HL7 Version 2.5.1 Implementation Guide: Syndromic Surveillance, Release 1 - US Realm Standard for Trial Use

V251_IG_SYNDROM_SURV_STU_R1_2019JUL

July 2019

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IMPLEMENTATION GUIDE FOR SYNDROMIC SURVEILLANCE

Release 1.0 STU (US Realm)

2019/06/24 23:34

HL7 VERSION 2.5.1

1 ABOUT THIS GUIDE...... 7 1.1 PUBLICATION HISTORY ...... 7 1.2 COPYRIGHTS AND TRADEMARKS ...... 7 1.3 ACKNOWLEDGEMENTS ...... 8 1.4 IN THIS GUIDE ...... 8 1.5 ABOUT HL7 2.5.1 ...... 9 1.6 INTENDED AUDIENCE ...... 9 1.7 INTRODUCTION TO SYNDROMIC SURVEILLANCE ...... 9 1.8 POLICY BACKGROUND ...... 10 1.9 SCOPE ...... 11 1.10 ASSUMPTIONS ...... 12 1.11 USEFUL RESOURCES ...... 12 1.12 REVISION OF PHIN MESSAGING GUIDE, RELEASE 2.2 ...... 13 1.13 SNAPSHOT MODE ...... 14 1.14 FLAVORS ...... 14 1.15 BINDING STRENGTH AND LOCATION ...... 14 1.16 USAGE ...... 14 1.17 OPTIONAL ELEMENTS ...... 15 2 ACTORS, GOALS AND MESSAGING TRANSACTIONS ...... 16 2.1 USE CASE MODEL ...... 16 2.2 DYNAMIC INTERACTION MODELS ...... 18 2.2.1 SEND SYNDROMIC SURVEILLANCE DATA WITH ACKNOWLEDGEMENT ...... 18 2.2.2 SEND SYNDROMIC SURVEILLANCE DATA WITHOUT ACKNOWLEDGEMENT ...... 18 2.2.3 SEND SYNDROMIC SURVEILLANCE DATA - BATCH ...... 19 2.3 MESSAGE ACKNOWLEDGEMENTS ...... 19 2.3.1 ACKNOWLEDGEMENT CHOREOGRAPHY APPLIED ...... 20 2.4 INTERACTIONS ...... 20 2.5 A08 MESSAGE TRIGGERS...... 21 2.6 MESSAGING EXAMPLES ...... 27 3 MESSAGE INFRASTRUCTURE ...... 38 3.1 CONFORMANCE PROFILES ...... 38 3.1.1 PATIENT ADMIT - ADTÂ01 - INPATIENT VISIT BEGIN ...... 38 3.1.2 PATIENT REGISTRATION - ADTÂ04 - OUTPATIENT VISIT BEGIN...... 38 3.1.3 PATIENT DISCHARGE - ADTÂ03 - VISIT END ...... 39 3.1.4 PATIENT UPDATE - ADTÂ08 - VISIT UPDATE ...... 40 3.1.5 ACKNOWLEDGEMENT - ACK - ACK ...... 40 3.2 SEGMENTS AND FIELD DESCRIPTIONS ...... 41 3.2.1 DG1_SS - DIAGNOSIS ...... 41 3.2.2 EVN_SS - EVENT TYPE ...... 42 3.2.3 IN1_SS - INSURANCE ...... 42 3.2.4 MSA_SS - MESSAGE ACKNOWLEDGMENT ...... 43 3.2.5 MSH_SS - MESSAGE HEADER ...... 44 3.2.6 OBX_SS - OBSERVATION/RESULT ...... 46 3.2.7 PID_SS_A01 - PATIENT IDENTIFICATION ...... 54 3.2.8 PID_SS_A04_A08_A03 - PATIENT IDENTIFICATION ...... 55 3.2.9 PR1_SS - PROCEDURES...... 57 3.2.10 PV1_SS_A01 - PATIENT VISIT ...... 58 3.2.11 PV1_SS_A03 - PATIENT VISIT ...... 60 3.2.12 PV1_SS_A04 - PATIENT VISIT ...... 62 3.2.13 PV1_SS_A08 - PATIENT VISIT ...... 63 3.2.14 PV2_SS - PATIENT VISIT - ADDITIONAL INFORMATION ...... 64 3.3 DATATYPES ...... 65 3.3.1 CE_SS - CODED ELEMENT ...... 65 3.3.2 CWE_SS - CODED WITH EXCEPTIONS ...... 65 3.3.3 CX_SS - EXTENDED COMPOSITE ID WITH CHECK DIGIT ...... 66 3.3.4 DTM_SS_YYYYMMDD - DATE/TIME ...... 67 3.3.5 DTM_SS_YYYYMMDDHHMM - DATE/TIME...... 67 3.3.6 DTM_SS_YYYYMMDDHHMMSS - DATE/TIME ...... 68 3.3.7 EI - ENTITY IDENTIFIER...... 68 3.3.8 HD_SS - HIERARCHIC DESIGNATOR ...... 68 3.3.9 ID - CODED VALUE FOR HL7 DEFINED TABLES ...... 69 3.3.10 IS - CODED VALUE FOR USER-DEFINED TABLES ...... 69

3.3.11 MSG_SS - MESSAGE TYPE ...... 69 3.3.12 NM - NUMERIC ...... 70 3.3.13 PT_SS - PROCESSING TYPE ...... 70 3.3.14 SI - SEQUENCE ID ...... 70 3.3.15 ST - STRING DATA ...... 70 3.3.16 TS_SS_TODAY - TIME STAMP ...... 70 3.3.17 TS_SS_TOMINUTE - TIME STAMP ...... 70 3.3.18 TS_SS_TOSECOND - TIME STAMP ...... 70 3.3.19 TX - TEXT DATA ...... 70 3.3.20 VID_SS - VERSION IDENTIFIER ...... 70 3.3.21 XAD_SS - EXTENDED ADDRESS ...... 71 3.3.22 XPN_SS - EXTENDED PERSON NAME...... 72 3.4 VALUE SETS ...... 72 3.4.1 0009 - AMBULATORY STATUS ...... 72 3.4.2 0010 - PHYSICIAN ID ...... 73 3.4.3 0018 - PATIENT TYPE ...... 73 3.4.4 0061 - CHECK DIGIT SCHEME ...... 73 3.4.5 0069 - HOSPITAL SERVICE ...... 74 3.4.6 0072 - INSURANCE PLAN ID ...... 74 3.4.7 0085 - OBSERVATION RESULT STATUS CODES INTERPRETATION ...... 74 3.4.8 0088 - PROCEDURE CODE ...... 75 3.4.9 0089 - PROCEDURE CODING METHOD...... 75 3.4.10 0103 - PROCESSING ID ...... 76 3.4.11 0136 - YES/NO INDICATOR ...... 76 3.4.12 0155 - ACCEPT/APPLICATION ACKNOWLEDGMENT CONDITIONS ...... 76 3.4.13 0190 - ADDRESS TYPE ...... 77 3.4.14 0207 - PROCESSING MODE ...... 77 3.4.15 0288 - CENSUS TRACT ...... 78 3.4.16 0300 - NAMESPACE ID ...... 78 3.4.17 0301 - UNIVERSAL ID TYPE ...... 78 3.4.18 0360 - DEGREE/LICENSE/CERTIFICATE ...... 79 3.4.19 0361 - APPLICATION ...... 81 3.4.20 0362 - FACILITY ...... 81 3.4.21 0363 - ASSIGNING AUTHORITY ...... 81 3.4.22 0396 - CODING SYSTEM ...... 82 3.4.23 0399 - COUNTRY CODE ...... 88 3.4.24 0444 - NAME ASSEMBLY ORDER ...... 88 3.4.25 0448 - NAME CONTEXT ...... 88 3.4.26 0465 - NAME/ADDRESS REPRESENTATION ...... 89 3.4.27 0532 - EXPANDED YES/NO INDICATOR ...... 89 3.4.28 PHVS_ACKNOWLEDGMENTCODE_HL7_2X - ACKNOWLEDGMENT CODE (HL7)...... 89 3.4.29 PHVS_ADMINISTRATIVEDIAGNOSIS_CDC_ICD-10CM - DIAGNOSIS (ICD-10 CM) ...... 90 3.4.30 PHVS_ADMINISTRATIVEPROCEDURE_CDC_ICD-10PCS - PROCEDURE (ICD-10 PCS) ...... 91 3.4.31 PHVS_ADMISSIONTYPE_HL7_2X - ADMISSION TYPE (HL7) ...... 91 3.4.32 PHVS_ADMITSOURCE_HL7_2X - ADMISSION SOURCE (HL7) ...... 92 3.4.33 PHVS_AGEUNIT_SYNDROMICSURVEILLANCE - AGE UNIT (SYNDROMIC SURVEILLANCE) ...... 92 3.4.34 PHVS_BLOODPRESSUREUNIT_UCUM - BLOOD PRESSURE UNIT ...... 93 3.4.35 PHVS_COUNTRY_ISO_3166-1 - COUNTRY ...... 93 3.4.36 PHVS_COUNTY_FIPS_6-4 - COUNTY...... 100 3.4.37 PHVS_DIAGNOSISPRIORITY_HL7_2X - DIAGNOSIS PRIORITY (HL7) ...... 100 3.4.38 PHVS_DIAGNOSISTYPE_HL7_2X - DIAGNOSIS TYPE (HL7) ...... 102 3.4.39 PHVS_DISCHARGEDISPOSITION_HL7_2X - DISCHARGE DISPOSITION (HL7) ...... 102 3.4.40 PHVS_DISEASE_CDC - DISEASE ...... 107 3.4.41 PHVS_EMERGENCYSEVERITYINDEXACUITY_CDC - EMERGENCY SEVERITY INDEX - ACUITY ...... 108 3.4.42 PHVS_ETHNICITYGROUP_CDC - ETHNICITY GROUP ...... 108 3.4.43 PHVS_EVENTTYPE_SYNDROMICSURVEILLANCE - EVENT TYPE (SYNDROMIC SURVEILLANCE) ...... 109 3.4.44 PHVS_FACILITYVISITTYPE_SYNDROMICSURVEILLANCE - FACILITY / VISIT TYPE (SYNDROMIC SURVEILLANCE) ...... 109 3.4.45 PHVS_GENDER_SYNDROMICSURVEILLANCE - GENDER (SYNDROMIC SURVEILLANCE) ...... 110 3.4.46 PHVS_HEALTHCARESERVICELOCATION_SYNDROMIC - HEALTHCARE SERVICE LOCATION (SYNDROMIC) ...... 110 3.4.47 PHVS_HEIGHTUNIT_UCUM - HEIGHT UNIT ...... 116 3.4.48 PHVS_IDENTIFIERTYPE_SYNDROMICSURVEILLANCE - IDENTIFIER TYPE (SYNDROMIC SURVEILLANCE) ...... 117 3.4.49 PHVS_MEDICATIONBRANDNAME_HITSP - MEDICATION BRAND NAME VALUE SET ...... 119 3.4.50 PHVS_MEDICATIONCLINICALDRUGNAME_HITSP - MEDICATION CLINICAL DRUG NAME VALUE SET ...... 120 Page 5 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

3.4.51 PHVS_MESSAGESTRUCTURE_SYNDROMICSURVEILLANCE - MESSAGE STRUCTURE (SYNDROMIC SURVEILLANCE) ...... 120 3.4.52 PHVS_MESSAGETYPE_SYNDROMICSURVEILLANCE - MESSAGE TYPE (SYNDROMIC SURVEILLANCE) ...... 121 3.4.53 PHVS_NAMETYPE_SYNDROMICSURVEILLANCE - NAME TYPE (SYNDROMIC SURVEILLANCE) ...... 121 3.4.54 PHVS_OBSERVATIONIDENTIFIER_SYNDROMICSURVEILLANCE - OBSERVATION IDENTIFIER (SYNDROMIC SURVEILLANCE) ...... 122 3.4.55 PHVS_PATIENTCLASS_SYNDROMICSURVEILLANCE - PATIENT CLASS (SYNDROMIC SURVEILLANCE) ...... 122 3.4.56 PHVS_PULSEOXIMETRYUNIT_UCUM - PULSE OXIMETRY UNIT ...... 123 3.4.57 PHVS_RACECATEGORY_CDC - RACE CATEGORY ...... 123 3.4.58 PHVS_SMOKINGSTATUS_MU - SMOKING STATUS ...... 124 3.4.59 PHVS_SOURCEOFPAYMENTTYPOLOGY_PHDSC - SOURCE OF PAYMENT TYPOLOGY (PHDSC) ...... 125 3.4.60 PHVS_STATE_FIPS_5-2 - STATE ...... 129 3.4.61 PHVS_TEMPERATUREUNIT_UCUM - TEMPERATURE UNIT ...... 131 3.4.62 PHVS_UNIVERSALIDTYPE_SYNDROMICSURVEILLANCE - UNIVERSAL ID TYPE (SYNDROMIC SURVEILLANCE) ...... 132 3.4.63 PHVS_VALUETYPE_SYNDROMICSURVEILLANCE - VALUE TYPE (SYNDROMIC SURVEILLANCE) ...... 132 3.4.64 PHVS_VITALSIGNRESULT_HITSP - VITAL SIGN RESULT VALUE SET ...... 133 3.4.65 PHVS_WEIGHTUNIT_UCUM - WEIGHT UNIT ...... 134 3.5 CONFORMANCE INFORMATION ...... 134 3.5.1 CONFORMANCE STATEMENTS ...... 134 3.5.1.1 CONFORMANCE PROFILE LEVEL ...... 134 3.5.1.1.1 PATIENT ADMIT ...... 134 3.5.1.1.2 PATIENT REGISTRATION ...... 134 3.5.1.1.3 PATIENT DISCHARGE ...... 134 3.5.1.1.4 PATIENT UPDATE ...... 135 3.5.1.1.5 ACKNOWLEDGEMENT ...... 135 3.5.1.2 SEGMENT LEVEL ...... 135 3.5.1.2.1 DG1_SS - DIAGNOSIS ...... 135 3.5.1.2.2 MSA_SS - MESSAGE ACKNOWLEDGMENT ...... 135 3.5.1.2.3 MSH_SS - MESSAGE HEADER ...... 135 3.5.1.2.4 OBX_SS - OBSERVATION/RESULT...... 135 3.5.1.2.5 PID_SS_A01 - PATIENT IDENTIFICATION ...... 135 3.5.1.2.6 PID_SS_A04_A08_A03 - PATIENT IDENTIFICATION ...... 136 3.5.1.2.7 PR1_SS - PROCEDURES ...... 136 3.5.1.3 DATATYPE LEVEL ...... 136 3.5.1.3.1 XPN - EXTENDED PERSON NAME ...... 136 3.5.1.3.2 PT - PROCESSING TYPE...... 136 3.5.1.3.3 VID - VERSION IDENTIFIER ...... 136 3.5.2 CONDITIONAL PREDICATES ...... 136 3.5.2.1 SEGMENT LEVEL ...... 136 3.5.2.1.1 OBX_SS - OBSERVATION/RESULT...... 136 3.5.2.1.2 PID_SS_A04_A08_A03 - PATIENT IDENTIFICATION ...... 136 3.5.2.2 DATATYPE LEVEL ...... 136 3.5.2.2.1 CWE - CODED WITH EXCEPTIONS ...... 136 3.5.2.2.2 CE - CODED ELEMENT...... 137

1 ABOUT THIS GUIDE 1.1 Publication history

Prior to HL7, this guide was titled "PHIN Messaging Guide for Syndromic Surveillance" and had the following revisions. Revision Date Author Release 1.0 10/1/2011 ISDS, CDC Messaging Team Release 1.1 8/1/2012 ISDS, CDC Messaging Team Release 1.2 DRAFT for review 10/1/2012 ISDS, CDC Messaging Team Release 1.3 DRAFT for review 12/1/2012 ISDS, CDC Messaging Team Release 1.9 4/1/2013 ISDS, CDC Messaging Team Release 2.0 DRAFT for review 8/5/2014 ISDS, CDC Messaging Team Release 2.0 DRAFT for review 9/16/2014 ISDS, CDC Messaging Team and Standards and Interoperability activity Release 2.0 FINAL DRAFT 4/21/2015 ISDS, CDC Messaging Team and Standards and Interoperability activity Release 2.2 DRAFT for community 5/22/2017 ISDS, CDC Messaging Team contribution ISDS, Syndromic Surveillance CoP Release 1.0 STU 7/1/2019 Implementation Guide Workgroup, ONC, NIST

For information about HL7, contact:

Health Level Seven 3300 Washtenaw Avenue, Suite 227 Ann Arbor, MI 48104-4250 Phone: (734) 677-7777 Fax: (734) 677-6622 E-Mail: [email protected] Website: http://www.hl7.org

1.2 Copyrights and trademarks

HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. Pat & TM Off.

This document contains content from LOINC® (http://loinc.org). The LOINC table, LOINC codes, and LOINC panels and forms file are copyrighted works (c) 1995-2011, Regenstrief Institute, Inc., and the Logical Observation Identifiers Names and Codes (LOINC) Committee and are available at no cost under the license at http://loinc.org/terms-of-use.

This document includes SNOMED Clinical Terms® (SNOMED CT®) that are used by permission of the International Page 7 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Health Terminology Standards Development Organization (IHTSDO). All rights reserved. SNOMED CT was originally created by The College of American Pathologists. "SNOMED®" and "SNOMED CT®" are registered trademarks of the IHTSDO. 1.3 Acknowledgements

This guide was developed by the Implementation Guide Work Group, led by the International Society for Disease Surveillance (ISDS), and tasked to specify a standard of transmitting data for syndromic surveillance. The work group developed a list of core data elements for syndromic surveillance in collaboration with the Centers for Disease Control and Prevention (CDC), Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), and Division of Health Informatics and Surveillance (DHIS). The DHIS National Syndromic Surveillance Program funded the activities to develop this guide through a cooperative agreement with ISDS.

CDC, CSELS, and DHIS public health informatics staff participated in the development of this implementation guide*. Numerous drafts were reviewed by national and state public health organizations, vendors (including ISDS), the American Health Information Management Association (AHIMA), the Office of the National Coordinator (ONC), and the National Institute for Standards and Technology (NIST). Within Health Level Seven International (HL7), this standard is sponsored by the Public Health Work Group and co-sponsored by the Emergency Care Work Group and Patient Administration Work Group.

ISDS is a 501(c)3 nonprofit organization founded in 2005. ISDS ( http://www.healthsurveillance.org) strives to improve population health by advancing the science and practice of disease surveillance. ISDS's 430+ membership represents the public health surveillance community, including: • Local, state, federal, and global public health practitioners and policy makers • Government agencies • Academic researchers • Non-profit associations • Clinical health care providers • For-profit organizations • Other stakeholders in disease surveillance

* Information included in this document does not represent the official position of the Centers for Disease Control and Prevention (CDC), but rather reflects those of the Syndromic Surveillance Community of Practice- Implementation Guide Workgroup and other key stakeholders. 1.4 In this guide

This guide provides: • An HL7 implementation and content reference standard for facilitating syndromic surveillance electronic health record technology certification • A template for local and state syndromic surveillance implementation guides or for profiles, trading partner agreements, or constraints on this standard for specific purposes or trading partners. • A planning resource for increasing the use of electronic health records, including details on health data elements that could become requirements for public health syndromic surveillance.

This guide replaces or supersedes previous releases of syndromic surveillance guides and related documentation.

1.5 About HL7 2.5.1

This guide is based on the HL7 version 2.5.1 messaging standard, approved as an ANSI standard on February 21, 2007, as an update to the version 2.5 standard released in 2003. This guide describes the messages used for syndromic surveillance, and the constraints it imposes on the Messaging Standard. This guide also introduces HL7 terms and concepts. For more information, see the full HL7 version 2.5.1 Messaging Standard (http://www.hl7.org/implement/standards/index.cfm). 1.6 Intended audience

This guide has three audiences: (1) managers of healthcare and public health information systems who need to understand high-level processes; (2) technical personnel who develop or work with information systems that extract, transport, load, and transform electronic health record (EHR) data for syndromic surveillance; and (3) national health information technology policy makers who develop and implement EHR technology certification rules and procedures to improve system functionality and interoperability. 1.7 Introduction to syndromic surveillance

Syndromic surveillance is a process that regularly and systematically monitors pre-diagnostic groups of symptoms (syndromes) and then uses these and other health-related data in near real-time to make information available on the health of a community. This information includes statistics on disease trends and community health-seeking behaviors that support essential public health surveillance functions in public health authorities (PHAs). Syndromic surveillance is particularly useful to local, state, and federal PHAs for improving public health situational awareness, emergency response management, and outbreak recognition and characterization. Patient visit data from healthcare settings are a critical input for syndromic surveillance. Clinical data are provided by hospitals and urgent care centers to PHAs for all patient visits. PHAs then use these data under authorities granted to them by applicable local and state laws.

This guide uses the terms emergency department and urgent care services as defined by the Centers for Medicare and Medicaid Services (CMS), Medicare Benefit Policy Manual, Chapter 15 (Rev. 157, 06-08-12); Section 40.29-Definition of Emergency and Urgent Care Situations (Rev. 1, 10-01-03); B3-3044.29. Available online: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

CDC's Public Health Information Network (PHIN) ( https://www.cdc.gov/phin/index.html) is a national initiative to increase the capacity of PHAs to electronically exchange data and information across organizations and public health jurisdictions (e.g., clinical care to public health, public health to public health, and public health to federal agencies). PHIN promotes the use of standards and defines functional and technical requirements for public health information exchange.

HL7 is an internationally recognized, not-for-profit, ANSI-accredited health interoperability standard and vocabulary for exchanging electronic data across healthcare systems. The HL7 standard defines the syntax, or grammar, and standard vocabulary for formulating messages. HL7 is software independent and can be used on any platform.

This national standard for electronic messaging enables disparate healthcare software applications to transmit administrative and clinical data for public health surveillance and response. A set of recommendations made by expert committees convened by ISDS and CDC serve as the basis for this guide: • International Society for Disease Surveillance. (2011, January). Final Recommendation: Core Processes and EHR Requirements for Public Health Syndromic surveillance. Available online: https://healthsurveillance.site- ym.com/?page=sys_MU_2011_recom • International Society for Disease Surveillance. Electronic Syndromic Surveillance Using Hospital Inpatient and Ambulatory Clinical Care Electronic Health Record Data: Recommendations from the ISDS Meaningful Use Workgroup. 2012. Available online: https://www.surveillancerepository.org/electronic-syndromicsurveillance-using-hospital-inpatient-and-ambulatory-clinical-care-electronic

1.8 Policy background

On February 17, 2009, the President signed the American Recovery and Reinvestment Act of 2009 (Recovery Act). Two sections in the Recovery Act-Title XIII of Division A and Title IV of Division B-are cited together as the Health Information Technology for Economic and Clinical Health Act (HITECH Act). The HITECH Act promotes meaningful use of health information technology (health IT) to improve the quality and value of healthcare in the United States.

In July 2010, the Center for Medicare and Medicaid Services (CMS) released Stage 1 Final Rule - Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, July 28, 2010. As a companion regulation, the Office of the National Coordinator for Health Information Technology (ONC) released "Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology: Final Rule July 28, 2010." The final rule defined standards, specifications, and certification criteria for the 2011 Edition Electronic Health Record (EHR) Technology necessary to meet objectives for Meaningful Use (MU), renamed the "Promoting Interoperability" program, as defined in the CMS Stage 1 Final Rule. An optional objective was to report syndromic surveillance data. Although Stage 1 (HL7 2.3.1 or HL7 2.5.1) specified a standard for reporting syndromic surveillance, there was no implementation guide or specification mandated in the 2011 Edition EHR certification criteria published in the national register.

In September 2010, CDC supported ISDS by recommending EHR requirements for core syndromic surveillance business practices. ISDS engaged the community and used a consensus-driven process to develop its recommendation, receiving input from a workgroup of local and state syndromic surveillance experts who developed early iterations (i.e., Preliminary Recommendation on 9/30/2010 and Provisional Recommendation on 12/1/2010). ISDS collected input on the provisional recommendations document during a public comment period that informed ISDS's Final Recommendation: The Core Processes & EHR Requirements of Public Health Syndromic Surveillance, published January 2011. CDC translated the ISDS business requirement recommendations into technical specifications to publish the PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data, Release 1.0, October 2011.

The CMS Stage 2 EHR Meaningful Use final rule was published in the Federal Register on September 4, 2012. The corresponding ONC final rule (also published on September 4, 2012) defined the standards, implementation specifications, and certification criteria for 2014 Edition Electronic Health Record Technology. In Stage 2, the syndromic surveillance objective became a core (required) objective for eligible hospitals but remained an optional objective for eligible providers. The 2014 Edition EHR certification criteria mandated that EHR products certified for inpatient (hospital) settings follow the HL7 2.5.1 standard and PHIN Messaging Guide for Syndromic Surveillance: Emergency Department and Urgent Care Data, Release 1.1 (August 2012). The PHIN Messaging Guide is optional for EHR products certified for the ambulatory setting.

ONC adopted an optional 2014 Edition (Release 2.0) syndromic surveillance certification criterion (§ 170.314(f) (7)) for the ambulatory setting. In 2016, CDC released a clarification document along with an erratum for the PHIN Implementation Guide version 2.0, which provided additional guidance and clarity for interpreting the guide's specifications. In fall 2017, CDC established a cooperative agreement with ISDS to further refine the guide, renewed its engagement with the syndromic surveillance community, and began the balloting process through HL7. In 2018, ISDS released draft version 1.0 to the community for comments. ISDS received 320 comments, and the ISDS Messaging Guide Workgroup began the reconciliation process through the Syndromic Surveillance Community of Practice.

This optional certification criterion states that EHR technology can be used to submit syndrome-based public health surveillance data following the standards and guidance in this guide. The ONC 2014 Edition Release 2.0 Certification criteria included an optional set of data elements for additional specificity. The optional data elements follow: • Patient demographics (age, gender, address) • Provider specialty • Provider address • Problem list Page 10 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

• Vital signs • Triage notes • Travel history • Pregnancy status • Acuity • Admit reason • Diagnostic codes • Chief complaint • Procedures • Medications • Insurance

Although several data elements in the preceding list are optional for demonstrating compliance with the certification criterion, an EHR technology developer may want to certify EHR technology to this criterion as a whole, including the optional data set. The EHR technology developer would need to demonstrate that the technology can electronically produce syndromic surveillance information that contains all data elements.

In August 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to improve the use of electronic health records, empower patients through better access to hospital service and billing information, and make it easier for providers to spend time with their patients. This final rule also renamed the "Meaningful Use" program to "Promoting Interoperability" program (https://qpp.cms.gov/mips/promoting-interoperability) and updated the Promoting Interoperability Transition Objectives and Measures. 1.9 Scope

The scope of this document is to provide guidelines for transmitting HL7 v.2.5.1-compliant messages that also conform with specific profiles that facilitate communications from emergency departments, urgent care centers, and ambulatory care and inpatient settings to the PHAs that conduct syndromic surveillance.

The intent of this guide is to facilitate data exchange between different systems for syndromic surveillance purposes. Data include: • Required data elements for all patient visits • Treatment facility information • Demographics, limited patient identifiable information as required by jurisdiction • Visit context, time, place • Diagnostic and pre-diagnostic information • Procedures • Vital measurements • Risk factor and other information • Acknowledgement of message receipt

This guide is not intended to specify topics such as: • How healthcare providers and PHAs can establish and maintain a health data sharing relationships; • Legal and governance issues about data access authorizations, data ownership and data use; • Business rules not implicit in HL7 or applied when creating a message (including data extraction from source systems); • Standard transport layer; • Business rules not implicit in HL7 or applied when processing a received message (including translating, normalizing, and preparing data for statistical analyses); and • Data quality monitoring and control. Page 11 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Local and state implementers are responsible for the topics described above. One way to ensure that these topics are not overlooked is to publish a jurisdiction-specific technical document or profile of local business rules and processes. The local profile should complement, not contradict, this guide. Throughout this guide are key issues that should be part of a local profile. 1.10 Assumptions

This guide makes the following assumptions: • Infrastructure is in place to allow accurate and secure information exchange between systems; • Privacy and security are appropriately implemented; and • External and internal business rules are documented locally.

Syndromic surveillance requires that multiple records for the same patient visit can be joined with limited personally identifiable information and that additional patient information can be securely looked up. Depending on the public health jurisdiction, data senders may provide a record identifier with each visit record to maintain a history of data integration that can be used in public health investigations. Guidance for these and other core syndromic surveillance processes are available from the Syndromic Surveillance Community of Practice website (formally ISDS) in Core Processes and EHR Requirements for Public Health Syndromic Surveillance. Visit http://www.healthsurveillance.org for more information. 1.11 Useful resources

HHS and CDC Resources: • PHIN Messaging Guide for Syndromic surveillance: Emergency Department, Urgent Care, Inpatient and Ambulatory Care Settings (Release 2.0, January 2015) https://www.cdc.gov/nssp/documents/guides/syndrsurvmessagguide2_messagingguide_phn.pdf • All historic versions of the PHIN Messaging Guide for Syndromic surveillance are posted at: https://www.cdc.gov/phin/resources/phinguides.html • Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule : https://www.hhs.gov/hipaa/for- professionals/privacy/special-topics/de-identification/index.html • HIPAA Privacy Rule and Public Health; Guidance from CDC and the U.S. Department of Health and Human Services: https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm • CDC NSSP Resource Center : https://www.cdc.gov/nssp/biosense/publications.html • CDC PHIN VADS Resources : https://www.cdc.gov/phin/tools/phinvads/index.html#2 • CDC PHIN VADS Vocabulary : https://phinvads.cdc.gov/vads/SearchVocab.action • NIST HL7 V2 General Validation Tool : https://hl7v2.gvt.nist.gov/gvt/#/cf

Messaging and terminology standards and validation: • National Institute of Standards and Technology (NIST) validation tool https://hl7v2.gvt.nist.gov; then select "Syndromic Surveillance" from the "Tool Scopes" drop down. • Health Level Seven International (HL7) standards development organization http://www.hl7.org/ • PHIN Vocabulary Access and Distribution System (VADS) http://phinvads.cdc.gov/ • International Classification of Diseases, Tenth Revision (ICD10) http://www.icd10data.com/ • Logical Observation Identifiers Names and Codes (LOINC) resource http://loinc.org/ • Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) http://www.ihtsdo.org/snomed-ct/ • American Medical Association Current Procedural Terminology (CPT) https://www.ama-assn.org/practice- management/cpt-current-procedural-terminology

1.12 Revision of PHIN Messaging Guide, Release 2.2

The following decisions were made by the Implementation Guide Workgroup: • Removed references to laboratory data • Removed ICD 9-CM references • Removed references to HL7 v2.3.1 • Changed references of encounter to visit. Also, clarified guidance to state that visit ID (PV1-19) and visit time (PV1-44) should remain constant throughout the visit. • Reworded 2.1 Business Rules, Transmission Timeliness to "Electronic transmission to the PHA shall occur at the time of the visit if feasible, but not later than 12 hours from the start of the visit. Any subsequent updates to a patient's record must also be transmitted within 12 hours of the update. Real-time transmission and frequent batching are allowed as long as delivery to the PHA is within 12 hours of the trigger event. A delay in transmission should only come into effect in unusual circumstances, such as a system failure or power outage." • Reworded patient name guidance to "Patient name may be submitted according to applicable jurisdiction or PHA regulations and specifications. If the PHA does not require patient name to be submitted, Visit or Patient ID, as specified within this guide, shall NOT be used by PHAs to join related visit data and for working with hospitals to find additional visit information for syndromic surveillance signal confirmation or investigation. Since, however, HL7 requires the patient name, the field must be populated even when data patient name shall not be sent. In such an instance (i.e., patient name is not sent), patient name shall be presented in a pseudonymized manner."

• Added new or Updated Value Sets o Discharge disposition (PV1-36) - PHVS_DischargeDisposition_HL7_2x o Patient Class (PV1-2) - PHVS_PatientClass_SyndromicSurveillance o Diagnosis Code (DG1-3) - PHVS_AdministrativeDiagnosis_CDC_ICD-10CM and PHVS_Disease_CDC o Admit Reason (PV2-3) - PHVS_AdministrativeDiagnosis_CDC_ICD-10CM and PHVS_Disease_CDC o Procedure Codes (PR1-3) - PHVS_AdministrativeProcedure_CDC_ICD-10PCS o Medication List - PHVS_MedicationClinicalDrugName_HITSP and PHVS_MedicationBrandName_HITSP o Patient Service Location - PHVS_HealthcareServiceLocation_Syndromic o Initial Acuity - PHVS_EmergencySeverityIndexAcuity_CDC

• Updated OBX Usage, elevating the following from O to RE o Pregnancy Status o Travel History o Triage Notes o Acuity o Admit Reason o Smoking status o BMI (Body Mass Index)

Updated and corrected messaging examples to pass NIST conformance testing. To access this tool go to https://hl7v2.gvt.nist.gov, then select "Syndromic Surveillance" from the "Tool Scopes" drop down.

Reorganized the guide to reduce redundancy: • Section 5 - Syndromic surveillance data elements of interest into Message Infrastructure • Appendix A - Code Tables incorporated into Message Infrastructure Page 13 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

• Appendix B - Message Examples has become section 2.6 • Appendix C - Conformance Statements incorporated into Message Infrastructure • Appendix D - Future data elements was removed • Appendix E - Translation to 2.3.1 was removed • Appendix F - Useful Resources has become section 1.11 • Appendix G - Discharge Disposition incorporated into Message Infrastructure • Appendix H - A08 Message Triggers has become section 2.5 • Appendix I - Background has become sections 1.7 and 1.8 • Appendix J - Revision History has become section 1.12 1.13 Snapshot Mode

Messages for a given visit shall always be sent in snapshot mode, indicating information related to the smallest individually identifiable unit are complete. For syndromic messages, that would be the OBX segments. If a correction and/or update to one of the OBX segments is necessary, all OBX segments, even if previously sent, shall be resent with the correction and/or current status and/or current values. If a previously sent OBX is missing from a subsequent message, then that indicates the OBX should be deleted. 1.14 Flavors

Flavor is a specialization of the base. For example, when a data type (as defined in the base HL7 v2.x standard) is constrained for a particular use, it is given an identifier ending in _SS and deemed a data type flavor. An example of a data type flavor identifier is XAD_SS. The same is true of segment flavors. In this guide, any segment or data type identifier with the suffix _SS is a flavor of the base segment or data type. An example of a segment flavor identifier is MSH_SS. 1.15 Binding Strength and Location

Binding is the association of a coded data element with a vocabulary (see the PHIN VADS site for more information: https://phinvads.cdc.gov/vads/downloads/PHINVADS_Guide.pdf). Depending on the level of the specification, a coded data element may be bound to a concept domain, code system, or value set. The HL7 v2 tables can represent any of these three vocabulary types, depending on how the data element is defined and used. At each specification (profile) level, the binding becomes increasingly specific, refining the data semantics of the element by limiting its content to a particular set of coded values.

Binding strength indicates the conformance of the binding, that is, whether the vocabulary must be used or not. There are two possible values: Required ("R") and Suggested ("S," which is recommended).

Binding location defines the element location of the vocabulary binding for composite-coded element data types. For example: a field with a CWE data type and binding location of 1 restricts the vocabulary to CWE.1 (i.e., the first triplet). A location of 1 or 4 indicates that the vocabulary binding is either in element 1 or element 4 (i.e., either the first or second triplet in the CWE data type). 1.16 Usage

Segment and Field Usage: Usage of O does not require sending of receiving system support; rather, the guide only shows how to support the concept if data-trading partners agree to exchange specific data elements For more information on segment and field usage, see http://wiki.hl7.org/index.php?title=Conformance_Implementation_Manual 2.B.7.2.

Value Set Usage: Required (R) usage indicates that the code must be supported (and thus can be used); Permitted (P)

indicates that the code can be profiled to R, P, or E in a derived profile; and Excluded (E) indicates that the code must not be supported (and thus cannot be used) for the given element. 1.17 Optional Elements

If a data type or value set is defined for an Optional element like DG1-15, IN1-15, or MSH-6, then the field does not need to be supported. However, if the field is supported, it must use the data type/value set specified within the Implementation Guide.

2 ACTORS, GOALS AND MESSAGING TRANSACTIONS 2.1 Use case model

The use case model is based on business process documentation and core requirements for public health syndromic surveillance that uses electronic health record data from emergency department (ED), urgent care (UC), inpatient, and ambulatory care (AC) settings.

Table 2-1 Syndromic Surveillance Use Case Description TABLE 2-1: USE CASE: ED/UC/AC and INPATIENT Health Record Syndromic Data to Public Health ITEM DETAIL Description • The Public Health Syndromic Surveillance Use Case focuses on transmittal of electronic health data from healthcare providers (senders) and receipt of same data by PHAs (receivers). During a patient visit to a healthcare facility, health data tare captured in a health information system. • Senders of data include hospitals, emergency departments, urgent care centers, ambulatory care settings, clinician networks, hospital corporations, corporate third-party operators of information brokers, regional data centers for hospitals, health information exchanges (HIEs), and regional health information organizations (RHIOs). • Receivers may be a designated third party or a state, regional, or local PHAs. A PHA is broadly defined to include agencies or authorities of the United States, states, territories, political subdivisions of states or territories, American Indian tribes, or an individual or entity acting under a grant of authority from such agencies and responsible for public health matters as part of an official mandate. • The goal of the use case is to provide secure, reliable delivery of syndromic surveillance data to PHAs. Many transport methods may be used. A secure transport mechanism should be chosen. Consideration should be given for acknowledgement of messages, whether single or batch, and/or possible acknowledgement of payload before processing or ingestion. • When describing the relationships between Sender and Receiver at the regional or national level; it could be determined that the Local PHA is portraying the role of Sender and a larger regional (e.g. RHIO, HIE) or national entity (CDC) portrays the role of receiver. In such circumstances, the partner entities should resolve mutually beneficial business rules using this implementation guide as a framework to navigate potentially contradictory legislative and operational business rules. Actors • Patient-A person receiving or registered to receive medical treatment. • Senders of syndromic surveillance data include (but are not limited to) hospitals, emergency departments, urgent care centers, and regional data centers for hospitals. • Receivers of syndromic surveillance data include PHA's. Assumptions and The following assumptions are preconditions for the use of this profile: Limitations • Syndromic surveillance data senders are responsible for providing data that are syntactically and semantically consistent with the syndromic surveillance data receiver's requirements. • Before sending syndromic data, the data sender and receiver have completed all legal and administrative steps required for healthcare related data exchange. • The scope of data is limited to patient visit information and subsequent diagnoses related to the visit. Scheduled (future) visit data shall not be sent.

TABLE 2-1: USE CASE: ED/UC/AC and INPATIENT Health Record Syndromic Data to Public Health Business Rules All settings:

• Data must be timely for syndromic surveillance. Electronic transmission to the PHA shall occur at the time of the visit if feasible, but not later than 12 hours from the start of the visit. Any subsequent updates to a patient's record must also be transmitted within 12 hours of the update. Real-time transmission and frequent batching are allowed as long as delivery to the PHA is within 12 hours of the trigger event. A delay in transmission should only come into effect in unusual circumstances, such as a system failure or power outage. • Conformance Statement SS-001: Messages constrained by this guide and produced due to a single patient visit for the purpose of syndromic surveillance, SHALL have the same value for PV1-19.1 (Visit ID). • Conformance Statement SS-002: Messages constrained by this guide and produced due to a different patient visits for the purpose of syndromic surveillance, SHALL NOT have the same value for PV1-19.1 (Visit ID). • Visit ID (PV1-19) and visit time (PV1-44) should remain constant throughout the clinical encounter. • When the sender's system updates data elements (new or previously sent), the entire record (i.e., all specified elements) shall be resent. Message receivers will use unique identifiers to match and reconcile records. • Data should provide details about clinical patient visits. • Data should be de-identified to the level specified and required by jurisdictional regulations and legislation. Refer to 1.11 Useful Resources for information about de-identification and HIPAA.

The Send Syndromic Surveillance Data Use Case Model has two primary actors: the Syndromic Data Sender and the Syndromic Data Receiver. A secondary actor, the patient, triggers the original provider to send data.

2.2 Dynamic interaction models

2.2.1 SEND SYNDROMIC SURVEILLANCE DATA WITH ACKNOWLEDGEMENT

The Send Syndromic Surveillance Data with Acknowledgement activity model shows the Syndromic Surveillance Data Sender transmitting data to the Syndromic Surveillance Data Receiver. The Syndromic Surveillance Data Receiver will send an acknowledgement.

2.2.2 SEND SYNDROMIC SURVEILLANCE DATA WITHOUT ACKNOWLEDGEMENT

The Send Syndromic Surveillance Data without Acknowledgement model shows the Syndromic Surveillance Data Sender transmitting data to the Syndromic Surveillance Data Receiver. The Syndromic Surveillance Data Receiver will NOT send an acknowledgement.

2.2.3 SEND SYNDROMIC SURVEILLANCE DATA - BATCH

The Send Syndromic Surveillance Data Batch activity diagram model shows the Syndromic Surveillance Data Sender transmitting a batch to the Syndromic Surveillance Data Receiver. No acknowledgement is sent by the Syndromic Surveillance Data Receiver.

2.3 Message acknowledgements

This guide requires a mechanism to support Acknowledgement Messages to make sure the message has been received in good order by the intended recipient. The mechanism shall support both: • Node-to-node acknowledgement-the receiving system takes responsibility of the message and lets the preceding system know without sending acknowledgements to originating healthcare setting; and • End-to-end, application-level acknowledgement choreography-the intended recipient not only assumes responsibility of message after it passes through multiple systems, such as integration engines, but also consumes the message's application-specific data and lets the preceding system know with the expectation that this acknowledgement is being passed to the message originator through any of the intermediate systems.

End-to-end, application-level acknowledgement choreography requires the use of an Enhanced Page 19 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Acknowledgment Mode, i.e., MSH-15 (Accept Acknowledgment Type) and MSH-16 (Application Acknowledgement Type) values by the message sender and control the creation of an accept-level message and application-level acknowledgement message by the message receiver, or a node that enables transmission of the message across the various systems between the sender and receiver (e.g., integration engines, HIEs). For details on accept- and application-level acknowledgements, see Chapter 2 of V2.5.1 (or higher).

2.3.1 ACKNOWLEDGEMENT CHOREOGRAPHY APPLIED

Acknowledgement choreography starts with the initial ADT message that uses MSH-15 and MSH-16 to tell the receiving system how to respond. The communication partners must agree to support basic acknowledgements: accept- level acknowledgements only or end-to-end acknowledgements, including application-level acknowledgements.

For basic, accept level acknowledgements only, the following MSH-15 and MSH-16 values must be supported. ACCEPT LEVEL ACKNOWLEDGEMENT TABLE 2-2 CODES

Requirement MSH-15 MSH-16 SHALL support AL NE MAY support* NE NE

*ONLY in point-to-point environments, where the transport protocol guarantees delivery to the intended recipient.

When the communication partners agree to support end-to-end application level acknowledgements as well, then the following values must be supported for MSH-15 and MSH-16: APPLICATION LEVEL TABLE 2-3 ACKNOWLEDGEMENT CODES

Requirement MSH-15 MSH-16 SHALL support AL AL MAY support AL ER MAY support* NE AL MAY support* NE ER

*ONLY in point-to-point environments, where the transport protocol guarantees delivery to the intended recipient. Other values and combinations are NOT allowed.

Note: Based on industry adoption, support for only basic, accept-level acknowledgements may be removed; only end-to- end acknowledgements covering both accept- and application-level acknowledgements to the originator may be supported. 2.4 Interactions

The following ADT trigger events represent the primary message types that PHAs use to conduct syndromic surveillance (see PHVS_EventType_SyndromicSurveillance - Event Type (Syndromic Surveillance). A normal EHR workflow could include additional ADT trigger events. TABLE 2.4.1: INTERACTIONS - INDIVIDUAL TRANSACTION WITH ACKNOWLEDGEMENTS EVENT TYPE MESSAGE TYPE RECEIVER SENDER DATA VALUES

TABLE 2.4.1: INTERACTIONS - INDIVIDUAL TRANSACTION WITH ACKNOWLEDGEMENTS ACTION Accept, Reject, SS Data MSH-9 = Outpatient visit begins ADTÂ04ÂDT_A01 Error Sender 'ADTÂ04ÂDT_A01' Accept, Reject, SS Data MSH-9 = Outpatient visit ends ADTÂ03ÂDT_A03 Error Sender 'ADTÂ03ÂDT_A03' Patient registers at Accept, Reject, SS Data MSH-9 = ADTÂ04ÂDT_A01 facility Error Sender 'ADTÂ04ÂDT_A01' Patient is admitted to Accept, Reject, SS Data MSH-9 = ADTÂ01ÂDT_A01 facility Error Sender 'ADTÂ01ÂDT_A01' Patient is discharged ADTÂ03ÂDT_A03 Accept, Reject, SS Data MSH-9 = from facility Error Sender 'ADTÂ03ÂDT_A03' Patient record is Accept, Reject, SS Data MSH-9 = ADTÂ08ÂDT_A01 updated Error Sender 'ADTÂ08ÂDT_A01' Accept message ACK message related to type of None SS Data MSA-1 = 'AA' message sent Receiver Reject message ACK message related to type of None SS Data MSA-1 = 'AR' message sent Receiver Error Message ACK message related to type of None SS Data MSA-1 = 'AE' message sent Receiver

TABLE 2.4.2: INTERACTIONS - INDIVIDUAL TRANSACTION WITHOUT ACKNOWLEDGEMENT / BATCH EVENT MESSAGE TYPE RECEIVER SENDER DATA VALUES ACTION None SS Data MSH-9 = 'ADTÂ04ÂDT_A01' Outpatient visit begins ADTÂ04ÂDT_A01 Sender None SS Data MSH-9 = 'ADTÂ03ÂDT_A03' Outpatient visit ends ADTÂ03ÂDT_A03 Sender None SS Data MSH-9 = 'ADTÂ04ÂDT_A01' Patient registers at facility ADTÂ04ÂDT_A01 Sender Patient is admitted to None SS Data MSH-9 = 'ADTÂ01ÂDT_A01' ADTÂ01ÂDT_A01 facility Sender Patient is discharged from ADTÂ03ÂDT_A03 None SS Data MSH-9 = 'ADTÂ03ÂDT_A03' facility Sender None SS Data MSH-9 = 'ADTÂ08ÂDT_A01' Patient record is updated ADTÂ08ÂDT_A01 Sender

2.5 A08 Message Triggers

The following table relates data element changes to the triggering of an A08 message. Optional fields would only contribute to triggering an A08 if they are present in the message. TABLE 2.5: A08 MESSAGE TRIGGERS

DATA DESCRIPTION OF USAGE CARDINALITY RECOMMENDED HL7 TRIGGERS AN A08 TRANSACTION ELEMENT FIELD LOCATION NAME Facility Unique facility R [1..1] EVN-7.2 Event Facility - No, would not trigger a new A08 - Page 21 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

TABLE 2.5: A08 MESSAGE TRIGGERS

Identifier identifier where Facility Identifier already included with all ADT (Treating) patient was treated messages (original data provider) Facility Name Name of treating RE [0..1] EVN-7.1 Event Facility - No, would not trigger a new A08 - (Treating) facility where Facility Name already included with all ADT patient is treated messages Treating Facility Address of treating RE [0..1] OBX Segment with OBX-3 No, would not trigger a new A08 - Address facility location Observation Identifier of already included with all ADT (street address, SS002 Treating Facility messages city, state, ZIP, Location (PHINQUESTION) and county) and OBX-2 Value Type of XAD. Facility/Visit Facility type that R [1..1] OBX Segment with OBX-3 Yes, if visit type changes during a type patient visited for Observation Identifier specific visit treatment SS003^FACILITY/VISIT TYPE Message Date and time that R [1..1] EVN-2 Event Date/Time No, this field is a by-product of the (Event) report is created / trigger and when it occurred Date/Time generated from original source (from treating facility) Unique Unique identifier O [0..1] PV1-7 Attending Doctor Yes, if this optional field is being Physician for physician sent, and physician assignment Identifier providing care changes for a specific visit. Transactions that would translate to A08:

• CHANGE ATTENDING DOCTOR (EVENT A54) Unique Patient Unique identifier R [1..*] PID-3 Patient Identifier List Yes, if Medical Record Number or Identifier / for patient whatever identifier is being used in Medical Record PID-3 changes for a specific patient. Number PID-3 Patient Identifier value will be the only means of identifying a patient longitudinally. Potential transactions that would translate to A08:

• MERGE PATIENT INFORMATION (EVENT A18) • MERGE PERSON INFORMATION (EVENT A30) • UPDATE PERSON INFORMATION (EVENT A31) • MERGE PATIENT INFORMATION - PATIENT ID ONLY Page 22 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

TABLE 2.5: A08 MESSAGE TRIGGERS

(EVENT A34) • CHANGE PATIENT ID (EVENT A46) • MERGE PATIENT INFORMATION - PATIENT ID & ACCOUNT NUMBER (EVENT A36) • MERGE PERSON - PATIENT ID (EVENT A39) • MERGE PATIENT - PATIENT IDENTIFIER LIST (EVENT A40) • CHANGE PATIENT ID (EVENT A46) • CHANGE PATIENT IDENTIFIER LIST (EVENT A47) Unique Visit Unique identifier R [1..*] PV1-19 Visit ID Yes, if visit identifier is changed for a Identifier for visit specific visit. Potential transactions that would translate to A08:

• CHANGE AN OUTPATIENT TO AN INPATIENT (EVENT A06) • CHANGE AN INPATIENT TO AN OUTPATIENT (EVENT A07) • MERGE PATIENT INFORMATION (EVENT A18) • MERGE PERSON INFORMATION (EVENT A30) • UPDATE PERSON INFORMATION (EVENT A31) • MERGE PATIENT INFORMATION - ACCOUNT NUMBER ONLY (EVENT A35) • MERGE PATIENT INFORMATION - PATIENT ID & ACCOUNT NUMBER (EVENT A36) • MERGE VISIT - VISIT NUMBER (EVENT A42) • MOVE VISIT

TABLE 2.5: A08 MESSAGE TRIGGERS

INFORMATION - VISIT NUMBER (EVENT A45) Age/Age Units Numeric value of RE [0..1] OBX Segment with OBX-3 Yes, when a new 21612-7 AGE patient age at time Observation Identifier of REPORTED (LOINC) observation of visit 21612-7 AGE - REPORTED becomes available or changes occur (LOINC) and OBX-2 Value in EHR Type of NM Gender Stated gender of RE [0..1] PID-8 Administrative Sex Yes, when PID-8 is added or patient updated Race Race of patient RE [0..*] PID-10 Race Yes, when PID-10 is added or updated Ethnicity Ethnicity of patient RE [0..*] PID-22 Ethnicity Yes, when PID-22 is added or updated Patient City or town of RE [0..1] PID-11.3 Patient Address City Yes, when PID-11.3 is added or City/Town patient residence updated Patient ZIP ZIP code of patient RE [0..1] PID-11.5 Patient Address Yes, when PID-11.5 is added or Code residence Postal Code updated Patient County County of patient RE [0..1] PID-11.9 Patient Address Yes, when PID-11.9 is added or residence County updated Patient State State of patient RE [0..1] PID-11.4 Patient Address Yes, when PID-11.4 is added or residence State updated Patient Country Country of patient RE [0..1] PID-11.6 Patient Address Yes, when PID-11.6 is added or residence Country updated Patient Death Patient Death Date PID-29 Patient Death Date Yes, when PID-29 is added or C [0..1] Date and Time and Time and Time updated Patient Death Patient Death PID-30 Patient Death Yes, when PID-30 is added or RE [0..1] Indicator Indicator Indicator updated Chief Complaint Patient's self- RE [0..*] OBX Segment with OBX-3 Yes, when a new 8661-1 Chief / Reason for reported chief Observation Identifier of Complaint - reported (LOINC) Visit complaint or 8661-1 Chief Complaint - observation becomes available in the reason for visit Reported (LOINC) of TX. EHR Free text chief complaint is entered as OBX-5 Observation Value. Admit or Visit Short description RE [0..1] PV2-3 Admit Reason Yes, if PV2-3 Admit or Visit Reason Reason of provider's value changes reason for admitting patient Admit or Visit Date and time of R [1..1] PV1-44 Admit Date Yes, if PV1-44 Admit or Visit Date / Time visit or admission Date/Time changes Date of onset Date that patient O [0..1] OBX Segment with OBX-3 Yes, when a new 11368-8 Illness or began having Observation Identifier 11368- Injury Onset Date (LOINC) symptoms of 8 Illness or Injury Onset Date observation becomes available in the condition being (LOINC) and OBX-2 Value EHR reported Type of TS Patient Class Patient R [1..1] PV1-2 Patient Class Yes, if PV1-2 Patient Class value classification within changes facility Admission Type Field that indicates O [0..1] PV1-4 Admission Type Yes, if this optional field is being circumstances sent, and PV1-4 Admission Type is Page 24 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

TABLE 2.5: A08 MESSAGE TRIGGERS

under which added or updated patient was or will be admitted Admit Source Field that indicates O [0..1] PV1-14 Admit Source Yes, if PV1-14 Admit Source value is where patient was added or updated admitted Hospital Unit Hospital unit where RE [0..1] OBX Segment with OBX-3 Yes, if PV1-3 Assigned Patient patient is at time Observation Identifier of Location value is added or updated. message is sent 56816-2 Patient Location ADT^A02 event is issued as a result (admission and (LOINC) and OBX-2 Value of the patient changing his or her discharge) Type of CWE assigned physical location. Previous Hospital unit where O [0..1] PV1-6 Prior Patient Location No Hospital Unit patient was before current transaction

Diagnosis Type Qualifier for RE [0..*] DG1-6 Diagnosis Type Yes, any time diagnosis information Diagnosis / Injury is updated, the DG1 requires an Code specifying Admitting, Working or Final type of diagnosis designation in DG1-6 Diagnosis Type Primary Primary diagnosis RE [0..*] DG1-3 Diagnosis Code Yes, any time diagnosis information Diagnosis / of patient's is added or updated, such as in Additional condition; BAR/ACK - UPDATE Diagnosis additional DIAGNOSIS/PROCEDURE (EVENT diagnoses of P12) patient's condition(s) Discharge Patient's RE (A03 [0..1] PV1-36 Discharge Disposition Yes, required element for A03 Disposition anticipated only) Discharge Transaction but allowable location or status in an A08 if PV1-36 is updated following discharge Discharge or Date and time of RE (A03 [0..1] PV1-45 Discharge Date/Time Yes, required element for A03 Disposition discharge only) Discharge Transaction but allowable Date/Time in an A08 if PV145 is updated

Procedure Procedures O [0..1] PR1-3 Procedure Code Yes, any time procedure information Code administered to the is added or updated, such as in patient BAR/ACK - UPDATE DIAGNOSIS/PROCEDURE (EVENT P12) Triage Notes Triage notes for RE [0..1] OBX Segment with OBX-3 Yes, when a new 54094-8 the patient visit Observation Identifier 54094- Emergency Department Triage 8 Emergency Department Notes (LOINC) observation becomes Triage Notes (LOINC) and available in EHR OBX-2 Value Type of TX to allow free text input only in OBX-5 Observation Value.

Clinical Clinical impression O [0..1] OBX Segment with OBX-3 Yes, when a new 44833-2 Page 25 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

TABLE 2.5: A08 MESSAGE TRIGGERS

Impression (free text) of Observation Identifier 44833- Preliminary Diagnosis (LOINC) diagnosis 2 Preliminary Diagnosis observation becomes available in (LOINC) and OBX-2 Value EHR Type of TX to allow free text input only in OBX-5 Observation Value. Height Height of patient RE [0..1] OBX Segment with OBX-3 Yes, when a new 8302-2 Body Observation Identifier 8302-2 Height (LOINC) observation Body Height (LOINC) and becomes available in EHR (but not OBX-2 Value Type of NM. every time height is entered) Weight Weight of patient RE [0..1] OBX Segment with OBX-3 Yes, when a 3141-9 Body Weight Observation Identifier 3141-9 Measured (LOINC) observation Body Weight Measured becomes available in EHR (but not (LOINC) and OBX-2 Value every time a weight is entered) Type of NM. BMI Body Mass Index RE [0..1] OBX Segment with OBX-3 Yes, when 39156-5 Body Mass Observation Identifier 39156- Index (LOINC) observation becomes 5 Body Mass Index (LOINC) available in EHR and OBX-2 Value Type of NM. Systolic and Most recent O [0..1] Blood Pressure is Yes, if a 8480-6 BP Systolic (LOINC) Diastolic Blood systolic and communicated using 2 and/or 8462-4 BP Diastolic (LOINC) Pressure diastolic blood different data elements for observation becomes available in the (SBP/DBP) - pressure of Systolic and Diastolic Blood EHR (expecting at least one set per Most recent patient. Pressure. visit). Every BP reading should trigger a new A08. Also, please see previous discussion of snapshot mode. Initial Initial temperature O [0..1] OBX Segment with OBX-3 Yes, when a 11289-6 Body Temperature of patient Observation Identifier 11289- Temperature Initial (LOINC) 6 Body temperature: observation becomes available in Temp:Enctrfirst (LOINC) and EHR OBX-2 Value Type of NM. Initial Pulse First recorded O [0..1] OBX Segment with OBX-3 Yes, when a 59408-5 Initial Pulse Oximetry pulse oximetry Observation Identifier 59408- Oximetry (LOINC) observation value 5 OXYGEN SATURATION IN becomes available in EHR ARTERIAL BLOOD BY PULSE OXIMETRY (LOINC) and OBX-2 Value Type of NM. Smoking Status Smoking status of RE [0..1] OBX Segment with OBX-3 Yes, when a 72166-2 Tobacco patient Observation Identifier 72166- Smoking Status (LOINC) observation 2 Tobacco Smoking Status becomes available in EHR (LOINC) and OBX-2 Value Type of CWE. Initial Acuity Assessment of O [0..1] OBX Segment with OBX-3 Yes, when a 11283-9 Initial Acuity intensity of medical Observation Identifier 11283- (LOINC) observation becomes care patient 9 Initial Acuity (LOINC) and available in EHR requires. OBX-2 Value Type of CWE. Insurance Health insurance O [0..*] IN1-15 Insurance Plan ID Yes, when Insurance Plan Coverage coverage of patient information changes, which may occur in other message types such

TABLE 2.5: A08 MESSAGE TRIGGERS

as:

• BAR/ACK - ADD PATIENT ACCOUNT (EVENT P01) • DFT/ACK - POST DETAIL FINANCIAL TRANSACTIONS (EVENT P03) • BAR/ACK - UPDATE ACCOUNT (EVENT P05) • DFT/ACK - POST DETAIL FINANCIAL TRANSACTIONS - EXPANDED (EVENT P11)

2.6 Messaging examples

This section presents six (6) case studies to illustrate how this guide should be used for messaging syndromic surveillance information about a patient visit. These examples passed NIST conformance testing (visit https://hl7v2.gvt.nist.gov, then select "Syndromic Surveillance" from the "Tool Scopes" drop down). The example messages in this section of are for illustration purposes and are not intended for system design. Readers should not infer requirements solely on the basis of these messages.

Minimal data are used in each case study to emphasize important aspects of the message structure. Data elements of interest are varied to emphasize clinical or administrative concepts about syndromic surveillance. Each case study describes ADT trigger events that represent core data elements for syndromic surveillance. Keep in mind, however, that a normal EHR workflow could include additional ADT trigger events.

Case 1 - Brief Urgent Care or Emergency Department Visit

Case Study 1 provides an example of a brief patient visit that could take place in either urgent care or emergency department clinical settings. The patient's chief complaint is captured as an unstructured, free-text value using the patient's own words. ADT A04 and A03 messages for this visit are generated and sent to the PHA.

Step 1: Registration Trigger - ADT A04

A 38-year-old female walks into Midtown Urgent Care on August 17, 2017 at 12:00 PM. The patient is registered by a clerical assistant who records the patient's name, date of birth, residence information, race, ethnicity, and patient's reason for visit, which is "Fever, chills, smelly urine with burning during urination."

At 12:30 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Registration message to Big City Health Department about this visit.

Example Message - Step 1, Case 1:

MSH|^~\&||MidTwnUrgentC^2231231234^NPI|||20170817123000-0500||ADTÂ04ÂDT_A01|NIST-SS-001.12|P|2.5.1| ||AL|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3ÎSO EVN||20140817123000-0500|||||MidTwnUrgentC^2231231234^NPI PID|1||2222^^^MidTwnUrgentC&2231231234&NPI^MR||~^^^^^^S||19790505|F||2106- 3^White^CDCREC|^^Decatur^13^30303^^13121|||||||||||2135-2^Hispanic or Latino^CDCREC PV1|1|O|1160-1^^^MidTwnUrgentC&2231231234&NPI|U|||||||||||||| |2222_001^^^MidTwnUrgentC&2231231234& NPI^VN|||||||||||||||||||||||||201708171200-0500 PV2|||^Fever, chills, smelly urine with burning during urination OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QU0200XÛrgent Care^HCPT||||||F|||201408171200- 0500 OBX|2|XAD|SS002^TREATINGFACILITYLOCATION^PHINQUESTION||1234 Anywhere Street^^Doraville^13^30341ÛSA^C^DEKALB||||||F|||201708171200-0500 OBX|3|NM|21612-7Âge-Reported^LN||38|a^yearÛCUM|||||F|||201708171200-0500 OBX|4|TX|8661-1^ChiefComplaint^LN||Fever, chills, smelly urine with burning during urination|||| ||F|||201708171200-0500

Step 2: Discharge Trigger: ADT A03

At 12:35 PM a nurse practitioner examines the patient and diagnoses a urinary tract infection. The nurse assigns an ICD- 10-CM diagnosis code within the EHR, and orders a course of antibiotics for the patient. The patient is discharged from the urgent care center at 12:45 PM.

At 2:30 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Discharge message to Big City Health Department about this visit.

Example Message - Step 2, Case 1:

MSH|^~\&||MidTwnUrgentC^2231231234^NPI|||20170817143000-0500||ADTÂ03ÂDT_A03|NIST-SS-001.22|P|2.5.1| ||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3ÎSO EVN||20170817143000-0500|||||MidTwnUrgentC^2231231234^NPI PID|1||2222^^^MidTwnUrgentC&2231231234&NPI^MR||~^^^^^^S||19790505|F||2106-3^White^CDCREC|^^Decatur ^13^30303^^13121|||||||||||2135-2^Hispanic or Latino^CDCREC PV1|1|O|1160-1^^^MidTwnUrgentC&2231231234&NPI|U|||||||||||||||2222_001^^^MidTwnUrgentC&2231231234 &NPI^VN|||||||||||||||||01||||||||201708171200-0500|201708171245-0500 PV2|||N39.0Ûrinary tract infection, site not specifiedÎ10 DG1|1|I10|N39.0Ûrinary tract infection, site not specifiedÎ10||201708171235-0500|F OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QU0200XÛrgent Care^HCPT||||||F|||201708171200- 0500 OBX|2|XAD|SS002^TREATINGFACILITYLOCATION^PHINQUESTION||1234 Anywhere Street^^Doraville^13^30341 ÛSA^C^DEKALB||||||F|||201708171200-0500 OBX|3|NM|21612-7Âge-Reported^LN||38|a^ÛCUM|||||F|||201708171200-0500 OBX|4|TX|8661-1^ChiefComplaint^LN||Fever, chills, smelly urine with burning during urination||||||F| ||201708171200-0500 OBX|5|CWE|8677-7^MedicationsPrescribedOrDispensed^LN||617296Âmoxicillin 500 MG / Clavulanate 125 MG Oral Tablet^RXNORM||||||F|||201708171235-0500

Case 2 - Unconscious Patient Dies in Emergency Department

Case Study 2 provides an example of a hospital emergency department visit where the patient demographic information is unavailable at registration, chief complaint is captured as a coded value in PV2-3 Admit Reason, ICD-10-CM codes are captured as part of the working diagnoses, and the patient dies. ADT A04, A08, and A03 messages are generated for this visit and sent to the PHA.

Step 1: Registration Trigger - ADT A04

An unconscious white male with no visible injuries is brought by ambulance to Pacific Northwest Hospital's Emergency Page 28 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Department at 11:45 PM on August 2, 2017. The paramedics report that firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed the patient on a ventilator. Unable to find identification, the patient is registered without his true name, date of birth, or ethnicity. His reason for visit is logged as ICD-10-CM code.

At 2:00 AM on August 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an ADT A04 message for this visit to the state health department.

Example Message - Step 1, Case 2:

MSH|^~\&||PacificNWHospitalED^2231231234^NPI|||20170803020000-0500||ADTÂ04ÂDT_A01|NIST-SS-001.12|P| 2.5.1|||NE|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3ÎSO EVN||20170802234500-0500|||||PacificNWHospitalED^2231231234^NPI PID|1||3333^^^PacificNWHospitalED&2231231234&NPI^MR||~^^^^^Û|||M||2106-3^White^CDCREC PV1|1|E|1108-0^TR14^2A^PacificNWHospitalED&2231231234&NPI|E|||||||||||||||3333_001^^^ PacificNWHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201708022345-0500 PV2|||X00.1Êxposure to smoke in uncontrolled fire in building or structureÎ10 OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QE0002XÊmergency Care^HCPT||||||F|| |201708022345-0500 OBX|2|CWE|56816-2^HospitalUnit^LN||1108-0ÊmergencyDepartment^HSLOC||||||F|||201708022345-0500 OBX|3|TX|54094-8ÊmergencyDepartmentTriageNote^LN||firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed on a ventilator||||||F|||201708022345-0500 OBX|4|CWE|11283-9ÎNITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500

Step 2: Record Update Trigger: ADT A08

ED physicians perform a physical examination and blood work and find extremely abnormal blood gas numbers. While these tests are being performed a woman shows up in the ED stating that she is a friend. She provides the clinicians with the patient's name and date of birth, and states that she believes he has been homeless recently. At 2:30 AM on August 3, 2017, a working ICD-10-CM diagnosis code is entered into the patient record along with updated name, ethnicity and date of birth. (Note that due to State reporting rules in the hospital location, the patient name is sent in PID-5).

At 4:00 AM on August 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an ADT A08 message for this visit to the state health department.

Example Message - Step 2, Case 2:

MSH|^~\&||PacificNWHospitalED^2231231234^NPI|||20170803040000-0500||ADTÂ08ÂDT_A01|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A08^^2.16.840.1.114222.4.10.3ÎSO EVN||20170803023000-0500|||||PacificNWHospitalED^2231231234^NPI PID|1||3333^^^PacificNWHospitalED&2231231234&NPI^MR||Chaplin^Charles^^^^^L||19650314|M||2106- 3^White^CDCREC||||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|E|1108-0^TR14^2A^PacificNWHospitalED&2231231234&NPI|E|||||||||||||| |3333_001^^^PacificNWHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201708022345-0500 PV2|||X00.1Êxposure to smoke in uncontrolled fire in building or structureÎ10 OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QE0002XÊmergency Care^HCPT||||||F|||201708022345-0500 OBX|2|CWE|56816-2^HospitalUnit^LN||1108-0ÊmergencyDepartment^HSLOC||||||F|||201708022345-0500 OBX|3|TX|54094-8ÊmergencyDepartmentTriageNote^LN||firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed on a ventilator||||||F|||201708022345-0500 OBX|4|CWE|11283-9ÎNITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500 DG1|1|I10|J96.0Âcute respiratory failureÎ10||201708030230-0500|W DG1|2|I10|Z59.0^HomelessnessÎ10||201708030230-0500|W

Step 3: Discharge Trigger: ADT A03

At 8:30 AM, the patient's heart suddenly stops beating. After several minutes of resuscitation attempts, the attending physician determines the patient died of cardiopulmonary arrest. Time of patient death is 8:55 AM. Final ICD-10-CM diagnosis of I469 is assigned to the patient medical record. PV1-36 is assigned 41 to indicate that the patient died at the facility. PID-29 contains the time of death and PID-30 contains Y.

At 10:00 AM on August 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an ADT A03 message for this visit to the state health department.

Example Message - Step 3, Case 2:

MSH|^~\&||PacificNWHospitalED^2231231234^NPI|||20170803100000-0500||ADTÂ03ÂDT_A03|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3ÎSO EVN||20170803100000-0500|||||PacificNWHospitalED^2231231234^NPI PID|1||3333^^^PacificNWHospitalED&2231231234&NPI^MR||Chaplin^Charles^^^^^L||19650314|M||2106- 3^White^CDCREC||||||||||||2186-5^Not Hispanic or Latino^CDCREC|||||||201708030855-0500|Y PV1|1|E|1108-0^TR14^2A^PacificNWHospitalED&2231231234&NPI|E|||||||||||||| |3333_001^^^PacificNWHospitalED&2231231234&NPI^VN|||||||||||||||||41||||||||201708022345- 0500|201708031000-0500 DG1|1|I10|Z59.0^HomelessnessÎ10||201708030230-0500|F DG1|2|I10|I46.9^Cardiac arrestÎ10||201708030830-0500|F OBX|1|CWE|SS003^FACILITY/VISITTYPE^PHINQUESTION||261QE0002XÊmergency Care^HCPT||||||F|| |201708022345-0500 OBX|2|CWE|56816-2^HospitalUnit^LN||1108-0ÊmergencyDepartment^HSLOC||||||F|||201708022345-0500 OBX|3|TX|54094-8ÊmergencyDepartmentTriageNote^LN||firefighters responding to a warehouse fire found the patient unconscious. The patient was not breathing when he was found. Once resuscitated, the paramedics performed an intubation and placed on a ventilator||||||F|||201708022345-0500 OBX|4|CWE|11283-9ÎNITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500

Case 3 - Patient Admitted from Emergency Department

Case Study 3 provides an example of a hospital emergency department visit that is captured as an unstructured, free-text chief complaint, and the patient is discharged from the ED and admitted for inpatient care. ADT A04, A08, A03, and A01 messages for this visit are generated and sent to the PHA.

Step 1: Registration Trigger - ADT A04

A 13-year-old boy is brought to the ED at Southwest Corner Hospital by his parents at 3:30 PM on December 27, 2016. The patient is complaining of fever, cough and difficulty breathing. A clerical assistant registers the patient with the parent's help. She records the patient's name, date of birth, race (note that two races are entered), ethnicity, residence, and insurance information. The clerical assistant also enters the patient's chief complaint as "fever, cough, difficulty breathing."

At 4:00 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits a Registration message about this visit to the state health department.

Example Message - Step 1, Case 3:

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20161227160000-0500||ADTÂ04ÂDT_A01|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3ÎSO EVN||20161227153000-0500|||||SWCornerHospitalED^2231231234^NPI PID|1||4444^^^SWCornerHospitalED&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9Âsian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|E|1108-0^^^SWCornerHospitalED&2231231234&NPI|E||||||||||||||

|4444_001^^^SWCornerHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201612271530-0500 OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QE0002XÊmergency Care^HCPT||||||F|||201612271530-0500 OBX|2|NM|21612-7Âge-Reported^LN||13|a^ÛCUM|||||F|||201612271530-0500 OBX|3|NM|11289-6^BodyTemperature^LN||101.1|[degF]^FarenheitÛCUM|||||F|||201612271530-0500 OBX|4|NM|39156-5^BMI^LN||35|kg/m2^kilogram / (meter squared)ÛCUM|||||F|||201612271530-0500 OBX|5|NM|59408-5ÔxygenSaturationinArterialBloodbyPulseOximetry^LN||99|%^PercentÛCUM| ||||F|||201612271530-0500 OBX|6|NM|8480-6^SystolicBloodPressure^LN||128|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]ÛCUM|||||F|||201612271530-0500 OBX|7|NM|8462-4^DiastolicBloodPressure^LN||92|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]ÛCUM|||||F|||201612271530-0500 OBX|8|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612271530-0500 OBX|9|TS|11368-8ÎllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612271530-0500 OBX|10|CWE|11283-9ÎnitialAcuity^LN||2Êmergent^CDCEDACUITY||||||F|||201612271530-0500 OBX|11|TX|44833-2^ClinicalImpression^LN||Shortness of breath, cough, fever||||||F|||201612271530-0500 OBX|12|CWE|56816-2^HospitalUnit^LN||1108-0ÊmergencyDepartment^HSLOC||||||F|||201612271530-0500

Step 2: Record Update Trigger - ADT A08

The attending physician orders treatment and diagnostic tests for influenza and pneumonia. At 5:00 PM, she updates the clinical record with working ICD-10-CM diagnosis codes of R0602 (shortness of breath) and R05 (cough). Shortness of breath is the primary diagnosis.

At 5:15 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits an Update message about this visit to the state health department.

Example Message - Step 2, Case 3

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20161227171005-0500||ADTÂ08ÂDT_A01|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A08^^2.16.840.1.114222.4.10.3ÎSO EVN||20161227171500-0500|||||SWCornerHospitalED^2231231234^NPI PID|1||4444^^^SWCornerHospitalED&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9Âsian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|E|1108-0^^^SWCornerHospitalED&2231231234&NPI|E|||||||||||||||4444_001 ^^^SWCornerHospitalED&2231231234&NPI^VN|||||||||||||||||||||||||201612271530-0500 OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QE0002XÊmergency Care^HCPT||||||F|||201612271530-0500 OBX|2|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612271530-0500 OBX|3|TS|11368-8ÎllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612271530-0500 OBX|4|CWE|11283-9ÎnitialAcuity^LN||2Êmergent^CDCEDACUITY||||||F|||201612271530-0500 OBX|5|TX|44833-2^ClinicalImpression^LN||Shortness of breath, cough, fever||||||F|||201612271530-0500 OBX|6|CWE|56816-2^HospitalUnit^LN||1108-0ÊmergencyDepartment^HSLOC||||||F|||201612271530-0500 DG1|1|I10|R06.02^Shortness of breathÎ10||201612271700-0500|W|||||||||1 DG1|2|I10|R05^CoughÎ10||201612271700-0500|W|||||||||2

Step 3: Discharge Trigger - ADT A03*

At 7:00 PM, radiology tests indicate the patient has pneumonia and a rapid influenza test is positive. The physician orders treatment and hospital admission. At 7:30 PM, ED staff complete the patient record and administratively discharge the patient from the ED. The final ICD-10-CM diagnoses codes are J1100 (influenza with pneumonia).

At 7:40 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits a Discharge message about this visit to the state health department.

*Please note that if the patient is admitted directly from the ED without a discharge transaction, the A03 Discharge message may be created by extrapolating from existing transactions such as the ADT^A06 Change from Outpatient to Inpatient or ADT^A02 Patient Transfer. In addition to Patient Class in PV1-2, the following data elements that are often Page 31 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019 available in the ADT messages may also help for filtering in the absence of an A03 Discharge transaction: PV1-4 Admission Type, PV1-14 Admit Source, PV1-6 Prior Patient Location.

Example Message - Step 3, Case 3:

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20161227194000-0500||ADTÂ03ÂDT_A03|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3ÎSO EVN||20161227193000-0500|||||SWCornerHospitalED^2231231234^NPI PID|1||4444^^^SWCornerHospitalED&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9Âsian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|E|1108-0^^^SWCornerHospitalED&2231231234&NPI|E|||||||||||||||4444_001 ^^^SWCornerHospitalED&2231231234&NPI^VN|||||||||||||||||09||||||||201612271530-0500|201612271930-0500 DG1|1|I10|J11.00Înfluenza due to unidentified influenza virus with unspecified type of pneumoniaÎ10||201612271700-0500|F OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QE0002XÊmergency Care^HCPT||||||F|||201612271530-0500 OBX|2|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612271530-0500 OBX|3|TS|11368-8ÎllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612271530-0500 OBX|4|CWE|56816-2^HospitalUnit^LN||1108-0ÊmergencyDepartment^HSLOC||||||F|||201612271530-0500

Step 4: Admission Trigger - ADT A01

At 8:00 PM the patient is transported to a hospital room in the Pediatric ICU Unit. Clinical staff complete an admission record with the admit reason recorded as ICD-10-CM diagnosis code J1100 (influenza with pneumonia).

At 8:15 PM on December 27, 2016, the hospital's EHR module for syndromic surveillance data assembles and transmits an Admission message about to this visit to the state health department.

Example Message - Step 4, Case 3:

MSH|^~\&|| SWCornerHospitalED^2231231234^NPI|||20161227201500-0500||ADTÂ01ÂDT_A01|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A01^^2.16.840.1.114222.4.10.3ÎSO EVN||20161227200000-0500|||||SWCornerHospital^2231231234^NPI PID|1||4444^^^SWCornerHospital&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9Âsian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|I|1047-0^302A^^SWCornerHospital&2231231234&NPI|E||1108-0^^^SWCornerHospital&2231231234&NPI| ||||||||||||4444_001^^^SWCornerHospital&2231231234&NPI^VN|||||||||||||||||||||||||201612272000-0500 PV2|||J11.00Înfluenza due to unidentified influenza virus with unspecified type of pneumoniaÎ10 OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||1021-5ÎnpatientPracticeSetting^HCPT||||||F|| |201612272000-0500 OBX|2|NM|21612-7Âge-Reported^LN||13|a^ÛCUM|||||F|||201612272000-0500 OBX|3|NM|11289-6^BodyTemperature^LN||102.5|[degF]^FarenheitÛCUM|||||F|||201612272000-0500 OBX|4|NM|39156-5^BMI^LN||35|kg/m2^kilogram / (meter squared)ÛCUM|||||F|||201612272000-0500 OBX|5|TX|8661-1^ChiefComplaint^LN||fever, cough, difficulty breathing||||||F|||201612272000-0500 OBX|6|TS|11368-8ÎllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612272000-0500 OBX|7|CWE|56816-2^HospitalUnit^LN||1047-0^PediatricRespiratoryCriticalCare^HSLOC|||| ||F|||201612272000-0500 DG1|1|I10|J11.00Înfluenza due to unidentified influenza virus with unspecified type of pneumoniaÎ10||201612272000-0500|A

Step 5: Discharge Trigger: ADT A03

At 7:30 PM on December 28, 2016, the patient is feeling better and is transferred to the general Pediatrics unit. On January 2, 2017 at 3:00 PM the patient is discharged to his home. The final discharge diagnosis is ICD-10-CM diagnosis code J1100 (influenza with pneumonia). Note that the admit time changes on the transfer, which is not ideal. It is preferred that the admit time remains constant.

The next day, at 12:00 PM on January 3, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits a Discharge message about this visit to the state health department.

Example Message - Step 5, Case 3:

MSH|^~\&||SWCornerHospitalED^2231231234^NPI|||20170103120000-0500||ADTÂ03ÂDT_A03|NIST-SS- 001.12|P|2.5.1|||NE|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3ÎSO EVN||20140102150000-0500|||||SWCornerHospitalED^2231231234^NPI PID|1||4444^^^SWCornerHospital&2231231234&NPI^MR||~^^^^^^S||20030523|M||2076-8^Native Hawaiian or Other Pacific Islander^CDCREC~2028-9Âsian^CDCREC|^^City^GA^30303^^^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|I|1211-2^602^1B^SWCornerHospital&2231231234&NPI|E||1047-0^302A^^SWCornerHospital&2231231234 &NPI|||||||||||||4444_001^^^SWCornerHospital&2231231234&NPI^VN|||||||||||||||||01||||||||201612281930 -0500|201701021500-0500 DG1|1|I10|J11.00Înfluenza due to unidentified influenza virus with unspecified type of pneumoniaÎ10||201401021500-0500|F OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||1021-5ÎnpatientPracticeSetting^HCPT|| ||||F|||201612272000-0500 OBX|2|NM|8302-2^BodyHeight^LN||45|[in_us]închÛCUM|||||F|||201612272000-0500 OBX|3|NM|3141-9^BodyWeighMeasured^LN||768|[oz_av]ôunceÛCUM|||||F|||201612272000-0500 OBX|4|TX|8661-1^Chief Complaint^LN||fever, cough, difficulty breathing||||||F|||201612272000-0500 OBX|5|TS|11368-8ÎllnessorInjuryOnsetDateandTime^LN||201612262200-0500||||||F|||201612272000-0500 OBX|6|CWE|56816-2^HospitalUnit^LN||1211-2^PediatricMixedAcuityUnit^HSLOC||||||F|||201612281930-0500 OBX|7|CWE|8677-7^MedicationsPrescribedOrDispensed^LN||1163466^Levofloxacin 25 MG/ML Oral Solution^RXNORM||||||F|||201701021500-0500

Case 4: Inpatient Visit

Case 4 presents an example of direct hospital admission containing all of the hospital inpatient data elements of interest with a Sender Usage of R or RE. ADT A01 and A03 messages are generated and sent to the PHA about this visit.

Step 1: Admission Trigger - ADT A01

On June 7, 2017 at 12:30 PM, a black, non-Hispanic 89-year-old male shows up at the Greater North Medical Center (Facility Identifier: 4356012945) with a request from his physician to admit him for complications from influenza. During registration, the patient's address is recorded as Billings, Yellowstone County, ZIP Code 59101. He tells the physician that he is suffering from fever, chills, and body aches as well as worsening shortness of breath. These symptoms are recorded as the patient's chief complaint. At 1:00 PM on June 7, 2017, the patient is admitted to an inpatient respiratory unit with an Admit Reason of ICD-10-CM J111 (influenza with other respiratory manifestations). The diagnosis type is recorded as an admitting diagnosis. The medical record number assigned by Greater North Medical Center, 123451247, is used to uniquely identify the patient. A visit number is assigned, 100023451247, which is used to uniquely identify the visit..

At 2:00 PM on June 7, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits an Admission message about this visit to the state health department. PV1-4 Admission Type = 'U' for Urgent; PV1-14 Admission Source = '1' for Physician's referral.

Example Message - Step 1, Case 4

MSH|^~\&||GreaterNorthMedCtr^4356012945^NPI|||20170607140000-0500||ADTÂ01ÂDT_A01|NIST-SS- 001.12|P|2.5.1|||AL|NE|||||PH_SS_A01^^2.16.840.1.114222.4.10.3ÎSO EVN||20170607130000-0500|||||GreaterNorthMedCtr^4356012945^NPI PID|1||123451247^^^GreaterNorthMedCtr&4356012945&NPI^MR||~^^^^^^S||19280204|M||2054-5^Black or African American^CDCREC|^^Billings^MT^59101^^^^30111|||||||||||2186-5^Not Hispanic or Latino^CDCREC

PV1|1|I|1069-4^^^GreaterNorthMedCtr&4356012945&NPI|U||||||||||1|||||100023451247 ^^^GreaterNorthMedCtr&4356012945&NPI^VN|||||||||||||||||||||||||201706071300-0500 PV2|||J10.1Înfluenza due to other identified influenza virus with other respiratory manifestationsÎ10 OBX|1|CWE|56816-2^HospitalUnit^LN||1069-4ÎnpatientPulmonaryWard^HSLOC||||||F|||201706071300-0500 OBX|2|NM|21612-7Âge-Reported^LN||89|a^yearÛCUM|||||F|||201706071300-0500 OBX|3|TX|8661-1^Chief Complaint^LN||fever, chills and body aches; worsening shortness of breath||||||F|||201706071300-0500 OBX|4|NM|11289-6^BodyTemperature^LN||99.8|[degF]^FarenheitÛCUM|||||F|||201706071300-0500 OBX|5|NM|39156-5^BMI^LN||30|kg/m2^kilogram / (meter squared)ÛCUM|||||F|||201706071300-0500 OBX|6|NM|59408-5ÔxygenSaturationinArterialBloodbyPulseOximetry^LN|| 99|%^PercentÛCUM|||||F|||201706071300-0500 OBX|7|NM|8480-6^SystolicBloodPressure^LN||128|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]ÛCUM|||||F|||201706071300-0500 OBX|8|NM|8462-4^DiastolicBloodPressure^LN||92|mm[Hg]^MilliMeters of Mercury [Blood Pressure Unit]ÛCUM|||||F|||201706071300-0500 OBX|9|TX|10182-4^HistoryOfTravelNarrative^LN||Travel within the past 30 days:yes~Travel outside the United States:no||||||F|||201706071300-0500 OBX|10|CWE|72166-2^TobaccoSmokingStatus^LN||449868002^Current every day smoker^SCT||||||F|||201706071300-0500 OBX|11|CWE|11450-4^ProblemList^LN|1|47372000Âdjustment disorder with anxious mood^SCT||||||F|||201706071300-0500 OBX|12|CWE|11450-4^ProblemList^LN|2|F4321Âdjustment disorder with depressed moodÎ10||||||F|||201706071300-0500 OBX|13|CWE|11450-4^ProblemList^LN|3|195967001Âsthma (disorder)^SCT||||||F|||201706071300-0500 OBX|14|CWE|11450-4^ProblemList^LN|4|H547Ûnspecified visual lossÎ10||||||F|||201706071300-0500 OBX|15|CWE|11450-4^ProblemList^LN|5|K2970^Gastritis, unspecified, without bleedingÎ10||||||F|||201706071300-0500 OBX|16|CWE|11450-4^ProblemList^LN|6|104931000119100^Chronic kidney disease due to hypertension (disorder)^SCT||||||F|||201706071300-0500 OBX|17|CWE|11450-4^ProblemList^LN|7|13644009^Hypercholesterolemia (disorder)^SCT||||||F|||201706071300-0500 OBX|18|TX|10160-0^MedicationList^LN||Lasix 20 mg po bid; Simvastatin 40 mg po qd||||||F|||201706071300-0500 DG1|1|I10|J10.1Înfluenza due to other identified influenza virus with other respiratory manifestationsÎ10||201706071300-0500|A

Step 2: Discharge Trigger: ADT A03

After admission, the patient is treated for influenza and over the course of the next 7 days begins to recover from the respiratory complications of his influenza. After laboratory testing, the physicians confirm that the patient suffered from the H1N1 strain of influenza, possibly accounting for its severe manifestations. On June 15, 2017 at 3:45 PM, the patient is discharged from the hospital to his home with a final discharge diagnosis of ICD-10-CM J09X9 (INFLUENZA DUE TO IDENTIFIED NOVEL INFLUENZA A VIRUS WITH OTHER MANIFESTATIONS). The final discharge message is ready 3 days after discharge.

At 2:15 PM on June 18, 2017, the hospital's EHR module for syndromic surveillance data assembles and transmits a Discharge message about this visit to the state health department.

Example Message - Step 2, Case 4:

MSH|^~\&||GreaterNorthMedCtr^4356012945^NPI|||20170618141500-0500||ADTÂ03ÂDT_A03|NIST-SS- 001.12|P|2.5.1|||AL|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3ÎSO EVN||20170615154500-0500|||||GreaterNorthMedCtr^4356012945^NPI PID|1||123451247^^^GreaterNorthMedCtr&4356012945&NPI^MR||~^^^^^^S||19280204|M||2054-5^Black or African American^CDCREC|^^Billings^MT^59101^^^^30111|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|I|1069-4^^^GreaterNorthMedCtr&4356012945&NPI|U||||||||||1|||||100023451247 ^^^GreaterNorthMedCtr&4356012945&NPI^VN|||||||||||||||||01||||||||201706071300-0500|201706151545-0500 DG1|1|I10|J10.1Înfluenza due to other identified influenza virus with other respiratory manifestationsÎ10||201706151534-0500|F OBX|1|CWE|56816-2^HospitalUnit^LN||1069-4ÎnpatientPulmonaryWard^HSLOC||||||F|||201706071300-0500 OBX|2|NM|21612-7Âge-Reported^LN||89|a^yearÛCUM|||||F|||201706071300-0500 OBX|3|TX|8661-1^ChiefComplaint^LN||fever, chills and body aches; worsening shortness of breath||||||F|||201706071300-0500

Case 5 - Ambulatory Care Visit

Case Study 5 provides an example of a routine patient visit in an ambulatory care clinical setting. The patient's chief complaint is captured as an unstructured, free-text value using the patient's own words. ADT A04 and A03 messages are generated and sent to the PHA about this visit.

Step 1: Registration Trigger - ADT A04

A 28-year-old female walks into Midtown Obstetric Clinic on August 17, 2017 at 1:00 PM. The patient arrival is noted in the registration/appointment system by a clerical assistant who verifies the patient's demographics and appointment information. The patient gave her race as white and black and her ethnic group as non-Hispanic, which is captured with the demographic information in the EHR.

At 1:05 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Registration/Patient Arrival message to Big City Health Department about this visit.

Example Message - Step 1, Case 5:

MSH|^~\&||MidTwnObstetricCl^2231231234^NPI|||20170817130500-0500||ADTÂ04ÂDT_A01|NIST-SS- 001.14|P|2.5.1|||AL|NE|||||PH_SS_A04^^2.16.840.1.114222.4.10.3ÎSO EVN||20170817130500-0500|||||MidTwnObstetricCl^2231231234^NPI PID|1||233222^^^MidTwnObstetricCl&2231231234&NPI^MR||~^^^^^^S||19890312|F||2106-3^White^CDCREC~2054- 5^BLACK OR AFRICAN AMERICAN^CDCREC|^Âtlanta^13^30303^^13121|||||||||||2186-5^Not Hispanic or Latino^CDCREC PV1|1|O|1117-1^^R102^MidTwnObstetricCl&2231231234&NPI|R|||1234567890^^^^^^^^NPI &2.16.840.1.113883.4.6ÎSO||||||||||||233222_04^^^MidTwnObstetricCl&2231231234&NPI^VN|||||||||||||||| |||||||||201708171300-0500 OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QP2300X^Primary Care^HCPT||||||F|||201708171300- 0500 OBX|2|NM|21612-7Âge-Reported^LN||28|a^yearÛCUM|||||F|||201708171300-0500 OBX|3|TX|8661-1^ChiefComplaint^LN||Routine obstetric appointment but may have a cold and is concerned||||||F|||201708171300-0500 OBX|4|CWE|11449-6^PregnancyStatus^LN||Y^Yes^HL70532||||||F|||201708171300-0500 OBX|5|NM|39156-5^BMI^LN||28|kg/m2^kilogram / (meter squared)ÛCUM|||||F|||201708171300-0500 OBX|6|CWE|11450-4^ProblemList-Reported^LN||N390Ûrinary tract infection, site not specifiedÎ10||||||F|||201708171445-0500 OBX|7|TX|10160-6^MedicationUse^LN||Estrogen therapy (Estradiol) Antianxiety treatment (Serzone, Wellbutrin)||||||F|||201708171300-0500

Step 2: Discharge Trigger: ADT A03

After the patient is seen for her routine visit, a discharge message is created that includes the diagnosis and procedure codes from the billing face sheet. The final discharge message is ready immediately when the patient checks out.

At 2:45 PM on August 17, 2017, the facility's EHR module for syndromic surveillance data assembles and transmits a Discharge/Visit End message to Big City Health Department about this visit.

Example Message - Step 2, Case 5:

MSH|^~\&||MidTwnObstetricCl^2231231234^NPI|||20170817144500-0500||ADTÂ03ÂDT_A03|NIST-SS- 001.12|P|2.5.1|||AL|NE|||||PH_SS_A03^^2.16.840.1.114222.4.10.3ÎSO EVN||20170817144500-0500|||||MidTwnObstetricCl^2231231234^NPI PID|1||233222^^^MidTwnObstetricCl&2231231234&NPI^MR||~^^^^^^S||19890607|F||2106-3^White^CDCREC~2054- 5^BLACK OR AFRICAN AMERICAN^CDCREC|^Âtlanta^13^30303^^13121|||||||||||2186-5^Not Hispanic or

Latino^CDCREC PV1|1|O|1117-1^^R102^MidTwnObstetricCl&2231231234&NPI|R|||1234567890^^^^^^^^ NPI&2.16.840.1.113883.4.6ÎSO||||||||||||233222_04^^^MidTwnObstetricCl&2231231234&NPI^VN||||||||||||| ||||01||||||||201708171305-0500|20170817144500-0500 DG1|1|I10|Z34.9Êncounter for supervision of normal pregnancy, unspecifiedÎ10||20170817144500-0500|F OBX|1|CWE|SS003^FACILITY/VISIT TYPE^PHINQUESTION||261QP2300X^Primary Care^HCPT||||||F|||201708171300- 0500 OBX|2|NM|21612-7Âge-Reported^LN||28|a^yearÛCUM|||||F|||201708171300-0500 OBX|3|TX|8661-1^Chief complaint^LN||Routine obstetric appointment but may have a cold and is concerned||||||F|||201708171300-0500 OBX|4|CWE|11449-6^Pregnancy Status^LN||Y^Yes^HL70532||||||F|||201708171300-0500 OBX|5|NM|39156-5^BMI^LN||28|kg/m2^kilogram / (meter squared)ÛCUM|||||F|||201708171300-0500 OBX|6|CWE|11450-4^ProblemListReported^LN||N390Ûrinary tract infection, site not specifiedÎ10||||||F|||201708171445-0500 OBX|7|CWE|8677-7^MedicationUseReported^LN||749856Êstradiol 1 MG / noregestimate 0.09 MG OralTablet^RXNORM~151679^Serzone^RXNORM~42568^Wellbutrin^RXNORM~431722^12 HR Tramadol 100 MG Extended Release Tablet^RXNORM||||||F|||201708171445-0500

Case 6: Batch Messaging Example

Mid-Co Health Center routinely sends syndromic data to the state public health authority. Mid-Co sends the messages that have gathered during the previous 12-hour period in batch message format. There are 240 messages.

FHS|^~\&|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1ÎSO|SPH^2.16.840.1.1 13883.19.3.2ÎSO|20110123120000-0500 BHS|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1ÎSO|SPH^2.16.840.1.113883 .19.3.2ÎSO|20110123120000-0500

MSH|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1ÎSO|SPH^2.16.840.1.113883 .19.3.2ÎSO|20110123003938-0500||ADTÂ01ÂDT_A01|ER1-20110123-001|P|2.5.1 . . . (Last segment of 1st message) (Continue to append subsequent messages …) . . . MSH|^~\&|ER1|MICO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1ÎSO|SPH^2.16.840.1.113883 .19.3.2ÎSO|20110123115826-0500||ADTÂ01ÂDT_A01|ER1-20110123-240|P|2.5.1 (Last segment of 240th message)

BTS|240|MiCo reporting 1-23-2011: 0000-1200 hrs FTS|1

Case 7: Sample International Address Formats

Mexico

Super Manzana 3 - 403 [street name + building number - apartment number] Puerto Juarez [village] 77520 CANCUN, Q. ROO [postcode + locality name, province abbreviation MEXICO [country name]

Example PID Segment - Mexico Address, Case 7: PID|1||MX01059711||~^^^^^^S|||M|||Super Manzana 3 - 403^Puerto Juarez^CANCUN^Q. ROO^77520^MEX

Canada

111 FAIRFORD STREET EAST MOOSE JAW SK S6H 2X1 CANADA

Example PID Segment - Canada Address, Case 7: PID|1||CA01059711||~^^^^^^S|||M|||111 FAIRFORD STREET EAST^^MOOSE JAW^SK^S6H 2X1^CAN

3 MESSAGE INFRASTRUCTURE 3.1 Conformance Profiles

3.1.1 PATIENT ADMIT - ADT^A01 - INPATIENT VISIT BEGIN

HL7 Version Publication Date Publication Version 2.5.1 0

Conformance Profile Definition Segment Flavor Element name Usage Cardinality MSH MSH_SS Message Header R [1..1] EVN EVN_SS Event Type R [1..1] PID PID_SS_A01 Patient Identification R [1..1] PV1 PV1_SS_A01 Patient Visit R [1..1] Patient Visit - Additional PV2 PV2_SS RE [0..1] Information OBX OBX_SS Observation/Result R [1..*] DG1 DG1_SS Diagnosis RE [0..*] [ BEGIN PROCEDURE GROUP RE [0..*] PR1 PR1_SS Procedures R [1..1] ] END PROCEDURE GROUP [ BEGIN INSURANCE GROUP RE [0..*] IN1 IN1_SS Insurance R [1..1] ] END INSURANCE GROUP

Conformance Statements Message: ID Description ADTÂ01_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A01'. ADTÂ01_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'. ADTÂ01_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A01'. ADTÂ01_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.

3.1.2 PATIENT REGISTRATION - ADT^A04 - OUTPATIENT VISIT BEGIN

HL7 Version Publication Date Publication Version 2.5.1 0

Segment Flavor Element name Usage Cardinality Patient Visit - Additional PV2 PV2_SS RE [0..1] Information OBX OBX_SS Observation/Result R [1..*] DG1 DG1_SS Diagnosis RE [0..*] [ BEGIN PROCEDURE GROUP RE [0..*] PR1 PR1_SS Procedures R [1..1] ] END PROCEDURE GROUP [ BEGIN INSURANCE GROUP RE [0..*] IN1 IN1_SS Insurance R [1..1] ] END INSURANCE GROUP

Conformance Statements Message: ID Description ADTÂ04_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A04'. ADTÂ04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'. ADTÂ04_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A04'. ADTÂ04_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'.

3.1.3 PATIENT DISCHARGE - ADT^A03 - VISIT END

HL7 Version Publication Date Publication Version 2.5.1 0

Conformance Profile Definition Segment Flavor Element name Usage Cardinality MSH MSH_SS Message Header R [1..1] EVN EVN_SS Event Type R [1..1] PID PID_SS_A04_A08_A03 Patient Identification R [1..1] PV1 PV1_SS_A03 Patient Visit R [1..1] Patient Visit - Additional PV2 PV2_SS RE [0..1] Information DG1 DG1_SS Diagnosis RE [0..*] [ BEGIN PROCEDURE GROUP RE [0..*] PR1 PR1_SS Procedures R [1..1] ] END PROCEDURE GROUP OBX OBX_SS Observation/Result R [1..*] [ BEGIN INSURANCE GROUP RE [0..*] IN1 IN1_SS Insurance R [1..1] ] END INSURANCE GROUP

ID Description ADTÂ03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A03'. ADTÂ03_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'. ADTÂ03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A03'. ADTÂ03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A03'.

3.1.4 PATIENT UPDATE - ADT^A08 - VISIT UPDATE

HL7 Version Publication Date Publication Version 2.5.1 0

Conformance Profile Definition Segment Flavor Element name Usage Cardinality MSH MSH_SS Message Header R [1..1] EVN EVN_SS Event Type R [1..1] PID PID_SS_A04_A08_A03 Patient Identification R [1..1] PV1 PV1_SS_A08 Patient Visit R [1..1] Patient Visit - Additional PV2 PV2_SS RE [0..1] Information OBX OBX_SS Observation/Result R [1..*] DG1 DG1_SS Diagnosis RE [0..*] [ BEGIN PROCEDURE GROUP RE [0..*] PR1 PR1_SS Procedures R [1..1] ] END PROCEDURE GROUP [ BEGIN INSURANCE GROUP RE [0..*] IN1 IN1_SS Insurance R [1..1] ] END INSURANCE GROUP

Conformance Statements Message: ID Description ADTÂ03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A08'. ADTÂ03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A08'. ADTÂ03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'. ADTÂ04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'.

3.1.5 ACKNOWLEDGEMENT - ACK - ACK

HL7 Version Publication Date Publication Version 2.5.1 0

Conformance Profile Definition Segment Flavor Element name Usage Cardinality MSH MSH_SS Message Header R [1..1] MSA MSA_SS Message Acknowledgment R [1..1]

Conformance Statements Message: ID Description MSH_SS_ACK_01 The value of MSH.9.1 (Message Code) SHALL be 'ACK'. MSH_SS_ACK_02 The value of MSH.9.3 (Message Structure) SHALL be 'ACK'. MSH_SS_ACK_03 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_ACK'.

3.2 Segments and Field Descriptions

Message segments are listed below in alphabetical order. See the previous section for proper segment order within the message. Fields with usage of X are not shown in the segment definitions, since they should not be sent.

3.2.1 DG1_SS - DIAGNOSIS

The DG1 segment contains patient diagnosis information of various types. Syndromic surveillance supports Admitting, Working and Final Diagnosis types.

Segment Definition Element Seq Data type Usage Cardinality Value Set name Set ID - 1 SI R [1..1] DG1 Diagnosis 2 Coding ID R [1..1] Method Diagnosis PHVS_AdministrativeDiagnosis_CDC_ICD- 3 CE_SS R [1..1] Code - DG1 10CM,PHVS_Disease_CDC Diagnosis 5 TS_SS_toMinute R [1..1] Date/Time Diagnosis 6 IS R [1..1] PHVS_DiagnosisType_HL7_2x Type Diagnosis 15 ID O [0..1] PHVS_DiagnosisPriority_HL7_2x Priority

Conformance Statements ID Description DG1_SS_8603629 The value of DG1-3.3 SHALL be one of list values: I10,SCT.

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Diagnosis (ICD-10 DG1_SS-3 PHVS_AdministrativeDiagnosis_CDC_ICD-10CM CM) DG1_SS-3 PHVS_Disease_CDC Disease Diagnosis Type DG1_SS-6 PHVS_DiagnosisType_HL7_2x (HL7)

Single Code Location Value Set ID Value Set Name Value Diagnosis Priority DG1_SS-15 PHVS_DiagnosisPriority_HL7_2x (HL7)

Note: If possible the first DG1 should contain the primary diagnosis because not all EHRs implement DG1-15, diagnosis priority.

Example segments: • DG1|1|I10|R11^NAUSEA AND VOMITING^I10|||W (Working diagnosis from ICD10) • DG1|2|SCT|16932000^NAUSEA AND VOMITING^SCT|||W (Working diagnosis from SNOMED-CT)

DG1-6: Diagnosis Type (IS)

It is critical for a syndromic surveillance system to be able to distinguish among diagnosis types in real-time. Diagnosis Type can help identify the type/status of diagnosis since it may change over the course of the patient visit.

3.2.2 EVN_SS - EVENT TYPE Segment Definition Seq Element name Data type Usage Cardinality Value Set 2 Recorded Date/Time TS_SS_toSecond R [1..1] 7 Event Facility HD_SS R [1..1]

Example Segment that shows the use of the National Provider Identifier (NPI) for the facility identifier: • EVN||201406071300.1234-0500|||||GreaterNorthMedCtr^4356012945^NPI

EVN-2: Recorded Date/Time (TS_SS_toSecond)

If data flows through an intermediary or third party, the intermediary must keep the original date/time of transmission.

EVN-7: Event Facility (HD_SS)

This field identifies the location where patient was treated. Use of the organization's legal name associated with the National Provider Identifier (NPI) standard provided by Centers for Medicare and Medicaid Services is recommended. If NPI is not available, use a different unique identifier, such as an OID or a state-designated identifier. This number should be specific for each facility location (not a number representing an umbrella business). NPI is a 10-digit identifier. Note: The use of NPI should be discussed during the implementation process because local public health jurisdictions may differ on their use of identifiers for this field, and sending healthcare facilities may have different NPIs for different services, staff, and departments operating at different levels across their organization.

3.2.3 IN1_SS - INSURANCE Segment Definition Seq Element name Data type Usage Cardinality Value Set 1 Set ID - IN1 SI R [1..1] Page 42 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Seq Element name Data type Usage Cardinality Value Set Insurance Plan 2 CE_SS R [1..1] 0072 ID Insurance 3 CX_SS R [1..*] Company ID 15 Plan Type IS O [0..1] PHVS_SourceOfPaymentTypology_PHDSC

Value Set Bindings Single Code Location Value Set ID Value Set Name Value IN1_SS-2 0072 Insurance Plan ID Source of Payment IN1_SS-15 PHVS_SourceOfPaymentTypology_PHDSC Typology (PHDSC)

IN1-2: Insurance Plan ID (CE_SS)

This field contains a unique identifier for the insurance plan. If an insurance plan ID is unavailable, use |UNK^UNKNOWN^NULLFL| to meet the requirement to populate the field with a CE value type for HL7 compliance.

IN1-3: Insurance Company ID (CX_SS)

This field contains unique identifiers for the insurance company. The assigning authority and identifier type code are strongly recommended for all CX data types. If an insurance company identifier is unavailable, use |UNKNOWN^^^UNKNOWN| to meet the requirement to populate the field as a CX value type for HL7 compliance.

3.2.4 MSA_SS - MESSAGE ACKNOWLEDGMENT Segment Definition Seq Element name Data type Usage Cardinality Value Set 1 Acknowledgment Code ID R [1..1] PHVS_AcknowledgmentCode_HL7_2x 2 Message Control ID ST R [1..1]

Conformance Statements ID Description MSA_SS_5067426 MSH-2 Shall match MSH-10 value of message being acknowledged

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Acknowledgment Code MSA_SS-1 PHVS_AcknowledgmentCode_HL7_2x (HL7)

MSA-2: Message Control ID (ST)

This field contains the message control ID of the message sent by the SS Data Sender. It allows the SS Data Sender to associate this response with the message for which it is intended.

3.2.5 MSH_SS - MESSAGE HEADER Segment Definition Seq Element name Data type Usage Cardinality Value Set 1 Field Separator ST R [1..1] 2 Encoding Characters ST R [1..1] 3 Sending Application HD_SS RE [0..1] 0361 4 Sending Facility HD_SS R [1..1] 0362 5 Receiving Application HD_SS RE [0..1] 0361 6 Receiving Facility HD_SS RE [0..1] 0362 7 Date/Time Of Message TS_SS_toSecond R [1..1] 9 Message Type MSG_SS R [1..1] 10 Message Control ID ST R [1..1] 11 Processing ID PT_SS R [1..1] 12 Version ID VID_SS R [1..1] Accept Acknowledgment 15 ID R [1..1] 0155 Type Application Acknowledgment 16 ID R [1..1] 0155 Type 21 Message Profile Identifier EI R [1..*]

Conformance Statements ID Description MSH_SS_4611129 The value of MSH-1 (Field Separator) SHALL be '|'. MSH_SS_6631423 The value of MSH-21[*].3 SHALL be '2.16.840.1.114222.4.10.3'. MSH_SS_7465888 The value of MSH-2 (Encoding Characters) SHALL be '^~\&'. MSH_SS_9284050 The value of MSH-21[*].4 SHALL be 'ISO'.

Value Set Bindings Location Value Set ID Value Set Name Single Code Value MSH_SS-3 0361 Application MSH_SS-4 0362 Facility MSH_SS-5 0361 Application MSH_SS-6 0362 Facility Accept/application MSH_SS-15 0155 acknowledgment conditions Accept/application MSH_SS-16 0155 acknowledgment conditions

MSH-1: Field Separator (ST)

This field contains the separator (literal value of | ) between the segment ID and the first real field, MSH-2-encoding characters. As such, it serves as the separator and defines the character to be used as a separator for the rest of the message.

MSH-2: Encoding Characters (ST)

This field contains the four characters in the following order: the component separator, repetition separator, escape character, and subcomponent separator.

MSH-3: Sending Application (HD_SS)

This field uniquely identifies the sending application from the other applications in the network enterprise. The network enterprise comprises all applications that participate in the exchange of HL7 messages.

MSH-4: Sending Facility (HD_SS)

This field uniquely identifies the facility associated with the application that sends the message, as documented in MSH-3, the sending application. If Acknowledgements are in use, this facility will receive any related Acknowledgement message. Use of NPI is recommended (10-digit identifier).

MSH-5: Receiving Application (HD_SS)

This field uniquely identifies the receiving application among all other applications within the network enterprise. The network enterprise comprises all applications that participate in the exchange of HL7 messages. This field is entirely site- defined.

MSH-6: Receiving Facility (HD_SS)

This field identifies the receiving application among multiple identical instances of the application running on behalf of different organizations. If acknowledgements are in use, this represents the facility that would generate and send acknowledgement messages.

MSH-7: Date/Time Of Message (TS_SS_toSecond)

This field contains the date/time that the sending system created the message. If the time zone is specified, it will be used throughout the message as the default time zone.

MSH-10: Message Control ID (ST)

This field contains a number or other identifier that uniquely identifies the message. The receiving system echoes this ID back to the sending system in the Message acknowledgment segment (MSA). Note: This field is a number or other identifier that uniquely identifies the message.

MSH-11: Processing ID (PT_SS)

Indicates how to process the message as defined in HL7 processing rules; whether the message should be handled for production (P) usage, for training (T), or for debugging (D).

MSH-12: Version ID (VID_SS)

The HL7 version number is used to interpret message format and content. This field is matched by the receiving system to its own version to be sure the message will be interpreted correctly. For this guide, the value shall be 2.5.1.

MSH-21: Message Profile Identifier (EI)

Sites may use this field to assert adherence to, or reference, a message profile. Message profiles contain detailed explanations of grammar, syntax, and usage for a particular message or set of messages.

3.2.6 OBX_SS - OBSERVATION/RESULT

The OBX co-constraint is a related constraint concept used to express dependencies across a set of data values. The co- constraints table below typically follows the form "IF OBX-3 equals LOINC XXXXX-X, THEN OBX-2 shall be CWE and OBX-5 shall be constrained to value set YYY" or a similar form, sometimes involving OBX-6 as well. The USER portion of the table includes description, usage, examples, and implementation notes.

Segment Definition Se Element Usag Cardinali Data type Value Set q name e ty Set ID - 1 SI R [1..1] OBX Value 2 ID R [1..1] PHVS_ValueType_SyndromicSurveillance Type Observati PHVS_ObservationIdentifier_SyndromicSurveillance,PHVS_VitalSignRes 3 on CE_SS R [1..1] ult_HITSP Identifier Observati 4 ST O [0..1] on Sub-ID Observati 5 VARIES RE [0..*] on Value C(R/ 6 Units CE_SS [0..1] X) Observati 11 on Result ID R [1..1] 0085 Status Date/Time of the TS_SS_toMin 14 RE [0..1] Observati ute on

Conformance Statements ID Description OBX_SS_001 If OBX-3.1 contains 11449-6, the value of OBX-5 SHALL be one of list values: Y, N, UNK OBX_SS_002 The value of OBX-1 (Set ID - OBX) SHALL be valued sequentially starting with the value '1'.

Conditional Predicates Location Usage Description OBX-6 C(R/X) If the value of OBX-2 (Value Type) is 'NM'.

Co-Constraints

IF (OBX- Column Value 3) THEN OBX-2(Value) XAD OBX-2(Flavor) XAD_SS USER Description Treating Facility Location SS002 Usage RE OBX|1|XAD|SS002^TREATING FACILITY LOCATION^PHINQUESTION||1 234 Anywhere Example Street^^Doraville^13^303 41ÛSA^C^^13089||||||F|| |201102091114-0500 If this data element is captured and maintained as part of the facility registration process, it may Implementation not be sent with every message. See ISDS recommendations, section 4.2, on Facility Notes Registration.8 This data can also be accommodated in the Facility Registration process as defined by ISDS. THEN OBX-2(Value) CWE OBX-2(Flavor) CWE_SS OBX-5(Value PHVS_FacilityVisitType_SyndromicSurveillance Set) USER SS003 Description Facility/Visit Type Usage R OBX|2|CWE|SS003^FACILIT Y/VISIT TYPE^PHINQUESTION|| 261QU0200XÛrgent Care^ Example HCPTNUCC||||||F|||20110 2091114-0500 Relevant facility/visit type values are defined in value set. These data can also be Implementation accommodated in the Facility Registration process, as defined by Syndromic Surveillance Notes Community of Practice for facilities where a single facility/visit type is expected. THEN OBX-2(Value) NM OBX-2(Flavor) NM OBX-6(Value PHVS_AgeUnit_SyndromicSurveillance Set) USER Description Age Usage RE 21612- For a patient older than 2 years: OBX|4|NM|21612-7ÂGE- 7 REPORTED^LN||43|a^YEARÛCUM|||||F|||201102170000-0500 For a patient younger than 2 Example years: OBX|4|NM|21612-7ÂGE-REPORTED^LN||5|mo^month^ UCUM|||||F|||201102170000- 0500 Data providers and receivers should determine specific data restrictions for their jurisdiction. To de-identify age, the age must be rounded to an integer. For patient age greater than or equal to Implementation (>=) 2 years old, report in whole years. Unit value should be "Year" • Truncate age to integer. Notes For example, 16.75 years = 16 years old. For patient age less than (<) 2 years old, report the age in integer months. Do not report days or weeks. • Truncate month to integer. For example, 5 months and 20 days = 5 months old. • Unit value should be "Months" for patient age less than

IF (OBX- Column Value 3) (<) 2 years old. THEN OBX-2(Value) CWE OBX-2(Flavor) CWE_SS OBX-5(Value PHVS_HealthcareServiceLocation_Syndromic Set) USER 56816- 2 Description Patient Service Location Usage RE OBX|3|CWE|56816-2^PATIENT LOCATION^LN||1029- 8^Medical/Surgical critical care Example unit^HSLOC||||||F|||201102170000-0500 INPATIENT DATA ELEMENT OF INTEREST ONLY NOTE: this is a standardization of the PV1- Implementation 3 Assigned Patient Location that will require a mapping to the Healthcare Service Location Notes codes. THEN OBX-2(Value) NM OBX-2(Flavor) NM OBX-6(Value PHVS_HeightUnit_UCUM Set) USER 8302-2 Description Height Usage RE OBX|3|NM|8302-2^BODY HEIGHT^LN||69|[in_us]în ch [length]ÛCUM |||||F|||201102170000- Example 0500 Allows calculation of Body Mass Index (BMI), which may be an indicator of obesity for chronic Implementation disease. Note: If BMI can be calculated within the EHR, then it is preferable to just receive BMI Notes instead of height and weight. THEN OBX-2(Value) NM OBX-2(Flavor) NM OBX-6(Value PHVS_WeightUnit_UCUM Set) USER 3141-9 Description Weight Usage RE OBX|3|NM|3141-9^BODY WEIGHT MEASURED^LN||120|[lb_av]^ Example pound[mass]ÛCUM|||||F|||201102170800-0500 Allows calculation of Body Mass Index (BMI), which may be an indicator of obesity for chronic Implementation disease. Note: If BMI can be calculated within the EHR, then it is preferable to just receive BMI Notes instead of height and weight. 39156- THEN 5 OBX-2(Value) NM

IF (OBX- Column Value 3) OBX-2(Flavor) NM USER Description Body mass index (BMI) [Ratio] Usage RE OBX|3|NM|39156-5^Body Mass Index^LN||35|kg/m2^kilogram / (meter squared)ÛCUM| Example ||||F|||201102170800-0500 Implementation If BMI can be calculated within the EHR, then it is preferable to just receive BMI instead of Notes height and weight THEN OBX-2(Value) TX OBX-2(Flavor) TX USER Description Chief complaint Usage RE OBX|3|TX|8661-1^CHIEF COMPLAINT - REPORTED^LN||STOMACH ACHE THAT HAS Example LASTED 2 DAYS; NAUSEA AND VOMITING; MAYBE A FEVER||||||F|||201102171 531-0500 8661-1 This field is the patient's self-reported chief complaint or reason for visit. The field is distinct from the Admit Reason field, which is the provider's reason for admitting the patient. Senders should send the most complete description of the patient's chief complaint. Only send a single chief complaint, but use commas and/or semicolons to break up the text as agreed upon by Implementation data-trading partners. Although free text is preferred, if text for both the free-text chief complaint Notes and drop-down selection chief complaint are available, send both. Some systems may automatically overwrite chief complaint with final diagnosis when the final diagnosis code is assigned. The chief complaint text should NOT be replaced with other information either manually or by the data provider's system. Keep the chief complaint the same as how it was initially captured. THEN OBX-2(Value) TS OBX-2(Flavor) TS_SS_toDay USER 11368- Description Date of Onset 8 Usage O OBX|7|TS|11368-8ÎLLNESS OR INJURY ONSET DATE^LN||20110215||||||F|||201102170325- Example 0500 Implementation Refers to the time when the health episode described by the chief complaint(s) began. Notes THEN OBX-2(Value) TX OBX-2(Flavor) TX 54094- USER 8 Description Triage Note Usage RE Example OBX|7|TX|54094-8ÊMERGENCY DEPARTMENT TRIAGE NOTE^LN||Pain a recurrent Page 49 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

IF (OBX- Column Value 3) cramping sensation.||||||F|||201102091114-0500 ED/UC DATA ELEMENT OF INTEREST ONLY This element is represented by the LOINC Implementation code: 54094-8 in the OBX observation identifier. Send Triage Notes as free text. Triage notes Notes may benefit from additional processing (e.g., negation processing, natural language processing) to maximize the utility of the data. THEN OBX-2(Value) TX OBX-2(Flavor) TX USER 44833- Description Clinical impression 2 Usage O OBX|1|TX|44833- 2^PRELIMINARY DIAGNOSIS^LN||Pain consist with appendicitis||||||F|||20 Example 1102091115-0500 Implementation Send Clinical Impression as free text. Notes THEN OBX-2(Value) CWE OBX-2(Flavor) CWE_SS OBX-5(Value 0532 Set) 11449- USER 6 Description Pregnancy status Usage RE Example OBX|1|CWE|11449-6 Pregnancy Status ^LN||Y^Yes^HL70532||||||F|||201102170000-0500 Implementation Y, N, UNK Notes THEN OBX-2(Value) CWE OBX-2(Flavor) CWE_SS USER Description Problem list Usage O 11450- OBX|1|CWE|11450- 4^Problem List - Reported^LN|| N39.0^Urinary tract infection, site not 4 Example specified^I10 ||||||F|||201102170000-0500 Rationale: Can provide co-morbidity, pregnancy status, and indications of chronic disease conditions, level of severity and medical and surgical histories. The Problem List may be Implementation derived from the HL7 Message types PPR - Patient Problem Message (Events PC1, PC2, Notes PC3). The patient problem message is used to send problems from one application to another (e.g., a point-of-care system to a clinical repository). This option allows systems that need this information to set up transactions that fulfill requirements. 10160- THEN 0 OBX-2(Value) TX

IF (OBX- Column Value 3) OBX-2(Flavor) TX USER Description Medication List - Current medications entered as narrative Usage O OBX|1|TX|10160-0^Medication Use Reported^LN||Lasix 20 mg po bid, Simvastatin 40 mg po Example qd||||||F|||201102170000-0500 Implementation Current medications entered as narrative. OBX-14, observation datetime, indicates when the Notes observation was made and has nothing to do with date parameters of the prescription. THEN OBX-2(Value) CWE OBX-2(Flavor) CWE_SS OBX-6(Value PHVS_MedicationClinicalDrugName_HITSP,PHVS_MedicationBrandName_HITSP Set) USER 8677-7 Description Medications prescribed or dispensed - Current medications entered as standardized codes Usage O OBX|7|CWE|8677-7^MedicationsPrescribedOrDispensed^LN||1163466^Levofloxacin 25 MG/ML Example Oral Solution^RXNORM||||||F|||201401021500-0500 Current medications entered as standardized codes. OBX-14, observation datetime, indicates Implementation when the observation was made and has nothing to do with date parameters of the prescription. Notes The preferred method to send multiple medications is by repetition of OBX-5. See case 5, seventh OBX of the Messaging Examples. THEN OBX-2(Value) NM OBX-2(Flavor) NM OBX-6(Value PHVS_BloodPressureUnit_UCUM Set) USER 8480-6 Description Systolic blood pressure Usage O OBX|5|NM|8480- 6^SYSTOLIC BLOOD PRESSURE^LN||120|mm(hg) |||||F|||201102170345- Example 0500 Allows monitoring of chronic conditions and "most recent" patient's systolic and diastolic blood Implementation pressure. "Most recent" is the blood pressure taken most closely to the time that message is Notes constructed/assembled. THEN OBX-2(Value) NM OBX-2(Flavor) NM 8462-4 OBX-6(Value PHVS_BloodPressureUnit_UCUM Set) USER Description Diastolic blood pressure

IF (OBX- Column Value 3) Usage O OBX|6|NM|8462- 4^DIASTOLIC BLOOD PRESSURE^LN||90|mm(hg)| ||||F|||201102170235- Example 0500 Allows monitoring of chronic conditions and "most recent" patient's systolic and diastolic blood Implementation pressure. "Most recent" is the blood pressure taken most closely to the time that message is Notes constructed/assembled. THEN OBX-2(Value) NM OBX-2(Flavor) NM OBX-6(Value PHVS_TemperatureUnit_UCUM 11289- Set) 6 USER Description Initial temperature Usage O OBX|3|NM|11289-6^BODY TEMPERATURE^LN||100.1|[ Example degF]^FARENHEITÛCUM|||||F|||201102170000-0500 THEN OBX-2(Value) NM OBX-2(Flavor) NM OBX-6(Value PHVS_PulseOximetryUnit_UCUM 59408- Set) 5 USER Description Initial pulse oximetry Usage O OBX|4|NM|59408-5ÔXYGENSATURATION IN ARTERIALBLOOD BY Example PULSEOXIMETRY^LN||91|%^PERCENTÛCUM||A|||F|||20110217145139-0500 THEN OBX-2(Value) CWE OBX-2(Flavor) CWE_SS OBX-5(Value PHVS_SmokingStatus_MU Set) 72166- USER 2 Description Smoking status Usage RE OBX|1|CWE|72166-2^TOBACCO SMOKINGSTATUS^LN||428071000124 103 ^Current Heavy Example tobacco smoker^SCT||||||F|||201102170000-0500 Implementation This data element is required by Promoting Interoperability (formerly Meaningful Use). Allows Notes monitoring of chronic conditions. THEN 11283- OBX-2(Value) CWE 9 OBX-2(Flavor) CWE_SS OBX-5(Value PHVS_EmergencySeverityIndexAcuity_CDC

IF (OBX- Column Value 3) Set) USER Description Initial acuity Usage O OBX|1|CWE|11283- Example 9^INITIALACUITY^LN||1^Resuscitation^CDCEDACUITY||||||F|||201708022345-0500 THEN OBX-2(Value) TX OBX-2(Flavor) TX USER 10182- Description Travel history 4 Usage RE OBX|1|TX|10182-4^History of travel Narrative^LN||Arrived home from Liberia two days Example ago.||||||F|||201102170000-0500 Implementation Some public health jurisdictions find utility in putting "YES" or "NO" at the beginning of this field, Notes followed by the travel location if "Yes."

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Value Type OBX_SS-2 PHVS_ValueType_SyndromicSurveillance (Syndromic Surveillance) Observation Identifier OBX_SS-3 PHVS_ObservationIdentifier_SyndromicSurveillance (Syndromic Surveillance) Vital Sign Result OBX_SS-3 PHVS_VitalSignResult_HITSP Value Set Observation result OBX_SS-11 0085 status codes interpretation

OBX-1: Set ID - OBX (SI)

This field contains the sequence number. Set ID numbers the repetitions of the segments.

OBX-11: Observation Result Status (ID)

This field contains the observation result status. This field reflects the current completion status of the results for one Observation Identifier.

OBX-14: Date/Time of the Observation (TS_SS_toMinute)

This field is the observation date/time which is physiologically relevant or the closest approximation.

3.2.7 PID_SS_A01 - PATIENT IDENTIFICATION Segment Definition Seq Element name Data type Usage Cardinality Value Set 1 Set ID - PID SI R [1..1] Patient Identifier 3 CX_SS R [1..*] List 5 Patient Name XPN_SS R [1..*] 7 Date/Time of Birth TS_SS_toDay O [0..1] Administrative 8 IS RE [0..1] PHVS_Gender_SyndromicSurveillance Sex 10 Race CE_SS RE [0..*] PHVS_RaceCategory_CDC 11 Patient Address XAD_SS RE [0..1] Patient Account 18 CX_SS O [0..1] Number 22 Ethnic Group CE_SS RE [0..1] PHVS_EthnicityGroup_CDC Last Update 33 TS_SS_toMinute O [0..1] Date/Time Last Update 34 HD_SS O [0..1] Facility

Conformance Statements ID Description If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL be one of PID_SS_6738094 list values: |~^^^^^^S|,|~^^^^^^U|

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Gender (Syndromic PID_SS_A01-8 PHVS_Gender_SyndromicSurveillance Surveillance) PID_SS_A01-10 PHVS_RaceCategory_CDC Race Category PID_SS_A01-22 PHVS_EthnicityGroup_CDC Ethnicity group

Example PID Segment that shows a Hispanic white female patient. The deceased indicator and date fields are used. Patient address is described as the mailing address, with 13 as the FIPS numeric for Georgia. • PID|1||2222^^^GreaterNorthMedCtr&4356012945&NPI^MR||~^^^^^^S|||F||2106- 3^White^CDCREC|^^Decatur^13^30303^USA^M^^13121|||||||100221223^^^GreaterNorthMedCtr&435601294 5&NPI^AN||||2135-2^Hispanic or Latino^CDCREC|||||||20140826202100|Y

Example PID Segment that shows a male patient with multiple patient identifiers and multiple race codes. • PID|1||2111000222^^^NEMedCtr&1234567890&NPI^MR~12345789^^^NEMedCtr&1234567890&NPI^LR||~^ ^^^^^S|||M||2054-5^Black or AfricanAmerican^CDCREC~2028- 9Âsian^CDCREC|^^Decatur^13^30303ÛSA^M^^13121|||||||100221223^^^NEMed Ctr&1234567890&NPIÂN||||2135-2^Hispanic or Latino^CDCREC

PID-3: Patient Identifier List (CX_SS)

PID-3 is a repeating field that can accommodate multiple patient identifiers. Field contents can be used to crosswalk patient visits with multiple visit numbers due to one-to-many relationship between PID-3 and PV1-19. It is recommended that data providers submit the patient medical record number to quickly identify the patient if a follow-up investigation is required. Without the medical record number, the data provider might invest considerable time to follow-up on the records of interest, causing unacceptable delays in public health response. In addition, the medical record number might aid in de- duplicating records and often helps resolve apparent transcription errors.

PID-5: Patient Name (XPN_SS)

This field contains patient names, and the primary or legal name is reported first. Submit patient name in accord with applicable PHA or jurisdiction regulations and specifications. If the PHA does not require patient name to be submitted, PHAs should not use Visit or Patient ID, as specified in this guide, to join related visit data and, if working with hospitals, to find additional visit information for syndromic surveillance signal confirmation or investigation. However, since HL7 requires the patient name, the field must be populated even when patient name shall not be sent. In such an instance (i.e., patient name is not sent), patient name shall be presented in a pseudonymized manner.

PID-10: Race (CE_SS)

General race category reported by the patient - subject may have more than one race category.

PID-33: Last Update Date/Time (TS_SS_toMinute)

This field contains the last update date and time for the patient's identifying and demographic data, as defined in the PID segment.

PID-34: Last Update Facility (HD_SS)

This field identifies the facility of the last update to a patient's identifying and demographic data, as defined in the PID segment.

3.2.8 PID_SS_A04_A08_A03 - PATIENT IDENTIFICATION Segment Definition Seq Element name Data type Usage Cardinality Value Set 1 Set ID - PID SI R [1..1] Patient Identifier 3 CX_SS R [1..*] List 5 Patient Name XPN_SS R [1..*] 7 Date/Time of Birth TS_SS_toDay O [0..1] Administrative 8 IS RE [0..1] PHVS_Gender_SyndromicSurveillance Sex Page 55 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Seq Element name Data type Usage Cardinality Value Set 10 Race CE_SS RE [0..*] PHVS_RaceCategory_CDC 11 Patient Address XAD_SS RE [0..1] Patient Account 18 CX_SS O [0..1] Number 22 Ethnic Group CE_SS RE [0..*] PHVS_EthnicityGroup_CDC Patient Death 29 TS_SS_toMinute C [0..1] Date and Time Patient Death 30 ID RE [0..1] 0136 Indicator Last Update 33 TS_SS_toMinute O [0..1] Date/Time Last Update 34 HD_SS O [0..1] Facility

Conformance Statements ID Description If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL PID_SS_6738094 be one of list values: |~^^^^^^S|,|~^^^^^^U| If PV1-36 (Discharge Disposition) is valued with any of the following: '20', '40', '41', PID_SS_A04_A08_A03_1 '42', PID-30 shall be 'Y'

Conditional Predicates Location Usage Description PID-29 C(R/X) If the value of PID-30 is 'Y'.

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Gender PID_SS_A04_A08_A03-8 PHVS_Gender_SyndromicSurveillance (Syndromic Surveillance) PID_SS_A04_A08_A03-10 PHVS_RaceCategory_CDC Race Category PID_SS_A04_A08_A03-22 PHVS_EthnicityGroup_CDC Ethnicity group PID_SS_A04_A08_A03-30 0136 Yes/no indicator

PID-3: Patient Identifier List (CX_SS)

PID-5: Patient Name (XPN_SS)

PID-33: Last Update Date/Time (TS_SS_toMinute)

This field contains the last update date and time for the patient's identifying and demographic data, as defined in the PID segment.

PID-34: Last Update Facility (HD_SS)

This field identifies the facility of the last update to a patient's identifying and demographic data, as defined in the PID segment.

3.2.9 PR1_SS - PROCEDURES Segment Definition Element Seq Data type Usage Cardinality Value Set name Set ID - 1 SI R [1..1] PR1 Procedure 2 Coding IS R [1..1] 0089 Method Procedure 3 CE_SS R [1..1] 0088,PHVS_AdministrativeProcedure_CDC_ICD-10PCS Code Procedure 5 TS_SS_toMinute R [1..1] Date/Time

Conformance Statements ID Description PR1-3.1 shall be populated with a value from one for the following coding systems: CPT4, PR1_SS_6639954 ICD10-CM-PCS

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Procedure Coding PR1_SS-2 0089 Method PR1_SS-3 0088 Procedure Code Procedure (ICD-10 PR1_SS-3 PHVS_AdministrativeProcedure_CDC_ICD-10PCS PCS)

Example: • PR1|1||0WQ.F0ZZ^Repair Abdominal Wall, Open Approach^I10P||201408081816

3.2.10 PV1_SS_A01 - PATIENT VISIT Segment Definition Element Seq Data type Usage Cardinality Value Set name 1 Set ID - PV1 SI R [1..1] 2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance Assigned 3 Patient PL_SS O [0..1] Location Admission 4 IS O [0..1] PHVS_AdmissionType_HL7_2x Type Prior Patient 6 PL_SS O [0..1] Location Attending 7 XCN O [0..*] 0010 Doctor Hospital 10 IS O [0..1] 0069 Service 14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x Ambulatory 15 IS O [0..*] 0009 Status 18 Patient Type IS O 0018 19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance Admit 44 TS_SS_toMinute R [1..1] Date/Time

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Patient Class PV1_SS_A01-2 PHVS_PatientClass_SyndromicSurveillance (Syndromic Surveillance) Admission Type PV1_SS_A01-4 PHVS_AdmissionType_HL7_2x (HL7) PV1_SS_A01-7 0010 Physician ID PV1_SS_A01-10 0069 Hospital Service Admission Source PV1_SS_A01-14 PHVS_AdmitSource_HL7_2x (HL7) PV1_SS_A01-15 0009 Ambulatory Status PV1_SS_A01-18 0018 Patient Type Identifier Type PV1_SS_A01-19 PHVS_IdentifierType_SyndromicSurveillance (Syndromic Surveillance)

Example PV1 for an Inpatient: This PV1 segment shows the following information • PV1-2 Patient Class = I (Inpatient) • PV1-4 Admission Type = E (Emergency) (US UB92 code '1') • PV1-7 Attending Doctor populated with an identifier assigned by NE Medical Center • PV1-10 Medical Service = MED (Medical Service) • PV1-14 Admit source = 7 (suggested UB code for Emergency) • PV1-19 Visit Number populated with an identifier assigned by Greater North Medical Center • PV1-44 Admit Date/time of August 17, 2014 at 12 noon

PV1|1|I||E|||112345^Familyname^Givenname^^^DR^MD^^NEMedCtr&1234567890&NPI|||MED||||7|||||2222_001^^^Great erNorthMedCtr&4356012945&NPI^VN|||||||||||||||||||||||||201408171200

PV1-3: Assigned Patient Location (PL_SS)

This field contains the patient's initial assigned location or the location to which the patient is being moved. The first component may be the nursing station for inpatient locations, or clinic or department, for locations other than inpatient.

PV1-4: Admission Type (IS)

Potentially used for filtering on ED patients to create the A03 Discharge when one is not created when an ED patient is admitted as an inpatient

PV1-7: Attending Doctor (XCN)

Recommend the use of the National Provider Identifier Standard provided by Centers for Medicare and Medicaid Services. To search for, get information about, or apply for an NPI, go to https://www.cms.gov/Regulations-and- Guidance/Administrative-Simplification/NationalProvIdentStand/. If an NPI is not available, try using a different unique identifier, such as an OID or a State-designated identifier.

PV1-10: Hospital Service (IS)

This field contains the treatment or type of surgery that the patient is scheduled to receive.

PV1-14: Admit Source (IS)

This field indicates where the patient was admitted. In the US, this field is used on UB92 FL20 'Source of Admission'. The UB codes listed as examples are not an exhaustive or current list; refer to a UB specification for additional information.

PV1-15: Ambulatory Status (IS)

This field indicates any permanent or transient handicapped conditions.

PV1-19: Visit Number (CX_SS)

This field contains the unique number assigned to each patient visit, which should remain constant throughout the visit.

This field contains the admit date/time. This field also reflects the date/time of an outpatient/emergency patient registration, which should remain constant throughout the visit.

3.2.11 PV1_SS_A03 - PATIENT VISIT Segment Definition Element Seq Data type Usage Cardinality Value Set name 1 Set ID - PV1 SI R [1..1] 2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance Assigned 3 Patient PL_SS O [0..1] Location Admission 4 IS O [0..1] PHVS_AdmissionType_HL7_2x Type Prior Patient 6 PL_SS O [0..1] Location Attending 7 XCN O [0..*] 0010 Doctor Hospital 10 IS O [0..1] 0069 Service 14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x Ambulatory 15 IS O [0..*] 0009 Status 18 Patient Type IS O 0018 19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance Discharge 36 IS R [1..1] PHVS_DischargeDisposition_HL7_2x Disposition Admit 44 TS_SS_toMinute R [1..1] Date/Time Discharge 45 TS_SS_toMinute R [1..*] Date/Time

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Patient Class PV1_SS_A03-2 PHVS_PatientClass_SyndromicSurveillance (Syndromic Surveillance) Admission Type PV1_SS_A03-4 PHVS_AdmissionType_HL7_2x (HL7) PV1_SS_A03-7 0010 Physician ID PV1_SS_A03-10 0069 Hospital Service Admission Source PV1_SS_A03-14 PHVS_AdmitSource_HL7_2x (HL7) PV1_SS_A03-15 0009 Ambulatory Status

Single Code Location Value Set ID Value Set Name Value PV1_SS_A03-18 0018 Patient Type Identifier Type PV1_SS_A03-19 PHVS_IdentifierType_SyndromicSurveillance (Syndromic Surveillance) Discharge PV1_SS_A03-36 PHVS_DischargeDisposition_HL7_2x Disposition (HL7)

PV1-3: Assigned Patient Location (PL_SS)

PV1-4: Admission Type (IS)

Potentially used for filtering on ED patients to create the A03 Discharge when one is not created when an ED patient is admitted as an inpatient

PV1-7: Attending Doctor (XCN)

PV1-10: Hospital Service (IS)

This field contains the treatment or type of surgery that the patient is scheduled to receive.

PV1-14: Admit Source (IS)

PV1-15: Ambulatory Status (IS)

This field indicates any permanent or transient handicapped conditions.

PV1-19: Visit Number (CX_SS)

This field contains the unique number assigned to each patient visit, which should remain constant throughout the visit.

PV1-36: Discharge Disposition (IS)

N/A FOR AMBULATORY CARE Helps identify severity of patient's condition and any indication of death. It is expected that this field will update with multiple submissions. Include both the code and text description of the code. This field should indicate patient death, if applicable.

This field contains the admit date/time. This field also reflects the date/time of an outpatient/emergency patient registration, which should remain constant throughout the visit.

PV1-45: Discharge Date/Time (TS_SS_toMinute)

This field contains the discharge date/time

3.2.12 PV1_SS_A04 - PATIENT VISIT Segment Definition Element Seq Data type Usage Cardinality Value Set name 1 Set ID - PV1 SI R [1..1] 2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance Assigned 3 Patient PL_SS O [0..1] Location Admission 4 IS O [0..1] PHVS_AdmissionType_HL7_2x Type Prior Patient 6 PL_SS O [0..1] Location Attending 7 XCN O [0..*] 0010 Doctor Hospital 10 IS O [0..1] 0069 Service 14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x Ambulatory 15 IS O [0..*] 0009 Status 18 Patient Type IS O 0018 19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance Admit 44 TS_SS_toMinute R [1..1] Date/Time

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Patient Class PV1_SS_A04-2 PHVS_PatientClass_SyndromicSurveillance (Syndromic Surveillance) Admission Type PV1_SS_A04-4 PHVS_AdmissionType_HL7_2x (HL7) PV1_SS_A04-7 0010 Physician ID PV1_SS_A04-10 0069 Hospital Service Admission Source PV1_SS_A04-14 PHVS_AdmitSource_HL7_2x (HL7) PV1_SS_A04-15 0009 Ambulatory Status

Single Code Location Value Set ID Value Set Name Value PV1_SS_A04-18 0018 Patient Type Identifier Type PV1_SS_A04-19 PHVS_IdentifierType_SyndromicSurveillance (Syndromic Surveillance)

3.2.13 PV1_SS_A08 - PATIENT VISIT Segment Definition Element Seq Data type Usage Cardinality Value Set name 1 Set ID - PV1 SI R [1..1] 2 Patient Class IS R [1..1] PHVS_PatientClass_SyndromicSurveillance Assigned 3 Patient PL_SS O [0..1] Location Admission 4 IS O [0..1] PHVS_AdmissionType_HL7_2x Type Prior Patient 6 PL_SS O [0..1] Location Attending 7 XCN O [0..*] 0010 Doctor Hospital 10 IS O [0..1] 0069 Service 14 Admit Source IS O [0..1] PHVS_AdmitSource_HL7_2x Ambulatory 15 IS O [0..*] 0009 Status 18 Patient Type IS O 0018 19 Visit Number CX_SS R [1..1] PHVS_IdentifierType_SyndromicSurveillance Discharge 36 IS RE [0..1] PHVS_DischargeDisposition_HL7_2x Disposition Admit 44 TS_SS_toMinute R [1..1] Date/Time Discharge 45 TS_SS_toMinute RE [0..*] Date/Time

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Patient Class PV1_SS_A08-2 PHVS_PatientClass_SyndromicSurveillance (Syndromic Surveillance) Admission Type PV1_SS_A08-4 PHVS_AdmissionType_HL7_2x (HL7) PV1_SS_A08-7 0010 Physician ID PV1_SS_A08-10 0069 Hospital Service Page 63 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Single Code Location Value Set ID Value Set Name Value Admission Source PV1_SS_A08-14 PHVS_AdmitSource_HL7_2x (HL7) PV1_SS_A08-15 0009 Ambulatory Status PV1_SS_A08-18 0018 Patient Type Identifier Type PV1_SS_A08-19 PHVS_IdentifierType_SyndromicSurveillance (Syndromic Surveillance) Discharge PV1_SS_A08-36 PHVS_DischargeDisposition_HL7_2x Disposition (HL7)

3.2.14 PV2_SS - PATIENT VISIT - ADDITIONAL INFORMATION

The PV2 segment is a continuation of visit-specific information and is the segment where the Admit Reason is passed.

Segment Definition Element Data Seq Usage Cardinality Value Set name type Admit PHVS_AdministrativeDiagnosis_CDC_ICD- 3 CE_SS RE [0..1] Reason 10CM,PHVS_Disease_CDC

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Diagnosis (ICD-10 PV2_SS-3 PHVS_AdministrativeDiagnosis_CDC_ICD-10CM CM) PV2_SS-3 PHVS_Disease_CDC Disease

Examples: • PV2|||11530004^Brittle Diabetes^SCT (PV2-3 Admit Reason is SNOMED encoded) • PV2|||O24.4^Diabetes Mellitus arising in pregnancy^I10 (PV2-3 Admit Reason is ICD10 encoded) • PV2|||^Diabetes Mellitus (non-coded from drop-down or free text)

PV2-3: Admit Reason (CE_SS)

May be coded (CE.1 - CE.3) or free text (CE.2), although free text is preferred. This field contains the provider's reason for admitting the patient. It is distinct from the Chief Complaint / Reason for Visit field, which is the patient's self-reported chief complaint or reason for visit. Senders should transmit the richest and most complete description of the patient's reason for admission or encounter. If both free-text and drop-down selection text are available, send both. If only drop- down list fields are available, then concatenate all drop-down list values selected and submit.

3.3 Datatypes

3.3.1 CE_SS - CODED ELEMENT Data Type Definition Seq Element name Data type Usage Value Set 1 Identifier ST RE 2 Text ST C(R/RE) 3 Name of Coding System ID C(R/X) 0396 6 Name of Alternate Coding System ID C(R/X) 0396

Conditional Predicates Location Usage Description CE.2 C(R/RE) If CE.1 (Identifier) is not valued CE.3 C(R/X) If CE.1 (Identifier) is valued CE.6 C(R/X) If CE.4 (Alternate Identifier) is valued

Value Set Bindings Location Value Set ID Value Set Name Single Code Value CE_SS-3 0396 Coding System CE_SS-6 0396 Coding System

Component Definitions

CE.2 : Text

It is strongly recommended that text be sent to accompany any identifier. When a coded value is not known, text can still be sent, in which case no coding system should be identified.

3.3.2 CWE_SS - CODED WITH EXCEPTIONS Data Type Definition Seq Element name Data type Usage Value Set 1 Identifier ST RE 2 Text ST C(R/RE) 3 Name of Coding System ID C(R/X) 0396 6 Name of Alternate Coding System ID C(R/X) 0396 9 Original Text ST RE

Conditional Predicates Location Usage Description CWE.2 C(R/RE) If CWE.1 (Identifier) is not valued CWE.3 C(R/X) If CWE.3 (Name of Coding System) is valued CWE.6 C(R/X) If CWE.6 (Name of Alternate Coding System) is valued

Location Value Set ID Value Set Name Single Code Value CWE_SS-3 0396 Coding System CWE_SS-6 0396 Coding System

Comments

CWE_SS.4: The alternate identifier (from the alternate coding system) should be the closest match for the identifier found in component 1. CWE_SS.5: It is strongly recommended that alternate text be sent to accompany any alternate identifier. CWE_SS.9: The original text that was available to an automated process or a human before a specific code was assigned CWE_SS.2: It is strongly recommended that text be sent to accompany a code. When a coded value is not known, text can still be sent, in which case no coding system should be identified; however, in this case, the preferred method is to send the text in position 9, "original text."

3.3.3 CX_SS - EXTENDED COMPOSITE ID WITH CHECK DIGIT Data Type Definition Seq Element name Data type Usage Value Set 1 ID Number ST R 4 Assigning Authority HD_SS R 0363 5 Identifier Type Code ID R PHVS_IdentifierType_SyndromicSurveillance

Value Set Bindings Single Code Location Value Set ID Value Set Name Value CX_SS-4 0363 Assigning authority Identifier Type CX_SS-5 PHVS_IdentifierType_SyndromicSurveillance (Syndromic Surveillance)

Note: The check digit and check digit scheme are null if ID is alphanumeric.

Example: PID-3 Patient ID: |PSN101059711^^^TX01&OID&ISO|

Component Definitions

CX.1 : ID Number

Identifier may be alphanumeric.

CX.4 : Assigning Authority

A unique name of the system (or organization or agency or department) that creates the data.

3.3.4 DTM_SS_YYYYMMDD - DATE/TIME Data Type Definition # Value Usage Predicate 1 YYYY R 2 MM R 3 DD R 4 HH O 5 MM C(O/X) If HH(Hour) is valued. 6 SS C(O/X) If MM(Minute) is valued. 7 s C(O/X) If SS(Second) is valued. 8 s C(O/X) If s(1/10 second) is valued. 9 s C(O/X) If s(1/100 second) is valued. 10 s C(O/X) If s(1/1000 second) is valued. 11 ZZZZ O

Usage Note:

Format: YYYYMMDD[HH[MM[SS[.s[s[s[s]]]]]]][+/-ZZZZ].

The number of characters populated (excluding the time zone) specifies the precision.

Thus: • only the first four are used to specify a precision of "year" • the first six are used to specify a precision of "month" • the first eight are used to specify a precision of "day" • the first ten are used to specify a precision of "hour" • the first twelve are used to specify a precision of "minute" • the first fourteen are used to specify a precision of "second" • the first sixteen are used to specify a precision of "one tenth of a second" • the first nineteen are used to specify a precision of "one ten thousandths of a second"

Example: |199904| specifies April 1999.

The time zone (+/-ZZZZ) is represented as +/-HHMM offset from Co-ordinated Universal Time (UTC) (formerly Greenwich Mean Time [GMT]), where +0000 or 0000 both represent UTC (without offset). The specific data representations used in the HL7 encoding rules are compatible with ISO 8824-1987(E). Note that if the time zone is not included, the time zone is assumed to be that of the local time zone of the sender. Also note that a DTM- or TS-valued field with the HHMM part set to "0000" represents midnight of the night extending from the previous day to the day given by the YYYYMMDD part.

The HL7 standard recommends that all systems routinely send the time zone offset but does not require it. HL7 systems are required to accept the time zone offset, but how this is done depends on the software application. For many applications, the time of interest is the local time of the sender.

3.3.5 DTM_SS_YYYYMMDDHHMM - DATE/TIME Data Type Definition # Value Usage Predicate

# Value Usage Predicate 1 YYYY R 2 MM R 3 DD R 4 HH R 5 MM R 6 SS O 7 s C(O/X) If SS(Second) is valued. 8 s C(O/X) If s(1/10 second) is valued. 9 s C(O/X) If s(1/100 second) is valued. 10 s C(O/X) If s(1/1000 second) is valued. 11 ZZZZ O

3.3.6 DTM_SS_YYYYMMDDHHMMSS - DATE/TIME Data Type Definition # Value Usage Predicate 1 YYYY R 2 MM R 3 DD R 4 HH R 5 MM R 6 SS R 7 s O 8 s C(O/X) If s(1/10 second) is valued. 9 s C(O/X) If s(1/100 second) is valued. 10 s C(O/X) If s(1/1000 second) is valued. 11 ZZZZ R

3.3.7 EI - ENTITY IDENTIFIER Data Type Definition Seq Element name Data type Usage Value Set 3 Universal ID ST C 4 Universal ID Type ID C 0301

Value Set Bindings Location Value Set ID Value Set Name Single Code Value EI-4 0301 Universal ID type

3.3.8 HD_SS - HIERARCHIC DESIGNATOR Data Type Definition Seq Element name Data type Usage Value Set 1 Namespace ID IS RE 0300

Seq Element name Data type Usage Value Set 2 Universal ID ST R 3 Universal ID Type ID R PHVS_UniversalIDType_SyndromicSurveillance

Value Set Bindings Single Code Location Value Set ID Value Set Name Value HD_SS-1 0300 Namespace ID Universal ID Type HD_SS-3 PHVS_UniversalIDType_SyndromicSurveillance (Syndromic Surveillance)

Component Definitions

HD.2 : Universal ID

This is string formatted according to the scheme defined by the third component, .The UID is intended to be unique over time within the UID type. This convention is rigorously defined. Each UID must belong to one of the specifically enumerated schemes for constructing UIDs (defined by the UID type).

HD.3 : Universal ID Type

Universal ID Type (ID) governs the interpretation of the second component of the HD. This component contains the code system identifier "NPI" if National Provider Identifiers are used. PHVS_UniversalIDType_SyndromicSurveillance lists Universal ID Types supported.

3.3.9 ID - CODED VALUE FOR HL7 DEFINED TABLES

3.3.10 IS - CODED VALUE FOR USER-DEFINED TABLES

3.3.11 MSG_SS - MESSAGE TYPE Data Type Definition Seq Element name Data type Usage Value Set 1 Message Code ID R PHVS_MessageType_SyndromicSurveillance 2 Trigger Event ID R PHVS_EventType_SyndromicSurveillance 3 Message Structure ID R PHVS_MessageStructure_SyndromicSurveillance

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Message Type MSG_SS-1 PHVS_MessageType_SyndromicSurveillance (Syndromic Surveillance) Event Type MSG_SS-2 PHVS_EventType_SyndromicSurveillance (Syndromic Surveillance) Page 69 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Single Code Location Value Set ID Value Set Name Value Message Structure MSG_SS-3 PHVS_MessageStructure_SyndromicSurveillance (Syndromic Surveillance)

3.3.12 NM - NUMERIC

3.3.13 PT_SS - PROCESSING TYPE Data Type Definition Seq Element name Data type Usage Value Set 1 Processing ID ID R 0103

Conformance Statements ID Description PT_SS_6152904 The value of PT-1 (Processing ID) SHALL be one of list values: P,T,D.

Value Set Bindings Location Value Set ID Value Set Name Single Code Value PT_SS-1 0103 Processing ID

3.3.14 SI - SEQUENCE ID

3.3.15 ST - STRING DATA

3.3.16 TS_SS_TODAY - TIME STAMP Data Type Definition Seq Element name Data type Usage Value Set 1 Time DTM_SS_YYYYMMDD R

3.3.17 TS_SS_TOMINUTE - TIME STAMP Data Type Definition Seq Element name Data type Usage Value Set 1 Time DTM_SS_YYYYMMDDHHMM R

3.3.18 TS_SS_TOSECOND - TIME STAMP Data Type Definition Seq Element name Data type Usage Value Set 1 Time DTM_SS_YYYYMMDDHHMMSS R

3.3.19 TX - TEXT DATA

3.3.20 VID_SS - VERSION IDENTIFIER Data Type Definition Seq Element name Data type Usage Value Set Page 70 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Seq Element name Data type Usage Value Set 1 Version ID ID R

Conformance Statements ID Description VID_SS_001 The value of VID-1 (Version ID) SHALL be '2.5.1'.

Usage Note:

Example: MSH-12 Version ID: |2.5.1|

3.3.21 XAD_SS - EXTENDED ADDRESS

The mailing address of the patient is preferred, but if not available, another address such as local address may be substituted.

Data Type Definition Seq Element name Data type Usage Value Set 3 City ST RE 4 State or Province ST RE PHVS_State_FIPS_5-2 5 Zip or Postal Code ST RE 6 Country ID RE PHVS_Country_ISO_3166-1 9 County/Parish Code IS RE PHVS_County_FIPS_6-4

Value Set Bindings Location Value Set ID Value Set Name Single Code Value XAD_SS-4 PHVS_State_FIPS_5-2 State XAD_SS-6 PHVS_Country_ISO_3166-1 Country XAD_SS-9 PHVS_County_FIPS_6-4 County

Component Definitions

XAD.4 : State or Province

Use the 2-digit (numeric) FIPS code for patient's State (domestic home address), rather than two letter abbriviations. The 2-digit FIPS code helps characterize spatial-temporal patterns for analysis based on patient's residence. Also, the state abbreviation is a readily available data element that is useful if other patient location data elements are not available.

XAD.5 : Zip or Postal Code

Provide a minimum of 5 digits for domestic ZIP codes. Foreign postal codes should be supported. Supports the federal use case. County helps to further target spatial temporal patterns since ZIP Code can cross multiple counties. This core data element allows for differences in geographical characterization across jurisdictions (e.g., some states operate public health activities on a county level, whereas others operate on a city or town level).

XAD.6 : Country

Where possible, use the 3-character country codes for Country of the patient home address

3.3.22 XPN_SS - EXTENDED PERSON NAME Data Type Definition Seq Element name Data type Usage Value Set 7 Name Type Code ID R PHVS_NameType_SyndromicSurveillance

Conformance Statements ID Description XPN_SS_007 The value of XPN-7 (Name Type Code) SHALL be one of list values: L,S,U.

Value Set Bindings Single Code Location Value Set ID Value Set Name Value Name Type XPN_SS-7 PHVS_NameType_SyndromicSurveillance (Syndromic Surveillance)

3.4 Value Sets

All value sets are closed unless stated otherwise.

3.4.1 0009 - AMBULATORY STATUS Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description A6 HL70009 Hearing impaired B5 HL70009 Paraplegic A1 HL70009 Ambulates with assistive device A9 HL70009 Functional level unknown A4 HL70009 Disoriented B3 HL70009 Amputee A7 HL70009 Speech impaired B6 HL70009 Pregnant A2 HL70009 Wheelchair/stretcher bound B1 HL70009 Oxygen therapy

Value Code System Description A5 HL70009 Vision impaired B4 HL70009 Mastectomy A0 HL70009 No functional limitations A8 HL70009 Non-English speaking A3 HL70009 Comatose; non-responsive B2 HL70009 Special equipment (tubes, IVs, catheters)

3.4.2 0010 - PHYSICIAN ID Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70010 no suggested values

3.4.3 0018 - PATIENT TYPE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70018 no suggested values

3.4.4 0061 - CHECK DIGIT SCHEME Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description M11 HL70061 Mod 11 algorithm ISO HL70061 ISO 7064: 1983 NPI HL70061 Check digit algorithm in the US Page 73 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description National Provider Identifier M10 HL70061 Mod 10 algorithm

3.4.5 0069 - HOSPITAL SERVICE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description SUR HL70069 Surgical Service CAR HL70069 Cardiac Service URO HL70069 Urology Service MED HL70069 Medical Service PUL HL70069 Pulmonary Service

3.4.6 0072 - INSURANCE PLAN ID Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70072 No suggested values defined

3.4.7 0085 - OBSERVATION RESULT STATUS CODES INTERPRETATION Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description I HL70085 Specimen in lab; results pending Results cannot be obtained for this X HL70085 observation Page 74 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description P HL70085 Preliminary results D HL70085 Deletes the OBX record Results status change to final without retransmitting results U HL70085 already sent as 'preliminary.' E.g., radiology changes status from preliminary to final Not asked; used to affirmatively document that the observation identified in the OBX was not N HL70085 sought when the universal service ID in OBR-4 implies that it would be sought. R HL70085 Results entered -- not verified Final results; Can only be changed F HL70085 with a corrected result. Post original as wrong, e.g., W HL70085 transmitted for wrong patient Order detail description only (no O HL70085 result) Record coming over is a correction C HL70085 and thus replaces a final result S HL70085 Partial results

3.4.8 0088 - PROCEDURE CODE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70088 No suggested values defined

3.4.9 0089 - PROCEDURE CODING METHOD Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes

Value Code System Description ... HL70089 No suggested values defined

3.4.10 0103 - PROCESSING ID Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description T HL70103 Training D HL70103 Debugging P HL70103 Production

3.4.11 0136 - YES/NO INDICATOR Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description N HL70136 No Y HL70136 Yes

3.4.12 0155 - ACCEPT/APPLICATION ACKNOWLEDGMENT CONDITIONS Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description SU HL70155 Successful completion only ER HL70155 Error/reject conditions only NE HL70155 Never AL HL70155 Always

3.4.13 0190 - ADDRESS TYPE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description C HL70190 Current Or Temporary Registry home. Refers to the information system, typically managed by a public health agency, RH HL70190 that stores patient information such as immunization histories or cancer data, regardless of where the patient obtains services. L HL70190 Legal Address Birth delivery location (address BDL HL70190 where birth occurred) O HL70190 Office F HL70190 Country Of Origin B HL70190 Firm/Business M HL70190 Mailing Residence at birth (home address at BR HL70190 time of birth) P HL70190 Permanent H HL70190 Home BA HL70190 Bad address Birth (nee) (birth address, not N HL70190 otherwise specified)

3.4.14 0207 - PROCESSING MODE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description R HL70207 Restore from archive I HL70207 Initial load

Value Code System Description Current processing, transmitted at T HL70207 intervals (scheduled or on demand) Not present (the default, meaning Not present HL70207 current processing) A HL70207 Archive

3.4.15 0288 - CENSUS TRACT Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70288 No suggested values defined

3.4.16 0300 - NAMESPACE ID Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70300 No suggested values defined

3.4.17 0301 - UNIVERSAL ID TYPE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description These are reserved for locally L,M,N HL70301 defined coding schemes. GUID HL70301 Same as UUID.

Value Code System Description URI HL70301 Uniform Resource Identifier An International Standards ISO HL70301 Organization Object Identifier x500 HL70301 An X.500 directory name B HL70301 M HL70301 The CEN Healthcare Coding Scheme Designator. (Identifiers HCD HL70301 used in DICOM follow this assignment scheme.) The DCE Universal Unique UUID HL70301 Identifier L HL70301 An Internet dotted name. Either in DNS HL70301 ASCII or as integers Usually a base64 encoded string of random bits.

The uniqueness depends on the length of the bits. Mail systems often Random HL70301 generate ASCII string "unique names," from a combination of random bits and system names. Obviously, such identifiers will not be constr Reserved for future HL7 HL7 HL70301 registration schemes x400 HL70301 An X.400 MHS format identifier

3.4.18 0360 - DEGREE/LICENSE/CERTIFICATE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description MCE HL70360 Master of Civil Engineering MME HL70360 Master of Mechanical Engineering PharmD HL70360 Doctor of Pharmacy TS HL70360 Trade School Graduate BBA HL70360 Bachelor of Business Administration CNM HL70360 Certified Nurse Midwife DO HL70360 Doctor of Osteopathy

Value Code System Description MDI HL70360 Master of Divinity MSN HL70360 Master of Science - Nursing PHS HL70360 Doctor of Science AAS HL70360 Associate of Applied Science BN HL70360 Bachelor of Nursing BSN HL70360 Bachelor on Science - Nursing Certified Pediatric Nurse CPNP HL70360 Practitioner FPNP HL70360 Family Practice Nurse Practitioner MEE HL70360 Master of Electrical Engineering NP HL70360 Nurse Practitioner RPH HL70360 Registered Pharmacist AS HL70360 Associate of Science CER HL70360 Certificate DED HL70360 Doctor of Education MA HL70360 Master of Arts MD HL70360 Doctor of Medicine MS HL70360 Master of Science PHD HL70360 Doctor of Philosophy BE HL70360 Bachelor or Engineering CNP HL70360 Certified Nurse Practitioner EMT HL70360 Emergency Medical Technician ME HL70360 Master of Engineering MT HL70360 Master of Theology PN HL70360 Advanced Practice Nurse Associate of Business ABA HL70360 Administration BS HL70360 Bachelor of Science BT HL70360 Bachelor of Theology CRN HL70360 Certified Registered Nurse HS HL70360 High School Graduate MFA HL70360 Master of Fine Arts PA HL70360 Physician Assistant SEC HL70360 Secretarial Certificate BA HL70360 Bachelor of Arts CMA HL70360 Certified Medical Assistant DIP HL70360 Diploma MBA HL70360 Master of Business Administration MDA HL70360 Medical Assistant MSL HL70360 Master of Science - Law PHE HL70360 Doctor of Engineering AA HL70360 Associate of Arts

Value Code System Description BFA HL70360 Bachelor of Fine Arts CNS HL70360 Certified Nurse Specialist Emergency Medical Technician - EMTP HL70360 Paramedic MED HL70360 Master of Education NG HL70360 Non-Graduate RMA HL70360 Registered Medical Assistant AE HL70360 Associate of Engineering BSL HL70360 Bachelor of Science - Law CANP HL70360 Certified Adult Nurse Practitioner DBA HL70360 Doctor of Business Administration JD HL70360 Juris Doctor

3.4.19 0361 - APPLICATION Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70361 No suggested values defined

3.4.20 0362 - FACILITY Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70362 No suggested values defined

3.4.21 0363 - ASSIGNING AUTHORITY Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined Page 81 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Codes Value Code System Description ... HL70363 No suggested values

3.4.22 0396 - CODING SYSTEM Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Dynamic Open Extensional

Reference URL: http://www.hl7.org/documentcenter/public/wg/vocab/Tbl0396.xls

Codes Value Code System Description Local general code for a site-defined code system used for a specific set of trading partners. The 'zzz' SHALL be any printable 99zzz or L HL70396 ASCII string. Length of the name SHALL not exceed field width, and is subject to local implementation. American College of Radiology finding ACR HL70396 codes ACTCODE HL70396 Table of HL7 Version 3 ActCode values Used to indicate that the target of the relationship will be a filtered subset of the total related set of targets. Used when there ACTRELSS HL70396 is a need to limit the number of components to the first, the last, the next, the total, the average or some other filtered or calculated subset. ALPHAID2006 HL70396 German Alpha-ID v2006 ALPHAID2007 HL70396 German Alpha-ID v2007 ALPHAID2008 HL70396 German Alpha-ID v2008 ALPHAID2009 HL70396 German Alpha-ID v2009 AMTv2 HL70396 Australian Medicines Terminology (v2) ANS+ HL70396 HL7 set of units of measure ART HL70396 WHO Adverse Reaction Terms AS4 HL70396 ASTM E1238/ E1467 Universal AS4E HL70396 AS4 Neurophysiology Codes ATC HL70396 American Type Culture Collection C4 HL70396 CPT-4 CAPECC HL70396 College of American Pathologists Electronic

Value Code System Description Cancer Checklist CAS HL70396 Chemical abstract codes CCC HL70396 Clinical Care Classification system CD2 HL70396 CDT-2 Codes CDCA HL70396 CDC Analyte Codes CDCEDACUITY HL70396 CDC Emergency Department Acuity cdcgs1vis HL70396 VIS Bar Codes (IIS) CDCINDUSTRY2010 HL70396 Industry CDC Census 2010 CDCM HL70396 CDC Methods/Instruments Codes CDC National Healthcare Safety Network CDCNHSN HL70396 Codes CDC BioSense RT observations (Census) - CDCOBS HL70396 CDC CDCOCCUPATION2010 HL70396 Occupation CDC Census 2010 CDCODH HL70396 Occupational Data for Health (ODH) CDCPHINVS HL70396 CDC PHIN Vocabulary Coding System CDCREC HL70396 Race & Ethnicity - CDC CDS HL70396 CDC Surveillance Chrom-Loc HL70396 Cytogenetic (chromosome) location CLINVAR-V HL70396 ClinVar Variant ID CLP HL70396 CLIP CMSOEC HL70396 OCE Edit Code CMSOMC HL70396 OCE Modifier Code COSMIC-Smpl HL70396 COSMIC - Simple variants COSMIC-Strc HL70396 COSMIC-Structural variants CPTM HL70396 CPT Modifier Code CST HL70396 COSTART CVX HL70396 CDC Vaccine Codes dbVar-GL HL70396 dbVar-Germline dbVar-som HL70396 dbVar-Somatic DCM HL70396 DICOM Controlled Terminology E HL70396 EUCLIDES E5 HL70396 Euclides quantity codes E6 HL70396 Euclides Lab method codes E7 HL70396 Euclides Lab equipment codes EDLEVEL HL70396 Education Level ensembl-G HL70396 Ensembl genomic reference sequence Ensembl-P HL70396 Ensembl protein reference sequence ensembl-T HL70396 Ensembl transcript reference sequence ENTITYCODE HL70396 Entity Code ENTITYHDLG HL70396 Entity Handling Code ENZC HL70396 Enzyme Codes

Value Code System Description EPASRS HL70396 EPA SRS FDAUNII HL70396 Unique Ingredient Identifier (UNII) FDDC HL70396 First DataBank Drug Codes FDDX HL70396 First DataBank Diagnostic Codes FDK HL70396 FDA K10 FIPS5_2 HL70396 FIPS 5-2 (State) FIPS55_3 HL70396 Populated Places (FIPS 55-3) FIPS6_4 HL70396 FIPS 6-4 (County) GDRG2006 HL70396 G-DRG German DRG Codes v 2006 GDRG2007 HL70396 G-DRG German DRG Codes v2007 GDRG2008 HL70396 G-DRG German DRG Codes v2008 GDRG2009 HL70396 G-DRG German DRG Codes v2008 GMDC2006 HL70396 German Major v2006 Diagnostic Codes GMDC2007 HL70396 German Major Diagnostic Codes v2007 GMDC2008 HL70396 German Major Diagnostic Codes v2008 HB HL70396 HIBCC CMS (formerly HCFA) Common Procedure HCPCS HL70396 Coding System HCPT HL70396 Health Care Provider Taxonomy HGNC-Symb HL70396 HGNC-symb HGVS.c HL70396 HGVS- Transcript syntax HGVS.g HL70396 HGVS- Genomic syntax HGVS.p HL70396 HGVS-Protein syntax HHC HL70396 Home Health Care HI HL70396 Health Outcomes HOT HL70396 Japanese Nationwide Medicine Code CMS (formerly HCFA )Procedure Codes HPC HL70396 (HCPCS) HSLOC HL70396 Healthcare Service Location I10 HL70396 ICD-10 International Classification of Diseases, 10th I10C HL70396 Revision, Clinical Modification (ICD-10-CM) I10G2006 HL70396 ICD 10 Germany 2006 International Classification of Diseases, 10th I10P HL70396 Revision, Procedure Coding System (ICD- 10-PCS) I10P0 HL70396 ICD-10 Place of Occurrence I9 HL70396 ICD9 International Classification of Diseases, 9th I9C HL70396 Revision, Clinical Modification (ICD-9-CM) I9CDX HL70396 ICD-9CM Diagnosis codes I9CP HL70396 ICD-9CM Procedure codes IBT0001 HL70396 ISBT 128 Standard

Value Code System Description transfusion/transplantation data items IC2 HL70396 ICHPPC-2 ICD10AM HL70396 ICD-10 Australian modification ICD10CA HL70396 ICD-10 Canada ICD10GM2007 HL70396 ICD 10 Germany v2007 ICD10GM2008 HL70396 ICD 10 Germany v2008 ICD10GM2009 HL70396 ICD 10 Germany v2009 International Classification of Diseases for ICDO HL70396 Oncology International Classification of Disease for ICDO2 HL70396 Oncology Second Edition International Classification of Disease for ICDO3 HL70396 Oncology Third Edition International Classification of Functioning, ICF HL70396 Disability and Health (ICF) ICS HL70396 ICCS International Classification of Sleep ICSD HL70396 Disorders IHE Laboratory Analytical Workflow (LAW) IHELAW HL70396 Profile Codes. International System for Human Cytogenetic ISCN HL70396 Nomenclature (ISCN) ISO 2955.83 (units of measure) with HL7 ISO+ HL70396 extensions ISO3166_1 HL70396 ISO 3166-1 Country Codes ISO3166_2 HL70396 ISO 3166-2 Country subdivisions ISO4217 HL70396 ISO4217 Currency Codes ISO639 HL70396 ISO 639 Language ITIS HL70396 Integrated Taxonomic Information System IUPC HL70396 IUPAC/IFCC Component Codes IUPP HL70396 IUPAC/IFCC Property Codes JC10 HL70396 JLAC/JSLM, nationwide laboratory code JC8 HL70396 Japanese Chemistry JJ1017 HL70396 Japanese Image Examination Cache LANGUAL HL70396 LanguaL LB HL70396 Local billing code Logical Observation Identifier Names and LN HL70396 Codes (LOINC®) LRG-RefSeq HL70396 Locus Reference Genomic (LRG) MCD HL70396 Medicaid MCR HL70396 Medicare MDC HL70396 Medical Device Communication MDDX HL70396 Medispan Diagnostic Codes

Value Code System Description MEDC HL70396 Medical Economics Drug Codes Medgen-Dis HL70396 NCBI MedGen disease subset MEDIATYPE HL70396 MIME Media Type IANA Medical Dictionary for Drug Regulatory MEDR HL70396 Affairs (MEDDRA) MEDX HL70396 Medical Economics Diagnostic Codes MGPI HL70396 Medispan GPI MVX HL70396 CDC Vaccine Manufacturer Codes NAICS HL70396 Industry (NAICS) NCPDP code list for data element nnnn [as NCPDPnnnnsss HL70396 used in segment sss] NDA HL70396 NANDA NDC HL70396 National drug codes NDFRT HL70396 NDF-RT (Drug Classification) NIC HL70396 Nursing Interventions Classification NIP001 HL70396 Source of Information (Immunization) NIP002 HL70396 Substance refusal reason Vaccination - Contraindications, NIP004 HL70396 Precautions, and Immunities NIP007 HL70396 Vaccinated at location (facility) NIP008 HL70396 Vaccine purchased with (Type of funding) NIP009 HL70396 Reported adverse event previously NIP010 HL70396 VAERS Report type Notifiable Event (Disease/Condition) Code NND HL70396 List NPI HL70396 National Provider Identifier NUBC HL70396 National Uniform Billing Committee Code NULLFL HL70396 Flavors of NULL O3012006 HL70396 Ops Germany 2006 OBSMETHOD HL70396 Observation Method Code OHA HL70396 Omaha System OPS2007 HL70396 OPS Germany v2007 OPS2008 HL70396 OPS Germany v2008 OPS2009 HL70396 OPS Germany v2008 PHDSCSOPT HL70396 Source of Payment Typology CDC Public Health Information Network PHINQUESTION HL70396 (PHIN) Question CDC PHLIP Lab result codes that are not PLR HL70396 covered in SNOMED at the time of this implementation CDC PHLIP Lab test codes, where LOINC concept is too broad or not yet available, PLT HL70396 especially as needed for ordering and or lab to lab reporting ) Page 86 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description POS HL70396 POS Codes PRTCPTNMODE HL70396 Paticipation Mode Code RC HL70396 Read Classification NCBI - genomic and chromosome reference refSeq-G HL70396 sequences RefSeq-P HL70396 NCBI - protein reference sequence NCBI-transcript reference sequences refSeq-T HL70396 (RefSeq) ROLECLASS HL70396 Used initially for contact roles. ROLECODE HL70396 Participation Mode Specifies the mode, immediate versus deferred or queued, by which a receiver RSPMODE HL70396 should communicate its receiver responsibilities. RXNORM HL70396 RxNorm RxT-Ingrd HL70396 RxTerms-Ingredients Subset SCT HL70396 SNOMED Clinical Terms SNOMED Clinical Terms alphanumeric SCT2 HL70396 codes SDM HL70396 SNOMED- DICOM Microglossary SIC HL70396 Industry (SIC) Systemized Nomenclature of Medicine SNM HL70396 (SNOMED) SNM3 HL70396 SNOMED International SNT HL70396 SNOMED topology codes (anatomic sites) SOC HL70396 Occupation (SOC 2000) UB04FL14 HL70396 Priority (Type) of Visit UB04FL15 HL70396 Point of Origin UB04FL17 HL70396 Patient Discharge Status UB04FL31 HL70396 Occurrence Code UB04FL35 HL70396 Occurrence Span UB04FL39 HL70396 Value Code UB04FL42 HL70396 Revenue Code UB04FL67 HL70396 Present on Admission UC HL70396 UCDS UCUM code set for units of measure(from UCUM HL70396 Regenstrief) UMD HL70396 MDNS UML HL70396 Unified Medical Language UPC HL70396 Universal Product Code UPIN HL70396 UPIN U.S. Board on Geographic Names (USGS - USGSGNIS HL70396 GNIS)

Value Code System Description USPS HL70396 United States Postal Service Clinicians are required to track the Vaccine Information Sheet (VIS) that was shared with the recipient of a vaccination. This code VIS HL70396 system contains codes that identify the document type and the owner of the document. W1 HL70396 WHO record # drug codes (6 digit) W2 HL70396 WHO record # drug codes (8 digit) W4 HL70396 WHO record # code with ASTM extension WC HL70396 WHO ATC X12DEnnnn HL70396 ASC X12 Code List nnnn

3.4.23 0399 - COUNTRY CODE Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description use 3-character (alphabetic) form ... HL70399 of ISO 3166

3.4.24 0444 - NAME ASSEMBLY ORDER Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description F HL70444 Prefix Family Middle Given Suffix G HL70444 Prefix Given Middle Family Suffix

3.4.25 0448 - NAME CONTEXT Metadata Type: Internally managed

Attributes

Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description ... HL70448 No suggested values defined

3.4.26 0465 - NAME/ADDRESS REPRESENTATION Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description Phonetic (i.e., ASCII, Katakana, P HL70465 Hiragana, etc.) Alphabetic (i.e., Default or some A HL70465 single-byte) I HL70465 Ideographic (i.e., Kanji)

3.4.27 0532 - EXPANDED YES/NO INDICATOR Metadata Type: Internally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Codes Value Code System Description NP HL70532 not present N HL70532 No NAV HL70532 temporarily unavailable UNK HL70532 unknown NA HL70532 not applicable NI HL70532 No Information ASKU HL70532 asked but unknown Y HL70532 Yes NASK HL70532 not asked

3.4.28 PHVS_ACKNOWLEDGMENTCODE_HL7_2X - ACKNOWLEDGMENT CODE (HL7) Metadata Page 89 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

OID: 2.16.840.1.114222.4.11.958 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.958

Codes Value Code System Description Enhanced mode: Accept CA HL70008 acknowledgment: Commit Accept Enhanced mode: Accept CE HL70008 acknowledgment: Commit Error Enhanced mode: Accept CR HL70008 acknowledgment: Commit Reject Original mode: Application Accept - AA HL70008 Enhanced mode: Application acknowledgment: Accept Original mode: Application Error - AE HL70008 Enhanced mode: Application acknowledgment: Error Original mode: Application Reject - AR HL70008 Enhanced mode: Application acknowledgment: Reject

Acknowledgment code indicating receipt of message. (See message processing rules. Refer to HL7 Table 0008 - Acknowledgment code for valid values.) Null flavors are not allowed.

3.4.29 PHVS_ADMINISTRATIVEDIAGNOSIS_CDC_ICD-10CM - DIAGNOSIS (ICD-10 CM) ICD-10 CM Administrative Diagnosis Codes used for billing purposes, Reason for Study, DG1 Diagnosis segments Keyword: ICD-10 CM

Metadata OID: 2.16.840.1.114222.4.11.7356 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7356

ICD-10 CM Administrative Diagnosis Codes used for billing purposes, Reason for Study, DG1 Diagnosis segments Keyword: ICD-10 CM

3.4.30 PHVS_ADMINISTRATIVEPROCEDURE_CDC_ICD-10PCS - PROCEDURE (ICD-10 PCS) ICD-10 PCS Procedure Codes used for billing purposes, Reason for Study, PR1 Diagnosis segments

Metadata OID: 2.16.840.1.114222.4.11.7371 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7371

ICD-10 PCS Procedure Codes used for billing purposes, Reason for Study, PR1 Diagnosis segments

3.4.31 PHVS_ADMISSIONTYPE_HL7_2X - ADMISSION TYPE (HL7) Metadata OID: 2.16.840.1.114222.4.11.913 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.913

Codes Value Code System Description A HL70007 Accident C HL70007 Elective E HL70007 Emergency L HL70007 Labor and Delivery Newborn (Birth in healthcare N HL70007 facility) R HL70007 Routine U HL70007 Urgent

HL7 version 2.5 User-Defined Table 0007 Admit Type codes used in ADT messages

3.4.32 PHVS_ADMITSOURCE_HL7_2X - ADMISSION SOURCE (HL7) A user defined set of codes that can be used to indicate from where the patient came in.

Metadata OID: 2.16.840.1.114222.4.11.918 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.918

Codes Value Code System Description born HL70023 Born in hospital emd HL70023 From accident/emergency department nursing HL70023 From nursing home outp HL70023 From outpatient department psych HL70023 From psychiatric hospital rehab HL70023 From rehabilitation facility gp HL70023 General Practitioner referral mp HL70023 Medical Practitioner/physician referral other HL70023 Other Self HL70023 Self-Referral hosp-trans HL70023 Transferred from other hospital 1 HL70023 Physician referral 2 HL70023 Clinic referral 3 HL70023 HMO referral 4 HL70023 Transfer from a hospital 5 HL70023 Transfer from a skilled nursing facility 6 HL70023 Transfer from another health care facility 7 HL70023 Emergency room 8 HL70023 Court/law enforcement 9 HL70023 Information not available

HL7 version 2.5 User-Defined Table 0023 Admit Source codes used in ADT messages

3.4.33 PHVS_AGEUNIT_SYNDROMICSURVEILLANCE - AGE UNIT (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.3402 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3402

Codes Value Code System Description d UCUM day mo UCUM month UNK NULLFL unknown wk UCUM week a UCUM year

Unit corresponding to numeric value of patient age (e.g. Days, Month or Years) specific for syndromic surveillance

3.4.34 PHVS_BLOODPRESSUREUNIT_UCUM - BLOOD PRESSURE UNIT Metadata OID: 2.16.840.1.114222.4.11.920 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.920

Codes Value Code System Description MilliMeters of Mercury [Blood mm[Hg] UCUM Pressure Unit]

Units of measure for Blood Pressure

3.4.35 PHVS_COUNTRY_ISO_3166-1 - COUNTRY Codes representing country of origin, nationality, citizenship, address country

Metadata OID: 2.16.840.1.114222.4.11.828 Type: Externally managed

Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.828

Codes Value Code System Description AFG ISO3166_1 AFGHANISTAN ALA ISO3166_1 ÅLAND ISLANDS ALB ISO3166_1 ALBANIA DZA ISO3166_1 ALGERIA ASM ISO3166_1 AMERICAN SAMOA AND ISO3166_1 ANDORRA AGO ISO3166_1 ANGOLA AIA ISO3166_1 ANGUILLA ATA ISO3166_1 ANTARCTICA ATG ISO3166_1 ANTIGUA AND BARBUDA ARG ISO3166_1 ARGENTINA ARM ISO3166_1 ARMENIA ABW ISO3166_1 ARUBA AUS ISO3166_1 AUSTRALIA AUT ISO3166_1 AUSTRIA AZE ISO3166_1 AZERBAIJAN BHS ISO3166_1 BAHAMAS BHR ISO3166_1 BAHRAIN BGD ISO3166_1 BANGLADESH BRB ISO3166_1 BARBADOS BLR ISO3166_1 BELARUS BEL ISO3166_1 BELGIUM BLZ ISO3166_1 BELIZE BEN ISO3166_1 BENIN BMU ISO3166_1 BERMUDA BTN ISO3166_1 BHUTAN BOL ISO3166_1 BOLIVIA BONAIRE, SINT EUSTATIUS and BES ISO3166_1 SABA BIH ISO3166_1 BOSNIA AND HERZEGOVINA BWA ISO3166_1 BOTSWANA BVT ISO3166_1 BOUVET ISLAND BRA ISO3166_1 BRAZIL IOT ISO3166_1 BRITISH INDIAN OCEAN TERRITORY BRN ISO3166_1 BRUNEI DARUSSALAM BGR ISO3166_1 BULGARIA Page 94 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description BFA ISO3166_1 BURKINA FASO BDI ISO3166_1 BURUNDI KHM ISO3166_1 CAMBODIA CMR ISO3166_1 CAMEROON CAN ISO3166_1 CANADA CPV ISO3166_1 CAPE VERDE CYM ISO3166_1 CAYMAN ISLANDS CAF ISO3166_1 CENTRAL AFRICAN REPUBLIC TCD ISO3166_1 CHAD CHL ISO3166_1 CHILE CHN ISO3166_1 CHINA CXR ISO3166_1 CHRISTMAS ISLAND CCK ISO3166_1 COCOS (KEELING) ISLANDS COL ISO3166_1 COLOMBIA COM ISO3166_1 COMOROS COG ISO3166_1 CONGO CONGO, THE DEMOCRATIC COD ISO3166_1 REPUBLIC OF THE COK ISO3166_1 COOK ISLANDS CRI ISO3166_1 COSTA RICA CIV ISO3166_1 CÔTE D'IVOIRE HRV ISO3166_1 CROATIA CUB ISO3166_1 CUBA CUW ISO3166_1 CURACAO CYP ISO3166_1 CYPRUS CZE ISO3166_1 CZECH REPUBLIC DNK ISO3166_1 DENMARK DJI ISO3166_1 DJIBOUTI DMA ISO3166_1 DOMINICA DOM ISO3166_1 DOMINICAN REPUBLIC ECU ISO3166_1 ECUADOR EGY ISO3166_1 EGYPT SLV ISO3166_1 EL SALVADOR GNQ ISO3166_1 EQUATORIAL GUINEA ERI ISO3166_1 ERITREA EST ISO3166_1 ESTONIA SWZ ISO3166_1 ESWATINI ETH ISO3166_1 ETHIOPIA FLK ISO3166_1 FALKLAND ISLANDS (MALVINAS) FRO ISO3166_1 FAROE ISLANDS FJI ISO3166_1 FIJI FIN ISO3166_1 FINLAND

Value Code System Description FRA ISO3166_1 FRANCE GUF ISO3166_1 FRENCH GUIANA PYF ISO3166_1 FRENCH POLYNESIA ATF ISO3166_1 FRENCH SOUTHERN TERRITORIES GAB ISO3166_1 GABON GMB ISO3166_1 GAMBIA GEO ISO3166_1 GEORGIA DEU ISO3166_1 GERMANY GHA ISO3166_1 GHANA GIB ISO3166_1 GIBRALTAR GRC ISO3166_1 GREECE GRL ISO3166_1 GREENLAND GRD ISO3166_1 GRENADA GLP ISO3166_1 GUADELOUPE GUM ISO3166_1 GUAM GTM ISO3166_1 GUATEMALA GGY ISO3166_1 GUERNSEY GIN ISO3166_1 GUINEA GNB ISO3166_1 GUINEA-BISSAU GUY ISO3166_1 GUYANA HTI ISO3166_1 HAITI HEARD ISLAND AND MCDONALD HMD ISO3166_1 ISLANDS VAT ISO3166_1 HOLY SEE HND ISO3166_1 HONDURAS HKG ISO3166_1 HONG KONG HUN ISO3166_1 HUNGARY ISL ISO3166_1 ICELAND IND ISO3166_1 INDIA IDN ISO3166_1 INDONESIA IRN ISO3166_1 IRAN, ISLAMIC REPUBLIC OF IRQ ISO3166_1 IRAQ IRL ISO3166_1 IRELAND IMN ISO3166_1 ISLE OF MAN ISR ISO3166_1 ISRAEL ITA ISO3166_1 ITALY JAM ISO3166_1 JAMAICA JPN ISO3166_1 JAPAN JEY ISO3166_1 JERSEY JOR ISO3166_1 JORDAN KAZ ISO3166_1 KAZAKHSTAN KEN ISO3166_1 KENYA

Value Code System Description KIR ISO3166_1 KIRIBATI KOREA, DEMOCRATIC PEOPLE'S PRK ISO3166_1 REPUBLIC OF KOR ISO3166_1 KOREA, REPUBLIC OF KWT ISO3166_1 KUWAIT KGZ ISO3166_1 KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC LAO ISO3166_1 REPUBLIC LVA ISO3166_1 LATVIA LBN ISO3166_1 LEBANON LSO ISO3166_1 LESOTHO LBR ISO3166_1 LIBERIA LBY ISO3166_1 LIBYAN ARAB JAMAHIRIYA LIE ISO3166_1 LIECHTENSTEIN LTU ISO3166_1 LITHUANIA LUX ISO3166_1 LUXEMBOURG MAC ISO3166_1 MACAO MACEDONIA, THE FORMER MKD ISO3166_1 YUGOSLAV REPUBLIC OF MDG ISO3166_1 MADAGASCAR MWI ISO3166_1 MALAWI MYS ISO3166_1 MALAYSIA MDV ISO3166_1 MALDIVES MLI ISO3166_1 MALI MLT ISO3166_1 MALTA MHL ISO3166_1 MARSHALL ISLANDS MTQ ISO3166_1 MARTINIQUE MRT ISO3166_1 MAURITANIA MUS ISO3166_1 MAURITIUS MYT ISO3166_1 MAYOTTE MEX ISO3166_1 MEXICO MICRONESIA, FEDERATED STATES FSM ISO3166_1 OF MDA ISO3166_1 MOLDOVA, REPUBLIC OF MCO ISO3166_1 MONACO MNG ISO3166_1 MONGOLIA MNE ISO3166_1 MONTENEGRO MSR ISO3166_1 MONTSERRAT MAR ISO3166_1 MOROCCO MOZ ISO3166_1 MOZAMBIQUE MMR ISO3166_1 MYANMAR NAM ISO3166_1 NAMIBIA NRU ISO3166_1 NAURU Page 97 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description NPL ISO3166_1 NEPAL NLD ISO3166_1 NETHERLANDS NCL ISO3166_1 NEW CALEDONIA NZL ISO3166_1 NEW ZEALAND NIC ISO3166_1 NICARAGUA NER ISO3166_1 NIGER NGA ISO3166_1 NIGERIA NIU ISO3166_1 NIUE NFK ISO3166_1 NORFOLK ISLAND MNP ISO3166_1 NORTHERN MARIANA ISLANDS NOR ISO3166_1 NORWAY OMN ISO3166_1 OMAN OTH NULLFL other PAK ISO3166_1 PAKISTAN PLW ISO3166_1 PALAU PSE ISO3166_1 PALESTINE, STATE OF PAN ISO3166_1 PANAMA PNG ISO3166_1 PAPUA NEW GUINEA PRY ISO3166_1 PARAGUAY PER ISO3166_1 PERU PHL ISO3166_1 PHILIPPINES PCN ISO3166_1 PITCAIRN POL ISO3166_1 POLAND PRT ISO3166_1 PORTUGAL PRI ISO3166_1 PUERTO RICO QAT ISO3166_1 QATAR REU ISO3166_1 RÉUNION ROU ISO3166_1 ROMANIA RUS ISO3166_1 RUSSIAN FEDERATION RWA ISO3166_1 RWANDA BLM ISO3166_1 SAINT BARTHÉLEMY SHN ISO3166_1 SAINT HELENA KNA ISO3166_1 SAINT KITTS AND NEVIS LCA ISO3166_1 SAINT LUCIA MAF ISO3166_1 SAINT MARTIN (FRENCH PART) SPM ISO3166_1 SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE VCT ISO3166_1 GRENADINES WSM ISO3166_1 SAMOA SMR ISO3166_1 SAN MARINO STP ISO3166_1 SAO TOME AND PRINCIPE SAU ISO3166_1 SAUDI ARABIA

Value Code System Description SEN ISO3166_1 SENEGAL SRB ISO3166_1 SERBIA SYC ISO3166_1 SEYCHELLES SLE ISO3166_1 SIERRA LEONE SGP ISO3166_1 SINGAPORE SXM ISO3166_1 SINT MAARTEN (DUTCH PART) SVK ISO3166_1 SLOVAKIA SVN ISO3166_1 SLOVENIA SLB ISO3166_1 SOLOMON ISLANDS SOM ISO3166_1 SOMALIA ZAF ISO3166_1 SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SGS ISO3166_1 SANDWICH ISLANDS SSD ISO3166_1 South Sudan ESP ISO3166_1 SPAIN LKA ISO3166_1 SRI LANKA SDN ISO3166_1 SUDAN SUR ISO3166_1 SURINAME SJM ISO3166_1 SVALBARD AND JAN MAYEN SWE ISO3166_1 SWEDEN CHE ISO3166_1 SWITZERLAND SYR ISO3166_1 SYRIAN ARAB REPUBLIC TWN ISO3166_1 TAIWAN, PROVINCE OF CHINA TJK ISO3166_1 TAJIKISTAN TZA ISO3166_1 TANZANIA, UNITED REPUBLIC OF THA ISO3166_1 THAILAND TLS ISO3166_1 TIMOR-LESTE TGO ISO3166_1 TOGO TKL ISO3166_1 TOKELAU TON ISO3166_1 TONGA TTO ISO3166_1 TRINIDAD AND TOBAGO TUN ISO3166_1 TUNISIA TUR ISO3166_1 TURKEY TKM ISO3166_1 TURKMENISTAN TCA ISO3166_1 TURKS AND CAICOS ISLANDS TUV ISO3166_1 TUVALU UGA ISO3166_1 UGANDA UKR ISO3166_1 UKRAINE ARE ISO3166_1 UNITED ARAB EMIRATES GBR ISO3166_1 UNITED KINGDOM USA ISO3166_1 UNITED STATES UMI ISO3166_1 UNITED STATES MINOR OUTLYING

Value Code System Description ISLANDS UNK NULLFL unknown URY ISO3166_1 URUGUAY UZB ISO3166_1 UZBEKISTAN VUT ISO3166_1 VANUATU VENEZUELA, BOLIVARIAN REPUBLIC VEN ISO3166_1 OF VNM ISO3166_1 VIET NAM VGB ISO3166_1 VIRGIN ISLANDS, BRITISH VIR ISO3166_1 VIRGIN ISLANDS, U.S. WLF ISO3166_1 WALLIS AND FUTUNA ESH ISO3166_1 WESTERN SAHARA YEM ISO3166_1 YEMEN ZMB ISO3166_1 ZAMBIA ZWE ISO3166_1 ZIMBABWE

Codes representing country of origin, nationality, citizenship, address country

3.4.36 PHVS_COUNTY_FIPS_6-4 - COUNTY Metadata OID: 2.16.840.1.114222.4.11.829 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.829

Codes representing county of origin, address county, reporting county.

3.4.37 PHVS_DIAGNOSISPRIORITY_HL7_2X - DIAGNOSIS PRIORITY (HL7) Metadata OID: 2.16.840.1.114222.4.11.914 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.914 Page 100 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Codes Value Code System Description 0 HL70359 Not included in diagnosis ranking 1 HL70359 The primary diagnosis 2 HL70359 For ranked secondary diagnoses 3 HL70359 For ranked secondary diagnosis 4 HL70359 For ranked secondary diagnosis 5 HL70359 For ranked secondary diagnosis 6 HL70359 For ranked secondary diagnosis 7 HL70359 For ranked secondary diagnosis 8 HL70359 For ranked secondary diagnosis 9 HL70359 For ranked secondary diagnosis 10 HL70359 For ranked secondary diagnosis 11 HL70359 For ranked secondary diagnosis 12 HL70359 For ranked secondary diagnosis 13 HL70359 For ranked secondary diagnosis 14 HL70359 For ranked secondary diagnosis 15 HL70359 For ranked secondary diagnosis 16 HL70359 For ranked secondary diagnosis 17 HL70359 For ranked secondary diagnosis 18 HL70359 For ranked secondary diagnosis 19 HL70359 For ranked secondary diagnosis 20 HL70359 For ranked secondary diagnosis 21 HL70359 For ranked secondary diagnosis 22 HL70359 For ranked secondary diagnosis 23 HL70359 For ranked secondary diagnosis 24 HL70359 For ranked secondary diagnosis 25 HL70359 For ranked secondary diagnosis 26 HL70359 For ranked secondary diagnosis 27 HL70359 For ranked secondary diagnosis 28 HL70359 For ranked secondary diagnosis 29 HL70359 For ranked secondary diagnosis 30 HL70359 For ranked secondary diagnosis 31 HL70359 For ranked secondary diagnosis 32 HL70359 For ranked secondary diagnosis 33 HL70359 For ranked secondary diagnosis 34 HL70359 For ranked secondary diagnosis 35 HL70359 For ranked secondary diagnosis 36 HL70359 For ranked secondary diagnosis 37 HL70359 For ranked secondary diagnosis 38 HL70359 For ranked secondary diagnosis 39 HL70359 For ranked secondary diagnosis

Value Code System Description 40 HL70359 For ranked secondary diagnosis 41 HL70359 For ranked secondary diagnosis 42 HL70359 For ranked secondary diagnosis 43 HL70359 For ranked secondary diagnosis 44 HL70359 For ranked secondary diagnosis 45 HL70359 For ranked secondary diagnosis 46 HL70359 For ranked secondary diagnosis 47 HL70359 For ranked secondary diagnosis 48 HL70359 For ranked secondary diagnosis 49 HL70359 For ranked secondary diagnosis 50 HL70359 For ranked secondary diagnosis

The number from HL7 Table 0359 - Diagnosis Priority that identifies the significance or priority of the diagnosis code, with 1 being the Primary diagnosis, etc.

3.4.38 PHVS_DIAGNOSISTYPE_HL7_2X - DIAGNOSIS TYPE (HL7) Metadata OID: 2.16.840.1.114222.4.11.827 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.827

Codes Value Code System Description A HL70052 Admitting F HL70052 Final W HL70052 Working

A code from HL7 2.5 User-defined Table 0052 - Diagnosis Type that identifies the type of diagnosis being sent (Admitting, Working, Final).

3.4.39 PHVS_DISCHARGEDISPOSITION_HL7_2X - DISCHARGE DISPOSITION (HL7) The disposition of the patient at time of discharge (i.e., discharged to home, expired, etc.). Uses User-defined Table 0112 - Discharge Disposition; this field is used on UB92 FL22.

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Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.915

Codes Value Code System Description Discharged to home care or self care (routine 01 HL70112 discharge) "Discharged/transferred to a short term 02 HL70112 general hospital for inpatient care" "Discharged/transferred to skilled nursing 03 HL70112 facility (SNF) with Medicare certification in anticipation of covered skilled care" "Discharged/transferred to a facility that 04 HL70112 provides custodial or supportive care" Discharged/transferred to a designated cancer 05 HL70112 center or children’s hospital "Discharged/transferred to home under care of 06 HL70112 organized home health service organization in anticipation of covered skilled care" Left against medical advice or discontinued 07 HL70112 care Discharged/transferred to home under care of 08 HL70112 a Home IV provider 09 HL70112 Admitted as an inpatient to this hospital Discharge to be defined at state level, if 10 HL70112 necessary Discharge to be defined at state level, if 11 HL70112 necessary Discharge to be defined at state level, if 12 HL70112 necessary Discharge to be defined at state level, if 13 HL70112 necessary Discharge to be defined at state level, if 14 HL70112 necessary Discharge to be defined at state level, if 15 HL70112 necessary Discharge to be defined at state level, if 16 HL70112 necessary Discharge to be defined at state level, if 17 HL70112 necessary Discharge to be defined at state level, if 18 HL70112 necessary

Value Code System Description Discharge to be defined at state level, if 19 HL70112 necessary 20 HL70112 Expired Discharged/transferred to court/law 21 HL70112 enforcement Expired to be defined at state level, if 22 HL70112 necessary Expired to be defined at state level, if 23 HL70112 necessary Expired to be defined at state level, if 24 HL70112 necessary Expired to be defined at state level, if 25 HL70112 necessary Expired to be defined at state level, if 26 HL70112 necessary Expired to be defined at state level, if 27 HL70112 necessary Expired to be defined at state level, if 28 HL70112 necessary Expired to be defined at state level, if 29 HL70112 necessary 30 HL70112 Still Patient "Still patient to be defined at state level, if 31 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 32 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 33 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 34 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 35 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 36 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 37 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 38 HL70112 necessary (i.e. still a patient)" "Still patient to be defined at state level, if 39 HL70112 necessary (i.e. still a patient)" 40 HL70112 Expired (i.e. died) at home "Expired (i.e. died) in a medical facility; e.g., 41 HL70112 hospital, SNF, ICF, or free standing hospice" 42 HL70112 Expired - place unknown 43 HL70112 Discharged/transferred to a federal health care

Value Code System Description facility 44 HL70112 Reserved for national assignment 45 HL70112 Reserved for national assignment 46 HL70112 Reserved for national assignment 47 HL70112 Reserved for national assignment 48 HL70112 Reserved for national assignment 49 HL70112 Reserved for national assignment 50 HL70112 Hospice - home Hospice - medical facility (certified) providing 51 HL70112 hospice level of care 52 HL70112 Reserved for national assignment 53 HL70112 Reserved for national assignment 54 HL70112 Reserved for national assignment 55 HL70112 Reserved for national assignment 56 HL70112 Reserved for national assignment 57 HL70112 Reserved for national assignment 58 HL70112 Reserved for national assignment 59 HL70112 Reserved for national assignment 60 HL70112 Reserved for national assignment Discharged/transferred to hospital-based 61 HL70112 Medicare approved swing bed "Discharged/transferred to an inpatient 62 HL70112 rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital" "Discharged/transferred to a Medicare certified 63 HL70112 long term care hospital (LTCH)" "Discharged/transferred to a nursing facility 64 HL70112 certified under Medicaid but not certified under Medicare" "Discharged/transferred to a psychiatric 65 HL70112 hospital or psychiatric distinct part unit of a hospital" Discharged/transferred to a Critical Access 66 HL70112 Hospital (CAH) 67 HL70112 Reserved for national assignment 68 HL70112 Reserved for national assignment 69 HL70112 Reserved for national assignment "Discharged/transferred to another type of 70 HL70112 health care institution not defined elsewhere in this code list (See Code 05)" Reserved for national assignment 71 HL70112 (Discontinued effective 4/1/03) Reserved for national assignment 72 HL70112 (Discontinued effective 4/1/03)

Value Code System Description 73 HL70112 Reserved for national assignment 74 HL70112 Reserved for national assignment 75 HL70112 Reserved for national assignment 76 HL70112 Reserved for national assignment 77 HL70112 Reserved for national assignment 78 HL70112 Reserved for national assignment 79 HL70112 Reserved for national assignment 80 HL70112 Reserved for national assignment Discharged to home or self-care with a 81 HL70112 planned acute care hospital readmission Discharged/transferred to a short term general 82 HL70112 hospital for inpatient care with a planned acute care hospital inpatient readmission Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a 83 HL70112 planned acute care hospital inpatient readmission Discharged/transferred to a facility that provides custodial or supportive care with a 84 HL70112 planned acute care hospital inpatient readmission Discharged/transferred to a designated cancer 85 HL70112 center or children’s hospital with a planned acute care hospital inpatient readmission Discharged/transferred to home under care of organized home health service organization 86 HL70112 with a planned acute care hospital inpatient readmission Discharged/transferred to court/law 87 HL70112 enforcement with a planned acute care hospital inpatient readmission Discharged/transferred to a federal health care 88 HL70112 facility with a planned acute care hospital inpatient readmission Discharged/transferred to a hospital-based 89 HL70112 Medicare approved swing bed with a planned acute care hospital inpatient readmission Discharged/transferred to an inpatient rehabilitation facility (IRF) including 90 HL70112 rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission Discharged/transferred to a Medicare certified 91 HL70112 long term care hospital (LTCH) with a planned acute care hospital inpatient readmission 92 HL70112 Discharged/transferred to nursing facility

Value Code System Description certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission Discharged/transferred to a psychiatric hospital/distinct part unit of a hospital with a 93 HL70112 planned acute care hospital inpatient readmission Discharged/transferred to a critical access 94 HL70112 hospital (CAH) with a planned acute care hospital inpatient readmission Discharged/transferred to another type of health care institution not defined elsewhere in 95 HL70112 this code list with a planned acute care hospital inpatient readmission 96 HL70112 Reserved for national assignment 97 HL70112 Reserved for national assignment 98 HL70112 Reserved for national assignment 99 HL70112 Reserved for national assignment 100 HL70112 Discharged for Other Reasons 101 HL70112 Discharged to Care of Family/Friend(s) 102 HL70112 Discharged to Care of Paid Caregiver 103 HL70112 Discharged to Court/ Law Enforcement/Jail Discharged to Other Facility per Legal 104 HL70112 Guidelines 105 HL70112 Discharge required by Carrier Change 106 HL70112 Internal Transfer per Legal Guidelines 107 HL70112 Other Home Care 108 HL70112 Regular Discharge with Follow-up 109 HL70112 Return Transfer

The disposition of the patient at time of discharge (i.e., discharged to home, expired, etc.). Uses User-defined Table 0112 - Discharge Disposition; this field is used on UB92 FL22.

3.4.40 PHVS_DISEASE_CDC - DISEASE Disease or Disorder - 64572001 SNOMED Domain

Metadata OID: 2.16.840.1.114222.4.11.909 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.909

Disease or Disorder - 64572001 SNOMED Domain

3.4.41 PHVS_EMERGENCYSEVERITYINDEXACUITY_CDC - EMERGENCY SEVERITY INDEX - ACUITY Metadata OID: 2.16.840.1.114222.4.11.7776 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7776

Codes Value Code System Description 1 CDCEDACUITY Resuscitation 2 CDCEDACUITY Emergent 3 CDCEDACUITY Urgent 4 CDCEDACUITY Less Urgent 5 CDCEDACUITY Nonurgent

The Emergency Severity Index (ESI) is a tool for use in emergency department (ED) triage. The ESI triage algorithm yields rapid, reproducible, and clinically relevant stratification of patients into five groups, from level 1 (most urgent) to level 5 (least urgent). The ESI provides a method for categorizing ED patients by both acuity and resource needs. (https://www.ahrq.gov/professionals/systems/hospital/esi/index.html ) Based upon AHRQ 2012 Edition on the Implementation Handbook - version 4.

3.4.42 PHVS_ETHNICITYGROUP_CDC - ETHNICITY GROUP Metadata OID: 2.16.840.1.114222.4.11.837 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.837

Codes

Value Code System Description 2135-2 CDCREC Hispanic or Latino 2186-5 CDCREC Not Hispanic or Latino

Whether the patient is hispanic or not

3.4.43 PHVS_EVENTTYPE_SYNDROMICSURVEILLANCE - EVENT TYPE (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.6048 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6048

Codes Value Code System Description A03 HL70003 ADT/ACK - Discharge/end visit A04 HL70003 ADT/ACK - Register a patient ADT/ACK - Update patient A08 HL70003 information A01 HL70003 ADT/ACK - Admit/visit notification

List of Table 0003:?Event Types associated with Syndromic Surveillance IG.

3.4.44 PHVS_FACILITYVISITTYPE_SYNDROMICSURVEILLANCE - FACILITY / VISIT TYPE (SYNDROMIC SURVEILLANCE) Type of facility that the patient visited for treatment.

Metadata OID: 2.16.840.1.114222.4.11.3401 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3401

Value Code System Description Emergency Care [Ambulatory Health Care 261QE0002X HCPTNUCC Facilities\Clinic/Center] 1021-5 HSLOC Inpatient practice setting Medical Specialty [Ambulatory Health Care 261QM2500X HCPTNUCC Facilities\Clinic/Center] Primary Care [Ambulatory Health Care 261QP2300X HCPTNUCC Facilities\Clinic/Center] Urgent Care [Ambulatory Health Care 261QU0200X HCPTNUCC Facilities\Clinic/Center]

Type of facility that the patient visited for treatment.

3.4.45 PHVS_GENDER_SYNDROMICSURVEILLANCE - GENDER (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.3403 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3403

Codes Value Code System Description F HL70001 Female M HL70001 Male O HL70001 Other U HL70001 Unknown

3.4.46 PHVS_HEALTHCARESERVICELOCATION_SYNDROMIC - HEALTHCARE SERVICE LOCATION (SYNDROMIC) Metadata OID: 2.16.840.1.114222.4.11.7777 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7777

Codes Value Code System Description 1162-7 HSLOC 24-Hour Observation Area 1184-1 HSLOC Administrative Areas 1075-1 HSLOC Adolescent Behavioral Health Ward 1210-4 HSLOC Adult Mixed Acuity Unit 1099-1 HSLOC Adult Step Down Unit 1021-5 HSLOC All Inpatient Beds combined 1110-6 HSLOC Allergy Clinic 1243-5 HSLOC Ambulatory Surgery Center 1245-0 HSLOC Ambulatory Surgery Recovery Room 1205-4 HSLOC Antenatal Care Ward 1106-4 HSLOC Assisted Living Area 1145-2 HSLOC Behavioral Health Clinic 1051-2 HSLOC Behavioral Health/Psych Ward 1185-8 HSLOC Blood Bank 1195-7 HSLOC Blood Collection (Blood Drive Campaign) 1147-8 HSLOC Blood Collection Center 1026-4 HSLOC Burn Critical Care 1052-0 HSLOC Burn Ward 1005-8 HSLOC Cardiac Catheterization Room/Suite 1112-2 HSLOC Cardiac Rehabilitation Center 1113-0 HSLOC Cardiology Clinic 1186-6 HSLOC Central Sterile Supply 1187-4 HSLOC Central Trash Area 1261-7 HSLOC Centralized Transfusion Service 1095-9 HSLOC Cesarean Section Room/Suite 1103-1 HSLOC Chronic Alzheimer's Unit 1104-9 HSLOC Chronic Behavioral Health/Psych Unit 1102-3 HSLOC Chronic Care Unit 1105-6 HSLOC Chronic Rehabilitation Unit 1011-6 HSLOC Clinical Chemistry Laboratory 1148-6 HSLOC Continence Clinic 1150-2 HSLOC Dental Clinic 1115-5 HSLOC Dermatology Clinic 1116-3 HSLOC Diabetes-Endocrinology Clinic 1198-1 HSLOC Dialysis Specialty Care Area 1126-2 HSLOC Ear, Nose, Throat Clinic 1053-8 HSLOC Ear, Nose, Throat Ward 1108-0 HSLOC Emergency Department 1007-4 HSLOC Endoscopy Suite 1188-2 HSLOC Facility Grounds

Value Code System Description 1250-0 HSLOC Facility-wide Inpatient (FacWIDEIn) 1251-8 HSLOC Facility-wide Outpatient (FacWIDEOut) 1117-1 HSLOC Family Medicine Clinic 1206-2 HSLOC Float 1118-9 HSLOC Gastrointestinal Clinic 1054-6 HSLOC Gastrointestinal Ward 1010-8 HSLOC General Laboratory 1122-1 HSLOC Genetics Clinic 1055-3 HSLOC Genitourinary Ward 1056-1 HSLOC Gerontology Ward 1121-3 HSLOC Gynecology Clinic 1057-9 HSLOC Gynecology Ward 1012-4 HSLOC Hematology Laboratory 1200-5 HSLOC Hematology-Oncology Clinic 1013-2 HSLOC Histology-Surgical Pathology Laboratory 1154-4 HSLOC HIV Clinic 1161-9 HSLOC Holistic Medicine Center 1192-4 HSLOC Home Care 1262-1 HSLOC Home Hemodialysis 1194-0 HSLOC Home-based Hospice 1182-5 HSLOC Housekeeping/Environmental Services 1017-3 HSLOC Hyperbaric Oxygen Center 1018-1 HSLOC Infusion Center 1165-0 HSLOC Inpatient Hospice 1203-9 HSLOC Interventional Radiology 1171-8 HSLOC Jail Unit 1058-7 HSLOC Labor and Delivery Ward 1059-5 HSLOC Labor, Delivery, Recovery, Postpartum Suite 1183-3 HSLOC Laundry Room 1204-7 HSLOC Location outside facility 1220-3 HSLOC Long Term Acute Care Intensive Care Unit 1222-9 HSLOC Long Term Acute Care Pediatric Intensive Care Unit 1214-6 HSLOC Long Term Acute Care Pediatric Ward 1221-1 HSLOC Long Term Acute Care Ward 1260-9 HSLOC Long Term Care Facility Bariatric Unit 1255-9 HSLOC Long Term Care Facility Dementia Unit 1258-3 HSLOC Long Term Care Facility General Nursing Unit 1254-2 HSLOC Long Term Care Facility Inpatient Hospice Unit 1256-7 HSLOC Long Term Care Facility Psychiatric Unit Long Term Care Facility Skilled Nursing-Short Term 1257-5 HSLOC Rehabilitation Unit 1259-1 HSLOC Long Term Care Facility Ventilator Dependent Unit

Value Code System Description 1090-0 HSLOC Long-Term Acute Care 1028-0 HSLOC Medical Cardiac Critical Care 1120-5 HSLOC Medical Clinic 1027-2 HSLOC Medical Critical Care 1060-3 HSLOC Medical Ward 1029-8 HSLOC Medical-Surgical Critical Care 1061-1 HSLOC Medical-Surgical Ward 1014-0 HSLOC Microbiology Laboratory 1212-0 HSLOC Mixed Age Mixed Acuity Unit 1176-7 HSLOC Mobile Blood Collection center 1174-2 HSLOC Mobile Emergency Services/EMS 1175-9 HSLOC Mobile MRI/CT 1189-0 HSLOC Morgue/Autopsy Room 1040-5 HSLOC Neonatal Critical Care (Level III) 1039-7 HSLOC Neonatal Critical Care(Level II/III) 1037-1 HSLOC Neonatal unit 1135-3 HSLOC Nephrology clinic 1035-5 HSLOC Neurologic Critical Care 1123-9 HSLOC Neurology Clinic 1062-9 HSLOC Neurology Ward 1031-4 HSLOC Neurosurgical Critical Care 1063-7 HSLOC Neurosurgical Ward 1151-0 HSLOC Occupational Health Clinic 1152-8 HSLOC Occupational Therapy Clinic 1232-8 HSLOC Oncology General Hematology-Oncology Ward 1231-0 HSLOC Oncology Hematopoietic Stem Cell Transplant Ward 1226-0 HSLOC Oncology Leukemia Ward 1229-4 HSLOC Oncology Leukemia-Lymphoma Ward 1228-6 HSLOC Oncology Lymphoma Ward 1223-7 HSLOC Oncology Medical Critical Care 1225-2 HSLOC Oncology Medical-Surgical Critical Care 1236-9 HSLOC Oncology Mixed Acuity Unit (all ages) 1233-6 HSLOC Oncology Pediatric Critical Care Oncology Pediatric General Hematology-Oncology 1235-1 HSLOC Ward Oncology Pediatric Hematopoietic Stem Cell 1234-4 HSLOC Transplant Ward 1230-2 HSLOC Oncology Solid Tumor Ward 1227-8 HSLOC Oncology Step Down Unit 1224-5 HSLOC Oncology Surgical Critical Care 1094-2 HSLOC Operating and recovery rooms 1096-7 HSLOC Operating Room/Suite

Value Code System Description 1124-7 HSLOC Ophthalmology Clinic 1064-5 HSLOC Ophthalmology Ward 1125-4 HSLOC Orthopedic Clinic 1066-0 HSLOC Orthopedic Trauma Ward 1065-2 HSLOC Orthopedic Ward 1149-4 HSLOC Ostomy Clinic 1246-8 HSLOC Outpatient Ambulatory Pediatric Surgery Center 1247-6 HSLOC Outpatient Ambulatory Plastic Surgery Center 1153-6 HSLOC Outpatient Hemodialysis Clinic 1268-2 HSLOC Outpatient Hemodialysis Clinic - Acute Kidney Injury 1219-5 HSLOC Outpatient Hemodialysis Clinic (in Inpatient Facility) 1242-7 HSLOC Outpatient Operating Room/Suite (Attached) 1244-3 HSLOC Outpatient Operating Room/Suite (Detached) 1127-0 HSLOC Pain Clinic 1146-0 HSLOC Pediatric Behavioral Health Clinic 1077-7 HSLOC Pediatric Behavioral Health Ward 1042-1 HSLOC Pediatric Burn Critical Care 1078-5 HSLOC Pediatric Burn Ward 1129-6 HSLOC Pediatric Cardiology Center 1043-9 HSLOC Pediatric Cardiothoracic Critical Care 1128-8 HSLOC Pediatric Clinic 1130-4 HSLOC Pediatric Dental Clinic 1131-2 HSLOC Pediatric Dermatology Clinic 1132-0 HSLOC Pediatric Diabetes-Endocrinology Clinic 1091-8 HSLOC Pediatric Dialysis Specialty Care Area 1079-3 HSLOC Pediatric Ear, Nose, Throat Ward 1109-8 HSLOC Pediatric Emergency Department 1119-7 HSLOC Pediatric Gastrointestinal Clinic 1080-1 HSLOC Pediatric Genitourinary Ward 1136-1 HSLOC Pediatric Hematology-Oncology Clinic 1044-7 HSLOC Pediatric Medical Critical Care 1076-9 HSLOC Pediatric Medical Ward 1045-4 HSLOC Pediatric Medical-Surgical Critical Care 1081-9 HSLOC Pediatric Medical-Surgical Ward 1211-2 HSLOC Pediatric Mixed Acuity Unit 1137-9 HSLOC Pediatric Nephrology Clinic 1082-7 HSLOC Pediatric Neurology Ward 1046-2 HSLOC Pediatric Neurosurgical Critical Care 1083-5 HSLOC Pediatric Neurosurgical Ward 1133-8 HSLOC Pediatric Orthopedic Clinic 1084-3 HSLOC Pediatric Orthopedic Ward 1248-4 HSLOC Pediatric Outpatient Operating Room/Suite

Value Code System Description (Attached) Pediatric Outpatient Operating Room/Suite 1249-2 HSLOC (Detached) Pediatric Rehabilitation Ward (within Acute Care 1085-0 HSLOC Hospital) 1047-0 HSLOC Pediatric Respiratory Critical Care 1138-7 HSLOC Pediatric Rheumatology Clinic 1134-6 HSLOC Pediatric Scoliosis Clinic Pediatric Solid Organ Transplant Specialty Care 1093-4 HSLOC Area 1100-7 HSLOC Pediatric Step Down Unit 1048-8 HSLOC Pediatric Surgical Critical Care 1086-8 HSLOC Pediatric Surgical Ward 1049-6 HSLOC Pediatric Trauma Critical Care 1074-4 HSLOC Pediatric ward 1179-1 HSLOC Pharmacy 1181-7 HSLOC Physical Plant Operations Center 1202-1 HSLOC Physical Therapy Clinic 1141-1 HSLOC Physician's Office 1067-8 HSLOC Plastic Surgery Ward 1140-3 HSLOC Podiatry Clinic 1169-2 HSLOC Post-Anesthesia Care Unit 1097-5 HSLOC Post-Anesthesia Care Unit/Recovery Room 1068-6 HSLOC Postpartum Ward 1156-9 HSLOC Prenatal Clinic 1034-8 HSLOC Prenatal Critical Care 1180-9 HSLOC Public Area in Facility 1157-7 HSLOC Pulmonary Clinic 1009-0 HSLOC Pulmonary Function Testing 1069-4 HSLOC Pulmonary Ward 1008-2 HSLOC Radiology 1155-1 HSLOC Rehabilitation Clinic Rehabilitation Pediatric Ward (freestanding Inpatient 1218-7 HSLOC Rehabilitation Facility) Rehabilitation Ward (freestanding Inpatient 1217-9 HSLOC Rehabilitation Facility) 1070-2 HSLOC Rehabilitation Ward (within Acute Care Hospital) 1033-0 HSLOC Respiratory Critical Care 1142-9 HSLOC Rheumatology Clinic 1172-6 HSLOC School Infirmary 1170-0 HSLOC School or Prison Infirmary 1201-3 HSLOC Scoliosis clinic 1015-7 HSLOC Serology Laboratory Page 115 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description 1020-7 HSLOC Sleep Study Unit 1190-8 HSLOC Soiled Utility Area 1092-6 HSLOC Solid Organ Transplant Specialty Care Area 1196-5 HSLOC Specimen Collection Area (Community) 1019-9 HSLOC Specimen Collection Area (Healthcare) 1158-5 HSLOC Speech Therapy Clinic 1041-3 HSLOC Step down Neonatal Nursery (Level II) 1071-0 HSLOC Stroke (Acute) Ward 1032-2 HSLOC Surgical Cardiothoracic Critical Care 1030-6 HSLOC Surgical Critical Care 1143-7 HSLOC Surgical Services Clinic 1072-8 HSLOC Surgical Ward 1208-8 HSLOC Telemetry Ward 1207-0 HSLOC Therapeutic Apheresis Clinic 1178-3 HSLOC Transport Service 1025-6 HSLOC Trauma Critical Care 1209-6 HSLOC Treatment Room 1160-1 HSLOC Urgent Care Center 1073-6 HSLOC Vascular Surgery Ward 1164-3 HSLOC Ventilator Dependent Unit 1016-5 HSLOC Virology Laboratory 1139-5 HSLOC Well Baby Clinic 1038-9 HSLOC Well Baby Nursery (Level I) 1144-5 HSLOC Wound Center 1159-3 HSLOC Wound Ostomy Continence Clinic

Value set for healthcare service location used by the Implementation Guide for Syndromic Surveillance.

3.4.47 PHVS_HEIGHTUNIT_UCUM - HEIGHT UNIT Metadata OID: 2.16.840.1.114222.4.11.891 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.891

Codes Value Code System Description

Value Code System Description cm UCUM CentiMeter [SI Length Units] [ft_us] UCUM foot [in_us] UCUM inch m UCUM meter

Units for measuring height

3.4.48 PHVS_IDENTIFIERTYPE_SYNDROMICSURVEILLANCE - IDENTIFIER TYPE (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.3597 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3597

Codes Value Code System Description AN HL70203 Account number ANC HL70203 Account number Creditor AND HL70203 Account number debitor APRN HL70203 Advanced Practice Registered Nurse number AM HL70203 American Express ANON HL70203 Anonymous identifier BA HL70203 Bank Account Number BC HL70203 Bank Card Number BR HL70203 Birth registry number CY HL70203 County number DDS HL70203 Dentist license number DI HL70203 Diner_s Club card DS HL70203 Discover Card DN HL70203 Doctor number DR HL70203 Donor Registration Number DL HL70203 Driver_s license number Drug Enforcement Administration registration DEA HL70203 number Drug Furnishing or prescriptive authority DFN HL70203 Number EI HL70203 Employee number

Value Code System Description GL HL70203 General ledger number GN HL70203 Guarantor external identifier GI HL70203 Guarantor internal identifier HC HL70203 Health Card Number IND HL70203 Indigenous/Aboriginal JHN HL70203 Jurisdictional health number (Canada) LI HL70203 Labor and industries number LN HL70203 License number PE HL70203 Living Subject Enterprise Number LR HL70203 Local Registry ID MS HL70203 MasterCard MD HL70203 Medical License number MR HL70203 Medical record number Medicare/CMS (formerly HCFA)_s Universal UPIN HL70203 Physician Identification numbers MB HL70203 Member Number MCN HL70203 Microchip Number MI HL70203 Military ID number NH HL70203 National Health Plan Identifier NII HL70203 National Insurance Organization Identifier National Person Identifier where the xxx is the NNxxx HL70203 ISO table 3166 3-character (alphabetic) country code NPI HL70203 National provider identifier NI HL70203 National unique individual identifier NP HL70203 Nurse practitioner number OD HL70203 Optometrist license number DO HL70203 Osteopathic License number PPN HL70203 Passport number PT HL70203 Patient external identifier PI HL70203 Patient internal identifier MA HL70203 Patient Medicaid number MC HL70203 Patient's Medicare number PCN HL70203 Penitentiary/correctional institution Number PEN HL70203 Pension Number PRC HL70203 Permanent Resident Card Number PN HL70203 Person number RPH HL70203 Pharmacist license number PA HL70203 Physician Assistant number DPM HL70203 Podiatrist license number MCD HL70203 Practitioner Medicaid number MCR HL70203 Practitioner Medicare number

Value Code System Description PRN HL70203 Provider number QA HL70203 QA number RR HL70203 Railroad Retirement number RRI HL70203 Regional registry ID RN HL70203 Registered Nurse Number RI HL70203 Resource identifier SS HL70203 Social Security number SL HL70203 State license SR HL70203 State registry ID SN HL70203 Subscriber Number TAX HL70203 Tax ID number ANT HL70203 Temporary Account Number PNT HL70203 Temporary Living Subject Number MRT HL70203 Temporary Medical Record Number TN HL70203 Treaty Number/ (Canada) U HL70203 Unspecified identifier VS HL70203 VISA VN HL70203 Visit number WC HL70203 WIC identifier WCN HL70203 Workers_ Comp Number

Subset of HL7 2.x Identifier Type table (excluding organization identifier)

3.4.49 PHVS_MEDICATIONBRANDNAME_HITSP - MEDICATION BRAND NAME VALUE SET This identifies the product brand name of drugs, such as Tylenol, Claritin, etc. Shall contain RxNorm normal forms for concepts type of "Brand Name" or Brand Name Packs.

Metadata OID: 2.16.840.1.113883.3.88.12.80.16 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.88.12.80.16

This identifies the product brand name of drugs, such as Tylenol, Claritin, etc. Shall contain RxNorm normal forms for concepts type of "Brand Name" or Brand Name Packs.

3.4.50 PHVS_MEDICATIONCLINICALDRUGNAME_HITSP - MEDICATION CLINICAL DRUG NAME VALUE SET Shall contain RxNorm normal forms for concepts type of "Ingredient Name" or Generic Packs. The ingredient name concepts can be found in the RxNORM file RXCONSO.RRF selecting all terms where SAB=RXNORM (selecting the normal forms), and TTY=SCD (selecting the ingredient names) or TTY=GPCK (selecting the generic packs)

Metadata OID: 2.16.840.1.113883.3.88.12.80.17 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.88.12.80.17

Shall contain RxNorm normal forms for concepts type of "Ingredient Name" or Generic Packs. The ingredient name concepts can be found in the RxNORM file RXCONSO.RRF selecting all terms where SAB=RXNORM (selecting the normal forms), and TTY=SCD (selecting the ingredient names) or TTY=GPCK (selecting the generic packs)

3.4.51 PHVS_MESSAGESTRUCTURE_SYNDROMICSURVEILLANCE - MESSAGE STRUCTURE (SYNDROMIC SURVEILLANCE) List of HL7 Table 0354:?Message Structure associated with Syndromic Surveillance

Metadata OID: 2.16.840.1.114222.4.11.6047 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6047

Codes Value Code System Description ADT_A01 HL70354 A01, A04, A08, A13 ADT_A03 HL70354 A03 ACK HL70354 Varies

List of HL7 Table 0354:?Message Structure associated with Syndromic Surveillance

3.4.52 PHVS_MESSAGETYPE_SYNDROMICSURVEILLANCE - MESSAGE TYPE (SYNDROMIC SURVEILLANCE) List of Table 0076 Message Types supported by Syndromic Surveillance IG

Metadata OID: 2.16.840.1.114222.4.11.6049 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6049

Codes Value Code System Description ADT HL70076 ADT message ACK HL70076 General acknowledgment message

List of Table 0076 Message Types supported by Syndromic Surveillance IG

3.4.53 PHVS_NAMETYPE_SYNDROMICSURVEILLANCE - NAME TYPE (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.6056 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6056

Codes Value Code System Description Coded Pseudo-Name to ensure S HL70200 anonymity L HL70200 Legal Name U HL70200 Unspecified

Contains the constrained value set for syndromic surveillance (ED) IG with Legal, psuedonym and Unspecified name types.

3.4.54 PHVS_OBSERVATIONIDENTIFIER_SYNDROMICSURVEILLANCE - OBSERVATION IDENTIFIER (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.3589 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3589

Codes Value Code System Description 11283-9 LN Acuity assessment [Function] at First encounter 21612-7 LN Age:Time:Pt:Patient:Qn:Reported 39156-5 LN BMI 11289-6 LN Body temperature:Temp:Enctr-frst:Patient:Qn: 8661-1 LN Chief complaint:Find:Pt:Patient:Nom:Reported 44833-2 LN Diagnosis.preliminary:Imp:Pt:Patient:Nom: SS003 PHINQUESTION Facility / Visit Type 11368-8 LN Illness or injury onset date and time:TmStp:Pt:Patient:Qn: 8677-7 LN Medication use Hx Reported 10160-0 LN Medication use Hx Reported 59408-5 LN Oxygen saturation:MFr:Pt:BldA:Qn:Pulse oximetry 56816-2 LN Patient location 11449-6 LN Pregnancy status - reported 11450-4 LN Problem list Reported 54582-2 LN Provider type [MDSv3] 72166-2 LN Tobacco smoking status 10182-4 LN Travel Hx Reported SS001 PHINQUESTION Treating Facility Identifier SS002 PHINQUESTION Treating Facility Location 54094-8 LN Triage note:Find:Pt:Emergency department:Doc:

List of observation identifiers associated with syndromic surveillance that would be coming in the observation identifier field (OBX-3) in HL7 2.x messaging.

3.4.55 PHVS_PATIENTCLASS_SYNDROMICSURVEILLANCE - PATIENT CLASS (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.3404 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3404

Codes Value Code System Description D HL70004 Direct admit E HL70004 Emergency I HL70004 Inpatient V HL70004 Observation patient B HL70004 Obstetrics O HL70004 Outpatient P HL70004 Preadmit R HL70004 Recurring patient

Patient classification within facility

3.4.56 PHVS_PULSEOXIMETRYUNIT_UCUM - PULSE OXIMETRY UNIT Metadata OID: 2.16.840.1.114222.4.11.3590 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3590

Codes Value Code System Description % UCUM percent

UCUM units associated with Pulse Oximetry such as percent

3.4.57 PHVS_RACECATEGORY_CDC - RACE CATEGORY Metadata OID: 2.16.840.1.114222.4.11.836 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.836

Codes Value Code System Description 1002-5 CDCREC American Indian or Alaska Native 2028-9 CDCREC Asian 2054-5 CDCREC Black or African American Native Hawaiian or Other Pacific 2076-8 CDCREC Islander 2131-1 CDCREC Other Race 2106-3 CDCREC White

General race category reported by the patient - subject may have more than one

3.4.58 PHVS_SMOKINGSTATUS_MU - SMOKING STATUS Metadata OID: 2.16.840.1.114222.4.11.6027 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6027

Codes Value Code System Description 8517006 SCT Ex-smoker (finding) 77176002 SCT Smoker (finding) 266919005 SCT Never smoked tobacco (finding) Tobacco smoking consumption 266927001 SCT unknown (finding) 449868002 SCT Smokes tobacco daily (finding) 428041000124106 SCT Current some day smoker 428061000124105 SCT Current Light tobacco smoker 428071000124103 SCT Current Heavy tobacco smoker

Smoking Status - Meaningful Use

3.4.59 PHVS_SOURCEOFPAYMENTTYPOLOGY_PHDSC - SOURCE OF PAYMENT TYPOLOGY (PHDSC) Metadata OID: 2.16.840.1.114222.4.11.3591 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3591

Codes Value Code System Description 1 PHDSCPT MEDICARE 2 PHDSCPT MEDICAID OTHER GOVERNMENT (Federal/State/Local) (excluding 3 PHDSCPT Department of Corrections) 4 PHDSCPT DEPARTMENTS OF CORRECTIONS 5 PHDSCPT PRIVATE HEALTH INSURANCE 6 PHDSCPT BLUE CROSS/BLUE SHIELD MANAGED CARE, UNSPECIFIED (to be used only if one 7 PHDSCPT can't distinguish public from private) NO PAYMENT from an 8 PHDSCPT Organization/Agency/Program/Private Payer Listed 9 PHDSCPT MISCELLANEOUS/OTHER 11 PHDSCPT Medicare (Managed Care) 12 PHDSCPT Medicare (Non-managed Care) 13 PHDSCPT Medicare Hospice 14 PHDSCPT Dual Eligibility Medicare/Medicaid Organization 19 PHDSCPT Medicare Other 21 PHDSCPT Medicaid (Managed Care) 22 PHDSCPT Medicaid (Non-managed Care Plan) 23 PHDSCPT Medicaid/SCHIP 25 PHDSCPT Medicaid - Out of State 26 PHDSCPT Medicaid - Long Term Care 29 PHDSCPT Medicaid Other 31 PHDSCPT Department of Defense 32 PHDSCPT Department of Veterans Affairs 33 PHDSCPT Indian Health Service or Tribe 34 PHDSCPT HRSA Program 35 PHDSCPT Black Lung 36 PHDSCPT State Government Page 125 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description 37 PHDSCPT Local Government 38 PHDSCPT Other Government (Federal, State, Local not specified) 39 PHDSCPT Other Federal 41 PHDSCPT Corrections Federal 42 PHDSCPT Corrections State 43 PHDSCPT Corrections Local 44 PHDSCPT Corrections Unknown Level 51 PHDSCPT Managed Care (Private) 52 PHDSCPT Private Health Insurance - Indemnity Managed Care (private) or private health insurance 53 PHDSCPT (indemnity), not otherwise specified 54 PHDSCPT Organized Delivery System 55 PHDSCPT Small Employer Purchasing Group 56 PHDSCPT Specialized Stand Alone Plan 59 PHDSCPT Other Private Insurance 61 PHDSCPT BC Managed Care 62 PHDSCPT BC Indemnity 63 PHDSCPT BC (Indemnity or Managed Care) - Out of State 64 PHDSCPT BC (Indemnity or Managed Care) - Unspecified 69 PHDSCPT BC (Indemnity or Managed Care) - Other 71 PHDSCPT HMO 72 PHDSCPT PPO 73 PHDSCPT POS 79 PHDSCPT Other Managed Care, Unknown if public or private Self-pay (Includes applicants for insurance and Medicaid 81 PHDSCPT applicants) 82 PHDSCPT No Charge 83 PHDSCPT Refusal to Pay/Bad Debt 84 PHDSCPT Hill Burton Free Care 85 PHDSCPT Research/Donor 89 PHDSCPT No Payment, Other 91 PHDSCPT Foreign National 92 PHDSCPT Other (Non-government) 93 PHDSCPT Disability Insurance 94 PHDSCPT Long-term Care Insurance 95 PHDSCPT Worker's Compensation 96 PHDSCPT Auto Insurance (no fault) 97 PHDSCPT Legal Liability / Liability Insurance Other specified but not otherwise classifiable (includes 98 PHDSCPT Hospice - Unspecified plan) 99 PHDSCPT No Typology Code available for payment source 111 PHDSCPT Medicare HMO

Value Code System Description 112 PHDSCPT Medicare PPO 113 PHDSCPT Medicare POS 119 PHDSCPT Medicare Managed Care Other 121 PHDSCPT Medicare FFS 122 PHDSCPT Medicare Drug Benefit 123 PHDSCPT Medicare Medical Savings Account (MSA) 129 PHDSCPT Medicare Non-managed Care Other 191 PHDSCPT Medicare Pharmacy Benefit Manager 211 PHDSCPT Medicaid HMO 212 PHDSCPT Medicaid PPO 213 PHDSCPT Medicaid PCCM (Primary Care Case Management) 219 PHDSCPT Medicaid Managed Care Other 291 PHDSCPT Medicaid Pharmacy Benefit Manager 299 PHDSCPT Medicaid - Dental 311 PHDSCPT TRICARE (CHAMPUS) 312 PHDSCPT Military Treatment Facility 313 PHDSCPT Dental --Stand Alone 321 PHDSCPT Veteran care--Care provided to Veterans 322 PHDSCPT Non-veteran care 331 PHDSCPT Indian Health Service - Regular 332 PHDSCPT Indian Health Service - Contract 333 PHDSCPT Indian Health Service - Managed Care 334 PHDSCPT Indian Tribe - Sponsored Coverage 341 PHDSCPT Title V (MCH Block Grant) 342 PHDSCPT Migrant Health Program 343 PHDSCPT Ryan White Act 349 PHDSCPT Other 361 PHDSCPT State SCHIP program (codes for individual states) 362 PHDSCPT Specific state programs (list/ local code) 369 PHDSCPT State, not otherwise specified (other state) 371 PHDSCPT Local - Managed care 372 PHDSCPT FFS/Indemnity 379 PHDSCPT Local, not otherwise specified (other local, county) 381 PHDSCPT Federal, State, Local not specified managed care 382 PHDSCPT Federal, State, Local not specified - FFS 389 PHDSCPT Federal, State, Local not specified - Other 391 PHDSCPT Federal Employee Health Plan 511 PHDSCPT Commercial Managed Care - HMO 512 PHDSCPT Commercial Managed Care - PPO 513 PHDSCPT Commercial Managed Care - POS 514 PHDSCPT Exclusive Provider Organization 515 PHDSCPT Gatekeeper PPO (GPPO)

Value Code System Description 516 PHDSCPT Commercial Managed Care - Pharmacy Benefit Manager 517 PHDSCPT Commercial Managed Care - Dental 519 PHDSCPT Managed Care, Other (non HMO) 521 PHDSCPT Commercial Indemnity Self-insured (ERISA) Administrative Services Only (ASO) 522 PHDSCPT plan 523 PHDSCPT Medicare supplemental policy (as second payer) 524 PHDSCPT Indemnity Insurance - Dental 529 PHDSCPT Private health insurance-other commercial Indemnity 561 PHDSCPT Dental 562 PHDSCPT Vision 611 PHDSCPT BC Managed Care - HMO 612 PHDSCPT BC Managed Care - PPO 613 PHDSCPT BC Managed Care - POS 614 PHDSCPT BC Managed Care - Dental 619 PHDSCPT BC Managed Care - Other 621 PHDSCPT BC Indemnity BC Self-insured (ERISA) Administrative Services Only (ASO) 622 PHDSCPT Plan 623 PHDSCPT BC Medicare Supplemental Plan 629 PHDSCPT BC Indemnity - Dental 821 PHDSCPT Charity 822 PHDSCPT Professional Courtesy 823 PHDSCPT Research/Clinical Trial 951 PHDSCPT Worker's Comp HMO 953 PHDSCPT Worker's Comp Fee-for-Service 954 PHDSCPT Worker's Comp Other Managed Care 959 PHDSCPT Worker's Comp, Other unspecified 3111 PHDSCPT TRICARE Prime--HMO 3112 PHDSCPT TRICARE Extra--PPO 3113 PHDSCPT TRICARE Standard - Fee For Service 3114 PHDSCPT TRICARE For Life--Medicare Supplement 3115 PHDSCPT TRICARE Reserve Select 3116 PHDSCPT Uniformed Services Family Health Plan (USFHP) -- HMO 3119 PHDSCPT Department of Defense - (other) 3121 PHDSCPT Enrolled Prime--HMO 3122 PHDSCPT Non-enrolled Space Available 3123 PHDSCPT TRICARE For Life (TFL) 3211 PHDSCPT Direct Care--Care provided in VA facilities 3212 PHDSCPT Indirect Care--Care provided outside VA facilities 3221 PHDSCPT Civilian Health and Medical Program for the VA (CHAMPVA) 3222 PHDSCPT Spina Bifida Health Care Program (SB)

Value Code System Description 3223 PHDSCPT Children of Women Vietnam Veterans (CWVV) 3229 PHDSCPT Other non-veteran care 3711 PHDSCPT HMO 3712 PHDSCPT PPO 3713 PHDSCPT POS 3811 PHDSCPT Federal, State, Local not specified - HMO 3812 PHDSCPT Federal, State, Local not specified - PPO 3813 PHDSCPT Federal, State, Local not specified - POS Federal, State, Local not specified - not specified managed 3819 PHDSCPT care 9999 PHDSCPT Unavailable /No Payer Specified / Blank 32121 PHDSCPT Fee Basis 32122 PHDSCPT Foreign Fee/Foreign Medical Program(FMP) 32123 PHDSCPT Contract Nursing Home/Community Nursing Home 32124 PHDSCPT State Veterans Home 32125 PHDSCPT Sharing Agreements 32126 PHDSCPT Other Federal Agency 32127 PHDSCPT Dental Care 32128 PHDSCPT Vision Care

The development of a standard source of payment classification system is a high priority for public health and can be used for a wide variety of public health activities such as monitoring healthcare access and documenting disparities.

3.4.60 PHVS_STATE_FIPS_5-2 - STATE Metadata OID: 2.16.840.1.114222.4.11.830 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.830

Codes Value Code System Description 01 FIPS5_2 Alabama 02 FIPS5_2 Alaska 04 FIPS5_2 Arizona 05 FIPS5_2 Arkansas 06 FIPS5_2 California 08 FIPS5_2 Colorado Page 129 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Value Code System Description 09 FIPS5_2 Connecticut 10 FIPS5_2 Delaware 11 FIPS5_2 District of Columbia 12 FIPS5_2 Florida 13 FIPS5_2 Georgia 15 FIPS5_2 Hawaii 16 FIPS5_2 Idaho 17 FIPS5_2 Illinois 18 FIPS5_2 Indiana 19 FIPS5_2 Iowa 20 FIPS5_2 Kansas 21 FIPS5_2 Kentucky 22 FIPS5_2 Louisiana 23 FIPS5_2 Maine 24 FIPS5_2 Maryland 25 FIPS5_2 Massachusetts 26 FIPS5_2 Michigan 27 FIPS5_2 Minnesota 28 FIPS5_2 Mississippi 29 FIPS5_2 Missouri 30 FIPS5_2 Montana 31 FIPS5_2 Nebraska 32 FIPS5_2 Nevada 33 FIPS5_2 New Hampshire 34 FIPS5_2 New Jersey 35 FIPS5_2 New Mexico 36 FIPS5_2 New York 37 FIPS5_2 North Carolina 38 FIPS5_2 North Dakota 39 FIPS5_2 Ohio 40 FIPS5_2 Oklahoma 41 FIPS5_2 Oregon 42 FIPS5_2 Pennsylvania 44 FIPS5_2 Rhode Island 45 FIPS5_2 South Carolina 46 FIPS5_2 South Dakota 47 FIPS5_2 Tennessee 48 FIPS5_2 Texas 49 FIPS5_2 Utah 50 FIPS5_2 Vermont 51 FIPS5_2 Virginia 53 FIPS5_2 Washington

Value Code System Description 54 FIPS5_2 West Virginia 55 FIPS5_2 Wisconsin 56 FIPS5_2 Wyoming 60 FIPS5_2 American Samoa 64 FIPS5_2 Federated States of Micronesia 66 FIPS5_2 Guam 67 FIPS5_2 Johnston Atoll 68 FIPS5_2 Marshall Islands 69 FIPS5_2 Northern Mariana Islands 70 FIPS5_2 Palau 71 FIPS5_2 Midway Islands 72 FIPS5_2 Puerto Rico 74 FIPS5_2 U.S. Minor Outlying Islands 76 FIPS5_2 Navassa Island 78 FIPS5_2 Virgin Islands of the U.S. 79 FIPS5_2 Wake Island 81 FIPS5_2 Baker Island 84 FIPS5_2 Howland Island 86 FIPS5_2 Jarvis Island 89 FIPS5_2 Kingman Reef 95 FIPS5_2 Palmyra Atoll

State codes for U.S. based on FIPS 5-2

3.4.61 PHVS_TEMPERATUREUNIT_UCUM - TEMPERATURE UNIT Metadata OID: 2.16.840.1.114222.4.11.919 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.919

Codes Value Code System Description Cel UCUM degree Celsius [degF] UCUM degree Fahrenheit

3.4.62 PHVS_UNIVERSALIDTYPE_SYNDROMICSURVEILLANCE - UNIVERSAL ID TYPE (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.6050 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6050

Codes Value Code System Description An International Standards ISO HL70301 Organization Object Identifier An Internet dotted name. Either in DNS HL70301 ASCII or as integers x400 HL70301 An X.400 MHS format identifier x500 HL70301 An X.500 directory name Clinical Laboratory Improvement CLIA HL70301 Amendments NPI HL70203 National provider identifier Reserved for future HL7 HL7 HL70301 registration schemes GUID HL70301 Same as UUID. The CEN Healthcare Coding Scheme Designator. (Identifiers HCD HL70301 used in DICOM follow this assignment scheme.) The DCE Universal Unique UUID HL70301 Identifier These are reserved for locally L,M,N HL70301 defined coding schemes. URI HL70301 Uniform Resource Identifier Usually a base64 encoded string Random HL70301 of random bits.

List of Universal ID Types supported by Syndromic Surveillance IG.

3.4.63 PHVS_VALUETYPE_SYNDROMICSURVEILLANCE - VALUE TYPE (SYNDROMIC SURVEILLANCE) Metadata OID: 2.16.840.1.114222.4.11.6057 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.6057

Codes Value Code System Description CWE HL70125 Coded With Exceptions XAD HL70125 Extended Address HD HL70125 Hierarchic designator NM HL70125 Numeric TX HL70125 Text Data (Display) TS HL70125 Time Stamp (Date & Time)

Constrained value set of Hl7 Table 0125 Value Type for Syndromic Surveillance (ED).

3.4.64 PHVS_VITALSIGNRESULT_HITSP - VITAL SIGN RESULT VALUE SET Metadata OID: 2.16.840.1.113883.3.88.12.80.62 Type: Externally managed

Attributes Stability Extensibility Content Definition Static Closed Extensional

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.3.88.12.80.62

Codes Value Code System Description 8302-2 LN Body height:Len:Pt:Patient:Qn: 8306-3 LN Body height-lying:Len:Pt:Patient:Qn: 8310-5 LN Body temperature:Temp:Pt:Patient:Qn: 3141-9 LN Body weight:Mass:Pt:Patient:Qn:Measured 9279-1 LN Breaths:NRat:Pt:Respiratory system:Qn: 8287-5 LN Circumference.occipital-frontal:Len:Pt:Head:Qn:Tape measure 8867-4 LN Heart beat:NRat:Pt:XXX:Qn: 8462-4 LN Intravascular diastolic:Pres:Pt:Arterial system:Qn: 8480-6 LN Intravascular systolic:Pres:Pt:Arterial system:Qn: 2710-2 LN Oxygen saturation:SFr:Pt:BldC:Qn:Oximetry

This identifies the vital sign result type

3.4.65 PHVS_WEIGHTUNIT_UCUM - WEIGHT UNIT Metadata OID: 2.16.840.1.114222.4.11.879 Type: Externally managed

Attributes Stability Extensibility Content Definition Not defined Not defined Not defined

Reference URL: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.879

Codes Value Code System Description g UCUM gram kg UCUM KiloGram [SI Mass Units] [oz_av] UCUM ounce [lb_av] UCUM pound

Units for measuring weight based on UCUM std. 3.5 Conformance information

3.5.1 CONFORMANCE STATEMENTS

3.5.1.1 CONFORMANCE PROFILE LEVEL 3.5.1.1.1 PATIENT ADMIT

ID Description ADTÂ01_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A01'. ADTÂ01_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'. ADTÂ01_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A01'. ADTÂ01_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'. 3.5.1.1.2 PATIENT REGISTRATION

ID Description ADTÂ04_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A04'. ADTÂ04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'. ADTÂ04_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A04'. ADTÂ04_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'. 3.5.1.1.3 PATIENT DISCHARGE

ID Description

ID Description ADTÂ03_MSH_21 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_A08'. ADTÂ03_MSH_92 The value of MSH.9.2 (Trigger Event) SHALL be 'A08'. ADTÂ03_MSH_93 The value of MSH.9.3 (Message Structure) SHALL be 'ADT_A01'. ADTÂ04_MSH_91 The value of MSH.9.1 (Message Code) SHALL be 'ADT'. 3.5.1.1.5 ACKNOWLEDGEMENT

ID Description MSH_SS_ACK_01 The value of MSH.9.1 (Message Code) SHALL be 'ACK'. MSH_SS_ACK_02 The value of MSH.9.3 (Message Structure) SHALL be 'ACK'. MSH_SS_ACK_03 The value of MSH.21[*].1 (Entity Identifier) SHALL be 'PH_SS_ACK'.

3.5.1.2 SEGMENT LEVEL 3.5.1.2.1 DG1_SS - DIAGNOSIS

ID Description DG1_SS_8603629 The value of DG1-3.3 SHALL be one of list values: I10,SCT. 3.5.1.2.2 MSA_SS - MESSAGE ACKNOWLEDGMENT

ID Description MSA_SS_5067426 MSH-2 Shall match MSH-10 value of message being acknowledged 3.5.1.2.3 MSH_SS - MESSAGE HEADER

ID Description MSH_SS_4611129 The value of MSH-1 (Field Separator) SHALL be '|'. MSH_SS_6631423 The value of MSH-21[*].3 SHALL be '2.16.840.1.114222.4.10.3'. MSH_SS_7465888 The value of MSH-2 (Encoding Characters) SHALL be '^~\&'. MSH_SS_9284050 The value of MSH-21[*].4 SHALL be 'ISO'. 3.5.1.2.4 OBX_SS - OBSERVATION/RESULT

ID Description OBX_SS_001 If OBX-3.1 contains 11449-6, the value of OBX-5 SHALL be one of list values: Y, N, UNK OBX_SS_002 The value of OBX-1 (Set ID - OBX) SHALL be valued sequentially starting with the value '1'. 3.5.1.2.5 PID_SS_A01 - PATIENT IDENTIFICATION

ID Description PID_SS_6738094 If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL be one of

ID Description list values: |~^^^^^^S|,|~^^^^^^U| 3.5.1.2.6 PID_SS_A04_A08_A03 - PATIENT IDENTIFICATION

ID Description If the patient's legal name is not sent, the value of PID-5[*] (Patient Name) SHALL PID_SS_6738094 be one of list values: |~^^^^^^S|,|~^^^^^^U| If PV1-36 (Discharge Disposition) is valued with any of the following: '20', '40', '41', PID_SS_A04_A08_A03_1 '42', PID-30 shall be 'Y' 3.5.1.2.7 PR1_SS - PROCEDURES

ID Description PR1-3.1 shall be populated with a value from one for the following coding systems: CPT4, PR1_SS_6639954 ICD10-CM-PCS

3.5.1.3 DATATYPE LEVEL 3.5.1.3.1 XPN - EXTENDED PERSON NAME

ID Description XPN_SS_007 The value of XPN-7 (Name Type Code) SHALL be one of list values: L,S,U. 3.5.1.3.2 PT - PROCESSING TYPE

ID Description PT_SS_6152904 The value of PT-1 (Processing ID) SHALL be one of list values: P,T,D. 3.5.1.3.3 VID - VERSION IDENTIFIER

ID Description VID_SS_001 The value of VID-1 (Version ID) SHALL be '2.5.1'.

3.5.2 CONDITIONAL PREDICATES

3.5.2.1 SEGMENT LEVEL 3.5.2.1.1 OBX_SS - OBSERVATION/RESULT

Location Usage Description OBX-6 C(R/X) If the value of OBX-2 (Value Type) is 'NM'. 3.5.2.1.2 PID_SS_A04_A08_A03 - PATIENT IDENTIFICATION

Location Usage Description PID-29 C(R/X) If the value of PID-30 is 'Y'.

3.5.2.2 DATATYPE LEVEL 3.5.2.2.1 CWE - CODED WITH EXCEPTIONS

Location Usage Description CWE.2 C(R/RE) If CWE.1 (Identifier) is not valued Page 136 HL7 Version 2.5.1 IG: Syndromic Surveillance, Release 1 © 2019 Health Level Seven International. All rights reserved. July 2019

Location Usage Description CWE.3 C(R/X) If CWE.3 (Name of Coding System) is valued CWE.6 C(R/X) If CWE.6 (Name of Alternate Coding System) is valued 3.5.2.2.2 CE - CODED ELEMENT

Location Usage Description CE.2 C(R/RE) If CE.1 (Identifier) is not valued CE.3 C(R/X) If CE.1 (Identifier) is valued CE.6 C(R/X) If CE.4 (Alternate Identifier) is valued