• Include these codes as defined in http://hl7.org/fhir/v3/ObservationValue version 📍2016-11-11

  Code	Display	Definition
  A0	no reaction	Description:Patient exhibits no reaction to the challenge agent.
  A1	minimal reaction	Description:Patient exhibits a minimal reaction to the challenge agent.
  A2	mild reaction	Description:Patient exhibits a mild reaction to the challenge agent.
  A3	moderate reaction	Description:Patient exhibits moderate reaction to the challenge agent.
  A4	severe reaction	Description:Patient exhibits a severe reaction to the challenge agent.
  ABSTRED	abstracted	Security metadata observation values used to indicate the use of a more abstract version of the content, e.g., replacing exact value of an age or date field with a range, or remove the left digits of a credit card number or SSN.
  ABUSE	abuse victim	Indication of abuse victim.
  ACT	active coverage	Definition: Coverage is in effect for healthcare service(s) and/or product(s).
  ACTPEND	active - pending investigation	Definition: Coverage is in effect for healthcare service(s) and/or product(s) - Pending Investigation
  ADC	adult child	Description:Child over an age as specified by coverage policy or program, e.g., student, differently abled, and income dependent.
  ADOPT	adoption document	Indicator of adoption.
  AGGRED	aggregated	Security metadata observation values used to indicate the use of an algorithmic combination of actual values with the result of an aggregate function, e.g., average, sum, or count in order to limit disclosure of an IT resource (data, information object, service, or system capability) to the minimum necessary.
  ALLORNONESCR	All-or-nothing Scoring	Code specifying that the measure uses all-or-nothing scoring. All-or-nothing scoring places an individual in the numerator of the composite measure if and only if they are in the numerator of all component measures in which they are in the denominator.
  ALONE	alone	Living alone. Maps to PD1-2 Living arrangement (IS) 00742 [A]
  ANNUITY	annuity	Indicator of annuity ownership or status as beneficiary.
  ANONYED	anonymized	Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability) by used to indicate the mechanism by which software systems can strip portions of the resource that could allow the identification of the source of the information or the information subject. No key to relink the data is retained.
  ASSET	asset	Codes specifying asset indicators used to assess or establish eligibility for coverage under a policy or program.
  BTHCERT	birth certificate	Indicator of birth.
  CCOC	creditable coverage document	Indicator of creditable coverage.
  CHD	child	Description:Dependent biological, adopted, foster child as specified by coverage policy or program.
  CHILD	child support	Indicator of child support payments received or provided.
  CLINAST	clinician asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a clinician.
  CLINRPT	clinician reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a clinician.
  CLOTH	clothing expense	Indicator of clothing expenses.
  COHORT	cohort measure scoring	A measure in which either short-term cross-section or long-term longitudinal analysis is performed over a group of subjects defined by a set of common properties or defining characteristics (e.g., Male smokers between the ages of 40 and 50 years, exposure to treatment, exposure duration).
  COMPOSITE	composite measure type	A measure that is composed from one or more other measures and indicates an overall summary of those measures.
  CONTVAR	continuous variable measure scoring	A measure score in which each individual value for the measure can fall anywhere along a continuous scale (e.g., mean time to thrombolytics which aggregates the time in minutes from a case presenting with chest pain to the time of administration of thrombolytics).
  CRITH	high criticality	Worst case result of a future exposure is assessed to be life-threatening or having high potential for organ system failure.
  CRITL	low criticality	Worst case result of a future exposure is not assessed to be life-threatening or having high potential for organ system failure.
  CRITU	unable to assess criticality	Unable to assess the worst case result of a future exposure.
  CRYTOHASH	cryptographic hash function	Security metadata observation value used to indicate the mechanism by which software systems can establish that data was not modified in transit. Rationale: This definition is intended to align with the ISO 22600-2 3.3.19 definition of cryptographic checkvalue: Information which is derived by performing a cryptographic transformation (see cryptography) on the data unit. The derivation of the checkvalue may be performed in one or more steps and is a result of a mathematical function of the key and a data unit. It is usually used to check the integrity of a data unit. Examples: SHA-1 SHA-2 (Secure Hash Algorithm)
  DENEX	denominator exclusions	Patients who should be removed from the eMeasure population and denominator before determining if numerator criteria are met. Denominator exclusions are used in proportion and ratio measures to help narrow the denominator.
  DENEXCEP	denominator exceptions	Denominator exceptions are those conditions that should remove a patient, procedure or unit of measurement from the denominator only if the numerator criteria are not met. Denominator exceptions allow for adjustment of the calculated score for those providers with higher risk populations. Denominator exceptions are used only in proportion eMeasures. They are not appropriate for ratio or continuous variable eMeasures. Denominator exceptions allow for the exercise of clinical judgment and should be specifically defined where capturing the information in a structured manner fits the clinical workflow. Generic denominator exception reasons used in proportion eMeasures fall into three general categories: Medical reasons Patient reasons System reasons
  DENOM	denominator	It can be the same as the initial patient population or a subset of the initial patient population to further constrain the population for the purpose of the eMeasure. Different measures within an eMeasure set may have different Denominators. Continuous Variable eMeasures do not have a Denominator, but instead define a Measure Population.
  DEP	dependent	Description:Person requiring functional and/or financial assistance from another person as specified by coverage policy or program.
  DEPCHD	dependent children	Living with one or more dependent children requiring moderate supervision.
  DEPSPS	dependent spouse	Living with disabled spouse requiring functional and health care assistance
  DEPYGCHD	dependent young children	Living with one or more dependent children requiring intensive supervision
  DEVAST	device asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a device.
  DEVRPT	device reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a device.
  DIGSIG	digital signature	Security metadata observation value used to indicate the mechanism by which software systems use digital signature to establish that data has not been modified. Rationale: This definition is intended to align with the ISO 22600-2 3.3.26 definition of digital signature: Data appended to, or a cryptographic transformation (see cryptography) of, a data unit that allows a recipient of the data unit to prove the source and integrity of the data unit and protect against forgery e.g., by the recipient.
  DISABL	disability pay	Indicator of disability income replacement payment.
  DISABLE	disabled	Indication of disability.
  DP	domestic partner	Description:Persons registered as a family unit in a domestic partner registry as specified by law and by coverage policy or program.
  DRLIC	driver license	Indicator of driving status.
  DRUG	drug use	Indication of drug use.
  ECH	employee	Description:An individual employed by an employer who receive remuneration in wages, salary, commission, tips, piece-rates, or pay-in-kind through the employeraTMs payment system (i.e., not a contractor) as specified by coverage policy or program.
  EFFICIENCY	efficiency measure type	A measure related to the efficiency of medical treatment.
  ELG	eligible	Definition: Coverage is in effect for healthcare service(s) and/or product(s).
  ELSTAT	eligibility indicator	Code specifying eligibility indicators used to assess or establish eligibility for coverage under a policy or program eligibility status, e.g., certificates of creditable coverage; student enrollment; adoption, marriage or birth certificate.
  EXPERIENCE	experience measure type	A measure related to the level of patient engagement or patient experience of care.
  FAM	live with family	Living with family. Maps to PD1-2 Living arrangement (IS) 00742 [F]
  FLY	family coverage	Description:As specified by coverage policy or program.
  FOOD	food expense	Indicator of transportation expenses.
  FOSTER	foster child document	Indicator of foster child status.
  G	Great extent	Value for Act.partialCompletionCode attribute that implies 81-99% completion
  H	High	Indicates the condition may be life-threatening or has the potential to cause permanent injury.
  HCPAST	healthcare professional asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a healthcare professional.
  HCPRPT	healthcare professional reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a healthcare professional.
  HEALTH	health expense	Indicator of health expenses; including medication costs, health service costs, financial participations, and health coverage premiums.
  HLSTAT	health status	Code specifying non-clinical indicators related to health status used to assess or establish eligibility for coverage under a policy or program, e.g., pregnancy, disability, drug use, mental health issues.
  HMLESS	homeless	Indication of status as homeless.
  HOUSE	household expense	Indicator of housing expense, e.g., household appliances, fixtures, furnishings, and maintenance and repairs.
  HRELIABLE	highly reliable	Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be very high.
  Homozygote	HOMO	Description: An individual having different alleles at one or more loci regarding a specific character
  ILGIM	illegal immigrant	Indication of status as illegal immigrant.
  INACT	inactive	Definition: Coverage is not in effect for healthcare service(s) and/or product(s).
  INCAR	incarcerated	Indication of status as incarcerated.
  INCOME	income	Code specifying income indicators used to assess or establish eligibility for coverage under a policy or program; e.g., pay or pension check, child support payments received or provided, and taxes paid.
  IND	individual	Description:Person as specified by coverage policy or program.
  INPNDINV	inactive - pending investigation	Definition: Coverage is not in effect for healthcare service(s) and/or product(s) - Pending Investigation.
  INPNDUPD	inactive - pending eligibility update	Definition: Coverage is not in effect for healthcare service(s) and/or product(s) - Pending Eligibility Update.
  INVEST	investment income	Indicator of investment income, e.g., dividend check, annuity payment; real estate rent, investment divestiture proceeds; trust or endowment check.
  IP	initial population	The initial population refers to all entities to be evaluated by a specific quality measure who share a common set of specified characteristics within a specific measurement set to which a given measure belongs.
  IPP	initial patient population	The initial patient population refers to all patients to be evaluated by a specific quality measure who share a common set of specified characteristics within a specific measurement set to which a given measure belongs. Details often include information based upon specific age groups, diagnoses, diagnostic and procedure codes, and enrollment periods.
  IVDRG	IV drug use	Indication of IV drug use .
  L	Low	Indicates the condition may result in some adverse consequences but is unlikely to substantially affect the situation of the subject.
  LE	Large extent	Value for Act.partialCompletionCode attribute that implies 61-80% completion
  LEGAL	legal expense	Indicator of legal expenses.
  LINEARSCR	Linear Scoring	Code specifying that the measure uses linear scoring. Linear scoring computes the fraction of component measures in which the individual appears in the numerator, giving equal weight to each component measure.
  LIVDEP	living dependency	Code specifying observations related to living dependency, such as dependent upon spouse for activities of daily living.
  LIVEXP	living expense	Codes specifying living expense indicators used to assess or establish eligibility for coverage under a policy or program.
  LIVSIT	living situation	Code specifying observations related to living situation for a person in a private residence.
  LLD	left lateral decubitus	Lying on the left side.
  LOAAN	authentication level of assurance value	The value assigned as the indicator of the digital quality or reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. [Based on ISO 7498-2] For example, the degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies]
  LOAAN1	low authentication level of assurance	Indicator of low digital quality or reliability of the digital reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. [Based on ISO 7498-2] The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies] Low authentication level of assurance indicates that the relying party may have little or no confidence in the asserted identity's validity. Level 1 requires little or no confidence in the asserted identity. No identity proofing is required at this level, but the authentication mechanism should provide some assurance that the same claimant is accessing the protected transaction or data. A wide range of available authentication technologies can be employed and any of the token methods of Levels 2, 3, or 4, including Personal Identification Numbers (PINs), may be used. To be authenticated, the claimant must prove control of the token through a secure authentication protocol. At Level 1, long-term shared authentication secrets may be revealed to verifiers. Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAN2	basic authentication level of assurance	Indicator of basic digital quality or reliability of the digital reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. [Based on ISO 7498-2] The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies] Basic authentication level of assurance indicates that the relying party may have some confidence in the asserted identity's validity. Level 2 requires confidence that the asserted identity is accurate. Level 2 provides for single-factor remote network authentication, including identity-proofing requirements for presentation of identifying materials or information. A wide range of available authentication technologies can be employed, including any of the token methods of Levels 3 or 4, as well as passwords. Successful authentication requires that the claimant prove through a secure authentication protocol that the claimant controls the token. Eavesdropper, replay, and online guessing attacks are prevented. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Approved cryptographic techniques are required. Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAN3	medium authentication level of assurance	Indicator of medium digital quality or reliability of the digital reliability of verification and validation of the process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. [Based on ISO 7498-2] The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies] Medium authentication level of assurance indicates that the relying party may have high confidence in the asserted identity's validity. Level 3 is appropriate for transactions that need high confidence in the accuracy of the asserted identity. Level 3 provides multifactor remote network authentication. At this level, identity-proofing procedures require verification of identifying materials and information. Authentication is based on proof of possession of a key or password through a cryptographic protocol. Cryptographic strength mechanisms should protect the primary authentication token (a cryptographic key) against compromise by the protocol threats, including eavesdropper, replay, online guessing, verifier impersonation, and man-in-the-middle attacks. A minimum of two authentication factors is required. Three kinds of tokens may be used: "soft" cryptographic token, which has the key stored on a general-purpose computer, "hard" cryptographic token, which has the key stored on a special hardware device, and "one-time password" device token, which has symmetric key stored on a personal hardware device that is a cryptographic module validated at FIPS 140-2 Level 1 or higher. Validation testing of cryptographic modules and algorithms for conformance to Federal Information Processing Standard (FIPS) 140-2, Security Requirements for Cryptographic Modules, is managed by NIST. Authentication requires that the claimant prove control of the token through a secure authentication protocol. The token must be unlocked with a password or biometric representation, or a password must be used in a secure authentication protocol, to establish two-factor authentication. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Approved cryptographic techniques are used for all operations. Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAN4	high authentication level of assurance	Indicator of high digital quality or reliability of the digital reliability of the verification and validation process used to verify the claimed identity of an entity by securely associating an identifier and its authenticator. [Based on ISO 7498-2] The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies] High authentication level of assurance indicates that the relying party may have very high confidence in the asserted identity's validity. Level 4 is for transactions that need very high confidence in the accuracy of the asserted identity. Level 4 provides the highest practical assurance of remote network authentication. Authentication is based on proof of possession of a key through a cryptographic protocol. This level is similar to Level 3 except that only “hard� cryptographic tokens are allowed, cryptographic module validation requirements are strengthened, and subsequent critical data transfers must be authenticated via a key that is bound to the authentication process. The token should be a hardware cryptographic module validated at FIPS 140-2 Level 2 or higher overall with at least FIPS 140-2 Level 3 physical security. This level requires a physical token, which cannot readily be copied, and operator authentication at Level 2 and higher, and ensures good, two-factor remote authentication. Level 4 requires strong cryptographic authentication of all parties and all sensitive data transfers between the parties. Either public key or symmetric key technology may be used. Authentication requires that the claimant prove through a secure authentication protocol that the claimant controls the token. Eavesdropper, replay, online guessing, verifier impersonation, and man-in-the-middle attacks are prevented. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Strong approved cryptographic techniques are used for all operations. All sensitive data transfers are cryptographically authenticated using keys bound to the authentication process. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAP	authentication process level of assurance value	The value assigned as the indicator of the digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. [Based on NIST SP 800-63-2]
  LOAAP1	low authentication process level of assurance	Indicator of the low digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. [Based on NIST SP 800-63-2] Low authentication process level of assurance indicates that (1) long-term shared authentication secrets may be revealed to verifiers; and (2) assertions and assertion references require protection from manufacture/modification and reuse attacks. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAP2	basic authentication process level of assurance	Indicator of the basic digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. [Based on NIST SP 800-63-2] Basic authentication process level of assurance indicates that long-term shared authentication secrets are never revealed to any other party except Credential Service Provider (CSP). Sessions (temporary) shared secrets may be provided to independent verifiers by CSP. Long-term shared authentication secrets, if used, are never revealed to any other party except Verifiers operated by the Credential Service Provider (CSP); however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. In addition to Level 1 requirements, assertions are resistant to disclosure, redirection, capture and substitution attacks. Approved cryptographic techniques are required. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAP3	medium authentication process level of assurance	Indicator of the medium digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. [Based on NIST SP 800-63-2] Medium authentication process level of assurance indicates that the token can be unlocked with password, biometric, or uses a secure multi-token authentication protocol to establish two-factor authentication. Long-term shared authentication secrets are never revealed to any party except the Claimant and Credential Service Provider (CSP). Authentication requires that the Claimant prove, through a secure authentication protocol, that he or she controls the token. The Claimant unlocks the token with a password or biometric, or uses a secure multi-token authentication protocol to establish two-factor authentication (through proof of possession of a physical or software token in combination with some memorized secret knowledge). Long-term shared authentication secrets, if used, are never revealed to any party except the Claimant and Verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. In addition to Level 2 requirements, assertions are protected against repudiation by the Verifier.
  LOAAP4	high authentication process level of assurance	Indicator of the high digital quality or reliability of a defined sequence of messages between a Claimant and a Verifier that demonstrates that the Claimant has possession and control of a valid token to establish his/her identity, and optionally, demonstrates to the Claimant that he or she is communicating with the intended Verifier. [Based on NIST SP 800-63-2] High authentication process level of assurance indicates all sensitive data transfer are cryptographically authenticated using keys bound to the authentication process. Level 4 requires strong cryptographic authentication of all communicating parties and all sensitive data transfers between the parties. Either public key or symmetric key technology may be used. Authentication requires that the Claimant prove through a secure authentication protocol that he or she controls the token. All protocol threats at Level 3 are required to be prevented at Level 4. Protocols shall also be strongly resistant to man-in-the-middle attacks. Long-term shared authentication secrets, if used, are never revealed to any party except the Claimant and Verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. Approved cryptographic techniques are used for all operations. All sensitive data transfers are cryptographically authenticated using keys bound to the authentication process. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAS	assertion level of assurance value	The value assigned as the indicator of the high quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes.
  LOAAS1	low assertion level of assurance	Indicator of the low quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes. Assertions and assertion references require protection from modification and reuse attacks. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAS2	basic assertion level of assurance	Indicator of the basic quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes. Assertions are resistant to disclosure, redirection, capture and substitution attacks. Approved cryptographic techniques are required for all assertion protocols. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAS3	medium assertion level of assurance	Indicator of the medium quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes. Assertions are protected against repudiation by the verifier. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOAAS4	high assertion level of assurance	Indicator of the high quality or reliability of the statement from a Verifier to a Relying Party (RP) that contains identity information about a Subscriber. Assertions may also contain verified attributes. Strongly resistant to man-in-the-middle attacks. "Bearer" assertions are not used. "Holder-of-key" assertions may be used. RP maintains records of the assertions. [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]
  LOACM	token and credential management level of assurance value)	Indicator of the digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and its binding to an identity. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOACM1	low token and credential management level of assurance	Indicator of the low digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and its binding to an identity. Little or no confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include weak identity binding to tokens and plaintext passwords or secrets not transmitted across a network. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOACM2	basic token and credential management level of assurance	Indicator of the basic digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and its binding to an identity. Some confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include: Verification must prove claimant controls the token; token resists online guessing, replay, session hijacking, and eavesdropping attacks; and token is at least weakly resistant to man-in-the middle attacks. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOACM3	medium token and credential management level of assurance	Indicator of the medium digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and it’s binding to an identity. High confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include: Ownership of token verifiable through security authentication protocol and credential management protects against verifier impersonation attacks. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOACM4	high token and credential management level of assurance	Indicator of the high digital quality or reliability of the activities performed by the Credential Service Provider (CSP) subsequent to electronic authentication registration, identity proofing and issuance activities to manage and safeguard the integrity of an issued credential and it’s binding to an identity. Very high confidence that an individual has maintained control over a token that has been entrusted to him or her and that that token has not been compromised. Characteristics include: Verifier can prove control of token through a secure protocol; credential management supports strong cryptographic authentication of all communication parties. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOAID	identity proofing level of assurance	Indicator of the quality or reliability in the process of ascertaining that an individual is who he or she claims to be.
  LOAID1	low identity proofing level of assurance	Indicator of low digital quality or reliability in the process of ascertaining that an individual is who he or she claims to be. Requires that a continuity of identity be maintained but does not require identity proofing. [Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOAID2	basic identity proofing level of assurance	Indicator of some digital quality or reliability in the process of ascertaining that that an individual is who he or she claims to be. Requires identity proofing via presentation of identifying material or information. [Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOAID3	medium identity proofing level of assurance	Indicator of high digital quality or reliability in the process of ascertaining that an individual is who he or she claims to be. Requires identity proofing procedures for verification of identifying materials and information. [Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOAID4	high identity proofing level of assurance	Indicator of high digital quality or reliability in the process of ascertaining that an individual is who he or she claims to be. Requires identity proofing procedures for verification of identifying materials and information. [Based on Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOANR	non-repudiation level of assurance value	Indicator of the digital quality or reliability in the process of establishing proof of delivery and proof of origin. [Based on ISO 7498-2]
  LOANR1	low non-repudiation level of assurance	Indicator of low digital quality or reliability in the process of establishing proof of delivery and proof of origin. [Based on ISO 7498-2]
  LOANR2	basic non-repudiation level of assurance	Indicator of basic digital quality or reliability in the process of establishing proof of delivery and proof of origin. [Based on ISO 7498-2]
  LOANR3	medium non-repudiation level of assurance	Indicator of medium digital quality or reliability in the process of establishing proof of delivery and proof of origin. [Based on ISO 7498-2]
  LOANR4	high non-repudiation level of assurance	Indicator of high digital quality or reliability in the process of establishing proof of delivery and proof of origin. [Based on ISO 7498-2]
  LOARA	remote access level of assurance value	Indicator of the digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization’s security controls. [Based on NIST SP 800-63-2]
  LOARA1	low remote access level of assurance	Indicator of low digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization’s security controls. [Based on NIST SP 800-63-2]
  LOARA2	basic remote access level of assurance	Indicator of basic digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization’s security controls. [Based on NIST SP 800-63-2]
  LOARA3	medium remote access level of assurance	Indicator of medium digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization’s security controls. [Based on NIST SP 800-63-2]
  LOARA4	high remote access level of assurance	Indicator of high digital quality or reliability of the information exchange between network-connected devices where the information cannot be reliably protected end-to-end by a single organization's security controls. [Based on NIST SP 800-63-2]
  LOATK	token level of assurance value	Indicator of the digital quality or reliability of single and multi-token authentication. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOATK1	low token level of assurance	Indicator of the low digital quality or reliability of single and multi-token authentication. Permits the use of any of the token methods of Levels 2, 3, or 4. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOATK2	basic token level of assurance	Indicator of the basic digital quality or reliability of single and multi-token authentication. Requires single factor authentication using memorized secret tokens, pre-registered knowledge tokens, look-up secret tokens, out of band tokens, or single factor one-time password devices. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOATK3	medium token level of assurance	Indicator of the medium digital quality or reliability of single and multi-token authentication. Requires two authentication factors. Provides multi-factor remote network authentication. Permits multi-factor software cryptographic token. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  LOATK4	high token level of assurance	Indicator of the high digital quality or reliability of single and multi-token authentication. Requires token that is a hardware cryptographic module validated at validated at Federal Information Processing Standard (FIPS) 140-2 Level 2 or higher overall with at least FIPS 140-2 Level 3 physical security. Level 4 token requirements can be met by using the PIV authentication key of a FIPS 201 compliant Personal Identity Verification (PIV) Card. [Electronic Authentication Guideline - Recommendations of the National Institute of Standards and Technology, NIST Special Publication 800-63-1, Dec 2011]
  M	Moderate	Indicates the condition may result in noticable adverse adverse consequences but is unlikely to be life-threatening or cause permanent injury.
  MAPPED	mapped	Security metadata observation value used to indicate that the IT resource semantic content has been transformed from one encoding to another. Usage Note: "MAP" code does not indicate the semantic fidelity of the transformed content. To indicate semantic fidelity for maps of HL7 to other code systems, this security alteration integrity observation may be further specified using an Act valued with Value Set: MapRelationship (2.16.840.1.113883.1.11.11052). Semantic fidelity of the mapped IT Resource may also be indicated using a SecurityIntegrityConfidenceObservation.
  MASKED	masked	Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability) by indicating the mechanism by which software systems can make data unintelligible (that is, as unreadable and unusable by algorithmically transforming plaintext into ciphertext) such that it can only be accessed or used by authorized users. An authorized user may be provided a key to decrypt per license or "shared secret". Usage Note: "MASKED" may be used, per applicable policy, as a flag to indicate to a user or receiver that some portion of an IT resource has been further encrypted, and may be accessed only by an authorized user or receiver to which a decryption key is provided.
  ME	Medium extent	Value for Act.partialCompletionCode attribute that implies 41-60% completion
  MEMBER	program or policy member	Indicator of status as covered member under a policy or program, e.g., member id card or coverage document.
  MI	Minimal extent	Value for Act.partialCompletionCode attribute that implies 1-20% completion
  MIL	military identification	Indicator of military status.
  MORTG	mortgage	Indicator of mortgage amount, interest, and payments.
  MRGCERT	marriage certificate	Indicator of marriage status.
  MSRPOPL	measure population	Measure population is used only in continuous variable eMeasures. It is a narrative description of the eMeasure population. (e.g., all patients seen in the Emergency Department during the measurement period).
  N	None	Value for Act.partialCompletionCode attribute that implies 0% completion
  NELG	not eligible	Definition: Coverage is not in effect for healthcare service(s) and/or product(s). May optionally include reasons for the ineligibility.
  NUMER	numerator	Numerators are used in proportion and ratio eMeasures. In proportion measures the numerator criteria are the processes or outcomes expected for each patient, procedure, or other unit of measurement defined in the denominator. In ratio measures the numerator is related, but not directly derived from the denominator (e.g., a numerator listing the number of central line blood stream infections and a denominator indicating the days per thousand of central line usage in a specific time period).
  NUMEX	numerator exclusions	Numerator Exclusions are used only in ratio eMeasures to define instances that should not be included in the numerator data. (e.g., if the number of central line blood stream infections per 1000 catheter days were to exclude infections with a specific bacterium, that bacterium would be listed as a numerator exclusion.)
  OPPORSCR	Opportunity Scoring	Code specifying that the measure uses opportunity-based scoring. In opportunity-based scoring the measure score is determined by combining the denominator and numerator of each component measure to determine an overall composite score.
  OUTCOME	outcome measure type	A measure that indicates the result of the performance (or non-performance) of a function or process.
  PACQAST	patient acquaintance asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a patient acquaintance.
  PACQRPT	patient acquaintance reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a patient acquaintance.
  PASSPORT	passport	Indicator of citizenship.
  PATAST	patient asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a patient.
  PATRPT	patient reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a patient.
  PAY	paid employment	Indicator of paid employment, e.g., letter of hire, contract, employer letter; copy of pay check or pay stub.
  PAYAST	payer asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a payer.
  PAYRPT	payer reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a payer.
  PGNT	pregnant	Non-clinical report of pregnancy.
  PRN	prone	Lying with the front or ventral surface downward; lying face down.
  PROAST	professional asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a professional.
  PROB	probation	Indication of probation status.
  PROCESS	process measure type	A measure which focuses on a process which leads to a certain outcome, meaning that a scientific basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome.
  PROP	real property	Indicator of real property ownership, e.g., deed or real estate contract.
  PROPOR	proportion measure scoring	A score derived by dividing the number of cases that meet a criterion for quality (the numerator) by the number of eligible cases within a given time frame (the denominator) where the numerator cases are a subset of the denominator cases (e.g., percentage of eligible women with a mammogram performed in the last year).
  PRORPT	professional reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a professional.
  PSEUDED	pseudonymized	Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability), by indicating the mechanism by which software systems can strip portions of the resource that could allow the identification of the source of the information or the information subject. Custodian may retain a key to relink data necessary to reidentify the information subject. Rationale: Personal data which has been processed to make it impossible to know whose data it is. Used particularly for secondary use of health data. In some cases, it may be possible for authorized individuals to restore the identity of the individual, e.g.,for public health case management. Based on ISO/TS 25237:2008 Health informatics—Pseudonymization
  RATIO	ratio measure scoring	A score that may have a value of zero or greater that is derived by dividing a count of one type of data by a count of another type of data (e.g., the number of patients with central lines who develop infection divided by the number of central line days).
  REDACTED	redacted	Security metadata observation value used to indicate the mechanism by which software systems can filter an IT resource (data, information object, service, or system capability) to remove any portion of the resource that is not authorized to be access, used, or disclosed. Usage Note: "REDACTED" may be used, per applicable policy, as a flag to indicate to a user or receiver that some portion of an IT resource has filtered and not included in the content accessed or received.
  REFUG	refugee	Indication of refugee status.
  RELAT	relative	Living with one or more relatives. Maps to PD1-2 Living arrangement (IS) 00742 [R]
  RELDEP	relative dependent	Continued living in private residence requires functional and health care assistance from one or more relatives.
  RELIABLE	reliable	Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be adequate.
  RENT	rent	Indicator of rental or lease payments.
  RESOURCE	resource use measure type	A measure related to the extent of use of clinical resources or cost of care.
  RETACCT	retirement investment account	Indicator of retirement investment account ownership.
  RETIRE	retirement pay	Indicator of retirement payment, e.g., pension check.
  RLD	right lateral decubitus	Lying on the right side.
  RTRD	reverse trendelenburg	Lying on the back, on an inclined plane, typically about 30-45 degrees with head raised and feet lowered.
  S	Some extent	Value for Act.partialCompletionCode attribute that implies 21-40% completion
  SDMAST	substitute decision maker asserted	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was asserted by a substitute decision maker.
  SDMRPT	substitute decision maker reported	Security provenance metadata observation value used to indicate that an IT resource (data, information object, service, or system capability) was reported by a substitute decision maker.
  SECTRSTOBV	security trust observation	Observation value used to indicate aspects of trust applicable to an IT resource (data, information object, service, or system capability).
  SFWL	Semi-Fowler's	A semi-sitting position in bed with the head of the bed elevated approximately 45 degrees.
  SIT	sitting	Resting the body on the buttocks, typically with upper torso erect or semi erect.
  SOECSTAT	socio economic status	Code specifying observations or indicators related to socio-economic status used to assess to assess for services, e.g., discharge planning, or to establish eligibility for coverage under a policy or program.
  SPOUSAL	spousal or partner support	Indicator of spousal or partner support payments received or provided; e.g., alimony payment; support stipulations in a divorce settlement.
  SPS	spouse only	Living only with spouse or life partner. Maps to PD1-2 Living arrangement (IS) 00742 [S]
  SPSDEP	spouse dependent	Continued living in private residence requires functional and health care assistance from spouse or life partner.
  SSP	same sex partner	Description:A pair of people of the same gender who live together as a family as specified by coverage policy or program, e.g., Naomi and Ruth from the Book of Ruth; Socrates and Alcibiades
  STN	standing	To be stationary, upright, vertical, on one's legs.
  STRUCTURE	structure measure type	A measure related to the structure of patient care.
  STUDENRL	student enrollment	Indicator of student status.
  SUBSETTED	subsetted	Metadata observation used to indicate that some information has been removed from the source object when the view this object contains was constructed because of configuration options when the view was created. The content may not be suitable for use as the basis of a record update Usage Note: This is not suitable to be used when information is removed for security reasons - see the code REDACTED for this use.
  SUNDRY	sundry expense	Indicator of transportation expenses.
  SUP	supine	supine
  SUPPLE	income supplement	Indicator of income supplement, e.g., gifting, parental income support; stipend, or grant.
  SYNTAC	syntactic transform	Security metadata observation value used to indicate that the IT resource syntax has been transformed from one syntactical representation to another. Usage Note: "SYNTAC" code does not indicate the syntactical correctness of the syntactically transformed IT resource.
  TAX	tax obligation	Indicator of tax obligation or payment, e.g., statement of taxable income.
  TRANS	transportation expense	Indicator of transportation expenses, e.g., vehicle payments, vehicle insurance, vehicle fuel, and vehicle maintenance and repairs.
  TRD	trendelenburg	Lying on the back, on an inclined plane, typically about 30-45 degrees, with head lowered and feet raised.
  TRSLT	translated	Security metadata observation value used to indicate that the IT resource has been translated from one human language to another. Usage Note: "TRSLT" does not indicate the fidelity of the translation or the languages translated. The fidelity of the IT Resource translation may be indicated using a SecurityIntegrityConfidenceObservation. To indicate languages, use the Value Set:HumanLanguage (2.16.840.1.113883.1.11.11526)
  TRSTACCRDOBV	trust accreditation observation	Values for security trust accreditation metadata observation made about the formal declaration by an authority or neutral third party that validates the technical, security, trust, and business practice conformance of Trust Agents to facilitate security, interoperability, and trust among participants within a security domain or trust framework.
  TRSTAGREOBV	trust agreement observation	Values for security trust agreement metadata observation made about privacy and security requirements with which a security domain must comply. [ISO IEC 10181-1] [ISO IEC 10181-1]
  TRSTCERTOBV	trust certificate observation	Values for security trust certificate metadata observation made about a set of security-relevant data issued by a security authority or trusted third party, together with security information which is used to provide the integrity and data origin authentication services for an IT resource (data, information object, service, or system capability). [Based on ISO IEC 10181-1] For example, a Certificate Policy (CP), which is a named set of rules that indicates the applicability of a certificate to a particular community and/or class of application with common security requirements. A particular Certificate Policy might indicate the applicability of a type of certificate to the authentication of electronic data interchange transactions for the trading of goods within a given price range. Another example is Cross Certification with Federal Bridge.
  TRSTLOAOBV	trust assurance observation	Values for security trust assurance metadata observation made about the digital quality or reliability of a trust assertion, activity, capability, information exchange, mechanism, process, or protocol.
  TRSTMECOBV	none supplied 6	Values for security trust mechanism metadata observation made about a security architecture system component that supports enforcement of security policies.
  TRUST	trust	Indicator of status as trust beneficiary.
  UNCERTREL	uncertain reliability	Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be uncertain.
  UNEMPL	unemployed	Indication of unemployed status.
  UNREL	unrelated person	Living with one or more unrelated persons.
  UNRELIABLE	unreliable	Security metadata observation value used to indicate that the veracity or trustworthiness of an IT resource (data, information object, service, or system capability) for a specified purpose of use is perceived to be or deemed by policy to be inadequate.
  URELDEP	unrelated person dependent	Continued living in private residence requires functional and health care assistance from one or more unrelated persons.
  UTIL	utility expense	Indicator of transportation expenses.
  VERSIONED	versioned	Security metadata observation value conveying the alteration integrity of an IT resource (data, information object, service, or system capability) which indicates that the resource only retains versions of an IT resource for access and use per applicable policy Usage Note: When this code is used, expectation is that the system has removed historical versions of the data that falls outside the time period deemed to be the effective time of the applicable version.
  WEIGHTSCR	Weighted Scoring	Code specifying that the measure uses weighted scoring. Weighted scoring assigns a factor to each component measure to weight that measure's contribution to the overall score.
  _ActCoverageAssessmentObservationValue	ActCoverageAssessmentObservationValue	Codes specify the category of observation, evidence, or document used to assess for services, e.g., discharge planning, or to establish eligibility for coverage under a policy or program. The type of evidence is coded as observation values.
  _ActFinancialStatusObservationValue	ActFinancialStatusObservationValue	Code specifying financial indicators used to assess or establish eligibility for coverage under a policy or program; e.g., pay stub; tax or income document; asset document; living expenses.
  _AllergyTestValue	AllergyTestValue	Indicates the result of a particular allergy test. E.g. Negative, Mild, Moderate, Severe
  _AnnotationValue	AnnotationValue	AnnotationValue
  _CommonClinicalObservationValue	common clinical observation	Description:Used in a patient care message to value simple clinical (non-lab) observations.
  _CompositeMeasureScoring	CompositeMeasureScoring	Observation values that communicate the method used in a quality measure to combine the component measure results included in an composite measure.
  _CoverageLevelObservationValue	CoverageLevelObservationValue	Description:Coded observation values for types of covered parties under a policy or program based on their personal relationships or employment status.
  _CoverageLimitObservationValue	CoverageLimitObservationValue	Description:Coded observation values for coverage limitations, for e.g., types of claims or types of parties covered under a policy or program.
  _CriticalityObservationValue	CriticalityObservationValue	A clinical judgment as to the worst case result of a future exposure (including substance administration). When the worst case result is assessed to have a life-threatening or organ system threatening potential, it is considered to be of high criticality.
  _GeneticObservationValue	GeneticObservationValue	Description: The domain contains genetic analysis specific observation values, e.g. Homozygote, Heterozygote, etc.
  _IndicationValue	IndicationValue	Indicates the specific observation result which is the reason for the action (prescription, lab test, etc.). E.g. Headache, Ear infection, planned diagnostic image (requiring contrast agent), etc.
  _IndividualCaseSafetyReportValueDomains	Individual Case Safety Report Value Domains	This domain is established as a parent to a variety of value domains being defined to support the communication of Individual Case Safety Reports to regulatory bodies. Arguably, this aggregation is not taxonomically pure, but the grouping will facilitate the management of these domains.
  _ObservationMeasureScoring	ObservationMeasureScoring	Observation values used to indicate the type of scoring (e.g. proportion, ratio) used by a health quality measure.
  _ObservationMeasureType	ObservationMeasureType	Observation values used to indicate what kind of health quality measure is used.
  _ObservationPopulationInclusion	ObservationPopulationInclusion	Observation values used to assert various populations that a subject falls into.
  _PartialCompletionScale	PartialCompletionScale	PartialCompletionScale
  _SECALTINTOBV	alteration integrity	Abstract security metadata observation values used to indicate mechanism used for authorized alteration of an IT resource (data, information object, service, or system capability)
  _SECDATINTOBV	data integrity	Abstract security observation values used to indicate data integrity metadata. Examples: Codes conveying the mechanism used to preserve the accuracy and consistency of an IT resource such as a digital signature and a cryptographic hash function.
  _SECINTCONOBV	integrity confidence	Abstract security observation value used to indicate integrity confidence metadata. Examples: Codes conveying the level of reliability and trustworthiness of an IT resource.
  _SECINTOBV	security integrity	Abstract security observation values used to indicate security integrity metadata. Examples: Codes conveying integrity status, integrity confidence, and provenance.
  _SECINTPRVABOBV	provenance asserted by	Abstract security provenance metadata observation value used to indicate the entity that asserted an IT resource (data, information object, service, or system capability). Examples: Codes conveying the provenance metadata about the entity asserting the resource.
  _SECINTPRVOBV	provenance	Abstract security metadata observation value used to indicate the provenance of an IT resource (data, information object, service, or system capability). Examples: Codes conveying the provenance metadata about the entity reporting an IT resource.
  _SECINTPRVRBOBV	provenance reported by	Abstract security provenance metadata observation value used to indicate the entity that reported the resource (data, information object, service, or system capability). Examples: Codes conveying the provenance metadata about the entity reporting an IT resource.
  _SecurityObservationValue	SecurityObservationValue	Observation values used to indicate security observation metadata.
  _SeverityObservation	SeverityObservation	Potential values for observations of severity.
  _SubjectBodyPosition	_SubjectBodyPosition	Contains codes for defining the observed, physical position of a subject, such as during an observation, assessment, collection of a specimen, etc. ECG waveforms and vital signs, such as blood pressure, are two examples where a general, observed position typically needs to be noted.
  _VerificationOutcomeValue	verification outcome	Values for observations of verification act results Examples: Verified, not verified, verified with warning.

This value set expansion contains 233 concepts.

                       Rationale: This definition is intended to align with the ISO 22600-2 3.3.19 definition of cryptographic checkvalue: Information which is derived by performing a cryptographic transformation (see cryptography) on the data unit.  The derivation of the checkvalue may be performed in one or more steps and is a result of a mathematical function of the key and a data unit. It is usually used to check the integrity of a data unit.

                    
                       Examples: 
                    

                    
                       SHA-1
                       SHA-2 (Secure Hash Algorithm)

                       Medical reasons
                       Patient reasons
                       System reasons

                       Rationale: This definition is intended to align with the ISO 22600-2 3.3.26 definition of digital signature:  Data appended to, or a cryptographic transformation (see cryptography) of, a data unit that allows a recipient of the data unit to prove the source and integrity of the data unit and protect against forgery e.g., by the recipient.

                    For example, the degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies]

                    The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies] 

                    Low authentication level of assurance indicates that the relying party may have little or no confidence in the asserted identity's validity. Level 1 requires little or no confidence in the asserted identity. No identity proofing is required at this level, but the authentication mechanism should provide some assurance that the same claimant is accessing the protected transaction or data. A wide range of available authentication technologies can be employed and any of the token methods of Levels 2, 3, or 4, including Personal Identification Numbers (PINs), may be used. To be authenticated, the claimant must prove control of the token through a secure authentication protocol. At Level 1, long-term shared authentication secrets may be revealed to verifiers.  Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol.   [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies]

                    Basic authentication level of assurance indicates that the relying party may have some confidence in the asserted identity's validity. Level 2 requires confidence that the asserted identity is accurate. Level 2 provides for single-factor remote network authentication, including identity-proofing requirements for presentation of identifying materials or information. A wide range of available authentication technologies can be employed, including any of the token methods of Levels 3 or 4, as well as passwords. Successful authentication requires that the claimant prove through a secure authentication protocol that the claimant controls the token.  Eavesdropper, replay, and online guessing attacks are prevented.  

                    The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies] 

                    Medium authentication level of assurance indicates that the relying party may have high confidence in the asserted identity's validity.  Level 3 is appropriate for transactions that need high confidence in the accuracy of the asserted identity. Level 3 provides multifactor remote network authentication. At this level, identity-proofing procedures require verification of identifying materials and information. Authentication is based on proof of possession of a key or password through a cryptographic protocol. Cryptographic strength mechanisms should protect the primary authentication token (a cryptographic key) against compromise by the protocol threats, including eavesdropper, replay, online guessing, verifier impersonation, and man-in-the-middle attacks. A minimum of two authentication factors is required. Three kinds of tokens may be used:

                    
                       "soft" cryptographic token, which has the key stored on a general-purpose computer, 
                       "hard" cryptographic token, which has the key stored on a special hardware device, and 
                       "one-time password" device token, which has symmetric key stored on a personal hardware device that is a cryptographic module validated at FIPS 140-2 Level 1 or higher. Validation testing of cryptographic modules and algorithms for conformance to Federal Information Processing Standard (FIPS) 140-2, Security Requirements for Cryptographic Modules, is managed by NIST.
                    
                    Authentication requires that the claimant prove control of the token through a secure authentication protocol. The token must be unlocked with a password or biometric representation, or a password must be used in a secure authentication protocol, to establish two-factor authentication. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Approved cryptographic techniques are used for all operations.  Assertions issued about claimants as a result of a successful authentication are either cryptographically authenticated by relying parties (using approved methods) or are obtained directly from a trusted party via a secure authentication protocol.    [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    The degree of confidence in the vetting process used to establish the identity of the individual to whom the credential was issued, and 2) the degree of confidence that the individual who uses the credential is the individual to whom the credential was issued. [OMB M-04-04 E-Authentication Guidance for Federal Agencies]

                    High authentication level of assurance indicates that the relying party may have very high confidence in the asserted identity's validity. Level 4 is for transactions that need very high confidence in the accuracy of the asserted identity. Level 4 provides the highest practical assurance of remote network authentication. Authentication is based on proof of possession of a key through a cryptographic protocol. This level is similar to Level 3 except that only “hard� cryptographic tokens are allowed, cryptographic module validation requirements are strengthened, and subsequent critical data transfers must be authenticated via a key that is bound to the authentication process. The token should be a hardware cryptographic module validated at FIPS 140-2 Level 2 or higher overall with at least FIPS 140-2 Level 3 physical security. This level requires a physical token, which cannot readily be copied, and operator authentication at Level 2 and higher, and ensures good, two-factor remote authentication.

                    Level 4 requires strong cryptographic authentication of all parties and all sensitive data transfers between the parties. Either public key or symmetric key technology may be used. Authentication requires that the claimant prove through a secure authentication protocol that the claimant controls the token. Eavesdropper, replay, online guessing, verifier impersonation, and man-in-the-middle attacks are prevented. Long-term shared authentication secrets, if used, are never revealed to any party except the claimant and verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent verifiers by the CSP. Strong approved cryptographic techniques are used for all operations. All sensitive data transfers are cryptographically authenticated using keys bound to the authentication process.   [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Low authentication process level of assurance indicates that (1) long-term shared authentication secrets may be revealed to verifiers; and (2) assertions and assertion references require protection from manufacture/modification and reuse attacks.  [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Basic authentication process level of assurance indicates that long-term shared authentication secrets are never revealed to any other party except Credential Service Provider (CSP).  Sessions (temporary) shared secrets may be provided to independent verifiers by CSP. Long-term shared authentication secrets, if used, are never revealed to any other party except Verifiers operated by the Credential Service Provider (CSP); however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. In addition to Level 1 requirements, assertions are resistant to disclosure, redirection, capture and substitution attacks. Approved cryptographic techniques are required.  [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Medium authentication process level of assurance indicates that the token can be unlocked with password, biometric, or uses a secure multi-token authentication protocol to establish two-factor authentication.  Long-term shared authentication secrets are never revealed to any party except the Claimant and Credential Service Provider (CSP).

                    Authentication requires that the Claimant prove, through a secure authentication protocol, that he or she controls the token. The Claimant unlocks the token with a password or biometric, or uses a secure multi-token authentication protocol to establish two-factor authentication (through proof of possession of a physical or software token in combination with some memorized secret knowledge). Long-term shared authentication secrets, if used, are never revealed to any party except the Claimant and Verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. In addition to Level 2 requirements, assertions are protected against repudiation by the Verifier.

                    High authentication process level of assurance indicates all sensitive data transfer are cryptographically authenticated using keys bound to the authentication process.  Level 4 requires strong cryptographic authentication of all communicating parties and all sensitive data transfers between the parties. Either public key or symmetric key technology may be used. Authentication requires that the Claimant prove through a secure authentication protocol that he or she controls the token. All protocol threats at Level 3 are required to be prevented at Level 4. Protocols shall also be strongly resistant to man-in-the-middle attacks. Long-term shared authentication secrets, if used, are never revealed to any party except the Claimant and Verifiers operated directly by the CSP; however, session (temporary) shared secrets may be provided to independent Verifiers by the CSP. Approved cryptographic techniques are used for all operations. All sensitive data transfers are cryptographically authenticated using keys bound to the authentication process.   [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Assertions and assertion references require protection from modification and reuse attacks.  [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Assertions are resistant to disclosure, redirection, capture and substitution attacks.  Approved cryptographic techniques are required for all assertion protocols.  [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Assertions are protected against repudiation by the verifier.  [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                    Strongly resistant to man-in-the-middle attacks. "Bearer" assertions are not used.  "Holder-of-key" assertions may be used. RP maintains records of the assertions.  [Summary of the technical requirements specified in NIST SP 800-63 for the four levels of assurance defined by the December 2003, the Office of Management and Budget (OMB) issued Memorandum M-04-04, E-Authentication Guidance for Federal Agencies.]

                       Usage Note: "MAP" code does not indicate the semantic fidelity of the transformed content.

                    To indicate semantic fidelity for maps of HL7 to other code systems, this security alteration integrity observation may be further specified using an Act valued with Value Set: MapRelationship (2.16.840.1.113883.1.11.11052).

                    Semantic fidelity of the mapped IT Resource may also be indicated using a SecurityIntegrityConfidenceObservation.

                       Usage Note: "MASKED" may be used, per applicable policy, as a flag to indicate to a user or receiver that some portion of an IT resource has been further encrypted, and may be accessed only by an authorized user or receiver to which a decryption key is provided.

                       Rationale: Personal data which has been processed to make it impossible to know whose data it is. Used particularly for secondary use of health data. In some cases, it may be possible for authorized individuals to restore the identity of the individual, e.g.,for public health case management.  Based on ISO/TS 25237:2008 Health informatics—Pseudonymization

                       Usage Note: "REDACTED" may be used, per applicable policy, as a flag to indicate to a user or receiver that some portion of an IT resource has filtered and not included in the content accessed or received.

                       Usage Note: This is not suitable to be used when information is removed for security reasons - see the code REDACTED for this use.

                       Usage Note: "SYNTAC" code does not indicate the syntactical correctness of the syntactically transformed IT resource.

                       Usage Note: "TRSLT" does not indicate the fidelity of the translation or the languages translated.

                    The fidelity of the IT Resource translation may be indicated using a SecurityIntegrityConfidenceObservation.

                    To indicate languages, use the Value Set:HumanLanguage (2.16.840.1.113883.1.11.11526)

                    For example, a Certificate Policy (CP), which is a named set of rules that indicates the applicability of a certificate to a particular community and/or class of application with common security requirements.  A particular Certificate Policy might indicate the applicability of a type of certificate to the authentication of electronic data interchange transactions for the trading of goods within a given price range.  Another example is Cross Certification with Federal Bridge.

                       Usage Note: When this code is used, expectation is that the system has removed historical versions of the data that falls outside the time period deemed to be the effective time of the applicable version.

                       Examples: Codes conveying the mechanism used to preserve the accuracy and consistency of an IT resource such as a digital signature and a cryptographic hash function.

                       Examples: Codes conveying the level of reliability and trustworthiness of an IT resource.

                       Examples: Codes conveying integrity status, integrity confidence, and provenance.

                       Examples: Codes conveying the provenance metadata about the entity asserting the resource.

                       Examples: Codes conveying the provenance metadata about the entity reporting an IT resource.

                       Examples: Codes conveying the provenance metadata about the entity reporting an IT resource.

                       Examples: Verified, not verified, verified with warning.