by the organization or by applicable jurisdictional law.

# concept[].display
organizational limited data set information policy

# concept[].definition
Organizational policy on collection, access, use, or disclosure of information in a limited data set as defined by the organization or by applicable jurisdictional law.

# concept[].definition
Organizational policy on collection, access, use, or disclosure of information deemed non-sensitive by the organization or by applicable jurisdictional law.

# concept[].definition
Organizational policy on collection, access, use, or disclosure of public information as defined by the organization or by applicable jurisdictional law.

# concept[].definition
Organizational policy on collection, access, use, or disclosure of specified controlled unclassified information as defined by the organization or by applicable jurisdictional law.

# concept[].definition
Organizational policy on collection, access, use, or disclosure of uncontrolled unclassified information as defined by the organization or governing jurisdiction.

# concept[].definition
**Description:** A person reviews a list of known allergies of a given patient.

# concept[].definition
A clinician enters a clinical note about a given patient

# concept[].definition
**Description:** A person reviews a list of immunizations due or received for a given patient.

# concept[].definition
**Description:** A person reviews a list of health care reminders for a given patient.

# concept[].definition
**Description:** A person enters a known allergy for a given patient.

# concept[].display
clinical decision support intervention review

# concept[].definition
A person reviews a recommendation/assessment provided automatically by a clinical decision support application for a given patient.

# concept[].definition
A person reviews a clinical note of a given patient.

# concept[].definition
A person reviews a list of diagnoses of a given patient.

# concept[].definition
**Description:** A person enters an immunization due or received for a given patient.

# concept[].definition
A person reviews a list of laboratory results of a given patient.

# concept[].definition
A person reviews a list of microbiology results of a given patient.

# concept[].definition
A person reviews a list of medication orders submitted to a given patient

# concept[].definition
A person reviews a list of orders submitted to a given patient.

# concept[].definition
A person reviews a pathology report of a given patient.

# concept[].definition
A person reviews a list of problems of a given patient.

# concept[].definition
A person reviews a radiology report of a given patient.

# concept[].definition
**Description:** A person enters a health care reminder for a given patient.

# concept[].definition
A person reviews a Risk Assessment Instrument report of a given patient.

# concept[].display
violates stated preferences, alternate available

# concept[].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.

# concept[].definition
Personal policy on collection, access, use, or disclosure of de-identified information as defined by the information subject or by applicable jurisdictional law.

# concept[].display
personal limited data set information policy

# concept[].definition
Personal policy personal policy on collection, access, use, or disclosure of information in a limited data set by the information subject.

# concept[].definition
Personal policy on collection, access, use, or disclosure of information deemed non-sensitive by the information subject.

# concept[].definition
Personal policy on collection, access, use, or disclosure of information deemed public by the information subject.

# concept[].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.

# concept[].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.

# concept[].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

# concept[].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.

# concept[].definition
**Definition:** A public or government health program that administers and funds coverage for health and social services to assist program eligible who meet financial and health status criteria related to a particular disease.

**Example:** Reproductive health, sexually transmitted disease, and end renal disease programs.

# concept[].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).

# concept[].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.

# concept[].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).

# concept[].definition
**Definition:** A government health program that provides coverage 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.

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

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

# concept[].display
no disclosure without subject authorization

# concept[].definition
Prohibition on disclosure without information subject's authorization.

# concept[].definition
Prohibition on collection or storage of the information.

# concept[].definition
Prohibition on disclosure without organizational approved patient restriction.

# concept[].display
no disclosure without information subject's consent directive

# concept[].definition
Prohibition on disclosure without a consent directive from the information subject.

# concept[].definition
Prohibition on Integration into other records.

# concept[].definition
Prohibition on disclosure except to entities on specific access list.

# concept[].definition
Prohibition on disclosure without an interagency service agreement or memorandum of understanding (MOU).

# concept[].display
no disclosure to patient, family or caregivers without attending provider's authorization

# concept[].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).

# concept[].definition
Prohibition on collection of the information beyond time necessary to accomplish authorized purpose of use is prohibited.

# concept[].display
no redisclosure without consent directive

# concept[].definition
Prohibition on redisclosure without patient consent directive.

# concept[].display
no redisclosure without consent directive

# concept[].definition
Prohibition on redisclosure without patient consent directive.

# concept[].display
no redisclosure without information subject's consent directive

# concept[].definition
Prohibition on redisclosure without a consent directive from the information subject.

# concept[].definition
Prohibition on disclosure without authorization under jurisdictional law.

# concept[].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.

# concept[].definition
Prohibition on use of the information beyond the purpose of use initially authorized.

# concept[].definition
Prohibition on disclosure except to principals with access permission to specific VIP information.

# concept[].display
no disclosure without originator authorization

# concept[].definition
Prohibition on disclosure except as permitted by the information originator.

# concept[].definition
**Description:** A person enters a wellness or preventive care reminder for a given patient.

# concept[].definition
**Description:** A person reviews a list of wellness or preventive care reminders for a given patient.

# concept[].definition
**Description:**The number of repeating elements is above the maximum number of repetitions allowed.

# concept[].definition
**Description:**The number of repeating elements is below the minimum number of repetitions allowed.

# concept[].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.

# concept[].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.

# concept[].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.)

# concept[].definition
The first fill against an order that has already been filled at least once at another facility.

# concept[].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.)

# concept[].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).

# concept[].definition
A fill where the remainder of a 'complete' fill is provided after a trial fill has been provided.

# concept[].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).

# concept[].display
refill partial strength (first fill this facility)

# concept[].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).

# concept[].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).

# concept[].definition
A person reviews a Falls Risk Assessment Instrument report of a given patient.

# concept[].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.)

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

# concept[].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.)

# concept[].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

# concept[].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.

# concept[].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.

# concept[].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

# concept[].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.

# concept[].display
security integrity provenance asserted by observation

# concept[].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

# concept[].display
security integrity provenance reported by observation

# concept[].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

# concept[].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)

# concept[].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".

# concept[].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

# concept[].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

# concept[].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.

# concept[].definition
Type of security 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.

# concept[].definition
Type of security metadata observation made about privacy and security requirements with which a security domain must comply. \[ISO IEC 10181-1\]

# concept[].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. \[Trust Service Principles and Criteria for Certification Authorities Version 2.0 March 2011 Copyright 2011 by Canadian Institute of Chartered Accountants.\]

# concept[].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. \[Kantara Initiative\]

# concept[].definition
Type of security metadata observation made about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.

# concept[].definition
Type of security metadata observation made about a security architecture system component that supports enforcement of security policies.

# concept[].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.

# concept[].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.

# concept[].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.

# concept[].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

# concept[].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.

# concept[].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.

# concept[].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)

# concept[].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)

# concept[].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.

# concept[].property[].valueString
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.

# concept[].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.

# concept[].definition
Conveys prohibited actions which an information custodian, receiver, or user is not permitted to perform unless otherwise authorized or permitted under specified circumstances.

*Usage Notes:* ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing". Per HL7 Composite Security and Privacy Domain Analysis Model: May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

# concept[].property[].valueString
ISO 22600-2 species that a Refrain Policy "defines actions the subjects must refrain from performing".  Per HL7 Composite Security and Privacy Domain Analysis Model:  May be used to indicate that a specific action is prohibited based on specific access control attributes e.g., purpose of use, information type, user role, etc.

# concept[].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.

# concept[].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.

# concept[].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.

# concept[].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.

# concept[].display
substance use disorder information sensitivity

# concept[].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.

# concept[].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.

# concept[].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.

# concept[].display
alcohol use disorder information sensitivity

# concept[].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.

# concept[].display
opioid use disorder information sensitivity

# concept[].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.

# concept[].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).

# concept[].definition
**Definition:**Proposed therapy may be inappropriate or ineffective because the end of administration is too close to another planned therapy.

# concept[].definition
**Definition:**Proposed therapy may be inappropriate or ineffective because the start of administration is too late after the onset of the condition.

# concept[].definition
**Definition:**The therapy action is being performed outside the bounds of the time period requested

# concept[].display
too soon within frequency based on the usage

# concept[].definition
**Definition:**The therapy action is being performed too soon after the previous occurrence based on the requested frequency

# concept[].definition
Proposed therapy may interact with an existing or recent drug therapy

# concept[].definition
Proposed therapy may interact with existing or recent natural health product therapy

# concept[].definition
Proposed therapy may interact with a non-prescription drug (e.g. alcohol, tobacco, Aspirin)

# concept[].definition
Transfer of ownership for a product for financial compensation.

# concept[].definition
**Description:**A local business rule relating multiple elements has been violated.

# concept[].definition
**Description:**The specified code is not valid against the list of codes allowed for the element.

# concept[].definition
**Description:**The element does not follow the formatting or type rules defined for the field.

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

# concept[].definition
**Description:**The length of the data specified falls out of the range defined for the element.

# concept[].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.

# concept[].definition
**Description:**The specified element is mandatory and was not included in the instance.

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

# concept[].definition
**Description:** Element in submitted message will not persist in data storage based on detected issue.

# concept[].definition
**Description:**The number of repeating elements falls outside the range of the allowed number of repetitions.

# concept[].definition
The available quantity of specimen. This is the current quantity minus any planned consumption (e.g., tests that are planned)

# concept[].definition
The quantity of specimen that is used each time the equipment uses this substance

# concept[].definition
The current quantity of the specimen, i.e., initial quantity minus what has been actually used.

# concept[].definition
The initial quantity of the specimen in inventory