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18.9.1 ADT - Admission, Discharge, Transfer (99.1.1)

18.10 Chapter 3 Contents (3.1)

18.11 Purpose (3.2)

The Patient Administration transaction set provides for the transmission of new or updated demographic and visit information about patients. Since virtually any system attached to the network requires information about patients, the Patient Administration transaction set is one of the most commonly used.

Generally, information is entered into a Patient Administration system and passed to the nursing, ancillary and financial systems either in the form of an unsolicited update or a response to a record-oriented query.

This chapter defines the transactions that occur at the seventh level, that is, the abstract messages. The examples included in this chapter were constructed using the HL7 Encoding Rules.

18.12 Trigger Events and Message Definitions (3.3)

18.12.1 ADT/ACK - Admit/Visit Notification (Event A01) (3.3.1)

An A01 event is intended to be used for "Admitted" patients only. An A01 event is sent as a result of a patient undergoing the admission process which assigns the patient to a bed. It signals the beginning of a patient's stay in a healthcare facility. Normally, this information is entered in the primary Patient Administration system and broadcast to the nursing units and ancillary systems. It includes short stay and "Adam Everyman" (e.g., patient name is unknown) admissions. For example, an A01 event can be used to notify: the pharmacy system that a patient has been admitted and may be legitimately prescribed drugs; the nursing system that the patient has been admitted and needs a care plan prepared; the finance system of the start of the billing period; the dietary system that a new patient has been installed and requires dietary services; the laboratory, pathology, and radiology systems that a patient has been admitted and is entitled to receive services; the clinical repository that an admission has taken place for the EMR (electronic medical record).

When an account's start and end dates span a period greater than any particular visit, the P01 (add patient account) event should be used to transmit the opening of an account. The A01 event can notify systems of the creation of an account as well as notify them of a patient's arrival in the healthcare facility. In order to create a new account without notifying of patient's arrival, use the P01 event.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin and end date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A01^ADT_A01
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  
PDA

Patient Death and Autopsy

[0..1]  

 

ADT_A01

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A08^ADT_A01
Blank Blank - ADT^A13^ADT_A01
Blank Blank - ADT^A04^ADT_A01
Blank Blank - ACK^A01^ACK
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A13^ACK -
AL, SU, ER NE ACK^A01^ACK -
AL, SU, ER NE ACK^A08^ACK -
AL, SU, ER NE ACK^A04^ACK -
NE AL, SU, ER - ACK^A01^ACK
NE AL, SU, ER - ACK^A04^ACK
NE AL, SU, ER - ACK^A08^ACK
NE AL, SU, ER - ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A13^ACK ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A01^ACK ACK^A01^ACK
AL, SU, ER AL, SU, ER ACK^A08^ACK ACK^A08^ACK
AL, SU, ER AL, SU, ER ACK^A04^ACK ACK^A04^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A01^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.2 ADT/ACK - Transfer a Patient (Event A02) (3.3.2)

An A02 event is issued as a result of the patient changing his or her assigned physical location.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition. If the transfer function of your Patient Administration system allows demographics to change at the same time as the transfer (for example an address change), we recommend (but do not require) sending two messages (an A02 followed by an A08). This A02 event can be used with admitted and non-admitted patients.

The new patient location should appear in PV1-3 - Assigned Patient Location while the old patient location should appear in PV1-6 - Prior Patient Location. For example, an A02 event can be used to notify: laboratory, radiology, pathology that the patient has changed location and test results should be redirected; pharmacy that drugs should be redirected for the patient; dietary that the meals should be delivered to a different location; the clinical repository that a transfer has taken place for the Electronic Medical Record.

If the patient is going to a temporary location (such as the O/R, X-RAY, LIMBO, the HALLWAY) it is recommended that the A09 (patient departing-tracking) and A10 (patient arriving-tracking) events be used instead of A02. It is recommended that A02 be used only for a real change in the census bed in the Patient Administration system.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A02^ADT_A02
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
PDA

Patient Death and Autopsy

[0..1]  

 

ADT_A02

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A02^ADT_A02
NE NE - -
AL, SU, ER NE ACK^A02^ACK -
NE AL, SU, ER - ACK^A02^ACK
AL, SU, ER AL, SU, ER ACK^A02^ACK ACK^A02^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A02^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

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18.12.3 ADT/ACK - Discharge/End Visit (Event A03) (3.3.3)

An A03 event signals the end of a patient's stay in a healthcare facility. It signals that the patient's status has changed to "discharged" and that a discharge date has been recorded. The patient is no longer in the facility. The patient's location prior to discharge should be entered in PV1-3 - Assigned Patient Location.

An A03 event can be sent to notify: the pharmacy that the patient's stay has ended and that entitlement to drugs has changed accordingly; the nursing system that the patient has been discharged and that the care plan can be completed; the extended care or home health system that the patient has been discharged and that the new extended care or home health admission assessment can be scheduled; the finance system that the patient billing period has ended; and/or the clinical repository that discharge has taken place for the EMR.

For non-admitted patients, an A03 event signals the end of a patient's visit to a healthcare facility. It could be used to signal the end of a visit for a one-time or recurring outpatient who is not assigned to a bed. It could also be used to signal the end of a visit to the Emergency Room. PV1-45 - Discharge Date/Time can be used for the visit end date/time.

When an account's start and end dates span a period greater than any particular visit, the P06 (end account) event should be used to transmit information about the closing of an account. To indicate that a patient has expired, use an A03 event with the PID-29 - Patient Death Date and Time and PID-30 - Patient Death Indicator filled in.

The fields included when this message is sent should be the fields pertinent to communicate this event. The optional allergy, next-of-kin, insurance and guarantor fields should be sent when required to support advanced notification for pending extended care or home health admission requirements (such as scheduling of a nursing assessment in preparation for completion of the extended care plan). When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin date and end date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Particpation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A03^ADT_A03
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
PDA

Patient Death and Autopsy

[0..1]  

 

ADT_A03

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A03^ADT_A03
NE NE - -
AL, SU, ER NE ACK^A03^ACK -
NE AL, SU, ER - ACK^A03^ACK
AL, SU, ER AL, SU, ER ACK^A03^ACK ACK^A03^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A03^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.4 ADT/ACK - Register a Patient (Event A04) (3.3.4)

An A04 event signals that the patient has arrived or checked in as a one-time, or recurring outpatient, and is not assigned to a bed. One example might be its use to signal the beginning of a visit to the Emergency Room (= Casualty, etc.).

Note: Some systems refer to these events as outpatient registrations or emergency admissions. PV1-44 - Admit Date/Time is used for the visit start date/time.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRTsegment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A04^ADT_A01
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  
PDA

Patient Death and Autopsy

[0..1]  

 

ADT_A01

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A08^ADT_A01
Blank Blank - ADT^A13^ADT_A01
Blank Blank - ADT^A04^ADT_A01
Blank Blank - ACK^A01^ACK
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A13^ACK -
AL, SU, ER NE ACK^A01^ACK -
AL, SU, ER NE ACK^A08^ACK -
AL, SU, ER NE ACK^A04^ACK -
NE AL, SU, ER - ACK^A01^ACK
NE AL, SU, ER - ACK^A04^ACK
NE AL, SU, ER - ACK^A08^ACK
NE AL, SU, ER - ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A13^ACK ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A01^ACK ACK^A01^ACK
AL, SU, ER AL, SU, ER ACK^A08^ACK ACK^A08^ACK
AL, SU, ER AL, SU, ER ACK^A04^ACK ACK^A04^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A04^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.5 ADT/ACK - Pre-Admit a Patient (Event A05) (3.3.5)

An A05 event is sent when a patient undergoes the pre-admission process. During this process, episode-related data is collected in preparation for a patient's visit or stay in a healthcare facility. For example, a pre-admit may be performed prior to inpatient or outpatient surgery so that lab tests can be performed prior to the surgery. This event can also be used to pre-register a non-admitted patient.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Visit level providers (corresponding to the PV1 data) are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 15 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A05^ADT_A05
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  

 

ADT_A05

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A05^ADT_A05
Blank Blank - ADT^A14^ADT_A05
Blank Blank - ADT^A31^ADT_A05
Blank Blank - ADT^A28^ADT_A05
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A14^ACK -
AL, SU, ER NE ACK^A28^ACK -
AL, SU, ER NE ACK^A05^ACK -
AL, SU, ER NE ACK^A31^ACK -
NE AL, SU, ER - ACK^A28^ACK
NE AL, SU, ER - ACK^A31^ACK
NE AL, SU, ER - ACK^A05^ACK
NE AL, SU, ER - ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A14^ACK ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A28^ACK ACK^A28^ACK
AL, SU, ER AL, SU, ER ACK^A05^ACK ACK^A05^ACK
AL, SU, ER AL, SU, ER ACK^A31^ACK ACK^A31^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A05^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

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We need some XML examples...

18.12.6 ADT/ACK - Change an Outpatient to an Inpatient (Event A06) (3.3.6)

An A06 event is sent when a patient who was present for a non-admitted visit is being admitted after an evaluation of the seriousness of the patient's condition. This event changes a patient's status from non-admitted to admitted. The new patient location should appear in PV1-3 - Assigned Patient Location, while the old patient location (if different) should appear in PV1-6 - Prior Patient Location. The new patient class should appear in PV1-2 - Patient Class.

It will be left to implementation negotiation to determine whether disparate systems merely change the patient class, or close and open a new account. The current active account number should appear in field PID-18 - Patient Account Number; the prior account number can be included optionally in MRG-3 - Prior Patient Account Number. This arrangement is not intended to be a type of merge. The MRG segment is used here only for MRG-3 - Prior Patient Account Number. PV1-19 - Visit Number may also be changed during this event.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Visit level providers (corresponding to the PV1 data) are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the PRT-11 -Begin Date/Time and the PRT-12 -End Date/Time in the PRT segment, with the applicable PRT-4 - role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A06^ADT_A06
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
MRG

Merge Patient Information

[0..1]  
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  

 

ADT_A06

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A07^ADT_A06
Blank Blank - ADT^A06^ADT_A06
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A07^ACK -
AL, SU, ER NE ACK^A06^ACK -
NE AL, SU, ER - ACK^A07^ACK
NE AL, SU, ER - ACK^A06^ACK
AL, SU, ER AL, SU, ER ACK^A07^ACK ACK^A07^ACK
AL, SU, ER AL, SU, ER ACK^A06^ACK ACK^A06^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A06^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.7 ADT/ACK - Change an Inpatient to an Outpatient (Event A07) (3.3.7)

An A07 event is sent when a patient who was admitted changes his/her status to "no longer admitted" but is still being seen for this episode of care. This event changes a patient from an "admitted" to a "non-admitted" status. The new patient location should appear in PV1-3 - Assigned Patient Location, while the old patient location (if different) should appear in PV1-6 - Prior Patient Location.

It will be left to implementation negotiation to determine whether disparate systems merely change the patient class, or close and open a new account. The current active account number should appear in field PID-18 - Patient Account Number; the prior account number can be included optionally in MRG-3 - Prior Patient Account Number. This arrangement is not intended to be a type of merge. The MRG segment is used here only for MRG-3 - Prior Patient Account Number. PV1-19 - Visit Number may also be changed during this event.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin and end date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A07^ADT_A06
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
MRG

Merge Patient Information

[0..1]  
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  

 

ADT_A06

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A07^ADT_A06
Blank Blank - ADT^A06^ADT_A06
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A07^ACK -
AL, SU, ER NE ACK^A06^ACK -
NE AL, SU, ER - ACK^A07^ACK
NE AL, SU, ER - ACK^A06^ACK
AL, SU, ER AL, SU, ER ACK^A07^ACK ACK^A07^ACK
AL, SU, ER AL, SU, ER ACK^A06^ACK ACK^A06^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A07^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.8 ADT/ACK - Update Patient Information (Event A08) (3.3.8)

This trigger event is used when any patient information has changed but when no other trigger event has occurred. For example, an A08 event can be used to notify the receiving systems of a change of address or a name change. We strongly recommend that the A08 transaction be used to update fields that are not updated by any of the other trigger events. If there are specific trigger events for this update, these trigger events should be used. For example, if a patient's address and location are to be changed, then an A08 is used to change the patient address and the appropriate patient location trigger event is used to change the patient location. The A08 event can include information specific to an episode of care, but it can also be used for demographic information only.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT, with the applicable PRT-4 - role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A08^ADT_A01
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  
PDA

Patient Death and Autopsy

[0..1]  

 

ADT_A01

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A08^ADT_A01
Blank Blank - ADT^A13^ADT_A01
Blank Blank - ADT^A04^ADT_A01
Blank Blank - ACK^A01^ACK
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A13^ACK -
AL, SU, ER NE ACK^A01^ACK -
AL, SU, ER NE ACK^A08^ACK -
AL, SU, ER NE ACK^A04^ACK -
NE AL, SU, ER - ACK^A01^ACK
NE AL, SU, ER - ACK^A04^ACK
NE AL, SU, ER - ACK^A08^ACK
NE AL, SU, ER - ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A13^ACK ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A01^ACK ACK^A01^ACK
AL, SU, ER AL, SU, ER ACK^A08^ACK ACK^A08^ACK
AL, SU, ER AL, SU, ER ACK^A04^ACK ACK^A04^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A08^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.9 ADT/ACK - Patient Departing - Tracking (Event A09) (3.3.9)

The A09 and A10 - patient arriving-tracking events are used when there is a change in a patient's physical location (inpatient or outpatient) and when this is NOT a change in the official census bed location, as in the case of an outpatient setting. There are three situations that qualify as non-census location changes: (a) patient tracking, (b) the patient is in transit between locations for some time, (c) a notification of temporary location change.

Patient tracking: This can be used when the nursing application sends a "transfer" before the Patient Administration (or official census) system issues an A02 (transfer a patient) event. If the patient has left for a non-temporary location and is not in transit, then the PV1-3 - Assigned Patient Location must contain the new patient location, while PV1-6 - Prior Patient Location must contain the old patient location.

In transit: The patient's location during the time between an A09 and an A10 (patient arriving - tracking) is defined as "in transit." The A09 event is sent when a patient departs from one area of the healthcare facility for the purpose of arriving at another area, but without leaving the healthcare institution. This event is used when there is a time span during which the patient is neither at his/her old location nor at his/her new location. This process can take some time if a patient is being sent to another area in a multi-campus or multi-facility environment. The combination of an A09 and an A10 would serve the same purpose as an A02 (transfer a patient) event, except that it accounts for a gap in time required for transport between facilities. If the patient will be in transit during the time between the A09 (patient departing - tracking) event and the A10 (patient arriving - tracking) event, then PV1-42 - Pending Location is used for the new location, and PV1-11 - Temporary Location and PV1-43 - Prior Temporary Location would not be used. PV1-6 - Prior Patient Location should be used for the old location.

Temporary location: An A09 can also be used when the patient is being sent to a temporary location (such as the O/R, X-RAY, LIMBO, or HALLWAY). The patient may or may not return to the same assigned location after occupying the temporary location. If the patient is going to a temporary location (such as the O/R, X-RAY, LIMBO, or HALLWAY), then PV1-11 - Temporary Location is used to indicate the new temporary location. If the patient is moving from one temporary location to another, then PV1-43 - Prior Temporary Location may also be used. PV1-6 - Prior Patient Location and PV1-11 - Temporary Location should be used when the patient is moving from a permanent location to a temporary location.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Attention: The DG1 segment was retained for backward compatibility only as of v2.4 and was withdrawn and removed from this message structure as of v2.7.

Segment Cardinality Implement Status
ADT^A09^ADT_A09
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
DG1

Diagnosis

  withdrawn

 

ADT_A09

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A11^ADT_A09
Blank Blank - ADT^A10^ADT_A09
Blank Blank - ADT^A09^ADT_A09
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A11^ACK -
AL, SU, ER NE ACK^A10^ACK -
AL, SU, ER NE ACK^A09^ACK -
NE AL, SU, ER - ACK^A11^ACK
NE AL, SU, ER - ACK^A10^ACK
NE AL, SU, ER - ACK^A09^ACK
AL, SU, ER AL, SU, ER ACK^A11^ACK ACK^A11^ACK
AL, SU, ER AL, SU, ER ACK^A10^ACK ACK^A10^ACK
AL, SU, ER AL, SU, ER ACK^A09^ACK ACK^A09^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A09^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.10 ADT/ACK - Patient Arriving - Tracking (Event A10) (3.3.10)

The A10 event is sent when a patient arrives at a new location in the healthcare facility (inpatient or outpatient). The A09 - patient departing-tracking and A10 events are used when there is a change in a patient's physical location and when this is NOT a change in the official census bed location, as in the case of an outpatient setting. There are three varieties of these non-census location changes involving three different kinds of notification: (a) an unofficial notification of location change prior to the official notification of patient tracking, (b) the patient is in transit between locations for some time, (c) a notification of a temporary location change.

Patient tracking: If the patient is now at a non-temporary location and is not in transit, then PV1-3 - Assigned Patient Location must contain the new patient location and PV1-6 - Prior Patient Location can contain the old patient location.

In transit: This is used when there is some period of time between when the patient leaves his/her old location and when he/she arrives at the new assigned location. If the patient was in transit during the time between the A09 (patient departing-tracking) event and the A10 (patient arriving-tracking) event, then PV1-3 - Assigned Patient Location is used for the new location and PV1-6 - Prior Patient Location should be used for the old location. PV1-11 - Temporary Location and PV1-43 - Prior Temporary Location are not used.

Temporary location: An A10 event can also be used when the patient is being transferred from a temporary location (X-RAY, O/R, LIMBO, or HALLWAY) to the new assigned location. If the patient is arriving at a temporary location (such as the O/R, X-RAY, LIMBO, or HALLWAY), then PV1-11 - Temporary Location would be used to indicate the new temporary location. If the patient is moving from one temporary location to another, then PV1-43 - Prior Temporary Location may also be used. If the patient is arriving at a permanent location from a temporary location, PV1-3 - Assigned Patient Location should be used for the new location, and PV1-43 - Prior Temporary Location should be used for the old location.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Attention: The DG1 segment was retained for backward compatibility only as of v2.4 and was withdrawn and removed from this message structure as of v2.7.

Segment Cardinality Implement Status
ADT^A10^ADT_A09
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
DG1

Diagnosis

  withdrawn

 

ADT_A09

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A11^ADT_A09
Blank Blank - ADT^A10^ADT_A09
Blank Blank - ADT^A09^ADT_A09
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A11^ACK -
AL, SU, ER NE ACK^A10^ACK -
AL, SU, ER NE ACK^A09^ACK -
NE AL, SU, ER - ACK^A11^ACK
NE AL, SU, ER - ACK^A10^ACK
NE AL, SU, ER - ACK^A09^ACK
AL, SU, ER AL, SU, ER ACK^A11^ACK ACK^A11^ACK
AL, SU, ER AL, SU, ER ACK^A10^ACK ACK^A10^ACK
AL, SU, ER AL, SU, ER ACK^A09^ACK ACK^A09^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A10^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.11 ADT/ACK - Cancel Admit / Visit Notification (Event A11) (3.3.11)

For "admitted" patients, the A11 event is sent when an A01 (admit/visit notification) event is cancelled, either because of an erroneous entry of the A01 event, or because of a decision not to admit the patient after all.

For "non-admitted" patients, the A11 event is sent when an A04 (register a patient) event is cancelled, either because of an erroneous entry of the A04 event, or because of a decision not to check the patient in for the visit after all. To cancel an A05 (pre-admit a patient) event, use the A38 (cancel pre-admit), which was new for Version 2.3 of this Standard.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Attention: The DG1 segment was retained for backward compatibility only as of v2.4 and was withdrawn and removed from this message structure as of v2.7.

Segment Cardinality Implement Status
ADT^A11^ADT_A09
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
DG1

Diagnosis

  withdrawn

 

ADT_A09

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A11^ADT_A09
Blank Blank - ADT^A10^ADT_A09
Blank Blank - ADT^A09^ADT_A09
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A11^ACK -
AL, SU, ER NE ACK^A10^ACK -
AL, SU, ER NE ACK^A09^ACK -
NE AL, SU, ER - ACK^A11^ACK
NE AL, SU, ER - ACK^A10^ACK
NE AL, SU, ER - ACK^A09^ACK
AL, SU, ER AL, SU, ER ACK^A11^ACK ACK^A11^ACK
AL, SU, ER AL, SU, ER ACK^A10^ACK ACK^A10^ACK
AL, SU, ER AL, SU, ER ACK^A09^ACK ACK^A09^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A11^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.12 ADT/ACK - Cancel Transfer (Event A12) (3.3.12)

The A12 event is sent when an A02 (transfer a patient) event is cancelled, either because of erroneous entry of the A02 event or because of a decision not to transfer the patient after all. PV1-3 - Assigned Patient Location must show the location of the patient prior to the original transfer.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) even be used in addition.

Attention: The DG1 segment was retained for backward compatibility only as of v2.4 and was withdrawn and removed from this message structure as of v2.7.

Segment Cardinality Implement Status
ADT^A12^ADT_A12
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
DG1

Diagnosis

[0..1]   withdrawn

 

ADT_A12

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A12^ADT_A12
NE NE - -
AL, SU, ER NE ACK^A12^ACK -
NE AL, SU, ER - ACK^A12^ACK
AL, SU, ER AL, SU, ER ACK^A12^ACK ACK^A12^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A12^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.13 ADT/ACK - Cancel Discharge / End Visit (Event A13) (3.3.13)

The A13 event is sent when an A03 (discharge/end visit) event is cancelled, either because of erroneous entry of the A03 event or because of a decision not to discharge or end the visit of the patient after all. PV1-3 - Assigned Patient Location should reflect the location of the patient after the cancellation has been processed.

Note: This location may be different from the patient's location prior to the erroneous discharge. Prior Location could be used to show the location of the patient prior to the erroneous discharge.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The PRT - Participation Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the ROL, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A13^ADT_A01
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  
PDA

Patient Death and Autopsy

[0..1]  

 

ADT_A01

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A08^ADT_A01
Blank Blank - ADT^A13^ADT_A01
Blank Blank - ADT^A04^ADT_A01
Blank Blank - ACK^A01^ACK
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A13^ACK -
AL, SU, ER NE ACK^A01^ACK -
AL, SU, ER NE ACK^A08^ACK -
AL, SU, ER NE ACK^A04^ACK -
NE AL, SU, ER - ACK^A01^ACK
NE AL, SU, ER - ACK^A04^ACK
NE AL, SU, ER - ACK^A08^ACK
NE AL, SU, ER - ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A13^ACK ACK^A13^ACK
AL, SU, ER AL, SU, ER ACK^A01^ACK ACK^A01^ACK
AL, SU, ER AL, SU, ER ACK^A08^ACK ACK^A08^ACK
AL, SU, ER AL, SU, ER ACK^A04^ACK ACK^A04^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A13^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.14 ADT/ACK - Pending Admit (Event A14) (3.3.14)

An A14 event notifies other systems of a planned admission, when there is a reservation or when patient admission is to occur imminently. The A14 event is similar to a pre-admit, but without the implication that an account should be opened for the purposes of tests prior to admission. It is used when advanced notification of an admit is required in order to prepare for the patient's arrival.

The PRT - Participation Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the -PRT-11 - Begin Date/Time and the -PRT-12 - End Date/Time in the PRT, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A14^ADT_A05
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  

 

ADT_A05

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A05^ADT_A05
Blank Blank - ADT^A14^ADT_A05
Blank Blank - ADT^A31^ADT_A05
Blank Blank - ADT^A28^ADT_A05
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A14^ACK -
AL, SU, ER NE ACK^A28^ACK -
AL, SU, ER NE ACK^A05^ACK -
AL, SU, ER NE ACK^A31^ACK -
NE AL, SU, ER - ACK^A28^ACK
NE AL, SU, ER - ACK^A31^ACK
NE AL, SU, ER - ACK^A05^ACK
NE AL, SU, ER - ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A14^ACK ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A28^ACK ACK^A28^ACK
AL, SU, ER AL, SU, ER ACK^A05^ACK ACK^A05^ACK
AL, SU, ER AL, SU, ER ACK^A31^ACK ACK^A31^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A14^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.15 ADT/ACK - Pending Transfer (Event A15) (3.3.15)

An A15 event notifies other systems of a plan to transfer a patient to a new location when the patient has not yet left the old location. It is used when advanced notification of a transfer is required in order to prepare for the patient's location change. For example, this transaction could be sent so that staff will be on hand to move the patient or so that dietary services can route the next meal to the new location.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the PRT-11 - Begin Date/Time and the PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Attention: The DG1 segment was retained in this message for backward compatibility only as of v2.4 and was withdrawn and removed from this message structure as of v2.7.

Segment Cardinality Implement Status
ADT^A15^ADT_A15
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

[1..*] SHALL
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A15

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A15^ADT_A15
NE NE - -
AL, SU, ER NE ACK^A15^ACK -
NE AL, SU, ER - ACK^A15^ACK
AL, SU, ER AL, SU, ER ACK^A15^ACK ACK^A15^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A15^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.16 ADT/ACK - Pending Discharge (Event A16) (3.3.16)

An A16 event notifies other systems of a plan to discharge a patient when the patient has not yet left the healthcare facility. It is used when advanced notification of a discharge is required in order to prepare for the patient's change in location. For example, it is used to notify the pharmacy of the possible need for discharge drugs or to notify psychotherapy of the possible need for post-discharge appointments or to notify the extended care or home health system that the patient will be discharged and that the new extended care and home health admission assessment can be scheduled.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the PRT-11 - Begin Date/Time and the PRT-12 - End Date/Time in the PRT, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A16^ADT_A16
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  

 

ADT_A16

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A16^ADT_A16
NE NE - -
AL, SU, ER NE ACK^A16^ACK -
NE AL, SU, ER - ACK^A16^ACK
AL, SU, ER AL, SU, ER ACK^A16^ACK ACK^A16^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A16^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.17 ADT/ACK - Swap Patients (Event A17) (3.3.17)

The A17 is used when it is decided that two patients will exchange beds. The patient ID and visit data are repeated for the two patients changing places. See section 3.5.1, "Swapping a patient," for a discussion of issues related to implementing this trigger event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A17^ADT_A17
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION_RESULT_1  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION_RESULT_2  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A17

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A17^ADT_A17
NE NE - -
AL, SU, ER NE ACK^A17^ACK -
NE AL, SU, ER - ACK^A17^ACK
AL, SU, ER AL, SU, ER ACK^A17^ACK ACK^A17^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A17^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.18 ADT/ACK - Merge Patient Information (Event A18) (3.3.18)

The Original Mode Query was maintained for backward compatibility as of v2.3.1 and was withdrawn as of v2.7. The reader is referred to sections 3.3.40 - (event A40 - merge patient-patient identifier list), 3.3.41 (event A41 - merge account-patient account number) and 3.3.42 (event A42 - merge visit-visit number) for the current query/response message structure.

See section 3.5.2, "Merging patient/person information," for a discussion of issues related to implementing patient merge events.

18.12.19 QRY/ADR - Patient Query (Event A19) (3.3.19)

The Original Mode Query was maintained for backward compatibility as of v2.4 and was withdrawn as of v2.7. The reader is referred to chapter 5, section 5.4, for the current query/response message structure.

18.12.20 ADT/ACK - Bed Status Update (Event A20) (3.3.20)

Certain nursing/census applications need to be able to update the Patient Administration system's bed status. The following is the associated record layout:

Segment Cardinality Implement Status
ADT^A20^ADT_A20
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
EVN

Event Type

[1..1] SHALL
NPU

Bed Status Update

[1..1] SHALL

 

ADT_A20

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A20^ADT_A20
NE NE - -
AL, SU, ER NE ACK^A20^ACK -
NE AL, SU, ER - ACK^A20^ACK
AL, SU, ER AL, SU, ER ACK^A20^ACK ACK^A20^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A20^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.21 ADT/ACK - Patient Goes on a Leave of Absence (Event A21) (3.3.21)

An A21 event is sent to notify systems that an admitted patient has left the healthcare institution temporarily. It is used for systems in which a bed is still assigned to the patient, and it puts the current admitted patient activities on hold. For example, it is used to notify dietary services and laboratory systems when the patient goes home for the weekend.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

As there is no specific field for the LOA start date/time, it is recommended field EVN-6 - Event Occurred contain the date/time the patient actually left. PV2-47 - Expected LOA Return Date/Time is used to communicate the date/time the patient is expected to return from LOA.

Segment Cardinality Implement Status
ADT^A21^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A21^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.22 ADT/ACK - Patient Returns From a Leave of Absence (Event A22) (3.3.22)

An A22 event is sent to notify systems that an admitted patient has returned to the healthcare institution after a temporary "leave of absence." It is used for systems in which a bed is still assigned to the patient, and it takes their current admitted patient activities off of "hold" status. For example, it is used to notify dietary services and laboratory systems when the patient returns from a weekend trip to his/her home.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

As there is no specific field for the LOA start date/time, it is recommended that field EVN-6 - Event Occurred contain the date/time the patient actually returned from LOA. PV2-47 - Expected LOA Return Date/Time is used to communicate the date/time the patient was expected to return from LOA.

Segment Cardinality Implement Status
ADT^A22^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A22^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.23 ADT/ACK - Delete a Patient Record (Event A23) (3.3.23)

The A23 event is used to delete visit or episode-specific information from the patient record. For example, it is used to remove old data from a database that cannot hold all historical patient visit data. When an event was entered erroneously, use one of the cancel transactions. This event can be used to purge account-level data while retaining the person in the database.

Segment Cardinality Implement Status
ADT^A23^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A23^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.24 ADT/ACK - Link Patient Information (Event A24) (3.3.24)

The A24 event is used when the first PID segment needs to be linked to the second PID segment and when both patient identifiers identify the same patient. Linking two or more patients does not require the actual merging of patient information; following a link event, the affected patient data records should remain distinct. For example, this event could be used in a hospital network environment in which there are multiple campuses and in which records need to be linked. For example, hospital A, hospital B, and hospital C would each keep their own records on a patient, but an A24 link event would be sent to a corporate-wide MPI to enable the coupling of ID information with the corporate ID number. It is used for corporate data repositories, etc. This event is not meant to link mothers and babies since a field exists (PID-21 - Mother's Identifier) for that purpose. See section 3.5.3, "Patient record links," for a discussion of issues related to implementing patient link messages and MPI issues.

This event can also be used to link two patient identifiers when a patient changes from inpatient to outpatient, or vice versa. This event can also be used to link two visits of the same patient.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A24^ADT_A24
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[0..1]  
DB1

Disability

 
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[0..1]  
DB1

Disability

 

 

ADT_A24

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A24^ADT_A24
NE NE - -
AL, SU, ER NE ACK^A24^ACK -
NE AL, SU, ER - ACK^A24^ACK
AL, SU, ER AL, SU, ER ACK^A24^ACK ACK^A24^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A24^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.25 ADT/ACK - Cancel Pending Discharge (Event A25) (3.3.25)

The A25 event is sent when an A16 (pending discharge) event is cancelled, either because of erroneous entry of the A16 event or because of a decision not to discharge the patient after all.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A25^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A25^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.26 ADT/ACK - Cancel Pending Transfer (Event A26) (3.3.26)

The A26 event is sent when an A15 (pending transfer) event is cancelled, either because of erroneous entry of the A15 event or because of a decision not to transfer the patient after all.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A26^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A26^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.27 ADT/ACK - Cancel Pending Admit (Event A27) (3.3.27)

The A27 event is sent when an A14 (pending admit) event is cancelled, either because of erroneous entry of the A14 event or because of a decision not to admit the patient after all.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A27^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A27^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.28 ADT/ACK - Add Person or Patient Information (Event A28) (3.3.28)

The purpose of this and the three following messages was to allow sites with multiple systems and respective master patient databases to communicate activity related to a person regardless of whether that person is currently a patient on each system. Each system has an interest in the database activity of the others in order to maintain data integrity across an institution. Though they are defined within the ADT message set, these messages differ in that they are not patient-specific. To a certain registry, the person may be a person of interest, a potential future patient, or a potential guarantor. For example, these events can be used to maintain an MPI (master patient index), a cancer registry, members of a managed care plan, an HIV database, etc.

These events should not replace the use of the A01 (admit/visit notification), A03 (discharge/end visit), A04 (register a patient), A08 (update patient information), etc., events. They are not intended to be used for notification of real-time Patient Administration events. These events are primarily for demographic data, but optional historical non-demographic data may be sent as well.

The person whose data is being sent should be identified in the PID segment using the PID-3 - Patient Identifier List, even when the person is not a patient and may be a potential guarantor. An A28 establishes person identifiers, e.g., social security number, guarantor identifier, or other unique identifiers, and contains a person identifier in the PID-3 - Patient Identifier List. The person involved may or may not have active or inactive cases associated with them. When field names and descriptions say "patient," we must translate that to "person" for these transactions. In this manner, "person information" about a guarantor can be sent independently of the guarantor's relation to any patient.

For example, a site with separate inpatient, outpatient and medical records systems may require that each system maintain concurrent person information. Prior to an admit, the new person is added to the master database of the inpatient system, resulting in the broadcast of a message. The outpatient system receives the message and adds the person to its database with the possibility that the person may someday become a patient in its system. The medical records system receives the message and adds the person to its database with the possibility that it will track inpatient, outpatient, or clinical data for that person. The clinical repository database or MPI receives the message to keep all potential patients and guarantors in its database.

The A28 event can be used to send everything that is known about a person. For example, it can be sent to an ICU unit (in addition to the A02 (transfer a patient) event) when a patient is transferred to the ICU unit in order to backload all demographic information for the patient into the ICU system. An A28 (add person information) or A31 (update person information) can also be used for backloading MPI information for the person, or for backloading person and historical information.

In addition to adding a person to a database, the delete, update, and merge messages work in a similar manner to maintain concurrent person information. It is left up to site-specific negotiations to decide how much data must be transmitted or re-transmitted when a person becomes a patient.

To maintain backward compatibility with previous releases, the PV1 segment is required. However, a "pseudo-optional" PV1 can be achieved by valuing PV1-2 - Patient Class to N - not applicable.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin and end date of the provider, use the PRT-11 - Begin Date/Time and the PRT-12 - End Date/Time in the PRT, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A28^ADT_A05
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  

 

ADT_A05

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A05^ADT_A05
Blank Blank - ADT^A14^ADT_A05
Blank Blank - ADT^A31^ADT_A05
Blank Blank - ADT^A28^ADT_A05
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A14^ACK -
AL, SU, ER NE ACK^A28^ACK -
AL, SU, ER NE ACK^A05^ACK -
AL, SU, ER NE ACK^A31^ACK -
NE AL, SU, ER - ACK^A28^ACK
NE AL, SU, ER - ACK^A31^ACK
NE AL, SU, ER - ACK^A05^ACK
NE AL, SU, ER - ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A14^ACK ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A28^ACK ACK^A28^ACK
AL, SU, ER AL, SU, ER ACK^A05^ACK ACK^A05^ACK
AL, SU, ER AL, SU, ER ACK^A31^ACK ACK^A31^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A28^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.29 ADT/ACK - Delete Person Information (Event A29) (3.3.29)

An A29 event can be used to delete all demographic information related to a given person. This event "undoes" an A28 (add person information) event. The information from the A28 event is deleted. This event is used, for example, when adding the information was performed in error, or when another record already exists for the person, or when one wants to purge the person from the database. When this event occurs, all visit and account level data for this person is also purged.

To maintain backward compatibility with previous releases, the PV1 segment is required. However, a "pseudo-optional" PV1 can be achieved by valuing PV1-2 - Patient Class to N - not applicable.

Segment Cardinality Implement Status
ADT^A29^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A29^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.30 ADT/ACK - Merge Person Information (Event A30) (3.3.30)

Attention: The Merge Person Information event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A40 (merge patient-patient identifier list) event to be used to merge patient information for a current episode.

18.12.31 ADT/ACK - Update Person Information (Event A31) (3.3.31)

An A31 event can be used to update person information on an MPI. It is similar to an A08 (update patient information) event, but an A08 (update patient information) event should be used to update patient information for a current episode. An A28 (add person information) or A31 can also be used for backloading MPI information for the person, or for backloading person and historical information.

To maintain backward compatibility with previous releases, the PV1 segment is required. However, a "pseudo-optional" PV1 can be achieved by valuing PV1-2 - Patient Class to N - not applicable.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin and end date of the provider, use the PRT-11 - Begin Date/Time and the PRT-12 - End Date/Time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A31^ADT_A05
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
OH1

Person Employment Status

 
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
OH4

Combat Zone Work

 
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
NEXT_OF_KIN  
NK1

Next of Kin / Associated Parties

[1..1] SHALL
OH2

Past or Present Job

 
OH3

Usual Work

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ROL

Role

  B
PRT

Participation Information

 
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
AL1

Patient Allergy Information

 
IAM

Patient Adverse Reaction Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  
PROCEDURE  
PR1

Procedures

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
GT1

Guarantor

 
INSURANCE  
IN1

Insurance

[1..1] SHALL
IN2

Insurance Additional Information

[0..1]  
IN3

Insurance Additional Information, Certification

 
ROL

Role

  B
PRT

Participation Information

 
AUTHORIZATION  
AUT

Authorization Information

[1..1] SHALL
PRT

Participation Information

 
REFERRAL  
RF1

Referral Information

[1..1] SHALL
PRT

Participation Information

 
ACC

Accident

[0..1]  
UB1

Uniform Billing Data 1

[0..1]  
UB2

Uniform Billing Data 2

[0..1]  

 

ADT_A05

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A05^ADT_A05
Blank Blank - ADT^A14^ADT_A05
Blank Blank - ADT^A31^ADT_A05
Blank Blank - ADT^A28^ADT_A05
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A14^ACK -
AL, SU, ER NE ACK^A28^ACK -
AL, SU, ER NE ACK^A05^ACK -
AL, SU, ER NE ACK^A31^ACK -
NE AL, SU, ER - ACK^A28^ACK
NE AL, SU, ER - ACK^A31^ACK
NE AL, SU, ER - ACK^A05^ACK
NE AL, SU, ER - ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A14^ACK ACK^A14^ACK
AL, SU, ER AL, SU, ER ACK^A28^ACK ACK^A28^ACK
AL, SU, ER AL, SU, ER ACK^A05^ACK ACK^A05^ACK
AL, SU, ER AL, SU, ER ACK^A31^ACK ACK^A31^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A31^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.32 ADT/ACK - Cancel Patient Arriving - Tracking (Event A32) (3.3.32)

The A32 event is sent when an A10 (patient arriving-tracking) event is cancelled, either because of erroneous entry of the A10 event or because of a decision not to receive the patient after all.

If the patient was in a non-temporary location, then the PV1-3 - Assigned Patient Location may contain (if known) the original patient location prior to the erroneous A10 (patient arriving-tracking) event. If the patient was in a temporary location, then PV1-11 - Temporary Location may contain (if known) the original patient location prior to the erroneous A10 (patient arriving-tracking) event.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A32^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A32^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
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18.12.33 ADT/ACK - Cancel Patient Departing - Tracking (Event A33) (3.3.33)

The A33 event is sent when an A09 (patient departing-tracking) event is cancelled, either because of erroneous entry of the A09 event or because of a decision not to send the patient after all.

If the patient was in a non-temporary location, then PV1-3 - Assigned Patient location must contain the original patient location prior to the erroneous A09 (patient departing-tracking) event. If the patient was in a temporary location, then PV1-11 - Temporary Location must contain the original patient location prior to the erroneous A09 (patient departing-tracking) event.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A33^ADT_A21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 

 

ADT_A21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A33^ADT_A21
Blank Blank - ADT^A23^ADT_A21
Blank Blank - ADT^A25^ADT_A21
Blank Blank - ADT^A27^ADT_A21
Blank Blank - ADT^A29^ADT_A21
Blank Blank - ADT^A22^ADT_A21
Blank Blank - ADT^A21^ADT_A21
Blank Blank - ADT^A26^ADT_A21
Blank Blank - ADT^A32^ADT_A21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A27^ACK -
AL, SU, ER NE ACK^A26^ACK -
AL, SU, ER NE ACK^A32^ACK -
AL, SU, ER NE ACK^A21^ACK -
AL, SU, ER NE ACK^A25^ACK -
AL, SU, ER NE ACK^A23^ACK -
AL, SU, ER NE ACK^A29^ACK -
AL, SU, ER NE ACK^A22^ACK -
AL, SU, ER NE ACK^A33^ACK -
NE AL, SU, ER - ACK^A25^ACK
NE AL, SU, ER - ACK^A26^ACK
NE AL, SU, ER - ACK^A23^ACK
NE AL, SU, ER - ACK^A27^ACK
NE AL, SU, ER - ACK^A29^ACK
NE AL, SU, ER - ACK^A32^ACK
NE AL, SU, ER - ACK^A33^ACK
NE AL, SU, ER - ACK^A21^ACK
NE AL, SU, ER - ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A27^ACK ACK^A27^ACK
AL, SU, ER AL, SU, ER ACK^A26^ACK ACK^A26^ACK
AL, SU, ER AL, SU, ER ACK^A32^ACK ACK^A32^ACK
AL, SU, ER AL, SU, ER ACK^A25^ACK ACK^A25^ACK
AL, SU, ER AL, SU, ER ACK^A33^ACK ACK^A33^ACK
AL, SU, ER AL, SU, ER ACK^A21^ACK ACK^A21^ACK
AL, SU, ER AL, SU, ER ACK^A23^ACK ACK^A23^ACK
AL, SU, ER AL, SU, ER ACK^A22^ACK ACK^A22^ACK
AL, SU, ER AL, SU, ER ACK^A29^ACK ACK^A29^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A33^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.34 ADT/ACK - Merge Patient Information - Patient ID Only (Event A34) (3.3.34)

Attention: The Merge Patient Information - Patient ID Only (A34) event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A40 (Merge Patient-Patient Identifier List) event.

18.12.35 ADT/ACK - Merge Patient Information - Account Number Only (Event A35) (3.3.35)

Attention: The Merge Patient Information - Account Number Only (A35) event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A41 (Merge Patient - Patient Account Number) event.

18.12.36 ADT/ACK - Merge Patient Information - Patient ID & Account Number (Event A36) (3.3.36)

Attention: The Merge Patient Information - Patient ID & Account Number (A36) event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A40 (Merge Patient-Patient Identifier List) event and the A41 (merge patient - patient account number) event.

18.12.37 ADT/ACK - Unlink Patient Information (Event A37) (3.3.37)

The A37 event unlinks two patient identifiers.

Segment Cardinality Implement Status
ADT^A37^ADT_A37
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[0..1]  
DB1

Disability

 
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[0..1]  
DB1

Disability

 

 

ADT_A37

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A37^ADT_A15
NE NE - -
AL, SU, ER NE ACK^A37^ACK -
NE AL, SU, ER - ACK^A37^ACK
AL, SU, ER AL, SU, ER ACK^A37^ACK ACK^A37^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A37^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.38 ADT/ACK - Cancel Pre-Admit (Event A38) (3.3.38)

The A38 event is sent when an A05 (pre-admit a patient) event is cancelled, either because of erroneous entry of the A05 event or because of a decision not to pre-admit the patient after all.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A38^ADT_A38
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
DB1

Disability

 
OBSERVATION  
OBX

Observation/Result

[1..1] SHALL
PRT

Participation Information

 
DG1

Diagnosis

 
DRG

Diagnosis Related Group

[0..1]  

 

ADT_A38

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A38^ADT_A38
NE NE - -
AL, SU, ER NE ACK^A38^ACK -
NE AL, SU, ER - ACK^A38^ACK
AL, SU, ER AL, SU, ER ACK^A38^ACK ACK^A38^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A38^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

st

18.12.39 ADT/ACK - Merge Person - Patient ID (Event A39) (3.3.39)

Attention: The Merge Person - Patient ID (A39) event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A41 (Merge Patient - Patient Account Number) event.

18.12.40 ADT/ACK - Merge Patient - Patient Identifier List (Event A40) (3.3.40)

A merge has been done at the patient identifier list level. That is, two PID-3 - Patient Identifier List identifiers have been merged into one.

An A40 event is used to signal a merge of records for a patient that was incorrectly filed under two different identifiers. The "incorrect source identifier" identified in the MRG segment (MRG-1 - Prior Patient Identifier List) is to be merged with the required "correct target identifier" of the same "identifier type code" component identified in the PID segment (PID-3 - Patient Identifier List). The "incorrect source identifier" would then logically never be referenced in future transactions. It is noted that some systems may still physically keep this "incorrect identifier" for audit trail purposes or other reasons associated with database index implementation requirements.

The identifiers involved in identifying the patients may or may not have accounts, which may or may not have visits. An A40 (merge patient-patient identifier list) event is intended for merging patient records without merging other subordinate identifiers. Any other subordinate identifiers that were previously associated with the "incorrect source identifier" are now associated with the "correct target identifier." Specification of these other subordinate identifiers is not required.

This event and the message syntax do, however, allow for the specification of any other "new subordinate identifiers" (in addition to the PID-3 - Patient Identifier List identifier). For those environments that may require changes to these other subordinate identifiers because of the A40 (merge patient-patient identifier list) event, it is required that the old and new identifiers be a "tightly coupled" pair.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.2, "Merge," for a discussion of issues related to the implementation of merge messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other fields change, it is recommended that the A31 (update person information) event be used for person level updates and A08 (update patient information) event for patient level updates.

Segment Cardinality Implement Status
ADT^A40^ADT_A39
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL
PV1

Patient Visit

[0..1]  

 

ADT_A39

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A42^ADT_A39
Blank Blank - ADT^A41^ADT_A39
Blank Blank - ADT^A40^ADT_A39
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A42^ACK -
AL, SU, ER NE ACK^A41^ACK -
AL, SU, ER NE ACK^A40^ACK -
NE AL, SU, ER - ACK^A42^ACK
NE AL, SU, ER - ACK^A41^ACK
NE AL, SU, ER - ACK^A40^ACK
AL, SU, ER AL, SU, ER ACK^A42^ACK ACK^A42^ACK
AL, SU, ER AL, SU, ER ACK^A41^ACK ACK^A41^ACK
AL, SU, ER AL, SU, ER ACK^A40^ACK ACK^A40^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A40^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.41 ADT/ACK - Merge Account - Patient Account Number (Event A41) (3.3.41)

A merge has been done at the account identifier level. That is, two PID-18 - Patient Account Number identifiers have been merged into one.

An A41 event is used to signal a merge of records for an account that was incorrectly filed under two different account numbers. The "incorrect source patient account number" identified in the MRG segment (MRG-3 - Prior Patient Account Number) is to be merged with the "correct target patient account number" identified in the PID segment (PID-18 - Patient Account Number). The "incorrect source patient account number" would then logically never be referenced in future transactions. It is noted that some systems may still physically keep this "incorrect identifier" for audit trail purposes or other reasons associated with database index implementation requirements.

The patient account numbers involved may or may not have visits. An A41 (merge account-patient account number) is intended for merging account records without merging other subordinate identifiers. Any other subordinate identifiers that were previously associated with the "incorrect source account number" are now associated with the required "correct target account number." Specification of these other subordinate identifiers is not required.

This event and the message syntax do, however, allow for the specification of any other "new subordinate identifiers" (in addition to the PID-18 - Patient Account Number identifier). For those environments that may require changes to these other subordinate identifiers because of this A41 (merge account-patient account number) event, it is required that the old and new identifiers be a "tightly coupled" pair.

Each superior identifier associated with this account identifier level should have the same value in both the PID and MRG segments.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.2, "Merge," for a discussion of issues related to the implementation of merge messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other fields change, it is recommended that the A08 (update patient information) event be used in addition

Segment Cardinality Implement Status
ADT^A41^ADT_A39
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL
PV1

Patient Visit

[0..1]  

 

ADT_A39

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A42^ADT_A39
Blank Blank - ADT^A41^ADT_A39
Blank Blank - ADT^A40^ADT_A39
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A42^ACK -
AL, SU, ER NE ACK^A41^ACK -
AL, SU, ER NE ACK^A40^ACK -
NE AL, SU, ER - ACK^A42^ACK
NE AL, SU, ER - ACK^A41^ACK
NE AL, SU, ER - ACK^A40^ACK
AL, SU, ER AL, SU, ER ACK^A42^ACK ACK^A42^ACK
AL, SU, ER AL, SU, ER ACK^A41^ACK ACK^A41^ACK
AL, SU, ER AL, SU, ER ACK^A40^ACK ACK^A40^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A41^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.42 ADT/ACK - Merge Visit - Visit Number (Event A42) (3.3.42)

A merge has been done at the visit identifier level. That is, two PV1-19 - Visit Number identifiers have been merged into one.

An A42 event is used to signal a merge of records for a visit that was incorrectly filed under two different visit numbers. The "incorrect source visit number" identified in the MRG segment (MRG-5 - Prior Visit Number) is to be merged with the required "correct target visit number" identified in the PV1 segment (PV1-19 - Visit Number). The "incorrect source visit number" would then logically never be referenced in future transactions. It is noted that some systems may still physically keep this "incorrect identifier" for audit trail purposes or other reasons associated with database index implementation requirements.

An A42 (merge visit-visit number) event is intended for merging visit records without merging other identifiers. Any other identifiers that were previously associated with the "incorrect source visit number" are now associated with the "correct target visit number."

Each superior identifier associated with this visit identifier level should have the same value in the PID and MRG segments, or the MRG and PV1 segments, as appropriate.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.2, "Merge," for a discussion of issues related to the implementation of merge messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other fields change, it is recommended that the A08 (update patient information) event be used in addition

Segment Cardinality Implement Status
ADT^A42^ADT_A39
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL
PV1

Patient Visit

[0..1]  

 

ADT_A39

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A42^ADT_A39
Blank Blank - ADT^A41^ADT_A39
Blank Blank - ADT^A40^ADT_A39
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A42^ACK -
AL, SU, ER NE ACK^A41^ACK -
AL, SU, ER NE ACK^A40^ACK -
NE AL, SU, ER - ACK^A42^ACK
NE AL, SU, ER - ACK^A41^ACK
NE AL, SU, ER - ACK^A40^ACK
AL, SU, ER AL, SU, ER ACK^A42^ACK ACK^A42^ACK
AL, SU, ER AL, SU, ER ACK^A41^ACK ACK^A41^ACK
AL, SU, ER AL, SU, ER ACK^A40^ACK ACK^A40^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A42^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.43 ADT/ACK - Move Patient Information - Patient Identifier List (Event A43) (3.3.43)

A move has been done at the patient identifier list level. Identifier to be moved in the PID-3 - Patient Identifier List and MRG-1 - Prior Patient Identifier List will have the same value. The "from" (incorrect source patient ID) and "to" (correct target patient ID) identifiers have different values. See A43 examples in section 5. The identifiers involved in identifying the patient to be moved (MRG-1 - Prior Patient Identifier List) may or may not have accounts, which may or may not have visits. In any case, all subordinate data sets associated with the identifier in MRG-1 - Prior Patient Identifier List are moved along with the identifier, from the "incorrect source patient ID" to the "correct target patient ID."

No identifiers subordinate to the identifier (account number, visit number, alternate visit ID) are valued in this message. Specification of these other subordinate identifiers is not required.

This event and the message syntax do, however, allow for the specification of a "new identifier" (PID-3 - Patient Identifier List), which may be application and/or implementation specific and therefore require site negotiation.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.3, "Move," for a discussion of issues related to the implementation of move messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A08 (update patient information) event be used in conjunction with this message. However, all PID data associated with the "correct target identifier" (PID-3 - Patient Identifier List) are treated as updated information.

Segment Cardinality Implement Status
ADT^A43^ADT_A43
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL

 

ADT_A43

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A49^ADT_A43
Blank Blank - ADT^A43^ADT_A43
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A49^ACK -
AL, SU, ER NE ACK^A43^ACK -
NE AL, SU, ER - ACK^A49^ACK
NE AL, SU, ER - ACK^A43^ACK
AL, SU, ER AL, SU, ER ACK^A49^ACK ACK^A49^ACK
AL, SU, ER AL, SU, ER ACK^A43^ACK ACK^A43^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A43^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.44 ADT/ACK - Move Account Information - Patient Account Number (Event A44) (3.3.44)

A move has been done at the account identifier level. That is, a PID-18 - Patient Account Number associated with one PID-3 - Patient Identifier List has been moved to another patient identifier list.

An A44 event is used to signal a move of records identified by the MRG-3 - Prior Patient Account Number from the "incorrect source patient identifier list" identified in the MRG segment (MRG-1 - Prior Patient Identifier List) to the "correct target patient identifier list" identified in the PID segment (PID-3 - Patient Identifier List).

The account number involved in identifying the account to be moved (MRG-3 - Prior Patient Account Number) may or may not have visits. In any case, all subordinate data sets associated with the account number in MRG-3 - Prior Patient Account Number are moved along with the account number, from the "incorrect source" ID (MRG-1 - Prior Patient Identifier List) to the "correct target" ID (PID-3 - Patient Identifier List).

No identifiers subordinate to the account number (visit number, alternate visit ID) are valued in this message.

This event and the message syntax do, however, allow for the specification of a "new identifier" (PID-18 - Patient Account Number), which may be application and/or implementation-specific and therefore require site negotiation.

All of the identifiers superior to the account number should be valued in both the MRG segment and the PID segment. In this message, the PID-3 - Patient Identifier List is superior to the account number.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.3, "Move," for a discussion of issues related to the implementation of move messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A08 (update patient information) event be used in conjunction with this message. However, all PID data associated with the "account number" are treated as updated information.

Segment Cardinality Implement Status
ADT^A44^ADT_A44
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ARV

Access Restriction

  B
MRG

Merge Patient Information

[1..1] SHALL

 

ADT_A44

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A47^ADT_A44
Blank Blank - ADT^A44^ADT_A44
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A47^ACK -
AL, SU, ER NE ACK^A44^ACK -
NE AL, SU, ER - ACK^A47^ACK
NE AL, SU, ER - ACK^A44^ACK
AL, SU, ER AL, SU, ER ACK^A47^ACK ACK^A47^ACK
AL, SU, ER AL, SU, ER ACK^A44^ACK ACK^A44^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A44^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.45 ADT/ACK - Move Visit Information - Visit Number (Event A45) (3.3.45)

A move has been done at the visit identifier level. That is, a PV1-19 - Visit Number or PV1-50 - Alternate Visit ID associated with one account identifier (PID-18 - Patient Account Number) has been moved to another account identifier.

An A45 event is used to signal a move of records identified by the MRG-5 - Prior Visit Number or the MRG-6 - Prior Alternate Visit ID from the "incorrect source account identifier" identified in the MRG segment (MRG-3 - Prior Patient Account Number) to the "correct target account identifier" identified in the PID segment (PID-18 - Patient Account Number).

This event and the message syntax do allow for the specification of "new identifiers" (PV1-19 - Visit Number, or PV1-50 - Alternate Visit ID), which may be application and/or implementation-specific and therefore require site negotiation.

All of the identifiers superior to the visit number or alternate visit ID should be valued in both the MRG segment and the PID segments. In this message, the account number and PID-3 - Patient Identifier List are superior to the visit number and alternate visit ID.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.3, "Move," for a discussion of issues related to the implementation of move messages. The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A08 (update patient information) event be used in conjunction with this message. However, all PID data associated with the "correct target visit ID" are treated as updated information.

Segment Cardinality Implement Status
ADT^A45^ADT_A45
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MERGE_INFO [1..*] SHALL
MRG

Merge Patient Information

[1..1] SHALL
PV1

Patient Visit

[1..1] SHALL

 

ADT_A45

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A45^ADT_A45
NE NE - -
AL, SU, ER NE ACK^A45^ACK -
NE AL, SU, ER - ACK^A45^ACK
AL, SU, ER AL, SU, ER ACK^A45^ACK ACK^A45^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A45^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.46 ADT/ACK - Change Patient ID (Event A46) (3.3.46)

Attention: The Change Patient ID(A46) event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A47 (Change patient Identifier List) event..

18.12.47 ADT/ACK - Change Patient Identifier List (Event A47) (3.3.47)

A change has been done at the patient identifier list level. That is, a single PID-3 - patient identifier list value has been found to be incorrect and has been changed.

An A47 event is used to signal a change of an incorrectly assigned PID-3 - Patient Identifier List value. The "incorrect source identifier" value is stored in the MRG segment (MRG-1 - Prior Patient Identifier List) and is to be changed to the "correct target patient ID" value stored in the PID segment (PID-3 - Patient Identifier List).

The identifier involved in identifying the patient may or may not have accounts, which may or may not have visits. An A47 (change patient identifier list) event is intended for changing the value of the patient identifier list without affecting other subordinate identifiers. Any other subordinate identifiers that were previously associated with the "incorrect source identifier" are now associated with the "correct target identifier." Specification of these other subordinate identifiers is not required.

This event and the message syntax do, however, allow for the specification of "new subordinate identifiers" (in addition to the PID-3 - Patient Identifier List identifier). For those environments that may require changes to these other subordinate identifiers because of this A47 (change patient identifier list) event, it is required that the old and new identifiers be a "tightly coupled" pair.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.4, "Change identifier," for a discussion of issues related to the implementation of change messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A31 (update patient information) event be used in conjunction with this message.

Segment Cardinality Implement Status
ADT^A47^ADT_A44
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ARV

Access Restriction

  B
MRG

Merge Patient Information

[1..1] SHALL

 

ADT_A44

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A47^ADT_A44
Blank Blank - ADT^A44^ADT_A44
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A47^ACK -
AL, SU, ER NE ACK^A44^ACK -
NE AL, SU, ER - ACK^A47^ACK
NE AL, SU, ER - ACK^A44^ACK
AL, SU, ER AL, SU, ER ACK^A47^ACK ACK^A47^ACK
AL, SU, ER AL, SU, ER ACK^A44^ACK ACK^A44^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A47^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.48 ADT/ACK - Change Alternate Patient ID (Event A48) (3.3.48)

Attention: The Change Alternate Patient ID (A48) event was maintained for backward compatibility only as of v2.3.1 and withdrawn as of v2.7. From V 2.3.1 onwards, the reader is referred to the A37 (Change patient Identifier List) event.

18.12.49 ADT/ACK - Change Patient Account Number (Event A49) (3.3.49)

A change has been done at the account identifier level. That is, a PID-18 - patient account number has been found to be incorrect and has been changed.

An A49 event is used to signal a change of an incorrectly assigned account number value. The "incorrect source account number" value is stored in the MRG segment (MRG-3 - Prior Patient Account Number) and is to be changed to the "correct target account number" value stored in the PID segment (PID-18 - Patient Account Number).

The patient account identifier involved in identifying the account may or may not have visits. An A49 (change patient account number) event is intended for changing the value of the account identifier without affecting other subordinate identifiers. Any other subordinate identifiers that were previously associated with the "incorrect source account number" are now associated with the "correct target account number". Specification of these other subordinate identifiers is not required.

This event and the message syntax do, however, allow for the specification of "new subordinate identifiers" (in addition to the PID-18 - Patient Account Number Identifier). For those environments that may require changes to these other subordinate identifiers because of this A49 (change patient account number) event, it is required that the old and new identifiers be a "tightly coupled" pair.

Each superior identifier associated with this account identifier level, i.e. the PID-3/MRG-1 should have the same value in both the PID and MRG segments.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.4, "Change identifier," for a discussion of issues related to the implementation of change messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A08 (update patient information) event be used in conjunction with this message.

Segment Cardinality Implement Status
ADT^A49^ADT_A43
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PATIENT [1..*] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL

 

ADT_A43

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A49^ADT_A43
Blank Blank - ADT^A43^ADT_A43
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A49^ACK -
AL, SU, ER NE ACK^A43^ACK -
NE AL, SU, ER - ACK^A49^ACK
NE AL, SU, ER - ACK^A43^ACK
AL, SU, ER AL, SU, ER ACK^A49^ACK ACK^A49^ACK
AL, SU, ER AL, SU, ER ACK^A43^ACK ACK^A43^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A49^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.50 ADT/ACK - Change Visit Number (Event A50) (3.3.50)

A change has been done at the visit identifier level. That is, a PV1-19 - Visit Number has been found to be incorrect and has been changed.

An A50 event is used to signal a change of an incorrectly assigned visit number value. The "incorrect source visit number" value is stored in the MRG segment (MRG-5 - Prior Visit Number) and is to be changed to the "correct target visit number" value stored in the PV1 segment (PV1-19 - Visit Number).

Each superior identifier associated with this visit number identifier level, i.e. PID-3/MRG-1 and PID-18/MRG-3 should have the same value in both the PID and MRG segments.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.4, "Change identifier," for a discussion of issues related to the implementation of change messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A08 (update patient information) event be used in conjunction with this message.

Segment Cardinality Implement Status
ADT^A50^ADT_A50
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL
PV1

Patient Visit

[1..1] SHALL

 

ADT_A50

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A51^ADT_A50
Blank Blank - ADT^A50^ADT_A50
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A51^ACK -
AL, SU, ER NE ACK^A50^ACK -
NE AL, SU, ER - ACK^A51^ACK
NE AL, SU, ER - ACK^A50^ACK
AL, SU, ER AL, SU, ER ACK^A51^ACK ACK^A51^ACK
AL, SU, ER AL, SU, ER ACK^A50^ACK ACK^A50^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A50^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.51 ADT/ACK - Change Alternate Visit ID (Event A51) (3.3.51)

A change has been done at the alternate visit identifier level. That is, a PV1-50 - Alternate Visit ID has been found to be incorrect and has been changed.

An A51 event is used to signal a change of an incorrectly assigned alternate visit ID value. The "incorrect source alternate visit ID" value is stored in the MRG segment (MRG-6 - Prior Alternate Visit ID) and is to be changed to the "correct target alternate visit ID" value stored in the PV1 segment (PV1-50 - Alternate Visit ID).

Each superior identifier associated with this alternate visit identifier level, i.e. PID-3/MRG-1 and PID-18/MRG-3 should have the same value in both the PID and MRG segments.

See sections 3.5.2, "Merging patient/person information," and 3.5.2.1.4, "Change identifier," for a discussion of issues related to the implementation of change messages.

The fields included when this message is sent should be the fields pertinent to communicate this event. When demographic data in other fields change, it is recommended that the A08 (update patient information) event be used in conjunction with this message.

Segment Cardinality Implement Status
ADT^A51^ADT_A50
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
MRG

Merge Patient Information

[1..1] SHALL
PV1

Patient Visit

[1..1] SHALL

 

ADT_A50

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A51^ADT_A50
Blank Blank - ADT^A50^ADT_A50
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A51^ACK -
AL, SU, ER NE ACK^A50^ACK -
NE AL, SU, ER - ACK^A51^ACK
NE AL, SU, ER - ACK^A50^ACK
AL, SU, ER AL, SU, ER ACK^A51^ACK ACK^A51^ACK
AL, SU, ER AL, SU, ER ACK^A50^ACK ACK^A50^ACK
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
ACK^A51^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.52 ADT/ACK- Cancel Leave of Absence for a Patient (Event A52) (3.3.52)

The A52 event is sent when an A21 (patient goes on "leave of absence") event is cancelled, either because of erroneous entry of the A21 event or because of a decision not to put the patient on "leave of absence" after all.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

As there is no specific field for the cancel LOA date/time, it is recommended field EVN-6 - Event Occurred contain the date/time the LOA was actually cancelled (but not necessarily recorded).

Segment Cardinality Implement Status
ADT^A52^ADT_A52
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  

 

ADT_A52

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A53^ADT_A52
Blank Blank - ADT^A52^ADT_A52
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A53^ACK -
AL, SU, ER NE ACK^A52^ACK -
NE AL, SU, ER - ACK^A53^ACK
NE AL, SU, ER - ACK^A52^ACK
AL, SU, ER AL, SU, ER ACK^A53^ACK ACK^A53^ACK
AL, SU, ER AL, SU, ER ACK^A52^ACK ACK^A52^ACK
We need some ER7 examples...
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Segment Cardinality Implement Status
ACK^A52^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
We need some XML examples...

18.12.53 ADT/ACK - Cancel Patient Returns from a Leave of Absence (Event A53) (3.3.53)

The A53 event is sent when an A22 (patient returns from "leave of absence") event is cancelled, either because of erroneous entry of the A22 event or because of a decision not to return the patient from "leave of absence" after all.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

As there is no specific field for the cancel LOA date/time, it is recommended that field EVN-6 - Event Occurred contain the date/time the return from LOA was actually cancelled (but not necessarily recorded).

PV2-47 - Expected LOA Return Date/Time is used to communicate the date/time the patient is expected to return from LOA.

Segment Cardinality Implement Status
ADT^A53^ADT_A52
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  

 

ADT_A52

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A53^ADT_A52
Blank Blank - ADT^A52^ADT_A52
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A53^ACK -
AL, SU, ER NE ACK^A52^ACK -
NE AL, SU, ER - ACK^A53^ACK
NE AL, SU, ER - ACK^A52^ACK
AL, SU, ER AL, SU, ER ACK^A53^ACK ACK^A53^ACK
AL, SU, ER AL, SU, ER ACK^A52^ACK ACK^A52^ACK
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Segment Cardinality Implement Status
ACK^A53^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
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18.12.54 ADT/ACK - Change Attending Doctor (Event A54) (3.3.54)

An A54 event is issued as a result of a change in the attending doctor responsible for the treatment of a patient.

When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

The new attending doctor of the patient should appear in the PV1-7 - Attending Doctor. For example, an A54 event can be used to notify the billing system that doctors' fees should be billed to the new doctor starting from the timestamp in the message.

The ROL - Role Segment was used in this message to communicate providers not specified elsewhere. As of v2.9, this has been deprecated in preference to the PRT segment as a more robust and flexible method of conveying participation. Hereafter, instructions for the PRT segment should apply, using the PRT segment. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments.

To communicate the begin and end date of the attending, referring, or admitting doctor, use the PRT-11 - Begin Date/Time and the PRT-12 - End Date/time in the PRT segment, with the applicable PRT-4 - Role of Participation. Refer to Chapter 7 for the definition of the PRT segment. Use "UP" in PRT-2 - Action Code.

Segment Cardinality Implement Status
ADT^A54^ADT_A54
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ROL

Role

  B
PRT

Participation Information

 
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ROL

Role

  B
PRT

Participation Information

 

 

ADT_A54

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A55^ADT_A54
Blank Blank - ADT^A54^ADT_A54
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A55^ACK -
AL, SU, ER NE ACK^A54^ACK -
NE AL, SU, ER - ACK^A55^ACK
NE AL, SU, ER - ACK^A54^ACK
AL, SU, ER AL, SU, ER ACK^A55^ACK ACK^A55^ACK
AL, SU, ER AL, SU, ER ACK^A54^ACK ACK^A54^ACK
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Segment Cardinality Implement Status
ACK^A54^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

We need some ER7 examples...
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18.12.55 ADT/ACK - Cancel Change Attending Doctor (Event A55) (3.3.55)

The A55 event is sent when an A54 (change attending doctor) event is cancelled, either because of erroneous entry of the A54 event or because of a decision not to change the attending doctor after all. PV1-7 - Attending Doctor must contain the patient's doctor prior to the change of attending doctor.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event be used in addition.

Segment Cardinality Implement Status
ADT^A55^ADT_A54
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ROL

Role

  B
PRT

Participation Information

 
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ROL

Role

  B
PRT

Participation Information

 

 

ADT_A54

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A55^ADT_A54
Blank Blank - ADT^A54^ADT_A54
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A55^ACK -
AL, SU, ER NE ACK^A54^ACK -
NE AL, SU, ER - ACK^A55^ACK
NE AL, SU, ER - ACK^A54^ACK
AL, SU, ER AL, SU, ER ACK^A55^ACK ACK^A55^ACK
AL, SU, ER AL, SU, ER ACK^A54^ACK ACK^A54^ACK
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Segment Cardinality Implement Status
ACK^A55^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

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18.12.56 QBP/RSP - Get Person Demographics (QBP) and Response (RSP) (Events Q21 and K21) (3.3.56)

This query/response is designed for interaction between a client system and an MPI (Master Person Index). The query consists of an identifier for a person, and the response of the demographics for that person.

Segment Cardinality Implement Status
QBP^Q21^QBP_Q21
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
QPD

Query Parameter Definition

[1..1] SHALL
RCP

Response Control Parameter

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

QBP_Q21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - RSP^K22^RSP_K22
Blank Blank - RSP^K23^RSP_K23
Blank Blank - RSP^K25^RSP_K25
Blank Blank - RSP^K32^RSP_K32
Blank Blank - RSP^K2^4^RSP_K24
Blank Blank - RSP^K21^RSP_K21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^Q23^ACK -
AL, SU, ER NE ACK^Q22^ACK -
AL, SU, ER NE ACK^Q24^ACK -
AL, SU, ER NE ACK^Q32^ACK -
AL, SU, ER NE ACK^Q21^ACK -
NE AL, SU, ER - RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K22^RSP_K22
NE AL, SU, ER - RSP^K21^RSP_K21
NE AL, SU, ER - RSP^K23^RSP_K23
AL, SU, ER AL, SU, ER ACK^Q25^ACK RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K24^RSP_K24
NE AL, SU, ER - RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q22^ACK RSP^K22^RSP_K22
AL, SU, ER AL, SU, ER ACK^Q21^ACK RSP^K21^RSP_K21
AL, SU, ER AL, SU, ER ACK^Q24^ACK RSP^K24^RSP_K24
AL, SU, ER AL, SU, ER ACK^Q32^ACK RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q23^ACK RSP^K23^RSP_K23
We need some ER7 examples...
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Segment Cardinality Implement Status
RSP^K21^RSP_K21
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

[0..1]  
QAK

Query Acknowledgment

[1..1] SHALL
QPD

Query Parameter Definition

[1..1] SHALL
QUERY_RESPONSE [0..1]  
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ARV

Access Restriction

  B
NK1

Next of Kin / Associated Parties

 
QRI

Query Response Instance

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

RSP_K21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - -
NE NE - -
AL, SU, ER NE ACK^K21^ACK -
We need some ER7 examples...
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Following is an example of a Q21/K21 query/response pair of messages. First is the query:

MSH|^~\&|CLINREG|WESTCLIN|HOSPMPI|HOSP|199912121135-0600||QBP^Q21^QBP_Q21|1|D|2.5

QPD|Q21^Get Person Demographics^HL7nnn|111069|112234^^^GOOD HEALTH HOSPITAL|^^^ GOOD HEALTH HOSPITAL~^^^SOUTH LAB|

RCP|I|

This query is asking for demographics for the person identified by the identifier 112234 from the assigning authority GOOD HEALTH HOSPITAL. With the demographics, we want identifiers returned for the person from the assigning authorities GOOD HEALTH HOSPITAL and SOUTH LAB. Here is a sample response:

MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN|199912121135-0600||RSP^K21^RSP_K21|1|D|2.5|

MSA|AA|8699|

QAK|111069|OK|Q21^Get Person Demographics^HL7nnn|1|

QPD|Q21^Get Person Demographics^HL7nnn|111069|112234^^^GOOD HEALTH HOSPITAL|^^^ GOOD HEALTH HOSPITAL~^^^SOUTH LAB|

PID|||112234^^^GOOD HEALTH HOSPITAL~98223^^^SOUTH LAB||Everyman^Adam||19600614|M||C|2101 Webster # 106^^Oakland^CA^94612|

QRI|100|

18.12.57 QBP/RSP - Find Candidates (QBP) and Response (RSP) (Events Q22 and K22) (3.3.57)

This query/response is designed for interaction between a client system and an MPI (Master Person Index). The query consists of a set of demographics for a person, and the response is the list of candidates considered by the MPI to match that set.

Each returned person, specified by a PID segment, can also have an optional QRI - Query Response Instance segment containing information about the quality of the match.

Segment Cardinality Implement Status
QBP^Q22^QBP_Q21
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
QPD

Query Parameter Definition

[1..1] SHALL
RCP

Response Control Parameter

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

QBP_Q21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - RSP^K22^RSP_K22
Blank Blank - RSP^K23^RSP_K23
Blank Blank - RSP^K25^RSP_K25
Blank Blank - RSP^K32^RSP_K32
Blank Blank - RSP^K2^4^RSP_K24
Blank Blank - RSP^K21^RSP_K21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^Q23^ACK -
AL, SU, ER NE ACK^Q22^ACK -
AL, SU, ER NE ACK^Q24^ACK -
AL, SU, ER NE ACK^Q32^ACK -
AL, SU, ER NE ACK^Q21^ACK -
NE AL, SU, ER - RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K22^RSP_K22
NE AL, SU, ER - RSP^K21^RSP_K21
NE AL, SU, ER - RSP^K23^RSP_K23
AL, SU, ER AL, SU, ER ACK^Q25^ACK RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K24^RSP_K24
NE AL, SU, ER - RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q22^ACK RSP^K22^RSP_K22
AL, SU, ER AL, SU, ER ACK^Q21^ACK RSP^K21^RSP_K21
AL, SU, ER AL, SU, ER ACK^Q24^ACK RSP^K24^RSP_K24
AL, SU, ER AL, SU, ER ACK^Q32^ACK RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q23^ACK RSP^K23^RSP_K23
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Segment Cardinality Implement Status
RSP^K22^RSP_K22
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

  v2.9
UAC

User Authentication Credential Segment

[0..1]  
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

[0..1]  
QAK

Query Acknowledgment

[1..1] SHALL
QPD

Query Parameter Definition

[1..1] SHALL
QUERY_RESPONSE  
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
NK1

Next of Kin / Associated Parties

 
QRI

Query Response Instance

[0..1]  
DSC

Continuation Pointer

[0..1]  

 

RSP_K22

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - -
NE NE - -
AL, SU, ER NE ACK^K22^ACK -
We need some ER7 examples...
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Following is an example of a Q22/K22 query/response pair of messages. First is the query:

MSH|^~\&|CLINREG|WESTCLIN|HOSPMPI|HOSP|199912121135-0600||QBP^Q22^QBP_Q21|1|D|2.5

QPD|Q22^Find Candidates^HL7nnn|111069|@PID.5.1^EVERYMAN~@PID.5.2^ADAM~ @PID.8^M|80|MATCHWARE|1.2||^^^GOOD HEALTH HOSPITAL~^^^SOUTH LAB|

RCP|I|20^RD

This query is asking for a list of persons matching the name ADAM EVERYMAN with the gender Male. Candidates with a match level above 80 using the algorithm Matchware version 1.2 should be returned. The returned records should include identifiers for both the assigning authorities GOOD HEALTH HOSPITAL and SOUTH LAB. The RCP segment specifies that the number of matches should be limited to 20. Here is a sample response:

MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN|200712121135-0600||RSP^K22^RSP_K22|1|D|2.5.1|

MSA|AA|8699|

QAK|111069|OK|Q22^Find Candidates^HL7nnnn|3|

QPD|Q22^Find Candidates^HL7nnn|111069|@PID.5.1^EVERYMAN~ @PID.5.2^ADAM~@PID.8^M|80|MATCHWARE|1.2||^^^GOOD HEALTH HOSPITAL~^^^SOUTH LAB|

PID|||66785^^^GOOD HEALTH HOSPITAL~99999^^^SOUTH LAB||Everyman^Adam||19630423|M||C|C^^Madison^WI^99999|

QRI|95||MATCHWARE 1.2|

PID|||87443^^^GOOD HEALTH HOSPITAL~651189^^^SOUTH LAB||Everyman^Adam||19470606|M||C|555-555-2004^^Madison^WI^99999|

QRI|90||MATCHWARE 1.2|

PID|||43266^^^GOOD HEALTH HOSPITAL~81209^^^SOUTH LAB||Everyman^Adam||19901210|M||C|4444 Home Street^^Lodi^WI^99999|

QRI|85||MATCHWARE 1.2|

Three candidates were returned. Notice the 3 at the end of the QAK segment signifying the number of matches. Each has a PID and QRI segment, and the QRI segment in each case gives a confidence factor for each of the candidates

18.12.58 QBP/RSP - Get Corresponding Identifiers (QBP) and Response (RSP) (Events Q23 and K23) (3.3.58)

This query/response is designed for interaction between a client system and an MPI (Master Person Index). The query consists of an identifier for a person, and the response is a list of identifiers for that person from the domains specified.

Segment Cardinality Implement Status
QBP^Q23^QBP_Q21
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
QPD

Query Parameter Definition

[1..1] SHALL
RCP

Response Control Parameter

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

QBP_Q21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - RSP^K22^RSP_K22
Blank Blank - RSP^K23^RSP_K23
Blank Blank - RSP^K25^RSP_K25
Blank Blank - RSP^K32^RSP_K32
Blank Blank - RSP^K2^4^RSP_K24
Blank Blank - RSP^K21^RSP_K21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^Q23^ACK -
AL, SU, ER NE ACK^Q22^ACK -
AL, SU, ER NE ACK^Q24^ACK -
AL, SU, ER NE ACK^Q32^ACK -
AL, SU, ER NE ACK^Q21^ACK -
NE AL, SU, ER - RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K22^RSP_K22
NE AL, SU, ER - RSP^K21^RSP_K21
NE AL, SU, ER - RSP^K23^RSP_K23
AL, SU, ER AL, SU, ER ACK^Q25^ACK RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K24^RSP_K24
NE AL, SU, ER - RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q22^ACK RSP^K22^RSP_K22
AL, SU, ER AL, SU, ER ACK^Q21^ACK RSP^K21^RSP_K21
AL, SU, ER AL, SU, ER ACK^Q24^ACK RSP^K24^RSP_K24
AL, SU, ER AL, SU, ER ACK^Q32^ACK RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q23^ACK RSP^K23^RSP_K23
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Segment Cardinality Implement Status
RSP^K23^RSP_K23
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

  v2.9
UAC

User Authentication Credential Segment

[0..1]  
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

[0..1]  
QAK

Query Acknowledgment

[1..1] SHALL
QPD

Query Parameter Definition

[1..1] SHALL
QUERY_RESPONSE [0..1]  
PID

Patient Identification

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

RSP_K23

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - -
Blank Blank - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^K24^ACK -
AL, SU, ER NE ACK^K23^ACK -
We need some ER7 examples...
We need some XML examples...

Following is an example of a Q23/K23 query/response pair of messages. First is the query:

MSH|^~\&|CLINREG|WESTCLIN|HOSPMPI|HOSP|199912121135-0600||QBP^Q23^QBP_Q21|1|D|2.5

QPD|Q23^Get Corresponding IDs^HL7nnnn|111069|112234^^^GOOD HEALTH HOSPITAL|^^^WEST CLINIC~^^^SOUTH LAB|

RCP||I|

This query is asking for identifiers from WEST CLINIC and SOUTH LAB for the person identified with the identifier 112234 from the assigning authority GOOD HEALTH HOSPITAL. Here is a sample response:

MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN|199912121135-0600||RSP^K23^RSP_K23|1|D|2.5|

MSA|AA|8699|

QAK|111069|OK|Q23^Get Corresponding IDs^HL7nnnn|1|

QPD|Q23^Get Corresponding IDs^HL7nnn|111069|112234^^^GOOD HEALTH HOSPITAL|^^^WEST CLINIC~^^^SOUTH LAB|

PID|||56321A^^^WEST CLINIC~66532^^^SOUTH LAB||EVERYMAN^ADAM||19630423|M||C|N2378 South Street^^Madison^WI^53711|

Note: that the identifiers returned do not include the GOOD HEALTH HOSPITAL identifier, as it was not specified in the list of WhatDomainsReturned.

18.12.59 QBP/RSP - Allocate Identifiers (QBP) and Response (RSP) (Events Q24 and K24) (3.3.59)

This query/response is designed for interaction between a client system and an MPI (Master Person Index). The query consists of domains in which identifiers should be allocated. The response is new identifiers in those domains.

This event is not meant to cause the creation of a new person record, or to bind identifiers to a particular person record. The events A28 - Add person information and A24 - Link patient information should be used for that purpose. This event is meant to simply reserve the use of identifiers.

Segment Cardinality Implement Status
QBP^Q24^QBP_Q21
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
QPD

Query Parameter Definition

[1..1] SHALL
RCP

Response Control Parameter

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

QBP_Q21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - RSP^K22^RSP_K22
Blank Blank - RSP^K23^RSP_K23
Blank Blank - RSP^K25^RSP_K25
Blank Blank - RSP^K32^RSP_K32
Blank Blank - RSP^K2^4^RSP_K24
Blank Blank - RSP^K21^RSP_K21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^Q23^ACK -
AL, SU, ER NE ACK^Q22^ACK -
AL, SU, ER NE ACK^Q24^ACK -
AL, SU, ER NE ACK^Q32^ACK -
AL, SU, ER NE ACK^Q21^ACK -
NE AL, SU, ER - RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K22^RSP_K22
NE AL, SU, ER - RSP^K21^RSP_K21
NE AL, SU, ER - RSP^K23^RSP_K23
AL, SU, ER AL, SU, ER ACK^Q25^ACK RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K24^RSP_K24
NE AL, SU, ER - RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q22^ACK RSP^K22^RSP_K22
AL, SU, ER AL, SU, ER ACK^Q21^ACK RSP^K21^RSP_K21
AL, SU, ER AL, SU, ER ACK^Q24^ACK RSP^K24^RSP_K24
AL, SU, ER AL, SU, ER ACK^Q32^ACK RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q23^ACK RSP^K23^RSP_K23
We need some ER7 examples...
We need some XML examples...
Segment Cardinality Implement Status
RSP^K24^RSP_K23
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

  v2.9
UAC

User Authentication Credential Segment

[0..1]  
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

[0..1]  
QAK

Query Acknowledgment

[1..1] SHALL
QPD

Query Parameter Definition

[1..1] SHALL
QUERY_RESPONSE [0..1]  
PID

Patient Identification

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

RSP_K23

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - -
Blank Blank - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^K24^ACK -
AL, SU, ER NE ACK^K23^ACK -
We need some ER7 examples...
We need some XML examples...

Following is an example of a Q24/K24 query/response pair of messages. First is the query:

MSH|^~\&|CLINREG|WESTCLIN|HOSPMPI|HOSP|199912121135-0600||QBP^Q24^QBP_Q21|1|D|2.5

QPD|Q24^Allocate Identifiers^HL7nnnn|111069|^^^WEST CLINIC~^^^SOUTH LAB|

RCP||I|

This query is asking for identifiers from WEST CLINIC and SOUTH LAB to be reserved and returned. Here is a sample response:

MSH|^~\&|HOSPMPI|HOSP|CLINREG|WESTCLIN|199912121135-0600||RSP^K24^RSP_K23|1|D|2.5|

MSA|AA|8699|

QAK|111069|OK|Q24^Allocate Identifiers^HL7nnnn|1|

QPD|A56^Allocate Identifiers^HL7nnn|111069|^^^WEST CLINIC~^^^SOUTH LAB|

PID|||624335A^^^WEST CLINIC~564325^^^SOUTH LAB|

Note: The PID segment returned does not include any person demographics as the identifiers are not yet "attached" to any person record. Presumably the querying system would eventually send back to the MPI an A28 Add person information to create a person record for the identifiers or an A24 Link patient information to link the identifiers to an existing person record.

18.12.60 ADT/ACK - Update Adverse Reaction Information (Event A60) (3.3.60)

This trigger event is used when person/patient allergy information has changed. It is used in conjunction with a new allergy segment, the IAM - Patient Allergy Information Segment-Unique Identifier, which supports Action code/unique identifier mode update for repeating segments as defined in 2.10.4, "Protocol for interpreting repeating segments or segment groups in an update Message."

Segment Cardinality Implement Status
ADT^A60^ADT_A60
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
ARV

Access Restriction

  B
VISIT_GROUP [0..1]  
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
ARV

Access Restriction

  B
ADVERSE_REACTION_GROUP  
IAM

Patient Adverse Reaction Information

[1..1] SHALL
NTE

Notes and Comments

 
IAR

allergy reaction

 

 

ADT_A60

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A60^ADT_A60
NE NE - -
AL, SU, ER NE ACK^A60^ACK -
NE AL, SU, ER - ACK^A60^ACK
AL, SU, ER AL, SU, ER ACK^A60^ACK ACK^A60^ACK
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Segment Cardinality Implement Status
ACK^A60^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

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18.12.61 ADT/ACK - Change Consulting Doctor (Event A61) (3.3.61)

An A61 event is used as a result of a change in the consulting physician(s) for the treatment of a patient.

When other important fields change, it is recommended that the A08 (update patient information) event be used in addition. If the Patient Administration system allows demographics to change at the same time (for example an address change), two messages (an A61 followed by an A08) should be sent.

The new consulting doctor(s) of the patient should appear in the PV1-9 - Consulting Doctor and may appear in a role segment per new consulting physician.

If a consulting doctor stops being consulting doctor for this patient-visit, the end date/time can be sent in the PRT-12 - End Date/Time.

For example, an A61 event can be used to notify the billing system that doctors' fees for being a consulting doctor, should be billed to the new doctor(s) starting from the timestamp in the message.

It is recommended that field EVN-6 - Event Occurred contains the date/time the event actually occurred to the patient.

The ROL segment has been deprecated and retained for backwards compatiblity purposes only as of v 2.9. The reader is referred to the PRT segment instead.

The PRT - Participation Information Segment is used in this message to communicate providers not specified elsewhere. Person level providers with an ongoing relationship are reported in the PRT segment following the PID/PD1 segments. Providers corresponding to the PV1 data are reported in the PRT segment following the PV1/PV2 segments. Providers related to a specific procedure are reported in the PRT segment following the PR1 segment. Providers related to a specific insurance are reported in the PRT segment following the IN1/IN2/IN3 segments. To communicate the begin- and end-date of the provider, use the PRT-11 - Participation Begin Date/Time and the PRT-12 - Participation End Date/Time in the PRT segment, with the applicable PRT-4 - PArticipation. Refer to Chapter 7 for the definition of the PRT segment.

Segment Cardinality Implement Status
ADT^A61^ADT_A61
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ROL

Role

  B
PRT

Participation Information

 
PV1

Patient Visit

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
PV2

Patient Visit - Additional Information

[0..1]  

 

ADT_A61

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A62^ADT_A61
Blank Blank - ADT^A61^ADT_A61
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A62^ACK -
AL, SU, ER NE ACK^A61^ACK -
NE AL, SU, ER - ACK^A62^ACK
NE AL, SU, ER - ACK^A61^ACK
AL, SU, ER AL, SU, ER ACK^A62^ACK ACK^A62^ACK
AL, SU, ER AL, SU, ER ACK^A61^ACK ACK^A61^ACK
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Segment Cardinality Implement Status
ACK^A61^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

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18.12.62 ADT/ACK - Cancel Change Consulting Doctor (Event A62) (3.3.62)

The A62 event is sent when an A61 (change consulting doctor) event is cancelled, either because of erroneous entry of the A61 event or because of a decision not to change the consulting physician(s) after all. PV1-9 - Consulting Doctor must show the patient's doctor prior to the change being cancelled.

The fields included when this message is sent should be the fields pertinent to communicate this event. When other important fields change, it is recommended that the A08 (update patient information) event is used.

Segment Cardinality Implement Status
ADT^A62^ADT_A61
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

 
UAC

User Authentication Credential Segment

[0..1]  
EVN

Event Type

[1..1] SHALL
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
ROL

Role

  B
PRT

Participation Information

 
PV1

Patient Visit

[1..1] SHALL
ROL

Role

  B
PRT

Participation Information

 
PV2

Patient Visit - Additional Information

[0..1]  

 

ADT_A61

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - ADT^A62^ADT_A61
Blank Blank - ADT^A61^ADT_A61
NE NE - -
NE NE - -
AL, SU, ER NE ACK^A62^ACK -
AL, SU, ER NE ACK^A61^ACK -
NE AL, SU, ER - ACK^A62^ACK
NE AL, SU, ER - ACK^A61^ACK
AL, SU, ER AL, SU, ER ACK^A62^ACK ACK^A62^ACK
AL, SU, ER AL, SU, ER ACK^A61^ACK ACK^A61^ACK
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Segment Cardinality Implement Status
ACK^A62^ACK
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

 

 

ACK

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18.12.63 QBP/RSP - Find Candidates including Visit Information (QBP) and Response (RSP) (Events Q32 and K32 ) (3.3.63)

This query/response is designed for interaction between a client system and an MPI (Master Person Index). The query consists of a set of demographic and/or visit attribute values for a person, and the response is the list of candidates considered by the MPI to match that set.

Each returned person, specified by a PID segment and by a PV1 segment containing information about the current visit, can also have an optional QRI - Query Response Instance segment containing information about the quality of the match.

Segment Cardinality Implement Status
QBP^Q32^QBP_Q21
MSH

Message Header

[1..1] SHALL
SFT

Software Segment

 
QPD

Query Parameter Definition

[1..1] SHALL
RCP

Response Control Parameter

[1..1] SHALL
DSC

Continuation Pointer

[0..1]  

 

QBP_Q21

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - RSP^K22^RSP_K22
Blank Blank - RSP^K23^RSP_K23
Blank Blank - RSP^K25^RSP_K25
Blank Blank - RSP^K32^RSP_K32
Blank Blank - RSP^K2^4^RSP_K24
Blank Blank - RSP^K21^RSP_K21
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
NE NE - -
AL, SU, ER NE ACK^Q23^ACK -
AL, SU, ER NE ACK^Q22^ACK -
AL, SU, ER NE ACK^Q24^ACK -
AL, SU, ER NE ACK^Q32^ACK -
AL, SU, ER NE ACK^Q21^ACK -
NE AL, SU, ER - RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K22^RSP_K22
NE AL, SU, ER - RSP^K21^RSP_K21
NE AL, SU, ER - RSP^K23^RSP_K23
AL, SU, ER AL, SU, ER ACK^Q25^ACK RSP^K25^RSP_K25
NE AL, SU, ER - RSP^K24^RSP_K24
NE AL, SU, ER - RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q22^ACK RSP^K22^RSP_K22
AL, SU, ER AL, SU, ER ACK^Q21^ACK RSP^K21^RSP_K21
AL, SU, ER AL, SU, ER ACK^Q24^ACK RSP^K24^RSP_K24
AL, SU, ER AL, SU, ER ACK^Q32^ACK RSP^K32^RSP_K32
AL, SU, ER AL, SU, ER ACK^Q23^ACK RSP^K23^RSP_K23
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Segment Cardinality Implement Status
RSP^K32^RSP_K32
MSH

Message Header

[1..1] SHALL
ARV

Access Restriction

  v2.9
MSA

Message Acknowledgment

[1..1] SHALL
ERR

Error

[0..1]  
QAK

Query Acknowledgment

[1..1] SHALL
QPD

Query Parameter Definition

[1..1] SHALL
QUERY_RESPONSE  
PID

Patient Identification

[1..1] SHALL
PD1

Patient Additional Demographic

[0..1]  
NK1

Next of Kin / Associated Parties

 
PV1

Patient Visit

[1..1] SHALL
PV2

Patient Visit - Additional Information

[0..1]  
QRI

Query Response Instance

[0..1]  
DSC

Continuation Pointer

[0..1]  

 

RSP_K32

MSH-15 MSH-16 Immediate ACK Application Ack
Blank Blank - -
NE NE - -
AL, SU, ER NE ACK^K32^ACK -
We need some ER7 examples...
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Following is an example of a Q25/K25 query/response pair of messages. First is the query:

MSH|^&~\|CLINREG|WESTCLIN|HOSPMPI|HOSP|199912121135-0600||QBP^Q25^QBP_Q21|8702|D|2.6

QPD|Q25^Find Candidates Including Visit Information^HL70471|111069|@PID.5.1^SMITH~@PV1.3.2^389 |80|MATCHWARE|1.2||^^^METRO HOSPITAL

RCP||I|20^RD

This query is asking for a list of persons matching the name SMITH who are recorded as being in Room 389. Candidates with a match level above 80 using the algorithm Matchware version 1.2 should be returned. The returned records should include identifiers for assigning authority METRO HOSPITAL. The RCP segment specifies that the number of matches should be limited to 20. Here is a sample response:

MSH|^&~\|HOSPMPI|HOSP|CLINREG|WESTCLIN|200412121135-0600||RSP^K25^RSP_K25|H352357509|D|2.6

MSA|AA|8702

QAK|111069|OK|Q25^Find Candidates Including Visit Information^HL70471|1

QPD|Q25^Find Candidates Including Visit Information^HL70471|111069|@PID.5.1^SMITH~ @PID.5.2^JOHN~@PID.8^M|80|MATCHWARE|1.2||^^^METRO HOSPITAL

PID|||66785^^^METRO HOSPITAL||Smith^John||19630423|M||C|N2378 South Street^^Madison^WI^53711

PV1||I|W^389^1^METRO HOSPITAL^^^^3||||12345^MORGAN^REX^J^^^MD^0010^METRO HOSPITAL^L||67890^GRAINGER^LUCY^X^^^MD^0010^METRO HOSPITAL^L|MED|||||A0||13579^POTTER^SHERMAN^T^^^MD^0010^METRO HOSPITAL^L

QRI|95||MATCHWARE 1.2

One candidate was returned. Notice the 1 at the end of the QAK segment signifying the number of matches. The group of segments includes a PID, PV1, and QRI segment; the QRI segment gives a confidence factor for the candidate.

18.13 Example Transactions (3.5)

18.13.1 Admit/visit notification - event A01 (admitted patient)- (3.5.1)

MSH|^~\&|ADT1|GOOD HEALTH HOSPITAL|GHH LAB, INC.|GOOD HEALTH HOSPITAL|198808181126|SECURITY|ADT^A01^ADT_A01|MSG00001|P|2.8||

EVN|A01|200708181123||

PID|1||PATID1234^5^M11^ADT1^MR^GOOD HEALTH HOSPITAL~123456789^^^USSSA^SS||EVERYMAN^ADAM^A^III||19610615|M||C|2222 HOME STREET^^GREENSBORO^NC^27401-1020|GL|(555) 555-2004|(555)555-2004||S||

PATID12345001^2^M10^ADT1^AN^A|444333333|987654^NC|

NK1|1|NUCLEAR^NELDA^W|SPO^SPOUSE||||NK^NEXT OF KIN

PV1|1|I|2000^2012^01||||004777^ATTEND^AARON^A|||SUR||||ADM|A0|

Patient Adam A. Everyman, III was admitted on July 18, 2007 at 11:23 a.m. by Doctor Aaron A. Attending (#004777) for surgery (SUR). He has been assigned to room 2012, bed 01 on nursing unit 2000.

The message was sent from system ADT1 at the Good Health Hospital site to system GHH Lab, also at the Good Health Hospital site, on the same date as the admission took place, but three minutes after the admit.

18.13.2 Pre-admit notification - event A05 (nonadmitted patient) (3.5.2)

MSH|^~\&|REGADT|GOOD HEALTH HOSPITAL|GHH LAB||200701061000||ADT^A05^ADT_A05|000001|P|2.8||||

EVN|A05|200701061000|200701101400|01||200701061000

PID|1|| PATID1234^^^GOOD HEALTH HOSPITAL^MR^GOOD HEALTH HOSPITAL~123456789^^^USSSA^SS|253763|EVERYMAN^ADAM^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||(555) 555-2004|(555)555-2004||S|C|99999^^^GOOD HEALTH HOSPITAL^AN|444-33-3333||

NK1|1|NUCLEAR^NELDA^W|SPO^SPOUSE|6666 HOME STREET ^^ISHPEMING^MI^49849^""^|555-555-5001|555-555-5001555-555-5001|EC^EMERGENCY CONTACT

NK1|2|MUM^MARTHA^M|MOTHER|4444 HOME STREET ^^ISHPEMING^MI^49849^""^|555-555-2006|555-555-2006~555-555-2006|EC^EMERGENCY CONTACT

NK1|3

NK1|4|||6666 WORKER LOOP^^ISHPEMING^MI^49849|555-555-3003|EM^EMPLOYER|19940605||PROGRAMMER|||WORK IS FUN, INC.

PV1||O|||||0148^ATTEND^AARON^A|0148^SENDER^SAM||AMB|||||||0148^ATTEND^AARON^A|S|1400|A|||||||||||||||||||GOOD HEALTH HOSPITAL||||||

PV2||||||||200301101400||||||||||||||||||||||||||200301101400

OBX||ST|1010.1^BODY WEIGHT||62|kg|||||F

OBX||ST|1010.1^HEIGHT||190|cm|||||F

DG1|1|19||BIOPSY||00

GT1|1||EVERYMAN^ADAM^A^""^""^""^""^||2222 HOME STREET ^ISHPEMING^MI^49849^""^|(555) 555-2004|555 555-2004||||SE^SELF|444-33 3333|||||2222 HOME STREET^^ISHPEMING^MI^49849^""|555-555-2004 |||||||||||||||||||||||||||||||||AUTO CLINIC

IN1|1|0|UA1|UARE INSURED, INC.|8888 INSURERS CIRCLE^^ISHPEMING^M1^49849^^||555-555-3015|90||||||50 OK

IN1|2|""|""

Patient Adam A. Everyman was pre-admitted on January 6th, 2007 for ambulatory surgery, which is scheduled for January 10, 2007 at 1400. As part of the pre-admission process, he specified two emergency contacts as well as employer, insurance, and guarantor information. He also was measured and weighed.

Note: Above, the REGADT system supports the entry of four NK1 type records: first, second, and third emergency contacts and employer information. A third emergency contact was not provided for Adam A. Everyman. However, an NK1 record must be sent to support "snapshot" mode of update. The REGADT system also supports entry of two insurance plans, one guarantor, and one diagnosis.

18.13.3 Register a patient - event A04 (nonadmitted patient) (3.5.3)

MSH|^~\&|REGADT|GOOD HEALTH HOSPITAL|GHH LAB||200712311501||ADT^A04^ADT_A01|000001|P|2.8||||

EVN|A04|200701101500|200701101400|01||200701101410

PID|||191919^^^GOOD HEALTH HOSPITAL^MR^GOOD HEALTH HOSPITAL^^^USSSA^SS|253763|EVERYMAN^ADAM^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||555-555-2004|555-555- 2004||S|C|10199925^^^GOOD HEALTH HOSPITAL^AN|371-66-9256||

NK1|1|NUCLEAR^NELDA|SPOUSE|6666 HOME STREET^^ISHPEMING^MI^49849^""^|555-555-5001|555-555-5001~555-555-5001|EC1^FIRST EMERGENCY CONTACT

NK1|2|MUM^MARTHA|MOTHER|4444 HOME STREET^^ISHPEMING^MI^49849^""^|555-555 2006|555-555-2006~555-555-2006|EC2^SECOND EMERGENCY CONTACT

NK1|3

NK1|4|||6666 WORKER LOOP^^ISHPEMING^MI^49849^""^||(900)545-1200|EM^EMPLOYER|19940605||PROGRAMMER|||WORK IS FUN, INC.

PV1||O|O/R||||0148^ATTEND^AARON^A|0148^ATTEND^AARON^A|0148^ATTEND^AARON^A|AMB|||||||0148^ATTEND^AARON^A|S|1400|A|||||||||||||||||||GOOD HEALTH HOSPITAL|||||199501101410|

PV2||||||||200701101400||||||||||||||||||||||||||200301101400

OBX||ST|1010.1^BODY WEIGHT||62|kg|||||F

OBX||ST|1010.1^HEIGHT||190|cm|||||F

DG1|1|19||BIOPSY||00|

GT1|1||EVERYMAN^ADAM^A||2222 HOME STREET^^ISHPEMING^MI^49849^""^|444-33 3333|555-555-2004||||SE^SELF|444-33 3333||||AUTO CLINIC|2222 HOME STREET^^ISHPEMING^MI^49849^""|555-555-2004|

IN1|0|0|UA1|UARE INSURED, INC.|8888 INSURERS CIRCLE^^ISHPEMING^M149849^""^||555-555-3015|90||||||50 OK|

IN1|2|""|""

Patient Adam A. Everyman arrived at location O/R for surgery on January 10th, 2007 at 1410 for ambulatory surgery which was scheduled for January 10, 2007 at 1400. The visit event was recorded into the Good Health Hospital system on January 10, 2007 at 1500. It was sent to the interface engine (IFENG) at 1501.

18.13.4 Change an outpatient to an inpatient - event A06 (3.5.4)

MSH|^~\&|REGADT|MCM|IFENG||200701110025||ADT^A06^ADT_A06|000001|P|2.8||||

EVN|A06|200701100250||01||200701102300

PID|||191919^^^GOOD HEALTH HOSPITAL^MR^FAC1~11111^^^USSSA^SS|253763|MASSIE^JAMES^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||555-555-2004|555-555-2004||S|C|10199925^^^GOOD HEALTH HOSPITAL^AN|371-66-9256||

NK1|1|MASSIE^ELLEN|SPOUSE|2222 HOME STREET^^ISHPEMING^MI^49849^""^|555) 555 2004|555-555-5001~555-555-5001|EC1^FIRST EMERGENCY CONTACT

NK1|2|MASSIE^MARYLOU|MOTHER|300 ZOBERLEIN^^ISHPEMING^MI^49849^""^|555) 555 2004|555-555-5001~555-555-5001|EC2^SECOND EMERGENCY CONTACT

NK1|3

NK1|4|||6666 WORKER LOOP^^ISHPEMING^MI^49849^""^||(900)545-1200|EM^EMPLOYER|19940605||PROGRAMMER|||WORK IS FUN, INC.

PV1||I|6N^1234^A^GOOD HEALTH HOSPITAL||||0100^SENDER,SAM|0148^ATTEND^AARON^A||SUR|||||||0148^SENDER,SAM|S|1400|A|||||||||||||||||||GOOD HEALTH HOSPITAL|||||199501102300|

OBX||ST|1010.1^BODY WEIGHT||62|kg|||||F

OBX||ST|1010.1^HEIGHT||190|cm|||||F

DG1|1|19||BIOPSY||00

GT1|1||EVERYMAN^ADAM^A||2222 HOME STREET^^ISHPEMING^MI^49849^""^|444-33 3333|555-555-2004||||SE^SELF|444-33 3333||||AUTO CLINIC|2222 HOME STREET^^ISHPEMING^MI^49849^""|555-555-2004

IN1|0|0|UA1|UARE INSURED, INC.|8888 INSURERS CIRCLE^^ISHPEMING^M149849^""^||555-555-3015|90||||||50 OK

IN1|2|""|""

Patient Adam A. Everyman was later converted to an inpatient on January 10th, 2007 at 2300 to recover from the operation. The change from outpatient to inpatient was recorded on the MCM system on January 11, 2007 at 0020. He was assigned to room 1234, bed A on unit 6N. When Patient Adam A. Everyman was converted to an inpatient on January 10th, 2007 at 2300, his hospital service changed to SUR. His attending doctor and admitting doctors changed to Dr Sam Sender. As a result of the conversion, his account number changed from 10199923 to 10199925

18.13.5 Transfer patient - event A02 (first example) (3.5.5)

MSH|^~\&|REGADT|GOOD HEALTH HOSPITAL|IFENG||200701110500||ADT^A02^ADT_A02|000001|P|2.8||||

EVN|A02|200701110520||01||200701110500

PID|||191919^^^GOOD HEALTH HOSPITAL^MR~111111^^^USSSA^SS|253763|EVERYMAN^ADAM^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||555-555-2004|555-555-2004||S|C|10199925^^^GOOD HEALTH HOSPITAL^AN|444-33-3333|||||||||

PV1||I|SICU^0001^01^GOOD HEALTH HOSPITAL|||6N^1234^A^GOOD HEALTH HOSPITAL|0200^ATTEND^AARON^A|0148^ SENDER^SAM||ICU|||||||0148^SENDER^SAM|S|1400|A|||||||||||||||||||GOOD HEALTH HOSPITAL|||||200701102300|

On January 11th, 2007 at 0500, Adam A. Everyman condition became worse due to a complication. As a result, he was transferred to the surgical ICU (SICU). The transfer was recorded on the Good Health Hospital system on January 11, 2007 at 0520. He was assigned to room 0001, bed 1. When Patient Adam A. Everyman was transferred to SICU, his hospital service changed to ICU and his attending doctor changed to Dr. Sam Sender.

18.13.6 Cancel transfer - event A12 (3.5.6)

MSH|^~\&|REGADT|GOOD HEALTH HOSPITAL|IFENG||200701110600||ADT^A12^ADT_A12|000001|P|2.8||||

EVN|A02|200701110600||01||200701110500

PID|||191919^^^GOOD HEALTH HOSPITAL|253763|EVERYMAN^ADAM^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||555-555-2004|555-555-2004||S|C|10199925|444-33-3333||

PV1||I|6N^1234^A^GOOD HEALTH HOSPITAL|||SICU^0001^1^GOOD HEALTH HOSPITAL|0100^ATTEND^AARON^A|0148^ATTEND^AARON^A||SUR|||||||0148^ATTEND^AARON^A|S|1400|A|||||||||||||||||||GOOD HEALTH HOSPITAL|||||200701102300|

It was determined that Adam A. Everyman was transferred to the wrong room in the SICU. Therefore, the transfer was cancelled.

18.13.7 Transfer patient - event A02 (second example) (3.5.7)

MSH|^~\&|REGADT|GOOD HEALTH HOSPITAL|IFENG||200701110603||ADT^A02^ADT_A02|000001|P|2.8||||

EVN|A02|200701110603||01||200701110500

PID|||191919^^^GOOD HEALTH HOSPITAL^MR^FAC1~1111^^^USSSA^SS|253763|EVERYMAN^ADAM^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||555-555-2004|555-555-2004||S|C|10199925^^^GOOD HEALTH HOSPITAL^AN|444-33-3333||

PV1||I|SICU^0001^02^GOOD HEALTH HOSPITAL|||6N^1234^A^GOOD HEALTH HOSPITAL|0100^ATTEND^AARON^A|0148^ATTEND^AARON^A||SUR|||||||0148^ATTEND^AARON^A|S|1400|A|||||||||||||||||||GOOD HEALTH HOSPITAL|||||200701102300|

The transfer is then repeated, this time to the correct bed: bed 2 of room 0001 in the SICU.

18.13.8 Discharge patient - event A03 (3.5.8)

MSH|^~\&|REGADT|GOOD HEALTH HOSPITAL|IFENG||200701121005||ADT^A03^ADT_A03|000001|P|2.8||||

EVN|A03|200701121005||01||200701121000

PID|||191919^^^GOOD HEALTH HOSPITAL^MR~11111^^^USSSA^SS|253763|EVERYMAN^ADAM^A||19560129|M|||2222 HOME STREET^^ISHPEMING^MI^49849^""^||555-555-2004|555-555-2004||S|C|10199925^^^GOOD HEALTH HOSPITAL^AN|444-33-3333|||||||||

PV1||I|6N||||0100^ATTEND^AARON^A|0148^ATTEND^AARON^A||SUR|||||||0148^ATTEND^AARON^A|S|1400|A||||||||||||||||SNF|ISH^GREEN ACRES RETIREMENT HOME||GOOD HEALTH HOSPITAL|||||200701102300|200791121005

When Adam A. Everyman's condition became more stable, he returned to 6N for another day (transfer not shown) and then was discharged to the Green Acres Retirement Home.

18.13.9 Update adverse reaction info - unique identifier is provided - event A60 (where unique identifier is provided) (3.5.9)

MSH|^~\&|ADT|CA.SCA|IE|200701310815-0800|200702010101||ADT^A60^ADT_A60|6757498734|P|2.8|

EVN||200701310815-0800

PID|||987654321098||EVERYWOMAN^EVE^E||19530406|F

PV1||O

PV2||||||||200701310800-0800

IAM|1|DA|^Penicillin|SV^^HL70128|^rash on back|A^^HL70323|12345||AL^^HL70436|19990127||200301311015|NUCLEAR^NEVILLE^H|^Husband||C^^HL70438|MLEE^ATTEND^AARON^A^^^MD||

18.13.10 Update adverse reaction info - allergen code provides unique identifier - event A60 (where the allergen code provides unique identifier) (3.5.10)

MSH|^~\&|ADT|CA.SCA|IE|200701310815-0800|200702010101||ADT^A60^ADT_A60|6757498734|P|2.8|

EVN||200701310815-0800

PID|||987654321098||EVERYWOMAN^EVE^E||19530406|F

PV1||O

PV2||||||||200701310800-0800

IAM|1|DA|PHM1345^Penicillin^local|SV^^HL70128|^rash on back|A^^HL70323|||AL^^HL70436| 01^Penicillins,Cephalosporins^NDDF DAC|20070127||200701311015| NUCLEAR^NEVILLE^H|^Husband||C^^HL70438|MLEE^ATTEND^AARON^A^^^MD||

18.14 Implementation Notes (3.6)

18.14.1 Swapping a patient (3.6.1)

Some systems may handle this as a single function. Others may require a multiple process in which:

This three-step scenario requires three separate transfer messages instead of a single swap message. If all beds in a hospital are occupied, it may be necessary to use a dummy location.

18.14.2 Merging patient/person information (3.6.2)

18.14.2.1 Definitions: Merge, move, and change identifier events (3.6.2.0)

The term "identifier" is used throughout this section. An identifier is associated with a set (or sets) of data. For example, an identifier (PID-3 - Patient Identifier List) may be a medical record number which has associated with it account numbers (PID-18 - Patient Account Number). Account number (PID-18 - Patient Account Number) is a type of identifier which may have associated with it visit numbers (PV1-19 - Visit Number).

This section addresses the events that occur usually for the purposes of correcting errors in person, patient, account, or visit identifiers. The types of errors that occur typically fall into three categories:

18.14.2.1.1 Hierarchy of Identifiers (3.6.2.0.1)

This section was written from the perspective of one controlling MPI and does not adequately cover the implementation of peer MPIs or multiple enterprise identifiers. To avoid future problems implementors should carefully examine the inferences of multiple identifiers.

Enterprise level MPI systems may collaborate forming either peer-to-peer or hierarchical relationships. When this occurs, multiple enterprise level identifiers may be required in the context of a single HL7 message. An example of a peer-to-peer MPI relationship might be represented by a data sharing application between the US Department of Veterans Affairs and the US Department of Defense, where each have their own MPI. An example of a hierarchical MPI relationship might be required by the need for local, city, and state organizations to collaborate, where each have an MPI.

These events assume a hierarchy of identifiers exists between person, patient, account, and visit. The hierarchy is as follows:

Level 3 - Patient (identified by PID-3 - Patient Identifier List)

Level 2 - Account (identified by PID-18 - Patient Account Number)

Level 1 - Visit (identified by PV1-19 - Visit Number)

The visit-level identifier PV1-19 - Visit Number is the lowest level identifier and is considered subordinate to the account-level identifier PID-18 - Patient Account Number.

This means that visit identifiers are defined within the context of an account identifier, and implies that visit identifiers are unique within account identifiers. Similarly, account identifiers are subordinate to, and unique within, patient identifiers; patient identifiers are subordinate to, and unique within, person identifiers.

Conversely, the person-level identifier is the highest-level identifier and is considered superior to the patient-level identifiers, which are superior to the account-level identifier, which is superior to any visit-level identifiers.

Note that these events will also apply to environments in which one or more of these levels do not occur. For example, some environments may not have a person (or MPI) level, or they may not have a visit level, or they may have a visit level without an account level. The hierarchy concept is depicted graphically below. For example, Adam Everyman might be assigned an MPI number at the Good Health Hospital network (depicted by the circle). He may have different medical records at two hospitals within the network (depicted by the squares). Associated with each of these medical records are two accounts (depicted by the triangles). Note that the environment illustrated does not support the "visit" level, although in other implementations it might.

18.14.2.1.2 Merge (3.6.2.0.2)

A merge event signals that two distinct records have been combined together into a single record with a single set of identifiers and data surviving at the level of the merge. All records at a level subordinate to the merged identifier are combined under the surviving record. For example, an A40 (merge patient - patient identifier list) event would be sent to signal that two person records (identified by MRG-1 - Prior Patient ID and by PID-3 - Patient ID) have been merged into a single record. All of the identifiers, accounts, and visits under the person record are not merged together - they are instead combined under the same person record. The following figure graphically depicts the merge event:

Note: It is not the intent of the merge definition to define the application or implementation specifics of how various systems or environments define, use or handle non-surviving information. "Non-surviving" in this document implies that a data set was existing in a fashion that was incorrect. Merging it into a new data set in itself implies that where there were two datasets, there is now only one. The means by which any system or environment conveys this new data set and the absence of the previous data set to the user is application specific. It is noted that some systems may still physically keep these "incorrect" datasets for audit trail or other purposes.
18.14.2.1.3 Move (3.6.2.0.3)

A "move" involves transferring one or more datasets (identified by a subordinate identifier) from one superior identifier at the next hierarchical level to another superior identifier at the next hierarchical level, while all identifiers involved retain their original value. An exception to retaining the original identifier value may occur if any of the subordinate source identifiers already exist under the target superior identifier. In this case the identifier value may have to be renumbered in order to be uniquely identified under the target superior identifier. (Refer to section 3.5.2.2.8, "A45 - Move visit information" for an illustration of this.)

A move event signals that a patient, account, or visit has been moved from one person, patient, or account, respectively, to another. All records at a subordinate level are also moved. For example, an A43 (move patient information - patient identifier list) event would be sent to signal that a medical records administrator has moved a medical record attached to an incorrect person to a correct person. The following figure graphically depicts the move event:

Note:The move event implies that all data related to the incorrect source ID and its subordinate IDs (specified in the MRG segment) will be moved to the correct target ID (specified in the PID or PV1 segment). Specifying each subordinate ID in repeating PID/MRG/PV1 sets is optional but not recommended.
18.14.2.1.4 Change identifier (3.6.2.0.4)

A change identifier event signals that a single person, patient, account, or visit identifier has been changed. It does not reflect a merge or a move; it is simply a change of an identifier. For example, a "Change Identifier" event would be sent to signal that the registrar has changed an incorrectly assigned person identifier to a correct person identifier. The following picture graphically depicts this event:

18.14.2.1.5 Source and target identifiers (3.6.2.0.5)

Merge, move, and change events reference target and source identifiers. The incorrect source identifier is specified in the MRG segment. The correct target identifier is identified in the PID or PV1 segment. For example, when you are changing a patient account number the source would be MRG-3 - Prior Patient Account Number. The target is PID-18 - Patient Account Number.

18.14.2.1.6 Tightly coupled relationship (3.6.2.0.6)

When patient/person identifiers are the target in merge, move, or change events, as specified in the PID-2 - Patient ID, PID-3 - Patient Identifier List and PID-4 - Alternate Patient ID-PID, the associated source identifiers in the MRG-4 - Prior Patient ID, MRG-1 - Prior Patient Identifier List, and MRG-2 - Prior Alternate Patient ID, respectively, must be "tightly coupled." Each event that is defined as a merge, move, or change message carries the "tightly" coupled relationship at the appropriate level in one of two ways: first, by virtue of positional placement in the sequence of identifiers; or, second, by identifier type and assigning authority. The methodology used to establish the definition of "tightly coupled" relationship is determined by site negotiation. The recommended definition is by virtue of positional placement in the sequence of identifiers (pairwise). In addition, HL7 allows the use of the second definition by identifier type and assigning authority as an acceptable convention to establish a "tightly coupled" relationship. In the absence of a site negotiated definition, it is assumed that the positional placement of the identifiers is the default method.

The list of identifiers can be aligned positionally in their respective segment fields and processed by the receiving system by virtue of their order. This is sometimes referred to as an "ordered pairwise" relationship and is described further in section 3.5.2.1.7, "Ordered pairwise relationship".

Alternatively, the uniqueness of the identifiers included in the message is determined by the combination of identifier type and assigning authority. It is assumed that both sending system and receiving system can inspect both of these qualifiers as a message is constructed or processed to determine the "tightly coupled" relationship between the identifiers. This can be referred to as "identifier type/assigning authority" relationship and is described further in section 3.5.2.1.8, "Identifier type/assigning authority relationship".

The pairing of identifiers between the MRG segment fields and their associated identifiers in the PID or PV1 segment are defined below:

Person

PID-2 - Patient ID

with

MRG-4 - Prior Patient ID

Patient

Pid-3 - Patient Identifier List

with

MRG-1 - Prior Patient Identifier List

and by

Explicit order of identifiers in the list

or by

and field components

PID-4 - Alternate Patient ID

with

MRG-2 - Prior Alternate Patient ID

Account

PID-18 - Patient Account Number

with

MRG-3 - Prior Patient Account Number

Visit

PV1-19 - Visit Number

with

MRG-5 - Prior Visit Number

PV1-50 - Alternate Visit ID

with

MRG-6 - Prior Alternate Visit ID

18.14.2.1.7 Ordered pairwise relationship (3.6.2.0.7)

In a strict sense, this type of relationship is characterized by a one-to-one association based on type (e.g., medical record number to medical record number, etc.) and the corresponding order of the element, and is typically found in list or set operations. However, for purposes of practical implementation, this relationship will be defined as a simple one-for-one pairing, as exists between the PID-3 - Patient Identifier List and the MRG-1 - Prior Patient Identifier List. In other words, elements "A", "B", and "C" in the first list would directly correspond to elements "X", "Y", and "Z" in the second list. No consideration is made to the type or value of the corresponding elements; it is the explicit order of the elements which controls the association process. This scenario could be expressed as follows:

List1 = {A,B,C}

List2 = {X,Y,Z}

A : X

B : Y

C : Z

A second scenario may arise which deserves mention. As in the list example above, elements "A", "B", and "C" in the first list would "pair-up" with elements "X", "Y", "Z", "Q", "R", and "S" in the second list. Again, no consideration is made to the type or value of the corresponding elements; it is the order and presence which controls the association process. This scenario could be expressed as follows:

List1 = {A,B,C}

List2 = {X,Y,Z,Q,R,S}

A : X

B : Y

C : Z

: Q

: R

: S

In the second scenario, the last three elements "Q", "R", and "S" are not affected and their value remains as if no association had been made.

A third scenario may arise which deserves mention. As in the list example above, elements "A", "B", "C", "D", "E", and "F" in the first list would "pair-up" with elements "X", "Y", and "Z" in the second list. Again, no consideration is made to the type or value of the corresponding elements; it is the order and presence which controls the association process. This scenario could be expressed as follows:

List1 = {A,B,C,D,E,F}

List2 = {X,Y,Z}

A : X

B : Y

C : Z

D :

E :

F :

In the third scenario, the last three elements "D", "E", and "F" are not affected and their value remains the same as if no association had been made.

18.14.2.1.8 Identifier type / assigning authority relationship (3.6.2.0.8)

As stated earlier, the uniqueness of the identifiers included in a message can be determined by the combination of identifier type (t) and assigning authority (a). It is assumed that both sending system and receiving system can inspect both of these qualifiers as a message is constructed or processed. This method is used to determine the "tightly coupled" relationship between the identifiers. The implementation of this relationship exists between the PID-3 - Patient Identifier List and the MRG-1 - Prior Patient Identifier List. In other words, elements "B^t2^a1", "C^t3^a1", "D^t4^a1", "A^t1^a1", "E^t5^a1", and "F^t6^a1" in the first list would be associated with elements "X^t1^a1", "Y^t2^a1", and "Z^t3^a1 in the second list. This scenario could be expressed as follows:

List1 = {B^t2^a1,C^t3^a1,D^t4^a1,A^t1^a1,E^t5^a1,F^t6^a1}

List2 = {X^t1^a1,Y^t2^a1,Z^t3^a1}

B^t2^a1 : Y^t2^a1

C^t3^a1 : Z^t3^a1

D^t4^a1 :

A^t1^a1 : X^t1^a1

E^t5^a1 :

F^t6^a1 :

In this scenario, the three elements which do not have corresponding identifier type and assigning authority "D^t4^a1", "E^t5^a1", and "F^t6^a1" are not affected and their value remains the same as if no association had been made.

A second scenario may arise which deserves mention. In the case of identifier type and assigning authority definition, the elements "A^t1^a1", "B^t2^a1", and "C^t3^a1" in the first list would be associated with elements "X^t4^a1", "Y^t2^a1", "Z^t3^a1", "Q^t1^a1", "R^t5^a1", and "S^t6^a1" in the second list. No consideration is made to the order of the identifiers; it is the identifier type and assigning authority of the corresponding elements which controls the association process. This scenario could be expressed as follows:

List1 = {A^t1^a1,B^t2^a1,C^t3^a1}

List2 = {X^t4^a1,Y^t2^a1,Z^t3^a1, Q^t1^a1,R^t5^a1,S^t6^a1}

A^t1^a1 : Q^t1^a1

B^t2^a1 : Y^t2^a1

C^t3^a1 : Z^t3^a1

: X^t4^a1

: R^t5^a1

: S^t6^a1

In the second scenario, the three elements which do not have corresponding identifier type and assigning authority "X^t4^a1", "R^t5^a1", and "S^t6^a1" are not affected and their value remains the same as if no association had been made.

18.14.2.1.9 Global merge and move message construct versus repeating segment message constructs (3.6.2.0.9)

A flexible message construct is provided for merge trigger events. The message construct allows for a repeating set of PID, optional PD1, MRG, and optional PV1 segments as illustrated below:

MSH

EVN

{ PID

[PD1]

MRG

[PV1]

}

Trigger events support the concept of a global move or merge, where all the subordinate identifiers are moved or merged. For example, the use case for A41 (merge account-patient account number) (Section 3.5.2.2.3, "A41 - merge account - patient account number (global)") illustrates a merge on the patient account number (PID-18 - Patient Account Number). All subordinate identifiers (PV1-19 - Visit Number) are moved to the target PID-18 - Patient Account Number Identifier, even though they are not specified in the message.

A repeating segment message construct supports reporting of the subordinate identifiers using the repeating segments. This is illustrated in the use case for A40 (merge patient - patient identifier list) (Section 3.5.2.2.2, "A40 - merge patient - patient identifier list (repeating segment)," A41 (merge account - patient account number) (Section 3.5.2.2.4, "A41 - merge account - patient account number (repeating segment)"), and A45 (move visit information-visit number) (Section 3.5.2.2.9 "A45 - move visit information - visit number (repeating segment)"). Specifying each subordinate ID in repeating segments is optional but not recommended. This construct can be used when renumbering of identifiers is necessary as illustrated in Sections 3.5.2.2.2, "A40 - merge patient - patient identifier list (repeating segment)," 3.5.2.2.4, "A41 - merge account - patient account number (repeating segment)," and 3.5.2.2.9, "A45 - move visit information - visit number (repeating segment)," or to explicitly identify individual subordinate identifiers as illustrated in Section 3.5.2.2.9, "A45 - move visit information - visit number (repeating segment)."

18.14.2.1.10 Identifier renumbering (3.6.2.0.10)

When renumbering of identifiers occurs, the repeating segment construct may be required in order to report identifier number changes. When renumbering occurs, the incorrect source identifier is specified in the MRG segment and the correct target identifier is reported in the PID or PV1 segment. Refer to the use case for A41 (merge account-patient account number) for an illustration.

18.14.2.1.11 Superior identifier reporting (3.6.2.0.11)

When merging or moving subordinate numbers, the higher level, "superior" identifiers should be included in the message. For example, when merging an account where the target is PID-18 - Patient Account Number and the source is MRG-3 - Prior Patient Account Number, the higher level patient identifiers (PID-3 -Patient Identifier List and MRG-1 - Prior Patient Identifier List) and person identifiers (PID-2 - Patient ID and MRG-4 - Prior Patient ID) should also be reported in the message.

18.14.2.2 Trigger events (3.6.2.1)

The intent of trigger events A40 (merge patient- patient identifier list), A41 (merge account-patient account number), A42 (merge visit-visit number), A43 (move patient information-patient identifier list), A44 (move account information-patient account number), A45 (move visit information-visit number), A47 (change patient identifier list), A49 (change patient account number), A50 (change visit number), and A51 (change alternate visit ID) is to reconcile distinct sets of existing person/patient data records that have been entered under different identification numbers, either deliberately or because of errors. Ideally, following any of these trigger events, all of the person/patient data should be accessible under whatever surviving identifiers were specified in the messages. Because of substantial differences in database architectures and system-dependent data processing requirements or limitations, the exact meaning and implementation of these events must be negotiated between systems.

18.14.2.2.1 A40 - merge patient - patient identifier list (3.6.2.1.1)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A40^ADT_A39|00000003|P|2.8|

EVN|A40|200301051530

PID|||MR1^^^XYZ||MAIDENNAME^EVE|....

MRG|MR2^^^XYZ

A40 - Merge patient - patient identifier list

Use Case - During the admission process, the registrar does not find a record for patient EVE EVERYWOMAN in the ADT system and creates a new record with patient identifier MR2. EVE EVERYWOMAN has actually been to the healthcare facility several times in the past under her maiden name, Eve Maidenname with patient identifier MR1. The problem persists for a while. During that time, several more accounts are assigned to Eve under her newly created patient ID MR2. Finally, the problem is discovered and Medical Records merges her two charts together leaving patient identifier MR1. All the accounts (ACCT1, ACCT2) that were assigned to MR2 are combined under MR1 as a result.

Target: PID-3 - Patient Identifier List (Note: PID-18 - Patient Account Number is not valued; all accounts associated with MR2 are combined under MR1). To merge PID-18 - Patient Account Number data only, use event A41 (merge account-patient account number). To move PID-18 - Patient Account Number data use event A44 (move account information-patient account number).

Source: MRG-1 - Prior Patient Identifier List) (Note: MRG-3 - Prior Patient Account Number is not valued; all accounts associated with MR2 are combined under MR1.)

Example Transaction:

Before Merge

After Merge

MR1 MR2

ACCT1 ACCT1

ACCT2 ACCT2

MR1

ACCT1

ACCT2

ACCT1

ACCT2

Implementation considerations: This scenario exists when two medical records are established for the same person.

Since there could be a discrepancy in the demographic information between the two records, reconciliation may be required. In the example above, the implementation allowed the older demographic information (in the PID) to survive. The demographics implied by the IDs in the MRG segment, did not survive. Surviving and non-surviving demographic information is application and implementation specific. An A08 (update patient information) event should be sent and/or negotiated as necessary to provide for implementation and application-specific needs.

18.14.2.2.2 A40 - merge patient - patient identifier list (repeating segment) (3.6.2.1.2)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A40^ADT_A39|00000003|P|2.8|

EVN|A40|200301051530

PID|||MR1^^^XYZ||EVERYWOMAN^EVE|||||||||||||ACCT3

MRG|MR2^^^XYZ||ACCT1

PID|||MR1^^^XYZ||EVERYWOMAN^EVE|||||||||||||ACCT4

MRG|MR2^^^XYZ||ACCT2

A40 - Merge patient - patient identifier list

Use Case - During the admission process, the registrar does not find a record for patient EVE EVERYWOMAN in the Patient Administration system and creates a new record with patient identifier MR2. EVE EVERYWOMAN has actually been to the healthcare facility several times in the past under her maiden name, EVE MAIDENNAME with patient identifier MR1. The problem persists for a while. During that time, several more accounts are assigned to EVE under her newly created patient ID MR2. Finally, the problem is discovered and Medical Records merges her two charts together leaving patient identifier MR1. All the accounts (ACCT1, ACCT2) that were assigned to MR2 are combined under MR1 as a result. Since the account numbers are not unique, they are also renumbered.

Target: PID-3 - Patient Identifier List and PID-18 - Patient Account Number

Source: MRG-1 - Prior Patient Identifier List and MRG-3 - Prior Patient Account Number

Example Transaction:

Before Merge

After Merge

MR1 MR2

ACCT1 ACCT1*

ACCT2 ACCT2*

MR1

ACCT1

ACCT2

ACCT3*

ACCT4*

*accounts renumbered

Implementation considerations: This scenario exists when two medical records are established for the same person.

If the account numbers are not unique (as implied by the After Merge example above) and renumbering of the accounts is required, you must use repeating segments as illustrated in the Example Transaction. Refer to Section 3.5.2.1.9, "Global merge and move message construct versus repeating segment message constructs," for additional information regarding message construct.

Since there could be a discrepancy in the demographic information between the two records, reconciliation may be required. In the example above, the implementation allowed the older demographic information (in the PID) to survive. The demographics implied by the IDs in the MRG segment, did not survive. Surviving and non-surviving demographic information is application and implementation specific. An A08 (update patient information) event should be sent and/or negotiated as necessary to provide for implementation and application specific needs.

18.14.2.2.3 A41 - merge account - patient account number (global) (3.6.2.1.3)

This event illustrates the concept of a global merge as defined in Section 3.5.2.1.9, "Global merge and move message construct versus repeating segment message constructs."

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A41^ADT_A39|00000005|P|2.8|

EVN|A41|200301051530

PID|||MR1^^^XYZ||EVERYWOMAN^EVE||19501010|M|||123 NORTH STREET^^NY^NY^10021||(212)111-3333|||S||ACCT1

MRG|MR1^^^XYZ||ACCT2

A41 - Merge account information - patient account number

Use Case - Eve Everywoman (patient identifier MR1) is a recurring outpatient at the Physical Therapy clinic at hospital XYZ with account number ACCT1. She has visited the clinic several times. When she arrives for therapy, a new registrar does not realize she already has an account and opens a new one with account number ACCT2. When the mistake is discovered, the two accounts are merged together, combining all visits under account ACCT1.

Target: PID-18 - Patient Account Number

Source: MRG-3 - Prior Patient Account Number

Example Transaction:

Before Merge

After Merge

MR1

ACCT1

96124

96126

ACCT2

96128

96130

MR1

ACCT1

96124

96126

96128

96130

Implementation considerations: This scenario exists when two accounts are established for the same patient.

The PV1 segment is not valued since this event is really a merge at the PID-18 - Patient Account Number level. All identifiers below the PID-18 - Patient Account Number are combined under the surviving Patient Account Number.

Since there could be a discrepancy in the demographic information between the two records, reconciliation may be required. Surviving and non-surviving demographic information is application and implementation specific. An A08 (update patient information) event should be sent and/or negotiated as necessary to provide for implementation and application-specific needs.

18.14.2.2.4 A41 - merge account - patient account number (repeating segment) (3.6.2.1.4)

This event illustrates the concept of a repeating segment merge as defined in 3.5.2.2.1.

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A41^ADT_A39|00000005|P|2.8|

EVN|A41|200301051530

PID|||MR1^^^XYZ||EVERYWOMAN^EVE||19501010|F|||123 NORTH STREET^^NY^NY^10021||(212)111-3333|||S||ACCT1

MRG|MR1^^^XYZ||ACCT2||VISIT1

PV1|1|I|||||||||||||||||VISIT3

PID|||MR1^^^XYZ||EVERYWOMAN^EVE||19501010|F|||123 NORTH STREET^^NY^NY^10021||(212)111-3333|||S||ACCT1

MRG|MR1^^^XYZ||ACCT2||VISIT2

PV1|1|I|||||||||||||||||VISIT4

A41 - Merge account - patient account number

Use Case - Eve Everywoman (patient identifier MR1) is a recurring outpatient at the Physical Therapy clinic at hospital XYZ with account number ACCT1. She has visited the clinic several times. When she arrives for therapy, a new registrar does not realize she already has an account and opens a new one with account number ACCT2. When the mistake is discovered, the two accounts are merged together, combining all visits under account ACCT1.

Target: PID-18 - Patient Account Number and PV1-19 - Visit Number

Source: MRG-3 - Prior Patient Account Number and MRG-5 - Prior Visit Number

Example Transaction:

Before Merge

After Merge

MR1

ACCT1

VISIT1

VISIT2

ACCT2

VISIT1*

VISIT2*

*Visits erroneously assigned

MR1

ACCT1

VISIT1

VISIT2

VISIT3**

VISIT4**

**Visits combined and renumbered as a result of merging the account

Implementation considerations: This scenario exists when two accounts and associated visits are established for the same patient.

Repeating PID/MRG/PV1 segments report each Account Number and Visit Number affected. This construct is required since the visits are renumbered in this example.

Since there could be a discrepancy in the demographic information between the two records, reconciliation may be required. Surviving and non-surviving demographic information is application and implementation specific. An A08 (update patient information) event should be sent and/or negotiated as necessary to provide for implementation and application-specific needs.

18.14.2.2.5 A42 - Merge visit - visit number (3.6.2.1.5)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A42^ADT_A39|00000005|P|2.8|

EVN|A42|200301051530

PID|||MR1^^^XYZ||EVERYEWOMAN^EVE||19501010|F|||123 NORTH STREET^^NY^NY^10021||(212)111-3333|||S||ACCT1

MRG|MR1^^^XYZ||ACCT1||VISIT2

PV1|1|I|||||||||||||||||VISIT1

A42 - Merge visit - visit number

Use Case - A42 (merge visit -visit number) - Eve Everywoman (patient identifier MR1) is a recurring outpatient at the Physical Therapy clinic at hospital XYZ with account number ACCT1. She has visited the clinic several times. When she arrives for therapy, two different registrars create a new visit numbers. The mistake is not discovered immediately and clinical data is recorded under both visit numbers. When the mistake is discovered, the two visits are merged together, leaving visit VISIT1.

Target: PV1-19 - Visit Number

Source: MRG-5 - Prior Visit Number

Example Transaction:

Before Merge

After Merge

MR1

ACCT1

VISIT1

VISIT2

MR1

ACCT1

VISIT1

Implementation considerations: This scenario exists when two visits are established in error for the same patient and episode of care.

18.14.2.2.6 A43 - move patient information - patient identifier list (3.6.2.1.6)

MSH|^~\&|REPOSITORY|ENT|RSP1P8|MCM|200301051530|SEC|ADT^A43^ADT_A43|0000009|P|2.8|

EVN|A43|200301051530

PID|1||E2^^^ENT1^PE~MR2^^^ABCHMO^MR|||EVERYWOMAN^EVI|....

MRG|E1^^^ENT1^PE~MR2^^^ABCHMO^MR|. . .

A43 - Move patient information - patient identifier list

Use Case - information from ABC HMO is loaded to a repository system each month. Eve Everywoman is entered in January and assigned Enterprise Number 1 (E1). Eve has visited Hospital XYZ and is assigned medical record number MR1. Evi Everywoman (a different person) is also a member of ABC HMO loaded to the repository and assigned Enterprise Number E2. Evi has visited Hospital XYZ and is assigned medical record number MR1. Evi visits Clinic DEF where she is assigned medical record number MR2 which is erroneously associated with Eve's Enterprise Number (E1). When the error is discovered MR2 is moved from Enterprise Number E1 to E2.

Target: PID-2 - Patient ID

Source: MRG-4 - Prior Patient ID

Example transaction:

MSH|^~\&|REPOSITORY|ENT|RSP1P8|MCM|200301051530|SEC|ADT^A43^ADT_A43|0000009|P|2.8|

EVN|A43|200301051530

PID|1|E2|MR2^^^ABCHMO|||EVERYWOMAN^EVI|....

MRG|MR2^^^ABCHMO|||E1

Before Move

After Move

E1 E2

MR1 MR1

MR2

E1 E2

MR1 MR1

MR2

Implementation considerations: PID-3 - Patient Identifier List and MRG-1 - Prior Patient Identifier List are the same value since the PID-3 value does not change in this scenario.

The example above would be expressed as follows. In the following example, the assigning authority ENT1 represents an Enterprise and the PE identifier type code represents the Person's Enterprise number. The MR1 identifier is omitted from the message because it is not moved.

18.14.2.2.7 A44 - move account information - patient account number (3.6.2.1.7)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A44^ADT_A43|00000007|P|2.8|

EVN|A44|200301051530

PID|||MR2^^^XYZ||Everyman^Adam^A^JR||19501010|M|||123 EAST STREET^^NY^NY^10021||(212)111-3333|||S||ACCT2

MRG|MR1^^^XYZ||ACCT2

A44 - Move account information - patient account number

Use Case - During the admission process, the admitting clerk uses the Medical Record Number of Adam Everyman III (MR1) instead of Adam Everyman, Jr. (MR2). The Patient Administration system assigns the new admission account number ACCT2. When the mistake is discovered, account ACCT2 is moved to the correct Medical Record, MR2. The account number is not changed.

Target: PID-3 - Patient Identifier List and PID-18 - Patient Account Number (Note: PID-18 - Patient Account Number and MRG-3 - Prior Patient Account Number will be the same since the account number does not change in this scenario).

Source: MRG-1 - Prior Patient Identifier List and MRG-3 - Prior Patient Account Number (NOTE: MRG-3 - Prior Patient Account Number must be valued to indicate which account to move)

Example Transaction:

Before Move

After Move

MR1 MR2

ACCT1 ACCT1

ACCT2

MR1 MR2

ACCT1 ACCT1

ACCT2

Implementation considerations: This scenario exists when two medical records legitimately exist for two different people and an account is incorrectly associated with the wrong medical record number.

18.14.2.2.8 A45 - move visit information - visit number (repeating segment) (3.6.2.1.8)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A45^ADT_A45|00000005|P|2.8|

EVN|A45|200301051530

PID|||MR1^^^XYZ||EVERYWOMAN^EVE||19501010|M|||123 NORTH STREET^^NY^NY^10021||(212)111-3333|||S||X1

MRG|MR1^^^XYZ||ACCT1||96102

PV1||O|PT||||||||||||||||96102

MRG|MR1^^^XYZ||ACCT1||96104

PV1||O|PT||||||||||||||||96104

A45 - Move visit information - visit number

Use Case - Eve Everywoman (patient identifier MR1) is a recurring outpatient at the Physical Therapy and Speech Therapy clinics at hospital XYZ. She is assigned a different account for each clinic; her account number for Physical Therapy is ACCT1 and her account number for Speech Therapy is X1. However, on two different occasions, the Speech Therapy registrar accidentally assigned her visits (96102 and 96104) to the Physical Therapy account. The problem is later discovered and the corresponding visits are moved to the correct account.

Target: PID-18 - Patient Account Number and PV1-19 - Visit Number.

Source: MRG-3 - Prior Patient Account Number and MRG-5 - Prior Visit Number.

Example Transaction:

Before Move

After Move

MR1

ACCT1

96100

96102*

96104*

X1

96101

96103

96105

*Visits erroneously assigned

MR1

ACCT1

96100

X1

96101

96102

96103

96104

96105

In the above transaction/implementation, the application that generated the message assigns unique visit numbers.

Implementation Considerations: In this scenario the repeating MRG/PV1 construct is used to indicate which visits are moved, as illustrated in the Example Transaction. MRG-5 - Prior Visit Number and PV1-19 - Visit Number are the same values because the visit numbers do not change. Refer to section 3.5.2.1.9, "Global merge and move message construct versus repeating segment message constructs," for additional information regarding message construct.

18.14.2.2.9 A45 - move visit information - visit number (repeating segment) (3.6.2.1.9)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A45^ADT_A45|00000005|P|2.8|

EVN|A45|200301051530

PID|||MR1^^^XYZ||EVERYWOMAN^EVE||19501010|M|||123 NORTH STREET^^NY^NY^10021||(212)111-3333|||S||X1

MRG|MR1^^^XYZ||ACCT1||VISIT2

PV1||O|PT||||||||||||||||VISIT4

MRG|MR1^^^XYZ||ACCT1||VISIT3

PV1||O|PT||||||||||||||||VISIT5

A45 - Move visit information - visit number

Use Case -Eve Everywoman (patient identifier MR1) is a recurring outpatient at the Physical Therapy and Speech Therapy clinics at hospital XYZ. She is assigned a different account for each clinic; her account number for Physical Therapy is ACCT1 and her account number for Speech Therapy is X1. However, on two different occasions, the Speech Therapy registrar accidentally assigned her visits (VISIT2 and VISIT3) to the Physical Therapy account. The problem is later discovered and the corresponding visits are moved to the correct account.

Target: PID-18 - Patient Account Number and PV1-19 - Visit Number.

Source: MRG-3 - Prior Patient Account Number and MRG-5 - Prior Visit Number.

Example Transaction:

Before Move

After Move

MR1

ACCT1

VISIT1

VISIT2*

VISIT3*

X1

VISIT1

VISIT2

VISIT3

*Visits erroneously assigned

MR1

ACCT1

VISIT1

X1

VISIT1

VISIT2

VISIT3

VISIT4**

VISIT5**

**visits moved and renumbered

In the above transaction/implementation, the application that generated the message allows non-unique visit numbers.

Implementation Considerations: If Visit Numbers are not unique (as implied by the After Move example above) and renumbering of the visits is required, you must use a repeating MRG/PV1 construct as illustrated in the Example Transaction. Refer to 3.5.2.2.1, "A40 - merge patient - patient identifier list," for additional information regarding message construct.

18.14.2.2.10 A47 - change patient identifier list (3.6.2.1.10)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A47|00000002|P|2.8|

EVN|A47|200301051530

PID|||MR1^^^XYZ||EVERYMAN^ADAM||19501010|M|||987 SOUTH STREET^^NY^NY^10021||(212)111-3333|||S||ACCT1

MRG|MR2^^^XYZ||ACCT1

A47 - Change patient identifier list

Use Case - The Medical Records Department of XYZ hospital uses a system of manual medical record number assignment. During the admission process, the registrar accidentally assigned the wrong Medical Record Number (MR2 instead of MR1) to ADAM EVERYMAN. Since the correct Medical Record has not yet been assigned to any patient, no merge takes place. The Patient Identifier List is simply changed.

Target: PID-3 - Patient Identifier List

Source: MRG-1 - Prior Patient Identifier List

Example Transaction:

Before Change

After Change

MR2

ACCT1

MR1

ACCT1

Implementation considerations: None.

18.14.2.2.11 A49 - change patient account number (3.6.2.1.11)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A49^ADT_A30|00000006|P|2.8|

EVN|A49|200301051530

PID|||MR1^^^XYZ||EVERYMAN^ADAM||19501010|M|||123 SOUTH STREET^^NY^NY^10021||(212)111-2222|||S|CAT|ACCT1

MRG|MR1^^^XYZ||X1

A49 - Change patient account number

Use Case - Patients are automatically assigned an account number by hospital XYZ's Patient Administration system at admission. However, when the Patient Administration system is down, the admitting clerk manually assigns account numbers from a pool of downtime account numbers. ADAM EVERYMAN (patient ID MR1) was manually assigned downtime account number ACCT1. When the Patient Administration system came back up, the admitting clerk accidentally entered the wrong account number, X1, into the system. When the problem was later discovered, the account number was changed from X1 to ACCT1.

Target: PID-18 - Patient Account Number

Source: MRG-3 - Prior Patient Account Number

Example Transaction:

Before Change

After Change

MR1

X1

MR1

ACCT1

Implementation Considerations: None.

18.14.2.2.12 A50 - change visit number (3.6.2.1.12)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A50^ADT_A50|00000006|P|2.8|

EVN|A50|200301051530

PID|||MR1^^^XYZ||EVERYMAN^ADAM||19501010|M|||123 SOUTH STREET^^NY^NY^10021||(212)111-2222|||S|CAT|ACCT1

MRG|MR1^^^XYZ||ACCT1||VISIT2

PV1|1|O||3|||99^BROWN^JERRY|||ONC||||1||VIP|99^BROWN^JERRY|O/P|VISIT1...

A50 - Change visit number

Use Case - Patients are automatically assigned a visit number by hospital XYZ's Patient Administration system at check-in. However, when the Patient Administration system is down, the admitting clerk manually assigns visit numbers from a pool of downtime numbers. ADAM EVERYMAN (patient ID MR1) was manually assigned downtime visit number VISIT1. When the Patient Administration system came back up, the admitting clerk accidentally entered the wrong visit number, VISIT2, into the system. When the problem was later discovered, the visit number was changed from VISIT2 to VISIT1.

Target: PV1-19 - Visit Number

Source: MRG-5 - Prior Visit Number

Example Transaction:

Before Change

After Change

MR1

ACCT1

VISIT2

MR1

ACCT1

VISIT1

Implementation considerations: None.

18.14.2.2.13 A51 - change alternate visit ID (3.6.2.1.13)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SECURITY|ADT^A51^ADT_A50|00000006|P|2.8|

EVN|A51|200301051530

PID|||MR1^^^XYZ||EVERYMAN^ADAM||19501010|M|||123 SOUTH STREET^^NY^NY^10021||(212)111-2222|||S|CAT|ACCT1

MRG|MR1^^^XYZ||ACCT1|||AV2

PV1|1|O||3|||99^BROWN^JERRY|||ONC||||1||VIP|99^BROWN^JERRY|O/P|V1|SP|||||||||||||||||||A|||||19990902081010||||||AV1

A51 - Change alternate visit ID

Use Case - Patients are automatically assigned an alternate visit number by hospital XYZ's Patient Administration system at check-in. However, when the Patient Administration system is down, the admitting clerk manually assigns alternate visit numbers from a pool of downtime numbers. ADAM EVERYMAN was manually assigned downtime alternate visit number AV1. When the Patient Administration system came back up, the admitting clerk accidentally entered the wrong alternate visit number, AV2, into the system. When the problem was later discovered, the alternate visit number was changed from AV2 to AV1.

Target: PV1-50 - Alternate Visit ID

Source: MRG-6 - Prior Alternate Visit ID

Example Transaction:

Before Change

After Change

MR1

ACCT1

VISIT1

AV2

MR1

ACCT1

VISIT1

AV1

Implementation Considerations: None.

18.14.2.2.14 Example using multiple messages (3.6.2.1.14)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A47^ADT_A30|00000006|P|2.8|

EVN|A47|200301051530

PID|||MR1^^^XYZ^MR||EVERYMAN^ADAM||19501010|M|||123 SOUTH STREET^^NY^NY^10021||(212)111-2222|||S|CAT|X1

MRG|MR2^^^XYZ^MR|

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A49^ADT_A30|00000006|P|2.5

EVN|A49|200301051530

PID|||MR1^^^XYZ^MR||EVERYMAN^ADAM||19501010|M|||123 SOUTH STREET^^NY^NY^10021||(212)111-2222|||S|CAT|ACCT1

MRG|MR1^^^XYZ^MR||X1

A47 - Change patient identifier list and A49 - Change patient account number

Use Case - Patients are automatically assigned Medical Records Numbers and account numbers by hospital XYZ's Patient Administration system at admission. However, when the Patient Administration system is down, the admitting clerk manually assigns account numbers and Medical Records numbers from a pool of downtime numbers. ADAM EVERYMAN was manually assigned downtime Medical Record Number MR1 and downtime account number A1. When the Patient Administration system came back up, the admitting clerk accidentally enters the wrong Medical Record Number (MR2) and account number (X1) into the system. The error occurred because she was reading from the paperwork for a different downtime admit not yet entered into the Patient Administration system. The problem is quickly discovered, and the medical record number and account number was fixed accordingly. Since the other downtime admit had not yet been entered into the Patient Administration system, no merge was required.

Target: PID-3 - Patient Identifier List (Message 1) and PID-18 - Patient Account Number (Message 2)

Source: MRG-1 - Prior Patient Identifier List (Message 1) and MRG-3 - Prior Patient Account Number (Message 2)

Example Transaction - Message 1:

Example Transaction - Message 2:

Before Change

After Change

MR2

X1

MR1

ACCT1

Implementation considerations: Message 1 (A47) changes the patient identifier list. Message 2 (A49) changes the account number.

18.14.2.2.15 Example using multiple messages (3.6.2.1.15)

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A44^ADT_A43|00000007|P|2.8|

EVN|A44|200301051530

PID|||MR2^^^XYZ^MR||EVERYMAN^ADAM^A^JR||19501010|M|||123 EAST STREET^^NY^NY^10021||(212)111-3333|||S||ACCT1

MRG|MR1^^^XYZ^MR||ACCT1

Example Transaction (Message 2):

MSH|^~\&|REGADT|MCM|RSP1P8|MCM|200301051530|SEC|ADT^A49^ADT_A30|00000007|P|2.5

EVN|A49|200301051530

PID|||MR2^^^XYZ^MR||EVERYMAN^ADAM^A^JR||19501010|M|||123 EAST STREET^^NY^NY^10021||(212)111-3333|||S||X1

MRG|MR2^^^XYZ^MR||ACCT1

A44 - Move account information - patient account number and A49 - Change patient account number

Use Case - During the admitting process, the admitting clerk uses the Medical Record Number of Adam Everyman, III (MR1) instead of Adam Everyman, Jr. (MR2). The Patient Administration system assigns the new admission account number A1. When the mistake is discovered, the account is moved to the correct Medical Record, MR2. The Patient Administration system generates a new account number as a result: number X1.

Target: PID-3 - Patient Identifier List (Message 1) and PID-18 - Patient Account Number (Message 2)

Source: MRG-1 - Prior Patient Identifier List (Message 1) and MRG-3 - Prior Patient Account Number (Message 2)

Example Transaction (Message 1):

Before Change

After Change

MR1 MR2

ACCT1

MR1 MR2

X1

Implementation Considerations: Message 1, A44 (move account information-patient account number), moves the account from MR1 to MR2. Message 2, A49 (change patient account number), changes the account number.

18.14.3 Patient record links (3.6.3)

Linking two or more patients does not require the actual merging of patient information as discussed in Section 3.5.2, "Merging patient/person information;" following a link trigger event, sets of affected patient data records should remain distinct. However, because of differences in database architectures, there may be system-dependent limitations or restrictions regarding the linking of one or more patients that must be negotiated.

There are multiple approaches for implementing Master Patient Indexes. It is useful for the purpose of MPI mediation to support two types of linkage. Explicit linkage requires a message declaring a link has been made between multiple identifiers. Implicit linkage is performed when a receiving system infers the linkage from the presence of multiple identifiers present in PID-3 - Patient Identifier List.

In an MPI setting, the A24 -link patient information message is preferred for transmitting an explicit link of identifiers whether they are in the same or different assigning authorities. The A37 unlink patient information message is preferred for transmitting the explicit unlinking of identifiers.

Implicit linkage of identifiers, sometimes called passive linking, has been implemented using various messages. An acknowledged method is inclusion of multiple identifiers in PID-3 - Patient Identifier List, which the receiving system implicitly links. An MPI or application that makes such an implicit linkage can generate an A24 - link patient information message to explicitly notify another system of this action.

18.14.4 MPI Integration - an introduction (3.6.4)

The purpose of this section is to provide some insight into how HL7 committees have approached the area of MPI integration, as well as to provide concrete examples of how the integration could be done using messages in Version 2.4 and later.

18.14.4.1 (hidden text) (3.6.4.0)

18.14.4.2 Definitions - what is an MPI? (3.6.4.1)

There can be quite a bit of confusion as to what defines an MPI. Early definitions called it a Master Patient Index, implying only patient data would be managed. Later the definition was expanded to mean persons in general, including patients, guarantors, subscribers, and even providers; essentially any entity that could be considered a "person." Thus the current acronym MPI generally is inferred to mean Master Person Index.

An MPI is generally used to manage person identification and cross-reference across disparate systems. Healthcare organizations may have several systems handling various different data processing needs, from laboratory to billing, each with its own database of persons and person identifier numbering schemes. Each of these can be called an ID Domain. An MPI can function as a Correlation Manager between these domains, providing a cross-reference of a person's identifiers across each of the domains. Typically an MPI will also have one universal or enterprise identifier that uniquely identifies the person in the MPI itself. The domain for this identifier may or may not be the domain for clients of the MPI.

MPI functionality also typically includes methods to provide an identifier for a person, given a set of traits or demographics for that person. An example of the use of this is for a client system to query the MPI for a person given a set of demographics. The MPI uses matching algorithms to find possible matching persons, and returns to the client system the identifiers for those persons.

This section currently deals only with MPI functionality related to persons in the context of Version 2.4 and later. It is assuming integration using Version 2.4 and later ADT messages, and the functionality surrounding finding and identifying a person.

18.14.4.3 HL7 and CORBAmed PIDS (3.6.4.2)

There has been an effort to harmonize the modeling work that has been done in the CORBAMed Patient Identification Service (PIDS) with the HL7 message set, with an eye toward HL7 Version 3.0. You may see evidence of CORBAMed modeling in this implementation, but that should not be taken as evidence that full harmonization has taken place. There is much work left to do in this area.

18.14.4.4 MPI QUERY for person lookup and identification (3.6.4.3)

Several QBP/RSP queries have been developed to aid in the integration of systems with an MPI. They consist of several Qxx/Kxx trigger/response pairs and one Q24/K24 trigger/response pair. The following table lists their functions:

MPI QBP/RSP Queries

Query

Name

MPI Use

Q21/K21

Get Person Demographics

Given a person identifier, return the PID and optionally the PD1 segments for the matching person.

Q22/K22

Find Candidates

Given some demographics, optionally a match threshold and algorithm, find and return a list of matching persons.

Q23/K23

Get Corresponding Identifiers

Given a person's identifier and a list of identifier domains, return the person's identifiers in those domains.

Q24/K24

Allocate Identifiers

Given a list of identifier domains, return new identifiers for those domains. Should not link to a person, just reserve and return identifiers.

The following sections show several scenarios involving looking up a person on a "client" system, and how it can be integrated to an MPI. The basic flow is for a user to enter person information on the client system, and the client system using services of the MPI to match the user's input to a person that exists somewhere on the two systems.

The scenarios are differentiated on two variables:

ID Creator - Which system assigns new person identifiers for the client system. This can either be the MPI or the client system.

Person Existence - On which system the person record currently exists - the client system, the MPI, or both.

18.14.4.5 Client system assigns identifier, person exists on MPI only (3.6.4.4)

In this scenario, a client system (e.g., a registration system) will query an MPI for a person that does not currently exist on the client system. The MPI returns a list of one or more possible matching candidates, and one is chosen by the user on the client system. The client system assigns the person an identifier and an update is sent to the MPI to notify it of the new assigned identifier.

18.14.4.5.1 Figure 3-1 - Client system assigns identifier, person exists on MPI only (3.6.4.4.1)

The messages are defined as follows:

Q22/K22 Find Candidates - This signals the MPI to search its database for a list of persons that match the demographic criteria sent in the query, using whatever algorithms it has at its disposal, or using the algorithm optionally specified in the query. The response includes a list of "candidates" that matched the criteria in the query, one PID segment for each candidate. The query can also specify the identifier domains to return in PID-3 - Patient Identifier List, so that the client system identifier and the MPI enterprise identifier could be returned for each match.

Q21/K21 Get Person Demographics - Once a candidate is chosen from the list, another query may be done to retrieve the full set of demographics for that person.

A24 or A01/A04/A05 - This transaction is to update the MPI with the new identifier the client system has created for the person. It is acceptable for systems to simply send an A01 Admit/visit notification, A04 Register a patient or A05 Pre-admit a patient as may have been done traditionally, with the new client system identifier and the existing MPI enterprise identifier in PID-3. However an A24 Link patient information may be sent instead, with one PID segment containing the MPI enterprise identifier for the person, and the second PID segment containing the new registration system identifier.

18.14.4.6 Client system assigns identifier, person exists on both systems (3.6.4.5)

In this scenario, a client system (e.g., a registration system) will query an MPI for a person, and the person record exists on both systems. The MPI returns a list of possible matching candidates, and one is chosen by the user on the client system. The client system simply asks the MPI for an updated set of demographics and does not assign an identifier since the person already exists with an identifier on the client system.

Prior to querying the MPI, the client system may query its own database to reduce network transactions. However, the full searching capabilities of the MPI may be preferred to the client system in order to prevent the selection of the wrong person.

18.14.4.6.1 Figure 3-2 - Client system assigns identifier, person exists on both systems (3.6.4.5.1)

The message flow is identical to the message flow in the 3.5.4.5 example, with the exception that the final update to the MPI is not needed in order to give the MPI a new identifier for the person. The MPI should already have the client system identifier from previous transactions.

An ADT event may be sent later by the client system simply to update the MPI with any demographic changes that occur.

18.14.4.7 Client system assigns identifier, person exists on neither system (3.6.4.6)

In this scenario, a client system (e.g., a registration system) will query an MPI for a person, and the person does not exist on either system. The MPI returns a list of possible matching candidates, or possibly an empty list. The user does not choose one, and a new person record is created.

18.14.4.7.1 Figure 3-3 - Client system assigns identifier, does not exist on either system (3.6.4.6.1)

The message flow again begins with a Q22/K22 Find Candidates query. The response may or may not contain a list of candidates.

If the client system assigns a person identifier when the record is created, an A28 Add person information could be sent to the MPI to notify it of the record creation. If the client system does not create an identifier until the registration is completed, the A01, A04 or A05 events could serve the purpose of notifying the MPI of an added person and identifier. The fact that the person will have an identifier unknown to the MPI, and no enterprise identifier, will allow the MPI to infer that a person record is being added.

When the person record is added to the MPI with the new identifier, an enterprise identifier is assigned, and ancillary systems may be notified of the new person record creation.

18.14.4.8 MPI assigns identifier, person exists on MPI (3.6.4.7)

In the next set of three scenarios, it is assumed that a third party (ID Manager) creates identifiers for the client system, and for these examples the MPI fulfills this role. The QBP/RSP queries support this service.

18.14.4.8.1 Figure 3-4 - Example of two healthcare organizations merging (3.6.4.7.1)

Figure 3-4 shows a case where identifiers may need to be assigned by a third party. In the example, East Health Organization had one identifier domain (XXXX numbers) for both the hospital registration system and the outpatient clinic registration numbers. Coordination was done through the use of pre-printed charts for new patients, which prevented the two systems from using the same XXXX number for two patients.

Later West Health Organization is bought and merged with East. West has been using its own identifier domain (YYYY numbers). An MPI is also implemented to keep a cross-reference between the two systems, and assigns its own enterprise identifier (EEEE number) to each patient.

Because the organization is attempting to go paperless, East decides to forgo its pre-printed charts, but still keep the XXXX numbers. Since the pre-printed charts are no longer there to keep numbers from being re-used between the hospital and clinic, a third party is needed to assign the XXXX numbers.

A patient arrives at East Hospital that had never been there, but had been to West previously. To register the patient, the hospital system submits a Find Candidates Q22/K22 query to get from the MPI a list of possible matching patients. The user finds the patient since she had been to West previously. Since the patient is new to East, she must be given a new East identifier (XXXX number). An Allocate Identifiers A56/K24 query is sent from the East Hospital to the MPI and the MPI generates an XXXX number and returns it. Later when the registration is finished, an A24 Link Person Information message is sent to notify the MPI that the allocated identifier has been assigned to a patient

In the following first scenario, the person record exists on the MPI, however it does not exist on the client system. The message flow assumes that the MPI is assigning identifiers for the client system that are not the enterprise identifiers. If this were not the case, the Allocate Identifiers A56/K24 query would not be needed.

18.14.4.8.2 Figure 3-5 - MPI assigns identifier, person exists on MPI (3.6.4.7.2)

The message flow is similar to previous examples, with the exception of the Q24/K24 Allocate Identifiers query and the final A24 Link Patient Information message:

Q24/K24 Allocate Identifiers - This query is for the client system to ask the MPI for an identifier in the client system's domain. It is not to assign the identifier to a particular person record, but rather just to reserve an identifier for later use.

A24 Link patient information - This message is to notify the MPI that the previously allocated identifier has been assigned to a person. The A24 should include one PID segment with the new identifier and one PID segment with the MPI enterprise identifier.

18.14.4.9 MPI assigns identifier, person exists on both systems (3.6.4.8)

is scenario is identical to the scenario in 3.5.4.2 Client system assigns identifier, person exists on both systems.

18.14.4.9.1 Figure 3- 6 - MPI assigns identifier, person exists on both systems (3.6.4.8.1)

18.14.4.10 MPI assigns identifier, person exists on neither system (3.6.4.9)

In this scenario, the person does not exist on either system. The message flow is similar to 3.5.4.7, "MPI assigns identifier, person exists on MPI"; however, there is no need for the Q21/K21Get person Demographics query as a double-check for the user since the person does not exist on the MPI. Also, after the person is registered and the identifier assigned, an A28 Add Person Information is sent to the MPI to have it add the person to its database and assign an enterprise identifier.

18.14.4.10.1 Figure 3-7 - MPI assigns identifier, person exists on neither system (3.6.4.9.1)

18.14.5 Usage notes: Non-human PID patient identification (3.6.5)

The species attribute is required for non-human patients. The breed and strain attributes are conditional. Thus if the strain attribute is populated, the species attribute must be populated, but the breed attribute is optional. The production class attribute is optional, but if populated the species attribute must also be populated. The name of the animal populates the PID-5 attribute, component 2. The last name of the owner may populate component 1 of PID-5. Owner information is transmitted in the NK1 segment.

Example 1: Mrs. EVERYWOMAN brings her 9 year old, female, spayed miniature poodle, Fluffy, into the Allstate University, Veterinary Medical Teaching Hospital to have skin growths removed. The poodle resides with Mrs. EVERYWOMAN in her apartment at 2222 Home Street, Apt 123, in Ann Arbor, MI 11111, Washtenaw County;

MSH|^~\&||ALLSTATE UNIV VMTH|||200702171830||ADT^A04

PID|1||A83245^^^VMTH^MR^UCD||EVERYWOMAN^Fluffy^^^^^^D||19901001|S|||2222 Home St^Apt 123^Ann Arbor^MI^11111^USA^^^Washtenaw||||||||||||MI||||||||||||L-80700^Canine, NOS^SNM3|L-80832^Miniature Poodle, NOS^SNM3

NK1|1|EVERYWOMAN^EVE^M^^Mrs.^^L|O|2222 Home St^Apt 123^Ann Arbor^MI ^11111^USA^^^Washtenaw|(530) 555-4325^^^emeverywoman123@AOL.COM||CP|

PV1|1|O||R|||0045^BARKER^BART^^Dr.^DVM||||||||||||||||||||||||||||||||||||199902161015

OBX|1|NM|21611-9^Age^LN||9|yr

OBX|2|NM|3141-9^Body Weight^LN||16|lb

Example 2: Over the Hill Horses owns the Morgan horse mare named Breeze that is referred by Dr. Equine of Foothill Veterinary Clinic for colic (acute abdominal pain) to the Allstate University, Veterinary Medical Teaching Hospital. The manager of the farm and contact person is Randall "Buck" Shins, who works at the farm headquarters in Ypsilanti, MI, 11111:

MSH|^~\&||Foothill Veterinary Clinic||Allstate Univ VMTH|200702171830||ADT^A04

PID|1||N324256^^^^^Foothill Vet Clinic||^Breeze^^^^^^D|||F|||^^^MI^^^^^Lassen||||||||||||||||||19981123|Y|||||L-80400^Horse^SNM3|L-80431^Morgan horse^SNM3||BR

NK1|1||||||O|||||Over the Hill Horses|||||||||||||||||~Shins^Buck^^^Mr.^^N|(530) 555-9843^^^Buckshins@OvertheHill.com|2222 Farm Rd ^Suite A^Ypsilanti^MI^11111^^^^Lassen

PV1|1|E||R|||^Equine^^^Dr.^DVM||||||||||||||||||||||||||||||||||||199903102013

18.15 Referenced Organizations and Documents (3.7)