PMS / EMR Message Specification (Version 2.3.1) (ADT, AL1, OBX, SIU, DFT, PPR (PRB), ORM, VXU)

i2itracks HL7 Interface PMS / EMR Message Specification (Version 2.3.1) (ADT, AL1, OBX, SIU, DFT, PPR (PRB), ORM, VXU) 3663 N. Laughlin Rd., Suite 200 Santa Rosa, CA 95403 866-820-2212 www.i2isys.com 1 i2itracks HL7 Interface PMS Message Specification All rights reserved. No part of this document shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from i2i Systems, Inc

This interface should be compatible with most implementations of ADT, AL1, OBX, SIU, DFT, PPR (PRB), ORM, VXU messages used for Patient Demographics, Allergies, Observations, Appointments and Financial Transactions, Problems, Medications, Immunizations. Each segment table defines the SEQ (Sequence) LEN (Length used by i2i), Element Name, DT (Data Type as defined by the HL7 standard), and i2i Usage. All Sequence and sub-sequence references are zero based. For each message handled, there is a list of the needed segments followed with the segment details. i2isystems has an extensive and flexible HL7 mapping system, please contact us if other formats are preferred. 2

Contents i2itracks HL7 Interface... 1 PMS / EMR Message Specification (Version 2.3.1)... 1 (ADT, AL1, OBX, SIU, DFT, PPR (PRB), ORM, VXU)... 1 ADT - Patient Message... 4 MSH - Message Header Segment... 4 PID - Patient Identification Segment... 5 PD1 - Patient Additional Demographic Segment... 6 PV1 Patient Visit... 6 AL1 Allergy Information Segment... 6 OBX Observation / Result Segment (CDI Events)... 7 Notes Regarding OBX and the Custom Data Integrator (CDI)... 7 SIU - Schedule Information Unsolicited (Patient Appointments)... 9 MSH - Message Header Segment... 9 PID - Patient Identification Segment... 10 SCH - Schedule Activity Information Segment... 11 AIP - Appointment Information Personnel Resource... 11 AIL - Appointment Information Location... 11 AIS - Appointment Status... 12 DFT Detail Financial Transaction (Procedure Record)... 13 MSH - Message Header Segment... 13 PID - Patient Identification Segment... 14 FT1 - Financial Transaction Segment... 15 PPR Patient Problem Message... 16 MSH - Message Header Segment... 16 PID - Patient Identification Segment... 17 PRB Problem Detail Segment... 18 ORM Patient Medication Message... 19 MSH - Message Header Segment... 19 PID - Patient Identification Segment... 20 ORC Common Order Segment... 21 RXO Pharmacy Order Segment... 22 VXU V04 Vaccination Record Message... 23 MSH - Message Header Segment... 23 PID - Patient Identification Segment... 24 RXA - Pharmacy Administration Segment... 25 RXR - Pharmacy Route Segment... 26 OBX Observation Result Segment... 27 3

ADT - Patient Message MSH PID PD1 PV1 ZP! AL1 Message Header (one allowed per message) Patient Identification (one allowed per message) Patient Additional Demographic Information (one allowed per message) Patient Visit Information (one allowed per message) Custom Patient Demographics (one allowed per message) Allergy Information Segment MSH - Message Header Segment 1 Field Separator ST Field Separator. 2 Encoding Characters ST Encoding Characters. 3 180 Sending Application ST i2i 4 180 Sending Facility 4^0 Sending Facility Location ID ST This is the ID for the Location-This field to be arranged with receiving Vendor. 4^1 Sending Facility Location Name ST This is the name for the Location- This field to be arranged with receiving Vendor. 5 Receiving Application 7 Date/Time of Message TS 9 Message Type 9^0 3 Message Type ID ID ADT 9^1 3 Trigger Event ID A04" = Add/Edit 10 20 Message control ID ST Unique message ID 11 1 Processing ID PT D= Debugging, P = Production, T = Training 12 Version VID 2.4 Example:MSH ^~\& i2i 12^West Covina Health Center 20100503150638 ADT^A04 123 P 2.4 4

PID - Patient Identification Segment 1 4 Set ID SI 2 50 ID Patient ST Patient ID other then Medical Record 3 50 ID Patient Medical Record Number ST The Patient ID for this patient. 5 Patient Name 5^0 50 Family Name XPN The last name of the patient. 5^1 50 Given Name XPN The first name of the patient. 5^2 50 Middle Name XPN The middle initial or name of the patient. 7 26 Date/Time of Birth TS The birth date of the patient. 8 1 Patient Sex ST Sex of Patient: M = Male, F = Female, U = Unknown. else Unknown 10 Patient Race CE 10^0 50 Patient Race ID ST Race ID 10^1 50 Race Description ST Example: Black, White, Etc. 11 Patient Address XAD 11^0 50 Address 1 ST The Address 1 of the patient. 11^1 50 Address 2 ST The Address 2 of the patient. 11^2 50 City ST The City of the patient. 11^3 2 State ST The State abrv. of the patient. 11^4 10 Zip ST The Zip Code of the patient. 13 Home Phone and Email Address XTN Fill out according to the XTN data type specification 15 Language CE 15^0 50 Primary language ID ST Primary language ID 15^1 50 Primary Language Description/Label ST Examples: English, Spanish 19 16 SSN ST The SSN of the patient 666381197 22 Patient Ethnic Group CE 22^0 50 Ethnic Group ID ST ID for Ethnic Group EX: 2 22^1 50 Ethnic Group Description/Label St Name of Ethnic Group EX: Non Hispanic Example:PID 1 83652 T234 999980000234 PATIENT^TEST^A 19690101 M W^White 615 Esplanad Ave.^Redondo Beach^CA^90277 213-111-1111 707-111-1111 x118 E^English 666381197 2^Non-Hispanic 5

PD1 - Patient Additional Demographic Segment 1 4 Set ID SI 3 Primary Patient Location XON 3^0 50 Primary Patient Location ID ST The ID of the patient s primary Facility. 3^1 50 Primary Patient Location Description/Label ST The name of the patient s primary Facility. 4 Patient Primary Care Provider. XCN 4^0 50 Provider ID ST The ID of the patient's primary provider. 4^1 50 Provider Name ST The name of the patient's primary provider. 11 1 Can Be Contacted INT 1 = Yes, 0= No Example: PD1 1 832^Redwood Health Center 1234^Benson, Michael MD 1 PV1 Patient Visit 1 4 Set ID SI Set ID 20 Financial Class FC Contains Financial Class of patient for reimbursement 20^0 50 Financial Class ID ST ID of Financial Class 20^1 50 Financial Class Description/Label ST Name/Description of Financial Class Example: PV1 1 0001^Blue Shield of CA AL1 Allergy Information Segment 1 10 Set ID SI Set ID 2 2 Allergy Type IS DA = Drug Allergy FA = Food Allergy OA = Other Allergy 3 Allergy code / mnemonic / description CE 3^0 50 Allergy ID ST Unique identifier for the allergy 3^1 50 Allergy Name ST Name of the allergy 3^2 50 Name of Coding System ST The coding system used to identify the allergy ( L = Local) 5 50 Allergy Reaction ST Short, textual description of the specific allergy reaction (convulsions, sneeze, rash, etc.) 6 8 Identification Date DT The date that the allergy was determined to be active / not active (YYYYMMDD) 7 1 Status IS A = Active N = Not Active E = Entered in Error Example: AL1 DA 00000000002^Penicillins^L bradycardia 20091204 A 6

OBX Observation / Result Segment (CDI Events) Used to report an observation / result for a patient. Typically, vitals and other patient indicators are reported using this segment. 1 10 Set ID SI Set ID 2 2 Value Type ID Possible Value Types: ST String Data. NM Numeric CE Coded Entry. TX Text Data. 3 Observation Identifier CE 3^0 50 Observation Type ID ST ID of the observation type that is being reported. 3^1 50 Observation Type Name ST Name of the observation type that is being reported. 3^2 50 Name of Coding System ST The coding system used to identify the observation type ( L = Local) 5 255 Observation Value ST The value for the observation 6 50 Units ST The units for the value 7 50 Reference Ranges ST Reference ranges for the value 14 14 Date / Time of the Observation TS YYYYMMDDHHMMSS Example: OBX 1 ST 177^Temperature^L 98.7 fhr 20080708144921 Example: OBX 2 ST 35^Smoking Status^L Past Smoker 20080708144921 Notes Regarding OBX and the Custom Data Integrator (CDI) The OBX segment can be used to report a wide variety of patient observations to i2itracks. There is no limit on the type and variety of events that can be sent Data sent in this segment can be mapped in the i2itracks Custom Data Integrator New types of data can be added at any time without additional HL7 mapping by simply adding the data to the message The following is a short list of data types being sent by customers: Asthma Daytime and Nighttime Symptoms Colonoscopy Contraindication to Immunizations Current Tobacco User Discharged after AMI, CABG or PTCA ECG 12 Lead Diagnostic Study Exclusion: End Stage Renal Disease Exclusion: Terminally ill Exclusion: Asthma medication Exclusion: Colectomy (MU) or Colorectal Cancer Exclusion: Hysterectomy (If it is not an ICD-9 code) Eye Exam Flexible Sigmoidoscopy 7

FOBT (Fecal Occult Blood Test)/FIT Follow up Plan For BMI Follow Up Plan for Depression Foot Exam Foot Exam: Visual Foot Exam: Sensory (Monofilament) Foot Exam: Pedal Pulse Hysterectomy Immunizations recorded, but given elsewhere - Historical Immunizations Indication of a sexually active female IUD Lifestyle Recommendations Mammogram Procedure Mastectomy Bilateral (exclusion) Mastectomy Unilateral (exclusion) Nephropathy Screening Nutrition counseling Palliative Care Pap Test/Pap History Persistent Asthma Indication Physical activity counseling Procedure: Cardiac Surgery Procedure: CABG or PTCA Terminal Illness Tobacco Cessation Intervention: Received cessation intervention or counseling Tobacco Use Assessment: Queried about tobacco use Use of Contraceptives Perinatal: Date entered into care Perinatal: Trimester of entry Perinatal: Location of first visit Perinatal: Delivery Date Perinatal: Baby Weight Perinatal: Baby Race Contact i2isystems if you have questions about this feature. 8

SIU - Schedule Information Unsolicited (Patient Appointments) MSH Message Header ( one allowed per message ) PID Patient Identification ( one allowed per message ) SCH Schedule Activity Information Segment (one allowed per message) AIP Appointment Information (one allowed per message) AIL Appointment Information (one allowed per message) AIS Appointment Status MSH - Message Header Segment 1 Field Separator ST Field Separator. 2 Encoding Characters ST Encoding Characters. 3 180 Sending Application ST 4 180 Sending Facility 4^0 Sending Facility Location ID ST This is the ID for the Location-This field to be arranged with receiving Vendor 4^1 Sending Facility Location Name ST This is the name for the Location- This field to be arranged with receiving Vendor. 5 Receiving Application 7 Date/Time of Message TS 9 Message Type 9^0 3 Message Type ID ID SIU 9^1 3 Trigger Event ID S12" = Add or Edit S15 = Cancellation 10 20 Message control ID ST Unique message ID 11 1 Processing ID PT D= Debugging, P = Production, T = Training 12 Version VID 2.4 Example: MSH ^~\& i2i 12^West Covina Health Center 20100503150638 SIU^S12 123 P 2.4 9

PID - Patient Identification Segment 1 4 Set ID SI Set ID 2 50 ID Patient ST Patient ID other then Medical Record 3 50 ID Patient Medical Record Number ST The Patient ID for this patient. 5 Patient Name 5^0 50 Family Name XPN The last name of the patient. 5^1 50 Given Name XPN The first name of the patient. 5^2 50 Middle Name XPN The middle initial or name of the patient. 7 26 Date/Time of Birth TS The birth date of the patient. 8 1 Patient Sex ST Sex of Patient: M = Male, F = Female, U = Unknown. else Unknown 10 Patient Race CE 10^0 50 Patient Race ID ST Race ID 10^1 50 Race Description ST Example: Black, White, Etc. 11 Patient Address XAD 11^0 50 Address 1 ST The Address 1 of the patient. 11^1 50 Address 2 ST The Address 2 of the patient. 11^2 50 City ST The City of the patient. 11^3 2 State ST The State abrv. of the patient. 11^4 10 Zip ST The Zip Code of the patient. 13 Home Phone and Email Address XTN Fill out according to the XTN data type specification 14 20 Work Phone Number XTN The work phone number of the patient. 15 Language CE 15^0 50 Primary language ID ST Primary language ID 15^1 50 Primary Language Description/Label ST Examples: English, Spanish 19 16 SSN ST The SSN of the patient 666381197 22 Patient Ethnic Group CE 22^0 50 Ethnic Group ID ST ID for Ethnic Group EX: 2 22^1 50 Ethnic Group Description/Label St Name of Ethnic Group EX: Non- Hispanic Example:PID 1 83652 T234 999980000234 PATIENT^TEST^A 19690101 M W^White 615 Esplanad Ave.^Redondo Beach^CA^90277 213-111-1111 707-111-1111 x118 E^English 666381197 2^Non-Hispanic 10

SCH - Schedule Activity Information Segment 1 4 Set ID SI Set ID 2 50 Filler Appointment ID ST The value that uniquely identifies this appointment. 7 50 Appointment Reason CE HL7 2.4 required field, i2i does not retain this data, but will include the Appointment Name for 2.4 Compliance. 8 Appointment Type CE 8^0 50 Appointment Type ID ST ID for the Appointment Type 8^1 50 Appointment Name ST Name of Appointment Type 11^4 18 Appointment Timing Quantity ST The begin date/time for which the appointment was scheduled. 16 3 Filler Contact Person ST HL7 2.4 Required field; i2i does not capture this data, the field will always be populated= Unknown 20 3 Entered By Person ST HL7 2.4 Required field; i2i does not capture this data, the field will always be populated= Unknown Example: SCH 1 2807389 AnnualVisit 1001^AnnualVisit ^^^201005261400 Unknown Unknown AIP - Appointment Information Personnel Resource 1 4 Set ID SI Set ID 3 Personnel Resource ST 3^0 50 Resource ID ST ID for appointment resource 3^1 50 Resource Name ST Resource Name; i2i stores the resource name in one field, therefore the name will not be delimited First Name, Last Name etc. 4 50 Resource Role ST HL7 2.4 Required field; i2i does not capture this data, the field will always be populated= Unknown Example: AIP 1 064^MORGAN,HELEN Unknown AIL - Appointment Information Location 1 4 Set ID SI Set ID 3 Appointment Location 3^0 50 Location ID ID The ID for the Location (hard Coded) 3^1 50 Location Name/Label ST The Name of the Health Center Location. This will be hardcoded 4 50 Location Role ST This will be the specific Site. 4^0 50 Site Location ID ID Site location ID 4^1 50 Site Location Name ST Name of Site Location Example:AIL 1 103^i2i Health Center 002^North CLNIC 11

AIS - Appointment Status 1 4 Set ID SI Set ID 10 Filler status code Status of appointment 10^0 1 Appointment Status ST C=Completed, R=Rescheduled, X=Cancelled, NS=No Show Example:AIS 1 X 12

DFT Detail Financial Transaction (Procedure Record) MSH PID FT1 Message Header (one allowed per message) Patient Identification (one allowed per message) Financial Transaction Segment (multiple segments allowed per message) MSH - Message Header Segment 1 Field Separator ST Field Separator. 2 Encoding Characters ST Encoding Characters. 3 180 Sending Application ST 4 180 Sending Facility 4^0 Sending Facility Location ID ST This is the ID for the Location-This field to be arranged with receiving Vendor 4^1 Sending Facility Location Name ST This is the name for the Location- This field to be arranged with receiving Vendor. 5 Receiving Application 7 Date/Time of Message TS 9 Message Type 9^0 3 Message Type ID ID DFT 9^1 3 Trigger Event ID P05" = Add or Edit 10 20 Message control ID ST Unique message ID 11 1 Processing ID PT D= Debugging, P = Production, T = Training 12 Version VID 2.4 Example:MSH ^~\& i2i 12^West Covina Health Center 20100503150638 DFT^P05 123 P 2.4 13

PID - Patient Identification Segment 1 4 Set ID SI Set ID 2 50 ID Patient ST Patient ID other then Medical Record 3 50 ID Patient Medical Record Number ST The Patient ID for this patient. 5 Patient Name 5^0 50 Family Name XPN The last name of the patient. 5^1 50 Given Name XPN The first name of the patient. 5^2 50 Middle Name XPN The middle initial or name of the patient. 7 26 Date/Time of Birth TS The birth date of the patient. 8 1 Patient Sex ST Sex of Patient: M = Male, F = Female, U = Unknown. else Unknown 10 Patient Race CE 10^0 50 Patient Race ID ST Race ID 10^1 50 Race Description ST Example: Black, White, Etc. 11 Patient Address XAD 11^0 50 Address 1 ST The Address 1 of the patient. 11^1 50 Address 2 ST The Address 2 of the patient. 11^2 50 City ST The City of the patient. 11^3 2 State ST The State abrv. of the patient. 11^4 10 Zip ST The Zip Code of the patient. 13 Home Phone and Email Address XTN 14 20 Work Phone Number XTN The work phone number of the patient. 15 Language CE 15^0 50 Primary language ID ST Primary language ID 15^1 50 Primary Language Description/Label ST Examples: English, Spanish 19 16 SSN ST The SSN of the patient 666381197 22 Patient Ethnic Group CE 22^0 50 Ethnic Group ID ST ID for Ethnic Group EX: 2 22^1 50 Ethnic Group Description/Label St Name of Ethnic Group EX: Non Hispanic Example:PID 1 83652 T234 999980000234 PATIENT^TEST^A 19690101 M W^White 615 Esplanad Ave.^Redondo Beach^CA^90277 213-111-1111 707-111-1111 x118 E^English 666381197 2^Non-Hispanic 14

FT1 - Financial Transaction Segment 1 4 Set ID SI Set ID 2 50 Transaction ID ST The value that uniquely identifies this record. 4 10 Transaction Date TS The date on which the visit occurred. 5 10 Transaction Posting Date ST The date on which the visit was entered in the external software. 6 2 Transaction Type IS Identifies type of transaction: CG = Charge, DE = Delete 14 Insurance Plan ST Primary Insurance of Transaction 14^0 50 Insurance Plan ID ST ID for insurance 14^2 50 Insurance Name/Label ST Insurance Name 16 Assigned Patient Location ST Point of Care 16^0 50 Assigned Patient Location ST The ID of the facility at which the visit occurred (from the Facility Record 16^1 50 Assigned Patient Location Name/Label ST Name of Location 19 Diagnosis Code(s) REPEAT CODE = ~ ST This Field has special formatting see example below. There might be multiple codes attached to one visit. 19^0 50 Diagnosis Code ID ST Diagnosis code/icd9-10 for visit 19^1 50 Diagnosis Code Label/Description ST Description of Diagnosis Code. 20 Performed By Code XCN Person/group that performed the test/procedure/transaction, etc 20^0 50 Performed By Code ID ST ID of Provider 20^1 50 Performed By Name ST i2i saves provider name in one field 25 Procedure Code ST 25^0 50 Procedure Code ID ST The CPT of the procedure type 25^1 50 Procedure Code Label/Name ST The Name Description for the Procedure Code Example:FT1 1 1234 20050506 20050610 CE 999^Blue Cross of CA 101^i2i Health Center 250.01^DIABETES UNCOMPLICATED TYPE I NOT STATED UNCNTRL~780.39^OTHER CONVULSIONS~272.4^OTHER AND UNSPECIFIED HYPERLIPIDEMIA~790.4^NONSPEC ELEVATION OF LEVELS OF TRANSAMINASE/LDH 205^Michael Swanson MD 99213^Annual Visit 15

PPR Patient Problem Message MSH PID PRB Message Header Patient Identification Problem Detail Segment MSH - Message Header Segment 1 Field Separator ST Field Separator. 2 Encoding Characters ST Encoding Characters. 3 180 Sending Application ST i2i 4 180 Sending Facility 4^0 Sending Facility Location ID ST This is the ID for the Location-This field to be arranged with receiving Vendor 4^1 Sending Facility Location Name ST This is the name for the Location- This field to be arranged with receiving Vendor. 5 Receiving Application 7 Date/Time of Message TS 9 Message Type ST 9^0 3 Message Type ID ID PPR 9^1 3 Trigger Event ID PC1 = PC/ Problem Add PC2 = PC/ Problem Update PC3 = PC/ Problem Delete 10 20 Message control ID ST Unique message ID 11 1 Processing ID PT D= Debugging, P = Production, T = Training 12 Version VID 2.4 Example:MSH ^~\& i2i 12^West Covina Health Center 20100503150638 PPR 123 P 2.4 16

PID - Patient Identification Segment 1 4 Set ID SI 2 50 ID Patient ST Patient ID other then Medical Record 3 50 ID Patient Medical Record Number ST The Patient ID for this patient. 5 Patient Name 5^0 50 Family Name XPN The last name of the patient. 5^1 50 Given Name XPN The first name of the patient. 5^2 50 Middle Name XPN The middle initial or name of the patient. 7 26 Date/Time of Birth TS The birth date of the patient. 8 1 Patient Sex ST Sex of Patient: M = Male, F = Female, U = Unknown. else Unknown 10 Patient Race CE 10^0 50 Patient Race ID ST Race ID 10^1 50 Race Description ST Example: Black, White, Etc. 11 Patient Address XAD 11^0 50 Address 1 ST The Address 1 of the patient. 11^1 50 Address 2 ST The Address 2 of the patient. 11^2 50 City ST The City of the patient. 11^3 2 State ST The State abrv. of the patient. 11^4 10 Zip ST The Zip Code of the patient. 13 Home Phone and Email Address XTN 13^0 20 Home Phone Number XTN The home phone number of the patient. 13^1 20 Cell Number XTN The cell phone number of the patient. 13^2 50 Email Address XTN The Email Address of patient. 14 20 Work Phone Number XTN The work phone number of the patient. 15 Language CE 15^0 50 Primary language ID ST Primary language ID 15^1 50 Primary Language Description/Label ST Examples: English, Spanish 19 16 SSN ST The SSN of the patient 666381197 22 Patient Ethnic Group CE 22^0 50 Ethnic Group ID ST ID for Ethnic Group EX: 2 22^1 50 Ethnic Group Description/Label St Name of Ethnic Group EX: Non Hispanic Example:PID 1 83652 T234 999980000234 PATIENT^TEST^A 19690101 M W^White 615 Esplanad Ave.^Redondo Beach^CA^90277 213-111-1111 707-111-1111 x118 E^English 666381197 2^Non-Hispanic 17

PRB Problem Detail Segment 1 2 Action Code ST AD = Add CO = Correct DE = Delete UP = Update 2 14 Action Date / Time TS The date / time that the operation represented by the action code was performed. (YYYYMMDDHHMMSS) 3 Problem ID 3^0 50 Problem Type ID ST The unique identifier for the problem type (from ID of Z16). 3^1 50 Problem Type Name ST The problem type name 3^2 50 Name of Coding System ST The coding system used to identify the problem type ( L = Local) 4 50 Problem Instance ID ST Unique identifier for the instance of the problem. 7 14 Problem Established Date/Time TS The date / time when the problem was initially identified by the care giver (YYYYMMDDHHMMSS). 14 1 Problem Life Cycle Status ST The current status of the problem: A = Active N = Not Active R = Resolved D = Entered in Error 15 14 Problem Life Cycle Status Date / Time TS The effective date / time of the problem status (YYYYMMDDHHMMSS). 16 14 Problem Date of Onset TS The date / time when the problem began (YYYYMMDDHHMMSS). Example:PRB UP 20110831130000 401.9^HYPERTENSION^L 253869 20110831130000 A 20110831130000 18

ORM Patient Medication Message MSH Message Header PID Patient Identification ORC RXO Common Order Pharmacy Order MSH - Message Header Segment 1 Field Separator ST Field Separator. 2 Encoding Characters ST Encoding Characters. 3 180 Sending Application ST 4 180 Sending Facility 4^0 Sending Facility Location ID ST This is the ID for the Location-This field to be arranged with receiving Vendor 4^1 Sending Facility Location Name ST This is the name for the Location- This field to be arranged with receiving Vendor. 5 Receiving Application 7 Date/Time of Message TS 9 Message Type 9^0 3 Message Type ID ID ORM 9^1 3 Trigger Event ID Ignored, always considered an Edit 10 20 Message control ID ST Unique message ID 11 1 Processing ID PT D= Debugging, P = Production, T = Training 12 Version VID 2.4 Example:MSH ^~\& i2i 12^West Covina Health Center 20100503150638 PPR 123 P 2.4 19

PID - Patient Identification Segment 1 4 Set ID SI 2 50 ID Patient ST Patient ID other then Medical Record 3 50 ID Patient Medical Record Number ST The Patient ID for this patient. 5 Patient Name 5^0 50 Family Name XPN The last name of the patient. 5^1 50 Given Name XPN The first name of the patient. 5^2 50 Middle Name XPN The middle initial or name of the patient. 7 26 Date/Time of Birth TS The birth date of the patient. 8 1 Patient Sex ST Sex of Patient: M = Male, F = Female, U = Unknown. else Unknown 10 Patient Race CE 10^0 50 Patient Race ID ST Race ID 10^1 50 Race Description ST Example: Black, White, Etc. 11 Patient Address XAD 11^0 50 Address 1 ST The Address 1 of the patient. 11^1 50 Address 2 ST The Address 2 of the patient. 11^2 50 City ST The City of the patient. 11^3 2 State ST The State abrv. of the patient. 11^4 10 Zip ST The Zip Code of the patient. 13 Home Phone and Email Address XTN 13^0 20 Home Phone Number XTN The home phone number of the patient. 13^1 20 Cell Number XTN The cell phone number of the patient. 13^2 50 Email Address XTN The Email Address of patient. 14 20 Work Phone Number XTN The work phone number of the patient. 15 Language CE 15^0 50 Primary language ID ST Primary language ID 15^1 50 Primary Language Description/Label ST Examples: English, Spanish 19 16 SSN ST The SSN of the patient 666381197 22 Patient Ethnic Group CE 22^0 50 Ethnic Group ID ST ID for Ethnic Group EX: 2 22^1 50 Ethnic Group Description/Label St Name of Ethnic Group EX: Non Hispanic Example:PID 1 83652 T234 999980000234 PATIENT^TEST^A 19690101 M W^White 615 Esplanad Ave.^Redondo Beach^CA^90277 213-111-1111 707-111-1111 x118 E^English 666381197 2^Non-Hispanic 20

ORC Common Order Segment 1 2 Order Control ID NW = Medication Prescribed FU = Medication Filled DC = Medication Discontinued XO = Medication Updated 2 50 Placer Order Number ST The value that uniquely identifies this medication event. 3 50 Filler Order Number ST The value that uniquely identifies this prescription (i.e. Prescription Number) 5 2 Order Status ST CA = Order was canceled CM = Order is completed ER = Entered in error 7 Quantity / Timing ST 7^0 6 Quantity NM Quantity of dosage (i.e. number of tablets) 7^1 30 Units ST Units (i.e. Tablets) 7^2 30 Interval ST Interval (i.e. 4 times a day) 7^3 14 Start Date / Time TS YYYYMMDDHHMMSS 7^4 14 End Date / Time TS YYYYMMDDHHMMSS 7^5 100 Text ST SIG (i.e. 1T BOD) 9 14 Date/Time of Transaction TS The date / time that the medication was prescribed, filled, discontinued, or updated. (YYYYMMDDHHMMSS) 12 Ordering Provider 12^0 50 ID ST Unique identifier for the ordering provider 12^1 50 Last Name ST The ordering provider s last name 12^2 50 First Name ST The ordering provider s first name 12^3 50 Middle Name ST The ordering provider s middle name 12^4 20 Suffix ST The ordering provider s name suffix 12^5 20 Prefix ST The ordering provider s name prefix Example:ORC NW 123 345 30^TABLETS^BID^20111113150000^20111213150000^BID 20111113150000 TY^TAYLOR^ROBE RT^K^MD^DR 21

RXO Pharmacy Order Segment 1 Requested Give Code The unique identifier for the drug 1^0 50 Identifier ST NDC code for the drug 1^1 50 Text ST Description of the drug 1^2 50 Name of coding system ST Always NDC 1^3 50 Alternate identifier ST The alternate identifier for the drug 1^4 50 Alternate text ST The alternate description of the drug 1^5 50 Name of alternate coding system ST The name of the alternate coding system used to identify the drug ( L = Local) 5 Requested Dosage Form ST The form of the drug 13 Number of Refills 13^0 3 Number of Refills Prescribed NM The initial number of refills prescribed 13^1 3 Number of Refills Remaining NM The number of refills remaining 14 50 Ordering Provider s DEA Number ST The ordering provider s DEA number 18 Give Strength NM 325 19 Give Strength Units ST Mg Example:RXO 62584-0265^METOPROLOL TARTRATE^NDC Tablet 2 2 AP1234567 325 mg 22

VXU V04 Vaccination Record Message MSH - Message Header PID - Patient Identification ( one allowed per message ) RXA - Pharmacy Administration Segment MSH - Message Header Segment 1 Field Separator ST Field Separator. 2 Encoding Characters ST Encoding Characters. 3 Sending Application 5 Receiving Application 7 Date/Time Of Message TS 9 3 Message Type ID Must be VXU. 9^1 3 Trigger Event ID Must be V04. 10 20 Message control ID ST Unique message ID 11 1 Processing ID PT D= Debugging, P = Production, T = Training 12 Version VID 2.4 Example:MSH ^~\& 20091013164358 VXU^V04 P 2.3.1 23

PID - Patient Identification Segment 1 4 Set ID SI 2 50 ID Patient ST Patient ID other then Medical Record 3 50 ID Patient Medical Record Number ST The Patient ID for this patient. 5 Patient Name 5^0 50 Family Name XPN The last name of the patient. 5^1 50 Given Name XPN The first name of the patient. 5^2 50 Middle Name XPN The middle initial or name of the patient. 7 26 Date/Time of Birth TS The birth date of the patient. 8 1 Patient Sex ST Sex of Patient: M = Male, F = Female, U = Unknown. else Unknown 10 Patient Race CE 10^0 50 Patient Race ID ST Race ID 10^1 50 Race Description ST Example: Black, White, Etc. 11 Patient Address XAD 11^0 50 Address 1 ST The Address 1 of the patient. 11^1 50 Address 2 ST The Address 2 of the patient. 11^2 50 City ST The City of the patient. 11^3 2 State ST The State abrv. of the patient. 11^4 10 Zip ST The Zip Code of the patient. 13 Home Phone and Email Address XTN 14 20 Work Phone Number XTN The work phone number of the patient. 15 Language CE 15^0 50 Primary language ID ST Primary language ID 15^1 50 Primary Language Description/Label ST Examples: English, Spanish 19 16 SSN ST The SSN of the patient 666381197 22 Patient Ethnic Group CE 22^0 50 Ethnic Group ID ST ID for Ethnic Group EX: 2 22^1 50 Ethnic Group Description/Label St Name of Ethnic Group EX: Non Hispanic Example:PID 1 83652 T234 999980000234 PATIENT^TEST^A 19690101 M W^White 615 Esplanad Ave.^Redondo Beach^CA^90277 213-111-1111 707-111-1111 x118 E^English 666381197 2^Non-Hispanic 24

RXA - Pharmacy Administration Segment 3 8 Given Date DT 5 Administered code CE 5^0 20 Vaccine CVX ST 5^1 255 Vaccine Name ST 5^2 20 Vaccine CPT ST 10 Administering provider XCN 10^0 255 Provider Name ST 15 50 Substance lot number ST 16 10 Substance expiration date TS 17 255 Substance manufacturer name ST 20 2 Status of Treatment of event ST CP = Complete, RE = Refused, NA = Not Administered 21 1 Action Code ST A = ADD, D = Delete, U = Update Example:RXA 0 4 20090918 100^^CVX^90669^^CPT 999 16241^Jean Gene,LVN D50003 Wyeth-Ayerst A 25

RXR - Pharmacy Route Segment 1 Administration Site CE 1^0 20 Site ST Possible Value Types: LT = Left Thigh LA = Left Arm LD = Left Deltoid LG = Left Gluteous Medius LVL = Left Vastus Lateralis LLFA = Left Lower Forearm RA = Right Arm RT = Right Thigh RVL = Right Vastus Lateralis RG = Right Gluteous Medius RD = Right Deltoid RLFA = Right Lower Forearm 2 Administration Route CE 2^0 20 Route ST Possible Value Types: ID = Intradermal IM = Intramuscular IN = Intranasal IV = Intravenous PO = Oral OTH = Other SC = Subcutaneous TD = Transdermal Example: RXR SC^Subcutaneous^HL70162 LT^LEFT THIGH^HL70163 26

OBX Observation Result Segment 1 4 Set ID - OBX SI Set ID. 2 2 Value Type ST TS 3.0 Observation Identifier 3^1 8 Observation Type ST Must be VIS Date. 5 8 Observation Value DT VIS Date. Example: OBX 1 TS 29768-9^VIS Date 20080313 F 27