TOC+Clinical+Information+Model

include component="page" wikiName="siframework" page="TOC Header" **TOC Clinical Information Model, Version 1.5**

toc [|TOC Clinical Information Model (CIM) Version 1.5 Consensus Review]
 * To download the latest version of the TOC CIM, click here:**


 * Overview:** This guide is intended to capture an overview of the Clinical Information Model (CIM) developed in support of the S&I Framework Transitions of Care Initiative. The TOC CIM is structured into several significant parts,designed for readability and ease of understanding. Several of the initial sections are explanatory and provide explicit guidance to stakeholders who may not have any exposure to the Transitions of Care initiative or the underlying mission of the CIM. Other sections are focused on the more technical concepts surrounding the CIM, including objects and attributes, and how the CIM is structured to promote clinician understanding of care transitions. Please review the introductory sections prior to reviewing the usage and data dictionary of the TOC CIM.

The data elements contained in the TOC CIM have been thoroughly reviewed by the WG, and UC Care Planning SWG members. For descriptions of the classifications, please reference TOC Classification of Data Elements.


 * Consensus Notice:** The WG achieved final consensus on the Clinical Information Model (CIM), Version 1.5, on Thursday, August 11, 2011. Please visit the TOC CIM Consensus Page to review the comments provided during the consensus process and the latest CIM specification.


 * Edits: ** Please make note of any edits or comments in the discussion tab to ensure proper version control.



** Transitions Care Clinical Information Model ** ** Version 1.5 - Consensus Review **



** ns of Care Clinical Information Model ** =Overview= ** Version 1.5 - Consensus Review ** This guide is intended to capture an overview of the Clinical Information Model developed in support of the S&I Framework Transitions of Care Initiative. The TOC CIM is structured into several significant parts, designed for readability and ease of understanding. Several of the initial sections are explanatory and provide explicit guidance to stakeholders who may not have any exposure to the Transitions of Care initiative or the underlying mission of the CIM.

Other sections are focused on the more technical concepts surrounding the CIM, including objects and attributes, and how the CIM is structured to promote clinician understanding of care transitions. __Please review the introductory sections prior to reviewing the usage and data dictionary of the TOC CIM.__

Audience
The intended audience for this guide includes the following stakeholders, who are the core of the value proposition for the CIM:


 * **Stakeholder** || **Usage of the TOC CIM** ||
 * Providers and specialists || Provide a clinical perspective and view into care transition data relevant to providers and specialists. ||
 * Care coordinators || Ensures that in each care transition, the right clinical data that is needed by the care coordinator is available. ||
 * Electronic Health Record Vendors || Gives EHR vendors an idea of the clinical data they need to support in each care transition. ||
 * Personal Health Record Vendors || Gives PHR vendors a view into the type of patient-level data that care transitions produce, and may be requested from patients. ||

Prerequisites
There are several prerequisites for usage of the TOC CIM:
 * An organization should have knowledge of the Health Level Seven International (HL7) Clinical Document Architecture (CDA). This is //critically important// as the CDA serves as the foundation for the TOC CIM and its objects/data elements.
 * An organization should have knowledge of the ISO/HL7 datatypes. CIM Data Elements are expressed using ISO/HL7 datatypes proposed by the members of the S&I Framework Transitions of Care Initiative.

Assumptions
There are several assumptions built into the CIM that are important to recognize:
 * 1) The CIM is not a physical “thing”. It is intended to be a logical representation and is thus represented as a data model for that purpose.
 * 2) ISO and CDA datatypes are used in the CIM representation, to allow for the common transformation of CDA documents to CIM objects and vice versa.
 * 3) CIM Objects are intended to be used primarily for requirements traceability. This means it is intended to map clinical data to the requirements of a use case. Because this initial representation of the CIM is CDA-based, the primary level of traceability is from the CIM to the key information exchanges defined in the Transitions of Care Use Case.
 * 4) The CIM is NOT intended to provide an overlay for the HL7 RIM. As such, RIM objects are not represented in the CIM in any form.
 * 5) The CIM is NOT based on an underlying information model, which limits its usage outside the scope intended.
 * 6) The modeling notation used is Information Exchange (IE), used as part of an ERD.

=Introduction=

The Transitions of Care (TOC) Clinical Information Model (CIM) is intended to serve as a logical overlay and neutral representation of the data needed to support care transitions. The value proposition inherent in the CIM is that it provides a view for clinicians into the type of data needed to support each care transition, and gives implementers and vendors an idea of how to store and exchange that data. The TOC CIM is intended to be a logical view of the common data model that underlies all care transition information. In practice, it will manifest itself as physical data within an organization engaged in transitions of care.

The TOC CIM is not intended to be a “pure” clinical information model. This means it is not tied to an underlying information model (such as the HL7 RIM). Its focus is on providing a clear view for a clinician on the data they are accustomed to looking at and manipulating within their clinical workflow. In this way, it provides a functional perspective that allows for the mapping of care transition requirements to an underlying technical standard. For the TOC CIM, this means mapping to the underlying CDA on which entity (known as a CIM Object and defined here ) would be based.

A secondary purpose is to enable the creation of an object-oriented model that maps the requirements for care transitions to TOC CIM objects. This is a longer-term goal that will require further testing and analysis of the TOC CIM.

The work on the TOC CIM was guided by practicing clinicians and other implementers who were interested in creating a simple, easy to understand model for functional stakeholders to use. The TOC CIM also draws heavily from best practices and models defined by several organizations involved in clinical information modeling, including:
 * NEHTA
 * FHIM
 * HL7 Version 3
 * Intermountain Healthcare (CEM)

Specific sources of information were drawn from the existing work of these organizations to create underlying CIM Objects and to help define the structure. It was not the intention in the development of the TOC CIM to specifically adopt an information model already in use, or to redefine existing information models, but simply to draw from previous work already done to create a new type of representation specifically targeted to the requirements of clinicians who may not have a deep understanding of care transition data, its structure, and its flow.

=CIM Concepts (TOC Object Model)=

A CIM concept includes Key Information Exchanges, CIM Objects and CIM Data Elements. It is important to understand these terms prior to reviewing the CIM itself. These terms may also collectively be referred to as the “TOC Object Model”, a figurative term used to outline the dependencies between these 3 concepts. The following figure provides an overview of this object model “structure”



Many of these concepts are analogous to existing data modeling terms. For clinicians, this section may be useful to help understand how the TOC CIM is structured.

Key Information Exchange
A key information exchange is the set of functional requirements that CIM objects “trace” to. The key information exchange forms the basis for new CIM objects that may be needed to fulfill clinical requirements that may come from the S&I Framework or from other sources of requirements within healthcare. The key information exchanges specific to care transitions can be found here :

The following figure shows how a Discharge Summary key information exchange is structured:



Because the CIM is designed for reuse, each of the CIM objects are intended for reuse outside the scope of the TOC CIM. This is due to the fact that the CIM is logical – the CIM objects are not designed to “force” conformance but simply capture the key data elements needed to exchange a bucket of information. Each bucket of information can be combined with other buckets to produce a key information exchange.
 * **//Example//** ||
 * The Transitions of Care Use Case defines 4 key information exchanges that must be met to satisfy the clinical requirements of the use case’s defined actors. Each of these 4 key information exchanges is mapped to specific CIM objects. ||

In the context of other use cases and other standards, this is an important concept to understand. CIM objects can logically be subsetted or extended depending on the requirements needed for the use case. Subsetting in this case means taking a subset of the CIM Object to be used as clinical data, while extends means adding additional data elements to the CIM Object depending on the care transition or clinical setting. CIM objects can be extended or subsetted based on 2 factors – __priority and requirements traceability__ (these will be discussed further in a later version of the TOC CIM).

Furthermore, the buckets do not have to be dependent on the underlying standard. This extension and subsetting is separate from the underlying standard used (discussed in the Data Element Set section of this document)
 * **//Example//** ||
 * A Discharge Instructions Key Information Exchange specifies a Demographics CIM Object. However, the object will contain both A data elements and C data elements. These elements can be sent depending on the rules for CIM priorities, and a subset of the Discharge Instructions can be sent if certain information is not available from the EHR. ||


 * **//Example//** ||
 * The Provider Directory use case creates a set of requirements surrounding Demographic data. This can be mapped to the Demographics CIM Object, which can be extended or subsetted depending on the requirements of the use case. Because the Demographics CIM object is only logically attached to the underlying standard, changes can be made by the Provider Directory initiative to create a new CIM for Provider Directory that reuses CIM objects used in another initiative. ||

CIM Object
A CIM Object represents a specific entity within a logical data model. Each CIM Object is designed to map to an underlying concept that is of some familiarity to practicing clinicians and specialists, and other stakeholders who may be involved in healthcare organizations. The TOC CIM specifically is targeted to those clinicians and specialists who may be involved in care transitions processes.

A key differential with CIM Objects is that they are not tied to any specific underlying information model. Thus, as an example, a CIM Object is not tied to the HL7 RIM, although it may use concepts or terms that are similar to the RIM. As noted in the previous section, this avoidance of connection to an underlying standard (and adherence to respect for the underlying standard) allows CIM objects to be reused in other contexts.

CIM Objects are intended to capture a real-world clinical concept and display it in a manner that is understandable to clinicians, patients, and other stakeholders who may be involved in a care transition. __This means that CIM objects are not intended to be represented as physical objects, meaning the representation of how data is stored within a physical data store.__

For CIM Objects, several key pieces of information are defined to assist in understanding clinical meaning. They are summarized in the following table:


 * **Characteristic** || **Description of the Characteristic** ||
 * Name || A clinically-relevant name for this CIM Object – should be understandable to clinicians ||
 * Definition || A clinically-relevant definition of the CIM Object ||
 * CDA ID References || Captures CDA specific references for Document, Section, and Entry ids ||
 * CIM Object Priority || The priority of this TOC CIM Object- please review the next section on CIM Priorities to understand how these priorities are created ||

CIM Data Elements
A CIM Data Element is an attribute of a CIM Object.

There are several rules associated with CIM Data Elements:
 * Aligned to underlying data element from the CDA, if possible
 * Aligned to S&I Framework Data Element Sets, if possible
 * Have proposed datatypes

For CIM Data Elements, several key pieces of information are defined to assist in understanding clinical meaning:


 * **Characteristic** || **Description of the Characteristic** ||
 * Name || A clinically-relevant name for this CIM Data Element – should be understandable to clinicians ||
 * Definition || A clinically-relevant definition of the CIM data element ||
 * Datatype || A possible datatype that can be used to represent this CIM data element – aligned to the underlying CDA datatype ||
 * Examples and guidance || Provides examples of what this clinical term means and guidance on value sets and vocabularies ||
 * Data Element Priority || The priority of this TOC CIM Data Element – please review the next section on CIM Priorities to understand how these priorities are created ||

Understanding CIM Priorities
CIM priorities are used to capture the specific priorities of both CIM Objects and CIM Data Elements. These priorities have been reviewed by clinicians and other stakeholders involved in care planning and care transitions within healthcare organizations throughout the United States. The TOC CIM defines specific priorities surrounding data to help in determining what key information needs to be exchanged in each care transition. The following table summarizes the priorities and their applicability:


 * = **Classifications of CIM Priority** ||
 * **CIM Data Element Priority** || **Description of Priority** ||
 * "A" Data Element || * Core data exchanged with every transition of care ||
 * "B" Data Elements || * NB subsets of categories of "additional" data elements (e.g. several results from the hundreds that may be in the EHR database for a patient) can be added by the clinician end user to the Direct Message depending on the clinical circumstance.
 * The variable data elements are selectively added to prevent information overload by the recipient clinician (e.g. a recipient clinician receiving several hundred results for a patient following an extended hospital stay would lead to the recipient clinician being data overloaded and not caring for the patient as effectively as in the circumstances of receiving the selected 2 or three results that would be helpful to the PCP for efficient care and management of the patient).
 * Selected "B" data elements are either very frequently required in most transition of care circumstances (e.g. results) and/or are regularly captured in many EHR systems as discrete data. ||
 * "C" Data Elements || * Variable data needed by the end user in some transition of care circumstances
 * Selected "C" data elements are either less frequently required in most transition of care circumstances and/or are not currently captured in many EHR systems as discrete data ||
 * "D" Data Elements || * Variable data needed by the end user in some transition of care circumstances
 * Selected "D" data elements are less frequently required in most transition of care circumstances than C, and/or are not captured in EHR systems as discrete data elements, or may not be captured currently in EHR systems at all ||

Usage of ISO/HL7 Data Types
A core set of datatypes is needed to support the representation of the CIM. The reason for this is that the TOC CIM is not based on any underlying information mdoel, and thus has to use a set of datatypes from some source to represent data logically. The TOC CIM adopted the ISO/HL7 datatypes that are commonly used as part of the HL7 RIM and the HL7 CDA. A list of these datatypes can be found here:

[]

It should be noted that several of the datatypes referenced in this list are specific to the HL7 CDA. As noted, a user of the TOC CIM should have basic knowledge of the CDA if at all possible.

The following table provides an overview of the datatypes used in the TOC CIM:


 * **ISO/HL7 Datatype** || **Description** || **Usage** ||
 * AD || Address || Used to capture a physical address ||
 * TN || Telephone Number || Used to capture phone numbers and email addresses ||
 * PN || Person Name || Used to capture the name of a person ||
 * CF || Coded Element with formatted values || Similar to CE but with formatted values ||
 * ED || Encapsulated Data || Used to capture text and multimedia that may be included in a care transition ||
 * BAG || Bag || Used to capture a an unordered, multiple collection of things ||
 * SET || Set || Used to represent an unordered collection type that stores unique elements ||
 * HIST || History || Used to capture historical items about something or set of things ||
 * LIST || List Sequence || Used to store ordered, non-unique elements ||
 * IVL || Interval || Used to capture an interval of things ||
 * IVL_TS || Interval – Timestamp || Used to capture an interval of time ||
 * CS || Coded – Simple Value || Used to capture a simple set of codes ||
 * PQ || Physical Quantity || Used to capture information about quantities, through a value and a unit of measure ||
 * CE || Coded Element || Used to capture a specific coded element or set of coded elements ||
 * BL || Boolean || Used to capture Boolean information (true/false, yes/no, etc…) ||
 * DATE || Date || Used to capture a date ||
 * II || Instance Identifier || Used to identify a unique instance of some thing ||
 * INTEGER || Integer || Used to capture a number ||
 * EN || Entity Name || Used to capture the name of an individual or organization ||

In addition, the TOC CIM defines a Structure datatype. This datatype is used in those cases where the data assembled might be another object or discrete set of data that is assembled somewhere else (outside the scope of the CIM). It is important to note that many of the CIM data elements can potentially be expressed using multiple data types. This is one of the foundational principles of the CIM itself; it is not meant to be prescriptive or to require conformance, it is simply meant to serve as a tool to represent the perspective of the clinician. As such, design decisions surrounding a Structure datatype can be made by implementers and vendors depending on the base derived datatype within their environment.

Each iteration of the TOC CIM is working to further clarify the proposed datatypes to be used for each CIM Data Element, so it is expected that as the TOC CIM evolves, additional detail will be offered for those CIM Data Elements defined with a datatype of Structure. Specific focus was concentrated in this initial version of the CIM on the "A" Data Elements.


 * //**Example**// ||
 * The Dose CIM Data Element has a datatype of PQ (Physical Quantity), a common data type used to capture dosage quantities in the CDA. ||

This implementation guidance on data element sets is provided to allow for the reuse of common data elements defined in the S&I Framework Data Element Sets are used to describe common data elements that may be reused across multiple settings among multiple S&I Framework initiatives. A DES can be used to provide a common set of elements that are used to capture information.


 * Difference between a DES and a CIM Object**

__An important difference between a DES and a CIM Object is that a DES is designed to support technical reuse within the S&I Framework. A CIM object is designed to support clinical reuse within the S&I Framework.__

=CIM Constraints= It is important to note that the only constraints on the CIM itself are “priorities” of CIM Objects and CIM Data Elements. These constraints for the TOC CIM are as follows:
 * All A CIM Data Elements must be sent as part of each care transition.
 * All B CIM Data Elements must be sent as part of each care transition if they are readily available and can be generated by the EHR
 * All C CIM Data Elements can be sent if available and if they can be generated
 * All D CIM Data Elements can be sent if available and if the EHR can actually generate them

The reason for making CIM constraints flexible is that different CIM’s may have different constraints to be applied to the same CIM Object. For example, a CIM Object might be an "A" Data Element according to the TOC Initiative, but CIM requirements for Provider Directory Initiative might express a similar CIM Object as a "C" data element.

CIM Conformance Statements
The CIM does not contain explicit conformance language that would list a set of conformance statements. There are several reasons for this:
 * The CIM is not a ballotable specification (meaning it is not owned by an SDO) and is not intended to serve as a standard
 * The CIM is informative and not normative - it is intended to serve as guidance and not be prescriptive. Being informative means that the CIM DOES NOT set out requirements, rules, or conformance statements. This is due to the fact that it is based on the CDA and that it is NOT based on an underlying information model.
 * The CIM is intended to be used for requirements traceability and is not normally implemented on its own (although it is possible to build an object-oriented model of it logically).

The intention is for implementers to use the underlying conformance language of the CDA when working with CIM objects. The TOC Implementation Guide (a companion document) outlines how each of the four information exchanges defined in the Transitions of Care Use Case can be implemented using the CDA. The conformance language used in the CDA Consolidation Guide is reusable in the context of the CIM. The section libraries in the CDA Consolidation Guide for each document type list the required and optional sections. In order to claim conformance to the CIM, an implementation would have to satisfy all the requirements and mandatory statements listed in the CDA Consolidation Guide.

Subsequent iterations of the TOC CIM may include more explicit conformance language that is developed based on implementer feedback.


 * **//Example of CDA constraint reuse://** ||
 * A constraint applied in the CDA for Allergy/Alert Observation section is brought up to the Allergy and Intolerance CIM object. The conformance statement:

SHALL contain exactly one [1..1] code, which SHALL be selected from ValueSet 2.16.840.1.113883.3.88.12.3221.6.2 Allergy/Adverse Event Type DYNAMIC (CONF:7383). \

applies to the Allergy and Intolerance CIM Object. || It is also expected that because the CIM is a logical overlay of a physical data store, the CIM would be subject to the constraints of the physical data model(s). Claims of conformance may also be made for the CIM Object itself for each key information exchange.


 * **//Example of CIM Object conformance//** ||
 * The CIM object “Social History” would inherit all of the conformance statements specific to the Social History in the CDA consolidation guide. An implementer would review the Social History Section-level template (2.16.840.1.113883.10.20.22.2.17) and would need to conform to this statement:

The Social History section MAY contain clinical statements. If present, the clinical statements SHALL conform to the social history observations. || As a general rule, the vocabularies and value sets defined in the CDA are inherited by CIM objects and CIM data elements.

__The TOC Implementation Guidance also relies on the recommendations of the HITSC Vocabulary Task Force for those CIM objects that have associated vocabulary/code set requirements. The following table captures the high-level recommendations from this__


 * **CIM Object** || **CIM Data Elements** || **Vocabulary Recommendation** ||
 * Physical Exam || Component || LOINC ||
 * ^  || Observation || SNOMED-CT ||
 * Family History || Component || LOINC ||
 * ^  || Response || SNOMED-CT ||
 * Active Medication List || Active Medication List || RxNORM ||
 * Procedures || Procedure || SNOMED-CT ||
 * Problem List || Problem || SNOMED-CT ||
 * Equipment || Equipment || SNOMED-CT ||
 * Culturally Sensitive Patient Care || Race || PHIN-VADS ||
 * ^  || Gender || HL7 ||
 * ^  || Language || ISO 639-2 ||
 * Payer Information || Primary Payer Information || ASC X12 ||
 * ^  || Secondary Payer Information || ASC X12 ||

Because vocabulary recommendations were not completed, these code set recommendations exist only as proposed at this time. They serve as a useful reminder for implementers who may be interested in implementing the CIM. Additional vocabulary recommendations can be reused from the NLM mappings and subsets available through UMLS.


 * //**Example:**// ||
 * An implementer may wish to implement a discharge summary using an existing vocabulary already implemented within their environment. The CIM Object “Problem List” does not exclude the use of this vocabulary, so long as an accurate mapping exists back to the SNOMED-CT recommendation provided by the Health IT Standards Committee Vocabulary Task Force. ||

=Usage of the CIM=

In this visual, usage of the CIM in various implementation geographies is outlined. This graphic is provided to explain how the Transitions of Care Clinical Information Model (CIM) can be used in support of reference implementations and other working environments, together with the underlying key information exchanges. Transport specifications would not actually “use” CIM Objects; they would use the CIM to provide traceability to the requirements they have for information exchange. In this way, the CIM can serve as a key tool to verify whether information is being exchanged in support of the clinical perspective.

In the following figure, the use of the CIM is outlined, together with the methods of health information exchange and the underlying standard. This figure is a key high-level view of the intention for the CIM, which is to link the requirements of the clinician to an underlying standard and a method of transporting clinical data:
 * Examples of CIM Usage**



Relevant Usage Diagrams
Associated usage diagrams for the TOC CIM are provided, to give context to implementers and clinicians about different usage scenarios for the TOC CIM. This section specifically highlights the 4 use case scenarios outlined in the S&I Framework Transitions of Care Use Case (please review this link if you are not familiar with the use case and its requirements.)

Transitions of Care - Scenario 2 User Story 2


= =
 * =TOC CIM – Detailed Data Dictionary= ||

Because the TOC CIM is intended to represent a logical representation of clinical data, it serves as a data dictionary for a care transition. The following sections contain specific tables that capture information about the TOC CIM in a tabular format for easy lookup of important implementation guidance, such as


 * 1) CDA implementation guidance
 * 2) Relevant CIM priority
 * 3) Clinical Examples (highlighted in Bold) to help understand the clinical meaning of the CIM Objects and CIM Data Elements

A summary of the TOC CIM structure is outlined below ·
 * Transitions of Care CIM Object Summary – summarizing each of the TOC CIM Objects
 * CIM Object Detail – individual details about each CIM Object
 * Transitions of Care CIM Data Element Summary – summarizing each of the TOC CIM Data Elements
 * Key Information Exchange Summary – highlighting the four information exchanges outlined in the Transitions of Care Use Case

Transitions of Care CIM Object Summary
The following table summarizes each of the TOC CIM Objects in alphabetical order. This table is formatted in data dictionary format to allow for the quick lookup of specific CDA template ID’s for CIM objects Important notes are listed below:
 * This table can be used to lookup CIM Object priorities
 * This table will also capture the relevant CDA Template ID’s for each CIM Object

To lookup CDA Section and Entry-Level ID’s, refer to the Key Information Exchange Summary

** Name ** || ** CIM Object ** ** Definition ** || ** CDA ID References ** || ** CIM Object Priority ** || The list of medications includes compounds that the patient may be taking (e.g. herbals) The metadata for the Active Medication List is to include: the clinician that last ordered the medication with the date/time stamp of when the medication was last ordered, and whether or not the Active Medication List was reconciled during this encounter and if so by whom, and if not when last reconciled and by whom. 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || "A" Data Element (core data exchanged with every transition) ||
 * ** Transitions of Care CIM Objects ** ||
 * ** CIM Object **
 * Active Medication List || A list of medications that patient should be taking or an entry of no known medications.
 * Clinical example**: The list of all of the medications that the patient is taking, or has been prescribed, and the patient is thought to be taking. If a clinician reads the patient a list of their medications and the patient reports that they actually stopped taking medication “X”, medication X would be removed from the list. D/C reconciliation would include consideration of the pre-hospitalization medications and whether these need to be continued or stopped. || 2.16.840.1.113883.10.20.22.2.1.1
 * Active Problem List || What clinician sending the message has determined to be the patient's active problems and/or diagnoses or determination of no known problems - this list may be reconciled at each care transition.

The metadata for the problem list is to include: the clinician that assigned the problem to the problem list with the date/time stamp of when the problem was assigned, the start date or onset of the problem, whether or not the problem list was reconciled during this encounter and if so by whom, and whether any problems were changed during this encounter.

For example, one problem might be removed from the active problem list during an encounter and another assigned. The removed problem would be visible to the next recipient clinician as removed from the problem list in the previous encounter.


 * Clinical Example ** : All of the chronic problems or health issues that the patient’s treating clinicians have determined to be chronic noteworthy problems, e.g. this list may include chronic health problems like chronic obstructive pulmonary disease as well as problems such as tobacco use disorder. || 2.16.840.1.113883.10.20.22.2.7 || "A" Data Element (core data exchanged with every transition) ||
 * Admitting and Discharging Diagnoses || Admitting Diagnoses are the diagnoses assigned to a patient at the time of admission to a facility. Discharge Diagnoses are the diagnoses assigned to a patient on discharge from a facility. These terms are consistent with admission to a facility and not applicable to the ambulatory environment

Admitting Diagnoses: Diabetic Ketoacidosis, Type II Diabetes, Hyperlipidemia, Obesity, Noncompliance Discharge Diagnoses: Type II Diabetes, Hyperlipidemia, Obesity. Admitting and discharge diagnosis might or might not be the same. Admitting diagnosis might often be prospective or might be a chief complaint that represents a health concern or symptom, e.g. chest pain. ||  || "B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility) ||
 * Clinical Example: **
 * Allergies and Intolerances || Captures a list of known allergies and intolerances, or no known allergies and intolerances. Allergic reactions occur when patients are exposed to an allergen an allergen can be a medication or an environmental compound (e.g. food, or pollen).

Patients may also have adverse reactions to substances that are not true allergic reactions, known as intolerances. This list is comprised of the agents causing the allergic reaction or intolerance. An example of intolerance is a patient that takes an antibiotic and becomes nauseous.

2.16.840.1.113883.10.20.21.2.6. || "A" Data Element (core data exchanged with every transition) ||
 * Clinical example ** : Allergic reactions occur when patients are exposed to an allergen an allergen can be a medication or an environmental compound (e.g. food, or pollen). Patients may also have adverse reactions to substances that are not true allergic reactions, known as intolerances. A patient with an allergic reaction to shellfish may develop anaphylactic shock after ingesting shellfish || 2.16.840.1.113883.10.20.21.2.6.1
 * Anticipatory Guidance || This is education and support relative to a patient's needs regarding both their health conditions and encouraging health maintenance and wellness

Would include advice from a pediatrician about home safety, e.g. storage of household chemicals or advice from an allergist to an asthmatic patient to avoid second hand cigarette smoke exposure. ||  || "C" Data Elements - Care Plan Data ||
 * Clinical Example: **
 * Behavioral Health History || Specifies the summary report intended to exchange selected information relevant across specialties. It may not include the details of an assessment but it will contain many data elements that are based on the information collected through the assessment and generated from its processing. May often include information that would be considered sensitive information.

History of conditions or episodes that would fall in the behavioral health domain, such as a history of depression treated by the patients previous PCP with antidepressant medications and an inpatient stay in a behavioral health facility. ||  || B" Data Elements for PCP to Specialist with Consultation Request
 * Clinical Example: **

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Care Team Members || A list of the care team members and their role in the patient’s care. In an advanced primary care model the care team would include anyone actively involved in the patient's care such as the PCMH team, the patient’s designees, entities providing care and all additional caregivers designated by the PCP or designated provider (including those outside the patient’s primary care practice that they have a relationship with and/or are referred to). ||  || "B" Data Elements - Care Plan Data Resides in PCP System e.g. Advanced Primary Care Team System ||
 * Consultant(s) Assessment(s) and Plan(s) Recommendations || Core (or A) data elements include diagnoses (on the active problem list) and medications (on the active medication list) entered by the consultant.

These data elements include any non-Core assessments, plans, and orders, including free text of the consultants assessments and plan recommendations


 * Clinical Example ** : Patient’s thyroid nodule FNA demonstrated follicular thyroid cancer; patient has been scheduled for surgery in one month. || 2.16.840.1.113883.10.20.22.1.9 || "B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Consultation Request including Clinical Summary || The Consultation Request including Clinical Summary CIM Object would include a standard set of data including demographic information, active reconciled medication list (with doses and sig), allergy list and problem list. This data set may also contain variable data relevant to the context of the request. In addition, this information exchange also includes a PCP-selected referral-specific variable dataset.

The Consultation Request including Clinical Summary CIM Object is a logical representation of the Consultation Request including Clinical Summary information exchange expressed in the S&I Framework Transitions of Care Use Case. ||  ||   ||
 * Consultation Summary || The Consultation Summary is a CIM object that represents a standard data set including demographic information, active reconciled medication list (with doses and sig), allergy list and problem list, and would also contain variable data relevant to the context of the request.

The Consultation Summary CIM Object is a logical representation of the Consultation Summary expressed in the S&I Framework Transitions of Care Use Case. ||  ||   ||
 * Culturally Sensitive Patient Care || Information specific to the patient's cultural, religious, and educational background.


 * Clinical Example ** : A patient who is a Jehovah’s witnesses refuses to undergo a blood transfusion.

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.21.1.1 [US Realm Document Header] || "A" Data Element (core data exchanged with every transition) || [US Realm Document Header] ||  || Diet appears in 2 places. The first is the diet that has been "ordered" or recommended by the clinician. The second is the diet that the patient is actually consuming. This second instance will be for patient self-monitoring
 * Demographics || The Demographics CIM object would assemble multiple child CIM objects into a Demographics parent CIM object || 2.16.840.1.113883.10.20.21.1.1
 * Diet || The diet that has been ordered or recommended by the clinician. (Distinct from the diet that the patient reports they follow, e.g. a vegetarian diet)


 * Clinical Example: ** Please follow a low salt, low fat, reduced calorie diet || 1.3.6.1.4.1.19376.1.5.3.1.3.33 || "C" Data Elements - Care Plan Data ||
 * Discharge Instructions || The Discharge Instructions CIM Object would include a standard data set including demographic information, active reconciled medication list (with doses and sig), allergy list and problem list. Discharge Instructions also contains dataset relevant to the Discharge Summary/Discharge Instructions context which includes follow-up/plan of care.

The Discharge Instructions CIM Object is a logical representation of the Discharge Instructions expressed in the S&I Framework Transitions of Care Use Case. ||  ||   ||
 * Discharge Summary || The Discharge Summary CIM Object would contain a standard set of data surrounding a discharge, and discharge context-relevant data, which is determined by the discharging provider organization in accordance with local policy, regulations and law. The receiving provider through its EHR system may determine how to incorporate and present the Discharge Summary document.

The Discharge summary should always include a basic set of information on the discharge that might also include content for the Discharge Instruction as well as the Discharge Summary. Discharge summary content examples include demographic information, active reconciled medication list (with doses and sig), allergy list, problem list, and reason for admission.

The Discharge Summary CIM Object is a logical representation of the Discharge Summary expressed in the S&I Framework Transitions of Care Use Case. ||  ||   ||
 * Discontinued Medications || This includes all discontinued medications with a date time stamp of when the medication was discontinued and the reason for discontinuation (if available).

If the medication had been discontinued during the specific care transition encounter this would be evident from the date time stamp of discontinuation. This should include medications that were just discontinued, but might still be physiologically active in the patient's system. There should be a date and time stamp of discontinuation with each discontinued medication.


 * Clinical Example ** : Patient reports that a new medication is making them feel queasy, the medication is discontinued and is removed from the active medication list and added to the discontinued medication list ||  || "A" Data Element (core data exchanged with every transition) ||
 * Equipment || Durable Medical Equipment (DME), and any other equipment ordered for the patient


 * Clinical Example ** : crutches, neck brace, cane || 2.16.840.1.113883.10.20.22.2.23 || "C" Data Elements - Care Plan Data ||
 * Existence of Advanced Directives || Captures the existence of advanced directives for a patient; simply whether or not the patient had advanced directives not what they are.


 * Clinical Example ** : The patient has discussed advanced directives with one of their treating clinicians, made decisions about their wishes and completed an AD form.

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.22.2.21 || "A" Data Element (core data exchanged with every transition) ||
 * Family History || The patient's family history data elements

Not a summary, as the sending physician may want to select specific elements for inclusion.


 * Clinical Example: ** Patient has a family history significant for: mother died of colon cancer at age 48, maternal grandmother, paternal grandfather, and father with hypertension; maternal grandfather with unknown cancer, deceased age 52. || 2.16.840.1.113883.10.20.22.2.15 || B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Follow-up Appointments || All of the patients scheduled future appointments


 * Clinical Example ** : Patient has an appointment 8/10/11 at 10 AM with her PCP and an appointment 8/20/11with for PT ||  || "C" Data Elements - Care Plan Data ||
 * Goals || This is a list of the health-related goals, such as smoking cessation agreed upon by the patient and the physician


 * Clinical Example: ** The patient and the clinician have discussed and agree on the patient’s goal of 5 lbs of weight loss over the next 2 months. Goals might or might not have a time frame. For example, maintaining a HgbA1 below a certain level might be a goal for a diabetic. ||  || "B" Data Elements - Care Plan Data Resides in PCP System e.g. Advanced Primary Care Team System ||
 * Health Literacy || Information on the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions


 * Clinical Example ** : Patient is able to understand health information provided at the 9th grade level ||  || "C" Data Elements - Care Plan Data ||
 * Health Maintenance || The education, scheduled or anticipated tests and studies, and self-monitoring activities related to Health maintenance


 * Clinical Example ** : Mammogram, Pap test, colonoscopy or patient tracking of a regular exercise routine ||  || "C" Data Elements - Care Plan Data ||
 * History Present Illness || In a medical encounter, a history of the present illness (abbreviated HPI)[1] (termed history of presenting complaint (HPC) in the UK) refers to a detailed interview prompted by the chief complaint or presenting symptom (for example, pain).


 * Clinical Example ** : Patient reports having new onset chest pain described as a dull pain like an elephant sitting on his chest. Pain radiates down the arm, is relieved with rest, began 1 week ago, and lasts for minutes. Pain is brought on with stress or climbing stairs. || 1.3.6.1.4.1.19376.1.5.3.1.3.4 || B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Immunization History || A list of the immunizations that the patient has received including date of immunization, where the immunization was administered if known, and lot or batch number if available

2.16.840.1.113883.10.20.22.2.2 || "B" Data Elements for PCP to Specialist with Consultation Request
 * Clinical Example: ** The patient’s immunization history includes includes BCG, or bacille Calmette-Guérin, is a vaccine for TB, as an infant. || 2.16.840.1.113883.10.20.22.2.2.1

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Invasive and Non-Invasive Procedures || A listing of invasive and non-invasive procedures for a patient. ||  || "C" Data Elements - Care Plan Data ||
 * Medical History || The patient's previous medical problems


 * Clinical Example ** : patient with a past medical history of gallstones x 2 episodes which resolved post cholecystectomy ||  || B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Medication History || The patient's previous medications that are no longer on the active medication list, including stop and start dates and reason for discontinuation if known


 * Clinical Example ** : a list of the patient’s discontinued medications, e.g. prior courses of antibiotics, previous oral birth control medications, previous lower doses of antihypertensive medications that have been changed to higher doses. (Distinct from a medication history service that might provide an aggregation of a patient’s known recent medications based on pharmacy fill data, claims history, and other data sources) ||  || "B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Operative Summary || Operative Report || 2.16.840.1.113883.10.20.22.1.7 || "B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Outcome of Allergy/Intolerance || Specific outcomes that result from an allergy and/or intolerance


 * Clinical Example ** : The patient in treated with Benadryl and steroids and discharged to home ||  || "D"Elements - Care Plan Data ||
 * Patient Consent Directive || The record of a healthcare consumer¡¦s privacy policy that grants or withholds consent for:
 * one or more principals (identified entity or role)
 * performing one or more operations (e.g., collect, access, use, disclose, amend, or delete)
 * purposes such as Treatment, Payment, Operations, Research, Public Health, Quality Measures, Health Status Evaluation by third parties, or Marketing
 * certain conditions, e.g., when unconscious
 * a specified time period, e.g., effective and expiry dates
 * a certain context, e.g., in an emergency


 * Clinical Example: ** patient has been explained the risks and benefits of the procedure that include: xxx, yyy, zzz, and potentially death, and has consented to the procedure ||  || "C" Data Elements - PCP to Specialist with Consultation Request ||
 * Patient Contact Information || Main contact information for the patient, including telecommunications and physical addresses. Also includes information on if the patient has a Direct-specific electronic endpoint address and has text messaging enabled.


 * Clinical Example ** : The clinical information that the patient provides about how to reach them

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.21.1.1 [US Realm Document Header] || "A" Data Element (core data exchanged with every transition) ||
 * Patient Information || Information used to specifically help in the identification of the patient.

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.21.1.1 [US Realm Document Header] || "A" Data Element (core data exchanged with every transition) ||
 * Patient Instructions || Information provided to the patient by the care team members detailing what the patient needs to do regarding their healthcare.


 * Clinical Example ** : The patient’s wound care instructions included washing the wound daily with warm soapy water, drying the area completely, applying a film of petroleum jelly over the wound and applying a fresh bandage loosely to cover the wound. Proposed MU Stage II also calls out some data for hospital discharge instructions, e.g. diet and activity. ||  || "B" Data Elements - Care Plan Data Resides in PCP System e.g. Advanced Primary Care Team System ||
 * Patient Self-Management || Activities to be performed by the patient to manage specific problems (e.g. recording of food consumed in a patient trying to modify their weight)


 * Clinical Example ** : (e.g. recording of food consumed in a patient trying to modify their weight) ||  || "C" Data Elements - Care Plan Data ||
 * Payer Information || Primary and secondary insurance provider information applicable to the patient.

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.22.2.18 || "A" Data Element (core data exchanged with every transition) ||
 * Pending Tests and Procedures || Those tests and procedures that have been ordered but not completed


 * Clinical Example ** : e.g. the patient had blood drawn for a Russell Viper Venom that needed to be sent to a special lab and the results are not back yet. The patient had a fasting Lipid panel ordered, but as the patient has eaten he will need to return tomorrow in a fasting state to have the blood drawn. ||  || "B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Physical Activity || The provider recommended physical activity to the patient, e.g. ambulate with a cane


 * Clinical Example ** : patient to ambulate using a 4 point walker ||  || "C" Data Elements - Care Plan Data ||
 * Physical Exam || Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan


 * Clinical Example ** : e.g. Pupils equal reactive to light and accommodation; equal ocular movements Intact, 2+ lower extremity edema; Heart: regular rate and rhythm || 2.16.840.1.113883.10.20.22.2.19 || "B" Data Elements for PCP to Specialist with Consultation Request ||
 * Primary Care Physicians and Designated Providers || A list of the primary care physicians applicable to the patient, as well as other designated providers and specialists who may work with the patient. This list will include information about the provider's specializations and whether they are part of the patient's care team.

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.21.1.1 [US Realm Document Header] || "A" Data Element (core data exchanged with every transition) ||
 * Reason for Consult Request || The reason that one physician or other clinical professional is asking for the specialty opinion or action of another physician or other clinical professional. This generally includes context specific patient history and the issues that the requesting physician wants the consulting physician to address, or the activities that the requesting physician or other clinical professional wants the consulting physician or other clinical professional to perform.


 * Clinical Example ** : The patient has a large left sided thyroid nodule; please evaluate and perform a fine needle aspiration if deemed appropriate ||  || "B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Restorative Care || Would include programs and treatments aimed at rehabilitation or restoring a patient to a greater level of function after an episode of illness or a surgery, e.g. a prescribed course of physical therapy, a course of home care, or a self management program. || Would require identification of an appropriate set of data elements, value set(s), and terminology ||  ||
 * Review of Systems || Subjective patient supplied information regarding the patient's different bodily systems.


 * Clinical Example ** : E.g. patient denies change in bowel habits, black stool or bright red blood per rectum. || 1.3.6.1.4.1.19376.1.5.3.1.3.18 || "B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Social Determinants of Health || The patient's social situation that will determine their ability to access, understand and comply with their healthcare recommendations, e.g. patient is uninsured and cannot afford their medication.


 * Clinical Example ** : e.g. patient is unable to afford the copay for their medicine. Patient was evicted and is currently living on the street, therefore unable to perform required wound changes ||  || "C" Data Elements - Care Plan Data ||
 * Social History || Subjective patient supplied information that addresses occupational and recreational aspects of the patient's personal life that have the potential to be clinically significant, e.g. sexual history, smoking history, etoh, etc...


 * Clinical Example ** : Patient smokes 2 packs of cigarettes per day for 20 years. || 2.16.840.1.113883.10.20.22.2.17 || B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Support Contacts || A list of the primary and secondary caregiver contacts and their relevant information

Part of the Demographics CIM Object || 2.16.840.1.113883.10.20.21.1.1 [US Realm Document Header] || "A" Data Element (core data exchanged with every transition) ||
 * Surgical/Procedure History || The previous surgery and procedures that a patient has had


 * Clinical Example ** : Cholecystectomy 1995 || 2.16.840.1.113883.10.20.22.2.7 || B" Data Elements for PCP to Specialist with Consultation Request

"B" Data Elements from Hospital to PCP or other facility (e.g. long term care facility)

"B" Data Elements to Patient: Data Exchange to PHR ||
 * Transitions of Care Summary || High level CIM Object used to incorporate all key information exchanges associated with the S&I Framework Transitions of Care Use Case ||  ||   ||
 * Vital Signs || Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions

2.16.840.1.113883.10.20.22.2.4 || "B" Data Elements for PCP to Specialist with Consultation Request
 * Clinical Example ** : Blood pressure 120/80, Temp 99 F; Height 5’ 3”, Weight 113; Respiratory Rate 14, Heart Rate 60. || 2.16.840.1.113883.10.20.22.2.4.1

"B" Data Elements to Patient: Data Exchange to PHR ||

CIM Objects (In Detail)
Within this section, each CIM object is detailed at the CIM Data element level. This table provides further context into the priority of specific CIM Data Elements so that CIM objects that are structured within an EHR or other health information system can also be prioritized. Specific columns to note include:


 * ISO/HL7 Datatypes – note that these datatypes are proposed in Version 1.3 of the TOC CIM. The B and C Priority data elements may require more work to finalizing typing of the data elements.
 * Examples and guidance are provided – clinically relevant terminology is given, as well as potential vocabularies and value sets to use in storing these CIM data elements.


 * **Active Medication List** ||
 * **Name of Data Element** || **Definition of Data Element** || **ISO/HL7 Datatype** || **Examples and Guidance** || **Data Element Priority** ||
 * Active Medication List || A list of clinically relevant medications, including:

PRN Medication List Active Medications (Held for Period of Time) Medications that patient was exposed to, now discontinued, but still clinically relevant Software need – document the delta || LIST (Sequence) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Associated Assessment || Reason the provider prescribed the medication || BAG (Bag) || ** Clinical Example ** : Hyperlipidemia: Lipitor

Includes ICD-9 codes and/or SNOMED codes || "A" Data Element (core data exchanged with every transition) ||
 * Changed Medications || Medications that have been modified in this encounter, i.e. dosage adjustments || CE (Coded element) || ** Clinical Example ** : Lipitor 10 mg discontinued; Lipitor 20 mg prescribed

Value Set: Medication Brand Name 2.16.840.1.113883.3.88.12.80.16

Code System(s): rxNorm 2.16.840.1.113883.6.88

Value Set: Medication Drug Class 2.16.840.1.113883.3.88.12.80.18

Code System(s): NDF-RT 2.16.840.1.113883.3.26.1.5

Value Set: Medication Clinical Drug 2.16.840.1.113883.3.88.12.80.17

Code System(s): RxNorm 2.16.840.1.113883.6.88 || "A" Data Element (core data exchanged with every transition) ||
 * Date Of Reconciliation || The date of the last active medication list reconciliation || DATE ||  || "A" Data Element (core data exchanged with every transition) ||
 * Discontinued Medications || Medications that have been discontinued || CE (Coded element) || ** Clinical Example ** : Lipitor 10 mg discontinued

Value Set: Medication Brand Name 2.16.840.1.113883.3.88.12.80.16

Code System(s): rxNorm 2.16.840.1.113883.6.88

Value Set: Medication Drug Class 2.16.840.1.113883.3.88.12.80.18

Code System(s): NDF-RT 2.16.840.1.113883.3.26.1.5

Value Set: Medication Clinical Drug 2.16.840.1.113883.3.88.12.80.17

Code System(s): RxNorm 2.16.840.1.113883.6.88 || "A" Data Element (core data exchanged with every transition) ||
 * Dose || The amount of the product to be given. This includes a dose in measurable units (e.g., milliliters, or mg), the form (or administrative unit (e.g. tablets, suppository, etc...), and the amount of the form to take. For example Medication XXX 500 mg, tablets; take ½ tablet, administration unit (e.g., tablet), or an amount of active ingredient (e.g., 250 mg). May define a variable dose, dose range or dose options based upon identified criteria (see Dose Indicator)

Need to have both the "dose" as well as the form or administration unit. || PQ || ** Clinical Example ** : 500 mg tablet

Value Set: Medication Brand Name 2.16.840.1.113883.3.88.12.80.16

Code System(s): rxNorm 2.16.840.1.113883.6.88 || "A" Data Element (core data exchanged with every transition) ||
 * Duration || The period of time that you are to take the medication if it is time limited, e.g. take abx for 10 days || IVL (Interval) || ** Clinical Example ** : for 10 days || "A" Data Element (core data exchanged with every transition) ||
 * Frequency || Defines how often the medication is to be administered as events per unit of time. Often expressed as the number of times per day (e.g., four times a day), but may also include event-related information (e.g., 1 hour before meals, in the morning, at bedtime). Complimentary to Interval, although equivalent expressions may have different implications (e.g., every 8 hours versus 3 times a day) || IVL_TS || ** Clinical Example ** :

6 hours while awake || "A" Data Element (core data exchanged with every transition) ||
 * Medication Code || This is the physical form of the product as presented to the individual. For example: tablet, capsule, liquid or ointment || CE (Coded element) || Value Set: Medication Product Form 2.16.840.1.113883.3.88.12.3221.8.11

Code System(s): National Cancer Institute (NCI) Thesaurus 2.16.840.1.113883.3.26.1.1 || "A" Data Element (core data exchanged with every transition) ||
 * Patient Instructions || Instructions to the patient that are not traditionally part of the Sig. For example, “keep in the refrigerator.” More extensive patient education materials can also be included || ED (Encapsulated Data) || ** Clinical example ** :

Store in the refrigerator. Take with food. || "A" Data Element (core data exchanged with every transition) ||
 * Prescriber || The person that wrote this order/prescription (may include both a name and an identifier) || EN (Entity Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reconciled By || The name of the individual who last reconciled the active medication list || EN (Entity Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Route || Indicates how the medication is received by the patient (e.g., by mouth, intravenously, topically, etc.) || CE (Coded element) || ** Clinical Example: **

by mouth; or apply to skin in area of rash

Value Set: Medication Route FDA Value Set 2.16.840.1.113883.3.88.12.3221.8.7

Code System(s): National Cancer Institute (NCI) Thesaurus 2.16.840.1.113883.3.26.1.1 || "A" Data Element (core data exchanged with every transition) ||
 * Start Date || Used to express the start date for a medication || DATE ||  || "A" Data Element (core data exchanged with every transition) ||
 * Status of Reconciliation || Is the active medication list reconciled? || CE (Coded element) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Stop Date || Used to express a "hard stop," such as the last Sig sequence in a tapering dose, where the last sequence is 'then D/C' or where the therapy/drug is used to treat a condition and that treatment is for a fixed duration with a hard stop, such as antibiotic treatment, etc || DATE ||  || "A" Data Element (core data exchanged with every transition) ||
 * When to Take || For PRN meds this information would be take when you are experiencing the system, e.g. take you nitroglycerine when you are experiencing chest pain || IVL_TS || ** Clinical Example ** :

at bedtime daily || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Active Problem List === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Active Codes || List of codes capturing problem health status || CS (Coded Simple Value) || Value Set: ProblemHealthStatusCode 2.16.840.1.113883.1.11.20.12

Code System: SNOMED CT 2.16.840.1.113883.6.96 || "A" Data Element (core data exchanged with every transition) ||
 * Problem Assignee || The person that entered the problem in the EHR date/time stamped || EN (Entity Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reconciled By || Who reconciled the problem list || EN (Entity Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reconciliation Date || The date/time stamp for the last reconciliation of the problem list || DATE ||  ||   ||
 * Reconciliation Status || Has the problem list been reconciled? || CE (Coded element) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Start Date Of Problem || This is the range of time of which the problem was active for the patient or subject

Includes the date of onset || DATE ||  || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** ||= ** Data Element Priority ** ||
 * = ===Admitting and Discharging Diagnoses === ||
 * = ** Name of Data Element ** ||= ** Definition of Data Element ** ||= ** ISO/HL7 Datatype ** ||= ** Examples and **
 * = Admitting Diagnosis ||=  ||= TEXT ||=   ||=   ||
 * = Discharging Diagnosis ||=  ||= TEXT ||=   ||=   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Allergies and Intolerances === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * A/I Attributes || Veracity of the data based on source and details available about index reaction(e.g. older patient has been told that had a rxn as a child vs. clinician has healthcare professional documentation of an anaphylactic episode) || ED (Encapsulated Data) || ** Clinical Example ** :

older patient has been told that had a rxn as a child vs. clinician has healthcare professional documentation of an anaphylactic episode ||  ||
 * Environmental Allergens || A list of associated environment allergens for the medication

Includes seasonal allergens || CE (Coded element) || Value Set: Allergy/Adverse Event Type 2.16.840.1.113883.3.88.12.3221.6.2

Code System(s): SNOMED CT 2.16.840.1.113883.6.96

Examples of environmental allergens include latex, pollen, animal dander, etc... || "A" Data Element (core data exchanged with every transition) ||
 * Food Allergens || A list of associated food allergens for the medication || CE (Coded element) || Value Set: Allergy/Adverse Event Type 2.16.840.1.113883.3.88.12.3221.6.2

Code System(s): SNOMED CT 2.16.840.1.113883.6.96

Examples of food allergens include shellfish, eggs, peanuts, etc. || "A" Data Element (core data exchanged with every transition) ||
 * List of Reactions || A list of reactions from allergies/intolerances || LIST (Sequence) || ** Clinical Example ** :

(e.g. anaphylaxis), nausea, morbilliform skin rash ||  ||
 * Medication Allergy or Intolerance || Medication (ingredient or class code, if available) that has been attributed to an allergic reaction or intolerance, or drug code if attribution to ingredient or class is unavailable || ED (Encapsulated Data) || ** Clinical Example ** : e.g. Opiates

Includes medications, biologicals, herbal supplements, OTCs, vaccine, etc. || "A" Data Element (core data exchanged with every transition) ||
 * Reaction Date || Date when this particular Intolerance Condition or Allergy first manifested itself or was confirmed via testing if it had not yet manifested itself. || TIMESTAMP ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reaction Identified By || Who reported the reaction (e.g. patient, provider, care taker) || EN (Entity Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Severity of Intolerance or Allergy || Severity associated with the reaction. This is a description of the level of severity of the allergy or intolerance || CE (Coded element) || ** Clinical Example: **

A patient was treated in the ED and hospitalized overnight 3 years ago for severe anaphylaxis 30 minutes after eating roasted peanuts; six months ago they ate a dish served with a utensil that had been contaminated with peanut sauce and had itching of their mouth that resolved after Benadryl; their condition is considered a severe peanut allergy, even though they have had a mild episode on one occasion

Need to be sure to distinguish the severity of the condition (intolerant to XXX) from the severity of a specific instance of a reaction || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Behavioral Health History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Confidentiality Code || This attribute is used to specify that the content of this clinical document is sensitive because it contains Behavioral Health information || INTEGER ||  ||   ||
 * DSM Axis 1 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis I: Clinical disorders, including major mental disorders, and learning disorders || Structure ||  ||   ||
 * DSM Axis 2 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis II: Personality disorders and intellectual disabilities (although developmental disorders, such as Autism, were coded on Axis II in the previous edition, these disorders are now included on Axis I) || Structure ||  ||   ||
 * DSM Axis 3 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis III: Acute medical conditions and physical disorders || Structure ||  ||   ||
 * DSM Axis 4 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis IV: Psychosocial and environmental factors contributing to the disorder || Structure ||  ||   ||
 * DSM Axis 5 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis V: Global Assessment of Functioning or Children's Global Assessment Scale for children and teens under the age of 18 || Structure ||  ||   ||
 * Environmental Factors ||  || Structure ||   ||   ||
 * GAF Score || Global Assessment of Functioning (GAF)

Part of the diagnosis on Axis 5 || INTEGER || ** Clinical Example ** :

Range from 0-100, e.g. 50 ||  ||
 * Homicidal Ideation ||  || HIST (History) || ** Clinical Example ** :

Patient reports fantasizing about killing his spouse with his gun. ||  ||
 * Suicidal Ideation ||  || HIST (History) || ** Clinical Example ** :

Patient reports thinking about jumping out of a window of a high story building ||  ||
 * Treatment Referral ||  || Structure ||   ||   ||

** Guidance ** ||= ** Data Element Priority ** ||
 * = ===Consultation Request including Clinical Summary CIM Object === ||
 * = ** Name of Data Element ** ||= ** Definition of Data Element ** ||= ** ISO/HL7 Datatype ** ||= ** Examples and **
 * = ID ||= A unique identifier for the Consultation Request ||= II (Instance Identifier) ||=  ||=   ||

** Guidance ** ||= ** Data Element Priority ** ||
 * = ===Consultation Summary CIM Object === ||
 * = ** Name of Data Element ** ||= ** Definition of Data Element ** ||= ** ISO/HL7 Datatype ** ||= ** Examples and **
 * = ID ||= A unique identified for the Consultation Summary ||= II (Instance Identifier) ||=  ||=   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Culturally Sensitive Patient Care === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Disability || The disability status of the patient || CE (Coded element) || ** Clinical Example ** : Deaf || "A" Data Element (core data exchanged with every transition) ||
 * Educational Level || Acceptable values for this data element include the following (Advanced Degree, College Graduate, Some College, High School Graduate, Elementary) || CE (Coded element) || ** Clinical Example ** : Graduate Degree || "A" Data Element (core data exchanged with every transition) ||
 * Ethnicity || Ethnicity is a term that extends the concept of race. The coding of ethnicity is aligned with public health and other federal reporting standards of the CDC and the Census Bureau || CE (Coded element) || ** Clinical Example ** : Latino

Value Set:

EthnicityGroup 2.16.840.1.113883.1.11.15836

Code System(s):

Race and Ethnicity Code Sets 2.16.840.1.113883.6.238 || "A" Data Element (core data exchanged with every transition) ||
 * Language || Language will be identified as spoken, written, or understood; but no attempt will be made to assess proficiency. The default language is English, but English is to be entered explicitly similar to any other listed language || CE (Coded element) || Clinical Example: Arabic

ValueSet

2.16.840.1.113883.1.11.11526

Language Value Set || "A" Data Element (core data exchanged with every transition) ||
 * Race || Race is usually a single valued term that may be constant over that patient's lifetime. The coding of race is aligned with public health and other federal reporting standards of the CDC and the Census Bureau. Typically the patient is the source of the content of this element. However, the individual may opt to omit race. || CE (Coded element) || ** Clinical Example ** : of Asian Pacific descent

Value Set: Race 2.16.840.1.113883.1.11.14914

Code System(s): Race and Ethnicity - CDC 2.16.840.1.113883.6.238 || "A" Data Element (core data exchanged with every transition) ||
 * Religion || Religious affiliation of the patient || CE (Coded element) || ** Clinical Example: ** Catholic

Value Set: Religious Affiliation 2.16.840.1.113883.1.11.19185

Code System(s): ReligiousAffiliation 2.16.840.1.113883.1.11.19185 || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** ||= ** Data Element Priority ** ||
 * = ===Demographics CIM Object === ||
 * = ** Name of Data Element ** ||= ** Definition of Data Element ** ||= ** ISO/HL7 Datatype ** ||= ** Examples and **
 * = ID ||= A unique identified for the Demographics CIM Object ||= II (Instance Identifier) ||=  ||=   ||



** Guidance ** || ** Data Element Priority ** ||
 * ===Diet === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Diet Narrative || Records a narrative description of the expectations for diet, including proposals, goals, and order requests for monitoring, tracking, or improving the dietary control of the patient, used in a discharge from a facility such as an emergency department, hospital, or nursing home. || Structure ||  ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Discharge Instructions CIM Object === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * ID || A unique identifier for the Discharge Instructions || II (Instance Identifier) ||  ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Discharge Summary CIM Object === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * ID || A unique identifier for the Discharge Summary || II (Instance Identifier) ||  ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===Discontinued Medications === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Discontinued Medication List || List of discontinued medications || LIST (Sequence) ||  ||   ||

** Guidance ** || ** Data Element Priority ** || developer. || CK (Composite ID with check digit) || Source: Federal Health Information Model (FHIM) - Durable Medical Equipment ||  ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Equipment === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Model Name || The human designated moniker for a device, assigned by the manufacturer || CK (Composite ID with check digit) || Source: Federal Health Information Model (FHIM) - Durable Medical Equipment ||  ||
 * Software Name || The moniker, version and release of the software that operates the device as assigned by the software manufacturer or

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Existence of Advanced Directives === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Advanced Directives || This is a coded value describing the type of the Advance Directive. Specifically asks: Has an Advanced Directive has been signed by the patient, and is contained in records. || BL (Boolean) ||  || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** || Patient has had individual genome analysis that revealed a genetic marker clearly established to represent an increased risk of breast cancer ||  ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Family History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Family History Summary || Textual description about the problems, diagnoses, and genetic markers found in genetic relatives. This field may be used to capture unstructured family history information recorded in clinical records. || HIST (History) ||  ||   ||
 * Family History Survey Question ||  || Structure ||   ||   ||
 * Family History Survey Response ||  || Structure ||   ||   ||
 * Genetic Marker Description || Description of risk-related genetic markers identified in this individual. || Structure || ** Clinical Example: **
 * Genetic Relative Age at Death || Age of the genetic relative at death. || INT (Integer) || Clinical Example: deceased age 45 ||  ||
 * Genetic Relative Medical History || Detail about problems or diagnoses for this genetic relative. || Structure || ** Clinical Example ** : Type II Diabetes ||  ||
 * Genetic Relative Name || Name of family member. For privacy reasons this may not be appropriate for sharing or public display and in this situation the 'label' should be used. || PN ||  ||   ||
 * Genetic Relative Relationship || The relationship of the genetic relative to the individual. Coding of the relationship with a terminology is preferred, where possible. || CE (Coded element) || Clinical Example: Mother ||  ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Goals === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Goal Description ||  || ED (Encapsulated Data) ||   ||   ||
 * Goal ID ||  || INT (Integer) ||   ||   ||
 * Goal Name ||  || ST (String) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">History Present Illness === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Medical Diagnosis ||  || HIST (History) || ** Clinical Example ** : e.g. Congestive Heart Failure ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Immunization History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Contraindication || Contraindication is the indicator if this immunization should be continued or should be stopped due to an adverse reaction being observed. || BOOLEAN || ** Clinical Example ** : Severe skin rubor, calor, and edema ||  ||
 * Immunization Category || What the immunization is for || CK (Composite ID with check digit) || ** Clinical Example ** : Pertussis ||  ||
 * Immunization Date || The date and time the immunization was given. || DATE ||  ||   ||
 * Immunization ID || Unique id given to the immunization test || II (Instance Identifier) ||  ||   ||
 * Immunization Series || Indicates which type of series the patient has been given. Current valid values are Series 1 through 8, Partially complete, booster, or complete || CK (Composite ID with check digit) ||  ||   ||
 * Observed Reaction || The response of cells or tissues to an antigen, as in a test for immunization || COLL (Collection) || ** Clinical Example ** : The observed response to an antigen which would normally be a description of skin reaction including size and time since test was applied, as in a test for immunization to be given or for tuberculosis ||  ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Medical History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Medical History Narrative ||  || ED (Encapsulated Data) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Medication History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Medication History ||  || HIST (History) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Operative Summary === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Operative Summary Narrative ||  || HIST (History) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Patient Contact Information === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Direct Address || The electronic endpoint address of the patient || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Cell Phone || A telephone number (mobile) || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Cell Phone Text Message Enabled || Is text messaging enabled on the patient's cell phone? || BL (Boolean) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Home Address || The current address of the individual to which the exchange refers. Multiple addresses are allowed and the work address may be a method of disclosing the employer || AD (Address) || Value Set: State Value Set 2.16.840.1.113883.3.88.12.80.1

Code System(s): FIPS 5-2 (State) 2.16.840.1.113883.6.92

Value Set: Postal Code Value Set 2.16.840.1.113883.3.88.12.80.2

Code System(s): US Postal Codes

Value Set: Country Value Set 2.16.840.1.113883.3.88.12.80.63

Code System(s): ISO 3166-1 Country Codes: 1.0.3166.1 || "A" Data Element (core data exchanged with every transition) ||
 * Patient Home Phone || A telephone number (voice or fax), || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Home Phone Text Message Enabled || Is text messaging enabled on the patient's home phone? || BL (Boolean) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Portal/PHR Available || Is a patient portal or PHR available? || BL (Boolean) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Portal/PHR URL || The URL of the patient portal or URI of the PHR || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Work Phone || A telephone number (voice or fax), || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Work Phone Text Message Enabled || Is text messaging enabled on the patient's work phone? || BL (Boolean) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Email Address || Primary email address for the patient || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Email Address || Secondary email address for the patient (may be a work-related email address) || TN (Telephone Number) ||  || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Patient Information === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Date of Birth || The date and time of birth of the individual to which this Exchange refers. The date of birth is typically a key patient identifier variable and used to enable computation of age at the effective date of any other data element. It is assumed to be unique and fixed throughout the patient's lifetime || DATE || Should include Month, Day, Year || "A" Data Element (core data exchanged with every transition) ||
 * Gender || The date and time of birth of the individual to which this Exchange refers. The date of birth is typically a key patient identifier variable and used to enable computation of age at the effective date of any other data element. It is assumed to be unique and fixed throughout the patient's lifetime || CE (Coded element) || Value Set: Administrative Gender (HL7 V3) 2.16.840.1.113883.1.11.1

Code System(s): AdministrativeGender 2.16.840.1.113883.5.1 || "A" Data Element (core data exchanged with every transition) ||
 * Marital Status || A value representing the domestic partnership status of a person. Marital status is important in determining insurance eligibility and other legal arrangements surrounding care. Marital status often changes during a patient's lifetime so the data should relate to the effective date of the patient data object and not be entered with multiple values like an address or contact number. This element should only have one instance reflecting the current status of the individual at the time the Exchange is produced. Former values might be part of the personal and social history || CE (Coded element) || Value Set: HL7 Marital Status 2.16.840.1.113883.1.11.12212

Code System(s): HL7 MaritalStatus 2.16.840.1.113883.5.2

Values include: Married Polygamous; Civil Union; Single; Divorced; Widowed || "A" Data Element (core data exchanged with every transition) ||
 * Mothers Maiden Name || The family name under which the Mother was born || PN (Person Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Identifiers || An identifier that uniquely identifies the individual to which the exchange refers and connects that document to the individual's personal health record. Potential security risks associated with use of SSN or driver's license for this element suggest that these should not be used routinely || II (Instance Identifier) || Everything currently legally used in an MPI algorithm, e.g. Reconciling and Managing EMPI and AHIMA reference documentation || "A" Data Element (core data exchanged with every transition) ||
 * Patient Name || The individual to whom the exchange refers. Multiple names are allowed to retain birth name, maiden name, legal names and aliases as required || PN (Person Name) ||  || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Patient Instructions === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Patient Instructions Narrative ||  || ED (Encapsulated Data) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Payer Information === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Primary Payer Information || The policy or group contract number identifying the contract between a health plan sponsor and the health plan. This is not a number that uniquely identifies either the subscriber or person covered by the health insurance || ED (Encapsulated Data) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Payer Information || The policy or group contract number identifying the contract between a health plan sponsor and the health plan. This is not a number that uniquely identifies either the subscriber or person covered by the health insurance || ED (Encapsulated Data) ||  || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Physical Activity === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Physical Activity Narrative ||  || ED (Encapsulated Data) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Physical Exam === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Physical Exam Component ||  || Structure ||   ||   ||
 * Physical Exam Narrative ||  || HIST (History) ||   ||   ||
 * Physical Exam Observation ||  || Structure ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Primary Care Physicians and Designated Providers === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Designated Provider Contact Information || The mailing address to which written correspondence to this provider should be directed || XAD (Extended Address) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider Domain of Management || Provider role uses a coded value to classify providers according to the role they play in the healthcare of the patient and comes from a very limited set of values. The purpose of this data element is to express the information often required during patient registration, identifying the patient's primary care provider, the referring physician or other consultant involved in the care of the patient || CF (Coded element with formatted values) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider NPI || National Provider Identifier or NPI is a unique identification number issued to healthcare providers in the United States || II (Instance Identifier) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider PCMH || The identifier used by this provider to identify the patient's PCMH || EN (Entity Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Providers Names || The name of the provider || PN (Person Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Providers Specialties || Provider type classifies providers according to the type of license or accreditation they hold (e.g. physician, dentist, pharmacist, etc.) or the service they provide || CF (Coded element with formatted values) || Value Set: Provider Type 2.16.840.1.113883.3.88.12.3221.4

Code System(s): Health Care Provider Taxonomy 2.16.840.1.113883.6.101 || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Reason for Consult Request === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Provisional Diagnosis ||  || ED (Encapsulated Data) ||   ||   ||
 * Request Reason || Reason for consult/procedure request || CE (Coded element) ||  || "A" Data Element ||
 * Requested Procedure || A procedure that is requested as part of this order. || CE (Coded element) ||  ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Social Determinants of Health === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Social Narrative ||  || ED (Encapsulated Data) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Social History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Social History Additional Details || Additional structured details || HIST (History) ||  ||   ||
 * Social History Description || Narrative description of social situation. This data element may be used to capture textual descriptions about Social History within existing clinical software applications. || HIST (History) ||  ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Support Contacts === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Primary Emergency Contact Information || The address of the contact individual or organization providing support to the individual for which this exchange is produced || AD (Address) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Emergency Contact Name || The name of the individual or organization providing support to the individual for which this exchange is produced || PN (Person Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Emergency Contact Relationship || Identifies the relationship of the contact person to the individual for which this exchange refers || CE (Coded element) || Value Set: Personal Relationship Role Type 2.16.840.1.113883.1.11.19563

Code System(s): Role Code 2.16.840.1.113883.5.111 || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Emergency Contact Information || The address of the contact individual or organization providing support to the individual for which this exchange is produced || AD (Address) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Emergency Contact Name || The name of the individual or organization providing support to the individual for which this exchange is produced || PN (Person Name) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Emergency Contact Relationship || Identifies the relationship of the contact person to the individual for which this exchange refers || CE (Coded element) || Value Set: Personal Relationship Role Type 2.16.840.1.113883.1.11.19563

Code System(s): Role Code 2.16.840.1.113883.5.111 || "A" Data Element (core data exchanged with every transition) ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Surgical/Procedure History === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Procedure History ||  || HIST (History) ||   ||   ||
 * Surgical History ||  || HIST (History) ||   ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Transitions of Care Summary CIM Object === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * ID || A unique identifier for the summary entity that may contain one or more of the other entities defined in the Transitions of Care Clinical Information Model (CIM) || II (Instance Identifier) ||  ||   ||

** Guidance ** || ** Data Element Priority ** ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Vital Signs === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** ISO/HL7 Datatype ** || ** Examples and **
 * Body Site || Indicates the anatomical site - intended to be specified as left arm, right arm, left leg, etc. May also indicate whether patient is sitting, standing, supine. || CHAR(18) || Value Set: Body Site Value Set 2.16.840.1.113883.3.88.12.3221.8.9

Code System(s): SNOMED CT 2.16.840.1.113883.6.96 ||  ||
 * Device || Identifies the device used to measure the vital sign. || VARCHAR || This would include cuff size for blood pressure, which is critical for sake of comparison or interpretation. A blood pressure cuff should be 2/3 size of upper arm, which in some individuals requires a "leg cuff". Using a cuff that is too small causes an erroneously high reading. ||  ||
 * Observation List || Indicates which Vital Sign was measured. From a code set of allowable Vital Sign codes. || CK (Composite ID with check digit) ||  ||   ||
 * Observation Method || A code that provides additional detail about the means or technique used to ascertain the observation. || CK (Composite ID with check digit) ||  ||   ||
 * Observation Time || The date/time on which the measurement was taken. || DATE ||  ||   ||
 * Patient State || Provides an indication of the state of the patient at the time of the observation. For example, a blood pressure may be taken while the patient is exercising or at rest. || VARCHAR || Standing blood pressure can be significantly different from supine and may, for example be an indication of a medication side effect as some blood pressure medications can cause a dangerous drop in blood pressure on standing which could cause falls and injury. ||  ||
 * Status || Indicates the status of the Vital Signs measurement record || VARCHAR ||  ||   ||
 * Telehealth Monitor || The Home TeleHealth Monitor Equipment used by the patient. || VARCHAR ||  ||   ||
 * Vital Sign ID || Uniquely identifies the Vital Signs measurement. || INTEGER ||  ||   ||


 * ==Transitions of Care CIM Data Element Summary== ||

The following table summarizes all of the CIM Data Elements within the TOC CIM. This table can be used to locate the priorities and examples for each TOC CIM Data Element and allow for lookups of appropriate vocabularies and value sets as needed.

Note that for those data elements listed as TBD, work is still ongoing to populate all or a portion of that TOC CIM Data Element’s representation within the TOC CIM.


 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">CIM Object Data Elements === ||
 * ** Name of Data Element ** || ** Definition of Data Element ** || ** Examples and Guidance ** || ** Data Element Priority ** ||
 * Medication Intolerance || Medication (ingredient or class code, if available) that has been attributed to an allergic reaction or intolerance, or drug code if attribution to ingredient or class is unavailable || Includes medications, biologicals, herbal supplements, OTCs, vaccine, etc. || "A" Data Element (core data exchanged with every transition) ||
 * All Environmental Allergens || A list of associated environment allergens for the medication

Includes seasonal allergens || Value Set: Allergy/Adverse Event Type 2.16.840.1.113883.3.88.12.3221.6.2

Code System(s): SNOMED CT 2.16.840.1.113883.6.96

Examples of environmental allergens include latex, pollen, animal dander, etc... || "A" Data Element (core data exchanged with every transition) ||
 * All Food Allergens || A list of associated food allergens for the medication || Value Set: Allergy/Adverse Event Type 2.16.840.1.113883.3.88.12.3221.6.2

Code System(s): SNOMED CT 2.16.840.1.113883.6.96

Examples of food allergens include shellfish, eggs, peanuts, etc. || "A" Data Element (core data exchanged with every transition) ||
 * Reaction Attributes || Severity of an individual episode ||  || "A" Data Element (core data exchanged with every transition) ||
 * Severity of Intolerance or Allergy || Severity associated with the reaction. This is a description of the level of severity of the allergy or intolerance || Need to be sure to distinguish the severity of the condition (intolerant to XXX) from the severity of a specific instance of a reaction || "A" Data Element (core data exchanged with every transition) ||
 * Reaction Date || Date when this particular Intolerance Condition or Allergy first manifested itself or was confirmed via testing if it had not yet manifested itself. ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reaction Identified By || Who reported the reaction (e.g. patient, provider, care taker) ||  || "A" Data Element (core data exchanged with every transition) ||
 * A/I Attributes || Severity, veracity of the data (e.g. older patient has been told that had a rxn as a child vs. clinician has healthcare professional documentation of an anaphylactic episode) ||  ||   ||
 * List of Reactions || A list of reactions from allergies/intolerances ||  ||   ||
 * Start Date Of Problem || This is the range of time of which the problem was active for the patient or subject

Includes the date of onset ||  || "A" Data Element (core data exchanged with every transition) ||
 * Problem Assignee || The person that entered the problem in the EHR date/time stamped ||  || "A" Data Element (core data exchanged with every transition) ||
 * Active Codes || List of codes capturing problem health status || Value Set: ProblemHealthStatusCode 2.16.840.1.113883.1.11.20.12

Code System: SNOMED CT 2.16.840.1.113883.6.96 || "A" Data Element (core data exchanged with every transition) ||
 * Reconciliation Status || Has the problem list been reconciled? ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reconciliation Date || The date/time stamp for the last reconciliation of the problem list ||  ||   ||
 * Reconciled By || Who reconciled the problem list ||  || "A" Data Element (core data exchanged with every transition) ||
 * Gender || The date and time of birth of the individual to which this Exchange refers. The date of birth is typically a key patient identifier variable and used to enable computation of age at the effective date of any other data element. It is assumed to be unique and fixed throughout the patient's lifetime || Value Set: Administrative Gender (HL7 V3) 2.16.840.1.113883.1.11.1

Code System(s): AdministrativeGender 2.16.840.1.113883.5.1 || "A" Data Element (core data exchanged with every transition) ||
 * Patient Name || The individual to whom the exchange refers. Multiple names are allowed to retain birth name, maiden name, legal names and aliases as required ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Identifiers || An identifier that uniquely identifies the individual to which the exchange refers and connects that document to the individual's personal health record. Potential security risks associated with use of SSN or driver's license for this element suggest that these should not be used routinely || Everything currently legally used in an MPI algorithm, e.g. Reconciling and Managing EMPI and AHIMA reference documentation || "A" Data Element (core data exchanged with every transition) ||
 * Mothers Maiden Name || The family name under which the Mother was born ||  || "A" Data Element (core data exchanged with every transition) ||
 * Marital Status || A value representing the domestic partnership status of a person. Marital status is important in determining insurance eligibility and other legal arrangements surrounding care. Marital status often changes during a patient's lifetime so the data should relate to the effective date of the patient data object and not be entered with multiple values like an address or contact number. This element should only have one instance reflecting the current status of the individual at the time the Exchange is produced. Former values might be part of the personal and social history || Value Set: HL7 Marital Status 2.16.840.1.113883.1.11.12212

Code System(s): HL7 MaritalStatus 2.16.840.1.113883.5.2

Values include: Married Polygamous; Civil Union; Single; Divorced; Widowed || "A" Data Element (core data exchanged with every transition) ||
 * Date of Birth || The date and time of birth of the individual to which this Exchange refers. The date of birth is typically a key patient identifier variable and used to enable computation of age at the effective date of any other data element. It is assumed to be unique and fixed throughout the patient's lifetime || Should include Month, Day, Year || "A" Data Element (core data exchanged with every transition) ||
 * Race || Race is usually a single valued term that may be constant over that patient's lifetime. The coding of race is aligned with public health and other federal reporting standards of the CDC and the Census Bureau. Typically the patient is the source of the content of this element. However, the individual may opt to omit race. || Value Set: Race 2.16.840.1.113883.1.11.14914

Code System(s): Race and Ethnicity - CDC 2.16.840.1.113883.6.238 || "A" Data Element (core data exchanged with every transition) ||
 * Ethnicity || Ethnicity is a term that extends the concept of race. The coding of ethnicity is aligned with public health and other federal reporting standards of the CDC and the Census Bureau || Value Set: EthnicityGroup 2.16.840.1.113883.1.11.15836

Code System(s): Race and Ethnicity Code Sets 2.16.840.1.113883.6.238 || "A" Data Element (core data exchanged with every transition) ||
 * Religion || Religious affiliation of the patient || Value Set: Religious Affiliation 2.16.840.1.113883.1.11.19185

Code System(s): ReligiousAffiliation 2.16.840.1.113883.1.11.19185 || "A" Data Element (core data exchanged with every transition) ||
 * Language || Language will be identified as spoken, written, or understood; but no attempt will be made to assess proficiency. The default language is English, but English is to be entered explicitly similar to any other listed language || ValueSet 2.16.840.1.113883.1.11.11526

Language Value Set || "A" Data Element (core data exchanged with every transition) ||
 * Disability || The disability status of the patient ||  || "A" Data Element (core data exchanged with every transition) ||
 * Educational Level || Acceptable values for this data element include the following (Advanced Degree, College Graduate, Some College, High School Graduate, Elementary) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Home Address || The current address of the individual to which the exchange refers. Multiple addresses are allowed and the work address may be a method of disclosing the employer || Value Set: State Value Set 2.16.840.1.113883.3.88.12.80.1

Code System(s): FIPS 5-2 (State) 2.16.840.1.113883.6.92

Value Set: Postal Code Value Set 2.16.840.1.113883.3.88.12.80.2

Code System(s): US Postal Codes

Value Set: Country Value Set 2.16.840.1.113883.3.88.12.80.63

Code System(s): ISO 3166-1 Country Codes: 1.0.3166.1 || "A" Data Element (core data exchanged with every transition) ||
 * Patient Home Phone || A telephone number (voice or fax), ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Email Address || Secondary email address for the patient (may be a work-related email address) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Work Phone || A telephone number (voice or fax), ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Cell Phone || A telephone number (mobile) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Email Address || Primary email address for the patient ||  || "A" Data Element (core data exchanged with every transition) ||
 * Direct Address || The electronic endpoint address of the patient ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Portal/PHR Available || Is a patient portal or PHR available? ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Portal/PHR URL || The URL of the patient portal or URI of the PHR ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Home Phone Text Message Enabled || Is text messaging enabled on the patient's home phone? ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Cell Phone Text Message Enabled || Is text messaging enabled on the patient's cell phone? ||  || "A" Data Element (core data exchanged with every transition) ||
 * Patient Work Phone Text Message Enabled || Is text messaging enabled on the patient's work phone? ||  || "A" Data Element (core data exchanged with every transition) ||
 * Advanced Directives || This is a coded value describing the type of the Advance Directive. Specifically asks: Has an Advanced Directive has been signed by the patient, and is contained in records. ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Providers Specialties || Provider type classifies providers according to the type of license or accreditation they hold (e.g. physician, dentist, pharmacist, etc.) or the service they provide || Value Set: Provider Type 2.16.840.1.113883.3.88.12.3221.4

Code System(s): Health Care Provider Taxonomy 2.16.840.1.113883.6.101 || "A" Data Element (core data exchanged with every transition) ||
 * Designated Providers Names || The name of the provider ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider NPI || National Provider Identifier or NPI is a unique identification number issued to healthcare providers in the United States ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider Contact Information || The mailing address to which written correspondence to this provider should be directed ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider Domain of Management || Provider role uses a coded value to classify providers according to the role they play in the healthcare of the patient and comes from a very limited set of values. The purpose of this data element is to express the information often required during patient registration, identifying the patient's primary care provider, the referring physician or other consultant involved in the care of the patient ||  || "A" Data Element (core data exchanged with every transition) ||
 * Designated Provider PCMH || The identifier used by this provider to identify the patient's PCMH ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Emergency Contact Name || The name of the individual or organization providing support to the individual for which this exchange is produced ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Emergency Contact Relationship || Identifies the relationship of the contact person to the individual for which this exchange refers || Value Set: Personal Relationship Role Type 2.16.840.1.113883.1.11.19563

Code System(s): Role Code 2.16.840.1.113883.5.111 || "A" Data Element (core data exchanged with every transition) ||
 * Primary Emergency Contact Information || The address of the contact individual or organization providing support to the individual for which this exchange is produced ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Emergency Contact Name || The name of the individual or organization providing support to the individual for which this exchange is produced ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Emergency Contact Relationship || Identifies the relationship of the contact person to the individual for which this exchange refers || Value Set: Personal Relationship Role Type 2.16.840.1.113883.1.11.19563

Code System(s): Role Code 2.16.840.1.113883.5.111 || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Emergency Contact Information || The address of the contact individual or organization providing support to the individual for which this exchange is produced ||  || "A" Data Element (core data exchanged with every transition) ||
 * Primary Payer Information || The policy or group contract number identifying the contract between a health plan sponsor and the health plan. This is not a number that uniquely identifies either the subscriber or person covered by the health insurance ||  || "A" Data Element (core data exchanged with every transition) ||
 * Secondary Payer Information || The policy or group contract number identifying the contract between a health plan sponsor and the health plan. This is not a number that uniquely identifies either the subscriber or person covered by the health insurance ||  || "A" Data Element (core data exchanged with every transition) ||
 * Active Medication List || A list of clinically relevant medications, including:

PRN Medication List Active Medications (Held for Period of Time) Medications that patient was exposed to, now discontinued, but still clinically relevant Software need – document the delta ||  || "A" Data Element (core data exchanged with every transition) ||
 * Date Of Reconciliation || The date of the last active medication list reconciliation ||  || "A" Data Element (core data exchanged with every transition) ||
 * Status of Reconciliation || Is the active medication list reconciled? ||  || "A" Data Element (core data exchanged with every transition) ||
 * Reconciled By || The name of the individual who last reconciled the active medication list ||  || "A" Data Element (core data exchanged with every transition) ||
 * Discontinued Medications || Medications that have been discontinued || Value Set: Medication Brand Name 2.16.840.1.113883.3.88.12.80.16

Code System(s): rxNorm 2.16.840.1.113883.6.88

Value Set: Medication Drug Class 2.16.840.1.113883.3.88.12.80.18

Code System(s): NDF-RT 2.16.840.1.113883.3.26.1.5

Value Set: Medication Clinical Drug 2.16.840.1.113883.3.88.12.80.17

Code System(s): RxNorm 2.16.840.1.113883.6.88 || "A" Data Element (core data exchanged with every transition) ||
 * Changed Medications || Medications that have been modified in this encounter, i.e. dosage adjustments || Value Set: Medication Brand Name 2.16.840.1.113883.3.88.12.80.16

Code System(s): rxNorm 2.16.840.1.113883.6.88

Value Set: Medication Drug Class 2.16.840.1.113883.3.88.12.80.18

Code System(s): NDF-RT 2.16.840.1.113883.3.26.1.5

Value Set: Medication Clinical Drug 2.16.840.1.113883.3.88.12.80.17

Code System(s): RxNorm 2.16.840.1.113883.6.88 || "A" Data Element (core data exchanged with every transition) ||
 * Medication Code || This is the physical form of the product as presented to the individual. For example: tablet, capsule, liquid or ointment || Value Set: Medication Product Form 2.16.840.1.113883.3.88.12.3221.8.11

Code System(s): National Cancer Institute (NCI) Thesaurus 2.16.840.1.113883.3.26.1.1 || "A" Data Element (core data exchanged with every transition) ||
 * Dose || The amount of the product to be given. This includes a dose in measurable units (e.g., milliliters, or mg), the form (or administrative unit (e.g. tablets, suppository, etc...), and the amount of the form to take. For example Medication XXX 500 mg, tablets; take ½ tablet, administration unit (e.g., tablet), or an amount of active ingredient (e.g., 250 mg). May define a variable dose, dose range or dose options based upon identified criteria (see Dose Indicator)

Need to have both the "dose" as well as the form or administration unit. || Value Set: Medication Brand Name 2.16.840.1.113883.3.88.12.80.16

Code System(s): rxNorm 2.16.840.1.113883.6.88 || "A" Data Element (core data exchanged with every transition) ||
 * Frequency || Defines how often the medication is to be administered as events per unit of time. Often expressed as the number of times per day (e.g., four times a day), but may also include event-related information (e.g., 1 hour before meals, in the morning, at bedtime). Complimentary to Interval, although equivalent expressions may have different implications (e.g., every 8 hours versus 3 times a day) ||  || "A" Data Element (core data exchanged with every transition) ||
 * When to Take || For PRN meds this information would be take when you are experiencing the system, e.g. take you nitroglycerine when you are experiencing chest pain ||  || "A" Data Element (core data exchanged with every transition) ||
 * Duration || The period of time that you are to take the medication if it is time limited, e.g. take abx for 10 days ||  || "A" Data Element (core data exchanged with every transition) ||
 * Route || Indicates how the medication is received by the patient (e.g., by mouth, intravenously, topically, etc.) || Value Set: Medication Route FDA Value Set 2.16.840.1.113883.3.88.12.3221.8.7

Code System(s): National Cancer Institute (NCI) Thesaurus 2.16.840.1.113883.3.26.1.1 || "A" Data Element (core data exchanged with every transition) ||
 * Patient Instructions || Instructions to the patient that are not traditionally part of the Sig. For example, “keep in the refrigerator.” More extensive patient education materials can also be included ||  || "A" Data Element (core data exchanged with every transition) ||
 * Start Date || Used to express the start date for a medication ||  || "A" Data Element (core data exchanged with every transition) ||
 * Stop Date || Used to express a "hard stop," such as the last Sig sequence in a tapering dose, where the last sequence is 'then D/C' or where the therapy/drug is used to treat a condition and that treatment is for a fixed duration with a hard stop, such as antibiotic treatment, etc ||  || "A" Data Element (core data exchanged with every transition) ||
 * Prescriber || The person that wrote this order/prescription (may include both a name and an identifier) ||  || "A" Data Element (core data exchanged with every transition) ||
 * Associated Assessment || Reason the provider prescribed the medication || Includes ICD-9 codes and/or SNOMED codes || "A" Data Element (core data exchanged with every transition) ||
 * Discontinued Medication List || List of discontinued medications ||  ||   ||
 * Medication History ||  ||   ||   ||
 * Immunization ID || Unique id given to the immunization test ||  ||   ||
 * Immunization Category || What the immunization is for ||  ||   ||
 * Immunization Date || The date and time the immunization was given. ||  ||   ||
 * Contraindication || ContraIndicated is the indicator if this immunization should be continued or should be stopped due to an adverse reaction being opserved. ||  ||   ||
 * Immunization Series || Indicates which type of series the patient has been given. Current valid values are Series 1 through 8, Partially complete, booster, or complete ||  ||   ||
 * Observed Reaction || The response of cells or tissues to an antigen, as in a test for immunization || The observed response to an antigen which would normally be a description of skin reaction including size and time since test was applied, as in a test for immunization to be given or for tuberculosis ||  ||
 * Vital Sign ID || Uniquely identifies the Vital Signs measurement. ||  ||   ||
 * Status || Indicates the status of the Vital Signs measurement record ||  ||   ||
 * Observation Time || The date/time on which the measurement was taken. ||  ||   ||
 * Observation List || Indicates which Vital Sign was measured. From a code set of allowable Vital Sign codes. ||  ||   ||
 * Observation Method || A code that provides additional detail about the means or technique used to ascertain the observation. ||  ||   ||
 * Device || Identifies the device used to measure the vital sign. || This would include cuff size for blood pressure, which is critical for sake of comparison or interpretation. A blood pressure cuff should be 2/3 size of upper arm, which in some individuals requires a "leg cuff". Using a cuff that is too small causes an erroneously high reading. ||  ||
 * Patient State || Provides an indication of the state of the patient at the time of the observation. For example, a blood pressure may be taken while the patient is exercising or at rest. || Standing blood pressure can be significantly different from supine and may, for example be an indication of a medication side effect as some blood pressure medications can cause a dangerous drop in blood pressure on standing which could cause falls and injury. ||  ||
 * Telehealth Monitor || The Home TeleHealth Monitor Equipment used by the patient. ||  ||   ||
 * Body Site || Indicates the anatomical site - intended to be specified as left arm, right arm, left leg, etc. May also indicate whether patient is sitting, standing, supine. || Value Set: Body Site Value Set 2.16.840.1.113883.3.88.12.3221.8.9

Code System(s): SNOMED CT 2.16.840.1.113883.6.96 ||  || developer. || Source: Federal Health Information Model (FHIM) - Durable Medical Equipment ||  ||
 * Physical Exam Narrative ||  ||   ||   ||
 * Physical Exam Component ||  ||   ||   ||
 * Physical Exam Observation ||  ||   ||   ||
 * Request Reason || Reason for consult/procedure request ||  || "A" Data Element (core data exchanged with every transition) ||
 * Requested Procedure || A procedure that is requested as part of this order. ||  ||   ||
 * Provisional Diagnosis ||  ||   ||   ||
 * Patient Instructions Narrative ||  ||   ||   ||
 * Goal ID ||  ||   ||   ||
 * Goal Name ||  ||   ||   ||
 * Goal Description ||  ||   ||   ||
 * Admitting Diagnosis ||  ||   ||   ||
 * Discharging Diagnosis ||  ||   ||   ||
 * Operative Summary Narrative ||  ||   ||   ||
 * Diet Narrative || Records a narrative description of the expectations for diet, including proposals, goals, and order requests for monitoring, tracking, or improving the dietary control of the patient, used in a discharge from a facility such as an emergency department, hospital, or nursing home. ||  ||   ||
 * Model Name || The human designated moniker for a device, assigned by the manufacturer || Source: Federal Health Information Model (FHIM) - Durable Medical Equipment ||  ||
 * Software Name || The moniker, version and release of the software that operates the device as assigned by the software manufacturer or
 * Physical Activity Narrative ||  ||   ||   ||
 * Social Narrative ||  ||   ||   ||
 * Medical Diagnosis ||  ||   ||   ||
 * GAF Score || Global Assessment of Functioning (GAF)

Part of the diagnosis on Axis 5 ||  ||   ||
 * Suicidal Ideation ||  ||   ||   ||
 * Homicidal Ideation ||  ||   ||   ||
 * DSM Axis 1 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis I: Clinical disorders, including major mental disorders, and learning disorders ||  ||   ||
 * DSM Axis 2 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis II: Personality disorders and intellectual disabilities (although developmental disorders, such as Autism, were coded on Axis II in the previous edition, these disorders are now included on Axis I) ||  ||   ||
 * DSM Axis 3 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis III: Acute medical conditions and physical disorders ||  ||   ||
 * DSM Axis 4 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis IV: Psychosocial and environmental factors contributing to the disorder ||  ||   ||
 * DSM Axis 5 || The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis V: Global Assessment of Functioning or Children's Global Assessment Scale for children and teens under the age of 18 ||  ||   ||
 * Confidentiality Code || This attribute is used to specify that the content of this clinical document is sensitive because it contains Behavioral Health information || This attribute is used to specify that the content of this clinical document is sensitive because it contains Behavioral Health information ||  ||
 * Environmental Factors || TBD ||  ||   ||
 * Treatment Referral || TBD ||  ||   ||
 * Social History Description || Narrative description of social situation. This data element may be used to capture textual descriptions about Social History within existing clinical software applications. ||  ||   ||
 * Social History Additional Details || Additional structured details ||  ||   ||
 * Medical History Narrative || TBD ||  ||   ||
 * Family History Summary || Textual description about the problems, diagnoses, and genetic markers found in genetic relatives. This field may be used to capture unstructured family history information recorded in clinical records. ||  ||   ||
 * Genetic Relative Name || Name of family member. For privacy reasons this may not be appropriate for sharing or public display and in this situation the 'label' should be used. ||  ||   ||
 * Genetic Relative Age || Age of the genetic relative at death. ||  ||   ||
 * Genetic Relative Relationship || The relationship of the genetic relative to the individual. Coding of the relationship with a terminology is preferred, where possible. ||  ||   ||
 * Genetic Relative Medical History || Detail about problems or diagnoses for this genetic relative. ||  ||   ||
 * Genetic Marker Description || Description of risk-related genetic markers identified in this individual. ||  ||   ||
 * Family History Survey Question ||  ||   ||   ||
 * Family History Survey Response ||  ||   ||   ||
 * Surgical History ||  ||   ||   ||
 * Procedure History ||  ||   ||   ||
 * Demographics ID || A unique identified for the Demographics CIM Object ||  ||   ||
 * Transitions of Care Summary ID || A unique identifier for the summary entity that may contain one or more of the other entities defined in the Transitions of Care Clinical Information Model (CIM) ||  ||   ||
 * Discharge Summary ID || A unique identifier for the Discharge Summary ||  ||   ||
 * Discharge Instructions ID || A unique identifier for the Discharge Instructions ||  ||   ||
 * Consultation Request ID || A unique identifier for the Consultation Request ||  ||   ||
 * Consultation Summary ID || A unique identified for the Consultation Summary ||  ||   ||


 * ==Key Information Exchanges== ||

The TOC CIM currently supports the following key information exchanges. The four key information exchanges to highlight as supportive of the Transitions of Care Initiative are: The following tables highlight the CDA implementation guidance needed to implement each of the CIM objects and the key information exchanges highlighted above.
 * Discharge Summary
 * Discharge Instructions
 * Consultation Request including Clinical Summary
 * Consultation Summary

The key information exchanges supported by the CIM. || The Discharge summary should always include a basic set of information on the discharge that might also include content for the Discharge Instruction as well as the Discharge Summary. Discharge summary content examples include demographic information, active reconciled medication list (with doses and sig), allergy list, problem list, and reason for admission. ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Key Information Exchange Summary ===
 * ** Name ** || ** Definition ** ||
 * TOC CIM || The high level view of the CIM that contains all CIM objects and relationships. This is the primary view accessible in the CIM data model. ||
 * Consultation Request including Clinical Summary || This information exchange would include a standard set of data including demographic information, active reconciled medication list (with doses and sig), allergy list and problem list. The Clinical Summary may also contain variable data relevant to the context of the request. In addition, this document also includes a PCP-selected referral-specific variable dataset. ||
 * Consultation Summary || This information exchange will include a standard data set including demographic information, active reconciled medication list (with doses and sig), allergy list and problem list. This information exchange would also contain variable data relevant to the context of the request. ||
 * Demographics || The demographics view shows how several CIM objects are assembled into a single Demographics CIM object. This is accomplished by combining both CDA header information with CDA template and section-level entries. ||
 * Discharge Instructions || This information exchange would include a standard data set including demographic information, active reconciled medication list (with doses and sig), allergy list and problem list. Discharge Instructions also contains dataset relevant to the Discharge Summary/Discharge Instructions context which includes follow-up/plan of care. ||
 * Discharge Summary || This information exchange would contain a standard set of data surrounding a discharge, and discharge context-relevant data, which is determined by the discharging provider organization in accordance with local policy, regulations and law. The receiving provider through its EHR system may determine how to incorporate and present the Discharge Summary document.
 * TOC A Data Elements || A view of the "A" priority CIM Objects.

"A" priority CIM Objects are core data exchanged with every transition of care ||
 * TOC B Data Elements || A view of the "B" priority CIM Objects.

NB subsets of categories of "additional" data elements (e.g. several results from the hundreds that may be in the EHR database for a patient) can be added by the clinician end user to the Direct Message depending on the clinical circumstance.

The variable data elements are selectively added to prevent information overload by the recipient clinician (e.g. a recipient clinician receiving several hundred results for a patient following an extended hospital stay would lead to the recipient clinician being data overloaded and not caring for the patient as effectively as in the circumstances of receiving the selected 2 or three results that would be helpful to the PCP for efficient care and management of the patient).

Selected "B" data elements are either very frequently required in most transition of care circumstances (e.g. results) and/or are regularly captured in many EHR systems as discrete data. ||
 * TOC C Data Elements || A view of the "C" priority CIM Objects.

Variable data needed by the end user in some transition of care circumstances

Selected "C" data elements are either less frequently required in most transition of care circumstances and/or are not currently captured in many EHR systems as discrete data ||
 * TOC D Data Elements || A view of the "D" priority data elements

Variable data needed by the end user in some transition of care circumstances

Selected "D" data elements are less frequently required in most transition of care circumstances than C, and/or are not captured in EHR systems as discrete data elements, or may not be captured currently in EHR systems at all ||

Lists the CDA implementation guidance for all TOC CIM Objects || 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || 4.28 Medications 5.14 Medication Activity 5.16 Medication Information 5.9 Drug Vehicle 5.12 Indication 5.13 Instructions 5.17 Medication Supply Order ||  || 5.6 Condition Entry ||  || 2.16.840.1.113883.10.20.21.2.6. || 4.2 Allergies, Adverse Reactions, Alerts 5.3: Allergy Problem Act ||  || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || 2.16.840.1.113883.10.20.22.2.2 ||  ||   || [US Realm Document Header] ||   ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || 2.16.840.1.113883.10.20.22.2.4 ||  ||   ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">All CDA Mappings ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Active Medication List || 2.16.840.1.113883.10.20.22.2.1.1
 * Active Problem List || 2.16.840.1.113883.10.20.22.2.7 || 4.40 Problem List
 * Admitting and Discharging Diagnoses ||  ||   ||   ||
 * Allergies and Intolerances || 2.16.840.1.113883.10.20.21.2.6.1
 * Anticipatory Guidance ||  ||   ||   ||
 * Behavioral Health History ||  ||   ||   ||
 * Care Team Members ||  ||   ||   ||
 * Consultant(s) Assessment(s) and Plan(s) Recommendations || 2.16.840.1.113883.10.20.22.1.9 ||  ||   ||
 * Consultation Request including Clinical Summary ||  ||   ||   ||
 * Consultation Summary ||  ||   ||   ||
 * Culturally Sensitive Patient Care || 2.16.840.1.113883.10.20.21.1.1
 * Demographics || 2.16.840.1.113883.10.20.21.1.1
 * Diet || 1.3.6.1.4.1.19376.1.5.3.1.3.33 ||  ||   ||
 * Discharge Instructions ||  ||   ||   ||
 * Discharge Summary ||  ||   ||   ||
 * Discontinued Medications ||  ||   ||   ||
 * Equipment || 2.16.840.1.113883.10.20.22.2.23 ||  ||   ||
 * Existence of Advanced Directives || 2.16.840.1.113883.10.20.22.2.21 ||  ||   ||
 * Family History || 2.16.840.1.113883.10.20.22.2.15 ||  ||   ||
 * Follow-up Appointments ||  ||   ||   ||
 * Goals ||  ||   ||   ||
 * Health Literacy ||  ||   ||   ||
 * Health Maintenance ||  ||   ||   ||
 * History Present Illness || 1.3.6.1.4.1.19376.1.5.3.1.3.4 ||  ||   ||
 * Immunization History || 2.16.840.1.113883.10.20.22.2.2.1
 * Invasive and Non-Invasive Procedures ||  ||   ||   ||
 * Medical History ||  ||   ||   ||
 * Medication History ||  ||   ||   ||
 * Operative Summary || 2.16.840.1.113883.10.20.22.1.7 ||  ||   ||
 * Outcome of Allergy/Intolerance ||  ||   ||   ||
 * Patient Consent Directive ||  ||   ||   ||
 * Patient Contact Information || 2.16.840.1.113883.10.20.21.1.1
 * Patient Information || 2.16.840.1.113883.10.20.21.1.1
 * Patient Instructions ||  ||   ||   ||
 * Patient Self-Management ||  ||   ||   ||
 * Payer Information || 2.16.840.1.113883.10.20.22.2.18 ||  ||   ||
 * Pending Tests and Procedures ||  ||   ||   ||
 * Physical Activity ||  ||   ||   ||
 * Physical Exam || 2.16.840.1.113883.10.20.22.2.19 ||  ||   ||
 * Primary Care Physicians and Designated Providers || 2.16.840.1.113883.10.20.21.1.1
 * Reason for Consult Request ||  ||   ||   ||
 * Restorative Care ||  ||   ||   ||
 * Review of Systems || 1.3.6.1.4.1.19376.1.5.3.1.3.18 ||  ||   ||
 * Social Determinants of Health ||  ||   ||   ||
 * Social History || 2.16.840.1.113883.10.20.22.2.17 ||  ||   ||
 * Support Contacts || 2.16.840.1.113883.10.20.21.1.1
 * Surgical/Procedure History || 2.16.840.1.113883.10.20.22.2.7 ||  ||   ||
 * Transitions of Care Summary ||  ||   ||   ||
 * Vital Signs || 2.16.840.1.113883.10.20.22.2.4.1

Lists the CDA implementation guidance needed to build the Consultation Request including Clinical Summary CIM Object. || 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || 4.28 Medications 5.14 Medication Activity 5.16 Medication Information 5.9 Drug Vehicle 5.12 Indication 5.13 Instructions 5.17 Medication Supply Order ||  || 5.6 Condition Entry ||  || 2.16.840.1.113883.10.20.21.2.6. || 4.2 Allergies, Adverse Reactions, Alerts 5.3: Allergy Problem Act ||  || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Consultation Request including Clinical Summary CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Active Medication List || 2.16.840.1.113883.10.20.22.2.1.1
 * Active Problem List || 2.16.840.1.113883.10.20.22.2.7 || 4.40 Problem List
 * Allergies and Intolerances || 2.16.840.1.113883.10.20.21.2.6.1
 * Culturally Sensitive Patient Care || 2.16.840.1.113883.10.20.21.1.1
 * Discontinued Medications ||  ||   ||   ||
 * Existence of Advanced Directives || 2.16.840.1.11388310.20.22.2.21 ||  ||   ||
 * Patient Contact Information || 2.16.840.1.113883.10.20.21.1.1
 * Patient Information || 2.16.840.1.113883.10.20.21.1.1
 * Payer Information || 2.16.840.1.113883.10.20.22.2.18 ||  ||   ||
 * Primary Care Physicians and Designated Providers || 2.16.840.1.113883.10.20.21.1.1
 * Support Contacts || 2.16.840.1.113883.10.20.21.1.1



Lists the CDA implementation guidance needed to build the Consultation Summary CIM Object. || 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || 4.28 Medications 5.14 Medication Activity 5.16 Medication Information 5.9 Drug Vehicle 5.12 Indication 5.13 Instructions 5.17 Medication Supply Order ||  || 5.6 Condition Entry ||  || 2.16.840.1.113883.10.20.21.2.6. || 4.2 Allergies, Adverse Reactions, Alerts 5.3: Allergy Problem Act ||  || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Consultation Summary CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Active Medication List || 2.16.840.1.113883.10.20.22.2.1.1
 * Active Problem List || 2.16.840.1.113883.10.20.22.2.7 || 4.40 Problem List
 * Allergies and Intolerances || 2.16.840.1.113883.10.20.21.2.6.1
 * Culturally Sensitive Patient Care || 2.16.840.1.113883..20.21.1.1
 * Existence of Advanced Directives || 2.16.840.1.113883.10.20.22.2.21 ||  ||   ||
 * Patient Contact Information || 2.16.840.1.113883.10.20.21.1.1
 * Patient Information || 2.16.840.1.113883.10.20.21.1.1
 * Payer Information || 2.16.840.1.113883.10.20.22.2.18 ||  ||   ||
 * Primary Care Physicians and Designated Providers || 2.16.840.1.113883.10.20.21.1.1
 * Support Contacts || 2.16.840.1.113883.10.20.21.1.1



Lists the CDA implementation guidance needed to build the Demographics CIM Object. Note that the Demographics CIM Object is assembled from other CIM objects and then may be reused within key information exchanges || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Demographics CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Culturally Sensitive Patient Care || 2.16.840.1.113883.10.20.21.1.1
 * Demographics || 2.16.840.1113883.10.20..1.1
 * Existence of Advanced Directives || 2.16.840.1.113883.10.20.22.2.21 ||  ||   ||
 * Patient Contact Information || 2.16.840.1.113883.10.20.21.1.1
 * Patient Information || 2.16.840.1.113883.10.20.21.1.1
 * Payer Information || 2.16.840.1.113883.10.20.22.2.18 ||  ||   ||
 * Primary Care Physicians and Designated Providers || 2.16.840.1.113883.10.20.21.1.1
 * Support Contacts || 2.16.840.1.113883.10.20.21.1.1



Lists the CDA implementation guidance needed to build the Discharge Instructions CIM Object || 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || 4.28 Medications 5.14 Medication Activity 5.16 Medication Information 5.9 Drug Vehicle 5.12 Indication 5.13 Instructions 5.17 Medication Supply Order ||  || 5.6 Condition Entry ||  || 2.16.840.1.113883.10.20.21.2.6. || 4.2 Allergies, Adverse Reactions, Alerts 5.3: Allergy Problem Act ||  ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Discharge Instructions CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Active Medication List || 2..840.1.113883.10.20.22.2.1.1
 * Active Problem List || 2.16.840.1.113883.10.20.22.2.7 || 4.40 Problem List
 * Allergies and Intolerances || 2.16.840.1.113883.10.20.21.2.6.1
 * Discharge Instructions ||  ||   ||   ||
 * Existence of Advanced Directives || 2.16.840.1.113883.10.20.22.2.21 ||  ||   ||



Lists the CDA implementation guidance needed to build the Discharge Summary CIM Object || 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || 4.28 Medications 5.14 Medication Activity 5.16 Medication Information 5.9 Drug Vehicle 5.12 Indication 5.13 Instructions 5.17 Medication Supply Order ||  || 5.6 Condition Entry ||  || 2.16.840.1.113883.10.20.21.2.6. || 4.2 Allergies, Adverse Reactions, Alerts 5.3: Allergy Problem Act ||  ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">Discharge Summary CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Active Medication List || 2.16.840.1.113883.10.20.22.2.1.1
 * Active Problem List || 2.16.840.1.113883.10.20.22.2.7 || 4.40 Problem List
 * Allergies and Intolerances || 2.16.840.1.113883.10.20.21.2.6.1



Provides a comprehensive view of the TOC A Priority CIM Objects that are part of the CIM, and the CDA implementation guidance needed to support those CIM objects. || 2.16.840.1.113883.10.20.22.2.1 2.16.840.1.113883.10.20.22.2.38 || 4.28 Medications 5.14 Medication Activity 5.16 Medication Information 5.9 Drug Vehicle 5.12 Indication 5.13 Instructions 5.17 Medication Supply Order ||  || 5.6 Condition Entry ||  || 2.16.840.1.113883.10.20.21.2.6. || 4.2 Allergies, Adverse Reactions, Alerts 5.3: Allergy Problem Act ||  || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   || [US Realm Document Header] ||  ||   ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">TOC Priority A CIM Objects - CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Active Medication List || 2.16.840.1.113883.10.20.22.2.1.1
 * Active Problem List || 2.16.840.1.113883.10.20.22.2.7 || 4.40 Problem List
 * Allergies and Intolerances || 2.16.840.1.113883.10.20.21.2.6.1
 * Culturally Sensitive Patient Care || 2.16.840.1.113883.10.20.21.1.1
 * Demographics || 2.16.840.1.113883.10.20.21.1.1
 * Discontinued Medications ||  ||   ||   ||
 * Existence of Advanced Directives || 2.16.840.1.113883.10.20.22.2.21 ||  ||   ||
 * Patient Contact Information || 2.16.840.1.113883.10.20.21.1.1
 * Patient Information || 2.16.840.1.113883.10.20.21.1.1
 * Payer Information || 2.16.840.1.113883.10.20.22.2.18 ||  ||   ||
 * Primary Care Physicians and Designated Providers || 2.16.840.1.113883.10.20.21.1.1
 * Support Contacts || 2.16.840.1.113883.10.20.21.1.1
 * Transitions of Care Summary ||  ||   ||   ||



Provides a comprehensive view of the TOC B Priority CIM Objects that are part of the CIM, and the CDA implementation guidance needed to support those CIM objects. Work on the B Priority CIM Objects is still ongoing and will be completed in a subsequent version of the CIM. || 2.16.840.1.113883.10.20.22.2.2 ||  ||   || 2.16.840.1.113883.10.20.22.2.4 ||   ||   ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">TOC Priority B CIM Objects - CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Admitting and Discharging Diagnoses ||  ||   ||   ||
 * Behavioral Health History ||  ||   ||   ||
 * Care Team Members ||  ||   ||   ||
 * Consultant(s) Assessment(s) and Plan(s) Recommendations || 2.16.840.1.113883.10.20.22.1.9 ||  ||   ||
 * Family History || 2.16.840.1.113883.10.20.22.2.15 ||  ||   ||
 * Goals ||  ||   ||   ||
 * History Present Illness || 1.3.6.1.4.1.19376.1.5.3.1.3.4 ||  ||   ||
 * Immunization History || 2.16.840.1.113883.10.20.22.2.2.1
 * Medical History ||  ||   ||   ||
 * Medication History ||  ||   ||   ||
 * Operative Summary || 2.16.840.1.113883.10.20.22.1.7 ||  ||   ||
 * Patient Instructions ||  ||   ||   ||
 * Pending Tests and Procedures ||  ||   ||   ||
 * Physical Exam || 2.16.840.1.113883.10.20.22.2.19 ||  ||   ||
 * Reason for Consult Request ||  ||   ||   ||
 * Social History || 2.16.840.1.113883.10.20.22.2.17 ||  ||   ||
 * Surgical/Procedure History || 2.16.840.1.113883.10.20.22.2.7 ||  ||   ||
 * Transitions of Care Summary ||  ||   ||   ||
 * Vital Signs || 2.16.840.1.113883.10.20.22.2.4.1



Provides a comprehensive view of the TOC C Priority CIM Objects that are part of the CIM, and the CDA implementation guidance needed to support those CIM objects. C Priority CIM Objects are still being developed and are not included in this release of the CIM. ||
 * ===<span style="color: #000000; font-family: 'Calibri','sans-serif';">TOC Priority C CIM Objects - CDA Implementation ===
 * ** CIM Object Name ** || ** CDA Template ID ** || ** CDA Section ID ** || ** CDA Entry ID ** ||
 * Health Literacy ||  ||   ||   ||
 * Health Maintenance ||  ||   ||   ||
 * Invasive and Non-Invasive Procedures ||  ||   ||   ||
 * Patient Consent Directive ||  ||   ||   ||
 * Patient Self-Management ||  ||   ||   ||
 * Physical Activity ||  ||   ||   ||
 * Social Determinants of Health ||  ||   ||   ||
 * Transitions of Care Summary ||  ||   ||   ||



=Version Tracker= This document will be reviewed for content and accuracy as needed.


 * **Version #** || **Date** || **Modified by** || **Description of Modification** ||
 * V1.0 || 7/28/2011 || Erik Pupo || Initial Draft ||

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