Connectathon 11 Snapshot

This page is part of the FHIR Specification (v1.2.0: STU 3 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

1.25.4.1.8 HL7 v3 Code System ActReason

This code system (http://hl7.org/fhir/v3/ActReason) is defined as part of HL7 v3.

Summary

Defining URL:http://hl7.org/fhir/ValueSet/v3-ActReason
Name:v3 Code System ActReason
Definition: A set of codes specifying the motivation, cause, or rationale of an Act, when such rationale is not reasonably represented as an ActRelationship of type "has reason" linking to another Act. Examples: Example reasons that might qualify for being coded in this field might be: "routine requirement", "infectious disease reporting requirement", "on patient request", "required by law".
OID: (for OID based terminology systems)
System URL:http://hl7.org/fhir/v3/ActReason
System OID:2.16.840.1.113883.5.8
Source ResourceXML / JSON

This value set is not currently used

1.25.4.1.8.1 Content Logical Definition


This value set has an inline code system http://hl7.org/fhir/v3/ActReason, which defines the following codes:

LvlCodeDisplayDefinition
1_ActAccommodationReason ActAccommodationReasonIdentifies the reason the patient is assigned to this accommodation type
2  ACCREQNA Accommodation Requested Not AvailableAccommodation requested is not available.
2  FLRCNV Floor ConvenienceAccommodation is assigned for floor convenience.
2  MEDNEC Medical NecessityRequired for medical reasons(s).
2  PAT Patient requestThe Patient requested the action
1_ActCoverageReason ActCoverageReasonDescription:Codes used to specify reasons or criteria relating to coverage provided under a policy or program. May be used to convey reasons pertaining to coverage contractual provisions, including criteria for eligibility, coverage limitations, coverage maximums, or financial participation required of covered parties.
2  _EligibilityActReasonCode EligibilityActReasonCodeIdentifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.
Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
3    _ActIneligibilityReason ActIneligibilityReasonIdentifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.
Examples are client deceased & adopted client has been given a new policy identifier.
4      COVSUS coverage suspendedWhen a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.
Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).
4      DECSD deceasedClient deceased.
4      REGERR registered in errorClient was registered in error.
3    _CoverageEligibilityReason CoverageEligibilityReasonDefinition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.
Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
4      AGE age eligibilityA person becomes eligible for a program based on age.
Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare.
4      CRIME crime victimA person becomes eligible for insurance or a program because of crime related health condition or injury.
Example: A person is a claimant under the U.S. Crime Victims Compensation program.
4      DIS disabilityA person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
4      EMPLOY employment benefitA person becomes eligible for insurance provided as an employment benefit based on employment status.
4      FINAN financial eligibilityA person becomes eligible for a program based on financial criteria.
Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
4      HEALTH health statusA person becomes eligible for a program because of a qualifying health condition or injury.
Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
4      MULTI multiple criteria eligibilityA person becomes eligible for a program based on more than one criterion.
Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
4      PNC property and casualty conditionA person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.
Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
4      STATUTORY statutory eligibilityA person becomes eligible for a program based on statutory criteria.
Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
4      VEHIC motor vehicle accident victimA person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
4      WORK work relatedA person becomes eligible for insurance or a program because of a work related health condition or injury.
Example: A person is a claimant under the U.S. Black Lung Program.
1_ActInformationManagementReason ActInformationManagementReasonDescription:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.
2  _ActHealthInformationManagementReason ActHealthInformationManagementReasonDescription:The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.
3    _ActConsentInformationAccessOverrideReason ActConsentInformationAccessOverrideReasonTo perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.
Usage Notes: Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.
4      OVRER emergency treatment overrideTo perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.
Usage Notes: The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.
4      OVRPJ professional judgment overrideTo perform one or more operations on information to which the patient declined to consent for providing health care.
Usage Notes: The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.
4      OVRPS public safety overrideTo perform one or more operations on information to which the patient has not consented for public safety reasons.
Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.
4      OVRTPS third party safety overrideTo perform one or more operations on information to which the patient has not consented for third party safety.
Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.
3    PurposeOfUse purpose of useReason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.
Usage Notes: The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.
4      HMARKT healthcare marketingTo perform one or more operations on information for marketing services and products related to health care.
4      HOPERAT healthcare operationsTo perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
5        DONAT donationTo perform one or more operations on information used for cadaveric organ, eye or tissue donation.
5        FRAUD fraudTo perform one or more operations on information used for fraud detection and prevention processes.
5        GOV governmentTo perform one or more operations on information used within government processes.
5        HACCRED health accreditationTo perform one or more operations on information for conducting activities related to meeting accreditation criteria.
5        HCOMPL health complianceTo perform one or more operations on information used for conducting activities required to meet a mandate.
5        HDECD decedentTo perform one or more operations on information used for handling deceased patient matters.
5        HDIRECT directoryTo perform one or more operation operations on information used to manage a patient directory.
Examples:
facility enterprise payer health information exchange patient directory
5        HLEGAL legalTo perform one or more operations on information for conducting activities required by legal proceeding.
5        HOUTCOMS health outcome measureTo perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
5        HPRGRP health program reportingTo perform one or more operations on information used for conducting activities to meet program accounting requirements.
5        HQUALIMP health quality improvementTo perform one or more operations on information used for conducting administrative activities to improve health care quality.
5        HSYSADMIN health system administrationTo perform one or more operations on information to administer the electronic systems used for the delivery of health care.
5        MEMADMIN member administrationTo perform one or more operations on information to administer health care coverage to an enrollee under a policy or program.
5        PATADMIN patient administrationTo perform one or more operations on information used for operational activities conducted to administer the delivery of health care to a patient.
5        PATSFTY patient safetyTo perform one or more operations on information in processes related to ensuring the safety of health care.
5        PERFMSR performance measureTo perform one or more operations on information used for monitoring performance of recommended health care practices and interventions.
5        RECORDMGT records managementTo perform one or more operations on information used within the health records management process.
5        TRAIN trainingTo perform one or more operations on information used in training and education.
4      HPAYMT healthcare paymentTo perform one or more operations on information for conducting financial or contractual activities related to payment for provision of health care.
5        CLMATTCH claim attachmentTo perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
5        COVAUTH coverage authorizationTo perform one or more operations on information for conducting prior authorization or predetermination of coverage for services.
5        COVERAGE coverage under policy or programTo perform one or more operations on information for conducting activities related to coverage under a program or policy.
6          ELIGDTRM eligibility determinationTo perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.
6          ELIGVER eligibility verificationTo perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.
6          ENROLLM enrollmentTo perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.
5        REMITADV remittance adviceTo perform one or more operations on information about the amount remitted for a health care claim.
4      HRESCH healthcare researchTo perform one or more operations on information for conducting scientific investigations to obtain health care knowledge.
5        CLINTRCH clinical trial researchTo perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
4      PATRQT patient requestedTo perform one or more operations on information in response to a patient's request.
5        FAMRQT family requestedTo perform one or more operations on information in response to a request by a family member authorized by the patient.
5        PWATRNY power of attorneyTo perform one or more operations on information in response to a request by a person appointed as the patient's legal representative.
5        SUPNWK support networkTo perform one or more operations on information in response to a request by a person authorized by the patient.
4      PUBHLTH public healthTo perform one or more operations on information for conducting public health activities, such as the reporting of notifiable conditions.
5        DISASTER disasterTo perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
5        THREAT threatTo perform one or more operations on information used to prevent injury or disease to living subjects who may be the target of violence.
4      TREAT treatmentTo perform one or more operations on information for provision of health care.
5        CAREMGT Care ManagementTo perform one or more operations on information for provision of health care coordination.
5        CLINTRL clinical trialTo perform health care as part of the clinical trial protocol.
5        ETREAT Emergency TreatmentTo perform one or more operations on information for provision of immediately needed health care for an emergent condition.
5        POPHLTH population healthTo perform one or more operations on information for provision of health care to a population of living subjects, e.g., needle exchange program.
2  _ActInformationPrivacyReason ActInformationPrivacyReasonDescription:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.
3    MARKT marketingDescription:
3    OPERAT operationsDescription:Administrative and contractual processes required to support an activity, product, or service
4      LEGAL subpoenaDefinition:To provide information as a result of a subpoena.
4      ACCRED accreditationDescription:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
4      COMPL complianceDescription:Operational activities required to meet a mandate related to an activity, product, or service
4      ENADMIN entity administrationDescription:Operational activities conducted to administer information relating to entities involves with an activity, product, or service
4      OUTCOMS outcome measureDescription:Operational activities conducted for the purposes of assessing the results of an activity, product, or service
4      PRGRPT program reportingDescription:Operational activities conducted to meet program accounting requirements related to an activity, product, or service
4      QUALIMP quality improvementDescription:Operational activities conducted for the purposes of improving the quality of an activity, product, or service
4      SYSADMN system administrationDescription:Operational activities conducted to administer the electronic systems used for an activity, product, or service
3    PAYMT paymentDescription:Administrative, financial, and contractual processes related to payment for an activity, product, or service
3    RESCH researchDescription:Investigative activities conducted for the purposes of obtaining knowledge
3    SRVC serviceDescription:Provision of a service, product, or capability to an individual or organization
1_ActInvalidReason ActInvalidReasonDescription: Types of reasons why a substance is invalid for use.
2  ADVSTORAGE adverse storage conditionDescription: Storage conditions caused the substance to be ineffective.
3    COLDCHNBRK cold chain breakDescription: Cold chain was not maintained for the substance.
2  EXPLOT expired lotDescription: The lot from which the substance was drawn was expired.
2  OUTSIDESCHED administered outside recommended schedule or practiceThe substance was administered outside of the recommended schedule or practice.
2  PRODRECALL product recallDescription: The substance was recalled by the manufacturer.
1_ActInvoiceCancelReason ActInvoiceCancelReasonDomain specifies the codes used to describe reasons why a Provider is cancelling an Invoice or Invoice Grouping.
2  INCCOVPTY incorrect covered party as patientThe covered party (patient) specified with the Invoice is not correct.
2  INCINVOICE incorrect billingThe billing information, specified in the Invoice Elements, is not correct. This could include incorrect costing for items included in the Invoice.
2  INCPOLICY incorrect policyThe policy specified with the Invoice is not correct. For example, it may belong to another Adjudicator or Covered Party.
2  INCPROV incorrect providerThe provider specified with the Invoice is not correct.
1_ActNoImmunizationReason ActNoImmunizationReasonA coded description of the reason for why a patient did not receive a scheduled immunization.
(important for public health strategy
2  IMMUNE immunityDefinition:Testing has shown that the patient already has immunity to the agent targeted by the immunization.
2  MEDPREC medical precautionDefinition:The patient currently has a medical condition for which the vaccine is contraindicated or for which precaution is warranted.
2  OSTOCK product out of stockDefinition:There was no supply of the product on hand to perform the service.
2  PATOBJ patient objectionDefinition:The patient or their guardian objects to receiving the vaccine.
2  PHILISOP philosophical objectionDefinition:The patient or their guardian objects to receiving the vaccine because of philosophical beliefs.
2  RELIG religious objectionDefinition:The patient or their guardian objects to receiving the vaccine on religious grounds.
2  VACEFF vaccine efficacy concernsDefinition:The intended vaccine has expired or is otherwise believed to no longer be effective.
Example:Due to temperature exposure.
2  VACSAF vaccine safety concernsDefinition:The patient or their guardian objects to receiving the vaccine because of concerns over its safety.
1_ActSupplyFulfillmentRefusalReason ActSupplyFulfillmentRefusalReasonIndicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated".
(used when capturing 'refusal to fill' annotations)
2  FRR01 order stoppedDefinition:The order has been stopped by the prescriber but this fact has not necessarily captured electronically.
Example:A verbal stop, a fax, etc.
2  FRR02 stale-dated orderDefinition:Order has not been fulfilled within a reasonable amount of time, and may not be current.
2  FRR03 incomplete dataDefinition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available
Example:Lab results, diagnostic imaging, etc.
2  FRR04 product unavailableDefinition:Product not available or manufactured. Cannot supply.
2  FRR05 ethical/religiousDefinition:The dispenser has ethical, religious or moral objections to fulfilling the order/dispensing the product.
2  FRR06 unable to provide careDefinition:Fulfiller not able to provide appropriate care associated with fulfilling the order.
Example:Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.
1_ClinicalResearchEventReason ClinicalResearchEventReasonDefinition:Specifies the reason that an event occurred in a clinical research study.
2  RET retestDefinition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
2  SCH scheduledDefinition:The event occurred due to it being scheduled in the research protocol.
2  TRM terminationDefinition:The event occurred in order to terminate the subject's participation in the study.
2  UNS unscheduledDefinition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.
1_ClinicalResearchObservationReason ClinicalResearchObservationReasonDefinition:SSpecifies the reason that a test was performed or observation collected in a clinical research study.
Note:This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.
2  NPT non-protocolDefinition:The observation or test was neither defined or scheduled in the study protocol.
2  PPT per protocolDefinition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
2  UPT per definition:The observation or test occurred as defined in the research protocol, but at a point in time not specified in the study protocol.
1_CombinedPharmacyOrderSuspendReasonCode CombinedPharmacyOrderSuspendReasonCodeDescription:Indicates why the prescription should be suspended.
2  ALTCHOICE try another treatment firstDescription:This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.
2  CLARIF prescription requires clarificationDescription:Clarification is required before the order can be acted upon.
2  DRUGHIGH drug level too highDescription:The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.
2  HOSPADM admission to hospitalDescription:The patient has been admitted to a care facility and their community medications are suspended until hospital discharge.
2  LABINT lab interference issuesDescription:The therapy would interfere with a planned lab test and the therapy is being withdrawn until the test is completed.
2  NON-AVAIL patient not-availableDescription:Patient not available for a period of time due to a scheduled therapy, leave of absence or other reason.
2  PREG parent is pregnant/breast feedingDescription:The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.
2  SALG allergyDescription:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
2  SDDI drug interacts with another drugDescription:The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.
2  SDUPTHER duplicate therapyDescription:Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.
2  SINTOL suspected intoleranceDescription:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
2  SURG patient scheduled for surgeryDescription:The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.
2  WASHOUT waiting for old drug to wash outDescription:The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.
1_ControlActNullificationReasonCode ControlActNullificationReasonCodeDescription:Identifies reasons for nullifying (retracting) a particular control act.
2  ALTD altered decisionDescription:The decision on which the recorded information was based was changed before the decision had an effect.
Example:Aborted prescription before patient left office, released prescription before suspend took effect.
2  EIE entered in errorDescription:The information was recorded incorrectly or was recorded in the wrong record.
2  NORECMTCH no record matchDescription: There is no match for the record in the database.
1_ControlActNullificationRefusalReasonType ControlActNullificationRefusalReasonTypeDescription: Reasons to refuse a transaction to be undone.
2  INRQSTATE in requested stateThe record is already in the requested state.
2  NOMATCH no matchDescription: There is no match.
3    NOPRODMTCH no product matchDescription: There is no match for the product in the master file repository.
3    NOSERMTCH no service matchDescription: There is no match for the service in the master file repository.
3    NOVERMTCH no version matchDescription: There is no match for the record and version.
2  NOPERM no permissionDescription: There is no permission.
3    NOUSERPERM no user permissionDefinition:The user does not have permission
3    NOAGNTPERM no agent permissionDescription: The agent does not have permission.
3    NOUSRPERM no user permissionDescription: The user does not have permission.
2  WRNGVER wrong versionDescription: The record and version requested to update is not the current version.
1_ControlActReason ControlActReasonIdentifies why a specific query, request, or other trigger event occurred.
2  _MedicationOrderAbortReasonCode medication order abort reasonDescription:Indicates the reason the medication order should be aborted.
3    DISCONT product discontinuedDescription:The medication is no longer being manufactured or is otherwise no longer available.
3    INEFFECT ineffectiveDescription:The therapy has been found to not have the desired therapeutic benefit on the patient.
3    MONIT response to monitoringDescription:Monitoring the patient while taking the medication, the decision has been made that the therapy is no longer appropriate.
3    NOREQ no longer required for treatmentDescription:The underlying condition has been resolved or has evolved such that a different treatment is no longer needed.
3    NOTCOVER not coveredDescription:The product does not have (or no longer has) coverage under the patientaTMs insurance policy.
3    PREFUS patient refuseDescription:The patient refused to take the product.
3    RECALL product recalledDescription:The manufacturer or other agency has requested that stocks of a medication be removed from circulation.
3    REPLACE change in orderDescription:Item in current order is no longer in use as requested and a new one has/will be created to replace it.
4      DOSECHG change in medication/doseDescription:The medication is being re-prescribed at a different dosage.
3    REPLACEFIX error in orderDescription:Current order was issued with incorrect data and a new order has/will be created to replace it.
3    UNABLE unable to useDescription:<The patient is not (or is no longer) able to use the medication in a manner prescribed.
Example:CanaTMt swallow.
2  _MedicationOrderReleaseReasonCode medication order release reasonDefinition:A collection of concepts that indicate why the prescription should be released from suspended state.
3    HOLDDONE suspend reason no longer appliesDefinition:The original reason for suspending the medication has ended.
3    HOLDINAP suspend reason inappropriateDefinition:
2  _ModifyPrescriptionReasonType ModifyPrescriptionReasonTypeTypes of reason why a prescription is being changed.
3    ADMINERROR administrative error in orderOrder was created with incorrect data and is changed to reflect the intended accuracy of the order.
3    CLINMOD clinical modificationOrder is changed based on a clinical reason.
2  _PharmacySupplyEventAbortReason PharmacySupplyEventAbortReasonDefinition:Identifies why the dispense event was not completed.
3    CONTRA contraindicationDefinition:Contraindication identified
3    FOABORT order abortedDefinition:Order to be fulfilled was aborted
3    FOSUSP order suspendedDefinition:Order to be fulfilled was suspended
3    NOPICK not picked upDefinition:Patient did not come to get medication
3    PATDEC patient changed mindDefinition:Patient changed their mind regarding obtaining medication
3    QUANTCHG change supply quantityDefinition:Patient requested a revised quantity of medication
2  _PharmacySupplyEventStockReasonCode pharmacy supply event stock reasonDefinition:A collection of concepts that indicates the reason for a "bulk supply" of medication.
3    FLRSTCK floor stockDefinition:The bulk supply is issued to replenish a ward for local dispensing. (Includes both mobile and fixed-location ward stocks.)
3    LTC long term care useDefinition:The bulk supply will be administered within a long term care facility.
3    OFFICE office useDefinition:The bulk supply is intended for general clinician office use.
3    PHARM pharmacy transferDefinition:The bulk supply is being transferred to another dispensing facility to.
Example:Alleviate a temporary shortage.
3    PROG program useDefinition:The bulk supply is intended for dispensing according to a specific program.
Example:Mass immunization.
2  _PharmacySupplyRequestRenewalRefusalReasonCode pharmacy supply request renewal refusal reasonDefinition:A collection of concepts that identifies why a renewal prescription has been refused.
3    ALREADYRX new prescription existsDefinition:Patient has already been given a new (renewal) prescription.
3    FAMPHYS family physician must authorize further fillsDefinition:Request for further authorization must be done through patient's family physician.
3    MODIFY modified prescription existsDefinition:Therapy has been changed and new prescription issued
3    NEEDAPMT patient must make appointmentDefinition:Patient must see prescriber prior to further fills.
3    NOTAVAIL prescriber not availableDefinition:Original prescriber is no longer available to prescribe and no other prescriber has taken responsibility for the patient.
3    NOTPAT patient no longer in this practiceDefinition:Patient no longer or has never been under this prescribers care.
3    ONHOLD medication on holdDefinition:This medication is on hold.
3    PRNA product not availableDescription:This product is not available or manufactured.
3    STOPMED prescriber stopped medication for patientRenewing or original prescriber informed patient to stop using the medication.
3    TOOEARLY too earlyDefinition:The patient should have medication remaining.
2  _SupplyOrderAbortReasonCode supply order abort reasonDefinition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
3    IMPROV condition improvedDefinition:The patient's medical condition has nearly abated.
3    INTOL intoleranceDescription:The patient has an intolerance to the medication.
3    NEWSTR new strengthDefinition:The current medication will be replaced by a new strength of the same medication.
3    NEWTHER new therapyDefinition:A new therapy will be commenced when current supply exhausted.
1_GenericUpdateReasonCode GenericUpdateReasonCodeDescription:Identifies why a change is being made to a record.
2  CHGDATA information changeDescription:Information has changed since the record was created.
2  FIXDATA error correctionDescription:Previously recorded information was erroneous and is being corrected.
2  MDATA merge dataInformation is combined into the record.
2  NEWDATA new informationDescription:New information has become available to supplement the record.
2  UMDATA unmerge dataInformation is separated from the record.
1_PatientProfileQueryReasonCode patient profile query reasonDefinition:A collection of concepts identifying why the patient's profile is being queried.
2  ADMREV administrative reviewDefinition: To evaluate for service authorization, payment, reporting, or performance/outcome measures.
2  PATCAR patient careDefinition:To obtain records as part of patient care.
2  PATREQ patient request queryDefinition:Patient requests information from their profile.
2  PRCREV practice reviewDefinition:To evaluate the provider's current practice for professional-improvement reasons.
2  REGUL regulatory reviewDescription:Review for the purpose of regulatory compliance.
2  RSRCH researchDefinition:To provide research data, as authorized by the patient.
2  VALIDATION validation reviewDescription:To validate the patient's record.
Example:Merging or unmerging records.
1_PharmacySupplyRequestFulfillerRevisionRefusalReasonCode PharmacySupplyRequestFulfillerRevisionRefusalReasonCodeDefinition:Indicates why the request to transfer a prescription from one dispensing facility to another has been refused.
2  LOCKED lockedDefinition:The prescription may not be reassigned from the original pharmacy.
2  UNKWNTARGET unknown targetDefinition:The target facility does not recognize the dispensing facility.
1_RefusalReasonCode RefusalReasonCodeDescription: Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.
1_SchedulingActReason SchedulingActReasonReasons for cancelling or rescheduling an Appointment
2  BLK Unexpected Block (of Schedule)The time slots previously allocated are now blocked and no longer available for booking Appointments
2  DEC Patient DeceasedThe Patient is deceased
2  FIN No Financial BackingPatient unable to pay and not covered by insurance
2  MED Medical Status AlteredThe medical condition of the Patient has changed
2  MTG In an outside meetingThe Physician is in a meeting. For example, he/she may request administrative time to talk to family after appointment
2  PHY Physician requestThe Physician requested the action
1_StatusRevisionRefusalReasonCode StatusRevisionRefusalReasonCodeIndicates why the act revision (status update) is being refused.
2  FILLED fully filledOrdered quantity has already been completely fulfilled.
1_SubstanceAdministrationPermissionRefusalReasonCode SubstanceAdministrationPermissionRefusalReasonCodeDefinition:Indicates why the requested authorization to prescribe or dispense a medication has been refused.
2  PATINELIG patient not eligibleDefinition:Patient not eligible for drug
2  PROTUNMET protocol not metDefinition:Patient does not meet required protocol
2  PROVUNAUTH provider not authorizedDefinition:Provider is not authorized to prescribe or dispense
1_SubstanceAdminSubstitutionNotAllowedReason SubstanceAdminSubstitutionNotAllowedReasonReasons why substitution of a substance administration request is not permitted.
2  ALGINT allergy intoleranceDefinition: Patient has had a prior allergic intolerance response to alternate product or one of its components.
2  COMPCON compliance concernDefinition: Patient has compliance issues with medication such as differing appearance, flavor, size, shape or consistency.
2  THERCHAR therapeutic characteristicsThe prescribed product has specific clinical release or other therapeutic characteristics not shared by other substitutable medications.
2  TRIAL clinical trial drugDefinition: The specific manufactured drug is part of a clinical trial.
1_SubstanceAdminSubstitutionReason SubstanceAdminSubstitutionReasonSubstanceAdminSubstitutionReason
2  CT continuing therapyIndicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.
2  FP formulary policyIndicates that the decision to substitute or to not substitute was driven by a policy expressed within the formulary.
2  OS out of stockIn the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.
2  RR regulatory requirementIndicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
1_TransferActReason TransferActReasonThe explanation for why a patient is moved from one location to another within the organization
2  ER ErrorMoved to an error in placing the patient in the original location.
2  RQ RequestMoved at the request of the patient.
1_ActBillableServiceReason ActBillableServiceReasonDefinition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
2  _ActBillableClinicalServiceReason ActBillableClinicalServiceReasonReason for Clinical Service being performed.
This domain excludes reasons specified by diagnosed conditions.
Examples of values from this domain include duplicate therapy and fraudulent prescription.
1BONUS
1CHD Children onlyDescription:The level of coverage under the policy or program is available only to children
1DEP Dependents onlyDescription:The level of coverage under the policy or program is available only to a subscriber's dependents.
1ECH Employee and childrenDescription:The level of coverage under the policy or program is available to an employee and his or her children.
1EDU
1EMP Employee onlyDescription:The level of coverage under the policy or program is available only to an employee.
1ESP Employee and spouseDescription:The level of coverage under the policy or program is available to an employee and his or her spouse.
1FAM FamilyDescription:The level of coverage under the policy or program is available to a subscriber's family.
1IND IndividualDescription:The level of coverage under the policy or program is available to an individual.
1INVOICE
1PROA
1RECOV
1RETRO
1SPC Spouse and childrenDescription:The level of coverage under the policy or program is available to a subscriber's spouse and children
1SPO Spouse onlyDescription:The level of coverage under the policy or program is available only to a subscribers spouse
1TRAN