HL7 Segment

ABS Abstract

ACC Accident

0. 1. 2. 3. 4. 5. 6.

Segment ID = ACC Accident Date/Time Accident Code Accident Location Auto Accident State Accident Job Related Indicator Accident Death Indicator

ADD Addendum ADJ Adjustment AFF Professional Affiliation AIG Appointment Information - General Resource AIL Appointment Information - Location Resource AIP Appointment Information - Personnel Resource AIS Appointment Information

AL1 Patient Allergy Information

AL1|1||^ASPIRIN

0. 1. 2. 3.

Segment ID = AL1 Set ID Internal = 1 Allergy Type = Allergy Description a. Allergy Identifier = b. Text = Aspirin 4. Allergy Severity = 5. Allergy Reaction = 6. Identification Date = -

APR Appointment Preferences ARQ Appointment Request ARV Access Restriction AUT Authorization Information

BHS Batch Header

BHS|^~\&||ABCHS||AUSDHSV|20070101123401||||abchs20070101123401-1 0. Segment ID = BHS 1. Batch Field Separator = | 2. Batch Encoding Characters = ^~\& 3. Batch Sending Application = 4. Batch Sending Facility = ABCHS 5. Batch Receiving Application = 6. Batch Receiving Facility = AUSDHSV 7. Batch Creation Date/Time =20070101123401 8. Batch Security = 9. Batch Name/ID/Type = 10. Batch Comment = 11. Batch Control ID = abchs20070101123401-1 12. Reference Batch Control ID = -

BLC Blood Code BLG Billing BPO Blood product order BPX Blood product dispense status

BTS Batch Trailer

BTS|1 0. 1. 2. 3. Segment ID = BTS Batch Message Count = 1 Batch Comment = Batch Totals = -

BTX Blood Product Transfusion/Disposition CDM Charge Description Master CER Certificate Detail CM0 Clinical Study Master CM1 Clinical Study Phase Master CM2 Clinical Study Schedule Master CNS Clear Notification CON Consent Segment CSP Clinical Study Phase CSR Clinical Study Registration CSS Clinical Study Data Schedule Segment CTD Contact Data CTI Clinical Trial Identification DB1 Disability

DG1 Diagnosis

DG1|1||786.50^CHEST PAIN, UNSPECIFIED^I9|||A

0. 1. 2. 3.

Segment ID = DG1 Set ID Diagnosis = 1 Diagnosis Code Method = Diagnosis Code a. 786.50 b. Chest Pain , Unspecified c. Code System = I9 = ICD9 4. Diagnosis Description = 5. Diagnosis Date/Time = 6. Diagnosis/DRG Type = A = Admitting 7. Major diagnostic category = 8. Diagnosis related group (DRG) = 9. DRG approval indicator = 10. DRG grouper review code = 11. Outlier type = 12. Outlier days = 13. Outlier cost = 14. Grouper version and type = No. 0 1 2 3 Field Segment ID Set ID Diagnosis Diagnosis Code Method Diagnosis Code a. b. c. Code System Diagnosis Description Diagnosis Date/Time Diagnosis/DRG Type Major diagnostic category Diagnosis related group (DRG) Data Elemen Value DG1 1 -

Diagnosa 786.50 Chest Pain , Unspecified I9 = ICD9 A = Admitting -

4 5 6 7 8

9 10 11 12 13 14

DRG approval indicator DRG grouper review code Outlier type Outlier days Outlier cost Grouper version and type

DMI DRG Master File Information DRG Diagnosis Related Group DSC Continuation Pointer DSP Display Data ECD Equipment Command ECR Equipment Command Response EDU Educational Detail EQP Equipment/log Service EQU Equipment Detail ERR Error

EVN Event Type

EVN||200605290901||||200605290900

0. 1. 2. 3. 4. 5. 6.

Segment ID = EVN Event Type Code = Recorded Date/Time = 200605290901 Date/Time Planned Event = Event Reason Code = Operator ID = Event Occurred = 200605290900

FAC Facility

FHS File Header

FHS|^~\&||ABCHS||AUSDHSV|20070101123401|||abchs20070101123401.hl7| 0. Segment ID = FHS 1. File Field Separator = | 2. File Encoding Characters = ^~\& 3. File Sending Application = 4. File Sending Facility = ABCHS 5. File Receiving Application = 6. File Receiving Facility = AUSDHSV 7. File Creation Date/Time = 20070101123401 8. File Security = 9. File Name/ID = 10. File Header Comment = abchs20070101123401.hl7 11. File Control ID = 12. Reference File Control ID = -

FT1 Financial Transaction

FTS File Trailer

FTS|1

0. Segment ID = FTS 1. File Batch Count = 1 2. File Trailer Comment = -

GOL Goal Detail GP1 Grouping/Reimbursement - Visit GP2 Grouping/Reimbursement - Procedure Line Item

GT1 Guarantor

GT1|0||JONES^ANN^M||756 E FANNIN ST^^LAGRANGE^TX^789450000|9799660489|||||M|||||CARE INN|457 NMAIN^^LAGRANGE^TX^78945|

0. 1. 2. 3.

Segment ID = GT1 Set ID - GT1 = 0 Guarantor Number = Guarantor Name a. Family Name = JONES b. Given Name = ANN c. Middle Initial or Name = M 4. Guarantor Spouse Name = 5. Guarantor Address a. Street Address = 756 E FANNIN ST b. 2nd Street Address Line = c. City = LAGRANGE d. State = TX e. Zip/Postal Code = 789450000 6. Guarantor Ph Num-Home = 9799660489 7. Guarantor Ph Num-Business = 8. Guarantor Date/Time Of Birth = 9. Guarantor Sex = 10. Guarantor Type = 11. Guarantor Relationship = M 12. Guarantor SSN = 13. Guarantor Date - Begin = 14. Guarantor Date - End = 15. Guarantor Priority = 16. Guarantor Employer Name = CARE INN 17. Guarantor Employer Address a. Street Address = 457 NMAIN b. 2nd Street Address Line = c. City = LAGRANGE d. State = TX e. Zip/Postal Code = 78945 18. Guarantor Employer Phone Number = 19. Guarantor Employee ID Number = 20. Guarantor Employment Status = -

21. Guarantor Organization Name = NOT APPLICABLE 22. Guarantor Billing Hold Flag 23. Guarantor Credit Rating Code 24. Guarantor Death Date And Time 25. Guarantor Death Flag 26. Guarantor Charge Adjustment Code 27. Guarantor Household Annual Income 28. Guarantor Household Size 29. Guarantor Employer ID Number 30. Guarantor Marital Status Code 31. Guarantor Hire Effective Date 32. Employment Stop Date 33. Living Dependency 34. Ambulatory Status 35. Citizenship 36. Primary Language 37. Living Arrangement 38. Publicity Indicator 39. Protection Indicator 40. Student Indicator 41. Religion 42. Mothers Maiden Name 43. Nationality 44. Ethnic Group 45. Contact Person Name 46. Contact Persons Telephone Number 47. Contact Reason 48. Contact Relationship 49. Job Title 50. Job Code/Class 51. Guarantor Employer's Organization Name 52. Handicap 53. Job Status 54. Guarantor Financial Class 55. Guarantor Race No Field 0 1 2 3 Segment ID Set ID - GT1 Guarantor Number Guarantor Name Data Elemen Value GT1 0 Technical Comment GT1 0 Opt. R O R O

a. Family Name b. Given Name c. Middle Initial or Name Guarantor Spouse Name Guarantor Address a. Street Address b. 2nd Street Address Line c. City d. State e. Zip/Postal Code Guarantor Ph Num-Home Guarantor Ph NumBusiness Guarantor Date/Time Of Birth Guarantor Sex Guarantor Type Guarantor Relationship Guarantor SSN Guarantor Date - Begin Guarantor Date - End Guarantor Priority Guarantor Employer Name Guarantor Employer Address a. Street Address b. 2nd Street Address Line c. City d. State e. Zip/Postal Code Guarantor Employer Phone Number Guarantor Employee ID Number Guarantor Employment Status Guarantor Organization Name Guarantor Billing Hold Flag Guarantor Credit Rating Code

Nama Lengkap

JONES ANN M -

4 5

O O

Alamat Tempat Tinggal

756 E FANNIN ST LAGRANGE TX 789450000 9799660489 M CARE INN

6 7 8 9 10 11 12 13 14 15 16 17

O O O O O O O O O O O O

M = Mother

Alamat Tempat Tinggal

457 NMAIN

18 19 20 21 22 23

LAGRANGE TX 78945 -

O O O O O O

24 25 26 27 28 29 30 31 32 33

Guarantor Death Date And Time Guarantor Death Flag Guarantor Charge Adjustment Code Guarantor Household Annual Income Guarantor Household Size Guarantor Employer ID Number Guarantor Marital Status Code Guarantor Hire Effective Date Employment Stop Date Living Dependency

O O O O O O O O O
D = Spouse dependent O M = Medical Supervision Required S = Small children WU = Walk up CB = Common Bath

34 35 36 37

Ambulatory Status Citizenship Primary Language Living Arrangement

A = Alone F = Family I = Institution R = Relative U = Unknown S = Spouse Only

O O O O

38 39 40 41 42 43 44 45 46 47 48

Publicity Indicator Protection Indicator Student Indicator Religion Mothers Maiden Name Nationality Ethnic Group Contact Person Name Contact Persons Telephone Number Contact Reason Contact Relationship

F = Full-time student P = Part-time student N = Not a student

O O O O O O O O O O O

49 50 51 52 53 54 55

Job Title Job Code/Class Guarantor Employer's Organization Name Handicap Job Status Guarantor Financial Class Guarantor Race

O O O O O O

IAM Patient Adverse Reaction Information IIM Inventory Item Master ILT Material Lot

IN1 Insurance

IN1|1|UNK.|MR1|MEDICARE/COMMERICAL|P.O. BOX C32086^^RICHMOND^VA^23261||0000000000|499032980||||00001231|00001231||MC|ODONNELL^RICHARD^W^^|1|19221027|7982 WELLINGTON DR^^WARRENTON^VA^22186^USA||||||||||||N|||||499032980-A|||||||M|| No Field 0 1 2 3 4 5 Segment ID Set ID - IN1 Insurance Plan ID Insurance Company ID Insurance Company Name Insurance Company Address a. street address b. other designation c. City d. state or province e. zip or postal code f. Country g. address type h. other geographic designation i. county/parish code j. census tract 6 7 8 9 Insurance Co. Contact Person Insurance Co Phone Number Group Number Group Name -0000000000 499032980 O O O O Data Elemen Value IN1 1 UNK. MR1 MEDICARE/COMMERICAL Technical Comment Opt.

R R R O O

P.O. BOX C32086 RICHMOND VA 23261

10 11 12 13 14 15 16 17

18 19

20 21 22 23 24 25 26 27 28 29

Insureds Group Emp ID Insureds Group Emp Name Plan Effective Date Plan Expiration Date Authorization Information Plan Type Name Of Insured Insureds Relationship To Patient Insureds Date Of Birth Insureds Address street address other designation city state or province zip or postal code country address type other geographic designation county/parish code census tract Assignment Of Benefits Coordination Of Benefits Coord Of Ben. Priority Notice Of Admission Flag Notice Of Admission Date Report Of Eligibility Flag Report Of Eligibility Date Release Information Code Pre-Admit Cert (PAC) Verification Date/Time

00001231 00001231 MC ODONNELL^RICHARD^W^^ 1

O O O O O O O O

-19221027

O O

7982 WELLINGTON DR WARRENTON VA 22186 USA

O O O O O O O O O O

30 31 32 33 34 35 36 37 38 39 40 41 42 43

Verification By Type Of Agreement Code Billing Status Lifetime Reserve Days Delay Before L.R. Day Company Plan Code Policy Number Policy Deductible Policy Limit - Amount Policy Limit - Days Room Rate - SemiPrivate Room Rate - Private Insureds Employment Status Insureds Sex

N 499032980-A M

S = Standard U = Unified M = Maternity

O O O O O O O O B O B B O

M = Male F = Female O = Other U = Unknown

44 45 46 47 48 49

Insureds Employer Address Verification Status Prior Insurance Plan ID Coverage Type Handicap Insureds ID Number

O O O O O O

IN2 Insurance Additional Information IN3 Insurance Additional Information, Certification INV Inventory Detail IPC Imaging Procedure Control Segment IPR Invoice Processing Results ISD Interaction Status Detail ITM Material Item IVC Invoice Segment IVT Material Location LAN Language Detail LCC Location Charge Code LCH Location Characteristic LDP Location Department LOC Location Identification LRL Location Relationship MFA Master File Acknowledgment MFE Master File Entry MFI Master File Identification MRG Merge Patient Information MSA Message Acknowledgment

MSH Message Header

MSH|^~\&|MegaReg|XYZHospC|SuperOE|XYZImgCtr|200605290901310500||ADT^A01^ADT_A01|01052901|P|2.5

0. 1. 2. 3. 4. 5. 6. 7. 8. 9.

Segment ID = MSH Field Separator = | Encoding Characters = ^~\& Sending Application = MegaReg Sending Facility = XYZHospC Receiving Application = SuperOE Receiving Facility = XYZImgCtr Date/Time of Message = 20060529090131-0500 Security = Message Type a. Message Type = ADT = ADT Message (Patient Admission, Discharge, Transfer, and etc.) b. Trigger Event = A01 = Admit a Patient c. Message Structure = ADT_A01 10. Message Control ID = 01052901 11. Processing ID = P = Production 12. Version ID = 2.5 13. Sequence Number = 14. Continuation Pointer = 15. Accept Acknowledge Type = 16. Application Acknowledge Type = 17. Country Code = 18. Character Set = 19. Principal Language of Message = -

NCK System Clock NDS Notification Detail

NK1 Next of Kin / Associated Parties

NK1||ROE^MARIE^^^^|SPO||(216)123-4567||EC||||||||||||||||||||||||||| 0. Segment ID = NK1 1. Set ID - NK1 = 2. Name a. Family Name = Roe b. Given Name = Marie c. Middle Initial or Name = d. Suffix = e. Prefix = f. Degree = 3. Relationship = SPO = Spouse 4. Address = 5. Phone Number = (216)123-4567 6. Business Phone Number = 7. Contact Role = EC = Emergency Contact 8. Start Date = 9. End Date = 10. Next of Kin / Associated Parties Job Title = 11. Next of Kin / Associated Parties Job Code/Class = 12. Next of Kin / Associated Parties Employee Number = 13. Organization Name = 14. Marital Status = 15. Sex = 16. Date/Time of Birth = 17. Living Dependency = 18. Ambulatory Status = 19. Citizenship = 20. Primary Language = 21. Living Arrangement = 22. Publicity Indicator = 23. Protection Indicator = 24. Student Indicator = 25. Religion = 26. Mothers Maiden Name = 27. Nationality = 28. Ethnic Group = 29. Contact Reason = 30. Contact Persons Name = -

31. Contact Persons Telephone Number = 32. Contact Persons Address = 33. Next of Kin/Associated Partys Identifiers = 34. Job Status = 35. Race = 36. Handicap = 37. Contact Person Social Security Number = -

NPU Bed Status Update NSC Application Status Change NST Application control level statistics NTE Notes and Comments OBR Observation Request

OBX Observation/Result

OBX|1|NM|^Body Height||1.80|m^Meter^ISO+|||||F

0. 1. 2. 3.

Segment ID = OBX Set ID OBX = 1 Value Type = NM = Numeric Observation Identifier a. Identifier = b. Text = Body Height 4. Observation Sub-ID = 5. Observation Value = 1.80 6. Units a. Identifier = m b. Text = Meter c. Code System = ISO+ 7. Reference Range = 8. Abnormal Flags = 9. Probability = 10. Nature of Abnormal Test = 11. Result Status = F = Final Results; Order is Complete and Verified 12. Date of Last Normal Values = 13. User Defined Access Checks = 14. Date/Time of the Observation = 15. Producer's ID = 16. Responsible Observer = 17. Observation Method = -

No. 0 1 2 3

4 5 6

Field Segment ID Set ID OBX Value Type Observation Identifier a. Identifier b. Text Observation Sub-ID Observation Value Units

Data Elemen

Value OBX 1 NM = Numeric

Tinggi Badan Body Height 1.80

7 8 9 10 11

a. Identifier b. Text c. Code System Reference Range Abnormal Flags Probability Nature of Abnormal Test Result Status

m Meter ISO+ F = Final Results; Order is Complete and Verified -

12 13 14 15 16 17

Date of Last Normal Values User Defined Access Checks Date/Time of the Observation Producer's ID Responsible Observer Observation Method

ODS Dietary Orders, Supplements, and Preferences ODT Diet Tray Instructions OM1 General Segment OM2 Numeric Observation OM3 Categorical Service/Test/Observation OM4 Observations that Require Specimens OM5 Observation Batteries (Sets) OM6 Observations that are Calculated from Other Observations OM7 Additional Basic Attributes

ORC Common Order

ORC|NW|RX12345^ABC|||||1^^INDEF^201108250200^^RTN||20110825012431

0. Segment ID = ORC 1. Order Control = NW = New Order 2. Placer Order Number a. Order Number = RX12345 b. Application ID = ABC 3. Filler Order Number = 4. Placer Group Number = 5. Order Status = 6. Response Flag = 7. Quantity/Timing a. Quantity = 1 b. Interval = c. Duration = INDEF d. Start date/time (TS) = 201108250200 e. End date/time (TS) = f. Priority (ID) = RTN g. Condition (ST) = h. Text (TX) = i. Conjunction (ID) = j. Order sequencing = 8. Parent = 9. Date/Time of Transaction = 20110825012431 10. Entered By = 11. Verified By = 12. Ordering Provider = 13. Enterer's Location = 14. Call Back Phone Number = 15. Order Effective Date/Time = 16. Order Control Code Reason = 17. Entering Organization = 18. Entering Device = 19. Action By = -

ORG Practitioner Organization Unit OVR Override Segment PCE Patient Charge Cost Center Exceptions PCR Possible Causal Relationship PD1 Patient Additional Demographic PDA Patient Death and Autopsy PDC Product Detail Country PEO Product Experience Observation PES Product Experience Sender

PID Patient Identification

PID|||56782445^^^UAReg^PI||KLEINSAMPLE^BARRY^Q^JR||19620910|M||20289^^HL70005^RA99113^^XYZ|260 GOODWIN CREST DRIVE^^BIRMINGHAM^AL^35 209^^M~NICKELLS PICKLES^10000 W 100TH AVE^BIRMINGHAM^AL^35200^^O |||||||0105I30001^^^99DEF^AN

0. Segment ID = PID 1. Set ID Patient ID = 2. Patient ID (External ID) a. ID b. check digit c. check digit scheme d. Assigning Authority i. namespace ID ii. universal ID iii. universal ID type e. identifier type f. Assigning Facility i. namespace ID ii. universal ID iii. universal ID type 3. Patient ID (Internal ID) a. ID = 56782445 b. Check Digit = c. Check Digit Scheme = d. Assigning Authority i. namespace ID = UAReg ii. universal ID iii. universal ID type e. Identifier Type Code = PI = Patient Internal Identifier f. Assigning Facility = i. namespace ID ii. universal ID iii. universal ID type 4. Alternate Patient ID PID = a. ID b. check digit

c. check digit scheme d. Assigning Authority i. namespace ID ii. universal ID iii. universal ID type e. identifier type f. Assigning Facility i. namespace ID ii. universal ID iii. universal ID type 5. Patient Name a. Family Name = Kleinsample b. Given Name = Barry c. Middle Initial or Name = Q d. Suffix = Jr e. Prefix = f. Degree = g. Name Type Code = 6. Mothers Maiden Name = a. Family Name = b. Given Name = c. Middle Initial or Name = d. Suffix = e. Prefix = f. Degree = g. Name Type Code = 7. Date/Time of Birth = 19620910 8. Sex = M = Male 9. Patient Alias a. Family Name = b. Given Name = c. Middle Initial or Name = d. Suffix = e. Prefix = f. Degree = g. Name Type Code = 10. Race a. Identifier = 2028-9 = Asian b. Text = c. Code System = HL70005 = Race table number d. Alternate Identifier = RA99113

e. Alternate Text = f. Alternate Code System = XYZ 11. Patient Address a. Street Address = 260 Goodwin Crest Drive b. 2nd Street Address Line = c. City = Birmingham d. State = Alabama e. Zip/Postal Code = 35209 f. Country = g. Address Type = M = Mailing h. Street Address = NICKELLS PICKLES i. 2nd Street Address Line = 10000 W 100TH AVE j. City = BIRMINGHAM k. State = AL l. Zip/Postal Code = 35200 m. Country = n. Address Type = O = Office o. other geographic designation = p. county/parish code = q. census tract = 12. Country Code = 13. Phone Number Home = 14. Phone Number Business = 15. Primary Language a. identifier b. text c. name of coding system d. alternate identifier e. alternate text f. name of alternate coding system 16. Marital Status = 17. Religion = 18. Patient Account Number a. Account Number = 0105I30001 b. c. d. Assigning Authority i. namespace ID = 99DEF ii. universal ID iii. universal ID type e. Identifier Type Code = AN = Account Number

f. Assigning Facility i. namespace ID ii. universal ID iii. universal ID type 19. SSN Number Patient = 20. Driver's License Number Patient a. license number b. issuing state, province, country c. expiration date 21. Mother's Identifier a. ID b. check digit c. check digit scheme d. assigning authority i. namespace ID ii. universal ID iii. universal ID type e. identifier type code f. assigning facility i. namespace ID ii. universal ID iii. universal ID type 22. Ethnic Group = 23. Birth Place = 24. Multiple Birth Indicator = 25. Birth Order = 26. Citizenship = 27. Veterans Military Status a. Identifier b. Text c. name of coding system d. alternate identifier e. alternate text f. name of alternate coding system 28. Nationality a. identifier b. text c. name of coding system d. alternate identifier e. alternate text f. name of alternate coding system

29. Patient Death Date and Time = 30. Patient Death Indicator = No. 0 1 2 3 Field Segment ID Set ID Patient ID Patient ID (External ID) Patient ID (Internal ID) a. ID b. Check Digit c. Check Digit Scheme d. Assigning Authority e. Identifier Type Code f. Assigning Facility Alternate Patient ID PID Patient Name a. Family Name b. Given Name c. Middle Initial or Name d. Suffix Mothers Maiden Name Date/Time of Birth Sex Data Elemen Value PID 56782445 UAReg PI = Patient Internal Identifier -

Nomor Rekam Medis

4 5

Nama Lengkap Kleinsample Barry Q Jr 19620910 M = Male F = Female O = Other U = Unknown 2028-9 = Asian HL70005 = Race table number RA99113 XYZ

6 7 8

Tanggal Lahir Jenis Kelamin

9 10

Patient Alias Race a. Identifier b. Text c. Code System d. Alternate Identifier e. Alternate Text f. Alternate Code System Patient Address a. Street Address b. 2nd Street Address Line c. City

11

Alamat Tempat Tinggal

260 Goodwin Crest Drive Birmingham

Kabupaten/Kotamadya Tempat Tinggal

d. State e. Zip/Postal Code f. Country g. Address Type h. Street Address i. 2nd Street Address Line j. City k. State l. Zip/Postal Code m. Country n. Address Type Country Code Phone Number Home Phone Number Business Primary Language Marital Status

Kode Pos

Alabama 35209 M = Mailing NICKELLS PICKLES 10000 W 100TH AVE BIRMINGHAM AL 35200 O = Office -

Kabupaten/Kotamadya Tempat Tinggal Kode Pos

12 13 14 15 16

Status Nikah

Value A D M S W -

Description Separated Divorced Married Single Widowed

17 18

19 20 21 22 23 24 25 26 27 28 29

Religion Patient Account Number a. Account Number b. c. d. Assigning Authority e. Identifier Type Code SSN Number Patient Driver's License Number Patient Mother's Identifier Ethnic Group Birth Place Multiple Birth Indicator Birth Order Citizenship Veterans Military Status Nationality Patient Death Date and Time

Agama

0105I30001

99DEF AN = Account Number -

30

Patient Death Indicator

PKG Item Packaging PMT Payment Information

PR1 Procedures

PR1|1||1||20060705|1 0. Segment ID = PR1 1. Set ID - PR1 = 1 2. Procedure Coding Method = 3. Procedure Code = 1 4. Procedure Description = 5. Procedure Date/Time = 20060705 6. Procedure Functional Type = 1 7. Procedure Minutes 8. Anesthesiologist 9. Anesthesia Code 10. Anesthesia Minutes 11. Surgeon 12. Procedure Practitioner 13. Consent Code 14. Procedure Priority 15. Associated Diagnosis Code

PRA Practitioner Detail

PRB Problem Details

PRB|AD|20060705|2111|2111^107|2111^100

0. 1. 2. 3. 4.

Segment ID = PRB Action Code = AD Action Date/Time = 20060705 Problem ID = 2111 Problem Instance ID a. Entity Identifier = 2111 b. Assigning Authority = 107 5. Episode of Care ID a. Entity Identifier = 2111 b. Assigning Authority = 100 6. Master Problem List Number 7. Problem Established Date/Time 8. Anticipated Problem Resolution Date/Time 9. Actual Problem Resolution Date/Time 10. Problem Classification 11. Problem Management Discipline 12. Problem Persistence 13. Problem Confirmation Status 14. Problem Life Cycle Status 15. Problem Life Cycle Status Date/Time 16. Problem Date of Onset 17. Problem Onset Text 18. Problem Ranking 19. Certainty of Problem 20. Probability of Problem (0-1) 21. Individual Awareness of Problem 22. Problem Prognosis 23. Individual Awareness of Prognosis 24. Family/Significant Other Awareness of Problem/Prognosis 25. Security/Sensitivity

PRC Pricing

PRD Provider Data

PRD|RP^^^1

0. Segment ID = PRD 1. Role a. Identifier = RP = Referring Provider b. Text = c. Name of Coding System = d. Alternate Identifier = 1 e. Alternate Text = f. Name of Alternate Coding System = 2. Provider Name 3. Provider Address 4. Provider Location 5. Provider Communication Information 6. Preferred Method of Contact 7. Provider Identifiers 8. Effective Start Date of Role 9. Effective End Date of Role

PSG Product/Service Group PSH Product Summary Header PSL Product/Service Line Item PSS Product/Service Section

PTH Pathway

PTH|AD|1|2111^107|20060705

0. 1. 2. 3.

Segment ID = PTH Action Code = AD Pathway ID = 1 Pathway Instance ID a. Entity Identifier = 2111 b. Assigning Authority = 107 4. Pathway Established Date Time = 20060705

PV1 Patient Visit

PV1||I|W^389^1^UABH^^^^3||||12345^MORGAN^REX^J^^^MD^0010^UAMC^L||678
90^GRAINGER^LUCY^X^^^MD^0010^UAMC^L|MED|||||A0||13579^POTTER^SHER MAN^T^^^MD^0010^UAMC^L|||||||||||||||||||||||||||200605290900

0. 1. 2. 3.

4. 5. 6. 7.

8. 9.

Segment ID = PV1 Set ID PV1 = Patient Class = I = Inpatient Assigned Patient Location a. Point of Care = W b. Room = 389 c. Bed = 1 d. Facility = UABH e. Location Status = f. Person Location Type = g. Building = h. Floor = 3 i. Location Description = Admission Type = Pre-Admit Number = Prior Patient Location = Attending Doctor a. ID Number = 12345 b. Family Name = Morgan c. Given Name = Rex d. Middle Initial = J e. Suffix = f. Prefix = g. Degree = MD = Doctor of Medicine h. Source Table = 0010 i. Assigning Authority = UAMC j. Name Type Code = L = Legal Name Referring Doctor = Consulting Doctor a. ID Number = 67890 b. Family Name = Grainger c. Given Name = Lucy

d. Middle Initial = X e. Suffix = f. Prefix = g. Degree = MD = Doctor of Medicine h. Source Table = 0010 i. Assigning Authority = UAMC j. Name Type Code = L = Legal Name 10. Hospital Service = Med = Medical Service 11. Temporary Location = 12. Pre-Admit Test Indicator = 13. Readmission Indicator = 14. Admit Source = 15. Ambulatory Status = A0 = No Functional Limitations 16. VIP Indicator = 17. Admitting Doctor a. ID Number = 13579 b. Family Name = Potter c. Given Name = Sherman d. Middle Initial = T e. Suffix = f. Prefix = g. Degree = MD = Doctor of Medicine h. Source Table = 0010 i. Assigning Authority = UAMC j. Name Type Code = L = Legal Name 18. Patient Type =19. Visit Number =20. Financial Class = 21. Charge Price Indicator = 22. Courtesy Code = 23. Credit Rating = 24. Contract Code = 25. Contract Effective Date = 26. Contract Amount = 27. Contract Period = 28. Interest Code = 29. Transfer to Bad Debt Code = 30. Transfer to Bad Debt Date = 31. Bad Debt Agency Code = 32. Bad Debt Transfer Amt. = 33. Bad Debt Recovery Amt. = -

34. Delete Account Indicator = 35. Delete Account Date = 36. Discharge Disposition = 37. Discharged to Location = 38. Diet Type = 39. Servicing Facility = 40. Bed Status = 41. Account Status = 42. Pending Location = 43. Prior Temporary Location = 44. Admit Date/Time = 200605290900 45. Discharge Date/Time = 46. Current Patient Balance = 47. Total Charges = 48. Total Adjustments = 49. Total Payments = 50. Alternate Visit ID = 51. Visit Indicator = 52. Other Healthcare Provider = No. 0 1 2 3 Field Data Elemen Segment ID Set ID PV1 Patient Class Jenis Rawat Assigned Patient Location a. Point of Care b. Room c. Bed d. Facility e. Location Status f. Person Location Type g. Building h. Floor i. Location Description Admission Type Pre-Admit Number Prior Patient Location Attending Doctor a. ID Number b. Family Name Nama Lengkap c. Given Name d. Middle Initial e. Suffix f. Prefix Value PV1 I = Inpatient W 389 1 UABH 3 12345 Morgan Rex J -

4 5 6 7

8 9

10 11 12 13 14 15 16 17

18 19 20 21 22 23 24 25 26 27 28 29

g. Degree h. Source Table i. Assigning Authority j. Name Type Code Referring Doctor Consulting Doctor a. ID Number b. Family Name c. Given Name d. Middle Initial e. Suffix f. Prefix g. Degree h. Source Table i. Assigning Authority j. Name Type Code Hospital Service Temporary Location Pre-Admit Test Indicator Readmission Indicator Admit Source Ambulatory Status VIP Indicator Admitting Doctor a. ID Number b. Family Name c. Given Name d. Middle Initial e. Suffix f. Prefix g. Degree h. Source Table i. Assigning Authority j. Name Type Code Patient Type Visit Number Financial Class Charge Price Indicator Courtesy Code Credit Rating Contract Code Contract Effective Date Contract Amount Contract Period Interest Code Transfer to Bad Debt Code

MD = Doctor of Medicine 0010 UAMC L = Legal Name 67890 Nama Lengkap Grainger Lucy X MD = Doctor of Medicine 0010 UAMC L = Legal Name Med = Medical Service A0 = No Functional Limitations 13579 Nama Lengkap Potter Sherman T MD = Doctor of Medicine 0010 UAMC L = Legal Name -

30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

Transfer to Bad Debt Date Bad Debt Agency Code Bad Debt Transfer Amt. Bad Debt Recovery Amt. Delete Account Indicator Delete Account Date Discharge Disposition Discharged to Location Diet Type Servicing Facility Bed Status Account Status Pending Location Prior Temporary Location Admit Date/Time Discharge Date/Time Current Patient Balance Total Charges Total Adjustments Total Payments Alternate Visit ID Visit Indicator Other Healthcare Provider

200605290900 -

PV2 Patient Visit - Additional Information

PV2|||||||1||||||||||||||||^^^^^^^^^103

0. Segment ID = PV2 1. Prior Pending Location = 2. Accommodation Code = 3. Admit Reason = 4. Transfer Reason = 5. Patient Valuables = 6. Patient Valuables Location = 7. Visit User Code = 1 8. Expected Admit Date = 9. Expected Discharge Date = 10. Estimated Length of Inpatient Stay = 11. Actual Length of Inpatient Stay = 12. Visit Description = 13. Referral Source Code = 14. Previous Service Date = 15. Employment Illness Related Indicator = 16. Purge Status Code = 17. Purge Status Date = 18. Special Program Code = 19. Retention Indicator = 20. Expected Number of Insurance Plans = 21. Visit Publicity Code = 22. Visit Protection Indicator = 23. Clinic Organization Name a. Organization Name = b. Organization Name Type Code = c. ID Number = d. Check Digit = e. Check Digit Scheme = f. Assigning Authority = g. Identifier Type Code = h. Assigning Facility = i. j. 103 24. Patient Status Code

25. Visit Priority Code 26. Previous Treatment Date 27. Expected Discharge Disposition 28. Signature on File Date 29. First Similar Illness Date 30. Patient Charge Adjustment Code 31. Recurring Service Code 32. Billing Media Code 33. Expected Surgery Date & Time 34. Military Partnership Code 35. Military Non-Availability Code 36. Newborn Baby Indicator 37. Baby Detained Indicator

PYE Payee Information QAK Query Acknowledgment QID Query Identification

QPD Query Parameter Definition

QPD|Q42^Tabular Dispense
History^HL7nnn|Q0010|555444222111^^^MPI^MR||19980531|19990531|

0. Segment ID = QPD 1. Message Query Name a. Identifier = Q42 b. Text = Tabular Dispense History c. Name of Coding System = HL7nnn 2. Query Tag = Q0010 3. Submitting Organization a. Organization Name = 555444222111 b. Organization Name Type Code = c. ID Number = d. Check Digit = MPI e. Code Identifying the Check Digit Scheme = MR f. Assigning Authority g. Assigning Facility 4. Provider Organization = 5. Payor Organization = 19980531 6. Patient Identifier List = 19990531 7. Patient Name = 8. Date/Time of Birth 9. Accident Date/Time 10. Insurance Plan ID 11. Group Number 12. Patient Member Number 13. Plan Type 14. Service Effective Date 15. Service Expiration Date 16. Coverage Inquiry Code 17. Role Person 18. Provider Type

QRD Original-Style Query Definition QRF Original style query filter QRI Query Response Instance RCP Response Control Parameter RDF Table Row Definition RDT Table Row Data REL Clinical Relationship Segment

RF1 Referral Information

RF1||||||8094|20060705||20060705||8094

0. Segment ID = RF1 1. Referral Status = 2. Referral Priority = 3. Referral Type = 4. Referral Disposition = 5. Referral Category = 6. Originating Referral Identifier = 8094 7. Effective Date = 20060705 8. Expiration Date = 9. Process Date = 20060705 10. Referral Reason = 11. 8094

RFI Request for Information RGS Resource Group RMI Risk Management Incident

ROL Role

ROL|1|AD|SAHCP|XXXXXXXXXX^^^^^^S|||||6|1

0. 1. 2. 3. 4.

Segment ID = ROL Role Instance ID = 1 Action Code = AD Role = SAHCP Role Person a. ID Number = XXXXXXXXXX b. Family Name = c. Given Name = d. Middle Initial or Name = e. Suffix = f. Prefix = g. Degree = S 5. Role Begin Date/Time = 6. Role End Date/Time = 7. Role Duration = 8. Role Action Reason = 9. - = 6 10. - = 1

RQ1 Requisition Detail-1 RQD Requisition Detail RXA Pharmacy/Treatment Administration RXC Pharmacy/Treatment Component Order RXD Pharmacy/Treatment Dispense RXE Pharmacy/Treatment Encoded Order RXG Pharmacy/Treatment Give RXO Pharmacy/Treatment Order RXR Pharmacy/Treatment Route SAC Specimen Container detail SCD Anti-Microbial Cycle Data SCH Scheduling Activity Information SCP Sterilizer Configuration Notification (Anti-Microbial Devices) SDD Sterilization Device Data SFT Software Segment SID Substance Identifier SLT Sterilization Lot SPM Specimen STF Staff Identification STZ Sterilization Parameter TCC Test Code Configuration TCD Test Code Detail TQ1 Timing/Quantity TQ2 Timing/Quantity Relationship TXA Transcription Document Header UAC User Authentication Credential Segment UB1 UB82 UB2 UB92 Data URD Results/update Definition URS Unsolicited Selection VAR Variance

VND Purchasing Vendor

Daftar Pustaka
http://ranger.uta.edu/~zikos/courses/5339-4392_content_repository/presentations/WEEK4THEORY8The%20Health%20Level%207.pdf

http://www.dicom4india.com/OtherStd.htm

http://www.corepointhealth.com/resource-center/hl7-resources/hl7-adt

http://www.hosinc.com/products/interfaces/interface_documentation.htm#MSH

http://jwenet.net/notebook/1777/1800.html

http://amisha.pragmaticdata.com/~gunther/oldhtml/tables.html

http://www.dt7.com/neodata/docs.html

https://www.hl7.org/special/committees/vocab/V26_Appendix_A.pdf

http://www.cdc.gov/vaccines/programs/iis/technical-guidance/downloads/hl7-clarification-R4.pdf

http://www.cdc.gov/vaccines/programs/iis/technical-guidance/downloads/hl7guide-1-4-2012-08.pdf

http://www.li.mahidol.ac.th/e-resource/ebook/HL7_Messaging/swf/ebook_docs.swf

http://gudanglinux.info/docs/pdf/gcos/Workshops/W-141/Standar%20Informatika%20Kesehatan%20gcos.pdf

http://msdn.microsoft.com/en-us/library/ee409288.aspx

http://www.mcir.org/forms/MCIR_HL7_Spec_Guide_with_MNF_CVX%20attach.pdf

http://www.mexi.be/documents/hl7/ch300056.htm

http://www.hl7.org/documentcenter/public_temp_A6A4723B-1C23-BA170C1D4DE174BA70E8/wg/xml/drafts/v2xmlmb1.pdf