# text.div
Generated Narrative: CodeSystem v3-ActReason

Language: en

Properties

This code system defines the following properties for its concepts

Name | Code | URI | Type | Description
Status | status | http://hl7.org/fhir/concept-properties#status | code | Designation of a concept's state. Normally is not populated unless the state is retired..
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
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-ActReason defines the following codes in a Is-A hierarchy:

Lvl | Code | Display | Definition | Status | Not Selectable | HL7 Concept Usage Notes | Parent

1

_ActAccommodationReason

ActAccommodationReason

Identifies the reason the patient is assigned to this accommodation type

active

true

2

ACCREQNA

Accommodation Requested Not Available

Accommodation requested is not available.

active

_ActAccommodationReason

2

FLRCNV

Floor Convenience

Accommodation is assigned for floor convenience.

active

_ActAccommodationReason

2

MEDNEC

Medical Necessity

Required for medical reasons(s).

active

_ActAccommodationReason

2

PAT

Patient request

The Patient requested the action

active

_ActAccommodationReason, _SchedulingActReason, _SubstanceAdminSubstitutionNotAllowedReason

1

_ActCoverageReason

ActCoverageReason

**Description:**Codes used to specify reasons or criteria relating to coverage provided under a policy or program. May be used to convey reasons pertaining to coverage contractual provisions, including criteria for eligibility, coverage limitations, coverage maximums, or financial participation required of covered parties.

active

true

2

_EligibilityActReasonCode

EligibilityActReasonCode

Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.

Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.

active

true

_ActCoverageReason

3

_ActIneligibilityReason

ActIneligibilityReason

Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.

Examples are client deceased & adopted client has been given a new policy identifier.

active

true

_EligibilityActReasonCode

4

COVSUS

coverage suspended

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

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

active

_ActIneligibilityReason

4

DECSD

deceased

Client deceased.

active

_ActIneligibilityReason

4

REGERR

registered in error

Client was registered in error.

active

_ActIneligibilityReason

3

_CoverageEligibilityReason

CoverageEligibilityReason

Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.

Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.

active

true

_EligibilityActReasonCode

4

AGE

age eligibility

A person becomes eligible for a program based on age.

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

active

_CoverageEligibilityReason

4

CRIME

crime victim

A person becomes eligible for insurance or a program because of crime related health condition or injury.

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

active

_CoverageEligibilityReason

4

DIS

disability

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

active

_CoverageEligibilityReason

4

EMPLOY

employment benefit

A person becomes eligible for insurance provided as an employment benefit based on employment status.

active

_CoverageEligibilityReason

4

FINAN

financial eligibility

A person becomes eligible for a program based on financial criteria.

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

active

_CoverageEligibilityReason

4

HEALTH

health status

A person becomes eligible for a program because of a qualifying health condition or injury.

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

active

_CoverageEligibilityReason

4

MULTI

multiple criteria eligibility

A person becomes eligible for a program based on more than one criterion.

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

active

_CoverageEligibilityReason

4

PNC

property and casualty condition

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

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

active

_CoverageEligibilityReason

4

STATUTORY

statutory eligibility

A person becomes eligible for a program based on statutory criteria.

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

active

_CoverageEligibilityReason

4

VEHIC

motor vehicle accident victim

A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.

active

_CoverageEligibilityReason

4

WORK

work related

A person becomes eligible for insurance or a program because of a work related health condition or injury.

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

active

_CoverageEligibilityReason

2

_ActCoverageProviderReason

ActCoverageProviderReason

**Description:**Identifies the reason or rationale for coverage of a service or product based on characteristics of the provider, e.g., contractual relationship to payor, such as in or out-of-network; relationship of the covered party to the provider.

**Example:**In closed managed care plan, a covered party is assigned a primary care provider who provides primary care services and authorizes referrals and ancillary and non-primary care services.

retired

true

_ActCoverageReason

2

_ActCoverageServiceReason

ActCoverageServiceReason

**Description:**Identifies the reason or rationale for coverage of a service or product based on clinical efficacy criteria or practices prescribed by the payor.

retired

true

_ActCoverageReason

2

_CoverageExclusionReason

CoverageExclusionReason

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

retired

true

_ActCoverageReason

2

_CoverageFinancialParticipationReason

CoverageFinancialParticipationReason

**Description:**Identifies the reason or rationale for coverage of a service or product based on financial participation responsibilities of the covered party.

retired

true

_ActCoverageReason

2

_CoverageLimitationReason

CoverageLimitationReason

**Description:**Identifies the reason or rationale for limitations on the coverage of a service or product based on coverage contract provisions.

**Example:**The maximum cost per unit; or the maximum number of units per period, which is typically the policy or program effective time.

retired

true

_ActCoverageReason

2

gold-card

Gold card

Ordering Practitioner has been granted 'gold card' status with this payer/coverage type. This status indicates that, because of their prior track record, fewer services require prior authorization and/or documentation requirements associated with prior authorization requests are reduced. While the phrase 'gold-card' is specific to U.S. national and state regulation, the concept can be used in other jurisdictions where the semantics are appropriate.

active

_ActCoverageReason

1

_ActInformationManagementReason

ActInformationManagementReason

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

active

true

2

_ActHealthInformationManagementReason

ActHealthInformationManagementReason

**Description:**The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.

active

true

_ActInformationManagementReason

3

_ActConsentInformationAccessOverrideReason

ActConsentInformationAccessOverrideReason

To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.

Usage Notes: Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.

active

true

Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.

_ActHealthInformationManagementReason

4

OVRER

emergency treatment override

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

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

active

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

_ActConsentInformationAccessOverrideReason

4

OVRINCOMP

incompetency override

To perform one or more operations on information to which the patient has not consented because deemed incompetent to provide consent.

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

active

_ActConsentInformationAccessOverrideReason

4

OVRPJ

professional judgment override

To perform one or more operations on information to which the patient declined to consent for providing health care.

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

active

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

_ActConsentInformationAccessOverrideReason

4

OVRPS

public safety override

To perform one or more operations on information to which the patient has not consented for public safety reasons.

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

active

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

_ActConsentInformationAccessOverrideReason

4

OVRTPS

third party safety override

To perform one or more operations on information to which the patient has not consented for third party safety.

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

active

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

_ActConsentInformationAccessOverrideReason

3

PurposeOfUse

purpose of use

Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.

Usage Notes: The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.

active

true

The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.

_ActHealthInformationManagementReason

4

HMARKT

healthcare marketing

To perform one or more operations on information for marketing services and products related to health care.

active

PurposeOfUse

4

HOPERAT

healthcare operations

To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.

active

PurposeOfUse

5

CAREMGT

care management

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

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

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

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

active

HOPERAT

5

DONAT

donation

To perform one or more operations on information used for cadaveric organ, eye or tissue donation.

active

HOPERAT

5

FRAUD

fraud

To perform one or more operations on information used for fraud detection and prevention processes.

active

HOPERAT

5

GOV

government

To perform one or more operations on information used within government processes.

active

HOPERAT

5

HACCRED

health accreditation

To perform one or more operations on information for conducting activities related to meeting accreditation criteria.

active

HOPERAT

5

HCOMPL

health compliance

To perform one or more operations on information used for conducting activities required to meet a mandate.

active

HOPERAT

5

HDECD

decedent

To perform one or more operations on information used for handling deceased patient matters.

active

HOPERAT

5

HDIRECT

directory

To perform one or more operation operations on information used to manage a patient directory.

Examples:

facility

enterprise

payer

health information exchange patient directory

active

HOPERAT

5

HDM

healthcare delivery management

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

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

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

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

active

HOPERAT

5

HLEGAL

legal

To perform one or more operations on information for conducting activities required by legal proceeding.

active

HOPERAT

5

HOUTCOMS

health outcome measure

To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.

active

HOPERAT

5

HPRGRP

health program reporting

To perform one or more operations on information used for conducting activities to meet program accounting requirements.

active

HOPERAT

5

HQUALIMP

health quality improvement

To perform one or more operations on information used for conducting administrative activities to improve health care quality.

active

HOPERAT

5

HSYSADMIN

health system administration

To perform one or more operations on information to administer the electronic systems used for the delivery of health care.

active

HOPERAT

6

LABELING

labeling

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

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

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

active

HSYSADMIN

6

METAMGT

metadata management

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

active

HSYSADMIN

5

MEMADMIN

member administration

To perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.

active

HOPERAT

5

MILCDM

military command

To perform one or more operations on information for conducting activities required by military processes, procedures, policies, or law.

active

HOPERAT

5

PATADMIN

patient administration

To perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.

active

HOPERAT

5

PATSFTY

patient safety

To perform one or more operations on information in processes related to ensuring the safety of health care.

active

HOPERAT

5

PERFMSR

performance measure

To perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.

active

HOPERAT

5

RECORDMGT

records management

To perform one or more operations on information used within the health records management process.

active

HOPERAT

5

SYSDEV

system development

To perform one or more operations on information to design, develop, implement, test, or deploy a healthcare system or application.

active

HOPERAT

6

HTEST

test health data

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

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

active

SYSDEV

5

TRAIN

training

To perform one or more operations on information used in training and education.

active

HOPERAT

5

MLTRAINING

machine learning training

To perform one or more operations on information used in training a machine learning (AI) model.

active

HOPERAT

4

HPAYMT

healthcare payment

To perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.

active

PurposeOfUse

5

CLMATTCH

claim attachment

To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.

active

HPAYMT

5

COVAUTH

coverage authorization

To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.

active

HPAYMT

5

COVERAGE

coverage under policy or program

To perform one or more operations on information for conducting activities related to coverage under a program or policy.

active

HPAYMT

6

ELIGDTRM

eligibility determination

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

active

COVERAGE

6

ELIGVER

eligibility verification

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

active

COVERAGE

6

ENROLLM

enrollment

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

active

COVERAGE

6

MILDCRG

military discharge

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

active

COVERAGE

5

REMITADV

remittance advice

To perform one or more operations on information about the amount remitted for a health care claim.

active

HPAYMT

5

PMTDS

decision support assisted payment decision

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

active

HPAYMT

4

HRESCH

healthcare research

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

active

PurposeOfUse

5

BIORCH

biomedical research

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

active

HRESCH

5

CLINTRCH

clinical trial research

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

active

HRESCH

6

CLINTRCHNPC

clinical trial research without patient care

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

active

CLINTRCH

6

CLINTRCHPC

clinical trial research with patient care

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

active

CLINTRCH

6

PRECLINTRCH

preclinical trial research

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

active

CLINTRCH

5

DSRCH

disease specific healthcare research

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

active

HRESCH

5

POARCH

population origins or ancestry healthcare research

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

active

HRESCH

5

TRANSRCH

translational healthcare research

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

active

HRESCH

4

PATRQT

patient requested

To perform one or more operations on information in response to a patient's request.

active

PurposeOfUse

5

FAMRQT

family requested

To perform one or more operations on information in response to a request by a family member authorized by the patient.

active

PATRQT

5

PWATRNY

power of attorney

To perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.

active

PATRQT

5

SUPNWK

support network

To perform one or more operations on information in response to a request by a person authorized by the patient.

active

PATRQT

4

PUBHLTH

public health

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

active

PurposeOfUse

5

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.

active

PUBHLTH

5

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.

active

PUBHLTH

4

TREAT

treatment

To perform one or more operations on information for provision of health care.

active

PurposeOfUse

5

CLINTRL

clinical trial

To perform health care as part of the clinical trial protocol.

active

TREAT

5

COC

coordination of care

To perform one or more actions on information in order to organize the provision and case management of an individual's healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care.

Usage Note: Use when describing these functions: 1. Monitoring a person's goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care.

The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment.

For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare.

Map: Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."

active

TREAT

5

ETREAT

Emergency Treatment

To perform one or more operations on information for provision of immediately needed health care for an emergent condition.

active

TREAT

6

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.

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

active

ETREAT

6

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.

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

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

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

active

ETREAT

5

POPHLTH

population health

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

active

TREAT

5

TREATDS

decision support assisted treatment decision

To apply algorithms (e.g. AI, CDS) to perform one or more operations on information to arrive at decision used in health care treatment.

active

TREAT

3

_ActHealthInformationPrivacyReason

ActHealthInformationPrivacyReason

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

retired

true

_ActHealthInformationManagementReason

2

_ActInformationPrivacyReason

ActInformationPrivacyReason

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

active

true

_ActInformationManagementReason

3

MARKT

marketing

Description:

active

_ActInformationPrivacyReason

3

OPERAT

operations

**Description:**Administrative and contractual processes required to support an activity, product, or service

active

_ActInformationPrivacyReason

4

LEGAL

subpoena

**Definition:**To provide information as a result of a subpoena.

active

_PatientProfileQueryReasonCode, OPERAT

4

ACCRED

accreditation

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

active

OPERAT

4

COMPL

compliance

**Description:**Operational activities required to meet a mandate related to an activity, product, or service

active

OPERAT

4

ENADMIN

entity administration

**Description:**Operational activities conducted to administer information relating to entities involves with an activity, product, or service

active

OPERAT

4

OUTCOMS

outcome measure

**Description:**Operational activities conducted for the purposes of assessing the results of an activity, product, or service

active

OPERAT

4

PRGRPT

program reporting

**Description:**Operational activities conducted to meet program accounting requirements related to an activity, product, or service

active

OPERAT

4

QUALIMP

quality improvement

**Description:**Operational activities conducted for the purposes of improving the quality of an activity, product, or service

active

OPERAT

4

SYSADMN

system administration

**Description:**Operational activities conducted to administer the electronic systems used for an activity, product, or service

active

OPERAT

3

PAYMT

payment

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

active

_ActInformationPrivacyReason

3

RESCH

research

**Description:**Investigative activities conducted for the purposes of obtaining knowledge

active

_ActInformationPrivacyReason

3

SRVC

service

**Description:**Provision of a service, product, or capability to an individual or organization

active

_ActInformationPrivacyReason

1

_ActInvalidReason

ActInvalidReason

Description: Types of reasons why a substance is invalid for use.

active

2

ADVSTORAGE

adverse storage condition

Description: Storage conditions caused the substance to be ineffective.

active

_ActInvalidReason

3

COLDCHNBRK

cold chain break

Description: Cold chain was not maintained for the substance.

active

ADVSTORAGE

2

EXPLOT

expired lot

Description: The lot from which the substance was drawn was expired.

active

_ActInvalidReason

2

OUTSIDESCHED

administered outside recommended schedule or practice

The substance was administered outside of the recommended schedule or practice.

active

_ActInvalidReason

2

PRODRECALL

product recall

Description: The substance was recalled by the manufacturer.

active

_ActInvalidReason

1

_ActInvoiceCancelReason

ActInvoiceCancelReason

Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.

active

true

2

INCCOVPTY

incorrect covered party as patient

The covered party (patient) specified with the Invoice is not correct.

active

_ActInvoiceCancelReason

2

INCINVOICE

incorrect billing

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

active

_ActInvoiceCancelReason

2

INCPOLICY

incorrect policy

The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.

active

_ActInvoiceCancelReason

2

INCPROV

incorrect provider

The provider specified with the Invoice is not correct.

active

_ActInvoiceCancelReason

1

_ActNoImmunizationReason

ActNoImmunizationReason

A coded description of the reason for why a patient did not receive a scheduled immunization.

(important for public health strategy

active

true

2

IMMUNE

immunity

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

active

_ActNoImmunizationReason

2

MEDPREC

medical precaution

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

active

_ActNoImmunizationReason

2

OSTOCK

product out of stock

**Definition:**There was no supply of the product on hand to perform the service.

active

_ActNoImmunizationReason

2

PATOBJ

patient objection

**Definition:**The patient or their guardian objects to receiving the vaccine.

active

_ActNoImmunizationReason

2

PHILISOP

philosophical objection

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

active

_ActNoImmunizationReason

2

RELIG

religious objection

**Definition:**The patient or their guardian objects to receiving the vaccine on religious grounds.

active

_ActNoImmunizationReason

2

VACEFF

vaccine efficacy concerns

**Definition:**The intended vaccine has expired or is otherwise believed to no longer be effective.

**Example:**Due to temperature exposure.

active

_ActNoImmunizationReason

2

VACSAF

vaccine safety concerns

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

active

_ActNoImmunizationReason

1

_ActSupplyFulfillmentRefusalReason

ActSupplyFulfillmentRefusalReason

Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated".

(used when capturing 'refusal to fill' annotations)

active

true

2

FRR01

order stopped

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

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

active

_ActSupplyFulfillmentRefusalReason

2

FRR02

stale-dated order

**Definition:**Order has not been fulfilled within a reasonable amount of time, and may not be current.

active

_ActSupplyFulfillmentRefusalReason

2

FRR03

incomplete data

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

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

active

_ActSupplyFulfillmentRefusalReason

2

FRR04

product unavailable

**Definition:**Product not available or manufactured. Cannot supply.

active

_ActSupplyFulfillmentRefusalReason

2

FRR05

ethical/religious

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

active

_ActSupplyFulfillmentRefusalReason

2

FRR06

unable to provide care

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

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

active

_ActSupplyFulfillmentRefusalReason

1

_ClinicalResearchEventReason

ClinicalResearchEventReason

**Definition:**Specifies the reason that an event occurred in a clinical research study.

active

true

2

RET

retest

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

active

_ClinicalResearchEventReason

2

SCH

scheduled

**Definition:**The event occurred due to it being scheduled in the research protocol.

active

_ClinicalResearchEventReason

2

TRM

termination

**Definition:**The event occurred in order to terminate the subject's participation in the study.

active

_ClinicalResearchEventReason

2

UNS

unscheduled

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

active

_ClinicalResearchEventReason

1

_ClinicalResearchObservationReason

ClinicalResearchObservationReason

**Definition:**SSpecifies the reason that a test was performed or observation collected in a clinical research study.

**Note:**This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.

active

true

2

NPT

non-protocol

**Definition:**The observation or test was neither defined or scheduled in the study protocol.

active

_ClinicalResearchObservationReason

2

PPT

per protocol

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

active

_ClinicalResearchObservationReason

2

UPT

per definition

**:**The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.

active

_ClinicalResearchObservationReason

1

_CombinedPharmacyOrderSuspendReasonCode

CombinedPharmacyOrderSuspendReasonCode

**Description:**Indicates why the prescription should be suspended.

active

true

2

ALTCHOICE

try another treatment first

**Description:**This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.

active

_CombinedPharmacyOrderSuspendReasonCode

2

CLARIF

prescription requires clarification

**Description:**Clarification is required before the order can be acted upon.

active

_CombinedPharmacyOrderSuspendReasonCode

2

DRUGHIGH

drug level too high

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

HOSPADM

admission to hospital

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

LABINT

lab interference issues

**Description:**The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.

active

_CombinedPharmacyOrderSuspendReasonCode

2

NON-AVAIL

patient not-available

**Description:**Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.

active

_CombinedPharmacyOrderSuspendReasonCode

2

PREG

parent is pregnant/breast feeding

**Description:**The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.

active

_CombinedPharmacyOrderSuspendReasonCode

2

SALG

allergy

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

SDDI

drug interacts with another drug

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

SDUPTHER

duplicate therapy

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

SINTOL

suspected intolerance

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

SURG

patient scheduled for surgery

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

active

_CombinedPharmacyOrderSuspendReasonCode

2

WASHOUT

waiting for old drug to wash out

**Description:**The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.

active

_CombinedPharmacyOrderSuspendReasonCode

1

_ControlActNullificationReasonCode

ControlActNullificationReasonCode

**Description:**Identifies reasons for nullifying (retracting) a particular control act.

active

2

ALTD

altered decision

**Description:**The decision on which the recorded information was based was changed before the decision had an effect.

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

active

_ControlActNullificationReasonCode

2

EIE

entered in error

**Description:**The information was recorded incorrectly or was recorded in the wrong record.

active

_ControlActNullificationReasonCode

2

NORECMTCH

no record match

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

active

_ControlActNullificationReasonCode, _StatusRevisionRefusalReasonCode, NOMATCH

1

_ControlActNullificationRefusalReasonType

ControlActNullificationRefusalReasonType

Description: Reasons to refuse a transaction to be undone.

active

true

2

INRQSTATE

in requested state

The record is already in the requested state.

active

_ControlActNullificationRefusalReasonType, _StatusRevisionRefusalReasonCode

2

NOMATCH

no match

Description: There is no match.

active

_ControlActNullificationRefusalReasonType, _RefusalReasonCode

3

NOPRODMTCH

no product match

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

active

NOMATCH

3

NOSERMTCH

no service match

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

active

NOMATCH

3

NOVERMTCH

no version match

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

active

NOMATCH

3 | NORECMTCH | no record match |

2

NOPERM

no permission

Description: There is no permission.

active

_ControlActNullificationRefusalReasonType, _RefusalReasonCode

3

NOUSERPERM

no user permission

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

active

_PharmacySupplyRequestFulfillerRevisionRefusalReasonCode, _StatusRevisionRefusalReasonCode, _SubstanceAdministrationPermissionRefusalReasonCode, NOPERM

3

NOAGNTPERM

no agent permission

Description: The agent does not have permission.

active

NOPERM

3

NOUSRPERM

no user permission

Description: The user does not have permission.

retired

NOPERM

2

WRNGVER

wrong version

Description: The record and version requested to update is not the current version.

active

_ControlActNullificationRefusalReasonType

1

_ControlActReason

ControlActReason

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

active

true

2

_MedicationOrderAbortReasonCode

medication order abort reason

**Description:**Indicates the reason the medication order should be aborted.

active

true

_ControlActReason

3

DISCONT

product discontinued

**Description:**The medication is no longer being manufactured or is otherwise no longer available.

active

_MedicationOrderAbortReasonCode, _PharmacySupplyRequestRenewalRefusalReasonCode

3

INEFFECT

ineffective

**Description:**The therapy has been found to not have the desired therapeutic benefit on the patient.

active

_MedicationOrderAbortReasonCode

3

MONIT

response to monitoring

**Description:**Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.

active

_MedicationOrderAbortReasonCode

3

NOREQ

no longer required for treatment

**Description:**The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.

active

_MedicationOrderAbortReasonCode

3

NOTCOVER

not covered

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

active

_MedicationOrderAbortReasonCode

3

PREFUS

patient refuse

**Description:**The patient refused to take the product.

active

_MedicationOrderAbortReasonCode

3

RECALL

product recalled

**Description:**The manufacturer or other agency has requested that stocks of a medication be removed from circulation.

active

_MedicationOrderAbortReasonCode

3

REPLACE

change in order

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

active

_MedicationOrderAbortReasonCode

4

DOSECHG

change in medication/dose

**Description:**The medication is being re-prescribed at a different dosage.

active

REPLACE

3

REPLACEFIX

error in order

**Description:**Current order was issued with incorrect data and a new order has/will be created to replace it.

active

_MedicationOrderAbortReasonCode

3

UNABLE

unable to use

Description:<The patient is not (or is no longer) able to use the medication in a manner prescribed.

**Example:**CanaTMt swallow.

active

_MedicationOrderAbortReasonCode

2

_MedicationOrderReleaseReasonCode

medication order release reason

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

active

true

_ControlActReason

3

HOLDDONE

suspend reason no longer applies

**Definition:**The original reason for suspending the medication has ended.

active

_MedicationOrderReleaseReasonCode

3

HOLDINAP

suspend reason inappropriate

Definition:

active

_MedicationOrderReleaseReasonCode

2

_ModifyPrescriptionReasonType

ModifyPrescriptionReasonType

Types of reason why a prescription is being changed.

active

true

_ControlActReason

3

ADMINERROR

administrative error in order

Order was created with incorrect data and is changed to reflect the intended accuracy of the order.

active

_ModifyPrescriptionReasonType

3

CLINMOD

clinical modification

Order is changed based on a clinical reason.

active

_ModifyPrescriptionReasonType

2

_PharmacySupplyEventAbortReason

PharmacySupplyEventAbortReason

**Definition:**Identifies why the dispense event was not completed.

active

_ControlActReason

3

CONTRA

contraindication

**Definition:**Contraindication identified

active

_PharmacySupplyEventAbortReason

3

FOABORT

order aborted

**Definition:**Order to be fulfilled was aborted

active

_PharmacySupplyEventAbortReason

3

FOSUSP

order suspended

**Definition:**Order to be fulfilled was suspended

active

_PharmacySupplyEventAbortReason

3

NOPICK

not picked up

**Definition:**Patient did not come to get medication

active

_PharmacySupplyEventAbortReason

3

PATDEC

patient changed mind

**Definition:**Patient changed their mind regarding obtaining medication

active

_PharmacySupplyEventAbortReason

3

QUANTCHG

change supply quantity

**Definition:**Patient requested a revised quantity of medication

active

_PharmacySupplyEventAbortReason

2

_PharmacySupplyEventStockReasonCode

pharmacy supply event stock reason

**Definition:**A collection of concepts that indicates the reason for a "bulk supply" of medication.

active

true

_ControlActReason

3

FLRSTCK

floor stock

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

active

_PharmacySupplyEventStockReasonCode

3

LTC

long term care use

**Definition:**The bulk supply will be administered within a long term care facility.

active

_PharmacySupplyEventStockReasonCode

3

OFFICE

office use

**Definition:**The bulk supply is intended for general clinician office use.

active

_PharmacySupplyEventStockReasonCode

3

PHARM

pharmacy transfer

**Definition:**The bulk supply is being transferred to another dispensing facility to.

**Example:**Alleviate a temporary shortage.

active

_PharmacySupplyEventStockReasonCode

3

PROG

program use

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

**Example:**Mass immunization.

active

_PharmacySupplyEventStockReasonCode

2

_PharmacySupplyRequestRenewalRefusalReasonCode

pharmacy supply request renewal refusal reason

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

active

true

_ControlActReason

3

ALREADYRX

new prescription exists

**Definition:**Patient has already been given a new (renewal) prescription.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

FAMPHYS

family physician must authorize further fills

**Definition:**Request for further authorization must be done through patient's family physician.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

MODIFY

modified prescription exists

**Definition:**Therapy has been changed and new prescription issued

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

NEEDAPMT

patient must make appointment

**Definition:**Patient must see prescriber prior to further fills.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

NOTAVAIL

prescriber not available

**Definition:**Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

NOTPAT

patient no longer in this practice

**Definition:**Patient no longer or has never been under this prescribers care.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

ONHOLD

medication on hold

**Definition:**This medication is on hold.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

PRNA

product not available

**Description:**This product is not available or manufactured.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

STOPMED

prescriber stopped medication for patient

Renewing or original prescriber informed patient to stop using the medication.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3

TOOEARLY

too early

**Definition:**The patient should have medication remaining.

active

_PharmacySupplyRequestRenewalRefusalReasonCode

3 | DISCONT | product discontinued |

2

_SupplyOrderAbortReasonCode

supply order abort reason

**Definition:**A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).

active

true

_ControlActReason

3

IMPROV

condition improved

**Definition:**The patient's medical condition has nearly abated.

active

_SupplyOrderAbortReasonCode

3

INTOL

intolerance

**Description:**The patient has an intolerance to the medication.

active

_SupplyOrderAbortReasonCode

3

NEWSTR

new strength

**Definition:**The current medication will be replaced by a new strength of the same medication.

active

_SupplyOrderAbortReasonCode

3

NEWTHER

new therapy

**Definition:**A new therapy will be commenced when current supply exhausted.

active

_SupplyOrderAbortReasonCode

2

_ControlActReasonConditionNullify

ControlActReasonConditionNullify

Indicates why the ConditionaTMs status was changed to Nullified. Examples administrative error, diagnostic error.

retired

true

_ControlActReason

1

_GenericUpdateReasonCode

GenericUpdateReasonCode

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

active

true

2

CHGDATA

information change

**Description:**Information has changed since the record was created.

active

_GenericUpdateReasonCode

2

FIXDATA

error correction

**Description:**Previously recorded information was erroneous and is being corrected.

active

_GenericUpdateReasonCode

2

MDATA

merge data

Information is combined into the record.

active

_GenericUpdateReasonCode

2

NEWDATA

new information

**Description:**New information has become available to supplement the record.

active

_GenericUpdateReasonCode

2

UMDATA

unmerge data

Information is separated from the record.

active

_GenericUpdateReasonCode

1

_PatientProfileQueryReasonCode

patient profile query reason

**Definition:**A collection of concepts identifying why the patient's profile is being queried.

active

true

2

ADMREV

administrative review

Definition: To evaluate for service authorization, payment, reporting, or performance/outcome measures.

active

_PatientProfileQueryReasonCode

2

PATCAR

patient care

**Definition:**To obtain records as part of patient care.

active

_PatientProfileQueryReasonCode

2

PATREQ

patient request query

**Definition:**Patient requests information from their profile.

active

_PatientProfileQueryReasonCode

2

PRCREV

practice review

**Definition:**To evaluate the provider's current practice for professional-improvement reasons.

active

_PatientProfileQueryReasonCode

2

REGUL

regulatory review

**Description:**Review for the purpose of regulatory compliance.

active

_PatientProfileQueryReasonCode

2

RSRCH

research

**Definition:**To provide research data, as authorized by the patient.

active

_PatientProfileQueryReasonCode

2

VALIDATION

validation review

**Description:**To validate the patient's record.

**Example:**Merging or unmerging records.

active

_PatientProfileQueryReasonCode

2 | LEGAL | subpoena |

1

_PharmacySupplyRequestFulfillerRevisionRefusalReasonCode

PharmacySupplyRequestFulfillerRevisionRefusalReasonCode

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

active

2

LOCKED

locked

**Definition:**The prescription may not be reassigned from the original pharmacy.

active

_PharmacySupplyRequestFulfillerRevisionRefusalReasonCode

2

UNKWNTARGET

unknown target

**Definition:**The target facility does not recognize the dispensing facility.

active

_PharmacySupplyRequestFulfillerRevisionRefusalReasonCode

2 | NOUSERPERM | no user permission |

1

_RefusalReasonCode

RefusalReasonCode

Description: Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.

active

true

2 | NOMATCH | no match |
2 | NOPERM | no permission |

1

_SchedulingActReason

SchedulingActReason

Reasons for cancelling or rescheduling an Appointment

active

true

2

BLK

Unexpected Block (of Schedule)

The time slots previously allocated are now blocked and no longer available for booking Appointments

active

_SchedulingActReason

2

DEC

Patient Deceased

The Patient is deceased

active

_SchedulingActReason

2

FIN

No Financial Backing

Patient unable to pay and not covered by insurance

active

_SchedulingActReason

2

MED

Medical Status Altered

The medical condition of the Patient has changed

active

_SchedulingActReason

2

MTG

In an outside meeting

The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment

active

_SchedulingActReason

2

PHY

Physician request

The Physician requested the action

active

_SchedulingActReason

2 | PAT | Patient request |

1

_StatusRevisionRefusalReasonCode

StatusRevisionRefusalReasonCode

Indicates why the act revision (status update) is being refused.

active

2

FILLED

fully filled

Ordered quantity has already been completely fulfilled.

active

_StatusRevisionRefusalReasonCode

2 | NORECMTCH | no record match |
2 | INRQSTATE | in requested state |
2 | NOUSERPERM | no user permission |

1

_SubstanceAdministrationPermissionRefusalReasonCode

SubstanceAdministrationPermissionRefusalReasonCode

**Definition:**Indicates why the requested authorization to prescribe or dispense a medication has been refused.

active

2

PATINELIG

patient not eligible

**Definition:**Patient not eligible for drug

active

_SubstanceAdministrationPermissionRefusalReasonCode

2

PROTUNMET

protocol not met

**Definition:**Patient does not meet required protocol

active

_SubstanceAdministrationPermissionRefusalReasonCode

2

PROVUNAUTH

provider not authorized

**Definition:**Provider is not authorized to prescribe or dispense

active

_SubstanceAdministrationPermissionRefusalReasonCode

2 | NOUSERPERM | no user permission |

1

_SubstanceAdminSubstitutionNotAllowedReason

SubstanceAdminSubstitutionNotAllowedReason

Reasons why substitution of a substance administration request is not permitted.

active

true

2

ALGINT

allergy intolerance

Definition: Patient has had a prior allergic intolerance response to alternate product or one of its components.

active

_SubstanceAdminSubstitutionNotAllowedReason

2

COMPCON

compliance concern

Definition: Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.

active

_SubstanceAdminSubstitutionNotAllowedReason

2

THERCHAR

therapeutic characteristics

The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.

active

_SubstanceAdminSubstitutionNotAllowedReason

2

TRIAL

clinical trial drug

Definition: The specific manufactured drug is part of a clinical trial.

active

_SubstanceAdminSubstitutionNotAllowedReason

2 | PAT | Patient request |
1 | _SubstanceAdminSubstitutionReason | SubstanceAdminSubstitutionReason | | active | true | |

2

CT

continuing therapy

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

active

_SubstanceAdminSubstitutionReason

2

FP

formulary policy

Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.

active

_SubstanceAdminSubstitutionReason

2

OS

out of stock

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

active

_SubstanceAdminSubstitutionReason

2

RR

regulatory requirement

Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.

active

_SubstanceAdminSubstitutionReason

1

_TransferActReason

TransferActReason

The explanation for why a patient is moved from one location to another within the organization

active

true

2

ER

Error

Moved to an error in placing the patient in the original location.

active

_TransferActReason

2

RQ

Request

Moved at the request of the patient.

active

_TransferActReason

1

_ActAdjudicationReason

ActAdjudicationReason

Explanatory codes that describe reasons why an Adjudicator has financially adjusted an invoice (claim).

A companion domain (ActAdjudicationInformationCode) includes information reasons which do not have a financial impact on an invoice (claim).

Example adjudication reason code is AA-CLAIM-0011 - Only Basic Procedure/Test Eligible.

Codes from this domain further rationalizes ActAdjudicationCodes (e.g. AA - Adjudicated with Adjustment), which are used to describe the process of adjudicating an invoice. For AS - Adjudicated as Submitted, there should be no specification of ActAdjudicationReason codes, as there are no financial adjustments against the invoice.

retired

true

1

_ActBillableServiceReason

ActBillableServiceReason

Definition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.

retired

true

2

_ActBillableClinicalServiceReason

ActBillableClinicalServiceReason

Reason for Clinical Service being performed.

This domain excludes reasons specified by diagnosed conditions.

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

retired

true

_ActBillableServiceReason

3

_MedicallyNecessaryDuplicateProcedureReason

MedicallyNecessaryDuplicateProcedureReason

Definition: This domain is used to document why the procedure is a duplicate of one ordered/charged previously for the same patient within the same date of service and has been determined to be medically necessary.

Example: A doctor needs a different view in a chest X-Ray.

retired

true

_ActBillableClinicalServiceReason

1

_ActCoverageLevelRasonCode

ActCoverageLevelRasonCode

**Description:**Represents the reason for 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

1

_ActImmunizationReason

ActImmunizationReason

**Description:**A coded description of the reason for why a patient was administered an immunization.

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

retired

true

1

_ConrolActNullificationReasonCode

ConrolActNullificationReasonCode

**Description:**Identifies reasons for nullifying (retracting) a particular control act.

Examples:"Entered in error", "altered decision", etc.

retired

true

1

_NonPerformanceReasonCode

NonPerformanceReasonCode

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

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

retired

true

1

_ReasonForNotEvaluatingDevice

ReasonForNotEvaluatingDevice

Code assigned to indicate the rationale for not performing an evaluation investigation on a device for which a defect has been reported.

Examples include: device received in a condition that made analysis impossible, device evaluation anticipated but not yet begun, device not made by company.

retired

true

1

_ReferralReasonCode

ReferralReasonCode

The reason a referral was made.

*Examples:*Specialized Medical Assistance, Other Care Requirements.

retired

true

1 | BONUS | | | retired | | |

1

CHD

Children only

**Description:**The level of coverage under the policy or program is available only to children

retired

1

DEP

Dependents only

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

retired

1

ECH

Employee and children

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

retired

1 | EDU | | | retired | | |

1

EMP

Employee only

**Description:**The level of coverage under the policy or program is available only to an employee.

retired

1

ESP

Employee and spouse

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

retired

1

FAM

Family

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

retired

1

IND

Individual

**Description:**The level of coverage under the policy or program is available to an individual.

retired

1 | INVOICE | | | retired | | |
1 | PROA | | | retired | | |
1 | RECOV | | | retired | | |
1 | RETRO | | | retired | | |

1

SPC

Spouse and children

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

retired

1

SPO

Spouse only

**Description:**The level of coverage under the policy or program is available only to a subscribers spouse

retired

1 | TRAN | | | retired | | |

# description
A set of codes specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably represented as an ActRelationship of type "has reason" linking to another Act.

*Examples:* Example reasons that might qualify for being coded in this field might be: "routine requirement", "infectious disease reporting requirement", "on patient request", "required by law".

# 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
Designation of a concept's state.  Normally is not populated unless the state is retired..

# property[].description
Indicates that the code is abstract - only intended to be used as a selector for other concepts

# concept[].definition
Identifies the reason the patient is assigned to this accommodation type

# concept[].definition
**Description:**Codes used to specify reasons or criteria relating to coverage provided under a policy or program. May be used to convey reasons pertaining to coverage contractual provisions, including criteria for eligibility, coverage limitations, coverage maximums, or financial participation required of covered parties.

# concept[].definition
**Description:**The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.

# concept[].definition
**Description:** Types of reasons why a substance is invalid for use.

# concept[].definition
Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.

# concept[].definition
A coded description of the reason for why a patient did not receive a scheduled immunization.

(important for public health strategy

# concept[].definition
Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated".

(used when capturing 'refusal to fill' annotations)

# concept[].definition
**Definition:**Specifies the reason that an event occurred in a clinical research study.

# concept[].definition
**Definition:**SSpecifies the reason that a test was performed or observation collected in a clinical research study.

**Note:**This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.

# concept[].definition
**Description:**Indicates why the prescription should be suspended.

# concept[].definition
**Description:**Identifies reasons for nullifying (retracting) a particular control act.

# concept[].definition
**Description:** Reasons to refuse a transaction to be undone.

# concept[].definition
Identifies why a specific query, request, or other trigger event occurred.

# concept[].definition
**Description:**Identifies why a change is being made to a record.

# concept[].definition
**Definition:**A collection of concepts identifying why the patient's profile is being queried.

# concept[].definition
**Definition:**Indicates why the request to transfer a prescription from one dispensing facility to another has been refused.

# concept[].definition
**Description:** Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.

# concept[].definition
Reasons for cancelling or rescheduling an Appointment

# concept[].definition
Indicates why the act revision (status update) is being refused.

# concept[].definition
**Definition:**Indicates why the requested authorization to prescribe or dispense a medication has been refused.

# concept[].definition
Reasons why substitution of a substance administration request is not permitted.

# concept[].definition
The explanation for why a patient is moved from one location to another within the organization

# concept[].definition
Explanatory codes that describe reasons why an Adjudicator has financially adjusted an invoice (claim).

A companion domain (ActAdjudicationInformationCode) includes information reasons which do not have a financial impact on an invoice (claim).

Example adjudication reason code is AA-CLAIM-0011 - Only Basic Procedure/Test Eligible.

Codes from this domain further rationalizes ActAdjudicationCodes (e.g. AA - Adjudicated with Adjustment), which are used to describe the process of adjudicating an invoice. For AS - Adjudicated as Submitted, there should be no specification of ActAdjudicationReason codes, as there are no financial adjustments against the invoice.

# concept[].definition
**Definition:** This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.

# concept[].definition
**Description:**Represents the reason for 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:**A coded description of the reason for why a patient was administered an immunization.

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

# concept[].definition
**Description:**Identifies reasons for nullifying (retracting) a particular control act.

**Examples:**"Entered in error", "altered decision", etc.

# concept[].definition
The reason the action wasn't performed, e.g. why the medication was not taken. If an action wasn"t performed, it is often clinically important to know why the action wasn"t taken.

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

# concept[].definition
Code assigned to indicate the rationale for not performing an evaluation investigation on a device for which a defect has been reported.

Examples include: device received in a condition that made analysis impossible, device evaluation anticipated but not yet begun, device not made by company.

# concept[].definition
The reason a referral was made.

*Examples:*Specialized Medical Assistance, Other Care Requirements.

# concept[].definition
**Description:**The level of coverage under the policy or program is available only to children

# concept[].definition
**Description:**The level of coverage under the policy or program is available only to a subscriber's dependents.

# concept[].definition
**Description:**The level of coverage under the policy or program is available to an employee and his or her children.

# concept[].definition
**Description:**The level of coverage under the policy or program is available only to an employee.

# concept[].definition
**Description:**The level of coverage under the policy or program is available to an employee and his or her spouse.

# concept[].definition
**Description:**The level of coverage under the policy or program is available to a subscriber's family.

# concept[].definition
**Description:**The level of coverage under the policy or program is available to an individual.

# concept[].definition
**Description:**The level of coverage under the policy or program is available to a subscriber's spouse and children

# concept[].definition
**Description:**The level of coverage under the policy or program is available only to a subscribers spouse

# concept[].definition
Accommodation requested is not available.

# concept[].definition
Accommodation is assigned for floor convenience.

# concept[].definition
**Definition:** This domain is used to document why the procedure is a duplicate of one ordered/charged previously for the same patient within the same date of service and has been determined to be medically necessary.

**Example:** A doctor needs a different view in a chest X-Ray.

# concept[].definition
Reason for Clinical Service being performed.

This domain excludes reasons specified by diagnosed conditions.

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

# concept[].definition
To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.

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

# concept[].property[].valueString
The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.

# concept[].definition
To perform one or more operations on information to which the patient has not consented because deemed incompetent to provide consent.

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

# concept[].definition
To perform one or more operations on information to which the patient declined to consent for providing health care.

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

# concept[].property[].valueString
The patient, while able to give consent, has not.  However the provider believes it is in the patient's interest to access the record without patient consent.

# concept[].definition
To perform one or more operations on information to which the patient has not consented for public safety reasons.

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

# concept[].property[].valueString
The patient, while able to give consent, has not.  However, the provider believes that access to masked patient information is justified because of concerns related to public safety.

# concept[].definition
To perform one or more operations on information to which the patient has not consented for third party safety.

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

# concept[].property[].valueString
The patient, while able to give consent, has not.  However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.

# concept[].definition
Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.

*Examples:*  A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.

# concept[].definition
**Description:**Identifies the reason or rationale for coverage of a service or product based on characteristics of the provider, e.g., contractual relationship to payor, such as in or out-of-network; relationship of the covered party to the provider.

**Example:**In closed managed care plan, a covered party is assigned a primary care provider who provides primary care services and authorizes referrals and ancillary and non-primary care services.

# concept[].definition
**Description:**Identifies the reason or rationale for coverage of a service or product based on clinical efficacy criteria or practices prescribed by the payor.

# concept[].definition
**Definition:** Identifies the reason or rationale for coverage of a service or product based on coverage exclusions related to the risk of adverse selection by covered parties.

# concept[].definition
**Description:**Identifies the reason or rationale for coverage of a service or product based on financial participation responsibilities of the covered party.

# concept[].definition
**Description:**Identifies the reason or rationale for limitations on the coverage of a service or product based on coverage contract provisions.

**Example:**The maximum cost per unit; or the maximum number of units per period, which is typically the policy or program effective time.

# concept[].definition
Ordering Practitioner has been granted 'gold card' status with this payer/coverage type.  This status indicates that, because of their prior track record, fewer services require prior authorization and/or documentation requirements associated with prior authorization requests are reduced.  While the phrase 'gold-card' is specific to U.S. national and state regulation, the concept can be used in other jurisdictions where the semantics are appropriate.

# concept[].definition
To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.

*Usage Notes:* Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.

# concept[].property[].valueString
Used to convey the reason that a provider or other entity may or has accessed personal healthcare information.  Typically, this involves overriding the subject's consent directives.

# concept[].definition
Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.

*Usage Notes:* The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.

# concept[].property[].valueString
The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.

# concept[].definition
**Description:**The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.

# concept[].definition
When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.

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

# concept[].definition
**Description:**The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.

# concept[].definition
**Description:**The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.

# concept[].definition
**Description:**Administrative and contractual processes required to support an activity, product, or service

# concept[].definition
**Description:**Administrative, financial, and contractual processes related to payment for an activity, product, or service

# concept[].definition
**Description:**Investigative activities conducted for the purposes of obtaining knowledge

# concept[].definition
**Description:**Provision of a service, product, or capability to an individual or organization

# concept[].definition
**Description:** Storage conditions caused the substance to be ineffective.

# concept[].definition
**Description:** The lot from which the substance was drawn was expired.

# concept[].display
administered outside recommended schedule or practice

# concept[].definition
The substance was administered outside of the recommended schedule or practice.

# concept[].definition
**Description:** The substance was recalled by the manufacturer.

# concept[].definition
The covered party (patient) specified with the Invoice is not correct.

# concept[].definition
The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.

# concept[].definition
The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.

# concept[].definition
The provider specified with the Invoice is not correct.

# concept[].definition
**Definition:**Testing has shown that the patient already has immunity to the agent targeted by the immunization.

# concept[].definition
**Definition:**The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.

# concept[].definition
**Definition:**There was no supply of the product on hand to perform the service.

# concept[].definition
**Definition:**The patient or their guardian objects to receiving the vaccine.

# concept[].definition
**Definition:**The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.

# concept[].definition
**Definition:**The patient or their guardian objects to receiving the vaccine on religious grounds.

# concept[].definition
**Definition:**The intended vaccine has expired or is otherwise believed to no longer be effective.

**Example:**Due to temperature exposure.

# concept[].definition
**Definition:**The patient or their guardian objects to receiving the vaccine because of concerns over its safety.

# concept[].definition
**Definition:**The order has been stopped by the prescriber but this fact has not necessarily captured electronically.

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

# concept[].definition
**Definition:**Order has not been fulfilled within a reasonable amount of time, and may not be current.

# concept[].definition
**Definition:**Data needed to safely act on the order which was expected to become available independent of the order is not yet available

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

# concept[].definition
**Definition:**Product not available or manufactured. Cannot supply.

# concept[].definition
**Definition:**The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.

# concept[].definition
**Definition:**Fulfiller not able to provide appropriate care associated with fulfilling the order.

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

# concept[].definition
**Definition:**The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.

# concept[].definition
**Definition:**The event occurred due to it being scheduled in the research protocol.

# concept[].definition
**Definition:**The event occurred in order to terminate the subject's participation in the study.

# concept[].definition
**Definition:**The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.

# concept[].definition
**Definition:**The observation or test was neither defined or scheduled in the study protocol.

# concept[].definition
**Definition:**The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.

# concept[].definition
**:**The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.

# concept[].definition
**Description:**This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.

# concept[].definition
**Description:**Clarification is required before the order can be acted upon.

# concept[].definition
**Description:**The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.

# concept[].definition
**Description:**The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.

# concept[].definition
**Description:**The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.

# concept[].definition
**Description:**Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.

# concept[].definition
**Description:**The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.

# concept[].definition
**Description:**The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.

# concept[].definition
**Description:**The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.

# concept[].definition
**Description:**Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.

# concept[].definition
**Description:**The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.

# concept[].definition
**Description:**The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.

# concept[].definition
**Description:**The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.

# concept[].definition
**Description:**The decision on which the recorded information was based was changed before the decision had an effect.

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

# concept[].definition
**Description:**The information was recorded incorrectly or was recorded in the wrong record.

# concept[].definition
**Description:** There is no match for the record in the database.

# concept[].definition
The record is already in the requested state.

# concept[].definition
**Description:** There is no permission.

# concept[].definition
**Description:** The record and version requested to update is not the current version.

# concept[].definition
**Description:**Indicates the reason the medication order should be aborted.

# concept[].definition
**Definition:**A collection of concepts that indicate why the prescription should be released from suspended state.

# concept[].definition
Types of reason why a prescription is being changed.

# concept[].definition
**Definition:**Identifies why the dispense event was not completed.

# concept[].definition
**Definition:**A collection of concepts that indicates the reason for a "bulk supply" of medication.

# concept[].display
pharmacy supply request renewal refusal reason

# concept[].definition
**Definition:**A collection of concepts that identifies why a renewal prescription has been refused.

# concept[].definition
**Definition:**A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).

# concept[].definition
Indicates why the ConditionaTMs status was changed to Nullified. *Examples* administrative error, diagnostic error.

# concept[].definition
A person becomes eligible for a program based on age.

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

# concept[].definition
A person becomes eligible for insurance or a program because of crime related health condition or injury.

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

# concept[].definition
A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.

# concept[].definition
A person becomes eligible for insurance provided as an employment benefit based on employment status.

# concept[].definition
A person becomes eligible for a program based on financial criteria.

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

# concept[].definition
A person becomes eligible for a program because of a qualifying health condition or injury.

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

# concept[].definition
A person becomes eligible for a program based on more than one criterion.

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

# concept[].definition
A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.

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

# concept[].definition
A person becomes eligible for a program based on statutory criteria.

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

# concept[].definition
A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.

# concept[].definition
A person becomes eligible for insurance or a program because of a work related health condition or injury.

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

# concept[].definition
Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.

Examples are client deceased & adopted client has been given a new policy identifier.

# concept[].definition
Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.

*Examples:*  A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.

# concept[].definition
**Description:**Information has changed since the record was created.

# concept[].definition
**Description:**Previously recorded information was erroneous and is being corrected.

# concept[].definition
Information is combined into the record.

# concept[].definition
**Description:**New information has become available to supplement the record.

# concept[].definition
Information is separated from the record.

# concept[].definition
**Description:**The medication is no longer being manufactured or is otherwise no longer available.

# concept[].definition
**Description:**The therapy has been found to not have the desired therapeutic benefit on the patient.

# concept[].definition
**Description:**Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.

# concept[].definition
**Description:**The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.

# concept[].definition
**Description:**The product does not have (or no longer has) coverage under the patientaTMs insurance policy.

# concept[].definition
**Description:**The patient refused to take the product.

# concept[].definition
**Description:**The manufacturer or other agency has requested that stocks of a medication be removed from circulation.

# concept[].definition
**Description:**Item in current order is no longer in use as requested and a new one has/will be created to replace it.

# concept[].definition
**Description:**Current order was issued with incorrect data and a new order has/will be created to replace it.

# concept[].definition
**Description:**<The patient is not (or is no longer) able to use the medication in a manner prescribed.

**Example:**CanaTMt swallow.

# concept[].definition
**Definition:**The original reason for suspending the medication has ended.

# concept[].definition
Order was created with incorrect data and is changed to reflect the intended accuracy of the order.

# concept[].definition
Order is changed based on a clinical reason.

# concept[].definition
**Definition:** To evaluate for service authorization, payment, reporting, or performance/outcome measures.

# concept[].definition
**Definition:**To provide information as a result of a subpoena.

# concept[].definition
**Definition:**To obtain records as part of patient care.

# concept[].definition
**Definition:**To evaluate the provider's current practice for professional-improvement reasons.

# concept[].definition
**Description:**Review for the purpose of regulatory compliance.

# concept[].definition
**Definition:**To provide research data, as authorized by the patient.

# concept[].definition
**Description:**To validate the patient's record.

**Example:**Merging or unmerging records.

# concept[].definition
**Definition:**Order to be fulfilled was aborted

# concept[].definition
**Definition:**Order to be fulfilled was suspended

# concept[].definition
**Definition:**Patient did not come to get medication

# concept[].definition
**Definition:**Patient changed their mind regarding obtaining medication

# concept[].definition
**Definition:**Patient requested a revised quantity of medication

# concept[].definition
**Definition:**The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)

# concept[].definition
**Definition:**The bulk supply will be administered within a long term care facility.

# concept[].definition
**Definition:**The bulk supply is intended for general clinician office use.

# concept[].definition
**Definition:**The bulk supply is being transferred to another dispensing facility to.

**Example:**Alleviate a temporary shortage.

# concept[].definition
**Definition:**The bulk supply is intended for dispensing according to a specific program.

**Example:**Mass immunization.

# concept[].definition
**Definition:**The prescription may not be reassigned from the original pharmacy.

# concept[].definition
**Definition:**The user does not have permission

# concept[].definition
**Definition:**The target facility does not recognize the dispensing facility.

# concept[].definition
**Definition:**Patient has already been given a new (renewal) prescription.

# concept[].display
family physician must authorize further fills

# concept[].definition
**Definition:**Request for further authorization must be done through patient's family physician.

# concept[].definition
**Definition:**Therapy has been changed and new prescription issued

# concept[].definition
**Definition:**Patient must see prescriber prior to further fills.

# concept[].definition
**Definition:**Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.

# concept[].definition
**Definition:**Patient no longer or has never been under this prescribers care.

# concept[].definition
**Definition:**This medication is on hold.

# concept[].definition
**Description:**This product is not available or manufactured.

# concept[].display
prescriber stopped medication for patient

# concept[].definition
Renewing or original prescriber informed patient to stop using the medication.

# concept[].definition
**Definition:**The patient should have medication remaining.

# concept[].definition
The time slots previously allocated are now blocked and no longer available for booking Appointments

# concept[].definition
Patient unable to pay and not covered by insurance

# concept[].definition
The medical condition of the Patient has changed

# concept[].definition
The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment

# concept[].definition
Ordered quantity has already been completely fulfilled.

# concept[].definition
**Definition:**Patient not eligible for drug

# concept[].definition
**Definition:**Patient does not meet required protocol

# concept[].definition
**Definition:**Provider is not authorized to prescribe or dispense

# concept[].definition
**Definition:** Patient has had a prior allergic intolerance response to alternate product or one of its components.

# concept[].definition
**Definition:** Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.

# concept[].definition
The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.

# concept[].definition
**Definition:** The specific manufactured drug is part of a clinical trial.

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

# concept[].definition
Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.

# concept[].definition
In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.

# concept[].definition
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.

# concept[].definition
**Definition:**The patient's medical condition has nearly abated.

# concept[].definition
**Description:**The patient has an intolerance to the medication.

# concept[].definition
**Definition:**The current medication will be replaced by a new strength of the same medication.

# concept[].definition
**Definition:**A new therapy will be commenced when current supply exhausted.

# concept[].definition
Moved to an error in placing the patient in the original location.

# concept[].definition
**Description:** Cold chain was not maintained for the substance.

# concept[].display
clinical trial research without patient care

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

# concept[].display
clinical trial research with patient care

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

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

# concept[].definition
To perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.

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

# concept[].definition
To perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.

# concept[].definition
To perform one or more operations on information for the process of releasing military personnel from their service obligations, which may include determining service merit, discharge benefits, and disability assessment.

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

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

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

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

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

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

# concept[].definition
To perform analytics, evaluation and other secondary uses of treatment and healthcare related information to manage the quality, efficacy, patient safety, population health, and cost effectiveness of healthcare delivery. Explicitly excludes the use of information to organize the delivery of health care for care coordination and case management, or to provide healthcare treatment.

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

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

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

# concept[].definition
To perform one or more operations on information used for cadaveric organ, eye or tissue donation.

# concept[].definition
To perform one or more operations on information used for fraud detection and prevention processes.

# concept[].definition
To perform one or more operations on information used within government processes.

# concept[].definition
To perform one or more operations on information for conducting activities related to meeting accreditation criteria.

# concept[].definition
To perform one or more operations on information used for conducting activities required to meet a mandate.

# concept[].definition
To perform one or more operations on information used for handling deceased patient matters.

# concept[].definition
To perform one or more operation operations on information used to manage a patient directory.

**Examples:** 

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

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

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

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

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

# concept[].definition
To perform one or more operations on information for conducting activities required by legal proceeding.

# concept[].definition
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.

# concept[].definition
To perform one or more operations on information used for conducting activities to meet program accounting requirements.

# concept[].definition
To perform one or more operations on information used for conducting administrative activities to improve health care quality.

# concept[].definition
To perform one or more operations on information to administer the electronic systems used for the delivery of health care.

# concept[].definition
To perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.

# concept[].definition
To perform one or more operations on information for conducting activities required by military processes, procedures, policies, or law.

# concept[].definition
To perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.

# concept[].definition
To perform one or more operations on information in processes related to ensuring the safety of health care.

# concept[].definition
To perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.

# concept[].definition
To perform one or more operations on information used within the health records management process.

# concept[].definition
To perform one or more operations on information to design, develop, implement, test, or deploy a healthcare system or application.

# concept[].definition
To perform one or more operations on information used in training and education.

# concept[].definition
To perform one or more operations on information used in training a machine learning (AI) model.

# concept[].definition
To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.

# concept[].definition
To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.

# concept[].definition
To perform one or more operations on information for conducting activities related to coverage under a program or policy.

# concept[].definition
To perform one or more operations on information about the amount remitted for a health care claim.

# concept[].display
decision support assisted payment decision

# concept[].definition
To apply algorithms (e.g. AI, CDS) to perform one or more operations on information to arrive at decision used in payment for provision of health care.

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

# concept[].definition
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.

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

# concept[].display
population origins or ancestry healthcare research

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

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

# concept[].definition
To perform one or more operations on information to assign, persist, and manage labels to healthcare data to characterize various aspects, such as its security classification, sensitivity, compartment, integrity, and provenance; applicable privacy, consent, security, provenance, and trust policies; and handling caveats such as purpose of use, obligations, and refrain policies.

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

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

# concept[].definition
To perform one or more operations on information to assign, persist, and manage metadata to healthcare data to characterize various aspects used for its indexing, discovery, retrieval, and processing by systems, applications, and end users. For example, master index identifier, media type, and location.

# concept[].definition
**Description:** There is no match for the product in the master file repository.

# concept[].definition
**Description:** There is no match for the service in the master file repository.

# concept[].definition
**Description:** There is no match for the record and version.

# concept[].definition
**Description:** The agent does not have permission.

# concept[].definition
**Description:** The user does not have permission.

# concept[].definition
**Description:**Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service

# concept[].definition
**Description:**Operational activities required to meet a mandate related to an activity, product, or service

# concept[].definition
**Description:**Operational activities conducted to administer information relating to entities involves with an activity, product, or service

# concept[].definition
**Description:**Operational activities conducted for the purposes of assessing the results of an activity, product, or service

# concept[].definition
**Description:**Operational activities conducted to meet program accounting requirements related to an activity, product, or service

# concept[].definition
**Description:**Operational activities conducted for the purposes of improving the quality of an activity, product, or service

# concept[].definition
**Description:**Operational activities conducted to administer the electronic systems used for an activity, product, or service

# concept[].definition
To perform one or more operations on information in response to a request by a family member authorized by the patient.

# concept[].definition
To perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.

# concept[].definition
To perform one or more operations on information in response to a request by a person authorized by the patient.

# concept[].definition
To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.

# concept[].definition
To perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.

# concept[].definition
To perform one or more operations on information for marketing services and products related to health care.

# concept[].definition
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.

# concept[].definition
To perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.

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

# concept[].definition
To perform one or more operations on information in response to a patient's request.

# concept[].definition
To perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.

# concept[].definition
To perform one or more operations on information for provision of health care.

# concept[].definition
**Description:**The medication is being re-prescribed at a different dosage.

# concept[].definition
To perform one or more operations on information that is simulated or synthetic health data used for testing system capabilities outside of a production or operational system environment.

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

# concept[].definition
To perform health care as part of the clinical trial protocol.

# concept[].definition
To perform one or more actions on information in order to organize the provision and case management of an individual's healthcare, including: Monitoring a person's goals, needs, and preferences; acting as the communication link between two or more participants concerned with a person's health and wellness; organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person; and ensuring safe, appropriate, non-duplicative, and effective integrated care.

*Usage Note:* Use when describing these functions: 1. Monitoring a person's goals, needs, and preferences. 2. Acting as the communication link between two or more participants concerned with a person's health and wellness. 3. Organizing and facilitating care activities and promoting self-management by advocating for, empowering, and educating a person. 4. Ensuring safe, appropriate, non-duplicative, and effective integrated care.

The goal is to clearly differentiate this type of coordination of care from HIPAA Operations by specifying that these actions on information are undertaken in the provision of healthcare treatment.

For similar uses of this concept, see SAMHSA Confidentiality of Substance Use Disorder Patient Records Supplemental notice of proposed rulemaking, which differentiates concepts of care coordination and case management for the provision of treatment as specifically distinct from activities related to health care delivery management and the operations of organizational entities involved in the delivery of healthcare.

*Map:* Maps to ISO 14265 Classification Terms: "Support of care activities within the provider organisation for an individual subject of care" described as "To inform persons or processes enabling others to provide health care services to the subject of care." "Subject of Care Uses" described as "To inform the subject of care in support of his or her own interests."

# concept[].definition
To perform one or more operations on information for provision of immediately needed health care for an emergent condition.

# concept[].definition
To perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.

# concept[].display
decision support assisted treatment decision

# concept[].definition
To apply algorithms (e.g. AI, CDS) to perform one or more operations on information to arrive at decision used in health care treatment.