Generated Narrative: CodeSystem v3-ActReason Language: en Properties This code system defines the following properties for its concepts Name Code URI Type Description Specializes 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 Generalizes Coding Inverse of Specializes. Only included as a derived relationship. internalId 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 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 internalId Status Not Selectable HL7 Concept Usage Notes Parent 1 _ActAccommodationReason ActAccommodationReason Identifies the reason the patient is assigned to this accommodation type 20937 active true 2 ACCREQNA Accommodation Requested Not Available Accommodation requested is not available. 17429 active _ActAccommodationReason 2 FLRCNV Floor Convenience Accommodation is assigned for floor convenience. 17430 active _ActAccommodationReason 2 MEDNEC Medical Necessity Required for medical reasons(s). 17428 active _ActAccommodationReason 2 PAT Patient request The Patient requested the action 14880 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. 22164 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. 21493 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. 20940 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). 19731 active _ActIneligibilityReason 4 DECSD deceased Client deceased. 19729 active _ActIneligibilityReason 4 REGERR registered in error Client was registered in error. 19730 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. 21555 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. 21565 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. 21558 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. 21560 active _CoverageEligibilityReason 4 EMPLOY employment benefit A person becomes eligible for insurance provided as an employment benefit based on employment status. 21556 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. 21564 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 21562 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. 21566 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. 21561 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. 21563 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. 21559 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. 21557 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. 22168 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. 22169 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. 22165 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. 22166 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. 22167 retired true _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. 22675 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. 22676 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. 22198 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. 22194 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". 23877 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. 22197 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. 22195 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. 22196 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. 23408 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. 22678 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. 22686 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. 22683 active HOPERAT 5 DONAT donation To perform one or more operations on information used for cadaveric organ, eye or tissue donation. 23412 active HOPERAT 5 FRAUD fraud To perform one or more operations on information used for fraud detection and prevention processes. 23413 active HOPERAT 5 GOV government To perform one or more operations on information used within government processes. 23414 active HOPERAT 5 HACCRED health accreditation To perform one or more operations on information for conducting activities related to meeting accreditation criteria. 22692 active HOPERAT 5 HCOMPL health compliance To perform one or more operations on information used for conducting activities required to meet a mandate. 22689 active HOPERAT 5 HDECD decedent To perform one or more operations on information used for handling deceased patient matters. 23415 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 23416 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. 23926 active HOPERAT 5 HLEGAL legal To perform one or more operations on information for conducting activities required by legal proceeding. 22690 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. 22688 active HOPERAT 5 HPRGRP health program reporting To perform one or more operations on information used for conducting activities to meet program accounting requirements. 22691 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. 22687 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. 22695 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. 23871 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. 23872 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. 22694 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. 23875 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. 22693 active HOPERAT 5 PATSFTY patient safety To perform one or more operations on information in processes related to ensuring the safety of health care. 22696 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. 23417 active HOPERAT 5 RECORDMGT records management To perform one or more operations on information used within the health records management process. 23418 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. 23873 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. 23874 active SYSDEV 5 TRAIN training To perform one or more operations on information used in training and education. 23419 active HOPERAT 5 MLTRAINING machine learning training To perform one or more operations on information used in training a machine learning (AI) model. 123419 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. 22685 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. 23421 active HPAYMT 5 COVAUTH coverage authorization To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services. 23422 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. 23456 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. 23420 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. 23457 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. 23458 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. 23876 active COVERAGE 5 REMITADV remittance advice To perform one or more operations on information about the amount remitted for a health care claim. 23423 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. 123423 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. 22679 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. 23864 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. 23424 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. 23868 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. 23869 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. 23870 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. 23865 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. 23866 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. 23867 active HRESCH 4 PATRQT patient requested To perform one or more operations on information in response to a patient's request. 23425 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. 23426 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. 23427 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. 23428 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. 23409 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. 23410 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. 23411 active PUBHLTH 4 TREAT treatment To perform one or more operations on information for provision of health care. 22680 active PurposeOfUse 5 CLINTRL clinical trial To perform health care as part of the clinical trial protocol. 22684 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." 23927 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. 22682 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. 23924 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. 23925 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. 22681 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. 122681 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. 22677 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. 22697 active true _ActInformationManagementReason 3 MARKT marketing Description: 22708 active _ActInformationPrivacyReason 3 OPERAT operations **Description:**Administrative and contractual processes required to support an activity, product, or service 22699 active _ActInformationPrivacyReason 4 LEGAL subpoena **Definition:**To provide information as a result of a subpoena. 21719 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 22704 active OPERAT 4 COMPL compliance **Description:**Operational activities required to meet a mandate related to an activity, product, or service 22702 active OPERAT 4 ENADMIN entity administration **Description:**Operational activities conducted to administer information relating to entities involves with an activity, product, or service 22705 active OPERAT 4 OUTCOMS outcome measure **Description:**Operational activities conducted for the purposes of assessing the results of an activity, product, or service 22701 active OPERAT 4 PRGRPT program reporting **Description:**Operational activities conducted to meet program accounting requirements related to an activity, product, or service 22703 active OPERAT 4 QUALIMP quality improvement **Description:**Operational activities conducted for the purposes of improving the quality of an activity, product, or service 22700 active OPERAT 4 SYSADMN system administration **Description:**Operational activities conducted to administer the electronic systems used for an activity, product, or service 22706 active OPERAT 3 PAYMT payment **Description:**Administrative, financial, and contractual processes related to payment for an activity, product, or service 22698 active _ActInformationPrivacyReason 3 RESCH research **Description:**Investigative activities conducted for the purposes of obtaining knowledge 22707 active _ActInformationPrivacyReason 3 SRVC service **Description:**Provision of a service, product, or capability to an individual or organization 22709 active _ActInformationPrivacyReason 1 _ActInvalidReason ActInvalidReason Description: Types of reasons why a substance is invalid for use. 23235 active 2 ADVSTORAGE adverse storage condition Description: Storage conditions caused the substance to be ineffective. 23238 active _ActInvalidReason 3 COLDCHNBRK cold chain break Description: Cold chain was not maintained for the substance. 23239 active ADVSTORAGE 2 EXPLOT expired lot Description: The lot from which the substance was drawn was expired. 23236 active _ActInvalidReason 2 OUTSIDESCHED administered outside recommended schedule or practice The substance was administered outside of the recommended schedule or practice. 23240 active _ActInvalidReason 2 PRODRECALL product recall Description: The substance was recalled by the manufacturer. 23237 active _ActInvalidReason 1 _ActInvoiceCancelReason ActInvoiceCancelReason Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping. 20941 active true 2 INCCOVPTY incorrect covered party as patient The covered party (patient) specified with the Invoice is not correct. 19733 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. 19735 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. 19734 active _ActInvoiceCancelReason 2 INCPROV incorrect provider The provider specified with the Invoice is not correct. 19736 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 21529 active true 2 IMMUNE immunity **Definition:**Testing has shown that the patient already has immunity to the agent targeted by the immunization. 21745 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. 21747 active _ActNoImmunizationReason 2 OSTOCK product out of stock **Definition:**There was no supply of the product on hand to perform the service. 21744 active _ActNoImmunizationReason 2 PATOBJ patient objection **Definition:**The patient or their guardian objects to receiving the vaccine. 21740 active _ActNoImmunizationReason 2 PHILISOP philosophical objection **Definition:**The patient or their guardian objects to receiving the vaccine because of philosophical beliefs. 21742 active _ActNoImmunizationReason 2 RELIG religious objection **Definition:**The patient or their guardian objects to receiving the vaccine on religious grounds. 21741 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. 21746 active _ActNoImmunizationReason 2 VACSAF vaccine safety concerns **Definition:**The patient or their guardian objects to receiving the vaccine because of concerns over its safety. 21743 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) 21530 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. 21748 active _ActSupplyFulfillmentRefusalReason 2 FRR02 stale-dated order **Definition:**Order has not been fulfilled within a reasonable amount of time, and may not be current. 21749 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. 21750 active _ActSupplyFulfillmentRefusalReason 2 FRR04 product unavailable **Definition:**Product not available or manufactured. Cannot supply. 21751 active _ActSupplyFulfillmentRefusalReason 2 FRR05 ethical/religious **Definition:**The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product. 21752 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. 21753 active _ActSupplyFulfillmentRefusalReason 1 _ClinicalResearchEventReason ClinicalResearchEventReason **Definition:**Specifies the reason that an event occurred in a clinical research study. 22391 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. 21623 active _ClinicalResearchEventReason 2 SCH scheduled **Definition:**The event occurred due to it being scheduled in the research protocol. 21622 active _ClinicalResearchEventReason 2 TRM termination **Definition:**The event occurred in order to terminate the subject's participation in the study. 21624 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. 21625 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. 22392 active true 2 NPT non-protocol **Definition:**The observation or test was neither defined or scheduled in the study protocol. 21628 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. 21626 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. 21627 active _ClinicalResearchObservationReason 1 _CombinedPharmacyOrderSuspendReasonCode CombinedPharmacyOrderSuspendReasonCode **Description:**Indicates why the prescription should be suspended. 22393 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. 21691 active _CombinedPharmacyOrderSuspendReasonCode 2 CLARIF prescription requires clarification **Description:**Clarification is required before the order can be acted upon. 21689 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. 21694 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. 21684 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. 21687 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. 21695 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. 21692 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. 21685 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. 21690 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. 21688 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. 21686 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. 21696 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. 21693 active _CombinedPharmacyOrderSuspendReasonCode 1 _ControlActNullificationReasonCode ControlActNullificationReasonCode **Description:**Identifies reasons for nullifying (retracting) a particular control act. 22809 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. 22024 active _ControlActNullificationReasonCode 2 EIE entered in error **Description:**The information was recorded incorrectly or was recorded in the wrong record. 22023 active _ControlActNullificationReasonCode 2 NORECMTCH no record match Description: There is no match for the record in the database. 22908 active _ControlActNullificationReasonCode, _StatusRevisionRefusalReasonCode, NOMATCH 1 _ControlActNullificationRefusalReasonType ControlActNullificationRefusalReasonType Description: Reasons to refuse a transaction to be undone. 23277 active true 2 INRQSTATE in requested state The record is already in the requested state. 23015 active _ControlActNullificationRefusalReasonType, _StatusRevisionRefusalReasonCode 2 NOMATCH no match Description: There is no match. 22907 active _ControlActNullificationRefusalReasonType, _RefusalReasonCode 3 NOPRODMTCH no product match Description: There is no match for the product in the master file repository. 22909 active NOMATCH 3 NOSERMTCH no service match Description: There is no match for the service in the master file repository. 22910 active NOMATCH 3 NOVERMTCH no version match Description: There is no match for the record and version. 23279 active NOMATCH 3 NORECMTCH no record match 2 NOPERM no permission Description: There is no permission. 22911 active _ControlActNullificationRefusalReasonType, _RefusalReasonCode 3 NOUSERPERM no user permission **Definition:**The user does not have permission 22865 active _PharmacySupplyRequestFulfillerRevisionRefusalReasonCode, _StatusRevisionRefusalReasonCode, _SubstanceAdministrationPermissionRefusalReasonCode, NOPERM 3 NOAGNTPERM no agent permission Description: The agent does not have permission. 22913 active NOPERM 3 NOUSRPERM no user permission Description: The user does not have permission. 22912 retired NOPERM 2 WRNGVER wrong version Description: The record and version requested to update is not the current version. 23278 active _ControlActNullificationRefusalReasonType 1 _ControlActReason ControlActReason Identifies why a specific query, request, or other trigger event occurred. 21491 active true 2 _MedicationOrderAbortReasonCode medication order abort reason **Description:**Indicates the reason the medication order should be aborted. 21701 active true _ControlActReason 3 DISCONT product discontinued **Description:**The medication is no longer being manufactured or is otherwise no longer available. 21706 active _MedicationOrderAbortReasonCode, _PharmacySupplyRequestRenewalRefusalReasonCode 3 INEFFECT ineffective **Description:**The therapy has been found to not have the desired therapeutic benefit on the patient. 21703 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. 21702 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. 21704 active _MedicationOrderAbortReasonCode 3 NOTCOVER not covered **Description:**The product does not have (or no longer has) coverage under the patientaTMs insurance policy. 21709 active _MedicationOrderAbortReasonCode 3 PREFUS patient refuse **Description:**The patient refused to take the product. 21710 active _MedicationOrderAbortReasonCode 3 RECALL product recalled **Description:**The manufacturer or other agency has requested that stocks of a medication be removed from circulation. 21707 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. 23262 active _MedicationOrderAbortReasonCode 4 DOSECHG change in medication/dose **Description:**The medication is being re-prescribed at a different dosage. 21705 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. 23263 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. 21708 active _MedicationOrderAbortReasonCode 2 _MedicationOrderReleaseReasonCode medication order release reason **Definition:**A collection of concepts that indicate why the prescription should be released from suspended state. 21711 active true _ControlActReason 3 HOLDDONE suspend reason no longer applies **Definition:**The original reason for suspending the medication has ended. 21713 active _MedicationOrderReleaseReasonCode 3 HOLDINAP suspend reason inappropriate Definition: 21712 active _MedicationOrderReleaseReasonCode 2 _ModifyPrescriptionReasonType ModifyPrescriptionReasonType Types of reason why a prescription is being changed. 23634 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. 23635 active _ModifyPrescriptionReasonType 3 CLINMOD clinical modification Order is changed based on a clinical reason. 23636 active _ModifyPrescriptionReasonType 2 _PharmacySupplyEventAbortReason PharmacySupplyEventAbortReason **Definition:**Identifies why the dispense event was not completed. 22849 active _ControlActReason 3 CONTRA contraindication **Definition:**Contraindication identified 22855 active _PharmacySupplyEventAbortReason 3 FOABORT order aborted **Definition:**Order to be fulfilled was aborted 22852 active _PharmacySupplyEventAbortReason 3 FOSUSP order suspended **Definition:**Order to be fulfilled was suspended 22853 active _PharmacySupplyEventAbortReason 3 NOPICK not picked up **Definition:**Patient did not come to get medication 22850 active _PharmacySupplyEventAbortReason 3 PATDEC patient changed mind **Definition:**Patient changed their mind regarding obtaining medication 22851 active _PharmacySupplyEventAbortReason 3 QUANTCHG change supply quantity **Definition:**Patient requested a revised quantity of medication 22854 active _PharmacySupplyEventAbortReason 2 _PharmacySupplyEventStockReasonCode pharmacy supply event stock reason **Definition:**A collection of concepts that indicates the reason for a "bulk supply" of medication. 21721 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.) 21722 active _PharmacySupplyEventStockReasonCode 3 LTC long term care use **Definition:**The bulk supply will be administered within a long term care facility. 21725 active _PharmacySupplyEventStockReasonCode 3 OFFICE office use **Definition:**The bulk supply is intended for general clinician office use. 21724 active _PharmacySupplyEventStockReasonCode 3 PHARM pharmacy transfer **Definition:**The bulk supply is being transferred to another dispensing facility to. **Example:**Alleviate a temporary shortage. 21726 active _PharmacySupplyEventStockReasonCode 3 PROG program use **Definition:**The bulk supply is intended for dispensing according to a specific program. **Example:**Mass immunization. 21723 active _PharmacySupplyEventStockReasonCode 2 _PharmacySupplyRequestRenewalRefusalReasonCode pharmacy supply request renewal refusal reason **Definition:**A collection of concepts that identifies why a renewal prescription has been refused. 21727 active true _ControlActReason 3 ALREADYRX new prescription exists **Definition:**Patient has already been given a new (renewal) prescription. 21732 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 FAMPHYS family physician must authorize further fills **Definition:**Request for further authorization must be done through patient's family physician. 21731 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 MODIFY modified prescription exists **Definition:**Therapy has been changed and new prescription issued 21733 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 NEEDAPMT patient must make appointment **Definition:**Patient must see prescriber prior to further fills. 21728 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. 21730 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 NOTPAT patient no longer in this practice **Definition:**Patient no longer or has never been under this prescribers care. 21729 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 ONHOLD medication on hold **Definition:**This medication is on hold. 21734 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 PRNA product not available **Description:**This product is not available or manufactured. 22867 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 STOPMED prescriber stopped medication for patient Renewing or original prescriber informed patient to stop using the medication. 23625 active _PharmacySupplyRequestRenewalRefusalReasonCode 3 TOOEARLY too early **Definition:**The patient should have medication remaining. 21735 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). 21736 active true _ControlActReason 3 IMPROV condition improved **Definition:**The patient's medical condition has nearly abated. 21737 active _SupplyOrderAbortReasonCode 3 INTOL intolerance **Description:**The patient has an intolerance to the medication. 21990 active _SupplyOrderAbortReasonCode 3 NEWSTR new strength **Definition:**The current medication will be replaced by a new strength of the same medication. 21739 active _SupplyOrderAbortReasonCode 3 NEWTHER new therapy **Definition:**A new therapy will be commenced when current supply exhausted. 21738 active _SupplyOrderAbortReasonCode 2 _ControlActReasonConditionNullify ControlActReasonConditionNullify Indicates why the ConditionaTMs status was changed to Nullified. Examples administrative error, diagnostic error. 21492 retired true _ControlActReason 1 _GenericUpdateReasonCode GenericUpdateReasonCode **Description:**Identifies why a change is being made to a record. 22395 active true 2 CHGDATA information change **Description:**Information has changed since the record was created. 21673 active _GenericUpdateReasonCode 2 FIXDATA error correction **Description:**Previously recorded information was erroneous and is being corrected. 21674 active _GenericUpdateReasonCode 2 MDATA merge data Information is combined into the record. 23469 active _GenericUpdateReasonCode 2 NEWDATA new information **Description:**New information has become available to supplement the record. 21672 active _GenericUpdateReasonCode 2 UMDATA unmerge data Information is separated from the record. 23470 active _GenericUpdateReasonCode 1 _PatientProfileQueryReasonCode patient profile query reason **Definition:**A collection of concepts identifying why the patient's profile is being queried. 21715 active true 2 ADMREV administrative review Definition: To evaluate for service authorization, payment, reporting, or performance/outcome measures. 22221 active _PatientProfileQueryReasonCode 2 PATCAR patient care **Definition:**To obtain records as part of patient care. 21717 active _PatientProfileQueryReasonCode 2 PATREQ patient request query **Definition:**Patient requests information from their profile. 21716 active _PatientProfileQueryReasonCode 2 PRCREV practice review **Definition:**To evaluate the provider's current practice for professional-improvement reasons. 21720 active _PatientProfileQueryReasonCode 2 REGUL regulatory review **Description:**Review for the purpose of regulatory compliance. 21991 active _PatientProfileQueryReasonCode 2 RSRCH research **Definition:**To provide research data, as authorized by the patient. 21718 active _PatientProfileQueryReasonCode 2 VALIDATION validation review **Description:**To validate the patient's record. **Example:**Merging or unmerging records. 21992 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. 22863 active 2 LOCKED locked **Definition:**The prescription may not be reassigned from the original pharmacy. 22864 active _PharmacySupplyRequestFulfillerRevisionRefusalReasonCode 2 UNKWNTARGET unknown target **Definition:**The target facility does not recognize the dispensing facility. 22866 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. 22906 active true 2 NOMATCH no match 2 NOPERM no permission 1 _SchedulingActReason SchedulingActReason Reasons for cancelling or rescheduling an Appointment 20942 active true 2 BLK Unexpected Block (of Schedule) The time slots previously allocated are now blocked and no longer available for booking Appointments 14885 active _SchedulingActReason 2 DEC Patient Deceased The Patient is deceased 14884 active _SchedulingActReason 2 FIN No Financial Backing Patient unable to pay and not covered by insurance 14882 active _SchedulingActReason 2 MED Medical Status Altered The medical condition of the Patient has changed 14883 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 14886 active _SchedulingActReason 2 PHY Physician request The Physician requested the action 14881 active _SchedulingActReason 2 PAT Patient request 1 _StatusRevisionRefusalReasonCode StatusRevisionRefusalReasonCode Indicates why the act revision (status update) is being refused. 23014 active 2 FILLED fully filled Ordered quantity has already been completely fulfilled. 23016 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. 22856 active 2 PATINELIG patient not eligible **Definition:**Patient not eligible for drug 22858 active _SubstanceAdministrationPermissionRefusalReasonCode 2 PROTUNMET protocol not met **Definition:**Patient does not meet required protocol 22857 active _SubstanceAdministrationPermissionRefusalReasonCode 2 PROVUNAUTH provider not authorized **Definition:**Provider is not authorized to prescribe or dispense 22859 active _SubstanceAdministrationPermissionRefusalReasonCode 2 NOUSERPERM no user permission 1 _SubstanceAdminSubstitutionNotAllowedReason SubstanceAdminSubstitutionNotAllowedReason Reasons why substitution of a substance administration request is not permitted. 21531 active true 2 ALGINT allergy intolerance Definition: Patient has had a prior allergic intolerance response to alternate product or one of its components. 22259 active _SubstanceAdminSubstitutionNotAllowedReason 2 COMPCON compliance concern Definition: Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency. 22260 active _SubstanceAdminSubstitutionNotAllowedReason 2 THERCHAR therapeutic characteristics The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications. 21815 active _SubstanceAdminSubstitutionNotAllowedReason 2 TRIAL clinical trial drug Definition: The specific manufactured drug is part of a clinical trial. 22261 active _SubstanceAdminSubstitutionNotAllowedReason 2 PAT Patient request 1 _SubstanceAdminSubstitutionReason SubstanceAdminSubstitutionReason 20943 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. 19989 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. 19990 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. 19987 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. 19988 active _SubstanceAdminSubstitutionReason 1 _TransferActReason TransferActReason The explanation for why a patient is moved from one location to another within the organization 20944 active true 2 ER Error Moved to an error in placing the patient in the original location. 15984 active _TransferActReason 2 RQ Request Moved at the request of the patient. 15985 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. 20938 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. 22209 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. 20939 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. 22210 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. 22081 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 22077 retired true 1 _ConrolActNullificationReasonCode ConrolActNullificationReasonCode **Description:**Identifies reasons for nullifying (retracting) a particular control act. Examples:"Entered in error", "altered decision", etc. 22394 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. 21569 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. 21408 retired true 1 _ReferralReasonCode ReferralReasonCode The reason a referral was made. *Examples:*Specialized Medical Assistance, Other Care Requirements. 21568 retired true 1 BONUS 17436 retired 1 CHD Children only **Description:**The level of coverage under the policy or program is available only to children 22082 retired 1 DEP Dependents only **Description:**The level of coverage under the policy or program is available only to a subscriber's dependents. 22083 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. 22084 retired 1 EDU 17438 retired 1 EMP Employee only **Description:**The level of coverage under the policy or program is available only to an employee. 22085 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. 22086 retired 1 FAM Family **Description:**The level of coverage under the policy or program is available to a subscriber's family. 22087 retired 1 IND Individual **Description:**The level of coverage under the policy or program is available to an individual. 22088 retired 1 INVOICE 19726 retired 1 PROA 17435 retired 1 RECOV 17437 retired 1 RETRO 17434 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 22089 retired 1 SPO Spouse only **Description:**The level of coverage under the policy or program is available only to a subscribers spouse 22090 retired 1 TRAN 19727 retired
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".
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
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..
Indicates that the code is abstract - only intended to be used as a selector for other concepts
Identifies the reason the patient is assigned to this accommodation type
**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.
**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.
**Description:** Types of reasons why a substance is invalid for use.
Domain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.
A coded description of the reason for why a patient did not receive a scheduled immunization. (important for public health strategy
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)
**Definition:**Specifies the reason that an event occurred in a clinical research study.
**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.
**Description:**Indicates why the prescription should be suspended.
**Description:**Identifies reasons for nullifying (retracting) a particular control act.
**Description:** Reasons to refuse a transaction to be undone.
Identifies why a specific query, request, or other trigger event occurred.
**Description:**Identifies why a change is being made to a record.
**Definition:**A collection of concepts identifying why the patient's profile is being queried.
**Definition:**Indicates why the request to transfer a prescription from one dispensing facility to another has been refused.
**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.
Reasons for cancelling or rescheduling an Appointment
Indicates why the act revision (status update) is being refused.
**Definition:**Indicates why the requested authorization to prescribe or dispense a medication has been refused.
Reasons why substitution of a substance administration request is not permitted.
The explanation for why a patient is moved from one location to another within the organization
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.
**Definition:** This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
**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.
**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
**Description:**Identifies reasons for nullifying (retracting) a particular control act. **Examples:**"Entered in error", "altered decision", etc.
The reason the action wasn't performed, e.g. why the medication was not taken. If an action wasn"t performed, it is often clinically important to know why the action wasn"t taken. *Examples:*Patient refused, clinically inappropriate, absolute contraindication etc.
Code 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.
The reason a referral was made. *Examples:*Specialized Medical Assistance, Other Care Requirements.
**Description:**The level of coverage under the policy or program is available only to children
**Description:**The level of coverage under the policy or program is available only to a subscriber's dependents.
**Description:**The level of coverage under the policy or program is available to an employee and his or her children.
**Description:**The level of coverage under the policy or program is available only to an employee.
**Description:**The level of coverage under the policy or program is available to an employee and his or her spouse.
**Description:**The level of coverage under the policy or program is available to a subscriber's family.
**Description:**The level of coverage under the policy or program is available to an individual.
**Description:**The level of coverage under the policy or program is available to a subscriber's spouse and children
**Description:**The level of coverage under the policy or program is available only to a subscribers spouse
Accommodation requested is not available.
Accommodation is assigned for floor convenience.
**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.
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.
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.
The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.
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".
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.
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.
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.
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.
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.
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.
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.
**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.
**Description:**Identifies the reason or rationale for coverage of a service or product based on clinical efficacy criteria or practices prescribed by the payor.
**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.
**Description:**Identifies the reason or rationale for coverage of a service or product based on financial participation responsibilities of the covered party.
**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.
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.
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.
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.
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.
**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.
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).
**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.
**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.
**Description:**Administrative and contractual processes required to support an activity, product, or service
**Description:**Administrative, financial, and contractual processes related to payment for an activity, product, or service
**Description:**Investigative activities conducted for the purposes of obtaining knowledge
**Description:**Provision of a service, product, or capability to an individual or organization
**Description:** Storage conditions caused the substance to be ineffective.
**Description:** The lot from which the substance was drawn was expired.
administered outside recommended schedule or practice
The substance was administered outside of the recommended schedule or practice.
**Description:** The substance was recalled by the manufacturer.
The covered party (patient) specified with the Invoice is not correct.
The billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.
The policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.
The provider specified with the Invoice is not correct.
**Definition:**Testing has shown that the patient already has immunity to the agent targeted by the immunization.
**Definition:**The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.
**Definition:**There was no supply of the product on hand to perform the service.
**Definition:**The patient or their guardian objects to receiving the vaccine.
**Definition:**The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.
**Definition:**The patient or their guardian objects to receiving the vaccine on religious grounds.
**Definition:**The intended vaccine has expired or is otherwise believed to no longer be effective. **Example:**Due to temperature exposure.
**Definition:**The patient or their guardian objects to receiving the vaccine because of concerns over its safety.
**Definition:**The order has been stopped by the prescriber but this fact has not necessarily captured electronically. **Example:**A verbal stop, a fax, etc.
**Definition:**Order has not been fulfilled within a reasonable amount of time, and may not be current.
**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.
**Definition:**Product not available or manufactured. Cannot supply.
**Definition:**The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.
**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.
**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.
**Definition:**The event occurred due to it being scheduled in the research protocol.
**Definition:**The event occurred in order to terminate the subject's participation in the study.
**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.
**Definition:**The observation or test was neither defined or scheduled in the study 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.
**:**The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.
**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.
**Description:**Clarification is required before the order can be acted upon.
**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.
**Description:**The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.
**Description:**The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.
**Description:**Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.
**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.
**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.
**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.
**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.
**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.
**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.
**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.
**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.
**Description:**The information was recorded incorrectly or was recorded in the wrong record.
**Description:** There is no match for the record in the database.
The record is already in the requested state.
**Description:** There is no permission.
**Description:** The record and version requested to update is not the current version.
**Description:**Indicates the reason the medication order should be aborted.
**Definition:**A collection of concepts that indicate why the prescription should be released from suspended state.
Types of reason why a prescription is being changed.
**Definition:**Identifies why the dispense event was not completed.
**Definition:**A collection of concepts that indicates the reason for a "bulk supply" of medication.
pharmacy supply request renewal refusal reason
**Definition:**A collection of concepts that identifies why a renewal prescription has been refused.
**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).
Indicates why the ConditionaTMs status was changed to Nullified. *Examples* administrative error, diagnostic error.
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.
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.
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.
A person becomes eligible for insurance provided as an employment benefit based on employment status.
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.
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
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.
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.
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.
A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
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.
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.
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.
**Description:**Information has changed since the record was created.
**Description:**Previously recorded information was erroneous and is being corrected.
Information is combined into the record.
**Description:**New information has become available to supplement the record.
Information is separated from the record.
**Description:**The medication is no longer being manufactured or is otherwise no longer available.
**Description:**The therapy has been found to not have the desired therapeutic benefit on the patient.
**Description:**Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.
**Description:**The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.
**Description:**The product does not have (or no longer has) coverage under the patientaTMs insurance policy.
**Description:**The patient refused to take the product.
**Description:**The manufacturer or other agency has requested that stocks of a medication be removed from circulation.
**Description:**Item in current order is no longer in use as requested and a new one has/will be created to replace it.
**Description:**Current order was issued with incorrect data and a new order has/will be created to replace it.
**Description:**<The patient is not (or is no longer) able to use the medication in a manner prescribed. **Example:**CanaTMt swallow.
**Definition:**The original reason for suspending the medication has ended.
Order was created with incorrect data and is changed to reflect the intended accuracy of the order.
Order is changed based on a clinical reason.
**Definition:** To evaluate for service authorization, payment, reporting, or performance/outcome measures.
**Definition:**To provide information as a result of a subpoena.
**Definition:**To obtain records as part of patient care.
**Definition:**Patient requests information from their profile.
**Definition:**To evaluate the provider's current practice for professional-improvement reasons.
**Description:**Review for the purpose of regulatory compliance.
**Definition:**To provide research data, as authorized by the patient.
**Description:**To validate the patient's record. **Example:**Merging or unmerging records.
**Definition:**Contraindication identified
**Definition:**Order to be fulfilled was aborted
**Definition:**Order to be fulfilled was suspended
**Definition:**Patient did not come to get medication
**Definition:**Patient changed their mind regarding obtaining medication
**Definition:**Patient requested a revised quantity of medication
**Definition:**The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)
**Definition:**The bulk supply will be administered within a long term care facility.
**Definition:**The bulk supply is intended for general clinician office use.
**Definition:**The bulk supply is being transferred to another dispensing facility to. **Example:**Alleviate a temporary shortage.
**Definition:**The bulk supply is intended for dispensing according to a specific program. **Example:**Mass immunization.
**Definition:**The prescription may not be reassigned from the original pharmacy.
**Definition:**The user does not have permission
**Definition:**The target facility does not recognize the dispensing facility.
**Definition:**Patient has already been given a new (renewal) prescription.
family physician must authorize further fills
**Definition:**Request for further authorization must be done through patient's family physician.
**Definition:**Therapy has been changed and new prescription issued
**Definition:**Patient must see prescriber prior to further fills.
**Definition:**Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.
**Definition:**Patient no longer or has never been under this prescribers care.
**Definition:**This medication is on hold.
**Description:**This product is not available or manufactured.
prescriber stopped medication for patient
Renewing or original prescriber informed patient to stop using the medication.
**Definition:**The patient should have medication remaining.
The time slots previously allocated are now blocked and no longer available for booking Appointments
Patient unable to pay and not covered by insurance
The medical condition of the Patient has changed
The Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment
Ordered quantity has already been completely fulfilled.
**Definition:**Patient not eligible for drug
**Definition:**Patient does not meet required protocol
**Definition:**Provider is not authorized to prescribe or dispense
**Definition:** Patient has had a prior allergic intolerance response to alternate product or one of its components.
**Definition:** Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.
The prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.
**Definition:** The specific manufactured drug is part of a clinical trial.
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.
Indicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.
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.
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
**Definition:**The patient's medical condition has nearly abated.
**Description:**The patient has an intolerance to the medication.
**Definition:**The current medication will be replaced by a new strength of the same medication.
**Definition:**A new therapy will be commenced when current supply exhausted.
Moved to an error in placing the patient in the original location.
**Description:** Cold chain was not maintained for the substance.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
To perform one or more operations on information used for cadaveric organ, eye or tissue donation.
To perform one or more operations on information used for fraud detection and prevention processes.
To perform one or more operations on information used within government processes.
To perform one or more operations on information for conducting activities related to meeting accreditation criteria.
To perform one or more operations on information used for conducting activities required to meet a mandate.
To perform one or more operations on information used for handling deceased patient matters.
To perform one or more operation operations on information used to manage a patient directory. **Examples:** * facility * enterprise * payer * health information exchange patient directory
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.
To perform one or more operations on information for conducting activities required by legal proceeding.
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
To perform one or more operations on information used for conducting activities to meet program accounting requirements.
To perform one or more operations on information used for conducting administrative activities to improve health care quality.
To perform one or more operations on information to administer the electronic systems used for the delivery of health care.
To perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.
To perform one or more operations on information for conducting activities required by military processes, procedures, policies, or law.
To perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.
To perform one or more operations on information in processes related to ensuring the safety of health care.
To perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.
To perform one or more operations on information used within the health records management process.
To perform one or more operations on information to design, develop, implement, test, or deploy a healthcare system or application.
To perform one or more operations on information used in training and education.
To perform one or more operations on information used in training a machine learning (AI) model.
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.
To perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
To perform one or more operations on information for conducting activities related to coverage under a program or policy.
To perform one or more operations on information about the amount remitted for a health care claim.
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.
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.
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
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.
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.
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.
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.
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.
**Description:** There is no match for the product in the master file repository.
**Description:** There is no match for the service in the master file repository.
**Description:** There is no match for the record and version.
**Description:** The agent does not have permission.
**Description:** The user does not have permission.
**Description:**Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
**Description:**Operational activities required to meet a mandate related to an activity, product, or service
**Description:**Operational activities conducted to administer information relating to entities involves with an activity, product, or service
**Description:**Operational activities conducted for the purposes of assessing the results of an activity, product, or service
**Description:**Operational activities conducted to meet program accounting requirements related to an activity, product, or service
**Description:**Operational activities conducted for the purposes of improving the quality of an activity, product, or service
**Description:**Operational activities conducted to administer the electronic systems used for an activity, product, or service
To perform one or more operations on information in response to a request by a family member authorized by the patient.
To perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.
To perform one or more operations on information in response to a request by a person authorized by the patient.
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.
To perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.
To perform one or more operations on information for marketing services and products related to health care.
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
To perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.
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.
To perform one or more operations on information in response to a patient's request.
To perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.
To perform one or more operations on information for provision of health care.
**Description:**The medication is being re-prescribed at a different dosage.
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.
To perform health care as part of the clinical trial protocol.
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."
To perform one or more operations on information for provision of immediately needed health care for an emergent condition.
To perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.
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.