Properties This code system defines the following properties for its concepts Code URI Type Description Specializes Coding The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric. Generalizes Coding Inverse of Specializes. Only included as a derived relationship. internalId http://terminology.hl7.org/CodeSystem/utg-concept-properties#v3-internal-id code The internal identifier for the concept in the HL7 Access database repository. status http://hl7.org/fhir/concept-properties#status code Designation of a concept's state. Normally is not populated unless the state is retired.. conductible http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-conductible boolean If true, indicates that ActRelationships or Participations of the specified type (and any specializations thereof) will normally conduct. For more usage information, refer to the Core Principles specification. isDocumentCharacteristic http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-document-characteristic boolean If true, indicates that the Act attribute or association (as represented by a typeCode for eaither ActRelationship or Pareticipation is a descriptor of the document (record) represented by the act object. If false, indicates the property is a descriptor of the action itself, actual, intended, or potential. Applies to interpretation of attributes and associations with respect to changes in the value of Act.actionNegationInd and Act.moodCode. (See descriptions of these attributes for further discussion.) For example, in an order, the id attribute [isDocumentCharacteristic = true] is an identifier of the record of the order, not an identifier of the intended event. On the other hand, the code attribute [isDocumentCharacteristic = false] describes a characteristic of the intended event. Name:Act:inboundRelationship:ActRelationship http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-inbound-relationship code Name of inboundRelationship from Act to ActReln Name:Act:outboundRelationship:ActRelationship http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-outbound-relationship code Formal name of outboundRelationship from Act to ActReln Sort:Act:inboundRelationship:ActRelationship http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-Act-inbound-sort code Sort key for the inboundRelationship from Act to ActReln Sort:Act:outboundRelationship:ActRelationship http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-act-outbound-sort code Sort key for the outboundRelationship from Act to ActReln appliesTo http://terminology.hl7.org/CodeSystem/utg-concept-properties#v3-applies-to string Haven't a clue! howApplies http://terminology.hl7.org/CodeSystem/utg-concept-properties#v3-how-applies string Haven't a clue! Name:ActRelationship:source:Act http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-ActRelationship-source string The name of the assciation from ActRelationship to the source Act Name:ActRelationship:target:Act http://terminology.hl7.org/CodeSystem/utg-concept-properties#rim-ActRelationship-target string The name of the assciation from ActRelationship to the source Act 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 synonymCode http://hl7.org/fhir/concept-properties#synonym code An additional concept code that was also attributed to a concept HL7usageNotes http://terminology.hl7.org/CodeSystem/utg-concept-properties#HL7usageNotes string HL7 Concept Usage Notes 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-ActRelationshipType defines the following codes in a Is-A hierarchy: Lvl Code Display Definition internalId status conductible isDocumentCharacteristic Name:Act:inboundRelationship:ActRelationship Name:Act:outboundRelationship:ActRelationship Sort:Act:inboundRelationship:ActRelationship Sort:Act:outboundRelationship:ActRelationship appliesTo howApplies Name:ActRelationship:source:Act Name:ActRelationship:target:Act Not Selectable synonymCode HL7 Concept Usage Notes Parent 1 ART act relationship type Description: A directed association between a source Act and a target Act. Usage Note: This code should never be transmitted in an instance as the value of ActRelationship.typeCode (attribute) 23252 active & & 2 _ActClassTemporallyPertains ActClassTemporallyPertains 21307 active true temporallyRelatesTo temporallyRelatedInformation DN_______ DN_______ & & true TemporallyPertains ART 3 _ActRelationshipTemporallyPertainsEnd ActRelationshipTemporallyPertainsEnd A relationship that defines the relative time of the end source act based on the time of the target act. 23077 active true endTemporallyRelatedTo temporallyRelatedEndInformation & & true _ActClassTemporallyPertains, TemporallyPertains 3 _ActRelationshipTemporallyPertainsStart ActRelationshipTemporallyPertainsStart A relationship that defines the relative time of the start source act based on the time of the target act. 23075 active true startTemporallyRelatedTo temporallyRelatedStartInformation DNA______ DNA______ & & true _ActClassTemporallyPertains, TemporallyPertains 2 TemporallyPertains ActClassTemporallyPertains 21307 retired true temporallyRelatesTo temporallyRelatedInformation DN_______ DN_______ & & true _ActClassTemporallyPertains ART 3 _ActRelationshipTemporallyPertainsEnd ActRelationshipTemporallyPertainsEnd 3 _ActRelationshipTemporallyPertainsStart ActRelationshipTemporallyPertainsStart 2 _ActRelationshipAccounting ActRelationshipAccounting Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element. 20946 active true accountingFor accounting DO_______ DO_______ & & true _ActRelationshipPosts ART 3 _ActRelationshipCostTracking ActRelationshipCostTracking Expresses values for describing the relationship relationship between an InvoiceElement or InvoiceElementGroup and a billable act. 21360 active true costTrackingOf costTracking DOB______ DOB______ & & true _ActRelationshipAccounting, _ActRelationshipPosts 4 CHRG has charge A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service. The financial transaction will define the charge (bill) for delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product. 14904 active true chargeFor charge DOBA_____ DOBA_____ & & _ActRelationshipCostTracking 4 COST has cost A relationship that provides an ability to associate a financial transaction (target) as a cost to a clinical act (source). A clinical act may have an inherit cost associated with the execution or delivery of the service. The financial transaction will define the cost of delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product. 14903 active true costOf cost DOBB_____ DOBB_____ & & _ActRelationshipCostTracking 3 _ActRelationshipPosting ActRelationshipPosting Expresses values for describing the relationship between a FinancialTransaction and an Account. 21359 active true postingTo posting DOA______ DOA______ & & true _ActRelationshipAccounting, _ActRelationshipPosts 4 CREDIT has credit A credit relationship ties a financial transaction (target) to an account (source). A credit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account credit will decrease the account balance. A non-asset account credit will decrease the account balance. 14902 active true creditTo credit DOAA_____ DOAA_____ & & _ActRelationshipPosting 4 DEBIT has debit A debit relationship ties a financial transaction (target) to an account (source). A debit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account debit will increase the account balance. A non-asset account debit will decrease the account balance. 14901 active true debitTo debit DOAB_____ DOAB_____ & & _ActRelationshipPosting 2 _ActRelationshipPosts ActRelationshipAccounting Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element. 20946 retired true accountingFor accounting DO_______ DO_______ & & true _ActRelationshipAccounting ART 3 _ActRelationshipCostTracking ActRelationshipCostTracking 3 _ActRelationshipPosting ActRelationshipPosting 2 _ActRelationshipConditional ActRelationshipConditional Specifies under what circumstances (target Act) the source-Act may, must, must not or has occurred 20945 active true true conditionedBy conditions C________ C________ & & true ART 3 CIND has contra-indication A contraindication is just a negation of a reason, i.e. it gives a condition under which the action is not to be done. Both, source and target can be any kind of service; target service is in criterion mood. How the strength of a contraindication is expressed (e.g., relative, absolute) is left as an open issue. The priorityNumber attribute could be used. 10323 active true true contraindicationFor contraindication CC_______ CC_______ action contra-indication & & _ActRelationshipConditional 3 PRCN has pre-condition A requirement to be true before a service is performed. The target can be any service in criterion mood. For multiple pre-conditions a conjunction attribute (AND, OR, XOR) is applicable. 10319 active true true preconditionFor precondition CD_______ CD_______ action pre-condition & & _ActRelationshipConditional 3 RSON has reason Description: The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action. As well as providing various types of information about the rationale for a service, the RSON act relationship is routinely used between a SBADM act and an OBS act to describe the indication for use of a medication. Child concepts may be used to describe types of indication. Discussion: In prior releases, the code "SUGG" (suggests) was expressed as "an inversion of the reason link." That code has been retired in favor of the inversion indicator that is an attribute of ActRelationship. 10321 active true true reasonOf reason CA_______ CA_______ action reason & & _ActRelationshipConditional 4 BLOCK blocks Definition: The source act is performed to block the effects of the target act. This act relationship should be used when describing near miss type incidents where potential harm could have occurred, but the action described in the source act blocked the potential harmful effects of the incident actually occurring. 22188 active true true blockedBy blocks & & RSON 4 DIAG diagnoses Description: The source act is intended to help establish the presence of a (an adverse) situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. 21644 active true true diagnosedBy & & RSON 4 IMM immunization against Description: The source act is intented to provide immunity against the effects of the target act (the target act describes an infectious disease) 23304 active true true immunizedAgainst & & RSON 5 ACTIMM active immunization against Description: The source act is intended to provide active immunity against the effects of the target act (the target act describes an infectious disease) 23305 active true true activelyImmunizedAgainst & & IMM 5 PASSIMM passive immunization against Description: The source act is intended to provide passive immunity against the effects of the target act (the target act describes an infectious disease). 23306 active true true passivelyImmunizedAgainst & & IMM 4 MITGT mitigates The source act removes or lessens the occurrence or effect of the target act. 19986 active true true mitigatedBy mitigates CAA______ CAA______ & & RSON 5 RCVY recovers Definition: The source act is performed to recover from the effects of the target act. 22189 active true true recoveredFrom recovers & & MITGT 4 PRYLX prophylaxis of Description: The source act is intended to reduce the risk of of an adverse situation to emerge as described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. 23303 active true true prophylaxisOf & & RSON 4 TREAT treats Description: The source act is intended to improve a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. 23307 active true true treatmentFor & & RSON 5 ADJUNCT adjunctive treatment Description: The source act is intended to offer an additional treatment for the management or cure of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. It is not a requirement that the non-adjunctive treatment is explicitly specified. 23310 active true true adjunctiveTreatmentFor & & TREAT 5 MTREAT maintenance treatment Description: The source act is intended to provide long term maintenance improvement or management of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. 23308 active true true maintenanceTreatmentFor & & TREAT 5 PALLTREAT palliates Description: The source act is intended to provide palliation for the effects of the target act. 23309 active true true palliativeTreatmentFor & & TREAT 5 SYMP symptomatic relief Description: The source act is intented to provide symptomatic relief for the effects of the target act. 21645 active true true symptomaticTreatmentFor & & TREAT 3 TRIG has trigger A pre-condition that if true should result in the source Act being executed. The target is in typically in criterion mood. When reported after the fact (i.e. the criterion has been met) it may be in Event mood. A delay between the trigger and the triggered action can be specified. Discussion: This includes the concept of a required act for a service or financial instrument such as an insurance plan or policy. In such cases, the trigger is the occurrence of a specific condition such as coverage limits being exceeded. 10320 active true true triggerFor trigger CB_______ CB_______ action trigger & & _ActRelationshipConditional 2 _ActRelationshipTemporallyPertains ActRelationshipTemporallyPertains Abstract collector for ActRelationhsip types that relate two acts by their timing. 23581 active & & true ART 3 _ActRelationshipTemporallyPertainsApproximates ActRelationshipTemporallyPertainsApproximates Abstract collector for ActRelationship types that relate two acts by their approximate timing. 23637 active & & true _ActRelationshipTemporallyPertains 4 ENE ends near end A relationship in which the source act's effective time ends near the end of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is ENS 23640 active endsNearStart endsNearEnd & & _ActRelationshipTemporallyPertainsApproximates 5 ECW ends concurrent with A relationship in which the source act's effective time ends with the end of the target act's effective time. UsageNote: This code is reflexive. Therefore its inverse code is itself. 23033 active endsConcurrentlyWith endsConcurrentlyWith & & EAEORECW, EBEORECW, ENE, OVERLAP 6 CONCURRENT concurrent with A relationship in which the source act's effective time is the same as the target act's effective time. UsageNote: This code is reflexive. Therefore its inverse code is itself. 23032 active isConcurrentWith isConcurrentWith & & ECW, SCW 6 SBSECWE starts before start of, ends with The source Act starts before the start of the target Act, and ends with the target Act. UsageNote: Inverse code is SASECWE 23591 active startsAfterStartOfEndsWith startsBeforeStartOfEndsWith & & ECW, SBSEAS 4 ENS ends near start A relationship in which the source act's effective time ends near the start of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is ENE 23641 active endsNearEnd endsNearStart & & _ActRelationshipTemporallyPertainsApproximates 5 ECWS ends concurrent with start of The source Act ends when the target act starts (i.e. if we say "ActOne ECWS ActTwo", it means that ActOne ends when ActTwo starts, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is SCWE 23463 active startsConcurrentWithEndOf endsConcurrentWithStartOf & & EASORECWS, EBSORECWS, ENS 4 SNE starts near end A relationship in which the source act's effective time starts near the end of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is SNS 23638 active startsNearStart startsNearEnd & & _ActRelationshipTemporallyPertainsApproximates 5 SCWE starts concurrent with end of The source Act starts when the target act ends (i.e. if we say "ActOne SCWE ActTwo", it means that ActOne starts when ActTwo ends, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is SBSECWS 23462 active endsConcurrentWithStartOf startsConcurrentWithEndOf & & OVERLAP, SAEORSCWE, SNE 4 SNS starts near start A relationship in which the source act's effective time starts near the start of the target act's effective time. Near is defined separately as a time interval. Usage Note: Inverse code is SNE 23639 active startsNearEnd startsNearStart & & _ActRelationshipTemporallyPertainsApproximates 5 SCW starts concurrent with A relationship in which the source act's effective time starts with the start of the target act's effective time. UsageNote: This code is reflexive. Therefore its inverse code is itself. 23036 active startsConcurrentlyWith startsConcurrentlyWith & & OVERLAP, SASORSCW, SBSORSCW, SNS 6 SCWSEBE starts with. ends before end of The source Act starts with.the target Act and ends before the end of the target Act. UsageNote: Inverse code is SCWSEAE 23593 active startsWithEndsAfterEndOf startsWithEndsBeforeEndOf & & EDU, SBE, SCW 6 SCWSEAE starts with, ends after end of The source Act starts with the target Act, and ends after the end of the target Act. 23592 active true startsWithEndsBeforeEndOf startsWithEndsAfterEndOf & & SBEEAE, SCW 6 CONCURRENT concurrent with 3 EAS ends after start of A relationship in which the source act ends after the target act starts. UsageNote: Inverse code is SBE 23079 active startsBeforeEndOf endsAfterStartOf & & _ActRelationshipTemporallyPertains, EASORECWS 4 EAE ends after end of A relationship in which the source act ends after the target act ends. UsageNote: Inverse code is EBE 23081 active endsBeforeEndOf endsAfterEndOf & & EAEORECW, EAS 5 SASEAE starts after start of, ends after end of The source Act starts after start of the target Act and ends after end of the target Act. UsageNote: Inverse code is SBSEBE 23583 active true startsBeforeStartOfEndsBeforeEndOf startsAfterStartOfEndsAfterAndOf & & EAE, SAS 6 SBEEAE contains end of The source Act contains the end of the target Act. UsageNote: Inverse code is EDU 23587 active true endsDuring containsEndOf & & OVERLAP, SASEAE 7 SBSEAE contains time of The source Act contains the time of the target Act. UsageNote: Inverse code is DURING 23588 active true occursDuring containsTimeOf & & SBEEAE, SBSEAS 7 SASSBEEAS start after start of, contains end of 7 SCWSEAE starts with, ends after end of 6 SASSBEEAS start after start of, contains end of The source Act start after the start of the target Act, and contains the end of the target Act. UsageNote: Inverse code is SBSEASEBE 23585 active true containsStartOfEndsBeforeEndOf startAfterStartOfContainsEndOf & & SASEAE, SBEEAE, SDU 4 SAS starts after start of The source Act starts after the start of the target Act (i.e. if we say "ActOne SAS ActTwo", it means that ActOne starts after the start of ActTwo, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is SBS 21308 active true startsBeforeStartOf startsAfterStartOf & & EAS, SASORSCW 5 SAE starts after end of A relationship in which the source act starts after the target act ends. UsageNote: Inverse code is EBS 22043 active true endsBeforeStartof startsAfterEndOf & & SAEORSCWE, SAS 5 DURING occurs during A relationship in which the source act's effective time is wholly within the target act's effective time (including end points, as defined in the act's effective times) UsageNote: Inverse code is SBSEAE 23034 active true spansOccurrenceOf occursDuring & & SAS 5 SASECWE starts after start of, ends with The source Act starts after start of the target Act, and ends with the target Act. UsageNote: Inverse code is SBSECWE 23584 active true startsBeforeStartOfEndsWith startsAfterStartOfEndsWith & & SAS 5 SASEAE starts after start of, ends after end of 3 EASORECWS ends after or concurrent with start of A relationship in which the source act's effective time ends after or concurrent with the start of the target act's effective time. Usage Note: Inverse code is EBSORECWS 23645 active endsBeforeOrConcurrentWithStartOf endsAfterOrConcurrentWithStartOf & & _ActRelationshipTemporallyPertains 4 EAEORECW ends after or concurrent with end of A relationship in which the source act's effective time ends after or concurrent with the end of the target act's effective time. Usage Note: Inverse code is EBEORECW 23646 active endsBeforeOrConcurrentWithEndOf endsAfterOrConcurrentWithEndOf & & EASORECWS 5 EAE ends after end of 5 ECW ends concurrent with 4 EAS ends after start of 4 ECWS ends concurrent with start of 3 INDEPENDENT independent of time of The source Act is independent of the time of the target Act. UsageNote: This code is reflexive. Therefore its inverse code is itself. 23582 active independentOfTimeOf independentOfTimeOf & & _ActRelationshipTemporallyPertains 3 SAEORSCWE starts after or concurrent with end of A relationship in which the source act's effective time starts after or concurrent with the end of the target act's effective time. Usage Note: Inverse code is SBEORSCWE 23644 active startsBeforeOrConcurrentWithEndOf startsAfterOrConcurrentWithEndOf & & _ActRelationshipTemporallyPertains 4 SCWE starts concurrent with end of 4 SAE starts after end of 3 SASORSCW starts after or concurrent with start of A relationship in which the source act's effective time starts after or concurrent with the start of the target act's effective time. Usage Note: Inverse code is SBSORSCW 23642 active startsBeforeOrConcurrentWithStartOf startsAfterOrConcurrentWithStartOf & & _ActRelationshipTemporallyPertains 4 SAS starts after start of 4 SCW starts concurrent with 3 SBEORSCWE starts before or concurrent with end of A relationship in which the source act's effective time starts before or concurrent with the end of the target act's effective time. Usage Note: Inverse code is SAEORSCWE 23643 active startsAfterOrConcurrentWithStartOf startsBeforeOrConcurrentWithEndOf & & _ActRelationshipTemporallyPertains 4 OVERLAP overlaps with A relationship in which the source act's effective time overlaps the target act's effective time in any way. UsageNote: This code is reflexive. Therefore its inverse code is itself. 23035 active overlapsWith overlapsWith & & SBEORSCWE 5 EDU ends during A relationship in which the source act ends within the target act's effective time (including end points, as defined in the act's effective times) UsageNote: Inverse code is SBEEAE 23080 active encompassesEndOf endsDuring & & OVERLAP 6 SBSEASEBE contains start of, ends before end of The source Act contains the start of the target Act, and ends before the end of the target Act. UsageNote: Inverse code is SASSBEEAS 23589 active startAfterStartOfContainsEndOf containsStartOfEndsBeforeEndOf & & EDU, SBE, SBSEAS, SBSEBE 6 SCWSEBE starts with. ends before end of 5 SBSEAS contains start of The source Act contains the start of the target Act. UsageNote: Inverse code is SDU 23586 active startsDuring containsStartOf & & OVERLAP, SBS 6 SBSECWE starts before start of, ends with 6 SBSEASEBE contains start of, ends before end of 6 SBSEAE contains time of 5 SDU starts during A relationship in which the source act starts within the target act's effective time (including end points, as defined in the act's effective times) UsageNote: Inverse code is SBSEAS 23082 active encompassesStartOf startsDuring & & OVERLAP 6 SASSBEEAS start after start of, contains end of 5 ECW ends concurrent with 5 SBEEAE contains end of 5 SCW starts concurrent with 5 SCWE starts concurrent with end of 4 SBE starts before end of The source Act starts before the end of the target Act (i.e. if we say "ActOne SBE ActTwo", it means that ActOne starts before the end of ActTwo, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is EAS 23460 active endsAfterStartOf startsBeforeEndOf & & SBEORSCWE 5 EBE ends before end of The source Act ends before the end of the target Act (i.e. if we say "ActOne EBE ActTwo", it means that ActOne ends before the end of ActTwo, therefore ActOne is the source and ActTwo is the target). UsageNote: Inverse code is EAE 23461 active endsAfterEndOf endsBeforeEndOf & & EBEORECW, SBE 6 SBSEBE starts before start of, ends before end of The source Act starts before the start of the target Act, and ends before the end of the target Act. UsageNote: Inverse code is SASEAE 23590 active startsAfterStartOfEndsAfterAndOf startsBeforeStartOfEndsBeforeEndOf & & EBE, SBS 7 EBSORECWS ends before or concurrent with start of A relationship in which the source act's effective time ends before or concurrent with the start of the target act's effective time. Usage Note: Inverse code is EASORECWS 23649 active endsAfterOrConcurrentWithStartOf endsBeforeOrConcurrentWithStartOf & & SBSEBE 8 EBS ends before start of A relationship in which the source act ends before the target act starts. UsageNote: Inverse code is SAE 23078 active startsAfterEndOf endsBeforeStartOf & & EBSORECWS 8 ECWS ends concurrent with start of 7 SBSEASEBE contains start of, ends before end of 5 EBEORECW ends before or concurrent with end of A relationship in which the source act's effective time ends before or concurrent with the end of the target act's effective time. Usage Note: Inverse code is EAEORECW 23648 active endsAfterOrConcurrentWithEndOf endsBeforeOrConcurrentWithEndOf & & SBE 6 ECW ends concurrent with 6 EBE ends before end of 5 SBSORSCW starts before or concurrent with start of A relationship in which the source act's effective time starts before or concurrent with the start of the target act's effective time. Usage Note: Inverse code is SASORSCW 23647 active startsAfterOrConcurrentWithStartOf startsBeforeOrConcurrentWithStartOf & & SBE 6 SBS starts before start of A relationship in which the source act begins before the target act begins. UsageNote: Inverse code is SAS 23076 active startsAfterStartOf startsBeforeStartOf & & SBSORSCW 7 SBSEBE starts before start of, ends before end of 7 SBSEAS contains start of 6 SCW starts concurrent with 5 SBSEASEBE contains start of, ends before end of 5 SCWSEBE starts with. ends before end of 2 AUTH authorized by A relationship in which the target act authorizes or certifies the source act. 14019 active true authorizationOf authorization DH_______ DH_______ & & ART 2 CAUS is etiology for Description: An assertion that an act was the cause of another act.This is stronger and more specific than the support link. The source (cause) is typically an observation, but may be any act, while the target may be any act. Examples: a growth of Staphylococcus aureus may be considered the cause of an abscess contamination of the infusion bag was deemed to be the cause of the infection that the patient experienced lack of staff on the shift was deemed to be a supporting factor (proximal factor) causing the patient safety incident where the patient fell out of bed because the bed-sides had not been put up which caused the night patient to fall out of bed 10332 active true cause causeOf DD_______ DD_______ cause effect & & ART 2 COMP has component The target act is a component of the source act, with no semantics regarding composition or aggregation implied. 10318 active false false componentOf component E________ E________ & & ART 3 CTRLV has control variable A relationship from an Act to a Control Variable. For example, if a Device makes an Observation, this relates the Observation to its Control Variables documenting the device's settings that influenced the observation. 17902 active false false controlVariableFor controlVariable EA_______ EA_______ & & COMP 3 MBR has member The target Acts are aggregated by the source Act. Target Acts may have independent existence, participate in multiple ActRelationships, and do not contribute to the meaning of the source. UsageNotes: This explicitly represents the conventional notion of aggregation. The target Act is part of a collection of Acts (no implication is made of cardinality, a source of Acts may contain zero, one, or more member target Acts). It is expected that this will be primarily used with _ActClassRecordOrganizer, BATTERY, and LIST 23594 active false false memberOf hasMember EA_______ EA_______ any Act & & This explicitly represents the conventional notion of aggregation. The target Act is part of a collection of Acts (no implication is made of cardinality, a source of Acts may contain zero, one, or more member target Acts). It is expected that this will be primarily used with _ActClassRecordOrganizer, BATTERY, and LIST COMP 4 STEP has step A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently. UsageNotes: Sequence of steps may be indicated by use of _ActRelationshipTemporallyPertains, as well as via ActRelationship.sequenceNumber, ActRelationship.pauseQuantity, Target.priorityCode. OpenIssue: Need Additional guidelines on when each approach should be used. 23595 active false false isStepOf hasStep EAA______ EAA______ any _ActMoodCompletionTrack & & Sequence of steps may be indicated by use of _ActRelationshipTemporallyPertains, as well as via ActRelationship.sequenceNumber, ActRelationship.pauseQuantity, Target.priorityCode. MBR 5 ARR arrival The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act entered into the source Act by means of the target Transportation act. 17911 active false false arrivalFor arrivedBy EAAB_____ EAAB_____ & & STEP 5 DEP departure The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act departed from the source Act by means of the target Transportation act. 17912 active false false departureFor departedBy EAAC_____ EAAC_____ & & STEP 3 PART has part The source Act is a composite of the target Acts. The target Acts do not have an existence independent of the source Act. UsageNote: In UML 1.1, this is a "composition" defined as: "A form of aggregation with strong ownership and coincident lifetime as part of the whole. Parts with non-fixed multiplicity may be created after the composite itself, but once created they live and die with it (i.e., they share lifetimes). Such parts can also be explicitly removed before the death of the composite. Composition may be recursive." 23596 active false false isPartOf hasPart EB_______ EB_______ any Act & & COMP 2 COVBY covered by A relationship in which the source act is covered by or is under the authority of a target act. A financial instrument such as an Invoice Element is covered by one or more specific instances of an Insurance Policy. 14894 active true coverageOf coverage DP_______ DP_______ & & ART 2 DRIV is derived from Associates a derived Act with its input parameters. E.G., an anion-gap observation can be associated as being derived from given sodium-, (potassium-,), chloride-, and bicarbonate-observations. The narrative content (Act.text) of a source act is wholly machine-derived from the collection of target acts. 10334 active true derivation derivedFrom DF_______ DF_______ output parameter input parameter & & ART 2 ELNK episodeLink Expresses an association that links two instances of the same act over time, indicating that the instance are part of the same episode, e.g. linking two condition nodes for episode of illness; linking two encounters for episode of encounter. 18865 active true linkedBy links BG_______ BG_______ & & ART 2 EVID provides evidence for Indicates that the target Act provides evidence in support of the action represented by the source Act. The target is not a 'reason' for the source act, but rather gives supporting information on why the source act is an appropriate course of action. Possible targets might be clinical trial results, journal articles, similar successful therapies, etc. Rationale: Provides a mechanism for conveying clinical justification for non-approved or otherwise non-traditional therapies. 21572 active true & & ART 2 EXACBY exacerbated by **Description:**The source act is aggravated by the target act. (Example "chest pain" EXACBY "exercise") 22827 active & & ART 2 EXPL has explanation This is the inversion of support. Used to indicate that a given observation is explained by another observation or condition. 10331 active true explanationFor explanation DI_______ DI_______ explaining observation or condition & & ART 2 INTF interfered by the target act documents a set of circumstances (events, risks) which prevent successful completion, or degradation of quality of, the source Act. UsageNote: This provides the semantics to document barriers to care 23597 active interferesWith interferedBy G________ G________ any Act & & ART 2 ITEMSLOC items located Items located 20841 active true itemStorageFor itemStorage DR_______ DR_______ & & ART 2 LIMIT limited by A relationship that limits or restricts the source act by the elements of the target act. For example, an authorization may be limited by a financial amount (up to $500). Target Act must be in EVN.CRIT mood. 14896 active true limitationOf limitation DQ_______ DQ_______ & & ART 2 META has metadata Definition: Indicates that the attributes and associations of the target act provide metadata (for example, identifiers, authorship, etc.) for the source act. Constraint: Source act must have either a mood code that is not "EVN" (event) or its "isCriterion" attribute must set to "true". Target act must be an Act with a mood code of EVN and with isCriterionInd attribute set to "true". 23111 active false true metadataFor metadata DZ_______ AA_______ & & ART 2 MFST is manifestation of An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation. 10333 active true manifestation manifestationOf DE_______ DE_______ manifestation cause & & ART 2 NAME assigns name Used to assign a "name" to a condition thread. Source is a condition node, target can be any service. 10336 active true assignedConditionName conditionNamed DJ_______ DJ_______ condition thread name & & ART 2 OUTC has outcome An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-conditional".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute (AND, OR, XOR) can be used. An outcome link is often inverted to describe an outcome assessment. 10324 active false true outcomeOf outcome A________ A________ condition or action outcome & & ART 3 _ActRelationsipObjective Act Relationsip Objective The target act is a desired outcome of the source act. Source is any act (typically an intervention). Target must be an observation in criterion mood. 21384 active false true goalOf goal AC_______ AC_______ & & true OUTC 4 OBJC has continuing objective A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood. 10327 active false true maintenanceGoalOf maintenanceGoal ACA______ ACA______ service criterion & & _ActRelationsipObjective 4 OBJF has final objective A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention). Target must be an observation in criterion mood. 10326 active false true finalGoalOf finalGoal ACB______ ACB______ service criterion & & _ActRelationsipObjective 3 GOAL has goal A goal that one defines given a patient's health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood. 10325 active false true goalOf goal AB_______ AB_______ observation, condition goal & & OUTC 3 RISK has risk A noteworthy undesired outcome of a patient's condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed. 10328 active false true riskOf risk AA_______ AA_______ observation, condition risk & & OUTC 2 PERT has pertinent information This is a very unspecific relationship from one item of clinical information to another. It does not judge about the role the pertinent information plays. 10329 active true true pertainsTo pertinentInformation D________ D________ any service any service & & ART 2 PREV has previous instance A relationship in which the target act is a predecessor instance to the source act. Generally each of these instances is similar, but no identical. In healthcare coverage it is used to link a claim item to a previous claim item that might have claimed for the same set of services. 14018 active true successor predecessor DC_______ DC_______ & & ART 2 REFR refers to A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee. 14020 active true referencedBy reference DK_______ DK_______ & & ART 3 USE uses Indicates that the source act makes use of (or will make use of) the information content of the target act. UsageNotes: A usage relationship only makes sense if the target act is authored and occurs independently of the source act. Otherwise a simpler relationship such as COMP would be appropriate. Rationale: There is a need when defining a clinical trial protocol to indicate that the protocol makes use of other protocol or treatment specifications. This is stronger than the assertion of "references". References may exist without usage, and in a clinical trial protocol is common to assert both: what other specifications does this trial use and what other specifications does it merely reference. 23102 active true usedBy uses DKA______ DKA______ & & A usage relationship only makes sense if the target act is authored and occurs independently of the source act. Otherwise a simpler relationship such as COMP would be appropriate. REFR 2 REFV has reference values Reference ranges are essentially descriptors of a class of result values assumed to be "normal", "abnormal", or "critical." Those can vary by sex, age, or any other criterion. Source and target are observations, the target is in criterion mood. This link type can act as a trigger in case of alarms being triggered by critical results. 10335 active true referenceRangeFor referenceRange DL_______ DL_______ range & & ART 2 RELVBY relieved by **Description:**The source act is wholly or partially alleviated by the target act. (Example "chest pain" RELVBY "sublingual nitroglycerin administration") 22828 active & & ART 2 SEQL is sequel An act relationship indicating that the source act follows the target act. The source act should in principle represent the same kind of act as the target. Source and target need not have the same mood code (mood will often differ). The target of a sequel is called antecedent. Examples for sequel relationships are: revision, transformation, derivation from a prototype (as a specialization is a derivation of a generalization), followup, realization, instantiation. 10337 active false true sequel sequelTo B________ B________ & & ART 3 APND is appendage An addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered. 10339 active false true appendageOf appendage BJ_______ BJ_______ & & SEQL 3 BSLN has baseline Indicates that the target observation(s) provide an initial reference for the source observation or observation group. UsageConstraints: Both source and target must be Observations or specializations thereof. 23101 active false true baselineFor baseline BG_______ BG_______ & & SEQL 3 COMPLY complies with **Description:**The source act complies with, adheres to, conforms to, or is permissible under (in whole or in part) the policy, contract, agreement, law, conformance criteria, certification guidelines or requirement conveyed by the target act. Examples for compliance relationships are: audits of adherence with a security policy, certificate of conformance to system certification requirements, or consent directive in compliance with or permissible under a privacy policy. 22626 active false true compliesWith compliance BO_______ BO_______ & & SEQL 3 DOC documents The source act documents the target act. 11609 active false true documentation documentationOf BH_______ BH_______ & & SEQL 3 FLFS fulfills The source act fulfills (in whole or in part) the target act. Source act must be in a mood equal or more actual than the target act. 10342 active false true fulfillment inFulfillmentOf BA_______ BA_______ & & SEQL 4 OCCR occurrence The source act is a single occurrence of a repeatable target act. The source and target act can be in any mood on the "completion track" but the source act must be as far as or further along the track than the target act (i.e., the occurrence of an intent can be an event but not vice versa). 11614 active false true occurrence occurrenceOf BAA______ BAA______ & & FLFS 4 OREF references order Relates either an appointment request or an appointment to the order for the service being scheduled. 11628 active false true referencedBy referencedOrder BAB______ BAB______ ActMood = ARQ or APT and ActMood = ORD & & FLFS 4 SCH schedules request Associates a specific time (and associated resources) with a scheduling request or other intent. 11627 active false true requestedBy scheduleRequest BAC______ BAC______ & & FLFS 3 GEN has generalization The generalization relationship can be used to express categorical knowledge about services (e.g., amilorid, triamterene, and spironolactone have the common generalization potassium sparing diuretic). 10348 active false true specialization generalization BC_______ BC_______ specialization generalization & & SEQL 3 GEVL evaluates (goal) A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal to observation) can be "calculated" and need not be sent explicitly. 10346 active false true evaluation evaluationOf BD_______ BD_______ evaluation goal & & SEQL 3 INST instantiates (master) Used to capture the link between a potential service ("master" or plan) and an actual service, where the actual service instantiates the potential service. The instantiation may override the master's defaults. 10341 active false true instantiation definition BB_______ BB_______ instance master & & SEQL 3 MOD modifies Definition: Used to link a newer version or 'snapshot' of a business object (source) to an older version or 'snapshot' of the same business object (target). *Usage:*The identifier of the Act should be the same for both source and target. If the identifiers are distinct, RPLC should be used instead. Name from source to target = "modifiesPrior" Name from target to source = "modifiesByNew" 21638 active false true & & SEQL 3 MTCH matches (trigger) A trigger-match links an actual service (e.g., an observation or procedure that took place) with a service in criterion mood. For example if the trigger is "observation of pain" and pain is actually observed, and if that pain-observation caused the trigger to fire, that pain-observation can be linked with the trigger. 10345 active false true match matchOf BF_______ BF_______ matching service trigger & & SEQL 3 OPTN has option A relationship between a source Act that provides more detailed properties to the target Act. The source act thus is a specialization of the target act, but instead of mentioning all the inherited properties it only mentions new property bindings or refinements. The typical use case is to specify certain alternative variants of one kind of Act. The priorityNumber attribute is used to weigh refinements as preferred over other alternative refinements. Example: several routing options for a drug are specified as one SubstanceAdministration for the general treatment with attached refinements for the various routing options. 10347 active false true optionFor option BN_______ BN_______ & & SEQL 3 RCHAL re-challenge **Description:**A relationship in which the target act is carried out to determine whether an effect attributed to the source act can be recreated. 22044 active false true & & SEQL 3 REV reverses A relationship between a source Act that seeks to reverse or undo the action of the prior target Act. Example: A posted financial transaction (e.g., a debit transaction) was applied in error and must be reversed (e.g., by a credit transaction) the credit transaction is identified as an undo (or reversal) of the prior target transaction. Constraints: the "completion track" mood of the target Act must be equally or more "actual" than the source act. I.e., when the target act is EVN the source act can be EVN, or any INT. If the target act is INT, the source act can be INT. 14898 active false true reversal reversalOf BK_______ BK_______ & & SEQL 3 RPLC replaces A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type. 10338 active false true replacement replacementOf BI_______ BI_______ & & SEQL 3 SUCC succeeds Definition: A new act that carries forward the intention of the original act, but does not completely replace it. The status of the predecessor act must be 'completed'. The original act is the target act and the successor is the source act. 11616 active false true successor predecessor BIA______ BIA______ & & SEQL 3 UPDT updates (condition) A condition thread relationship specifically links condition nodes together to form a condition thread. The source is the new condition node and the target links to the most recent node of the existing condition thread. 10340 active false true update updateOf BE_______ BE_______ new head of thread old head of thread & & SEQL 3 XCRPT Excerpts The source is an excerpt from the target. 18660 active false true excerpt excerptFrom BM_______ BM_______ & & SEQL 4 VRXCRPT Excerpt verbatim The source is a direct quote from the target. 18661 active false true verbatimExcerpt verbatimExcerptFrom BMA______ BMA______ & & XCRPT 3 XFRM transformation Used when the target Act is a transformation of the source Act. (For instance, used to show that a CDA document is a transformation of a DICOM SR document.) 11624 active false true transformation transformationOf BL_______ BL_______ & & SEQL 2 SPRT has support Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post). 10330 active true supportOf support DA_______ DA_______ supporting evidence & & ART 3 SPRTBND has bounded support A specialization of "has support" (SPRT), used to relate a secondary observation to a Region of Interest on a multidimensional observation, if the ROI specifies the true boundaries of the secondary observation as opposed to only marking the approximate area. For example, if the start and end of an ST elevation episode is visible in an EKG, this relation would indicate the ROI bounds the "ST elevation" observation -- the ROI defines the true beginning and ending of the episode. Conversely, if a ROI simply contains ST elevation, but it does not define the bounds (start and end) of the episode, the more general "has support" relation is used. Likewise, if a ROI on an image defines the true bounds of a "1st degree burn", the relation "has bounded support" is used; but if the ROI only points to the approximate area of the burn, the general "has support" relation is used. 17899 active true boundedSupportOf boundedSupport DAA______ DAA______ & & SPRT 2 SUBJ has subject Relates an Act to its subject Act that the first Act is primarily concerned with. Examples The first Act may be a ControlAct manipulating the subject Act The first act is a region of interest (ROI) that defines a region within the subject Act. The first act is a reporting or notification Act, that echos the subject Act for a specific new purpose. Constraints An Act may have multiple subject acts. Rationale The ActRelationshipType "has subject" is similar to the ParticipationType "subject", Acts that primarily operate on physical subjects use the Participation, those Acts that primarily operate on other Acts (other information) use the ActRelationship. 13971 active true subjectOf subject DB_______ DB_______ & & ART 3 QUALF has qualifier The target observation qualifies (refines) the semantics of the source observation. UsageNote: This is not intended to replace concept refinement and qualification via vocabulary. It is used when there are multiple components which together provide the complete understanding of the source Act. 23598 active true qualifies hasQualifier DBA______ DBA______ any Act & & SUBJ 2 SUMM summarized by An act that contains summary values for a list or set of subordinate acts. For example, a summary of transactions for a particular accounting period. 15988 active true summaryOf summary DM_______ DM_______ & & ART 2 VALUE has value **Description:**Indicates that the target Act represents the result of the source observation Act. FormalConstraint: Source Act must be an Observation or specialization there-of. Source Act must not have the value attribute specified UsageNote: This relationship allows the result of an observation to be fully expressed as RIM acts as opposed to being embedded in the value attribute. For example, sending a Document act as the result of an imaging observation, sending a list of Procedures and/or other acts as the result of a medical history observation. The valueNegationInd attribute on the source Act has the same semantics of "negated finding" when it applies to the target of a VALUE ActRelationship as it does to the value attribute. On the other hand, if the ActRelationship.negationInd is true for a VALUE ActRelationship, that means the specified observation does not have the indicated value but does not imply a negated finding. Because the semantics are extremely close, it is recommended that Observation.valueNegationInd be used, not ActRelationship.negationInd. OpenIssue: The implications of negationInd on ActRelationship and the valueNegationind on Observation. 23319 active & & ART 1 CURE curative indication 21642 retired true & & 1 CURE.ADJ adjunct curative indication 21643 retired true & & 1 MTGT.ADJ adjunct mitigation 21641 retired true & & 1 RACT 14892 retired & & 1 SUGG 10322 retired & &
The source is an excerpt from the target.
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
The child code is a more narrow version of the concept represented by the parent code. I.e. Every child concept is also a valid parent concept. Used to allow determination of subsumption. Must be transitive, irreflexive, antisymmetric.
Inverse of Specializes. Only included as a derived relationship.
The internal identifier for the concept in the HL7 Access database repository.
Designation of a concept's state. Normally is not populated unless the state is retired..
If true, indicates that ActRelationships or Participations of the specified type (and any specializations thereof) will normally conduct. For more usage information, refer to the Core Principles specification.
If true, indicates that the Act attribute or association (as represented by a typeCode for eaither ActRelationship or Pareticipation is a descriptor of the document (record) represented by the act object. If false, indicates the property is a descriptor of the action itself, actual, intended, or potential. Applies to interpretation of attributes and associations with respect to changes in the value of Act.actionNegationInd and Act.moodCode. (See descriptions of these attributes for further discussion.) For example, in an order, the id attribute [isDocumentCharacteristic = true] is an identifier of the record of the order, not an identifier of the intended event. On the other hand, the code attribute [isDocumentCharacteristic = false] describes a characteristic of the intended event.
Name of inboundRelationship from Act to ActReln
Formal name of outboundRelationship from Act to ActReln
Sort key for the inboundRelationship from Act to ActReln
Sort key for the outboundRelationship from Act to ActReln
The name of the assciation from ActRelationship to the source Act
Indicates that the code is abstract - only intended to be used as a selector for other concepts
An additional concept code that was also attributed to a concept
**Description:** A directed association between a source Act and a target Act. **Usage Note:** This code should never be transmitted in an instance as the value of ActRelationship.typeCode (attribute)
A relationship that defines the relative time of the end source act based on the time of the target act.
A relationship that defines the relative time of the start source act based on the time of the target act.
Expresses values for describing the relationship relationship between an InvoiceElement or InvoiceElementGroup and a billable act.
Expresses values for describing the relationship between a FinancialTransaction and an Account.
A contraindication is just a negation of a reason, i.e. it gives a condition under which the action is not to be done. Both, source and target can be any kind of service; target service is in criterion mood. How the strength of a contraindication is expressed (e.g., relative, absolute) is left as an open issue. The priorityNumber attribute could be used.
A requirement to be true before a service is performed. The target can be any service in criterion mood. For multiple pre-conditions a conjunction attribute (AND, OR, XOR) is applicable.
**Description:** The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action. As well as providing various types of information about the rationale for a service, the RSON act relationship is routinely used between a SBADM act and an OBS act to describe the indication for use of a medication. Child concepts may be used to describe types of indication. *Discussion:* In prior releases, the code "SUGG" (suggests) was expressed as "an inversion of the reason link." That code has been retired in favor of the inversion indicator that is an attribute of ActRelationship.
A pre-condition that if true should result in the source Act being executed. The target is in typically in criterion mood. When reported after the fact (i.e. the criterion has been met) it may be in Event mood. A delay between the trigger and the triggered action can be specified. *Discussion:* This includes the concept of a required act for a service or financial instrument such as an insurance plan or policy. In such cases, the trigger is the occurrence of a specific condition such as coverage limits being exceeded.
A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service. The financial transaction will define the charge (bill) for delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.
A relationship that provides an ability to associate a financial transaction (target) as a cost to a clinical act (source). A clinical act may have an inherit cost associated with the execution or delivery of the service. The financial transaction will define the cost of delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.
A credit relationship ties a financial transaction (target) to an account (source). A credit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account credit will decrease the account balance. A non-asset account credit will decrease the account balance.
A debit relationship ties a financial transaction (target) to an account (source). A debit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account debit will increase the account balance. A non-asset account debit will decrease the account balance.
Abstract collector for ActRelationship types that relate two acts by their approximate timing.
A relationship in which the source act ends after the target act starts. *UsageNote:* Inverse code is **SBE**
A relationship in which the source act's effective time ends after or concurrent with the start of the target act's effective time. *Usage Note:* Inverse code is EBSORECWS
The source Act is independent of the time of the target Act. *UsageNote:* This code is reflexive. Therefore its inverse code is itself.
A relationship in which the source act's effective time starts after or concurrent with the end of the target act's effective time. *Usage Note:* Inverse code is SBEORSCWE
starts after or concurrent with start of
A relationship in which the source act's effective time starts after or concurrent with the start of the target act's effective time. *Usage Note:* Inverse code is SBSORSCW
A relationship in which the source act's effective time starts before or concurrent with the end of the target act's effective time. *Usage Note:* Inverse code is SAEORSCWE
A relationship in which the source act's effective time ends near the end of the target act's effective time. Near is defined separately as a time interval. *Usage Note:* Inverse code is ENS
A relationship in which the source act's effective time ends near the start of the target act's effective time. Near is defined separately as a time interval. *Usage Note:* Inverse code is ENE
A relationship in which the source act's effective time starts near the end of the target act's effective time. Near is defined separately as a time interval. *Usage Note:* Inverse code is SNS
A relationship in which the source act's effective time starts near the start of the target act's effective time. Near is defined separately as a time interval. *Usage Note:* Inverse code is SNE
A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood.
A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention). Target must be an observation in criterion mood.
Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element.
Specifies under what circumstances (target Act) the source-Act may, must, must not or has occurred
Abstract collector for ActRelationhsip types that relate two acts by their timing.
A relationship in which the target act authorizes or certifies the source act.
**Description:** An assertion that an act was the cause of another act.This is stronger and more specific than the support link. The source (cause) is typically an observation, but may be any act, while the target may be any act. **Examples:** * a growth of Staphylococcus aureus may be considered the cause of an abscess * contamination of the infusion bag was deemed to be the cause of the infection that the patient experienced * lack of staff on the shift was deemed to be a supporting factor (proximal factor) causing the patient safety incident where the patient fell out of bed because the bed-sides had not been put up which caused the night patient to fall out of bed
The target act is a component of the source act, with no semantics regarding composition or aggregation implied.
A relationship in which the source act is covered by or is under the authority of a target act. A financial instrument such as an Invoice Element is covered by one or more specific instances of an Insurance Policy.
Associates a derived Act with its input parameters. E.G., an anion-gap observation can be associated as being derived from given sodium-, (potassium-,), chloride-, and bicarbonate-observations. The narrative content (Act.text) of a source act is wholly machine-derived from the collection of target acts.
Expresses an association that links two instances of the same act over time, indicating that the instance are part of the same episode, e.g. linking two condition nodes for episode of illness; linking two encounters for episode of encounter.
Indicates that the target Act provides evidence in support of the action represented by the source Act. The target is not a 'reason' for the source act, but rather gives supporting information on why the source act is an appropriate course of action. Possible targets might be clinical trial results, journal articles, similar successful therapies, etc. *Rationale:* Provides a mechanism for conveying clinical justification for non-approved or otherwise non-traditional therapies.
**Description:**The source act is aggravated by the target act. (Example "chest pain" EXACBY "exercise")
This is the inversion of support. Used to indicate that a given observation is explained by another observation or condition.
the target act documents a set of circumstances (events, risks) which prevent successful completion, or degradation of quality of, the source Act. *UsageNote:* This provides the semantics to document barriers to care
A relationship that limits or restricts the source act by the elements of the target act. For example, an authorization may be limited by a financial amount (up to $500). Target Act must be in EVN.CRIT mood.
**Definition:** Indicates that the attributes and associations of the target act provide metadata (for example, identifiers, authorship, etc.) for the source act. **Constraint:** Source act must have either a mood code that is not "EVN" (event) or its "isCriterion" attribute must set to "true". Target act must be an Act with a mood code of EVN and with isCriterionInd attribute set to "true".
An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation.
Used to assign a "name" to a condition thread. Source is a condition node, target can be any service.
An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-conditional".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute (AND, OR, XOR) can be used. An outcome link is often inverted to describe an outcome assessment.
This is a very unspecific relationship from one item of clinical information to another. It does not judge about the role the pertinent information plays.
A relationship in which the target act is a predecessor instance to the source act. Generally each of these instances is similar, but no identical. In healthcare coverage it is used to link a claim item to a previous claim item that might have claimed for the same set of services.
A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee.
Reference ranges are essentially descriptors of a class of result values assumed to be "normal", "abnormal", or "critical." Those can vary by sex, age, or any other criterion. Source and target are observations, the target is in criterion mood. This link type can act as a trigger in case of alarms being triggered by critical results.
**Description:**The source act is wholly or partially alleviated by the target act. (Example "chest pain" RELVBY "sublingual nitroglycerin administration")
An act relationship indicating that the source act follows the target act. The source act should in principle represent the same kind of act as the target. Source and target need not have the same mood code (mood will often differ). The target of a sequel is called antecedent. Examples for sequel relationships are: revision, transformation, derivation from a prototype (as a specialization is a derivation of a generalization), followup, realization, instantiation.
Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post).
Relates an Act to its subject Act that the first Act is primarily concerned with. Examples 1. The first Act may be a ControlAct manipulating the subject Act 2. The first act is a region of interest (ROI) that defines a region within the subject Act. 3. The first act is a reporting or notification Act, that echos the subject Act for a specific new purpose. Constraints An Act may have multiple subject acts. Rationale The ActRelationshipType "has subject" is similar to the ParticipationType "subject", Acts that primarily operate on physical subjects use the Participation, those Acts that primarily operate on other Acts (other information) use the ActRelationship.
An act that contains summary values for a list or set of subordinate acts. For example, a summary of transactions for a particular accounting period.
**Description:**Indicates that the target Act represents the result of the source observation Act. **FormalConstraint:** Source Act must be an Observation or specialization there-of. Source Act must not have the value attribute specified **UsageNote:** This relationship allows the result of an observation to be fully expressed as RIM acts as opposed to being embedded in the value attribute. For example, sending a Document act as the result of an imaging observation, sending a list of Procedures and/or other acts as the result of a medical history observation. The valueNegationInd attribute on the source Act has the same semantics of "negated finding" when it applies to the target of a VALUE ActRelationship as it does to the value attribute. On the other hand, if the ActRelationship.negationInd is true for a VALUE ActRelationship, that means the specified observation does not have the indicated value but does not imply a negated finding. Because the semantics are extremely close, it is recommended that Observation.valueNegationInd be used, not ActRelationship.negationInd. **OpenIssue:** The implications of negationInd on ActRelationship and the valueNegationind on Observation.
A relationship from an Act to a Control Variable. For example, if a Device makes an Observation, this relates the Observation to its Control Variables documenting the device's settings that influenced the observation.
The target Acts are aggregated by the source Act. Target Acts may have independent existence, participate in multiple ActRelationships, and do not contribute to the meaning of the source. **UsageNotes:** This explicitly represents the conventional notion of aggregation. The target Act is part of a collection of Acts (no implication is made of cardinality, a source of Acts may contain zero, one, or more member target Acts). It is expected that this will be primarily used with \_ActClassRecordOrganizer, BATTERY, and LIST
This explicitly represents the conventional notion of aggregation. The target Act is part of a collection of Acts (no implication is made of cardinality, a source of Acts may contain zero, one, or more member target Acts). It is expected that this will be primarily used with _ActClassRecordOrganizer, BATTERY, and LIST
The source Act is a composite of the target Acts. The target Acts do not have an existence independent of the source Act. *UsageNote:* In UML 1.1, this is a "composition" defined as: *"A form of aggregation with strong ownership and coincident lifetime as part of the whole. Parts with non-fixed multiplicity may be created after the composite itself, but once created they live and die with it (i.e., they share lifetimes). Such parts can also be explicitly removed before the death of the composite. Composition may be recursive."*
starts after start of, ends after end of
The source Act starts after start of the target Act and ends after end of the target Act. *UsageNote:* Inverse code is **SBSEBE**
A relationship in which the source act ends after the target act ends. *UsageNote:* Inverse code is **EBE**
A relationship in which the source act's effective time ends with the end of the target act's effective time. *UsageNote:* This code is reflexive. Therefore its inverse code is itself.
The source Act starts after the start of the target Act (i.e. if we say "ActOne SAS ActTwo", it means that ActOne starts after the start of ActTwo, therefore ActOne is the source and ActTwo is the target). *UsageNote:* Inverse code is **SBS**
A relationship in which the source act's effective time ends after or concurrent with the end of the target act's effective time. *Usage Note:* Inverse code is EBEORECW
The source Act ends when the target act starts (i.e. if we say "ActOne ECWS ActTwo", it means that ActOne ends when ActTwo starts, therefore ActOne is the source and ActTwo is the target). *UsageNote:* Inverse code is **SCWE**
starts before start of, ends before end of
The source Act starts before the start of the target Act, and ends before the end of the target Act. *UsageNote:* Inverse code is **SASEAE**
The source Act ends before the end of the target Act (i.e. if we say "ActOne EBE ActTwo", it means that ActOne ends before the end of ActTwo, therefore ActOne is the source and ActTwo is the target). *UsageNote:* Inverse code is **EAE**
A relationship in which the source act ends before the target act starts. *UsageNote:* Inverse code is **SAE**
A relationship in which the source act's effective time is the same as the target act's effective time. *UsageNote:* This code is reflexive. Therefore its inverse code is itself.
The source Act starts before the start of the target Act, and ends with the target Act. *UsageNote:* Inverse code is **SASECWE**
The source Act contains the start of the target Act, and ends before the end of the target Act. *UsageNote:* Inverse code is **SASSBEEAS**
The source Act starts with.the target Act and ends before the end of the target Act. *UsageNote:* Inverse code is **SCWSEAE**
The source act is a single occurrence of a repeatable target act. The source and target act can be in any mood on the "completion track" but the source act must be as far as or further along the track than the target act (i.e., the occurrence of an intent can be an event but not vice versa).
Relates either an appointment request or an appointment to the order for the service being scheduled.
Associates a specific time (and associated resources) with a scheduling request or other intent.
**Description:** The source act is intended to provide active immunity against the effects of the target act (the target act describes an infectious disease)
**Description:** The source act is intended to provide passive immunity against the effects of the target act (the target act describes an infectious disease).
A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently. *UsageNotes:* Sequence of steps may be indicated by use of \_ActRelationshipTemporallyPertains, as well as via ActRelationship.sequenceNumber, ActRelationship.pauseQuantity, Target.priorityCode. *OpenIssue:* Need Additional guidelines on when each approach should be used.
Sequence of steps may be indicated by use of _ActRelationshipTemporallyPertains, as well as via ActRelationship.sequenceNumber, ActRelationship.pauseQuantity, Target.priorityCode.
**Definition:** The source act is performed to recover from the effects of the target act.
The target act is a desired outcome of the source act. Source is any act (typically an intervention). Target must be an observation in criterion mood.
A goal that one defines given a patient's health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood.
A noteworthy undesired outcome of a patient's condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed.
A relationship in which the source act ends within the target act's effective time (including end points, as defined in the act's effective times) *UsageNote:* Inverse code is **SBEEAE**
The source Act contains the end of the target Act. *UsageNote:* Inverse code is **EDU**
The source Act contains the start of the target Act. *UsageNote:* Inverse code is **SDU**
A relationship in which the source act's effective time starts with the start of the target act's effective time. *UsageNote:* This code is reflexive. Therefore its inverse code is itself.
The source Act starts when the target act ends (i.e. if we say "ActOne SCWE ActTwo", it means that ActOne starts when ActTwo ends, therefore ActOne is the source and ActTwo is the target). *UsageNote:* Inverse code is **SBSECWS**
A relationship in which the source act starts within the target act's effective time (including end points, as defined in the act's effective times) *UsageNote:* Inverse code is **SBSEAS**
Indicates that the source act makes use of (or will make use of) the information content of the target act. *UsageNotes:* A usage relationship only makes sense if the target act is authored and occurs independently of the source act. Otherwise a simpler relationship such as COMP would be appropriate. *Rationale:* There is a need when defining a clinical trial protocol to indicate that the protocol makes use of other protocol or treatment specifications. This is stronger than the assertion of "references". References may exist without usage, and in a clinical trial protocol is common to assert both: what other specifications does this trial use and what other specifications does it merely reference.
A usage relationship only makes sense if the target act is authored and occurs independently of the source act. Otherwise a simpler relationship such as COMP would be appropriate.
**Definition:** The source act is performed to block the effects of the target act. This act relationship should be used when describing near miss type incidents where potential harm could have occurred, but the action described in the source act blocked the potential harmful effects of the incident actually occurring.
**Description:** The source act is intended to help establish the presence of a (an adverse) situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.
**Description:** The source act is intented to provide immunity against the effects of the target act (the target act describes an infectious disease)
The source act removes or lessens the occurrence or effect of the target act.
**Description:** The source act is intended to reduce the risk of of an adverse situation to emerge as described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.
**Description:** The source act is intended to improve a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.
A relationship in which the source act starts after the target act ends. *UsageNote:* Inverse code is **EBS**
A relationship in which the source act's effective time is wholly within the target act's effective time (including end points, as defined in the act's effective times) *UsageNote:* Inverse code is **SBSEAE**
The source Act starts after start of the target Act, and ends with the target Act. *UsageNote:* Inverse code is **SBSECWE**
The source Act start after the start of the target Act, and contains the end of the target Act. *UsageNote:* Inverse code is **SBSEASEBE**
A relationship in which the source act's effective time ends before or concurrent with the end of the target act's effective time. *Usage Note:* Inverse code is EAEORECW
starts before or concurrent with start of
A relationship in which the source act's effective time starts before or concurrent with the start of the target act's effective time. *Usage Note:* Inverse code is SASORSCW
The source Act contains the time of the target Act. *UsageNote:* Inverse code is **DURING**
The source Act starts with the target Act, and ends after the end of the target Act.
A relationship in which the source act's effective time overlaps the target act's effective time in any way. *UsageNote:* This code is reflexive. Therefore its inverse code is itself.
The source Act starts before the end of the target Act (i.e. if we say "ActOne SBE ActTwo", it means that ActOne starts before the end of ActTwo, therefore ActOne is the source and ActTwo is the target). *UsageNote:* Inverse code is **EAS**
A relationship in which the source act's effective time ends before or concurrent with the start of the target act's effective time. *Usage Note:* Inverse code is EASORECWS
A relationship in which the source act begins before the target act begins. *UsageNote:* Inverse code is **SAS**
An addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered.
Indicates that the target observation(s) provide an initial reference for the source observation or observation group. *UsageConstraints:* Both source and target must be Observations or specializations thereof.
**Description:**The source act complies with, adheres to, conforms to, or is permissible under (in whole or in part) the policy, contract, agreement, law, conformance criteria, certification guidelines or requirement conveyed by the target act. Examples for compliance relationships are: audits of adherence with a security policy, certificate of conformance to system certification requirements, or consent directive in compliance with or permissible under a privacy policy.
The source act documents the target act.
The source act fulfills (in whole or in part) the target act. Source act must be in a mood equal or more actual than the target act.
The generalization relationship can be used to express categorical knowledge about services (e.g., amilorid, triamterene, and spironolactone have the common generalization potassium sparing diuretic).
A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal to observation) can be "calculated" and need not be sent explicitly.
Used to capture the link between a potential service ("master" or plan) and an actual service, where the actual service instantiates the potential service. The instantiation may override the master's defaults.
Definition: Used to link a newer version or 'snapshot' of a business object (source) to an older version or 'snapshot' of the same business object (target). *Usage:*The identifier of the Act should be the same for both source and target. If the identifiers are distinct, RPLC should be used instead. Name from source to target = "modifiesPrior" Name from target to source = "modifiesByNew"
A trigger-match links an actual service (e.g., an observation or procedure that took place) with a service in criterion mood. For example if the trigger is "observation of pain" and pain is actually observed, and if that pain-observation caused the trigger to fire, that pain-observation can be linked with the trigger.
A relationship between a source Act that provides more detailed properties to the target Act. The source act thus is a specialization of the target act, but instead of mentioning all the inherited properties it only mentions new property bindings or refinements. The typical use case is to specify certain alternative variants of one kind of Act. The priorityNumber attribute is used to weigh refinements as preferred over other alternative refinements. Example: several routing options for a drug are specified as one SubstanceAdministration for the general treatment with attached refinements for the various routing options.
**Description:**A relationship in which the target act is carried out to determine whether an effect attributed to the source act can be recreated.
A relationship between a source Act that seeks to reverse or undo the action of the prior target Act. Example: A posted financial transaction (e.g., a debit transaction) was applied in error and must be reversed (e.g., by a credit transaction) the credit transaction is identified as an undo (or reversal) of the prior target transaction. Constraints: the "completion track" mood of the target Act must be equally or more "actual" than the source act. I.e., when the target act is EVN the source act can be EVN, or any INT. If the target act is INT, the source act can be INT.
A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type.
**Definition:** A new act that carries forward the intention of the original act, but does not completely replace it. The status of the predecessor act must be 'completed'. The original act is the target act and the successor is the source act.
A condition thread relationship specifically links condition nodes together to form a condition thread. The source is the new condition node and the target links to the most recent node of the existing condition thread.
Used when the target Act is a transformation of the source Act. (For instance, used to show that a CDA document is a transformation of a DICOM SR document.)
A specialization of "has support" (SPRT), used to relate a secondary observation to a Region of Interest on a multidimensional observation, if the ROI specifies the true boundaries of the secondary observation as opposed to only marking the approximate area. For example, if the start and end of an ST elevation episode is visible in an EKG, this relation would indicate the ROI bounds the "ST elevation" observation -- the ROI defines the true beginning and ending of the episode. Conversely, if a ROI simply contains ST elevation, but it does not define the bounds (start and end) of the episode, the more general "has support" relation is used. Likewise, if a ROI on an image defines the true bounds of a "1st degree burn", the relation "has bounded support" is used; but if the ROI only points to the approximate area of the burn, the general "has support" relation is used.
The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act entered into the source Act by means of the target Transportation act.
The relationship that links to a Transportation Act (target) from another Act (source) indicating that the subject of the source Act departed from the source Act by means of the target Transportation act.
The target observation qualifies (refines) the semantics of the source observation. *UsageNote:* This is not intended to replace concept refinement and qualification via vocabulary. It is used when there are multiple components which together provide the complete understanding of the source Act.
**Description:** The source act is intended to offer an additional treatment for the management or cure of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature. It is not a requirement that the non-adjunctive treatment is explicitly specified.
**Description:** The source act is intended to provide long term maintenance improvement or management of a pre-existing adverse situation described by the target act. This is not limited to diseases but can apply to any adverse situation or condition of medical or technical nature.
**Description:** The source act is intended to provide palliation for the effects of the target act.
**Description:** The source act is intented to provide symptomatic relief for the effects of the target act.
The source is a direct quote from the target.