Medicalis Workflow HL7 to SQL Specification

Medicalis Workflow HL7 to SQL Specification Medicalis Workflow HL7 to SQL Specification Version 6.7.0 January 2015 Document and Contact Information Document Revisions Version Date Author(s) Description Document Status 6.7.0 16 January 2015 Tiffany Quinlan Added 'Using this Document' section and links to dictionaries from field specs 6.6.0 December 2014 Balazs Igli OBX updates for observations and reports. Added two result processing instructions. 6.5.0 December 2014 Geoff Wheeler Minor updates for 6.5.0 6.2.0 October 2014 Geoff Wheeler Updated for 6.2.0 6.1.0 October 2014 Jeremy Hossfeld Added supplies (RQD), other charges (FT1) and pharmeceuticals (RQD, RQA) 6.0.0 July 2014 Geoff Wheeler Updated for 6.0.0 2.4.3 25 June 2013 Geoff Wheeler Added ZRP-16 - Worklist, ZRP-17 - Image Location, and ZOF Segment 2.2 22 March 2013 Tiffany Quinlan Addition of sections: Required & Optional Fields for HL7 into Professional/Analytics Validating HL7 Against the Medicalis HL7 Spec 2.1 23 November 2012 Balazs Igli Added ZRP-15.1.1 Create Call Report Request 2.0 15 June 2012 Geoff Wheeler Updated for Professional 2.4 1.1 20 January 2012 Geoff Wheeler Added tables for specific code values 0.4 9 June 2011 Balazs Igli Added RWF push data to MClinical (see issue 75278) 0.3 7 January, 2011 Geoff Wheeler Added processing of the DG1 segment and placer order data. 0.2 13 December, 2010 Geoff Wheeler Added processing of the AL1 segment. 0.1 4 August, 2010 Geoff Wheeler Draft document creation Using CDR HL7-XML Specification (CDR 1.5) as template. Draft Page 1

Primary Contact Cleon Hillwood cleon.hillwood@medicalis.com Position: Product Manager Corporate Office Medicalis Corporation 8 Riverbend Drive Kitchener, Ontario +1 (519) 579-5454 Document Stakeholders and Reviewers Role Name Email Reviewing Role (Author, Approve, Review, Copied) Product Manager Cleon Hill Wood-Salomon cleon.hillwood@medicalis.com Approve Director, Customer Operations Derek MacNeil derek.macneil@medicalis.com Review Architect Marc Durand marc.durand@medicalis.com Review HL7 Integration Tiffany Quinlan tiffany.quinlan@medicalis.com Review Development Lead Geoff Wheeler geoff.wheeler@medicalis.com Review DBA Karen Choi karen.choi@medicalis.com Review SV Representative Kristen Taylor kristen.taylor@medicalis.com Review Support Representative Jeff MacDonald jeff.macdonald@medicalis.com Review Legal Information Copyright Medicalis Corp., 2014. All rights reserved. This document and the information contained herein are proprietary and confidential. It may not be duplicated, redistributed, reused, or displayed to any other party without the express written consent of Medicalis. Medicalis and the Medicalis logo are trademarks of Medicalis Corp. All other names are trademarks of their respective companies, and are only used for identifying product and company information. Table of Contents 1.0 Introduction 1.1 HL7 Conformance 1.2 Document Overview 1.3 Terms 2.0 Data Communication 2.1 TCP/IP Communication HL7 Device 2.1.1 MLLP Minimal Lower Layer Protocol 2.2 File Communication File Device 2.3 Acknowledgement 2.3.1 ACK Formation 2.4 Invalid Characters 2.5 Escaping 2.6 Null vs. Empty Value 2.7 Data Quality and Asynchronous Messaging 3.0 Message Profile Overview 3.1 Dynamic Definition 3.2 Static Definition 3.2.1 CDR Database Table Column 3.2.2 Notes Column 3.2.3 Usage Column 3.3 Segment Definition 3.3.1 Database.Table.Column 3.3.2 Notes Column 3.4 User-defined Tables and Auto-population Page 2

3.5 Multiple MRN and Accession Issuers 3.6 Processing Instructions 3.7 Vendor Specific Data Types 3.7.1 WS Workflow Status 4.0 Message Profiles 4.0.1 Actors 4.1 Patient Update/Register Profile [ADT^A08 / ADT^A04] 4.1.1 Use Case 4.1.2 Interactions 4.1.3 Example Message 4.1.4 Example ACK 4.1.5 Message Static Definition 4.2 Patient Merge Profile [ADT^A18 / ADT^A40] 4.2.1 Use Case 4.2.2 Interactions 4.2.3 Example Message 4.2.4 Example ACK 4.2.5 Message Static Definition 4.3 Patient Link Profile [ADT^A24] 4.3.1 Use Case 4.3.2 Interactions 4.3.3 Example Message 4.3.4 Example ACK 4.3.5 MessageStatic Definition 4.4 General Order Profile [ORM^O01] 4.4.1 Use Case 4.4.2 Interactions 4.4.3 Example Message 4.4.4 Example ACK 4.4.5 Message Static Definition 4.5 Imaging Order Profile [OMI^O23] 4.5.1 Use Case 4.5.2 Interactions 4.5.3 Example Message 4.5.4 Example ACK 4.5.5 Message Static Definition 4.6 Result Profile [ORU^R01] 4.6.1 Use Case 4.6.2 Interactions 4.6.3 Example Message 4.6.4 Example ACK 4.6.5 Message Static Definition 4.7 Update Personnel Record [PMU^B02] 4.7.1 Use Case 4.7.2 Interactions 4.7.3 Example Message 4.7.4 Example ACK 4.7.5 Message Static Definition 4.8 Inventory Item Master File Message [MFN^M15] 4.8.1 Use Case 4.8.2 Interactions 4.8.3 Example Message 4.8.4 Example ACK 4.8.5 Message Static Definition 4.9 Patient Location Master File Message [MFN^M05] 4.9.1 Use Case 4.9.2 Interactions 4.9.3 Example Message 4.9.4 Example ACK 4.9.5 Message Static Definition 4.10 Additional Basic Observation/Service Attributes [MFN^M12] 4.10.1 Use Case 4.10.2 Interactions 4.10.3 Example Message 4.10.4 Example ACK Page 3

4.10.5 Message Static Definition 4.11 Medical Document Management Profile [MDM^T02 / MDM^T04 / MDM^T08 / MDM^T11] 4.11.1 Use Case 4.11.2 Interactions 4.11.3 Example Message Document Edit Notification 4.11.4 Example ACK 4.11.5 Message Static Definition 4.12 Application Management Data Message [NMD^N03] 4.12.1 Use Case 4.12.2 Interactions 4.12.3 Example Message 4.12.4 Example ACK 4.12.5 Message Static Definition 5.0 HL7 to SQL Mappings 5.0.1 Sample Mapping 5.1 MSH Segment 5.2 EVN Segment 5.3 PID 5.4 PD1 5.5 LAN 5.6 ROL 5.7 NK1 5.8 PV1 5.9 PV2 5.10 AL1 5.11 GT1 5.12 IN1 5.13 MRG 5.14 ORC 5.15 OBR 5.16 CTD 5.17 DG1 5.18 IPC 5.19 ZRP 5.20 ZOF 5.21 OBX (for Reports) 5.22 OBX (for Observations, Lab Results or Precautions) 5.23 OBX (for MDM OLF data) 5.24 BLG 5.25 STF 5.26 OVR 5.27 LOC 5.28 LCH 5.29 IIM 5.30 PRA 5.31 EDU 5.32 NTE 5.33 OM1 5.34 OM7 5.35 TXA 5.36 ZNF 5.37 FT1 5.38 RQD 5.39 RXD 5.40 RXA 6.0 Code Reference 6.1 Abnormal Flag 6.2 Address Type 6.3 Admission Type 6.4 Admit Source 6.5 Allergen Type 6.6 Allergy Clinical Status 6.7 Allergy Reliability 6.8 Allergy Severity 6.9 Ambulatory Status Page 4

6.10 Assigning Authority 6.11 Country 6.12 Employment Status 6.13 Filler Order Status 6.14 Degree 6.15 Filler Order Status 6.16 Hospital Service 6.17 Identity Reliability 6.18 Indication Category 6.19 Individual Sex 6.20 Language Proficiency 6.21 Marital Status 6.22 Name Type 6.23 Observation Result Status 6.24 Patient Class 6.25 Placer Order Status 6.26 Priority Code 6.27 Procedure Step Status 6.28 Province/State 6.29 Race 6.30 Relation Type 6.31 Religion 6.32 Requested Procedure Status 6.33 Result Status 6.34 Subspecialty 6.35 Telecommunication Use 6.36 Time Zone 6.37 VIP Indicator 6.38 Visit Indicator 7.0 Integration Notes 7.1 Order Control Codes 7.2-32 Common (ADT^A08, ORM, ORU) Processing Instructions 7.3-29 Common (ORM, ORU) Processing Instructions 7.4-1 Additional ORM Processing Instructions 7.5-6 Additional ORU Processing Instructions 8.0 Using This Document 8.1 Table of Contents 8.2 CTRL + F Hyperlinks 8.3 Required Fields 8.4 Issuers 1.0 Introduction This document defines how a standard set of HL7 messages for defining data received from a RIS that will be processed into the Medicalis databases. It is assumed that the reader of this document is familiar with the details of the Medicalis Interface Engine and the Medicalis databases. Medicalis employs a 2 part system for processing HL7 data. The Intelligo Interface Engine handles all HL7 communication including queue management, and user defined mappings. Intelligo transports messages but is not a long term clinical database. The CDR service handles processing of each message as a clinical transaction. The CDR deconstructs, validates, and then stores the data in each message into a long term clinical repository. 1.1 HL7 Conformance This document follows the Conformance methodology defined in Chapter 2 of the HL7 specification, version 2.5. The scope of this document covers only those elements of the HL7 Standard which are applicable to the CDR. The CDR data model is also based heavily on the HL7 2.5 specification, and the IHE patient registration, and scheduled order workflows. 1.2 Document Overview Page 5

The introductory sections of this document outline the general communication and workflow conformance of Intelligo and the CDR. This includes network communication, escaping, acknowledgement, vendor specific data types and behavior, and extensions to the message profile itself. These sections are followed by chapters for each supported message profile (e.g. ADT, ORM, ORU). The appendices contain reference information such as common user defined tables (e.g. Country Codes). 1.3 Terms This section defines a series of important terms. These descriptions are valid within the scope of this document: Intelligo CDR Medicalis Queue The Intelligo Interface Engine handles all HL7 communication including queue management, and user defined mappings. Intelligo transports messages but is not a long term clinical database. Intelligo is a trademark of Medicalis Corporation. The Medicalis CDR (Clinical Data Repository) is a service and SDK that handles processing of each message as a clinical transaction. The CDR deconstructs, validates, and then stores the data in each message into a long term clinical repository. The CDR is used as a foundation or platform for clinical applications such as a PACS, or an order entry application. The creator of Intelligo and the CDR. Medicalis delivers clinical knowledge to the point-of-care. Created with the goal of delivering evidencebased medicine, and founded upon deep expertise in healthcare information integration, Medicalis has the unique ability to capture clinical knowledge and deliver it to healthcare workers directly involved in patient care decisions. Part of the Intelligo Interface Engine. Intelligo processes messages asynchronously. When a message is received it is written to a Received Queue and acknowledged. Soon after, the message is processed, and is moved to a Processed Queue on success, or Error Queue on error. Queues are managed by the Intelligo system administrator. Placer Order Filler Order A diagnostic imaging order created typically by an ordering physician. Typically originates from a HIS or EMR system. A Placer Order is generally a high level request for imaging and is filled by 1 or many Filler Orders. The CDR simply stores the Placer Order Number as a linking attribute for Filler Orders. A departmental diagnostic imaging order managed by a RIS (Radiology Information System). A Filler Order fills a Placer Order. Also known as an Imaging Service Request. A Filler Order is identified by its Filler Order ID, or its Accession number. These are generally the same value, but can be different. These orders contain more detailed information about the study that is specific to the radiology department. Filler Orders are made up of 1 or more Requested Procedures. Requested Procedure Part of a Filler Order. This is a reportable unit of work that will typically be coded and billable. The CDR stores additional status information regarding Requested Procedures. In the CDR, results (reports) are associated with Requested Procedures. Requested Procedures are made up on 1 or more Procedure Steps. Procedure Step In the CDR, this object represents both a Scheduled Procedure Step and a Performed Procedure Step. These are the most granular units of work that can be acted on. Scheduled refers to a unit of work to be done. These are typically units of work that require a Protocol. Performed refers to a unit of work that has been done. In a PACS, Performed Procedure Steps would have Series and Instance data attached to them. The CDR does not implement the IHE data model past the level of the Procedure Step. 2.0 Data Communication This section focuses on the data communication elements related to this message profile. Page 6

2.1 TCP/IP Communication HL7 Device HL7 message communication is handled by the Intelligo Interface Engine. Intelligo is a Java (JDK 1.4.2) based system, and makes use of the standard Java socket communication libraries for access to network resources. The Intelligo HL7 Device uses TCP/IP to communicate HL7 messages as defined in Chapter 2 or the Hl7 2.5 specification. The sending/receiving ports are configurable and are therefore defined at the time of integration. Intelligo supports receiving messages over multiple connections. However it is recommended that a RIS open a single TCP/IP connection and make best efforts to maintain and reuse that connection for as long as possible. It is expected that each HL7 message transmitted will be constructed using the basic message formation rules outlined in Chapter 2 of the HL7 specifications (versions 2.0 2.5). Also, each message must be terminated with a message separator sequence according to the MLLP (Minimal Lower Layer Protocol). 2.1.1 MLLP Minimal Lower Layer Protocol HL7 defines a set of special wrapping characters that enclose an HL7 message. These characters are known as: Name Symbol Suggested Value (HEX) Purpose Start Block <SB> 0x0B Marks the beginning of a message (immediately precedes the MSH segment). End Block <EB> 0x1C Marks the end of a message. Carriage Return <CR> 0x0D Also marks the end of a message (follows the End Block). These characters wrap a message like so: <SB>MSH sample <EB><CR> As noted in the table above, the HL7 specification defines hex characters 0x1C0D as the default separator sequence. Intelligo allows this value to be configured in cases of non compliance. The Intelligo HL7 device does not require a Start Block character to be present when receiving messages. This device instead simply looks for the separator sequence <EB><CR> when reading messages form the socket stream. Therefore a sending system may safely send messages with or without a Start Block. However, all HL7 messages sent form the Intelligo HL7 Device will include a Start Block character. This includes acknowledgements. 2.2 File Communication File Device The Intelligo Interface Engine can also process HL7 2.5 messages via a file stream. The behavior of this device is configurable; however it can support reading and writing or individual files per message, or large files containing numerous messages. For large files, messages must be separated using the standard separation sequence (defined above in section 2.1.1). The File Device does not support the HL7 batch protocol. 2.3 Acknowledgement The Intelligo Interface Engine supports Original Mode Acknowledgement. As per the HL7 specification regarding acknowledgement Intelligo may acknowledge the message after placing it in an input queue, expecting to fully process the order into its database at a future time. The only assumption is that the input queue is maintained at the same level of integrity as the database. In this case, the database refers to the CDR. Intelligo immediately responds to a message with an Application Acknowledgement when all of the following steps have been completed: Validate that the HL7 message is well formed and does not contain invalid characters. Store the message to the Received Queue. (This is a persistent queue). This ACK does not imply that the data elements in the inbound message have been properly processed and inserted into the CDR database. Intelligo simply guarantees delivery of the message(s). Application Acknowledgement Codes include: AA Accept, AR Reject, AE Error. 2.3.1 ACK Formation Page 7

In accordance with the HL7 2.5 specification Intelligo uses the following logic when constructing an HL7 ACK message: The MSH segment in the response is constructed anew following the rules used to create the initial message described above. In particular, MSH-7-date/time of message and MSH-10-message control ID refer to the response message; they are not echoes of the fields in the initial message. MSH-5-receiving application, MSH-6-receiving facility, and MSH-11-processing ID contain codes that are copied from MSH-3-sending applica tion, MSH-4-sending facility and MSH-11-processing ID in the initiating message. In all the responses described above, the following values are put in the MSA segment. Note that the field definitions for the MSA segment fields are in Section Error! Reference source not found.. Field MSA-1-acknowledgment code MSA-2-message control ID MSA-3-text message Notes As described above. MSH-10-message control ID from MSH segment of incoming message. further describes an error condition 2.4 Invalid Characters The Intelligo Interface Engine will not process a message, and return an error ACK(AE) when any of the below control characters are present in an HL7 message. Symbol HEX Value Symbol HEX Value Symbol Hex Value NUL 0x00 SO 0x0E CAN 0x18 SOH 0x01 SI 0x0F EM 0x19 STX 0x02 DLE 0x10 SUB 0x1A ETX 0x03 DC1 0x11 ESC 0x1B EOT 0x04 DC2 0x12 GS 0x1D ENQ 0x05 DC3 0x13 RS 0x1E ACK 0x06 DC4 0x14 US 0x1F BEL 0x07 NAK 0x15 BS 0x08 SYN 0x16 FF 0x0C ETB 0x17 2.5 Escaping The Intelligo Interface Engine supports HL7 escape sequences. The default escape character is \, however the appropriate escape character will be read form field MSH.2 per message. All other escape sequences not mentioned below will be ignored and stored into the corresponding database field. The following HL7 escape sequences are supported by Intelligo: Sequence Name Purpose \F\ Field Separator Represents the field separator character (usually ) \S\ Component Separator Represents the component separator character (usually ^ ) \T\ Subcomponent Separator Represents the subcomponent separator character (usually & ) Page 8

\R\ Repetition Separator Represents the repetition separator character (usually ~ ) \E\ Escape Character Represents the escape character (usually \ ) \Xdddd\ or \Xdd\ Hexadecimal Data Represents a character defined by its hexadecimal value. Example \X0047\ is the letter G. This can also be escaped as \X47\ 2.6 Null vs. Empty Value The Intelligo Interface Engine distinguishes between a value of and a value of. A value of in a field of a segment causes no data to be passed to the underlying web service and therefore no update to that attribute stored in the database. A value of in a field of a segments causes a nullifying of that attribute stored in the database. For example, if no value is present in PID-3 (i.e. ), no patient identifier attribute is sent and no updates occur to that attribute in the database. If an empty string value is present in PID-3 (i.e. ), the empty string patient identifier attribute is sent and the patient identifier attribute in the database is nullified. The following table illustrates the general case. HL7 Value ABC Resulting Attribute Value ABC ABC NULL 2.7 Data Quality and Asynchronous Messaging Outbound HL7 messaging from the Medicalis Workflow engine is built on an asynchronous queuing structure and collects message data at the time of message sending. As such, there can be a small period between an action that triggers a message and that message being sent to external systems through Intelligo. During this period there is the possibility of subsequent updates to the relevant data that will be sent out in HL7. Medicalis will always collect and send the most up-to-date data stored in the application. Each triggered message would still be sent, but there is potential for multiple messages with the same up-to-date data being sent regardless of the original triggering action. 3.0 Message Profile Overview This section addresses any extensions made to the HL7 Message Profile conformance spec to provide further clarity to the document reader. Message profiles for the CDR are broken down by chapter. Each supported message (Message Type and Trigger Event) is defined in its own chapter. In cases where multiple events are supported and treated the same, both/all events will be referenced in the chapter title. 3.1 Dynamic Definition As per HL7 conformance, each message profile contains a Dynamic Definition. Although every message is processed in the same manner, each profile describes in detail the interactions that take place in diagram form. In addition, each profile provides one or many sample messages, and a sample acknowledgement (ACK). Sample messages contain anonymous data. Every supported field is fully populated. 3.2 Static Definition As per HL7 conformance, each message profile contains a Static Definition for messages, and for fields where detailed descriptions are necessary. All static definitions include two extra columns: CDR Database Table, and Notes. Static definitions also make use of the Usage column rather than Optionality. 3.2.1 CDR Database Table Column This column in the static definition specifies the database table where each segment, field, or component s data will be stored. In cases where a Page 9

segment is stored across multiple tables, a list of tables is provided. The value in this column serves as a general pointer to the location where the data will be stored in the clinical database. This document is not intended to be a data dictionary. It is expected that reader of this document understand the naming conventions and design patterns employed in the CDR clinical database. Therefore database locations are not exhaustively documented. For the purpose of this document, Table names begin with an upper case letter while column names begin with a lower case letter. In cases where a value is stored within a hierarchy of tables via foreign key relationships, table names are simply referred to in a dot (.) delimited format, but to simplify the document no joining map tables are included. For example, the CDR stores patient information such as identifiers (MRNs) in the Patient table. Contact information like names and addresses are stored generically in the Contact table. The value for PID-5-1 (Family Name) is stored in the familyname column of the Contact table. The Contact record is related to a record in the Patient table. Below is a sample static definition for component 1 of the PID-5 field. HL7 Element HL7 Element Name Database.Table.Column Length Notes PID-5.1 Patient Name.Family Name.Surname MClinical.Patient.Contact.familyName 3.2.2 Notes Column This column includes any important logic that should be considered when integrating. This column also contains logic for conditional fields. 3.2.3 Usage Column This message profile specifies Usage instead of Optionality as per the conformance spec. The usage codes used in this document are defined below. Value Description Comment R Required A conforming sending application shall populate all R elements with a non-empty value. RE Required but may be empty The element may be missing from the message, but must be sent by the sending application if there is relevant data. A conforming sending application must be capable of providing all "RE" elements. If the conforming sending application knows the required values for the element, then it must send that element. If the conforming sending application does not know the required values, then that element will be omitted. O Optional This code indicates that the Usage for this element has not yet been defined. C Conditional This usage has an associated condition predicate If the predicate is satisfied: A conformant sending application must always send the element. If the predicate is NOT satisfied: A conformant sending application is not required to send the element. CE X Conditional but it may be empty Not supported This usage has an associated condition predicate. If the predicate is satisfied: A conformant sending application must always send the element. If the predicate is NOT satisfied: A conformant sending application is not required to send the element. For conformant sending applications, the element will not be sent. The CDR will ignore the element if it is sent. 3.3 Segment Definition Page 10

As per HL7 conformance, each supported HL7 message segment has a Segment Definition found in the following section. 3.3.1 Database.Table.Column This column in the segment definition specifies the database table where each segment, field, or component s data will be stored. In cases where a segment is stored across multiple tables, a list of tables is provided. The value in this column serves as a general pointer to the location where the data will be stored in the clinical database. This document is not intended to be a data dictionary. It is expected that reader of this document understand the naming conventions and design patterns employed in the CDR clinical database. Therefore database locations are not exhaustively documented. For the purpose of this document, Table names begin with an upper case letter while column names begin with a lower case letter. In cases where a value is stored within a hierarchy of tables via foreign key relationships, table names are simply referred to in a dot (.) delimited format, but to simplify the document no joining map tables are included. For example, the CDR stores patient information such as identifiers (MRNs) in the Patient table. Contact information like names and addresses are stored generically in the Contact table. The value for PID-5-1 (Family Name) is stored in the familyname column of the Contact table. The Contact record is related to a record in the Patient table. Below is a sample static definition for component 1 of the PID-5 field. HL7 Element HL7 Element Name Database.Table.Column Length Notes PID-5.1 Patient Name.Family Name.Surname MClinical.Patient.Contact.familyName 3.3.2 Notes Column This column includes any important logic that should be considered when integrating. This column also contains logic for conditional fields. If a column requires a coded element that must match system dictionaries or reference tables a link to the default supported values at the end of this document will be included. 3.4 User-defined Tables and Auto-population For fields requiring coded elements (CE), user-defined tables are documented (a.k.a. Reference Tables, or Dictionaries. Example: Gender). The CDR supports auto-population of most of its dictionaries. Coded element fields that support this feature contain the phrase Supports auto-population in the notes column of the segment definition. The user-defined tables defined in this document contain the default dictionary entries for the given table. However tables supporting auto-population may in reality be wiped out and completely defined by the sending application (RIS). Tables that do not support auto-population are relied upon for crucial business logic such as state transition (example: Result Status Codes). 3.5 Multiple MRN and Accession Issuers Field containing a list of identifiers (one or more) must be paired with an Assigning Authority Namespace ID (also known as an Issuer or Org/Organization), Identifiers must be unique within that Assigning Authority/Issuer. If an issuer is not provided in the message, Intelligo will set a default value based on its configuration. 3.6 Processing Instructions The Intelligo Interface Engine and the CDR both support user configurable processing instructions. These processing instructions allow a user of Intelligo (integrator) to control key elements of the CDR s business logic. For example, ORM events coming from a RIS may be allowed to create and modify patients, and visits. While ORU events coming from a reporting system may be configured to only create new patients, but not modify existing patients or visit information. Each message profile contains a list of all supported processing instructions. By default, all processing instructions are enabled. Processing instructions can be enabled/disabled as part of mappings in the Intelligo Enterprise Manager. Processing instructions work independently. They allow the user to control various details of underlying business logic. The vast majority of processing instructions simply allow the user to control whether a message can create new records, or update existing records of a particular entity (Patient, Order, Provider, Result, etc, etc.) Example: For all "updateiffound" processing instructions, enabling them allows a message to update any of the entities fields/elements that would otherwise normally allow modification. Turning these instructions off simply entirely skips the update logic for the entity (Visit for example). So if this visit.updateiffound was turned off. No visit data would be modifiable, however new records could be created, assuming the visit.createifnotfou Page 11

nd instruction is enabled. 3.7 Vendor Specific Data Types This section contains custom data types defined by the CDR. 3.7.1 WS Workflow Status It is possible to manage the transitions of the some status values by including addition logic in the components of the field. The following table defines the role of each of the components. HL7 Element HL7 Element Name Database.Table.Column Length Notes ZRP-4.1.1 Diagnostic Imaging Status.Status Code MClinical.RequestedProcedure.diagnosticImagingStatusCd 3 ZRP-4.2.1 ZRP-4.3.1 Diagnostic Imaging Status.Allowed status list Diagnostic Imaging Status.Disallowed status list Status codes separated by commas (,). Only component 2 or component 3 can be set. They are mutually exclusive. See above Here are some usage examples of values stored in ZRP-4 segments and what they mean. NOTE: THESE ARE EXAMPLES ONLY. THE DIAGNOSTIC IMAGING STATES ARE DEFINED BY THE APPLICATION BUILT ON THE CDR. ZRP 1 S This message would be used to set the diagnostic imaging workflow status (ZRP-4) to S. However the sending system has potential knowledge of the previous state of the order. This status field could be extended to support the additions of workflow syntax to it. For example, below are two examples of possible workflow rules encoded within the same message: ZRP 1 S^^X The message above could be read as: Set the workflow status to scheduled S as long as the status is NOT currently X. ZRP 1 C^C,S,I^ Or in this example, set the workflow status to complete C as long as the status is currently complete C, scheduled S, or in progress I. Note that a state transition from C to C is not allowed by default, and must be declared. 4.0 Message Profiles Each supported message type will be detailed in this section. 4.0.1 Actors Actor: RIS Receives patient registration or update notification from the HIS, as well as visit changes. Sends demographic updates to downstream systems including the PACS. Actor: Intelligo Page 12

Receives, queues, and acknowledges messages. Applies user defined mappings. Receives messages from the RIS. Actor: CDR The receiving application. Stores patient identifier, demographic, encounter, and image information associated with orders. Receives information from Intelligo. 4.1 Patient Update/Register Profile [ADT^A08 / ADT^A04] 4.1.1 Use Case Patient Update and Patient Registration transactions transmit changes to patient demographics, location, visit, and provider information. These changes may occur at any time for a patient record. Both the A08 and A04 trigger events are supported, however they are handled as simple patient updates events by the CDR. 4.1.2 Interactions 4.1.3 Example Message The following is a sample message for expected ADT^A08 events. This sample also applies to the expected format of ADT^A04 events. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 ADT^A08 001 P 2.5 PID P123456^^^DPTISS&^^^^^^^ ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 1 23 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@home.com +1(905)555-3232^^O^^email@office.com EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N LAN 1 EN 1 ROL 1 PP 001^Provider^Test^^^Dr.^MD^^DO^^^^^^A Page 13

NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C PV1 I Left side station^room-3^bed-4^hospital-a&^^^west-building^floor-12^patient Bed - common^ha-r4b3&lociss^canon& R 007^SMITH MD&^ATTEND^M^JR^DR^MD^^VISATTISS& 001^SMITH MD&^REFER^J^JR.^DR^JD^^VISPROVISS& 008^SMITH MD&^CONSULT^M^JR^DR^MD^^VISCONISS& MED 1 A0 009^SMITH MD&^ADMIT^M^JR^DR^MD^^VISADMISS& V123456^^^VISISS& 20040623090000^ A PV2 ARR Patient in comatose state ROL 1 ATN ATN002^SMITH2 MD&^ATTEND2^M^JR^DR^MD^^VISPROVISSATT& OBX 1 CE OBID^LAB^DO Cholesterol.65 84^mg/dL 0.7-1.3 N 90 F 201108151203 RIS1 Hubert J. Farnsworth Fat Sample NTE 1 lab result comment RE AL1 DA ^GENERIC DRUG SV HYPOTENS 200323132900 Y S Allergist AllergySourceSystem GT1 G-NUM Doe^Jane^A^IV^Miss^Ph.D. 4 Oak Blvd..^^Tampa^FL^45725^USA 3331114444 9998884444 19980323132900 M FTH 5555555 20060323 20080321 Smith^Davi d^m^jr.^mr.^phd 8 Main St.^^Detroit^MC^45725^USA 1115553333 EMPID 1 Doe^John^O^Jr.^Mr.^P.Eng. 1115553333 S PO IN1 PLAN^Generic InsurancePlan PAYOR^^^PAISS^^OfficeId Insurer's 72 Elm St.^Office Name^Burbank^CA^90210^USA^B^OTHDESIG Employee^Joe^A^III^Mr.^Ph.D.^C 5555555555 GRP# Group Name GRPJOE Group 20020323132900 20070323132900 AUTH# TYPE Patient^Test^L^Sr.^Mrs.^M.A.Sc.^P EME 200528 8 River St.^^Fort Worth^TX^84235^USA^P^OTHDESIG N IN 1 20060517121200 Verifier S COPLANCD XX0001100 100 10000 4 1 M XXOLD H OVR issuer.donotautocreate^false 4.1.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.1.5 Message Static Definition Segment ADT Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ { SFT } ] Software Segment X 2 EVN Event Type O 3 Outbound messages only. PID Patient Identification R [1..1] 3 Patient, Contact [ PD1 ] Additional Demographics RE [0..1] 3 Provider, Contact [ LAN ] Language Detail O 15 Patient The LAN segment is only processed when LAN-2 is EN (English). [{ ROL }] Role O 15 Provider [{ NK1 }] Next of Kin / Associated Parties O 3 Contact PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [ PV2 ] Patient Visit - Additional Info. RE [0..1] 3 Visit The PV2 segment is only processed when PV1-19 is present. [{ ROL }] Role O 15 Provider Visit Provider [{ DB1 }] Disability Information X 3 Page 14

[{ OBX}] Observation/Result O 7 ObservationResult [{ AL1 }] Allergy Information O 3 Allergy [{ DG1 }] Diagnosis Information O 6 [ DRG ] Diagnosis Related Group X 6 [{ --- PROCEDURE begin PR1 Procedures X 6 [{ ROL }] Role X 15 }] --- PROCEDURE end [{ GT1 }] Guarantor O 6 Guarantor [{ --- INSURANCE begin IN1 Insurance O 6 InsurancePolicy, InsurancePlan, InsurancePayor [ IN2 ] Insurance Additional Info. [{ IN3 }] Insurance Additional Info - Cert. X 6 X 6 [{ ROL }] Role 15 }] --- INSURANCE end [ ACC ] Accident Information X 6 [ UB1 ] Universal Bill Information [ UB2 ] Universal Bill 92 Information X 6 X 6 4.2 Patient Merge Profile [ADT^A18 / ADT^A40] 4.2.1 Use Case The A18 event is used to merge current and previous patient records. This procedure is required, for example, when a previous patient is registered under a new patient identification number because of an error, or because there was insufficient time to determine the actual patient identification number. The merge event occurs when a decision is made to combine the information under either the new or the old identifier(s). The PID segment contains the surviving patient ID information. The MRG segment contains the non-surviving information. Patients can only be merged within the same Assigning Authority (a.k.a Issuer/Organization). The non-surviving patient record(s) are by default. However this behavior can be controlled via the MRG segment. Patient Linking is defined in section 4.3 under Patient Link Profile. Both the A18 and A40 trigger events are supported, however they are handled the same way by the CDR. 4.2.2 Interactions Page 15

4.2.3 Example Message The following is a sample message for expected ADT^A18 events. This sample also applies to the expected format of ADT^A40 events. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 ADT^A18 001 P 2.5 PID P123456^^^DPTISS&^^^^^^^ ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 1 23 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@home.com +1(905)555-3232^^O^^email@office.com EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N ROL 1 PP 001^Provider^Test^^^Dr.^MD^^DO^^^^^^A NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C MRG P123457^^^DPTISS&^true PV1 I Left side station^room-3^bed-4^hospital-a&^^^west-building^floor-12^patient Bed - common^ha-r4b3&lociss^canon& R 007^SMITH MD&^ATTEND^^^^^^VISATTISS& 002^SMITH MD&^REFER^J^JR.^^JD^^VISPROVISS& 008^SMITH MD&^CONSULT^^^^^^VISCONISS& MED 1 A0 009^SMITH MD&^ADMIT^^^^^^VISADMISS& V123456^^^VISISS& 20040623090000^ A PV2 ARR Patient in comatose state ROL 1 ATN ATN002^SMITH2 MD&^ATTEND2^M^JR^DR^MD^^VISPROVISSATT& AL1 DA ^GENERIC DRUG SV HYPOTENS 200323132900 Y S Allergist AllergySourceSystem OVR system.donotautocreate^false 4.2.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.2.5 Message Static Definition Page 16

Segment ADT Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ { SFT } ] Software Segment X 2 EVN Event Type X 3 PID Patient Identification R [1..1] 3 Patient, Contact [ PD1 ] Additional Demographics RE [0..1] 3 Provider, Contact [{ ROL }] Role X 15 [{ NK1 }] Next of Kin / Associated Parties X 3 MRG Merge Information R [0..1] 3 N/A (used for logic only) PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [ PV2 ] Patient Visit - Additional Info. RE [0..1] 3 Visit The PV2 segment is only processed when PV1-19 is present. [{ ROL }] Role X 15 Provider Visit provider [{ DB1 }] Disability Information X 3 [{ OBX }] Observation/Result X 7 ObservationResult [{ AL1 }] Allergy Information X 3 Allergy [{ DG1 }] Diagnosis Information X 6 [ DRG ] Diagnosis Related Group X 6 [{ --- PROCEDURE begin PR1 Procedures X 6 [{ ROL }] Role 15 }] --- PROCEDURE end [{ GT1 }] Guarantor X 6 Guarantor [{ --- INSURANCE begin IN1 Insurance X 6 InsurancePolicy, InsurancePlan, InsurancePayor [ IN2 ] Insurance Additional Info. [{ IN3 }] Insurance Additional Info - Cert. X 6 X 6 [{ ROL }] Role X 15 }] --- INSURANCE end [ ACC ] Accident Information X 6 Page 17

[ UB1 ] Universal Bill Information [ UB2 ] Universal Bill 92 Information X 6 X 6 4.3 Patient Link Profile [ADT^A24] 4.3.1 Use Case The A24 event is used to link 2 patient records. This procedure is required, for example, when a patient is registered under multiple information domains and is therefore represented by multiple MRNs. Linking patient records together indicates they represent the same person and should be treated as such. 4.3.2 Interactions 4.3.3 Example Message The following is a sample message for expected ADT^A24 events. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 ADT^A24 001 P 2.5 PID P123456^^^DPTISS&^^^^^^^ ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 1 23 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@ home.com +1(905)555-3232^^O^^email@ office.c om EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N ROL 1 PP 001^Provider^Test^^^Dr.^MD^^DO^^^^^^A NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C PID P456123^^^DPT2ISS&^^^^^^^ ALT321^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD. BUCK&^ 19690721163000^ F WHT^ 123 Page 18

ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^ +1(905)555-3232^ EN^ M^ ANG^ A456789^^^ SSN12345^ DL123 789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS OVR issuer.donotautocreate^false 4.3.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.3.5 MessageStatic Definition Segment ADT Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [{ SFT }] Software Segment X 2 EVN Event Type X 3 PID Patient Identification R [1..1] 3 Patient, Contact [ PD1 ] Additional Demographics RE [0..1] 3 Provider, Contact PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [{ DB1 }] Disability Information X 3 PID [ PD1 ] Patient Identification 2 Additional Demographics 2 R [1..1] 3 Patient, Contact RE [0..1] 3 Provider, Contact PV1 Patient Visit 2 RE [0..1] 3 Visit, Location, Provider The PV1[2] segment is only processed when PV1[2]-19 is present. [{ DB1 }] Disability Information 2 X 3 4.4 General Order Profile [ORM^O01] 4.4.1 Use Case Left for backward compatibility. It is recommended that the OMI trigger event be used instead when communicating orders and order related events. The function of this message is to initiate the transmission of information about an order. This includes placing new orders, cancellation of existing orders, discontinuation, holding, etc. ORM messages can originate also with a placer, filler, or an interested third party. Orders encapsulated in an ORM message assume a 1 to 1 relationship between Placer Order, Filler Order, Requested Procedure, and Procedure Step. When an ORM message is processed, one of each of the previously mentioned records is created automatically. To transmit multiple Filler Orders, Requested Procedures, and/or Procedure Steps, use the OMI message. 4.4.2 Interactions Page 19

4.4.3 Example Message The following is a sample message for expected ORM^O01 events. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 ORM^O01 001 P 2.5 PID P123456^^^DPTISS& ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 123 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@ home.com +1(905)555-3232^^O^^email@ office.com EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N LAN 1 EN 1 ROL 1 PP 001^Provider^Test^^^Dr.^MD^^DO^^^^^^A NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C PV1 I Left side station^room-3^bed-4^hospital-a&^^^west-building^floor-12^patient Bed - common^ha-r4b3&lociss^canon& R 002^SMITH MD&^ATTEND^M^JR^DR^MD^^VISPROVISSATT& 001^SMITH MD&^REFER^J^JR.^DR^JD^^VISPROVISS& 003^SMITH MD&^CONSULT^M^JR^DR^MD^^VISPROVISSCON& MED 1 A0 004^SMITH MD&^ADMIT^M^JR^DR^MD^^VISPROVISSADM& V123456^^^VISISS& 20040623090000^ A PV2 ARR Patient in comatose state ROL 1 ATN ATN002^SMITH2 MD&^ATTEND2^M^JR^DR^MD^^VISPROVISSATT& AL1 DA ^GENERIC DRUG SV HYPOTENS 200323132900 Y S Allergist AllergySourceSystem GT1 G-NUM Doe^Jane^A^IV^Miss^Ph.D. 4 Oak Blvd..^^Tampa^FL^45725^USA 3331114444 9998884444 19980323132900 M FTH 5555555 20060323 20080321 Smith^Davi d^m^jr.^mr.^phd 8 Main St.^^Detroit^MC^45725^USA 1115553333 EMPID 1 Doe^John^O^Jr.^Mr.^P.Eng. 1115553333 S PO IN1 PLAN^Generic InsurancePlan PAYOR^^^PAISS^^OfficeId Insurer's 72 Elm St.^Office Name^Burbank^CA^90210^USA^B^OTHDESIG Employee^Joe^A^III^Mr.^Ph.D.^C 5555555555 GRP# Group Name GRPJOE Group 20020323132900 20070323132900 AUTH# TYPE Patient^Test^L^Sr.^Mrs.^M.A.Sc.^P EME 200528 8 River St.^^Fort Worth^TX^84235^USA^P^OTHDESIG N IN 1 20060517121200 Verifier S COPLANCD XX0001100 100 10000 4 1 M XXOLD H ORC NW PO123456^POISS FO456789^FOISS^DO SC&SC 1 20040709113600^ 005^SMITH Page 20

MD&^ENTBY^^JR^DR^MD^^ORDISS& 025^SMITH MD&^VERIFIEDBY^^JR^DR^MD^^VERFISS& Pod 1^Room A11^Bed 3A1^CT-FAC&^^^^^CT-Ward^LOC1&ENTISS +1(905)555-2323 015^SMITH MD&^ACTIONBY^^JR^DR^MD^^ACTISS& 20070323132900 OBR 1 CTHEAD^CT of the Head^SNOMED R SARS^ RECURRENCE 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& WALK COLD^ 010&SMITH MD&RESULT TECHNICIAN&&JR.&DR&JD&&RESTECHISS^ 200407140910^ DDX^Test performed to rule out SARS^SNOMED Stat Contact Name^1-800-555-STAT^Stat Type A CTHEAD^CT of the Head^SNOMED NC^No contrast media^snomed&con NC^No contrast media^snomed&con CTD ENT Pod 1^Room A11^Bed 3A1^CT-FAC&^^^^^CT-Ward^LOC1&ENTISS^CANON OBX 1 CE OBID^LAB^DO Cholesterol.65 84^mg/dL 0.7-1.3 N 90 F 201108151203 RIS1 Hubert J. Farnsworth Fat Sample NTE 1 lab result comment RE ZRP 1 SCH SCH S^^X false SourceRIS ArchivePACS America/New_York ReportSystem AddtionalImagingSystem^2 0131003140000 BLG GR 258147 OVR issuer.donotautocreate^false 4.4.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.4.5 Message Static Definition Segment ORM Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ --- PATIENT begin PID [ PD1 ] Patient Identification Additional Demographics R [1..1] 3 Patient, Contact RE [0..1] 3 Provider, Contact [ --- PATIENT_VISIT begin PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [ PV2 ] Patient Visit- Additional Info RE [0..1] 3 Visit The PV2 segment is only processed when PV1-19 is present. [{ ROL }] Role O 15 Provider Visit provider ] --- PATIENT_VISIT end [{ --- INSURANCE begin IN1 Insurance X InsurancePolicy, InsurancePlan, InsurancePayor Page 21

}] --- INSURANCE end [ GT1 ] Guarantor X Guarantor [{ AL1 }] Allergy Information X Allergy ] --- PATIENT end ORC Common Order R [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location [ --- Procedure begin [1..1] OBR Order Detail Segment OBR, etc. RE [0..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location [{ ROL }] Role O 15 Provider Order provider [ ZRP] Medicalis Requested Procedure RE [0..1] FillerOrder, RequestedProcedure, ProcedureStep Vendor specific segment. ] 4.5 Imaging Order Profile [OMI^O23] 4.5.1 Use Case This message is used in communication between the information systems involved in the fulfillment of the request directed to the imaging department, such as a Radiology Information System (RIS) and a Picture Archiving and Communication System (PACS). The order for the imaging service is communicated between the Order Placer (such as an Order Entry system) and the Order Filler (such as an RIS). In the imaging department environment, the Order Filler also identifies the set of procedures (studies) and sub-procedures (procedure steps) that have to be performed in the process of fulfilling the order. Each sub-procedure is performed using a single device (station). The Order Filler identifies the type of device and either a specific device or group of devices (for example, by geographic location) one of which is to be used in performing the procedure step. Orders encapsulated in a CDR OMI message support a single Placer Order, with a single Filler Order, made up of many Requested Procedures, and many Procedure Steps. When an OMI message is processed, one of each of the previously mentioned records is created automatically. However many can be created be transmitting many OBR, ZRP, and IPC segment sequences. Each OMI message shall convey information about Requested Procedure(s) pertaining to one order. Segment OBR shall correspond to each requested procedure. If the Requested Procedure is comprised of multiple Procedure Steps, multiple IPC segments shall be included for each OBR in the message. In this case, the value of the IPC-2 field shall be identical in all IPC segments related to the same Requested Procedure. 4.5.2 Interactions Page 22

4.5.3 Example Message The following is a sample message for expected OMI^O23 events. This example shows a single Placer Order, Filler Order, Requested Procedure, and one Procedure Step. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 OMI^O23 001 P 2.5 PID P123456^^^DPTISS ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 123 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@ home.com +1(905)555-3232^^O^^email@ office.com EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N LAN 1 EN 1 ROL 1 PP 001^Provider^Test^^^Dr.^MD^^DO^^^^^^A NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C PV1 I Left side station^room-3^bed-4^hospital-a&^^^west-building^floor-12^patient Bed - common^ha-r4b3&lociss^canon& R 007^SMITH MD&^ATTEND^M^JR^DR^MD^^VISATTISS& 001^SMITH MD&^REFER^J^JR.^DR^JD^^VISPROVISS& 008^SMITH MD&^CONSULT^M^JR^DR^MD^^VISCONISS& MED 1 A0 009^SMITH MD&^ADMIT^M^JR^DR^MD^^VISADMISS& V123456^^^VISISS& 20040623090000^ A PV2 ARR Patient in comatose state ROL 1 ATN ATN002^SMITH2 MD&^ATTEND2^M^JR^DR^MD^^VISPROVISSATT& AL1 DA ^GENERIC DRUG SV HYPOTENS 200323132900 Y S Allergist AllergySourceSystem GT1 G-NUM Doe^Jane^A^IV^Miss^Ph.D. 4 Oak Blvd..^^Tampa^FL^45725^USA 3331114444 9998884444 19980323132900 M FTH 5555555 20060323 20080321 Smith^Davi d^m^jr.^mr.^phd 8 Main St.^^Detroit^MC^45725^USA 1115553333 EMPID 1 Doe^John^O^Jr.^Mr.^P.Eng. 1115553333 S PO IN1 PLAN^Generic InsurancePlan PAYOR^^^PAISS^^OfficeId Insurer's 72 Elm St.^Office Name^Burbank^CA^90210^USA^B^OTHDESIG Employee^Joe^A^III^Mr.^Ph.D.^C 5555555555 GRP# Group Name GRPJOE Group 20020323132900 20070323132900 AUTH# TYPE Patient^Test^L^Sr.^Mrs.^M.A.Sc.^P EME 200528 8 River St.^^Fort Worth^TX^84235^USA^P^OTHDESIG N IN 1 20060517121200 Verifier S COPLANCD XX0001100 100 10000 4 1 M XXOLD H ORC NW PO123456^POISS FO456789^FOISS^DO SC&SC 1 20040709113600^ 005^SMITH Page 23

MD&^ENTBY^^JR^DR^MD^^ORDISS& 025^SMITH MD&^VERIFIEDBY^^JR^DR^MD^^VERFISS& +1(905)555-2323 015^SMITH MD&^ACTIONBY^^JR^DR^MD^^ACTISS& 20070323132900 OBR 1 CTHEAD^CT of the Head^SNOMED R SARS^ RECURRENCE 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& WALK COLD^ 010&SMITH MD&RESULT TECHNICIAN&&JR.&DR&JD&&RESTECHISS^ 200407140910^ DDX^Test performed to rule out SARS^SNOMED Stat Contact Name^1-800-555-STAT^Stat Type A CTHEAD^CT of the Head^SNOMED NC^No contrast media^snomed&con NC^No contrast media^snomed&con CTD ENT Pod 1^Room A11^Bed 3A1^CT-FAC&^^^^^CT-Ward^LOC1&ENTISS^CANON OBX 1 CE OBID^LAB^DO Cholesterol.65 84^mg/dL 0.7-1.3 N 90 F 201108151203 RIS1 Hubert J. Farnsworth Fat Sample NTE 1 lab result comment RE ZRP 1 SCH SCH S^X false SourceRIS ArchivePACS America/New_York ReportSystem AddtionalImagingSystem^20 131003140000 IPC ACN124680^ RPID864280^ 1234.9483.1231.3908^ SPSID573827^ CT01 STSTN CTRM04^^RESISS CT-1001 BLG GR 258147 OVR system.donotautocreate^false 4.5.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.5.5 Message Static Definition Segment OMI Message Usage Cardinality Chaper CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ --- PATIENT begin PID Patient Identification R [1..1] 3 Patient, Contact [ PD1 ] Additional Demographics RE [0..1] 3 Provider, Contact [ --- PATIENT_VISIT begin PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [ PV2 ] Patient Visit- Additional Info RE [0..1] 3 Visit The PV2 segment is only processed when PV1-19 is present. [{ ROL }] Role O 15 Provider Visit provider ] --- PATIENT_VISIT end [{ --- INSURANCE begin IN1 Insurance X InsurancePolicy, InsurancePlan, InsurancePayor }] --- INSURANCE end [ GT1 ] Guarantor X Guarantor [{ AL1 }] Allergy Information X Allergy Page 24

] --- PATIENT end { --- ORDER begin [1..1] ORC Common Order R [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location { --- REQUESTED PROCEDURE begin [1..*] OBR Observation RE [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location [{ RQD }] Requisition Detail CompletableSupply Only supported in messages out of application [{ RXD }] Pharmacy/Treatment Dispense [{ RXA }] Pharmacy/Treatment Administration AdministeredPharmaceutical, Pharmac eutical AdministeredPharmaceutical, Pharmac eutical Only supported in messages out of application Only supported in messages out of application [ ZRP] Medicalis Requested Procedure RE [0..1] FillerOrder, RequestedProcedure, ProcedureStep Vendor specific segment. { IPC } Imaging Procedure Control R [1..*] FillerOrder, RequestedProcedure, ProcedureStep { ZOF} Online Form Data [0..*] Outbound only } --- REQUESTED PROCEDURE end [{ FT1 }] Financial Transaction CompletableOtherCharge Only supported in messages out of application } --- ORDER end 4.6 Result Profile [ORU^R01] 4.6.1 Use Case This event is used to communicate an imaging report. The CDR attaches the results contained in the OBX segments of this message to all Requested Procedures specified in the message. If a result needs to be attached to only a single Requested Procedure, then a message containing only that RP must be transmitted. Furthermore, the CDR assumes that the first Result Identifier located in the first OBX segment (OBX-3.1) is the same result identifier for all subsequent OBX segments. If multiple results need to be transmitted, they must be sent in separate messages. When sending Addendum messages Medicalis required the entire report text in the OBX segments, not just the amended text. 4.6.2 Interactions Page 25

4.6.3 Example Message The following is a sample message for expected ORU^R01 events. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 ORU^R01 001 P 2.5 PID P123456^^^DPTISS& ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 123 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@ home.com +1(905)555-3232^^O^^email@ office.com EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N LAN 1 EN 1 ROL 1 PP 001^Provider^Test^^^Dr.^MD^^DO^^^^^^A NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C PV1 I Left side station^room-3^bed-4^hospital-a&^^^west-building^floor-12^patient Bed - common^ha-r4b3&lociss^canon& R 007^SMITH MD&^ATTEND^M^JR^DR^MD^^VISATTISS& 001^SMITH MD&^REFER^J^JR.^DR^JD^^VISPROVISS& 008^SMITH MD&^CONSULT^M^JR^DR^MD^^VISCONISS& MED 1 A0 009^SMITH MD&^ADMIT^M^JR^DR^MD^^VISADMISS& V123456^^^VISISS& 20040623090000^ A PV2 ARR Patient in comatose state ROL 1 ATN ATN002^SMITH2 MD&^ATTEND2^M^JR^DR^MD^^VISPROVISSATT& AL1 DA ^GENERIC DRUG SV HYPOTENS 200323132900 Y S Allergist AllergySourceSystem GT1 G-NUM Doe^Jane^A^IV^Miss^Ph.D. 4 Oak Blvd..^^Tampa^FL^45725^USA 3331114444 9998884444 19980323132900 M FTH 5555555 20060323 20080321 Smith^Davi d^m^jr.^mr.^phd 8 Main St.^^Detroit^MC^45725^USA 1115553333 EMPID 1 Doe^John^O^Jr.^Mr.^P.Eng. 1115553333 S PO IN1 PLAN^Generic InsurancePlan PAYOR^^^PAISS^^OfficeId Insurer's 72 Elm St.^Office Name^Burbank^CA^90210^USA^B^OTHDESIG Employee^Joe^A^III^Mr.^Ph.D.^C 5555555555 GRP# Group Name GRPJOE Group 20020323132900 20070323132900 AUTH# TYPE Patient^Test^L^Sr.^Mrs.^M.A.Sc.^P EME 200528 8 River St.^^Fort Worth^TX^84235^USA^P^OTHDESIG N IN 1 20060517121200 Verifier S COPLANCD XX0001100 100 10000 4 1 M XXOLD H ORC NW PO123456^POISS FO456789^FOISS^DO SC&SC 1 20040709113600^ 005^SMITH Page 26

MD&^ENTBY^^JR^DR^MD^^ORDISS& 025^SMITH MD&^VERIFIEDBY^^JR^DR^MD^^VERFISS& +1(905)555-2323 015^SMITH MD&^ACTIONBY^^JR^DR^MD^^ACTISS& 20070323132900 OBR 1 71020^CHEST XRAY AP \T\ LATERAL^SNOMED R 198703290800 9218^MASTERS^JOHN^B SARS^ RECURRENCE 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& 200528191904^ P 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& WALK COLD^ 007&SMITH MD&PRINCIPAL RESULT INTERPRET&&JR.&DR&JD&&PRINCRESINTREPISS^ 008&SMITH MD&ASSISTANT RESULT INTERPRET&&JR.&DR&JD&&ASSISRESINTREPISS^ 010&SMITH MD&RESULT TECHNICIAN&&JR.&DR&JD&&RESTECHISS^ 009&SMITH MD&RESULT TRANSCRIPT&&JR.&DR&JD&&RESTRANSISS^ 200407140910^ DDX^Test performed to rule out SARS^SNOMED Stat Contact Name^1-800-555-STAT^Stat Type A 71020^CHEST XRAY AP \T\ LATERAL^SNOMED AC^Administer contrast media^snomed&con AC^Administer contrast media^snomed&con ROL 1 AST AST008^SMITH2 MD&^ASSISTANT RESULT INTERPRET2^M^JR^DR^MD^^ASSISRESINTREPISS7& CTD ENT Pod 1^Room A11^Bed 3A1^CT-FAC&^^^^^CT-Ward^LOC1&ENTISS^CANON ZRP 1 PRE COM P^P,S,I,U,V,C,R,D^ false SourceRIS ArchivePACS America/New_York ReportSystem AddtionalI magingsystem^20131003140000 IPC ACN124680^ RPID864280^ 1234.9483.1231.3908^ SPSID573827^ CT01 STSTN CTRM04^^RESISS CT-1001 OBX 1 CE 71020&IMP^RADIOLIOGIST'S REPORT^RISISSID 1 ^MASS LEFT LOWER LOBE A P 198703290800^ NTE 1 lab result comment RE BLG GR 258147 OVR system.donotautocreate^false 4.6.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.6.5 Message Static Definition Segment ORU Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ --- PATIENT begin PID Patient Identification R [1..1] 3 Patient, Contact [ PD1 ] Additional Demographics RE [0..1] 3 Provider, Contact [ --- PATIENT_VISIT begin PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [ PV2 ] Patient Visit- Additional Info RE [0..1] 3 Visit The PV2 segment is only processed when PV1-19 is present. [{ ROL }] Role O 15 Provider Visit provider ] --- PATIENT_VISIT end [{ --- INSURANCE begin IN1 Insurance X InsurancePolicy, InsurancePlan, InsurancePayor }] --- INSURANCE end [ GT1 ] Guarantor X Guarantor Page 27

[{ AL1 }] Allergy Information X Allergy ] --- PATIENT end { --- ORDER begin [1..1] ORC Common Order R [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location { --- REQUESTED PROCEDURE begin [1..*] OBR Observation RE [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location [{ RQD }] Requisition Detail CompletableSupply Only supported in messages out of application [{ RXD }] Pharmacy/Treatment Dispense [{ RXA }] Pharmacy/Treatment Administration AdministeredPharmaceutical, Pharmaceutical AdministeredPharmaceutical, Pharmaceutical Only supported in messages out of application Only supported in messages out of application [{ ROL }] Role O 15 Provider Order provider [ ZRP] Medicalis Requested Procedure RE [0..1] FillerOrder, RequestedProcedure, ProcedureStep Vendor specific segment. { IPC } Imaging Procedure Control RE [1..*] FillerOrder, RequestedProcedure, ProcedureStep [{ --- OBSERVATION begin OBX Observation related to OBR RE [0..*] 7 Result, ResultSection, Provider }] --- OBSERVATION end } --- REQUESTED PROCEDURE end { ZOF } Online Form Data [0..*] Outbound only [{ FT1 }] Financial Transaction CompletableOtherCharge Only supported in messages out of application } --- ORDER end 4.7 Update Personnel Record [PMU^B02] 4.7.1 Use Case Provider registry updates transmit demographic updates for personnel. The CDR uses the PMU message to updates its internal provider database. 4.7.2 Interactions Page 28

4.7.3 Example Message The following is a sample message for expected PMU^B02 event. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 200406241530 PMU^B02 001 P 2.5 STF PROVID2^^^PROVIS Smith&&NA^Johnson^A^BASc ^^^smithj@ server.com^^^^^wp^^^1-905-555-5555 9 Straight Road&&Apartment 1^^Beverly Hills^CA^90210^USA^O^WTF ^&Medicalis PRA AD NTE Notes EDU BE 4.7.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.7.5 Message Static Definition Segment PMU Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ { SFT } ] Software Segment X 2 EVN Event Type X 3 STF Staff R [1..1] 15 Provider, Contact [ PRA ] Practitioner RE [0..1] 15 Provider Page 29

[ { ORG } ] Organization X 15 [ { AFF } ] Affiliation X 15 [ { LAN } ] Language X 15 [ EDU ] Education RE [0..1] 15 Provider [ { CER } ] Certificate X 15 [ NTE ] Note RE [0..1] Provider 4.8 Inventory Item Master File Message [MFN^M15] 4.8.1 Use Case This event is used to communicate information that relates to the inventory of modalities that can be used to perform an ordered service in the CDR. 4.8.2 Interactions 4.8.3 Example Message The following is a sample message for expected MFN^M15 event. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 200406241530 MFN^M15 001 P 2.5 IIM MR-10113^^GE MR-LAB1-1^Lab 1 - station 1^^192.168.13.101 GE103396^General Electric^^^^^1.113 ^MR Laboratory - 1 MS Page 30

4.8.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.8.5 Message Static Definition Segment MFN Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ { SFT } ] Software Segment X 2 MFI Master File Identification X 8 { --- MF_INV_ITEM begin X MFE Master File Entry X 8 IIM Inventory Item Master R [1..1] 8 Modality } --- MF_INV_ITEM end X 4.9 Patient Location Master File Message [MFN^M05] 4.9.1 Use Case This section is specifically concerned with describing a master file message that should be used to transmit information which identifies the inventory of resources and the healthcare patient locations, such as nursing units, rooms, beds, clinics, exam rooms, etc, that each resource exists in. In a network environment, this segment can be used to define resources and locations to other applications. 4.9.2 Interactions Page 31

4.9.3 Example Message The following is a sample message for expected MFN^M05 event. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 200406241530 MFN^M05 001 P 2.5 LOC ^^^^^^^^^RCSCID&ISSID This is a resource LCH ^^^^^^^^^LOCID^LOCISS&CANON 4.9.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.9.5 Message Static Definition Segment MFN Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A MFI Master File Identification X { --- MF_LOCATION begin [1..*] MFE Master File Entry X 8 LOC Patient Location Master R [1..1] 8 Resource [{ LCH }] Location Characteristic RE [0..1] 8 Location [{ LRL }] Location Relationship X 8 Page 32

{ --- MF_LOC_DEPT begin LDP Location Department X 8 [{ LCH }] Location Characteristic X 8 [{ LCC }] Location Charge Code X 8 } --- MF_LOC_DEPT end } --- MF_LOCATION end 4.10 Additional Basic Observation/Service Attributes [MFN^M12] 4.10.1 Use Case This event deals with updating the CDR exam code dictionary. 4.10.2 Interactions 4.10.3 Example Message The following is a sample message for expected MFN^M12 event. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 200406241530 MFN^M12 001 P 2.5 OM1 D405^Abdominal Ultrasound^I9 LANDSCAPE ADB^Abdomen US OM7 AS Page 33

4.10.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.10.5 Message Static Definition Segment MFN Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [{ SFT }] Software X MFI Master File Identification { --- MF_OBS_ATTRIBUTES begin X [1..*] 8 MFE Master File Entry X 8 OM1 General Segment (Fields That Apply to Most Observations) R [1..1] 8 Exam [ OM7 ] Other Basic Observation/Service Attributes RE [0..1] 8 Exam } --- MF_OBS_ATTRIBUTES end 4.11 Medical Document Management Profile [MDM^T02 / MDM^T04 / MDM^T08 / MDM^T11] 4.11.1 Use Case This event is used to communicate new or updated documents or information about document status. 4.11.2 Interactions Page 34

4.11.3 Example Message Document Edit Notification The following is a sample message for expected MDM^T08 events. MSH ^~\& SNDAPP SNDFAC RECAPP RECFAC 20040624153000 MDM^T08 001 P 2.5 PID P123456^^^DPTISS& ALT123^^^ALTISS DOE&^JOHN^JULIE^JR.^MRS.^PHD BUCK&^ 19690721163000^ F WHT^ 123 ANYSTREET^^ANYTOWN^MO^ANYZIP^USA^H +1(905)555-1212^^P^^email@ home.com +1(905)555-3232^^O^^email@ office.com EN^ M^ ANG^ A456789^^^ SSN12345^ DL123789^ 1 FSM^ 200323132900^ FALSE AL PD1 001^SMITH MD&^PCP^M^JR^DR^MD^^PCPISS N LAN 1 EN 1 NK1 1 Jones^Eunice^M^^Mrs.^^L OTH 1634 J St^Apt 214^Davis^CA ^95616^USA^^^Yolo (530) 555-4325^^^emjones123@AOL.COM C PV1 I Left side station^room-3^bed-4^hospital-a&^^^west-building^floor-12^patient Bed - common^ha-r4b3&lociss^canon& R 007^SMITH MD&^ATTEND^M^JR^DR^MD^^VISATTISS& 001^SMITH MD&^REFER^J^JR.^DR^JD^^VISPROVISS& 008^SMITH MD&^CONSULT^M^JR^DR^MD^^VISCONISS& MED 1 A0 009^SMITH MD&^ADMIT^M^JR^DR^MD^^VISADMISS& V123456^^^VISISS& 20040623090000^ A PV2 ARR Patient in comatose state ORC NW PO123456^POISS FO456789^FOISS^DO SC&SC 1 20040709113600^ 005^SMITH MD&^ENTBY^^JR^DR^MD^^ORDISS& 025^SMITH MD&^VERIFIEDBY^^JR^DR^MD^^VERFISS& +1(905)555-2323 015^SMITH MD&^ACTIONBY^^JR^DR^MD^^ACTISS& 20070323132900 OBR 1 71020^CHEST XRAY AP \T\ LATERAL^SNOMED R 198703290800 9218^MASTERS^JOHN^B SARS^ RECURRENCE 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& 200528191904^ P 006^SMITH MD&^ORDPROV^^JR^DR^MD^^ORDPROVISS& WALK COLD^ 007&SMITH MD&PRINCIPAL RESULT INTERPRET&&JR.&DR&JD&&PRINCRESINTREPISS^ 008&SMITH MD&ASSISTANT RESULT INTERPRET&&JR.&DR&JD&&ASSISRESINTREPISS^ 010&SMITH MD&RESULT TECHNICIAN&&JR.&DR&JD&&RESTECHISS^ 009&SMITH MD&RESULT TRANSCRIPT&&JR.&DR&JD&&RESTRANSISS^ 200407140910^ DDX^Test performed to rule out SARS^SNOMED Stat Contact Name^1-800-555-STAT^Stat Type A 71020^CHEST XRAY AP \T\ LATERAL^SNOMED AC^Administer contrast media^snomed&con AC^Administer contrast media^snomed&con ZRP 1 PRE COM P^P,S,I,U,V,C,R,D^ false SourceRIS ArchivePACS America/New_York ReportSystem AddtionalI magingsystem^20131003140000 Page 35

IPC ACN124680^ RPID864280^ 1234.9483.1231.3908^ SPSID573827^ CT01 STSTN CTRM04^^RESISS CT-1001 OBX 1 ST MML Gadovist ^false OVR system.donotautocreate^false 4.11.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.11.5 Message Static Definition Segment MDM Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A [ --- PATIENT begin PID Patient Identification R [1..1] 3 Patient, Contact [ PD1 ] Additional Demographics RE [0..1] 3 Provider, Contact [ --- PATIENT_VISIT begin PV1 Patient Visit RE [0..1] 3 Visit, Location, Provider The PV1 segment is only processed when PV1-19 is present. [ PV2 ] Patient Visit- Additional Info RE [0..1] 3 Visit The PV2 segment is only processed when PV1-19 is present. ] --- PATIENT_VISIT end [{ --- INSURANCE begin IN1 Insurance X InsurancePolicy, InsurancePlan, InsurancePayor }] --- INSURANCE end [ GT1 ] Guarantor X Guarantor [{ AL1 }] Allergy Information X Allergy ] --- PATIENT end { --- ORDER begin [1..1] ORC Common Order R [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location { --- REQUESTED PROCEDURE begin [1..*] OBR Observation RE [1..1] 4 PlacerOrder, FillerOrder, RequestedProcedure, ProcedureStep, Provider, Location [ ZRP] Medicalis Requested Procedure RE [0..1] FillerOrder, RequestedProcedure, ProcedureStep Vendor specific segment. { IPC } Imaging Procedure Control RE [1..*] FillerOrder, RequestedProcedure, ProcedureStep Page 36

[{ --- OBSERVATION begin OBX Observation related to OBR RE [0..*] 7 Result, ResultSection, Provider }] --- OBSERVATION end } --- REQUESTED PROCEDURE end } --- ORDER end TXA Document Notification 9 OLF tables, PlacerOrder, FillerOrder OBX Observation/Result (one or more required) 9 OLFData tables 4.12 Application Management Data Message [NMD^N03] 4.12.1 Use Case This event allows external systems to send application level notifications to isite. Notification messages can be set up anywhere they are needed. Notifications are presented to users in isite as items of work to be completed. If desired, new message types can be added to the refswnotificationtype table to provide easier classification. The CDR will store the HL7 contained in the details element as is. Any processing/parsing of the HL7 is left to the eventual recipient of the notification event. An example of a Notification would be Manual Patient Merge Required. 4.12.2 Interactions Page 37

4.12.3 Example Message The following is a sample message for expected NMD^N03 event. MSH ^~\& RAD SHM SHM 200204132137 NMD^N03 OUTBOUND.5.38702 P 2.1 AL NE ZNF patientupdate PID1^^^DO^ 4.12.4 Example ACK MSH ^~\& RECAPP RECFAC SNDAPP SNDFAC 20070828120632 ACK 1 P 2.5 MSA AA 001 The message has been queued for processing 4.12.5 Message Static Definition Segment NDM Message Usage Cardinality Chapter CDR Database Table Notes MSH Message Header R [1..1] 2 N/A ZNF Notification Data R [1..1] NotificationEvent 5.0 HL7 to SQL Mappings The mappings have been organized similarly to the way HL7 messages are organized (e.g. ADT, Orders, and Results). Each mapping shall describe how a single HL7 message is mapped into to the RPQ databases. Each mapping shall describe how the attributes in an HL7 message are mapped into the SQL tables in to the RPQ databases. 5.0.1 Sample Mapping The HL7 Element is used as a short hand notation for describing where the HL7 element is located. The designator is constructed in the following manner: Segment-Field[.Component[.Subcomponent]] where Segment specifies the HL7 segment, Field specifies the field within that segment, Component is optional and if it exists specifies the component within the field and Subcomponent is optional and if it exists specifies the subcomponent within the component. HL7 Element HL7 Element Name Database.Table.Column Length Notes MSH-3.1 Sending Application.Namespace ID If present, may be used as the "issuer" attribute in the XML objects contained in the XML SOAP message if additional "issuer" attributes are not present in other HL7 segments. 5.1 MSH Segment This section describes how the HL7 MSH segment is mapped into the Medicalis databases. We use a table to describe the relationship between the HL7 Element and the database column. It is assumed that this description can be used to encode mappings from HL7 to SQL and from SQL to HL7. HL7 Element HL7 Element Name Database.Table.Column MSH-1.1.1 Field Separator MSH-2.1.1 Encoding Characters MSH-3.1.1 Sending Application.Namespace ID Page 38

MSH-4.1.1 Sending Facility.Namespace ID MSH-5.1.1 Receiving Application.Namespace ID MSH-6.1.1 Receiving Facility.Namespace ID MSH-7.1.1 Date/Time of Message.Time MSG-9.1.1 Message Type.Message Code Id MSH-9.2.1 Message Type.Trigger Event MSH-10.1.1 Message Control Id MSH-11.1.1 Processing ID.Processing ID MSH-12.1.1 Version ID.Version ID 5.2 EVN Segment HL7 Element HL7 Element Name Database.Table.Column Length Notes EVN-1.1.1 Event Type Code <<event type code>> (only in ADT messages) EVENT_PATIENT_REGISTRATION = "PRG"; EVENT_PATIENT_UPDATE = "PUP"; EVENT_PATIENT_LINK = "PLK"; EVENT_PATIENT_MERGE = "PMG"; EVENT_ALTERNATE_ID_ADD = "AAD"; EVENT_ALTERNATE_ID_REMOVE = "ARM"; EVENT_GUARANTOR_UPDATE = "GUP"; EVENT_GUARANTOR_REMOVE = "GRM"; EVENT_INSURANCE_UPDATE = "IUP"; EVENT_INSURANCE_REMOVE = "IRM"; EVENT_PROVIDER_UPDATE = "RUP"; EVENT_PROVIDER_REMOVE = "RRM"; EVENT_ALLERGY_UPDATE = "LUP"; EVENT_ALLERGY_REMOVE = "LRM"; EVENT_VISIT_STATUS = "VUP"; EVN-2.1.1 Recorded Date/Time <<event generated timestamp>> EVN-3.1.1 Date/Time Planned Event EVN-4.1.1 Event Reason Code EVN-5.1.1 Operator ID- ID Number MSystem.MtfUserCredential.userId 45 EVN-5.2.1 Operator ID- Family Name MSystem.MtfUser.Contact.familyName Page 39

EVN-5.3.1 Operator ID- Given Name MSystem.MtfUser.Contact.givenName EVN-5.4.1 Operator ID- Second and Further Given Names or Initials Thereof MSystem.MtfUser.Contact.middleName EVN-5.5.1 Operator ID- Suffix MSystem.MtfUser.Contact.suffix EVN-5.6.1 Operator ID- Prefix MSystem.MtfUser.Contact.title EVN-5.7.1 Operator ID- Degree MSystem.MtfUser.Contact.degreeCd 10 EVN-6.1.1 Event Occurred EVN-7.1.1 Event Facility- Namespace ID MClinical.Location.Issuer.issuerId (OMI, ORU, MDM) EVN-7.2.1 Event Facility- Universal ID MClinical.Location.locationId (OMI, ORU, MDM) 45 45 5.3 PID The PID segment is used by all applications as the primary means of communicating patient identification information. This segment contains permanent patient identifying and demographic information that, for the most part, is not likely to change frequently. The CDR stores one (1) patient record for each repeated patient identifier/issuer (PID-3). Patient records contain all of the demographic data transmitted in a message. When multiple identifiers are provided, a patient record is created for each identifier. All new records initially contain copies of the same demographic information. When updates are received, the update will be applied to all records where the identifier for the record is present in the message (PID-3 list). This allows patient records to be synchronized, managed in groups, or managed individually by Assigning Authority (a.k.a Issuer). PATIENT LINKING: All patient records present in the same message (PID-3 list) are considered to be the same person. Therefore, in this case, patient records are automatically linked. A Person record is simply a linking mechanism and does not sore any human readable information about the patient. A patient record cannot be linked to more than 1 person at a time. So if a patient record with ID 123 is linked to other patient records (forming person A), and ID 123 is sent in the PID-3 list containing IDs for a different person, the 123 patient record will be unlinked form Person A, and linked to Person B. The first sequence in PID-3 is considered the Primary Patient Identifier. This essentially dictates the link to record. All other IDs are secondary and will be linked to the person that the Primary Patient Identifier is linked to. HL7 Element HL7 Element Name Database.Table.Column Length Notes Usage PID-3.1.1 Patient ID.ID Number MClinical.Patient.patientId 45 R PID-3.4.1 Patient ID.Assigning Authority.Namespace ID MClinical.Issuer.issuerId 45 R PID-4.1.1 Alternate Patient ID List.ID Number MClinical.AlternatePatientId.patientId 45 PID-4.4.1 Alternate Patient ID List.Assigning Authority.Namespace ID MClinical.Issuer.issuerId 45 PID-5.1.1 Patient Name.Family Name.Surname MClinical.Patient.Contact.familyName R PID-5.2.1 Patient Name.Given Name MClinical.Patient.Contact.givenName PID-5.3.1 Patient Name.Second and Further Given Names or Initials Thereof MClinical.Patient.Contact.middleName PID-5.4.1 Patient Name.Suffix MClinical.Patient.Contact.suffix PID-5.5.1 Patient Name.Prefix MClinical.Patient.Contact.title PID-5.6.1 Patient Name.Degree MClinical.Patient.Contact.degreeCd 10 PID-5.7.1 Name Type Code MClinical.mapPatientContact.patientContactUseCd 16 PID-5.8.1 Name Representation Code Page 40

PID-6.1.1 Mother's Maiden Name.Family Name.Surname MClinical.Patient.mothersMaidenName 60 PID-7.1.1 Date/Time of Birth.Time MClinical.Patient.patientBirthDateTime DATETIME PID-8.1.1 Administrative Sex MClinical.Patient.individualSexCd 10 Dictionary: Individual_Sex PID-10.1.1 Race MClinical.Patient.patientRaceCd 10 PID-11.1.1 Patient Address.Street Address.Street or Mailing Address MClinical.Patient. Contact. Address.addr ess1 199 PID-11.3.1 Patient Address.City MClinical.Patient. Contact. Address.city 199 PID-11.4.1 Patient Address.State or Province MClinical.Patient.Contact.Address.provinceStateCd PID-11.5.1 Patient Address.Zip or Postal Code MClinical.Patient. Contact. Address.posta lzipcd PID-11.6.1 Patient Address.Country MClinical.Patient. Contact. Address.count rycd PID-11.7.1 Patient Address.Address Type MClinical.Patient. Contact. Address.addressType PID-11.8.1 Other Geographic Designation MClinical.Patient. Contact. Address.otherGeographicDesignation PID-13.1.1 Phone Number Home MClinical.Patient.Contact.PhoneNumber.phoneNumber PID-13.2.1 Telecommunication Use Code MClinical.Patient.Contact.PhoneNumber.contactPhoneNumberUseCd MClinical.Patient.Contact.EmailAddress.contactEmailAddressUseCd 10 Dictionary: Province/State 199 3 Dictionary: Country 3 Dictionary: Address_Type 199 60 3 Defaults to 'HP' (Home Phone) for phone numbers or 'P' (Personal) for email addresses PID-13.4.1 Email Address MClinical.Patient.Contact.EmailAddress PID-14.1.1 Phone Number Business MClinical.Patient.Contact.PhoneNumber.phoneNumber PID-14.2.1 Telecommunication Use Code MClinical.Patient.Contact.PhoneNumbe r.contactphonenumberusecd MClinical.Patient.Contact.EmailAddress.contactEmailAddressUseCd 60 3 Defaults to 'WP' (Work Phone) for phone numbers or 'O' (Office) for email addresses PID-14.4.1 Email Address MClinical.Patient.Contact.EmailAddress PID-15.1.1 Primary Language MClinical.Patient.languageCd 3 PID-16.1.1 Marital Status MClinical.Patient.maritalStatusCd 10 PID-17.1.1 Religion MClinical.Patient.patientReligionCd 10 PID-18.1.1 Patient Account Number MClinical.Patient.patientAccountNumber 255 PID-19.1.1 SSN Number Patient.ID Number MClinical.Patient.ssn PID-20.1.1 Driver's License Number MClinical.Patient.driversLicense 199 PID-25.1.1 Birth Order MClinical.Patient.birthOrderIdentifier TINYINT PID-28.1.1 Nationality MClinical.Patient.nationalityCd 3 Page 41

PID-29.1.1 Patient Death Date/Time MClinical.Patient.patientDeathDateTime DATETIME PID-31.1.1 Identity Unknown Indicator MClinical.Patient.identityUnknown FLAG PID-32.1.1 Identity Reliability Codde MClinical.Patient..identityReliabilityCd 10 PID-34.1.1 Event Facility- Namespace ID MClinical.Location.Issuer.issuerId 45 PID-34.2.1 Event Facility- Universal ID MClinical.Location.locationId 45 5.4 PD1 HL7 Element HL7 Element Name Database.Table.Column Length Notes patientproviderusecd = 'PP' (Primary Care Provider) PD1-4.1.1 PD1-4.2.1 PD1-4.3.1 PD1-4.4.1 PD1-4.5.1 PD1-4.6.1 PD1-4.7.1 PD1-4.9.1 Patient Primary Care Provider & ID No.ID Number Patient Primary Care Provider & ID No.Family Name.Surname Patient Primary Care Provider & ID No.Given Name Patient Primary Care Provider & ID No.Second and Further Given Names or Initials Thereof Patient Primary Care Provider & ID No.Suffix Patient Primary Care Provider & ID No.Prefix Patient Primary Care Provider & ID No.Degree Patient Primary Care Provider & ID No.Assigning Authority.Namespace ID MClinical.Patient.Provider.providerId 45 MClinical.Patient.Provider.Contact.familyName MClinical.Patient.Provider.Contact.givenName MClinical.Patient.Provider.Contact.middleName MClinical.Patient.Provider.Contact.suffix MClinical.Patient.Provider.Contact.title MClinical.Patient.Provider.Contact.degreeCd 10 MClinical.Patient.Provider.Issuer.issuerId 45 PD1-4.22.1 Patient Primary Care Provider NPI MClinical.Patient.Provider.NPI PD1-4.22.4 Patient Primary Care Provider UPIN MClinical.Patient.Provider.UPIN PD1-12.1.1 Protection Indicator (ID) MClinical.Patient.confidentialityConstraint FLAG PD1-13.1.1 Identifier Type Code MClinical.Patient.Provider.providerUseCd 16 PD1-22.1.1 Phone Number - Cell <<Use PID-13>> PD1-23.1.1 Email Address Personal <<Use PID-13>> PD1-24.1.1 Email Address Business <<Use PID-14>> 5.5 LAN Page 42

The LAN segment adds detailed language information to the patient identified by the PID segment. HL7 Element HL7 Element Name Database.Table.Column Length Notes LAN-1.1.1 Set ID LAN-2.1.1 Language Code EN (English) is the only value supported LAN-3.1.1 Language Ability Code LAN-4.1.1 Language Proficiency Code MClinical.Patient.translationServiceRequired FLAG 1,2,3 = false (no translation service required) 4,5,6 = true (translation service required) 1 Excellent 2 Good 3 Fair 4 Poor 5 Some (level unknown) 6 None 5.6 ROL The ROL segment contains the data about record persons involved, as well as their functional involvement with the activity being transmitted. HL7 Element Designator HL7 Element Name Database.Table.Column Length ROL-1.1.1 Role Instance ID ROL-2.1.1 Action Code ROL-3.1.1 Role MClinical.Patient.Provider.providerUseCd 16 ROL-4.1.1 Role Person ID Number MClinical.Patient.Provider.providerId 45 ROL-4.2.1 Role Person Family Name MClinical.Patient.Provider.Contact.familyName ROL-4.3.1 Role Person Given Name MClinical.Patient.Provider.Contact.givenName ROL-4.4.1 Role Person Second and Further Given Names MClinical.Patient.Provider.Contact.middleName ROL-4.5.1 Role Person Suffix MClinical.Patient.Provider.Contact.suffix ROL-4.6.1 Role Person Prefix MClinical.Patient.Provider.Contact.title ROL-4.7.1 Role Person Degree MClinical.Patient.Provider.Contact.degreeCd 10 ROL-4.9.1 Role Person Assigning Authority MClinical.Patient.Provider.Issuer.issuerId 45 ROL-4.15.1 Role Person Name Representation Code ROL-4.22.1 Patient Primary Care Provider NPI MClinical.Patient.Provider.NPI ROL-4.22.4 Patient Primary Care Provider UPIN MClinical.Patient.Provider.UPIN Page 43

5.7 NK1 The NK1 segment contains information about the patient s other related parties. Any associated parties may be identified. HL7 Element HL7 Element Name Database.Table.Column Length Notes NK1-1.1.1 Set ID NK1-2.1.1 Family Name MClinical.Patient.Contact.familyName NK1-2.2.1 Given Name MClinical.Patient.Contact.givenName NK1-2.3.1 Second and Further Given Names or Initials Thereof MClinical.Patient.Contact.middleName NK1-2.4.1 Suffix MClinical.Patient.Contact.suffix NK1-2.5.1 Prefix MClinical.Patient.Contact.title NK1-2.6.1 Degree MClinical.Patient.Contact.degreeCd 10 NK1-2.7.1 Name Type Code MClinical.mapPatientContact.patientContactUseCd 10 NK1-3.1.1 Relationship MClinical.mapPatientContact.relationTypeCd 10 NK1-4.1.1 Patient Address.Street Address.Street or Mailing Address MClinical.Patient.Contact.Address.address1 199 NK1-4.3.1 Patient Address.City MClinical.Patient.Contact.Address.city 199 NK1-4.4.1 Patient Address.State or Province MClinical.Patient.Contact.Address.provinceStateCd 10 Dictionary: Province/State NK1-4.5.1 Patient Address.Zip or Postal Code MClinical.Patient.Contact.Address.postalZipCd 199 NK1-4.6.1 Patient Address.Country MClinical.Patient.Contact.Address.countryCd 3 Dictionary: Country NK1-4.7.1 Patient Address.Address Type MClinical.Patient.Contact.Address.addressType 3 Dictionary: Address_Type NK1-4.8.1 Other Geographic Designation MClinical.Patient.Contact.Address.otherGeographicDesignation 199 NK1-5.1.1 Phone Number MClinical.Patient.Contact.PhoneNumber.phoneNumber 60 NK1-5.2.1 Telecommunication Use Code MClinical.mapContactPhoneNumber.contactPhoneNumberUseCd 3 NK1-6.1.1 Business Phone Number MClinical.Patient.Contact.PhoneNumber.phoneNumber 60 NK1-6.2.1 Business Telecommunication Use Code MClinical.mapContactPhoneNumber.contactPhoneNumberUseCd 3 NK1-7.1.1 Contact Role MClinical.mapPatientContact.patientContactUseCd 10 5.8 PV1 We only create a visit if there is an Admission Number PV1-19 (i.e. Visit Number). HL7 Element HL7 Element Name Database.Table.Column Length Notes PV1-2.1.1 Patient Class MClinical.Visit.patientClassCd 3 Dictionary: Patient_Class Page 44

PV1-3.1.1 + '^' + PV1-3.2.1 + '^' + PV1-3.3.1 + '^' + PV1-3.4.1 PV1-3.4.1 PV1-3.4.2 PV1-3.9.1 PV1-3.10.1 PV1-3.10.2 PV1-3.11.1 Assigned Patient Location.Point of Care + Assigned Patient Location.Room + Assigned Patient Location.Bed + Assigned Patient Location.Facility.Namespace ID Assigned Patient Location.Facility.Namespace ID Assigned Patient Location.Facility.Universal Id Assigned Patient Location.Location Description Assigned Patient Location.Comprehensive Location Identifier.Entity Identifier Assigned Patient Location.Comprehensive Location Identifier.Namespace ID Assigned Patient Location. Assigning Authority.Namespace ID MClinical.Visit.Location.locationName 255 MClinical.Visit.Location.locationName 255 MSystem.Node.nodeId 45 MClinical.Visit.Location.description 1024 MClinical.Visit.Location.locationId 45 MClinical.Visit.Location.Issuer.issuerId 45 MClinical.Visit.Location.assigningAuthorityCd 10 PV1-4.1.1 Admission Type MClinical.Visist.addmissionTypeCd 3 visitproviderusecd = 'ATN' PV1-7.1.1 Attending Doctor ID Number MClinical.Visit.Provider.providerId 45 PV1-7.2.1 Attending Doctor Family Name MClinical.Visit.Provider.Contact.familyName PV1-7.3.1 Attending Doctor Given Name MClinical.Visit.Provider.Contact.givenName PV1-7.4.1 Attending Doctor Second and Further Given Names MClinical.Visit.Provider.Contact.middleName PV1-7.5.1 Attending Doctor Suffix MClinical.Visit.Provider.Contact.suffix PV1-7.6.1 Attending Doctor Prefix MClinical.Visit.Provider.Contact.title PV1-7.7.1 Attending Doctor Degree MClinical.Visit.Provider.Contact.degreeCd 10 PV1-7.9.1 Attending Doctor Assigning Authority MClinical.Visit.Provider.Issuer.issuerId 45 PV1-7.13.1 Attending Doctor Identifier Type Code MClinical.Visit.Provider.providerUseCd 16 PV1-7.22.1 Attending Doctor NPI MClinical.Visit.Provider.NPI PV1-7.22.4 Attending Doctor UPIN MClinical.Visit.Provider.UPIN visitproviderusecd = 'REF' PV1-8.1.1 Referring Doctor.ID Number MClinical.Visit.Provider.providerId 45 PV1-8.2.1 Referring Doctor.Family Name.Surname MClinical.Visit.Provider.Contact.familyName PV1-8.3.1 Referring Doctor.Given Name MClinical.Visit.Provider.Contact.givenName Page 45

PV1-8.4.1 Referring Doctor.Second and Further Given Names or Initials Thereof MClinical.Visit.Provider.Contact.middleName PV1-8.5.1 Referring Doctor.Suffix MClinical.Visit.Provider.Contact.suffix PV1-8.6.1 Referring Doctor.Prefix MClinical.Visit.Provider.Contact.title PV1-8.7.1 Referring Doctor.Degree MClinical.Visit.Provider.Contact.degreeCd 10 PV1-8.9.1 Referring Doctor. Assigning Authority.Namespace ID MClinical.Visit.Provider.Issuer.issuerId 45 PV1-8.13.1 Referring Doctor Identifier Type Code MClinical.Visit.Provider.providerUseCd 16 PV1-8.22.1 Referring Doctor NPI MClinical.Visit.Provider.NPI PV1-8.22.4 Referring Doctor UPIN MClinical.Visit.Provider.UPIN visitproviderusecd = 'CON' PV1-9.1.1 Consulting Doctor ID Number MClinical.Visit.Provider.providerId 45 PV1-9.2.1 Consulting Doctor Family Name MClinical.Visit.Provider.Contact.familyName PV1-9.3.1 Consulting Doctor Given Name MClinical.Visit.Provider.Contact.givenName PV1-9.4.1 Consulting Doctor Second and Further Given Names MClinical.Visit.Provider.Contact.middleName PV1-9.5.1 Consulting Doctor Suffix MClinical.Visit.Provider.Contact.suffix PV1-9.6.1 Consulting Doctor Prefix MClinical.Visit.Provider.Contact.title PV1-9.7.1 Consulting Doctor Degree MClinical.Visit.Provider.Contact.degreeCd 10 PV1-9.9.1 Consulting Doctor Assigning Authority MClinical.Visit.Provider.Issuer.issuerId 45 PV1-9.13.1 Consulting Doctor Identifier Type Code MClinical.Visit.Provider.providerUseCd 16 PV1-9.22.1 Consulting Doctor NPI MClinical.Visit.Provider.NPI PV1-9.22.4 Consulting Doctor UPIN MClinical.Visit.Provider.UPIN Hospital Service MClinical.Visit.hospitalServiceCd 10 PV1-14.1.1 Admit Source MClinical.Visit.admitSourceCd 3 PV1.15.1.1 Ambulatory Status MClinical.Visit.ambulatoryStatusCd 9 Dictionary: Ambulatory_Status PV1.16.1.1 VIP indicator MClinical.Patient.vipStatusCd Support coming in future release PV1-17.1.1 Admitting Doctor.ID Number MClinical.Visit.Provider.providerId 45 PV1-17.2.1 Admitting Doctor.Family Name.Surname MClinical.Visit.Provider.Contact.familyName PV1-17.3.1 Admitting Doctor.Given Name MClinical.Visit.Provider.Contact.givenName visitproviderusecd = 'ADM' PV1-17.4.1 Admitting Doctor.Second and Further Given Names or Initials Thereof MClinical.Visit.Provider.Contact.middleName PV1-17.5.1 Admitting Doctor.Suffix MClinical.Visit.Provider.Contact.suffix PV1-17.6.1 Admitting Doctor.Prefix MClinical.Visit.Provider.Contact.title Page 46

PV1-17.7.1 Admitting Doctor.Degree MClinical.Visit.Provider.Contact.degreeCd 10 PV1-17.9.1 Admitting Doctor. Assigning Authority.Namespace ID MClinical.Issuer.issuerId 45 PV1-17.13.1 Admitting Doctor Identifier Type Code MClinical.Visit.Provider.providerUseCd 16 PV1-17.22.1 Admitting Doctor NPI MClinical.Visit.Provider.NPI PV1-17.22.4 Admitting Doctor UPIN MClinical.Visit.Provider.UPIN PV1-19.1.1 Visit Number.ID Number MClinical.Visit.admissionNum 64 PV1-19.4.1 Visit Number.Assigning Authority.Namespace ID MClinical.Visit.Issuer.issuerId 45 PV1-44.1.1 Admit Date/Time.Time MClinical.Visit.admittingDateTime DATETIME PV1-.1.1 Visit Indicator MClinical.Visit.visitIndicatorCd 3 5.9 PV2 HL7 Element HL7 Element Name Database.Table.Column Length PV2-7 Visit User Code MClinical.Visit.visitStatusCd 3 PV2-12.1.1 Visit Description MClinical.Visit.description 2048 5.10 AL1 We assume all allergy information for a specific source system(s) is provided in the segment. We clear all allergy information for the source system(s) before inserting to eliminate duplicates. HL7 Element HL7 Element Name Database.Table.Column Length Usage Notes AL1-1.1.1 Set ID AL1 AL1-2.1.1 Allergen Type Code MClinical.Allergy.allergenTypeCd 10 R Dictionary: Allergen_Type AL1-3.2.1 Allergen Code/Mnemonic/Description MClinical.Allergy.allergyComment max AL1-4.1.1 Allergy Severity Code MClinical.Allergy.allergySeverityCd 10 R Dictionary: Allergy_Severity AL1-5.1.1 Allergy Reaction Code MClinical.Allergy.allergyReaction 12 AL1-6.1.1 Identification Date MClinical.Allergy.identificationDate DATETIME AL1-7.1.1 Allergy Reliability Code MClinical.Allergy.allergyReliabilityCd 10 Dictionary: Allergy_Reliability AL1-8.1.1 Allergy Clinical Status Code MClinical.Allergy.allergyClinicalStatusCd 10 Dictionary: Allergy_Clinical_Status AL1-9.1.1 Entered By MClinical.Allergy.enteredBy 255 AL1-10.1.1 Source System Identifier MClinical.Allergy.sourceSystemKey/MSystem.Node.nodeId 45 R 5.11 GT1 Page 47

HL7 Element HL7 Element Name Database.Table.Column Length Notes GT1-1.1.1 Set ID - GT1 GT1-2.1.1 Guarantor Number MClinical.Guarantor.guarantorNumber 45 guarantorcontactusecd = P GT1-3.1.1 GT1-3.2.1 GT1-3.3.1 Guarantor Name Family Name Guarantor Name Given Name Guarantor Name Second and Further Given Names MClinical.Guarantor.Contact.familyName MClinical.Guarantor.Contact.givenName MClinical.Guarantor.Contact.middleName GT1-3.4.1 Guarantor Name Suffix MClinical.Guarantor.Contact.suffix GT1-3.5.1 Guarantor Name Prefix MClinical.Guarantor.Contact.title GT1-3.6.1 Guarantor Name Degree MClinical.Guarantor.Contact.degreeCd 10 GT1-5.1.1 Guarantor Address Street Address MClinical.Guarantor.Contact.Address.address1 199 GT1-5.3.1 Guarantor Address City MClinical.Guarantor.Contact.Address.city 199 GT1-5.4.1 GT1-5.5.1 Guarantor Address State or Province Guarantor Address Zip or Postal Code MClinical.Guarantor.Contact.Address.provinceStateCd 10 Dictionary: Province/State MClinical.Guarantor.Contact.Address.postalZipCd 199 GT1-5.6.1 Guarantor Address Country MClinical.Guarantor.Contact.Address.countryCd 3 Dictionary: Country GT1-5.7.1 Guarantor Address Type MClinical.Guarantor.Contact.Address.addressType 3 Dictionary: Address_Type GT1-5.8.1 Guarantor Address Other Geographic Designation MClinical.Guarantor.Contact. Address.otherGeographicDesignation 199 GT1-6.1.1 Guarantor Phone Number Home MClinical.Guarantor.Contact.PhoneNumber.phoneNumber 60 GT1-6.2.1 Guarantor Phone Number Home Telecommunication Use Code MClinical.Guarantor.Contact. PhoneNumber.contactPhoneNumberUseCd 3 GT1-7.1.1 Guarantor Phone Number Business MClinical.Guarantor.Contact.PhoneNumber.phoneNumber 60 GT1-7.2.1 Guarantor Phone Number Business Telecommunication Use Code MClinical.Guarantor.Contact. PhoneNumber.contactPhoneNumberUseCd 3 GT1-8.1.1 Guarantor Date/Time of Birth MClinical.Guarantor.guarantorBirthDateTime DATETIME GT1-9.1.1 Guarantor Administrative Sex MClinical.Guarantor.individualSexCd 10 Dictionary: Individual_Sex GT1-11.1.1 Guarantor Relationship MClinical.Guarantor.relationTypeCd 10 Page 48

GT1-12.1.1 Guarantor SSN MClinical.Guarantor.ssn GT1-13.1.1 Guarantor Date - Begin MClinical.Guarantor.guarantorStartDate DATETIME GT1-14.1.1 Guarantor Date - End MClinical.Guarantor.guarantorEndDate DATETIME guarantorcontactusecd = E GT1-16.1.1 GT1-16.2.1 GT1-16.3.1 GT1-16.4.1 GT1-16.5.1 GT1-16.6.1 GT1-17.1.1 GT1-17.3.1 GT1-17.4.1 GT1-17.5.1 GT1-17.6.1 GT1-17.7.1 Guarantor Employer Name Family Name Guarantor Employer Name Given Name Guarantor Employer Name Second and Further Given Names Guarantor Employer Name Suffix Guarantor Employer Name Prefix Guarantor Employer Name Degree Guarantor Employer Address Street Address Guarantor Employer Address City Guarantor Employer Address State or Province Guarantor Employer Address Zip or Postal Code Guarantor Employer Address Country Guarantor Employer Address Type MClinical.Guarantor.Contact.familyName MClinical.Guarantor.Contact.givenName MClinical.Guarantor.Contact.middleName MClinical.Guarantor.Contact.suffix MClinical.Guarantor.Contact.title MClinical.Guarantor.Contact.degreeCd 10 MClinical.Guarantor.Contact.Address.address1 199 MClinical.Guarantor.Contact.Address.city 199 MClinical.Guarantor.Contact.Address.provinceStateCd 10 Dictionary: Province/State MClinical.Guarantor.Contact.Address.postalZipCd 199 MClinical.Guarantor.Contact.Address.countryCd 3 Dictionary: Country MClinical.Guarantor.Contact.Address.addressType 3 Dictionary: Address_Type GT1-17.8.1 Guarantor Employer Address Other Geographic Designation MClinical.Guarantor.Contact. Address.otherGeographicDesignation 199 GT1-18.1.1 Guarantor Employer Phone Number MClinical.Guarantor.Contact.PhoneNumber.phoneNumber 60 GT1-18.2.1 Guarantor Employer Telecommunication Use Code MClinical.Guarantor.Contact. PhoneNumber.contactPhoneNumberUseCd 3 GT1-19.1.1 GT1-20.1.1 Guarantor Employee ID Number Guarantor Employment Status MClinical.Guarantor.employeeId 255 MClinical.Guarantor.employmentStatusCd 10 guarantorcontactusecd = O Page 49

GT1-45.1.1 GT1-45.2.1 GT1-45.3.1 GT1-45.4.1 GT1-45.5.1 GT1-45.6.1 GT1-46.1.1 Contact Person's Name Family Name Contact Person's Name Given Name Contact Person's Name Second and Further Given Names Contact Person's Name Suffix Contact Person's Name Prefix Contact Person's Name Degree Contact Person's Telephone Number MClinical.Guarantor.Contact.familyName MClinical. Guarantor.Contact.givenName MClinical. Guarantor.Contact.middleName MClinical. Guarantor.Contact.suffix MClinical. Guarantor.Contact.title MClinical. Guarantor.Contact.degreeCd 10 MClinical.Guarantor.Contact.PhoneNumber.phoneNumber 60 GT1-46.2.1 Contact Person's Telecommunication Use Code MClinical.Guarantor.Contact. PhoneNumber.contactPhoneNumberUseCd 3 5.12 IN1 HL7 Element HL7 Element Name Database.Table.Column Length Notes IN1-1.1.1 Set ID - IN1 IN1-2.1.1 Insurance Plan ID InsurancePlan.insurancePlanId 15 IN1-2.2.1 Insurance Plan Text InsurancePlan.planDescription 255 IN1-3.1.1 Insurance Company ID InsuranceCompany.insuranceCompanyId IN1-3.4.1 Insurance Company Assigning Authority InsuranceCompany.Issuer.issuerId 45 IN1-3.6.1 Insurance Company Assigning Facility InsuranceOffice.emdeonId IN1-4.1.1 Insurance Company Name InsuranceCompany.insuranceCompanyName 255 InsuranceOffice.officeName (if IN1-5.2.1 is empty) IN1-5.1.1 Insurance Company Address InsuranceOffice.Address.address1 199 IN1-5.2.1 Insurance Company Other Designation InsuranceOffice.officeName 255 IN1-5.3.1 Insurance Company City InsuranceOffice.Address.city 199 IN1-5.4.1 Insurance Company State or Province InsuranceOffice.Address.provinceStateCd 10 Dictionary: Province/State IN1-5.5.1 Insurance Company Zip or Postal Code InsuranceOffice.Address.postalZipCd 199 IN1-5.6.1 Insurance Company Country InsuranceOffice.Address.countryCd 3 Dictionary: Country IN1-5.8.1 Insurance Company Other Geographic Designation InsuranceOffice.Address.otherGeographicDesignation 199 IN1-6.1.1 Insurance Co Contact Person Page

IN1-7.1.1 Insurance Company Phone Number InsuranceOffice.phoneNumber 60 InsuranceOffice.faxNumber IN1-8.1.1 Group Number InsurancePolicy.groupNumber 64 IN1-9.1.1 Group Name InsurancePolicy.groupName 255 IN1-10.1.1 Insured's Group Emp ID InsurancePolicy.groupEmployeeId 255 IN1-11.1.1 Insured's Group Emp Name InsurancePolicy.groupEmployeeName 255 IN1-12.1.1 Plan Effective Date InsurancePolicy.policyEffectiveDate DATETIME IN1-13.1.1 Plan Expiration Date InsurancePolicy.policyExpiryDate DATETIME IN1-14.1.1 Authorization Information InsurancePolicy.authorizationInformation 255 IN1-15.1.1 Plan Type InsurancePlan.planType IN1-16.1.1 Name Of Insured Family Name InsurancePolicy.Contact.familyName IN1-16.2.1 Name Of Insured Given Name InsurancePolicy.Contact.givenName IN1-16.3.1 Name Of Insured Second and Furthur Given Names InsurancePolicy.Contact.middleName IN1-16.4.1 Name Of Insured Suffix InsurancePolicy.Contact.suffix IN1-16.5.1 Name Of Insured Prefix InsurancePolicy.Contact.title IN1-16.6.1 Name Of Insured Degree InsurancePolicy.Contact.degreeCd 10 IN1-16.7.1 Name Of Insured Name Type Code InsurancePolicy.Contact.contactUseCd IN1-17.1.1 Insured's Relationship To Patient InsurancePolicy.patientRelationTypeCd 10 IN1-18.1.1 Insured's Date Of Birth InsurancePolicy.insuredBirthDateTime DATETIME IN1-19.1.1 Insured's Address InsurancePolicy.Address.address1 199 IN1-19.3.1 Insured's Address City InsurancePolicy.Address.city 199 IN1-19.4.1 Insured's Address State or Province InsurancePolicy.Address.provinceStateCd 10 Dictionary: Province/State IN1-19.5.1 Insured's Address Zip or Postal Code InsurancePolicy.Address.postalZipCd 199 IN1-19.6.1 Insured's Address Country InsurancePolicy.Address.countryCd 3 Dictionary: Country IN1-19.8.1 Insured's Address Other Geographic Designation InsurancePolicy.Address.otherGeographicDesignation 199 IN1-20.1.1 Assignment Of Benefits InsurancePolicy.assignmentOfBenefitsCd 10 IN1-21.1.1 Coordination Of Benefits InsurancePolicy.coordinationOfBenefitsCd 10 IN1-22.1.1 Coord Of Ben. Priority InsurancePolicy.coordinationOfBenefitsPriority 2 IN1-29.1.1 Verification Date/Time InsurancePolicy.verificationDateTime DATETIME IN1-30.1.1 Verification By InsurancePolicy.verificationBy 255 IN1-31.1.1 Type of Agreement Code InsurancePolicy.insuranceAgreementTypeCd 10 IN1-35.1.1 Company Plan Code InsurancePolicy.companyPlanCode IN1-36.1.1 Policy Number InsurancePolicy.policyNumber 255 Page 51

IN1-37.1.1 Policy Deductible InsurancePolicy.policyDeductible MONEY IN1-38.1.1 Policy Limit - Amount InsurancePolicy.policyLimitAmount MONEY IN1-39.1.1 Policy Limit - Days InsurancePolicy.policyLimitDays SMALLINT IN1-42.1.1 Insured's Employment Status InsurancePolicy.insuredEmploymentStatusCd 10 IN1-43.1.1 Insured's Administrative Sex InsurancePolicy.insuredIndividualSexCd 10 Dictionary: Individual_Sex IN1-46.1.1 Prior Insurance Plan ID InsurancePolicy.priorInsurancePolicyNumber 255 IN1-47.1.1 Coverage Type InsurancePolicy.coverageTypeCd 10 5.13 MRG HL7 Element MRG-1 MRG-1.1.1 MRG-1.4.1 MRG-1.5.1 HL7 Element Name Prior Patient Identifier List Prior Patient ID.ID Prior Patient ID.Assigning Authority.ID Keep Merged Patient Database.Table.Column Length Notes Controls old patient deletion. Either a TRUE or FALSE is expected for this value. If none is provided FALSE is assumed. If is set to true for an ID the, the old patient will not be deleted. Instead it will be linked to the merge to Patient. Otherwise, the old patient will be deleted during the merge operation. 5.14 ORC The ORC-1 field (Order Control) is not being stored in the database. The CDR only stores Order Status. For example, when a cancellation comes in, the CDR does not perform any special cancellation logic. The order status is simply changed to CA. For outgoing messages sent via the clinical messaging service this value may be set by including the parameter key control.code when triggering the message. Orders are simply stored in the database in the current status (ORC-5). The CDR creates 1 Placer Order and Filler Order per ORC segment. Only the first sequence of the ORC segment is accepted per message. Therefore only 1 ORC segment, i.e. 1 Filler Order, is accepted per message. HL7 Element HL7 Element Name Database.Table.Column Length Notes Usage ORC-1.1.1 Order Control ORC-2.1.1 ORC-2.2.1 ORC-3.1.1 ORC-3.2.1 Placer Order Number.Entity Identifier Placer Order Number.Namespace ID Filler Order Number.Entity Identifier Filler Order Number.Namespace ID MClinical.PlacerOrder.placerOrderId 45 R MClinical.PlacerOrder.Issuer.issuerId 45 R MClinical.FillerOrder.fillerOrderId 64 R MClinical.FillerOrder.Issuer.issuerId 45 R Page 52

ORC-3.3.1 Filler Order Number.Universal ID MSystem.Node.nodeId MClinical.FillerOrder.organizationKey 45 R ORC-5.1.1 Order Status MClinical.FillerOrder.fillerOrderStatusCd 16 Dictionary: Filler_Order_Status R ORC-5.1.2 Placer Order Status MClinical.PlacerOrder.placerOrderStatusCd 16 Dictionary: Placer_Order_Status ORC-7.1.1 Quantity/Timing.Quantity MClinical.PlacerOrder.quantityTiming 255 R ORC-9.1.1 Date/Time of Transaction.Time MClinical.PlacerOrder.dateTimeTransaction DATETIME placerorderproviderusecd = 'ENT' ORC-10.1.1 Entered By.ID Number MClinical.PlacerOrder.Provider.providerId 45 R ORC-10.2.1 Entered By.Family Name.Surname MClinical.PlacerOrder.Provider.Contact.familyName ORC-10.3.1 Entered By.Given Name MClinical.PlacerOrder.Provider.Contact.givenName ORC-10.4.1 Entered By Second and Further Given Names MClinical.PlacerOrder.Provider.Contact.middleName ORC-10.5.1 Entered By.Suffix MClinical.PlacerOrder.Provider.Contact.suffix ORC-10.6.1 Entered By.Prefix MClinical.PlacerOrder.Provider.Contact.title ORC-10.7.1 Entered By.Degree MClinical.PlacerOrder.Provider.Contact.degreeCd 10 ORC-10.9.1 ORC-10.13.1 Entered By.Assigning Authority.Namespace Id Entered By Identifier Type Code MClinical.PlacerOrder.Provider.Issuer.issuerId 45 R MClinical.PlacerOrder.Provider.providerUseCd 16 ORC-10.22.1 Entered By NPI MClinical.PlacerOrder.Provider.NPI ORC-10.22.4 Entered By UPIN MClinical.PlacerOrder.Provider.UPIN Verified By ID Number MClinical.PlacerOrder.Provider.providerId 45 ORC-11.2.1 Verified By Family Name MClinical.PlacerOrder.Provider.Contact.familyName ORC-11.3.1 Verified By Given Name MClinical.PlacerOrder.Provider.Contact.givenName ORC-11.4.1 Verified By Second and Further Given Names MClinical.PlacerOrder.Provider.Contact.middleName ORC-11.5.1 Verified By Suffix MClinical.PlacerOrder.Provider.Contact.suffix ORC-11.6.1 Verified By Prefix MClinical.PlacerOrder.Provider.Contact.title ORC-11.7.1 Verified By Degree MClinical.PlacerOrder.Provider.Contact.degreeCd 10 ORC-11.9.1 ORC-11.13.1 Verified By Assigning Authority Verified By Identifier Type Code MClinical.PlacerOrder.Provider.Issuer.issuerId 45 MClinical.PlacerOrder.Provider.providerUseCd 16 Page 53

ORC-11.22.1 Entered By NPI MClinical.PlacerOrder.Provider.NPI ORC-11.22.4 Entered By UPIN MClinical.PlacerOrder.Provider.UPIN ORC-12.1.1 Ordering Provider.ID Number MClinical.PlacerOrder.Provider.providerId 45 ORC-12.2.1 Ordering Provider.Family Name.Surname MClinical.PlacerOrder.Provider.Contact.familyName ORC-12.3.1 Ordering Provider.Given Name MClinical.PlacerOrder.Provider.Contact.givenName ORC-12.4.1 Ordering Provider Second and Further Given Names MClinical.PlacerOrder.Provider.Contact.middleName ORC-12.5.1 Ordering Provider.Suffix MClinical.PlacerOrder.Provider.Contact.suffix ORC-12.6.1 Ordering Provider.Prefix MClinical.PlacerOrder.Provider.Contact.title ORC-12.7.1 Ordering Provider.Degree MClinical.PlacerOrder.Provider.Contact.degreeCd 10 ORC-12.9.1 Ordering Provider. Assigning Authority.Namespace Id MClinical.PlacerOrder.Provider.Issuer.issuerId 45 ORC-12.13. 1 Identifier Type Code MClinical.PlacerOrder.Provider.providerUseCd 16 ORC-12.22.1 Ordering Provide By NPI MClinical.PlacerOrder.Provider.NPI ORC-12.22.4 Ordering ProvideBy UPIN MClinical.PlacerOrder.Provider.UPIN ORC-13.1.1 Enterer's Location Point of Care MClinical.PlacerOrder.Location.locationName 255 ORC-13.2.1 Enterer's Location Room MClinical.PlacerOrder.Location.locationName 255 ORC-13.3.1 Enterer's Location Bed MClinical.PlacerOrder.Location.locationName 255 ORC-13.4.1 Enterer's Location Facility.Namespace ID MClinical.PlacerOrder.Location.locationName 255 ORC-13.4.2 Enterer's Location Facility.Universal Id MClinical.PlacerOrder.Location.parentLocationNode 45 ORC-13.9.1 ORC-13.10.1 ORC-13.10.2 Enterer's Location.Location Description Enterer's Location Comprehensive Location Identifier.Entity Identifier Enterer's Location.Comprehensive Location Identifier.Namespace ID MClinical.PlacerOrder.Location.description 1024 MClinical.PlacerOrder.Location.locationId 45 MClinical.PlacerOrder.Location.Issuer.issuerId 45 ORC-13.11.1 Enterer's Location. Assigning Authority.Namespace ID MClinical.PlacerOrder.Location.assigningAuthorityCd 10 ORC-14.1.1 Order Callback Phone Number MClinical.PlacerOrder.callBackPhoneNumber 60 Page 54

ORC-16.1.1 Order Control Code Reason Identifier MClinical.FillerOrder.orderControlCodeReasonCd 16 ORC-16.2.1 Order Control Code Reason Text MClinical.PlacerOrder.Note[COR] MClinical.PlacerOrder.Note[SCO] MAX for cancelled orders for scheduled orders ORC-19.2.1 Action By Family Name MClinical.PlacerOrder.Notes[SCO].Contact.familyName ORC-19.3.1 Action By Given Name MClinical.PlacerOrder.Notes[SCO].Contact.givenName ORC-19.4.1 Action By Second and Further Given Names MClinical.PlacerOrder.Notes[SCO].Contact.middleName ORC-19.5.1 Action By Suffix MClinical.PlacerOrder.Notes[SCO].Contact.suffix ORC-19.6.1 Action By Prefix MClinical.PlacerOrder.Notes[SCO].Contact.title ORC-19.7.1 Action By Degree MClinical.PlacerOrder.Notes[SCO].Contact.degreeCd ORC-27.1.1 MClinical.PlacerOrder.proposedScheduledDateTime 10 DATETIME 5.15 OBR The general order (ORM) message type allows only 1 OBR segment and therefore only 1 Requested Procedure. The OBR segment is associated with the first ORC segment. The ORC segment contains the Placer and Filler Order information. HL7 Element HL7 Element Name Database.Table.Column Length Notes Usage OBR-1.1.1 Set ID OBR OBR-4.1.1 Universal Service Identifier.Identifier MClinical.PlacerOrder.Exam.examCode 45 Repeated field in outbound messages for exam code cross references. The first is the original exam code, and any cross references are in the repeated fields (ExamCode, Description, IssuerId) OBR-4.2.1 Universal Service Identifier.Text MClinical.PlacerOrder.Exam.description 255 OBR-4.3.1 Universal Service Identifier. Name Of Coding System MClinical.PlacerOrder.Exam.Issuer.issuerId 45 OBR-4.4.1 Alternate Identifier MClinical.RequestedProcedure. ProcedureStep.Exam.examCode OBR-4.5.1 Alternate Text MClinical.RequestedProcedure. ProcedureStep.description 45 255 MClinical.PlacerOrder.examDescription OBR-4.6.1 Name of Alternate Coding System MClinical.RequestedProcedure.ProcedureStep.Exam.Issuer.issuerId 45 Page 55

OBR-5.1 Priority OBR MClinical.FillerOrder. RequestedProcedure.priorityCodeCd OBR-7.1.1 Observation Date/Time MClinical.RequestProcedure. ProcedureStep.performedEndDateTime 10 Dictionary: Priority_Code R DATETIME OBR-12.1.1 Danger Code.Identifier MClinical.FillerOrder.dangerCode 255 OBR-13.1.1 Relevant Clinical Information MClinical.FillerOrder.relevantClinicalInformation 1024 OBR-15.4.1 OBR-15.4.2 Specimen Source Body Site Identifier Specimen Source Body Site Text MClinical.PlacerOrder.bodypartCd INT MClinical.refBodyPart.description 255 Inbound messages do not update the dictionary placerorderproviderusecd = 'ORP' OBR-16.1.1 Ordering Provider.ID Number MClinical.PlacerOrder.Provider.providerId 45 R OBR-16.2.1 Ordering Provider.Family Name.Surname MClinical.PlacerOrder.Provider. Contact.familyName OBR-16.3.1 Ordering Provider.Given Name MClinical.PlacerOrder.Provider. Contact.givenName OBR-16.4.1 Ordering Provider Second and Further Given Names MClinical.PlacerOrder.Provider. Contact.middleName OBR-16.5.1 Ordering Provider.Suffix MClinical.PlacerOrder.Provider.Contact.suffix OBR-16.6.1 Ordering Provider.Prefix MClinical.PlacerOrder.Provider.Contact.title OBR-16.7.1 Ordering Provider.Degree MClinical.PlacerOrder.Provider. Contact.degreeCd 10 OBR-16.9.1 Ordering Provider.Assigning Authority - Namespace Id MClinical.PlacerOrder.Provider.Issuer.issuerId 45 R OBR-16.13.1 Identifier Type Code MClinical.PlacerOrder.Provider.providerUseCd OBR-16.22.1 OrderingProvider NPI MClinical.PlacerOrder.Provider.NPI OBR-16.22.4 OrderingProvider UPIN MClinical.PlacerOrder.Provider.UPIN OBR-18 Old Placer Order ID MClinical.PlacerOrder.oldOrderKey OBR-19 New Placer Order ID MClinical.PlacerOrder.newOrderKey OBR-20.1.1 Filler Field 1 MClinical.FillerOrder.Location.name OBR-20.2.1 Filler Field 1 MClinical.FillerOrder.Location.locationId 16 45 45 255 <<Use CTD segment with FLL>> OBR-20.1.1 is no longer used 45 <<Use CTD segment with FLL>> O BR-20.2.1 is no longer used Page 56

OBR-20.3.1 Filler Field 1 MClinical.FillerOrder.Location.Issuer.issuerId 45 <<Use CTD segment with FLL>> O BR-20.3.1 is no longer used OBR-21.1.1 Filler Field 2 MClinical.FillerOrder.ImageReady FLAG Will set the image ready date time to current time if not already set. OBR-21.2.1 Filler Field 2 MClinical.FillerOrder.TechReady FLAG Will set the tech ready date time to current time if not already set. OBR-22.1.1 Results Rpt/Status Chng Date/Time.Time MClinical.Result.statusChangeDateTime DATETIME OBR-25.1.1 Result Status.Status Code MClinical.Result.resultStatusCode 16 Dictionary: Result_Status OBR-27.6.1 Quantity/Timing.Priority MClinical.FillerOrder.isStat FLAG MClinical.PlacerOrder.statFlag placerorderproviderusecd='cp' OBR-28.1.1 Result Copies To ID Number MClinical.PlacerOrder.Provider.providerId 45 OBR-28.2.1 Result Copies To Family Name MClinical.PlacerOrder.Provider. Contact.familyName OBR-28.3.1 Result Copies To Given Name MClinical.PlacerOrder.Provider. Contact.givenName OBR-28.4.1 Result Copies To Second and Further Given Names MClinical.PlacerOrder.Provider. Contact.middleName OBR-28.5.1 Result Copies To Suffix MClinical.PlacerOrder.Provider.Contact.suffix OBR-28.6.1 Result Copies To Prefix MClinical.PlacerOrder.Provider.Contact.title OBR-28.7.1 Result Copies To Degree MClinical.PlacerOrder.Provider. Contact.degreeCd 10 OBR-28.9.1 Result Copies To Assigning Authority MClinical.PlacerOrder.Provider.Issuer.issuerId 45 OBR-28.22.1 Result Copies NPI MClinical.PlacerOrder.Provider.NPI OBR-28.22.4 Result Copies UPIN MClinical.PlacerOrder.Provider.UPIN OBR-30.1.1 Transportation Mode MClinical.FillerOrder.transportationMode OBR-31.1.1 Reason for Study.Identifier MClinical.FillerOrder.reasonForStudy 45 255 resultproviderusecd = 'PRN' OBR-32.1.1 Principal Result Interpreter.Name.ID Number MClinical.PlacerOrder.Provider.providerId 45 OBR-32.1.2 Principal Result Interpreter. Name.Family Name MClinical.PlacerOrder.Provider. Contact.familyName OBR-32.1.3 Principal Result Interpreter. Name.Given Name MClinical.PlacerOrder.Provider. Contact.givenName Page 57

OBR-32.1.5 Principal Result Interpreter.Name.Suffix MClinical.PlacerOrder.Provider.Contact.suffix OBR-32.1.6 Principal Result Interpreter.Name.Prefix MClinical.PlacerOrder.Provider.Contact.title OBR-32.1.7 Principal Result Interpreter.Name.Degree MClinical.PlacerOrder.Provider. Contact.degreeCd 10 OBR-32.1.9 Principal Result Interpreter.Name. Assigning Authority - Namespace Id MClinical.PlacerOrder.Provider.Issuer.issuerId 45 OBR-32.22.1 OBR-32.22.4 Principal Result Interpreter NPI Principal Result Interpreter UPIN MClinical.Result.Provider.NPI MClinical.Result.Provider.UPIN resultproviderusecd = 'AST' OBR-33.1.1 Assistant Result Interpreter.Name.ID Number MClinical.PlacerOrder.Provider.providerId 45 OBR-33.1.2 Assistant Result Interpreter. Name.Family Name MClinical.PlacerOrder.Provider. Contact.familyName OBR-33.1.3 Assistant Result Interpreter. Name.Given Name MClinical.PlacerOrder.Provider. Contact.givenName OBR-33.1.5 Assistant Result Interpreter.Name.Suffix MClinical.PlacerOrder.Provider.Contact.suffix OBR-33.1.6 Assistant Result Interpreter.Name.Prefix MClinical.PlacerOrder.Provider.Contact.title OBR-33.1.7 Assistant Result Interpreter.Name.Degree MClinical.PlacerOrder.Provider. Contact.degreeCd 10 OBR-33.1.9 Assistant Result Interpreter.Name. Assigning Authority - Namespace Id MClinical.PlacerOrder.Provider.Issuer.issuerId 45 OBR-33.22.1 OBR-33.22.4 Principal Result Interpreter NPI Principal Result Interpreter UPIN MClinical.Result.Provider.NPI MClinical.Result.Provider.UPIN 16 fillerorderproviderusecd = 'PTP' OBR-34.1.1 Technician.Name.ID Number MClinical.Result.Provider.providerId 45 OBR-34.1.2 Technician.Name.Family Name MClinical.Result.Provider.Contact.familyName OBR-34.1.3 Technician.Name.Given Name MClinical.Result.Provider.Contact.givenName OBR-34.1.4 Technician.Second and Further Given Names MClinical.Result.Provider.Contact.middleName OBR-34.1.5 Technician.Name.Suffix MClinical.Result.Provider.Contact.suffix Page 58

OBR-34.1.6 Technician.Name.Prefix MClinical.Result.Provider.Contact.title OBR-34.1.7 Technician.Name.Degree MClinical.Result.Provider.Contact.degreeCd 10 OBR-34.1.9 Technician.Name.Assigning Authority - Namespace ID MClinical.Result.Provider.Issuer.issuerId 45 OBR-34.1.11 TechnicianUniveral ID Type MClinical.Result.Provider.providerUseCd 16 OBR-34.22.1 Technician NPI MClinical.Result.Provider.NPI OBR-34.22.4 Technician UPIN MClinical.Result.Provider.UPIN 16 resultproviderusecd = 'TRN' OBR-35.1.1 Transcriptionist.Name.ID Number MClinical.Result.Provider.providerId 45 OBR-35.1.2 Transcriptionist.Name.Family Name MClinical.Result.Provider.Contact.familyName OBR-35.1.3 Transcriptionist.Name.Given Name MClinical.Result.Provider.Contact.givenName OBR-35.1.5 Transcriptionist.Name.Suffix MClinical.Result.Provider.Contact.suffix OBR-35.1.6 Transcriptionist.Name.Prefix MClinical.Result.Provider.Contact.title OBR-35.1.7 Transcriptionist.Name.Degree MClinical.Result.Provider.Contact.degreeCd 10 OBR-35.1.9 Transcriptionist.Name.Assigning Authority - Namespace Id MClinical.Result.Provider.Issuer.issuerId 45 OBR-35.22.1 Transcriptionist NPI MClinical.Result.Provider.NPI OBR-35.22.4 Transcriptionist UPIN MClinical.Result.Provider.UPIN OBR-36.1.1 Scheduled Date/Time.Time MClinical.ProcedureStep. scheduledstartdatetime OBR-39.1.1 Collector's Comments MClinical.FillerOrder.fillerOrderComments DATETIME max OBR-40.1.1 Transport Arrangement Responsibility MClinical.FillerOrder.StatContact.name 255 OBR-40.2.1 Transport Arrangement Responsibility MClinical.FillerOrder.StatContact.phoneNumber 60 OBR-40.3.1 Transport Arrangement Responsibility MClinical.FillerOrder.StatContact.type OBR-41.1.1 Transport Arranged MClinical.FillerOrder.transportArranged OBR-44.1.1 Procedure Code Identifier MClinical.RequestedProcedure. ProcedureStep.Exam OBR-44.2.1 Procedure Code Text MClinical.RequestedProcedure. ProcedureStep.description 45 45 255 Page 59

OBR-44.3.1 Procedure Code Name of Coding System MClinical.RequestedProcedure. ProcedureStep.ExamCode.Issuer 45 OBR-44.4.1 Procedure Code Alternate Identifier MClinical.RequestedProcedure. ProcedureStep.Exam 45 OBR-44.5.1 Procedure Code Alternate Text MClinical.RequestedProcedure. ProcedureStep.description 255 OBR-44.6.1 Procedure Code Name of Alternate Coding System MClinical.RequestedProcedure. ProcedureStep.ExamCode.Issuer 45 OBR-45.1.1 Procedure Code Modifier.Identifier MClinical.RequestedProcedure.ProcedureStep.ExamCodeModifier.examCodeModifierCd 16 OBR-45.2.1 Procedure Code Modifier Text MClinical.RequestedProcedure.ProcedureStep.ExamCodeModifier.description 255 OBR-45.3.1 Procedure Code Modifier Name of Coding System MClinical.RequestedProcedure.ProcedureStep.ExamCodeModifier.Issuer.issuerId 45 OBR-45.3.2 Procedure Code Modifier Type MClincial.RequestedProcedure.ProcedureStep.ExamCodeModifier.examCodeModifierTypeCd 16 OBR-46.1.1 Placer Supplemental Service Information - Identifier MClinical.PlacerOrder.ExamCodeModifier.examCodeModifierCd 16 OBR-46.2.1 Placer Supplemental Service Information - Text MClinical.PlacerOrder. ExamCodeModifier.description 255 OBR-46.3.1 Placer Supplemental Service Information - Name of Coding System MClinical.PlacerOrder. ExamCodeModifier.Issuer.issuerId 45 OBR-46.3.2 Placer Supplemental Service Information - Name of Coding System MClinical.PlacerOrder.ExamCodeModifier.examCodeModifierTypeCd 16 5.16 CTD HL7 Element HL7 Element Name Database.Table.Column Length Usage CTD-1.1.1 Contact Role ENT- PlacerOrder EnteringLocation, FillerOrder TimeOfOrderLocation (if ORC-13 not populated) FLL- PlacerOrder FillerLocation, FillerOrder scheduledlocation R CTD-2.1.1 Contact Name CTD-3.1.1 Contact Address CTD-4.1.1 Contact Location- Point of Care MClinical.Location.pointOfCare 80 CTD-4.2.1 Contact Location- Room MClinical.Location.room 80 Page 60

CTD-4.3.1 Contact Location- Bed MClinical.Location.bed 80 CTD-4.4.1 Contact Location- Facility Namespace ID MClinical.Location.locationName 255 CTD-4.4.2 Contact Location- Facility Universal ID **parentorganizationnode** 45 CTD-4.7.1 Contact Location- Building MClinical.Location.building 80 CTD-4.8.1 Contact Location- Floor MClinical.Location.floorName 80 CTD-4.9.1 Contact Location- Description MClinical.Location.description 1024 CTD-4.10.1 Contact Location- Location Identifier MClinical.Location.locationId 45 R CTD-4.10.2 Contact Location- Location Identifier Namespace MClinical.Location.Issuer.issuerId 45 R CTD-4.11.1 Contact Location- Assigning Authority MClinical.Location.assigningAuthorityCd 10 5.17 DG1 HL7 Element HL7 Element Name Database.Table.Column Length Notes Usage DG1-1.1.1 Set ID DG1 This field is used as the sequence identifier for all the indication information within a message. It is assumed that for every DG1 segment each will have a unique number, starting at 1. R DG1-2.1.1 Diagnosis Coding Method MClinical.Issuer.issuerId 45 R DG1-3.1.1 Diagnosis Code.Identifier MClinical.Indication.indicationId 45 If an indication does not have a specific ID use 'OtherDx', 'OtherSx' or 'OtherHx' to specify an unstructured indication. R DG1-3.1.2 MClinical.Indication.subIndicationId 45 Used in cases where a single indication id is not sufficient to unambiguously define an indication. DG1-3.2.1 DG1-3.3.1 Diagnosis Code.Text Diagnosis Code.Name of Coding System MClinical.Indication.indicationDescription 836 MClinical.Indication.indicationCategoryCd 3 Dictionary: Indication_Category R 5.18 IPC The IPC segment contains information about tasks that need to be performed in order to fulfill the request for imaging service. The information includes location, type and instance identification of equipment (acquisition modality) and stages (procedure steps). Each IPC segment will create 1 Procedure Step under its parent Requested Procedure in the CDR. HL7 Element Designator HL7 Element Name Database.Table.Column Length Usage IPC-1.1.1 Accession Number.Entity Identifier MClinical.FillerOrder.accessionNumber 64 IPC-2.1.1 Requested Procedure ID.Entity Identifier MClinical.RequestedProcedure.requestedProcedureId 16 R IPC-3.1.1 Study Instance UID.Entity Identifier MClinical.RequestedProcedure.proposedStudyInstanceUid MClinical.FillerOrder.studyInstanceUid 64 255 Page 61

IPC-4.1.1 Scheduled Procedure Step ID.Entity Identifier MClinical.ProcedureStep.procedureStepId 16 R IPC-5.1.1 Modality.Identifier MClinical.ProcedureStep.modalityTypeCd 16 IPC-7.1.1 IPC-8.1.1 IPC-8.2.1 IPC-8.3.1 IPC-8.4.1 Scheduled Station Name.Entity Identifier Scheduled Procedure Step Location.Identifier Scheduled Procedure Step Location.Text Scheduled Procedure Step Location.Name of Coding System Scheduled Procedure Step Location.Alternate Identifier MClinical.ProcedureStep.Resource.resourceId 45 MClinical.ProcedureStep.Resource.description 255 MClinical.ProcedureStep.Resource.Issuer.issuerId 45 MClinical.ProcedureStep.Resource.M3_Resource.resource_ref INT IPC-9.1.1 Scheduled Station AE Title MClinical.RoutineRadExamDetails.exam_ae_title 25 5.19 ZRP This is a custom vendor specific segment created by Medicalis to capture additional Requested Procedure status information. The general order (ORM) message type allows only 1 ZRP segment to be transmitted. The ZRP segment is associated with the OBR segment by the Set ID (ZRP-1, and OBR-1). HL7 Element HL7 Element Name Database.Table.Column Length Notes ZRP-1.1.1 Set Id ZRP-2.1.1 Requested Procedure Status RequestedProcedure.requestedProcedureStatusCd 16 ZRP-3.1.1 Procedure Step Status ProcedureStep.procedureStepStatusCd 16 ZRP-4.1.1 ZRP-4.2.1 ZRP-4.3.1 Diagnostic Imaging Status.Status Code Diagnostic Imaging Status.Allowed status list Diagnostic Imaging Status.Disallowed status List RequestedProcedure.diagnosticImagingStatusCd 3 ZRP-5.1.1 Allow Filler Order ID Reuse FillerOrder.allowFillerOrderIdReuse FLAG ZRP-6.1.1 Source System Identifier MClinical.PlacerOrder.sourceSystemKey MClinical.PlacerOrder.createdUser MClinical.FillerOrder.sourceSystemKey MClinical.FillerOrder.createdUser 45 ZRP-6.2.1 ZRP-6 Field Description ZRP-7.1.1 Archiving System ID MSystem.Node.nodeId 45 MClinical.FillerOrder.archivingSystemKey ZRP-9.1.1 Order subspecialty MClinical.ProcedureStep.subSpecialtyCd 10 Dictionary: Subspecialty ZRP-10.1.1 Message Time Zone MClinical.FillerOrder.timeZoneId 45 Dictionary: Time_Zone ZRP-10.2.1 ZRP-10 Field Description Page 62

ZRP-11.1.1 Default Reporting System ID MClinical.FillerOrder.defaultReportingSystemKey 45 ZRP-12.1.1 Auto-Create Issuers Flag << Use OVR issuer.donotautocreate >> ZRP-12.2.1 ZRP-12 Field Description ZRP-13.1.1 Auto-Create Systems Flag << User OVR system.donotautocreate >> ZRP-13.2.1 ZRP-13 Field Description ZRP-15.1.1 Auto-create Call Report Triggers automatic creation of a call report for orders in the message ZRP-16.1.1 Worklist Name MClinical.FillerOrder.Worklist.filter_name ZRP-17.1.1 Imaging System MClinical.FillerOrder.StudyLocation.imagingSystemKey 45 An imaging system (i.e. PACS) that has images for the given study. ZRP-17.2.1 Image available date time MClinical.FillerOrder.StudyLocation.createdDateTime DATETIME 5.20 ZOF HL7 Element HL7 Element Name Database.Table.Column Length ZOF-1.1.1 OLF Field Name OnlineForm.KeyValueList.keyValue.key 255 (MClinical.OLFDataElementObjects.data_read_element_ref) ZOF-2.1.1 OLF Field Value OnlineForm.KeyValueList.keyValue.value (MClinical.OLFDataDateTimeValues.result_value MClinical.OLFDataDateVarcharValues.result_value MClinical.OLFDataXmlValues.result_value) DATETIME max XML 5.21 OBX (for Reports) The OBX segment is used to transmit a single observation or observation fragment. It represents the smallest indivisible unit of a report. OBX segments intended to be used for reports MUST appear after the ORC segment. This is done to distinguish between reports and observations. HL7 Element HL7 Element Name Database.Table.Column Length Usage OBX-1.1.1 Set ID OBX MClinical.ResultSection.sequence SMALLINT O OBX-2.1.1 Value Type MClinical.ResultSection.valueType OBX-3.1.1 Observation Identifier.Identifier.Id MClinical.Result.resultId 45 R OBX-3.1.2 Observation Identifier.Identifier.Category MClinical.ResultSection.sectionCategory O Observation Identifier.Text MClinical.Result.resultType O OBX-3.2.1 Page 63

OBX-3.3.1 Observation Identifier.Name of Coding System MClinical.Result.Issuer.issuerId 45 R OBX-4.1.1 Observation Sub Id MClinical.ResultSection.subIdentifier R OBX-5.1.1 Observation Value MClinical.ResultSection.sectionValue max O OBX-8.1.1 Abnormal Flags MClinical.ResultSection.abnormalCd O OBX-11.1.1 Observation Result Status MClinical.ResultSection.sectionStatusCd OBX-14.1.1 Date/Time of the Observation MClinical.ResultSection.observationDateTime DATETIME O 5.22 OBX (for Observations, Lab Results or Precautions) The OBX segment is used to transmit a patient observation, including but not limited to laboratory result and precaution. When used in a report message, these OBX segments MUST appear before the ORC segment. This is done to distinguish between observations and reports. Observations for a patient are uniquely identified by resulttype, observationtype, observationdatetime and sourcesystemid. HL7 Element HL7 Element Name Database.Table.Column Length Usage OBX-1.1.1 Set ID OBX OBX-3.1.1 Observation Identifier.Identifier.Id MClinical.ObservationResult.observationId 45 OBX-3.2.1 Observation Identifier.Text MClinical.Result.resultType Defaults to 'LAB' when not supplied OBX-4.1.1 Observation Sub Id MClinical.ObservationResult.observationType R OBX-5.1.1 Observation Value MClinical.ObservationResult.observationValue MAX OBX-6.1.1 Units MClinical.ObservationResult.units SMALLINT OBX-7.1.1 References Range MClinical.ObservationResult.referenceRange 20 OBX-8.1.1 Abnormal Flags MClinical.ObservationResult.abnormalFlagCd 5 Dictionary: Abnormal_Flag OBX-9.1.1 Probability MClinical.ObservationResult.probability FLOAT OBX-11.1.1 Observation Result Status MClinical.ObservationResult.observationResultStatusCd 5 OBX-14.1.1 Date/Time of the Observation MClinical.ObservationResult.observationDateTime DATETIME OBX.15.1.1 Producer's ID MSystem.Node.nodeId MClinical.ObservationResult.sourceSystemKey 45 R OBX-16.1.1 Responsible Observer MClinical.ObservationResult.enteredBy 255 OBX-17.1.1 Observation Method MClinical.ObservationResult.observationMethod 255 5.23 OBX (for MDM OLF data) The OBX segment is used to transmit data for displaying in online form documents associated with the patient and/or order. HL7 Element HL7 Element Name Database.Table.Column Length OBX-1.1.1 Set ID OBX OBX-2.1.1 Value Type OnlineForm.KeyValueList.keyValue.dataType Page 64

OBX-3.1.1 Observation Identifier.Identifier.Id OnlineForm.KeyValueList.keyValue.key 255 (MClinical.OLFDataElementObjects.data_read_element_ref) OBX-5.2.1 Observation Value OnlineForm.KeyValueList.keyValue.value (MClinical.OLFDataDateTimeValues.result_value MClinical.OLFDataDateVarcharValues.result_value MClinical.OLFDataXmlValues.result_value) DATETIME max XML 5.24 BLG HL7 Element HL7 Element Name Database.Table.Column Length Notes BLG-2.1.1 Charge Type Only GR (Grant) is supported BLG-3.1.1 Account ID MClinical.PlacerOrder.grantNumber 64 5.25 STF HL7 Element HL7 Element Name Database.Table.Column Length Notes STF-2.1.1 Staff Identifier List MClinical.Provider.providerId OR MClinical.Provider.UPIN OR MClinical.Provider.NPI 45 STF-2.4.1 Identifier Type Code MClinical.Provider.Issuer.issuerId 45 STF-3.1.1 Staff Name Family MClinical.Provider.Contact.familyName STF-3.2.1 Staff Name Given MClinical.Provider.Contact.givenName STF-3.3.1 Staff Name Second and Further Given Names MClinical.Provider.Contact.middleName STF-3.4.1 Staff Name Suffix MClinical.Provider.Contact.suffix STF-3.5.1 Staff Name Prefix MClinical.Provider.Contact.title STF-3.6.1 Staff Name Degree MClinical.Provider.Contact.degreeCd 10 STF-10.4.1 Email Address MClinical.Provider.Contact.EmailAddress.emailAddress 255 STF-10.9.1 Phone Any Text MClinical.Provider.Contact.PhoneNumber.contactPhoneNumberUseCd 3 STF-10.12.1 STF-11.1.1 Unformatted Telephone number Office/Home Address/Birthplace Address MClinical.Provider.Contact.PhoneNumber.phoneNumber 60 MClinical.Provider.Contact.Address.address1 199 STF-11.3.1 City MClinical.Provider.Contact.Address.city 199 STF-11.4.1 State or Province MClinical.Provider.Contact.Address.provinceStateCd 10 Dictionary: Province/State STF-11.5.1 Zip or Postal Code MClinical.Provider.Contact.Address.postalZipCd 199 Page 65

STF-11.6.1 Country MClinical.Provider.Contact.Address.countryCd 3 Dictionary: Country STF-11.7.1 Address Type MClinical.Provider.Contact.Address.addressType 3 Dictionary: Address_Type STF-11.8.1 Other Geographic Designation MClinical.Provider.Contact.Address.otherGeographicDesignation 199 5.26 OVR HL7 Element HL7 Element Name Database.Table.Column Notes OVR-1.1.1 Business Rule Override Type ID Processing Instruction ID OVR-1.2.1 Business Rule Override Type Code true/false 5.27 LOC In the CDR, this segment represents a Resource. An HL7 event can contain multiple LOC segments (Resources). The LCH segment further defines the Resource s location. HL7 Element HL7 Element Name Database.Table.Column Length LOC-1 Primary Key Value - LOC LOC-1.10.1 Location Identifier.Identifier MClinical.Resource.resourceId 45 LOC-1.10.2 Location Identifier.Namespace ID MClinical.Resource.Issuer.issuerId 45 LOC-2.1.1 Location Description MClinical.Resource.description 255 5.28 LCH This optional segment allows assigning for assigning a Resource to a Location. HL7 Element HL7 Element Name Database.Table.Column Length LCH-1 Primary Key Value - LCH LCH-1.10.1 Location Identifier.Identifier MClinical.Location.locationId 45 LCH-1.11.1 Location Identifier.Namespace ID MClinical.Location.Issuer.issuerId 45 LCH-1.11.2 Assigning Authority for Location MClinical.Location.assigningAuthorityCd 10 5.29 IIM HL7 Element HL7 Element Name Database.Table.Column Length IIM-1 Primary Key Value - IIM IIM-1.1.1 Identifier MClinical.Modality.modalityId 45 IIM-1.3.1 Name of Coding System MClinical.Modality.Issuer.IssuerId 45 IIM-2 Service Item Code Page 66

IIM-2.1.1 Identifier MClinical.Modality.aeTitle 16 IIM-2.2.1 Text MClinical.Modality.stationName 255 IIM-2.4.1 Alternate Identifier MClinical.Modality.ipAddress 15 IIM-5 Inventory Manufacturer Name IIM-5.1.1 Identifier MClinical.Modality.manufacturerModelNumber 64 IIM-5.2.1 Text MClinical.Modality.manufacturer 64 IIM-5.7.1 Coding System Version ID MClinical.Modality.softwareVersion 64 IIM-6.1.1 Inventory Location MClinical.Modality.departmentName 64 IIM-14 Procedure Code MClinical.Modality.modalityTypeCd 16 5.30 PRA HL7 Element HL7 Element Name Database.Table.Column Length Notes PRA-3.1.1 Practitioner Category MClinical.Provider.providerTypeCd 10 Supports auto-population 5.31 EDU HL7 Element HL7 Element Name Database.Table.Column Length Notes EDU-2.1.1 Academic Degree MClinical.Provider.degreeCd 10 Supports auto-population 5.32 NTE HL7 Element HL7 Element Name Database.Table.Column Length NTE-3.1.1 Comment MClinical.Provider.notes MAX 5.33 OM1 The OM1 segment defines the attributes of the exam(s) being created/updated. HL7 Element OM1-2 HL7 Element Name Database.Table.Column Length Notes Preferred Long Name for the Observation OM1-20.1.1 Phone Number of Outside Site MClinical.ExamCode.hangingProtocolGroupCode 10 Supports auto-population OM1-46 Telephone Number of Section OM1-47.1.1 Nature of Service/Test/Observation MClinical.ExamCode.modalityTypeCd 16 Supports auto-population 5.34 OM7 Page 67

The OM7 segment defines additional attributes of the exam(s) being created/updated. HL7 Element HL7 Element Name Database.Table.Column Length Notes OM7-3.1.1 Category Identifier MClinical.ExamCode.subSpecialtyCd 10 Supports auto-population Dictionary: Subspecialty 5.35 TXA The TXA segment is used to transmit information about a transcribed document. HL7 Element HL7 Element Name Database.Table.Column Length TXA-2 Document Type MClinical.refFormType.ID_TypeOfForm BIGINT TXA-4 Activity Date/Time MClinical.OLFDataDateTimeValues.result_value DATETIME TXA-6 Origination Date/Time MClinical.OLFDataInstances.createdDateTime DATETIME TXA-12 Unique Document Number TXA-12.1.1 Entity Identifier MClinical.OLFDataInstanceOnlineForm.ID_DataInsatnceOnlineForms BIGINT TXA-12.2.1 Namespace ID MClinical.OLFDataVarcharValues.result_value MAX TXA-14 Placer Order Number TXA-14.1.1 Entity Identifier MClinical.PlacerOrder.placerOrderId 45 TXA-14.2.1 Namespace ID MClinical.PlacerOrder.Issuer.issuerId 45 TXA-15 Filler Order Number TXA-15.1.1 Entity Identifier MClinical.FillerOrder.fillerOrderId 64 TXA-15.2.1 Namespace ID MClinical.FillerOrder.Issuer.issuerId 45 TXA-17 Document Completion Status MClinical.OLFDataVarcharValues.result_value MAX 5.36 ZNF HL7 Element HL7 Element Name Database.Table.Column Length ZNF-1.1.1 Notification Headline ZNF-2.1.1 Notification Details 5.37 FT1 HL7 Element HL7 Element Name Database.Table.Column Length FT1-7.1.1 Transaction Code Identifier MClinical.CompletableOtherCharge.chargeTypeCd 10 FT1-7.2.1 Transaction Code Text MClinical.CompletableOtherCharge.description 510 5.38 RQD HL7 Element HL7 Element Name Database.Table.Column Length Page 68

RQD-2.1.1 Item Code - Internal Identifier MClinical.CompletableSupply.supplyTypeCd 6 RQD-2.2.1 Item Code - Internal Text MClinical.CompletableOtherCharge.description 510 5.39 RXD HL7 Element HL7 Element Name Database.Table.Column Length RXD-2.1.1 Dispense/Give Code Identifier MClinical.Pharmaceutical.parmaceuticalId 45 RXD-2.2.1 Dispense/Give Code Text MClinical.Pharmaceutical.productDescription 510 RXD-4.1.1 Actual Dispense Amount MClinical.AdministeredPharmaceutical.preparedAmount RXD-5.1.1 Actual Dispense Units MClinical.AdministeredPharmaceutical.preparedUnit 15 RXD-10.1.1 Dispensing Provider MClinical.Provider RXD-18.1.1 Substance Lot Number MClinical.AdministeredPharmaceutical.lotNumber 256 RXD-20.1.1 Substance Manufacturer Name MClinical.Pharmaceutical.brand 510 5.40 RXA HL7 Element HL7 Element Name Database.Table.Column Length RXA-5.1.1 Administered Code Identifier MClinical.Pharmaceutical.parmaceuticalId 45 RXA-5.2.1 Administered Code Text MClinical.Pharmaceutical.productDescription 510 RXA-6.1.1 Administered Amount MClinical.AdministeredPharmaceutical.administeredAmount RXA-7.1.1 Administered Units MClinical.AdministeredPharmaceutical.administeredUnit 15 RXA-10.1.1 Administering Provider MClinical.Provider RXA-15.1.1 Substance Lot Number MClinical.AdministeredPharmaceutical.lotNumber 256 RXA-17.1.1 Substance Manufacturer Name MClinical.Pharmaceutical.brand 510 6.0 Code Reference 6.1 Abnormal Flag Code Description < Below Absolute Low-Off Instrument Scale > Above Absolute High-Off Instrument Scale A AA B D H Abnormal Very Abnormal Better Significant Change Down Above High Normal Page 69

HH I L LL MS N R S U VS W Above Upper Panic Limits Intermediate Below Low Normal Below Lower Panic Limits Moderately Susceptible Normal Resistant Susceptible Significant Change Up Very Susceptible Worse 6.2 Address Type Code B BA BL BR C F H L M N O P RH Description Firm or Business Bad Address Birth Delivery Location Residence at Birth Current or Temporary Country of Origin Home Legal Address Mailing Birth Address Office Permanent Registry Home 6.3 Admission Type Code A E L Description Accident Emergency Labor and Delivery Page 70

R N U C Routine Newborn (Birth in healthcare facility) Urgent Elective 6.4 Admit Source Code Description 1 Physician referral 2 Clinic referral 3 HMO referral 4 Transfer from a hospital 5 Transfer from a skilled nursing facility 6 Transfer from another healthcare facility 7 Emergency room 8 Court/law enforcement 9 Information not available 6.5 Allergen Type Code AA CM DA EA FA LA MA MC PA Description Animal Allergy Contrast Media Drug Allergy Environmental Allergy Food Allergy Pollen Allergy Miscellaneous Allergy Miscellaneous Contraindication Plant Allergy 6.6 Allergy Clinical Status Code C D Description Confirmed or Verified Doubt Raised Page 71

E I P S U Erroneous Confirmed but Inactive Pending Suspect Unconfirmed 6.7 Allergy Reliability Code N U Y Description No Known Reaction Unknown Reaction Known Reaction 6.8 Allergy Severity Code MI MO SV U Description Mild Moderate Severe Unknown 6.9 Ambulatory Status Code A0 A1 A2 A3 A4 A5 A6 A7 A8 A9 B1 Description No functional limitations Ambulates with assistive device Wheelchair/stretcher bound Comatose; non-responsive Disoriented Vision impaired Hearing impaired Speech impaired Non-English speaking Functional level unknown Oxygen therapy Page 72

B2 B3 B4 B5 B6 Special equipment (tubes, IVs, catheters) Amputee Mastectomy Paraplegic Pregnant 6.10 Assigning Authority Code E I O P R B C N U Description Emergency Inpatient Outpatient Preadmit Recurring Patient Obstetrics Commercial Account Not Applicable Unknown 6.11 Country Code ABW AFG AGO AIA ALB AND ANT ARE ARG ARM ASM ATA ATF Description Aruba Afghanistan Angola Anguilla Albania Andorra Netherlands Antilles United Aram Emirates Argentina Armenia American Samoa Antarctica French Southern Territories Page 73

ATG AUS AUT AZE BDI BEL BEN BFA BGD BGR BHR BHS BIH BLR BLZ BMU BOL BRA BRB BRN BTN BVT BWA CAF CAN CCK CHE CHL CHN CIV CMR COD COG COK Antigua and Barbuda Australia Austria Azerbaijan Burundi Belgium Benin Burkina Faso Bangladesh Bulgaria Bahrain Bahamas Bosnia and Herzegovina Belarus Belize Bermuda Bolivia Brazil Barbados Brunei Darussalam Bhutan Bouvet Island Botswana Central African Republic Canada Cocos (Keeling) Islands Switzerland Chile China Cote D'Ivoire Cameroon Congo, The Democratic Republic of the Congo, People's Republic of Cook Island Page 74

COL COM CPV CRI CUB CXR CYM CYP CZE DEU DJI DMA DNK DOM DZA ECU EGY ERI ESH ESP EST ETH FIN FJI FLK FRA FRO FSM GAB GBR GEO GHA GIB GIN Columbia Comoros Cape Verde Costa Rica Cuba Christmas Islands Cayman Islands Cyprus Czech Republic Germany Djibouti Dominica Denmark Dominican Republic Algeria Ecuador Egypt Eritrea Western Sahara Spain Estonia Ethiopia Finland Fiji Falkland Islands (Malvinas) France Faroe Islands Micronesia, Federated States of Gabon United Kingdom Georgia Ghana Gibraltar Guinea Page 75

GLP GMB GNB GNQ GRC GRD GRL GTM GUF GUM GUY HKG HMD HND HRV HTI HUN IDN IOT IRL IRN IRQ ISL ISR ITA JAM JOR JPN KAZ KEN KGZ KHM KIR KNA Guadeloupe Gambia Guinea-Bissau Equatorial Guinea Greece Grenada Greenland Guatemala French Guiana Guam Guyana Hong Kong Heard Island and McDonald Islands Honduras Croatia Haiti Hungary Indonesia British Indian Ocean Territory Ireland Iran, Islamic Republic of Iraq Iceland Israel Italy Jamaica Jordan Japan Kazakhstan Kenya Kyrgyzstan Cambodia Kiribati Saint Kitts and Nevis Page 76

KOR KWT LAO LBN LBR LBY LCA LIE LKA LSO LTU LUX LVA MAC MAR MCO MDA MDG MDV MEX MHL MKD MLI MLT MMR MNG MNP MOZ MRT MSR MTQ MUS MWI MYS Korea, Republic of Kuwait Lao People's Democratic Republic Lebanon Liberia Libyan Arab Jamahiriya Saint Lucia Liechtenstein Sri Lanka Lesotho Lithuania Luxembourg Latvia Macau Morocco Monaco Moldova, Republic of Madagascar Maldives Mexico Marshall Islands Macedonia, The former Yugoslav Republic of Mali Malta Myanmar Mongolia Northern Mariana Islands Mozambique Mauritania Montserrat Martinique Mauritius Malawi Malaysia Page 77

MYT NAM NCL NER NFK NGA NIC NIU NLD NOR NPL NRU NZL OMN PAK PAN PCN PER PHL PLW PNG POL PRI PRK PRT PRY PYF QAT REU ROM RUS RWA SAU SDN Mayotte Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Niue Netherlands Norway Nepal Nauru New Zealand Oman Pakistan Panama Pitcairn Peru Philippines Palau Papua New Guinea Poland Puerto Rico Korea, Democratic People's Republic of Portugal Paraguay French Polynesia Qatar Reunion Romania Russian Federation Rwanda Saudi Arabia Sudan Page 78

SEN SGP SGS SHN SJM SLB SLE SLV SMR SOM SPM STP SUR SVK SVN SWE SWZ SYC SYR TCA TCD TGO THA TKL TKL TKM TMP TON TTO TUN TUR TUV TWN TZA Senegal Singapore South Georgia and the South Sandwich Islands Saint Helena Svalbard and Jan Mayen Solomon Islands Sierra Leone El Salvador San Marino Somalia Saint Pierre and Miquelon Sao Tome and Principe Suriname Slovakia Slovenia Sweden Swaziland Seychelles Syrian Arab Republic Turks and Caicos Islands Chad Togo Thailand Tajikistan Tokelau Turkmenistan East Timor Tonga Trinidad and Tobago Tunisia Turkey Tuvalu Taiwan, Province of China Tanzania, United Republic of Page 79

UGA UKR UMI URY USA UZB VAT VCT VEN VGB VIR VNM VUT WLF WSM YEM YUG ZAF ZMB ZWE OTH Uganda Ukraine United States Minor Outlying Islands Uruguay United States Uzbekistan Holy See (Vatican City State) Saint Vincent and the Grenadines Venezuela Virgin Islands, British Virgin Islands, U.S. Vietnam Vanuatu Wallis and Futuna Samoa Yemen Yugoslavia South Africa Zambia Zimbabwe Other 6.12 Employment Status Code Description 1 Full time employed 2 Part time employed 3 Unemployed 4 Self-employed 5 Retired 6 On active military duty 9 Unknown C L Contract Leave of absence Page 80

O T Other Temporarily unemployed 6.13 Filler Order Status Code A C D F I N P S T X Description Addended Completed Dictated Final In Progress Non-reportable Preliminary Scheduled Transcribed Cancelled 6.14 Degree Code AA AAS ABA AE AS BA BBA BE BFA BN BS BSL BT CER DBA Description Associate of Arts Associate of Applied Science Associate of Business Administration Associate of Engineering Associate of Science Bachelor of Arts Bachelor of Business Administration Bachelor or Engineering Bachelor of Fine Arts Bachelor of Nursing Bachelor of Science Bachelor of Science - Law Bachelor of Theology Certificate Doctor of Business Administration Page 81

DED DIP DO HS JD MA MBA MCE MD MDI ME MED MEE MFA MME MS MSL MT NG PharmD PHD PHE PHS SEC TS Doctor of Education Diploma Doctor of Osteopathy High School Graduate Juris Doctor Master of Arts Master of Business Administration Master of Civil Engineering Doctor of Medicine Master of Divinity Master of Engineering Master of Education Master of Electrical Engineering Master of Fine Arts Master of Mechanical Engineering Master of Science Master of Science - Law Master of Theology Non-Graduate Doctor of Pharmacy Doctor of Philosophy Doctor of Engineering Doctor of Science Secretarial Certificate Trade School Graduate 6.15 Filler Order Status Code A C D F I Description Addended Completed Dictated Final In progress Page 82

N P S T X Non-reportable Preliminary Scheduled Transcribed Cancelled 6.16 Hospital Service Code Description MED Medical Service SUR URO PUL CAR Surgical Service Urology Service Pulmonary Service Cardiac Service 6.17 Identity Reliability Code Description US UD UA AL Unknown/Default Social Security Number Unknown/Default Date of Birth Unknown/Default Address Patient/Person Name is an Alias 6.18 Indication Category Code APP DX HX PS RPP SX U Description Active Patient Problems Differential Diagnosis Relevant History Procedure Specific Resolved Patient Problems Signs and Symptoms Unspecified Page 83

6.19 Individual Sex Code A F M N O U Description Ambiguous Female Male Not applicable Other Unknown 6.20 Language Proficiency Code Description 1 Excellent 2 Good 3 Fair 4 Poor 5 Some (level unknown) 6 None 6.21 Marital Status Code A B C D E G I M N O P R Description Separated Unmarried Common law Divorced Legally Separated Living together Interlocutory Married Annulled Other Domestic partner Registered domestic partner Page 84

S T U W Single Unreported Unknown Widowed 6.22 Name Type Code Description A C E F I N O P S U B D L M R T Patient Alias Emergency Contact Employer Federal Agency Insurance Company Next-of-Kin Other Primary State Agency Unknown Name at Birth Display Name Legal Name Maiden Name Registered Name (animals only) Indigeous/Tribal/Community Name 6.23 Observation Result Status Code C D F I N Description Correction Delete Final Results Specimen in Lab; Results Pending Not Asked Page 85

O P R S X U W Order Detail Description Only (No Result) Preliminary Results Results Entered Not Verified Partial Results Results Cannot be Obtained for this Observation Results Status Change to Final Post Original as Wrong, Transmitted for Wrong Patient 6.24 Patient Class Code E I O P R B C N U Description Emergency Inpatient Outpatient Preadmit Recurring Patient Obstetrics Commercial Account Not Applicable Unknown 6.25 Placer Order Status Code CA CM CR DC F HD NW PR SC WK Description Cancelled Completed Created (saved) Discontinued (expired) Final On hold (draft) New (not saved) Scheduled (proposed) Scheduled (confirmed) Scheduled (walk-in) Page 86

6.26 Priority Code Code C E U R S Description Critical ER Urgent Routine Stat 6.27 Procedure Step Status Code ARR COM DIS PEN PRO SCH SUS Description Patient Arrived Completed Discontinued Pending In Progress Scheduled Suspended 6.28 Province/State Code AB BC MB NB NL NS NT NU ON PE QC SK Description Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Page 87

YT AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM Yukon Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Page 88

NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming 6.29 Race Code ASN BLK NAT OTH WHT Description Asian Black or African American Indian or Native Other White 6.30 Relation Type Code ASC BRO CGV CHD Description Associate Brother Care giver Child Page 89

DEP DOM EMC EME EMR EXF FCH FND FTH GCH GRD GRP MGR MTH NCH NON OAD OTH OWN PAR SCH SEL SIB SIS SPO TRA UNK WRD Handicapped dependent Life partner Emergency contact Employee Employer Extended family Foster child Friend Father Grandchild Guardian Grandparent Manager Mother Natural child None Other adult Other Owner Parent Stepchild Self Sibling Sister Spouse Trainer Unknown Ward of court 6.31 Religion Code ABC Description Christian: American Baptist Church Page 90

AGN AME AMT ANG AOG ATH BAH BAP BMA BOT BTA BTH BUD CAT CFR CHR CHS CMA CNF COC COG COI COL COM COP COT CRR EOT EPI ERL EVC FRQ FWB GRE Agnostic Christian: African Methodist Episcopal Zion Christian: African Methodist Episcopal Christian: Anglican Christian: Assembly of God Atheist Baha'i Christian: Baptist Buddhist: Mahayana Buddhist: Other Buddhist: Tantrayana Buddhist: Theravada Buddhist Christian: Roman Catholic Chinese Folk Religionist Christian Christian: Christian Science Christian: Christian Missionary Alliance Confucian Christian: Church of Christ Christian: Church of God Christian: Church of God in Christ Christian: Congregational Christian: Community Christian: Other Pentecostal Christian: Other Christian: Christian Reformed Christian: Eastern Orthodox Christian: Episcopalian Ethnic Religionist Christian: Evangelical Church Christian: Friends Christian: Free Will Baptist Christian: Greek Orthodox Page 91

HIN HOT HSH HVA JAI JCO JEW JOR JOT JRC JRF JRN JWN LMS LUT MEN MET MOM MOS MOT MSH MSU NAM NAZ NOE NRL ORT OTH PEN PRC PRE PRO QUA REC Hindu Hindu: Other Hindu: Shaivites Hindu: Vaishnavites Jain Jewish: Conservative Jewish Jewish: Orthodox Jewish: Other Jewish: Reconstructionist Jewish: Reform Jewish: Renewal Christian: Jehovah's Witness Christian: Lutheran Missouri Synod Christian: Lutheran Christian: Mennonite Christian: Methodist Christian: Latter-day Saints Muslim Muslim: Other Muslim: Shiite Muslim: Sunni Native American Christian: Church of the Nazarene Nonreligious New Religionist Christian: Orthodox Other Christian: Pentecostal Christian: Other Protestant Christian: Presbyterian Christian: Protestant Christian: Friends Christian: Reformed Church Page 92

REO SAA SEV SHN SIK SOU SPI UCC UMD UNI UNU VAR WES WMC Christian: Reorganized Church of Jesus Christ-LDS Christian: Salvation Army Christian: Seventh Day Adventist Shintoist Sikh Christian: Southern Baptist Spiritist Christian: United Church of Christ Christian: United Methodist Christian: Unitarian Christian: Unitarian Universalist Unknown Christian: Wesleyan Christian: Wesleyan Methodist 6.32 Requested Procedure Status Code CAN DCT FIN NRP PRE RSS SCH Description Cancelled Dictated Final Non-Reportable Preliminary Results Stored Scheduled 6.33 Result Status Code A D F P T Description Addendum to result Dictated Final results; results stored and verified. Can only be changed with a corrected result. Preliminary: A verified early result is available, final results not yet obtained Transcribed Page 93

6.34 Subspecialty Code ABDOMEN BONE BREAST CARDIO CHEST CT GI HEAD_NECK INTERVEN MR MUSCL NEURO NM ONCOLOGY PEDIATRIC TRAUMA US Description Abdomen Bone Breast Imaging Cardiovascular Chest Computed Tomography Gastrointestinal Head & Neck Interventional Magnetic Resonance Scan Musculoskeletal Neuroradiology Nuclear Medicine Radiation Oncology Pediatric Radiology Trauma/ER Ultrasound 6.35 Telecommunication Use Code CP FX HP IP OT PG WP Description Cell Phone Fax Home Phone International Phone Other Pager Work Phone 6.36 Time Zone Code Description Page 94

America/St_Johns America/Halifax America/New_York America/Chicago America/Denver America/Los_Angeles America/Anchorage Pacific/Honolulu (UTC-03:30) Newfoundland (UTC-04:00) Atlantic Time (Canada) (UTC-05:00) Eastern Time (US & Canada) (UTC-06:00) Central Time (US & Canada) (UTC-07:00) Mountain Time (US & Canada) (UTC-08:00) Pacific Time (US & Canada) (UTC-09:00) Alaska (UTC-10:00) Hawaii 6.37 VIP Indicator Code E S ES UNK Description Patient is a VA employee Patient record is sensitive Patient is a VA Employee and patient record is sensitive Unknown 6.38 Visit Indicator Code A V Description Account Level (default) Visit Level 7.0 Integration Notes 7.1 Order Control Codes Outbound HL7 from Medicalis Workflow will include an order control code in ORC-1 to indicate what action triggered the outbound message. Order Control Code CA IC NA NW RO SC Notes Order cancellation Image location change - a message will be sent whenever study images are added or removed from a given location (i.e. PACS) Number assigned - sent when a prior authorization request is assigned New Order - sent when an order is created Replacement Order - sent when an order is rescheduled Status Change - Sent any time the status of an order is changed Page 95

SJ WC XO Seed Job - Used to seed any destination systems that may need prior knowledge of a study before further data is sent (i.e. images to a PACS) Worklist change - a message will be sent whenever a study is moved from one worklist to another Changed Order - sent when an order is updated 7.2-32 Common (ADT^A08, ORM, ORU) Processing Instructions Message Type Processing Instruction Description Notes allergy.autopopulatedictionaries Populate the Allergy Dictionary Codes guarantor.autopopulatedictionaries Populate the Guarantor Dictionary Codes guarantor.createifnotfound Create the guarantor if it does not exist guarantor.overwritemode Modify the guarantor if it exists guarantor.updateiffound Modify the guarantor if it exists insurance.autopopulatedictionaries Populate the Insurance Dictionary Codes insurancecompany.createifnotfound Create the insurance company if it does not exist insurancecompany.updateiffound Modify the insurance company if it exists insuranceplan.createifnotfound Create the insurance plan if it does not exist insuranceplan.updateiffound Modify the insurance plan if it exists insurancepolicy.createifnotfound Create the insurance policy if it does not exist insurancepolicy.updateiffound Modify the insurance policy if it exists issuer.donotautocreate Do not auto create issuers Recommended Production State: enabled issuer.donotupdateiffound Do not modify existing issuers Recommended Production State: enabled location.autopopulatedictionaries Populate the location code dictionaries location.createifnotfound Create the location if it does not exist location.updateiffound Modify the location if it exists organization.donotautocreate Do not create the organization if it does not exist patient.appendproviders Keep existing patient provider relationships patient.autopopulatedictionaries Populate the patient code dictionaries patient.createifnotfound Create the patient if it does not exist patient.updateiffound Modify the patient if it exists person.createifnotfound Create the person linking patient records if it does not exist provider.autopopulatedictionaries Populate the provider code dictionaries Page 96

provider.createifnotfound Create the provider if it does not exist provider.updateiffound Modify the provider if it exists system.donotautocreate Do not auto create systems Recommended Production State: enabled visit.appendproviders Keep existing visit provider relationships visit.autopopulatedictionaries Populate the visit code dictionaries visit.createifnotfound Create the visit if it does not exist visit.disablestatussynchronization Don't synchronize statuses visit.updateiffound Modify the visit if it exists 7.3-29 Common (ORM, ORU) Processing Instructions Message Type Processing Instruction Description Notes exam.autopopulatedictionaries Populate all the exam code dictionaries exam.createifnotfound Create the exam if is does not exist exam.updateiffound Modify the exam if it exists exammodifier.createifnotfound exammodifier.updateiffound Creates the links between the exam and its modifiers Update the links between the exam and its modifiers fillerorder.appendproviders Keep existing filler order provider relationships fillerorder.autopopulatedictionaries Populate the filler order code dictionaries fillerorder.constrainstatuschange Constrain filler order status changes to forward changes only fillerorder.createifnotfound Create the filler order if it does not exist fillerorder.donotchangeplacerorder Do not allow filler orders to be moved to a new placer order Recommended Production State: enable fillerorder.procedurestep.autopopulatedictionaries fillerorder.requestedprocedure.autopopulatedictionaries Populate the scheduled procedure step dictionaries Populate all the requested procedure dictionaries fillerorder.updateiffound Modify the filler order if it exists patient.autolink person.updateiffound placerorder.appendproviders Automatically link patient records that have matching criteria Modify the person linking patient records if it exists Keep existing placer order provider relationships Page 97

placerorder.autopopulatedictionaries Populate the placer order dictionaries placerorder.constrainstatuschange Constrain placer order status changes to forward changes only placerorder.createifnotfound Create the placer order if it does not exist placerorder.donotsign Sign order placerorder.orp.donotreplace Fail if placer order ordering provider (ORP) changes placerorder.updateiffound Update the placer order if it exists procedurestep.appendproviders requestedprocedure.allowallstatetransitions requestedprocedure.reportdiagnosticimagingtransitionserrors requestedprocedure.resultstatus.allowallstatetransitions requestedprocedure.resultstatus.reporttransitionserrors Keep existing procedure step provider relationships Allow all requested procedure status transitions Report errors in diagnotic imaging status workflow transitions Do not validate the result status state transitions Raise an error if result status state transition is invalid resource.createifnotfound Create the resource if it is not found resource.updateiffound Modify the resource if it exists 7.4-1 Additional ORM Processing Instructions Message Type Processing Instruction placerorder.donotchangevisit Description When enabled the visit cannot be changed a placerorder. When disabled a visit on a placerorder can be changed Notes Should be disabled to allow inbound order messages to be moved to another visit. 7.5-6 Additional ORU Processing Instructions Message Type Processing Instruction Description Notes result.appendproviders Keep existing result provider relationships result.createifnotfound Create the result if it is not found result.synchronizefillerorderstatus Advance the filler order status with the new incoming result status result.updateiffound Modify the result if it exists resultsection.concatenatesections Concatenate similar result sections even if they don't appear together. resultsection.replacesections Replace any result sections that exist. Page 98

result.donotprependaddendedsections New sections in the HL7 message will be inserted before existing sections when false result.donotappendaddendedsections Ignore HL7 message sequence numbers and insert new sections with the next unused sequence number when false 8.0 Using This Document 8.1 Table of Contents The table of contents contains quick links to various sections in this document. If you want to find the specification for a specific message type, find it in the 'Message Profile' section and click on desired Message Type. Eg. ADT^A08. If you want to look for a specific segment, you can also click the link to the desired segment in the 'HL7 to SQL Mappings' section. Eg. PID. 8.2 CTRL + F This document supports finding text using CTRL + F. This is a handy way to jump around the document. Eg. CTRL + F and typing PV1-2.1.1 + Enter would jump you to the spec definition for the PV1-2.1.1 'Patient Class'. This can be useful when you want to look up a specific field in the HL7 spec. Any text can be searched in this document using CTRL + F. ** **Your PDF viewer or webbrowser may look differently than the image but should support the same 'Find' functionality. Hyperlinks Page 99

There are hyperlinks in this document that will jump to another location in the document. Outside of the table of contents, this is mostly used to jump to a Medicalis dictionary definition from the field spec where it is used. Eg. The PID-8.1.1 Patient Gender is expected to be a specific set of values in Medicalis. The specification for this field lists the dictionary and contains a hyperlink to jump to that dictionary. Clicking on this hyperlink will jump to the related dictionary where you can view the required coded value for that HL7 field and a description of what the coded values mean. The 'Code' must be sent to Medicalis. 8.3 Required Fields Certain fields are marked as required or optional fields. This is denoted in the 'Usage' column of the field mappings. The Usage code is defined in the 'Usage Column' section. Page 100

8.4 Issuers There are many fields listed as 'issuers'. These 'issuers' are typically not sent from systems, but they must be sent into Medicalis so that Medicalis knows where the data came from. Usually this data will be hardcoded to values or set based on other values in the hl7 message like Sending Application or a Location. Medicalis will help you determine which issuers to send in the HL7. Page 101