Definition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.
Description:The rationale or purpose for an act relating to health information management, such as archiving information for the purpose of complying with an organization policy or jurisdictional law relating to data retention.
Description:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.
Description:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.
Definition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
Description:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
Definition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available
Example:Lab results, diagnostic imaging, etc.
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.
A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.
Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.
Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
Description:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description: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.
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.
Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy.
Examples are client deceased & adopted client has been given a new policy identifier.
When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.
Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).
Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam.
Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status.
A person becomes eligible for insurance or a program because of crime related health condition or injury.
Example: A person is a claimant under the U.S. Crime Victims Compensation program.
A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.
A person becomes eligible for a program based on financial criteria.
Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.
A person becomes eligible for a program because of a qualifying health condition or injury.
Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program
A person becomes eligible for a program based on more than one criterion.
Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.
A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.
Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.
A person becomes eligible for a program based on statutory criteria.
Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.
A person becomes 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.
Description:The rationale or purpose for an act relating to information management, such as archiving information for the purpose of complying with an enterprise data retention policy.
Description: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.
To perform one or more operations on information to which the patient has not consented as deemed necessary by authorized entities for providing care in the best interest of the patient; providing immediately needed health care for an emergent condition; or for protecting public or third party safety.
Usage Notes: Used to convey the reason that a provider or other entity may or has accessed personal healthcare information. Typically, this involves overriding the subject's consent directives.
To perform one or more operations on information to which the patient has not consented by authorized entities for treating a condition which poses an immediate threat to the patient's health and which requires immediate medical intervention.
Usage Notes: The patient is unable to provide consent, but the provider determines they have an urgent healthcare related reason to access the record.
To perform one or more operations on information to which the patient declined to consent for providing health care.
Usage Notes: The patient, while able to give consent, has not. However the provider believes it is in the patient's interest to access the record without patient consent.
To perform one or more operations on information to which the patient has not consented for public safety reasons.
Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to public safety.
To perform one or more operations on information to which the patient has not consented for third party safety.
Usage Notes: The patient, while able to give consent, has not. However, the provider believes that access to masked patient information is justified because of concerns related to the health and safety of one or more third parties.
Reason for performing one or more operations on information, which may be permitted by source system's security policy in accordance with one or more privacy policies and consent directives.
Usage Notes: The rationale or purpose for an act relating to the management of personal health information, such as collecting personal health information for research or public health purposes.
To perform one or more operations on information used for conducting administrative and contractual activities related to the provision of health care.
To perform one or more operation operations on information used to manage a patient directory.
Examples:
facility
enterprise
payer
health information exchange patient directory
To perform one or more operations on information used for assessing results and comparative effectiveness achieved by health care practices and interventions.
To perform one or more operations on information for provision of additional clinical evidence in support of a request for coverage or payment for health services.
To perform one or more operations on information used for conducting eligibility determination for coverage in a program or policy. May entail review of financial status or disability assessment.
To perform one or more operations on information used for conducting eligibility verification of coverage in a program or policy. May entail provider contacting coverage source (e.g., government health program such as workers compensation or health plan) for confirmation of enrollment, eligibility for specific services, and any applicable copays.
To perform one or more operations on information used for enrolling a covered party in a program or policy. May entail recording of covered party's and any dependent's demographic information and benefit choices.
To perform one or more operations on information for conducting scientific investigations in accordance with clinical trial protocols to obtain health care knowledge.
To perform one or more operations on information used for provision of immediately needed health care to a population of living subjects located in a disaster zone.
Description:The rationale or purpose for an act relating to the management of personal information, such as disclosing personal tax information for the purpose of complying with a court order.
Description:Operational activities conducted for the purposes of meeting of criteria defined by an accrediting entity for an activity, product, or service
Indicates why a fulfiller refused to fulfill a supply order, and considered it important to notify other providers of their decision. E.g. "Suspect fraud", "Possible abuse", "Contraindicated".
(used when capturing 'refusal to fill' annotations)
Definition:Data needed to safely act on the order which was expected to become available independent of the order is not yet available
Example:Lab results, diagnostic imaging, etc.
Definition:Fulfiller not able to provide appropriate care associated with fulfilling the order.
Example:Therapy requires ongoing monitoring by fulfiller and fulfiller will be ending practice, leaving town, unable to schedule necessary time, etc.
Definition:The event occurred so that a test or observation performed at a prior event could be performed again due to conditions set forth in the protocol.
Definition:The event that occurred was initiated by a study participant (e.g. the subject or the investigator), and did not occur for protocol reasons.
Definition:SSpecifies the reason that a test was performed or observation collected in a clinical research study.
Note:This set of codes are not strictly reasons, but are used in the currently Normative standard. Future revisions of the specification will model these as ActRelationships and thes codes may subsequently be retired. Thus, these codes should not be used for new specifications.
Definition:The observation or test occurred due to it being defined in the research protocol, and during an activity or event that was scheduled in the protocol.
Description:This therapy has been ordered as a backup to a preferred therapy. This order will be released when and if the preferred therapy is unsuccessful.
Description:The current level of the medication in the patient's system is too high. The medication is suspended to allow the level to subside to a safer level.
Description:The patient is pregnant or breast feeding. The therapy will be resumed when the pregnancy is complete and the patient is no longer breastfeeding.
Description:The patient is believed to be allergic to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description:The drug interacts with a short-term treatment that is more urgently required. This order will be resumed when the short-term treatment is complete.
Description:Another short-term co-occurring therapy fulfills the same purpose as this therapy. This therapy will be resumed when the co-occuring therapy is complete.
Description:The patient is believed to have an intolerance to a substance that is part of the therapy and the therapy is being temporarily withdrawn to confirm.
Description:The drug is contraindicated for patients receiving surgery and the patient is scheduled to be admitted for surgery in the near future. The drug will be resumed when the patient has sufficiently recovered from the surgery.
Description:The patient was previously receiving a medication contraindicated with the current medication. The current medication will remain on hold until the prior medication has been cleansed from their system.
Description:The decision on which the recorded information was based was changed before the decision had an effect.
Example:Aborted prescription before patient left office, released prescription before suspend took effect.
Definition:A collection of concepts that indicates why the prescription should no longer be allowed to be dispensed (but can still administer what is already being dispensed).
Description: Identifies why a request to add (or activate) a record is being refused. Examples include the receiving system not able to match the identifier and find that record in the receiving system, having no permission, or a detected issue exists which precludes the requested action.
Indicates that the decision to substitute or to not substitute was driven by a desire to maintain consistency with a pre-existing therapy. I.e. The performer provided the same item/service as had been previously provided rather than providing exactly what was ordered, or rather than substituting with a lower-cost equivalent.
In the case of 'substitution', indicates that the substitution occurred because the ordered item was not in stock. In the case of 'no substitution', indicates that a cheaper equivalent was not substituted because it was not in stock.
Indicates that the decision to substitute or to not substitute was driven by a jurisdictional regulatory requirement mandating or prohibiting substitution.
Definition: This domain is used to document reasons for providing a billable service; the billable services may include both clinical services and social services.
Reason for Clinical Service being performed.
This domain excludes reasons specified by diagnosed conditions.
Examples of values from this domain include duplicate therapy and fraudulent prescription.
Returns the enum constant of this type with the specified name.
The string must match exactly an identifier used to declare an
enum constant in this type. (Extraneous whitespace characters are
not permitted.)
Parameters:
name - the name of the enum constant to be returned.