PHIN Laboratory Result ELR v231

Implementation Guide for Transmission of Laboratory-Based Reporting using HL7 2.3.
Implementation Guide for Transmission of

Laboratory-Based Reporting of Public Health Information using
Version 2.3.1 of the Health Level Seven (HL7)
Standard Protocol
Implementation Guide Update

March 2005
Centers for Disease Control and Prevention
Printed 5/4/2005 Page 1 of 85 Last Updated 5/14/04

Implementation Guide for Transmission of Laboratory-Based Reporting using HL7 2.3.1
Table of Contents
1 Introduction …………………………………………………………………................3
1.1 Background ......................................................................................................................... 3
1.2 HIPAA.................................................................................................................................. 3
1.3 Scope .................................................................................................................................. 4
1.4 Contacts .............................................................................................................................. 4
2 HL7 Concepts…………………………………………………………………………...5
2.1 HL7 Definitions .................................................................................................................... 5
2.2 Basic Message Construction Rules .................................................................................... 6
2.3 Unsolicited Observation Message (ORU)/ Event R01 ........................................................ 7
2.4 HL7 Standard Segment Usage............................................................................................ 8
2.5 Segment Attribute Table Abbreviations................................................................................ 9
3 Segment Definitions…………………………………………………………………..10
3.1 MESSAGE CONTROL SEGMENTS................................................................................. 10
3.1.1 Message Header (MSH) Segment……………………………………………………10
3.2 PATIENT ADMINISTRATION MESSAGE SEGMENTS .................................................... 15
3.2.1 Patient Identification (PID) Segment ......................................................................15
3.2.2 Next of Kin/Associated Parties (NK1) Segment .....................................................24
3.3 SEGMENTS COMMON TO ALL ORDERS....................................................................... 32
3.3.1 Common Order (ORC) Segment............................................................................32
3.3.2 Observation Request Segment (OBR)...................................................................39
3.3.3 Observation/Result (OBX) Segment. .....................................................................53
3.3.4 NOTES AND COMMENTS (NTE) SEGMENT .......................................................62
4 HL7 Batch Protocol………………………………………..……………………........63
4.1 HL7 batch file structure ..................................................................................................... 63
4.2 Acknowledging Batches .................................................................................................... 63
4.3 Batch Segments ............................................................................................................ ....64
4.3.1 File Header (FHS) Segment...................................................................................64
4.3.2 File Trailer (FTS) ....................................................................................................65
4.3.3 Batch Header (BHS) Segment ...............................................................................65
4.3.4 Batch Trailer (BTS) Segment .................................................................................66
5 APPENDIX A. HL7 Examples of Report Messages………………………………67
6 APPENDIX B: Code Tables………………………………………………………….68
7 APPENDIX C: Data Types used in this Implementation………………………..80

1 Introduction
1.1 Background
Monitoring the occurrence of diseases is a cornerstone of public health decision-making. This monitoring,
referred to as public health surveillance, can be used to trigger case or outbreak investigations, follow
trends, evaluate the effect of prevention measures such as immunizations, and suggest public health
priorities. Because disease trends have the potential to shift rapidly, especially with infectious diseases,
surveillance needs to be ongoing, timely, and complete.
Each state and territory has requirements for laboratories to report certain findings to health officials. In the
past, these reports were written by hand on forms provided by health departments and mailed to
appropriate offices. With computerization of laboratories, it has become possible for laboratories to send
reportable data to health departments electronically.
This guide contains the specifications for sending laboratory-reportable findings to appropriate state,
territorial, and federal health agencies using Health Level Seven (HL7) messages. The message is not
specific to any pathogen or reportable condition and is applicable for most laboratory-reportable findings in
the National Public Health Surveillance System (NPHSS) as defined by the Council of State and Territorial
Epidemiologists (CSTE).
This document is a guide for electronic communication of reportable diseases, consistent with
recommended reporting of reportable conditions from laboratories to public health agencies using HL7
Version 2.3.1. The implementation guide follows the specifications described in the HL7 Standard Version
2.3.1 and focuses on one type of HL7 message, the Observational Report - Unsolicited (ORU). HL7
describes the order and structure of data fields for sharing test results, but does not stipulate which coding
system or dictionary of descriptive terms should be used to identify specific tests and findings
unambiguously; this is determined by agreement of the parties sharing the information. For sharing
laboratory-based reports of public health findings, these coding systems are recommended: 1) Logical
Observation Identifier Names and Codes (LOINC®) for specific laboratory procedure names, 2) the
Systematized Nomenclature for Human and Veterinary Medicine (SNOMED®) for descriptions of findings,
notably organism names, and 3) International Classification of Diseases, Clinical Modification (ICD-9-CM)
coding system to code signs, symptoms, injuries, diseases, and conditions. The guide gives a description
of the utility and requirement of each data field in the ORU message, provides examples of complete
messages, and includes tables of recommended codes.
1.2 HIPAA
The Health Insurance Portability and Accountability Act (HIPAA, or the Act), P.L. 104-191, was enacted on
August 21, 1996. The Act included provisions relating to insurance coverage, but it also included a section
that is relevant to electronic reporting of health care information. Among the requirements in this section
called administrative simplification were: the adoption of standards for electronic health information
transactions for certain uniform financial and administrative transactions and data elements, including
claims, enrollment, eligibility, payment, coordination of benefits, and for the security of electronic health
information systems. HIPAA also addressed safeguards of information, electronic signatures, and
standards for various unique health identifiers, and specific code sets to be used in the transactions.
HIPAA also included provisions for adopting standards for the privacy of health information. The Law pre-
empts State laws and imposes civil money penalties and prison for certain violations and made some
changes in the membership and duties of the National Committee on Vital and Health Statistics (NCVHS).
There is also a provision that NCVHS will make recommendations and legislative proposals to the
Secretary on the adoption of uniform data standards for patient medical record information and the
electronic exchange of such information. It also addresses state regulatory reporting by stating, "[N]othing
in this part shall limit the ability of a State to require a health plan to report, or to provide access to,
information for management audits, financial audits, program monitoring and evaluation, facility licensure
or certification, or individual licensure or certification." Regulations issued under the Act provide the
implementation detail.

On the issue of public health, HIPAA states, "Nothing in this part shall be construed to invalidate or limit
the authority, power, or procedures established under any law providing for the reporting of disease or
injury, child abuse, birth, or death, public health surveillance, or public health investigation or intervention."
The covered entities (those who have to comply) named in the HIPAA legislation are "health plans, health
care clearinghouses, and health care providers who transmit any health information in electronic form in
connection with a transaction referred to in Section 1173(a) of the Act.” The transactions listed in Section
1173(a) specifically deal with eligibility, enrollment, claims, and others related to payment of insurance
claims. Many of the public health reports will occur between parties that are not covered entities under the
Act and do not involve the covered transactions, because public health agencies generally do not file
insurance claims. The regulation implementing the HIPAA privacy provisions allowed public health
exemptions for disclosure without patient consent of individually identifiable health information for the
purposes quoted above.
Public health reporting is not a part of the claims process and conceptually is most closely aligned with the
patient medical record, with Health Level Seven (HL7) as a recognized standards development
organization in that subject area. We do not believe the HIPAA requirements related to electronic
transactions will in any way affect our planned use of HL7 for electronic laboratory reporting. The HL7
message as defined in this document was carefully developed to provide a method for evidence of
reportable conditions to be transmitted electronically. We believe that laboratories can report this public
health information using the HL7 standard as described here and that these reports will not be altered by
HIPAA provisions.
1.3 Scope
The specifications in this guide are not intended as a tutorial for either HL7 or interfacing in general. The
reader is expected to have a basic understanding of interface concepts, HL7, and electronic laboratory-
based reporting of public health information. This guide describes a data exchange protocol applicable for
reporting most diseases of public health importance.
This implementation guide is based on and consistent with the HL7 Standard, Version 2.3.1. Any user-
defined variations from the standard are clearly described. Reporting requirements for reportable diseases
may vary by state. Electronic copies of this document are available.
1.4 Contacts
For information about HL7, contact: For information about this Guide, contact:
Health Level Seven Katherine Robinson
3300 Washtenaw Avenue, Suite 227 Tel: (404)202-6247
Ann Arbor, MI 48104-4250 Fax: (912)635-3565
Phone: (734) 677-7777 Email: [email protected]
Fax: (734) 677-6622 Mary Hamilton(404) 371-5362
E-Mail: [email protected] Margaret Marshburn (404) 371-5352
Website: www.hl7.org Centers for Disease Control and Prevention
Atlanta, GA 30333
: Website: www.cdc.gov/phin/messaging

2 HL7 Concepts
This project remains true to the HL7 2.3.1 Final Standard, dated May, 1999. The entries below are derived
from that standard for use with Electronic Laboratory Reporting.
2.1 HL7 Definitions

Message: A message is the entire unit of data transferred between systems in a single transmission. It is
a series of segments in a defined sequence, with a message type and a trigger event. Between text
messages in a batch, the hex characters 0D0A0D0A represent the end of each message.
Segment: A segment is a logical grouping of data fields. Segments within a defined message may be
required or optional, may occur only once, or may be allowed to repeat. Each segment is named and is
identified by a segment ID, a unique 3-character code. The hex characters ‘ 0D0A’ that act as a Segment
Terminator (equivalent to a Carriage Return and Line Feed) denote the end of each segment.
Field: A field is a string of characters. Each field is identified by the segment it is in and the position within
the segment; e.g., PID-5 is the fifth field of the PID segment. Optional data fields need not be valued.
Whether a field is required, optional, or conditional in a segment is specified in the segment attribute
tables. The designations are: R=Required, O=Optional, C=Conditional on the trigger event or on some
other field(s). The field definition should define any conditionality for the field: X=Not Supported with this
trigger event, B=Left in for backward compatibility with previous versions of HL7. A maximum length of the
field is stated as normative information. Exceeding the listed length should not be considered an error.
Component: A component is one of a logical grouping of items that comprise the contents of a coded or
composite field. Within a field having several components, not all components are required to be valued.
Examples in this guide demonstrate both fully valued and partially valued coded and composite fields.
Item number: Each field is assigned a unique item number. Fields that are used in more than one
segment will retain their unique item number across segments.
Null and empty fields: The null value is transmitted as two double quote marks (""). A null-valued field
differs from an empty field. An empty field should not overwrite previously entered data in the field. The
null value means that any previous value in this field should be overwritten.
Data type: A data type restricts the contents and format of the data field. Data types are given a 2- or 3-
letter code. Some data types are coded or composite types with several components. The applicable
data type is listed and defined in each field definition. Appendix D provides a complete listing of data
types used in this document and their definitions.
Delimiters: The delimiter values are given in MSH-2 and used throughout the message. Applications
must use agreed upon delimiters to parse the message. The recommended delimiters for laboratory
messages are ‘0D0A’ = Segment Terminator (hex characters equivalent to a Carriage Return and Line
Feed); | = Field Separator; ^ = Component Separator; & = Sub-Component Separator; ~ = Repetition
Separator; and \ = Escape Character.
Message syntax: The abstract message is defined in special notation that lists the 3-letter segment
identifiers in the order they will appear in the message. Braces, {}, indicate that one or more of the
enclosed group of segments may repeat, and brackets, [ ], indicate that the enclosed group of segments is
optional.
Trigger events: The HL7 Standard is written from the assumption that an event in the real world of
healthcare creates the need for data to flow among systems. The real-world event is called the trigger
event. For example, the trigger event a patient is admitted may cause the need for data about that patient
to be sent to a number of other systems. The trigger event, an observation (e.g., a CBC result) for a
patient is available, may cause the need for that observation to be sent to a number of other systems.
When the transfer of information is initiated by the application system that deals with the triggering event,

the transaction is termed an unsolicited update.
Z segments: All message types, trigger event codes, and segment ID codes beginning with Z are
reserved for locally defined messages. No such codes are defined within the HL7 Standard. In this Guide
are references to a legacy z-segment that is sent in the 2.3.z ELR messages designed before the 2.3.1
standard included a place to capture the Ordering Facility Name, Address and Phone Number, as well as
the Ordering Provider’s address. These fields are sent in the ZLR segment from some participating
Laboratories and converted to this 2.3.1 message format. That ZLR segment also contains Next of Kin
information that is translated to a NK1 segment, and may contain a Reported Patient Age field that is
converted to an OBR/OBX pair that uses the LOINC code for Reported Patient Age for 2.3.1 Electronic
Laboratory Reporting.
2.2 Basic Message Construction Rules

Encoding Rules for Sending
- Encode each segment in the order specified in the abstract message format.
- Place the Segment ID first in the segment.
- Precede each data field with the field separator.
- Encode the data fields in the order and data type specified in the segment definition table.
- End each segment with the segment terminator.
- Components, subcomponents, or repetitions that are not valued at the end of a field need not be
represented by component separators. The data fields below, for example, are equivalent:
^XXX&YYY&&^ is equal to ^XXX&YYY^

|ABC^DEF^^| is equal to |ABC^DEF|
Encoding Rules for Receiving
- If a data segment that is expected is not included, treat it as if all data fields within were not present.
- If a data segment is included that is not expected, ignore it; this is not an error.
- If data fields are found at the end of a data segment that are not expected, ignore them; this is not an
error.

2.3 Unsolicited Observation Message (ORU)/ Event R01

Laboratory information is reported through the ORU^R01 message to public health agencies. The
supported segments and usage for Public Health ORU/R01 message structure are described below.
ORU - unsolicited transmission of an observation message (event R01)
ORU^R01 Observational Results (Unsolicited) Chapter

MSH Message Header segment 2
PID Patient Identification segment 3
NK1 Next-Of-Kin segment 3
ORC Order common segment 4
{
OBR Observations Report ID segment 7
{
[OBX] Observation/Result segment 7
{ [NTE] } Notes and comments segment 2
}
}
Using the basic “building blocks” of MSH, PID, OBR and OBX segments (in bold type in table above), a
clinical report can be constructed as a three-level hierarchy with the patient information (PID) segment at
the upper level, one or more order records (OBR) at the next level, and one or more observation records
(OBX) at the bottom. The Message Header (MSH) segment is required for all HL7 messages. The Next of
Kin (NK1) segment can provide information about parties associated with the patient. The common order
(ORC) segment transmits fields common to all types of requested services, and the notes and comments
(NTE) segment is only supported at the Result level for ELR.
While certain elements of the message are required for laboratory-based reporting, data in non-required
fields will not be rejected. The standard ORU message allows for the optional use of PD1, PV1, PV2, CTI,
and DSC segments, but these segments are not defined or used in the laboratory-based reporting
message. For this reason, there is no discussion of these segments in this implementation guide.
Messages containing these segments, however, will not be rejected. For electronic laboratory purposes,
we do not anticipate the use of acknowledgment messages; therefore, we have not defined these in this
guide.

Example: Laboratory Report of Bordetella Pertussis
MSH|^~\&|| LABCORP^34D0655059^CLIA|WA|WA|200102171830|
|ORU^R01|200102170042|P|2.3.1|<hex 0D0A>
PID|||10543^^^^^Columbia Valley Memorial Hospital&01D0355944&CLIA~95101100001^^^^^MediLabCo-
Seattle&45D0470381&CLIA||Doe^John^Q^Jr^^^L|Clemmons^^^^^^M|19841004|M||W|2166 WellsDrÂptB
^Seattle^WA^98109ÛSA^M^^King^Â||^PRN^PH^^^206^6793240|||S^single^HL70002|||423523049|
DOEJ34556057^WA^ 19970801||N|||||||| <hex 0D0A>
NK1|1|Doe^Jane^Lee^^^^L|MTH^mother^HL70063|2166 Wells DrÂpt
B^Seattle^WA^98109ÛSA^M^^King^Â|(206) 679-3240^PRN^PH^^^206^6793240|<hex 0D0A>
ORC|CN||||||||||||||||||||MediLabCo - Northwest Pathology Ltd., Central Campus^^45D0470381^^^CLIA|2217
Rainier Way^^Renton^WA^98002ÛSA^M^^Black Hawk^Â|^^PH^[email protected]^^206^5549097
|115 Pike Plaza^Suite 2100^Seattle^WA^98122ÛSA^^^^Â|<hex 0D0A>
OBR|||MICR9700342|654324^Throat culture^L|||200011270930||||||||THRT&Throat&HL70070|
1234567^Welby^M^J^Jr^Dr^MD|^^^^^206^4884144||||||||F<hex 0D0A>
OBX||CE|626-2^Microorganism identified, Throat Culture^LN||L-12801^Bordetella pertussis^SNM||||||F|
||200012161330|45D0470381|<hex 0D0A>
This example demonstrates an ORU message for a laboratory report of Bordetella Pertussis, sent from a
laboratory in Seattle to Washington Department of Health specifying that the pertussis microorganism was
identified from the throat culture of the patient John Q Doe Jr.
The MSH segment shows a Version 2.3.1 ORU message being sent from a laboratory in Seattle to the
WADOH application in the Washington Department of Health on February 17, 2001, at 6:30 pm. The
message control ID indicates that this is the 42nd message of the day from this laboratory.
The PID segment shows that the patient named John Q. Doe, Jr., is a white male born on October 4th,
1984. All the patient identifiers and demographic details such as address, phone number, Social Security
number, driver’s license numbers, etc., are included in this segment. The NK1 segment shows the
reported data for the patient’s mother, Jane Lee Doe as the next of kin. The mother’s contact information
such as home address and phone number is shown here. The ORC segment shows the name, address,
phone number, email address and CLIA identifier for MediLabCo. the ordering facility. The OBR segment
specifies that a report identified as MICR9700342 was processed on November 27, 2000, at 9:30 am.
The report was a throat culture requested by Dr. M.J. Welby, Jr., MD, whose phone number is (206) 488-
4144. This is the final result. The OBX segment specifies that the organism Bordetella pertussis was
identified from the throat culture. This is the final result and was observed on December 16, 2000, at 1:30
p.m.
2.4 HL7 Standard Segment Usage

Each message is composed of a series of segments. Each segment is identified by its unique three-letter
code. The segments used in electronic laboratory-based reporting (ELR) are defined below. The segment
definitions are given in the most logical order for ELR messages and do not strictly adhere to the order in
which they are presented in the HL7 Standard. However, for ease of reference, the number preceding
each segment and field name indicates its reference place in the HL7 Standard, Version 2.3.1. Because
the segments here are re-ordered, these reference numbers are not always in sequential order.
The following format is used in this document for listing and defining message segments and fields. First,
the message segment’s use is defined, and a segment attribute table listing all fields defined in the
segment is shown. In the segment attribute table, the following attributes are given for each field:
sequence number within the segment, length of field, data type, whether required (R), optional (O),
conditional (C), or for backwards compatibility (B), whether repeating (Y), the applicable table number for
values, the field item number, and the field name.
Following the table, all fields are listed and defined. For each field, the HL7 segment code and reference
number are listed, followed by the field name. Items in parentheses after the field name show respectively
data type and length of field, whether the field is required or optional, and lists "repeating" if the field is

allowed to repeat. The HL7 item number follows the parenthesis and is given for reference convenience.
As part of the definitions, usage notes for laboratory-based reporting are provided, a description of the
data type is given in small font, and a statement about how the fields are valued in the example is given.
Fields that we do not anticipate physicians using are not defined. Users interested in learning more about
fields not discussed here should refer to the full text of HL7 Final Standard Version 2.3.1 dated 11/2000.
2.5 Segment Attribute Table Abbreviations

The abbreviated terms and their definitions used in the segment table headings are as follows:
ABBREVIATION DEFINITION
SEQ The sequence of the elements as they are numbered in the segment.
HL7 LEN The maximum length of the field suggested by the HL7 2.3.1 Standard.
NBS LEN The maximum defined length of the fields based on what the NBS database will
support. This value is often larger than the suggested HL7 length.
HL7 DT The data type of the element.
HL7 OPT Whether the field is required, optional, or conditional in a segment. Required fields are
defined by HL7 2.3.1 and do not refer to requirements for reporting laboratory findings
to public health agencies. The designations are:
Required.
Optional.
Conditional on the trigger event or on some other field(s). The field definitions
following the segment attribute table should specify the algorithm that defines the
conditionality for the field.
Not Supported with this trigger event.
Left in for backward compatibility with previous versions of HL7. The field definitions
following the segment attribute table should denote the optionality of the field for prior
versions.
HL7 RP/# Indicates if element repeats. If the number of repetitions is limited, the number of
allowed repetitions is given.
HL7 TBL# Specific table reference. Tables used in public health messages are listed in
Appendix C.
HL7 ITEM# HL7 unique item number for each element.
Element Name Descriptive name of element in the segment.
ELR Usage For this implementation, describes whether this field is required or optional for the
ELR message. If it is marked “Supported”, it can be handled if it is received but the
information has not yet been sent by the Lab at all or appears very infrequently. If it is
marked “Not Supported”, it is not expected nor can it be handled by the current
WADOH system database.

3 Segment Definitions
3.1 MESSAGE CONTROL SEGMENTS
These segments are necessary to support the functionality described in the Control/Query chapter of the
HL7 standard.
3.1.1 Message Header (MSH) Segment

The MSH segment is used to define the intent, source, destination, and some specifics of the syntax of a
message. This table is updated to reflect the implementation requirements specific to ELR.
MSH Attributes
HL7 NBS HL7 HL7 HL7 HL7 HL7
SEQ ELEMENT NAME ELR Usage
LEN LEN DT R/O RP# TBL# ITEM#
1 1 N/A ST R 00001 Field separator
2 4 N/A ST R 00002 Encoding characters
3 180 163 HD O 00003 Sending application
3.1 13* IS Sending Application Name *Lab system name must be 13
characters or less as it is used
to populate
MI_Communication_function.ty
pe_cd = ‘SENDER’ plus the
sending application name as
sent in this field, i.e.
“SENDER_LABSYSTEM-LIS”
3.2 100 ST Sending Application ID
3.3 50 ID Sending Application ID Type
4 180 250 HD R 00004 Sending facility |lab name^ CLIA code^CLIA|
4.1 100 IS Sending Facility Name
4.2 100 ST Sending Facility ID
4.3 50 ID Sending Facility ID Type
5 180 250 HD R 00005 Receiving application Expecting state postal code
plus “DOH” only
5.1 100 IS Receiving Application Name
5.2 100 ST Receiving Application ID
5.3 50 ID Receiving Application ID
Type
6 180 250 HD R 00006 Receiving facility Expecting 2-character state
postal code only
6.1 100 IS Receiving Facility Name
6.2 100 ST Receiving Facility ID
6.3 50 ID Receiving Facility ID Type
7 26 26 TS R 00007 Date/Time of message Required for ELR
8 40 N/A ST O 00008 Security Not supported
9 7 20 CM R 0076 00009 Message type/ ORU^R01
0003 Trigger Event
10 20 100 ST R 00010 Message control ID Expecting timestamp plus lab-
generated sequence number
11 3 20 PT R 00011 Processing ID Generally, ‘T’ Test or ‘P’

Production
12 60 20 VID R 0104 00012 Version ID 2.3.1
13 15 N/A NM O 00013 Sequence number Not Supported
14 180 N/A ST O 00014 Continuation pointer Not Supported
15 2 N/A ID O 0155 00015 Accept acknowledgment type Not Supported
16 2 N/A ID O 0155 00016 Application acknowledgment Not Supported
type
17 2 N/A ID O 00017 Country code Not Supported
18 10 N/A ID O Y 0211 00692 Character set Not Supported
19 60 N/A CE O 00693 Principal language of Not Supported
message
20 20 N/A ID O 0356 01317 Alternate character set Not Supported
handling scheme
Example segment of MSH:

MSH|^~\&|LIS|MediLabCo-Seattle^45D0470381^CLIA|WADOH^1644^WA|WA|200102171830|
|ORU^R01|200102170042|P|2.3.1|<hex 0D0A>
This example segment shows a Version 2.3.1 ORU message being sent from a laboratory in Seattle to the
WADOH application in the Washington Department of Health on February 17, 2001, at 6:30 pm. The
message control ID indicates that this is the 42nd message of the day from this laboratory.
MSH field definitions
MSH.1 Field separator (ST-1, Required) 00001
Definition: The character to be used as the field separator for the rest of the message.
The field separator always appears in the 4th character position of MSH segment and is used to
separate adjacent data fields within a segment. The recommended value is |, ASCII (124), as
shown in our examples.
MSH.2 Encoding characters (ST-4, Required) 00002
Definition: Four characters in the following order:

Component separator ‘^’ ASCII (94)
Repetition Separator ‘~’ ASCII (126)
Escape character ‘\’ ASCII (92)
Subcomponent separator ‘&’ ASCII (38)
Note that the characters in MSH-2 appear as:
|^~\&|
The component separator (^) separates adjacent components of a data field and the subcomponent
separator (&) separates the adjacent subcomponents of a data field. An example of a compound element
using components and subcomponents from PID-2, described below in another section of this document,
would appear as:
|10543^^^^^Columbia Valley Memorial Hospital&01D0355944&CLIA|
MSH.3 Sending application (HD-180, Optional) 00003
Definition: This field uniquely identifies the sending application among all other applications within
the network enterprise. The network enterprise consists of all those applications that participate in
the exchange of HL7 messages within the enterprise. The field is entirely site-defined. By site
agreement, implementers may use User-defined table 0361 Sending/receiving application for first
component.
HD data type components: <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID)>
In the example above, this field is populated with a generic LIS (Laboratory Information System)
designation.
MSH.4 Sending facility (HD-180, Required for this implementation) 00004
Definition: The originator of HL7 message will place the text name of the sending laboratory or
reporting site, followed by the unique Clinical Laboratory Improvement Act (CLIA) identifier of the
originating institution. Information about CLIA can be found at
http://www.phppo.cdc.gov/dls/default.asp on the World Wide Web.
For example: |MediLabCo-Seattle^45D0470381^CLIA|

HD data type components: <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID>
namespace ID Text name of the sending laboratory
universal ID CLIA number for the sending laboratory
universal ID type “CLIA”, indicating that the universal ID is a
nationally assigned unique identifier
MSH.5 Receiving application (HD-180, Optional) 00005
Definition: Uniquely identifies the receiving application among all other applications within the
network enterprise. The network enterprise consists of all the applications that participate in the
exchange of HL7 messages within the enterprise. Entirely site-defined. By site agreement,
implementers may use User-defined table 0361 Sending/receiving application for first component.
For example: |WADOH^1644^WA|
MSH.6 Receiving facility (HD-180, Required for this implementation) 00006
Definition: This field identifies the receiving application among multiple identical applications
running on behalf of different organizations. This may be used identify the receiving state health
department systems. Certain public health agencies may request that a unique identifier for the
state health department or specific program appear here.
For example: |WA|
MSH.7 Date/time of message (TS-26, Required for this implementation) 00007
Definition: Date/time the sending system created the message.
Time stamp (TS) data type must be in the format:

YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][ ]
The user values the field only as far as needed. When a system has only a partial date, e.g.,
month and year, but not day, the missing values may be interpreted as zeros. The time zone is
assumed to be that of the sender.
For example: 6:30 pm, February 17, 2004, would appear as:
|200402171830|
MSH.8 Security (ST-40, Optional) 00008
Definition: This field may be used to implement application level security. Within HL7, a
workgroup is studying further specification of this field. For ELR purposes, this field is not used if
it is valued.
MSH.9 Message type (CM-7, Required) 00009
Definition: The receiving system uses this field to know the data segments to recognize and,
possibly, the application to which to route this message.
The specific components of fields using the CM data type are defined within the field descriptions.
The components for this field are: <message type (ID)>^<trigger event (ID)>^<message structure (ID)>

Refer to HL7 Table 0076 - Message type, HL7 Table 0003 - Event type, and HL7 Table 0354 - Message
structure for values.
The unsolicited transmission of an observation message would appear as:
|ORU^R01|
MSH.10 Message control ID (ST-20, Required) 00010
Definition: Number or other identifier that uniquely identifies the message. The receiving system
echoes this ID back to the sending system in the message acknowledgment. For electronic
laboratory reporting, we recommend using a timestamp and counter as: YYYYLLDDHHMMSS.
The example below shows that the date of this message is February 17, 2001 and the sequence number
is 0042.
|200102170042|
MSH.11 Processing ID (PT-3, Required) 00011
Definition: Used to decide how to process the message as defined in HL7 processing rules.
Field appears as P for production, T for training, or D for debugging.
PT data type components: <processing ID (ID)>^<processing mode (ID)>
(1) Processing ID (ID). A value that defines whether the message is part of a production, training or
debugging system. Refer to HL7 Table 0103-Processing ID for valid values.
(2) Processing mode (ID). A value that defines whether the message is part of an archival process or an
initial load. Refer to HL7 Table 0207-Processing mode for valid values. The default (blank) means current
processing.
For Example: |P|
In our example, the use is production. The second component is not specified, indicating current
processing as the default.
MSH.12 Version ID (VID-60, Required) 00012
Definition: Matched by the receiving system to its own HL7 version to be sure the message will be
interpreted correctly.
VID data type components: <version ID (ID)>^<internationalization code (CE)>^<international version ID

(CE)>
(1) Version ID (ID). Used to identify the HL7 version. Refer to HL7 Table 0104 - Version ID for valid
values
(2) Internationalization code (CE). Used to identify the international affiliate country code. ISO 3166
provides a list of country codes that may be used (see User-defined Table 0212 - Nationality).
(3) International version ID (CE). Used when the international affiliate has more than a single local version
associated with a single U.S. version.
In these messages, the HL7 version is 2.3.1.
MSH.13 Sequence number (NM-15, Optional) 00013
Definition: Non-null value in this field implies that the sequence number protocol is in use. This
numeric field is incremented by one for each subsequent value.

In this interface, this field is Not Supported.
MSH.14 Continuation pointer (ST-180, Optional) 00014
Definition: Used to define continuations in application-specific ways.
MSH.15 Accept acknowledgment type (ID-2, Not supported) 00015
Definition: Identifies the conditions under which accept acknowledgments are required to be
returned in response to this message. HL7 Table 0155 - Accept/Application acknowledgment
conditions gives valid values.
MSH.16 Application acknowledgment type (ID-2, Optional) 00016
Definition: Identifies the conditions under which application acknowledgments are required to be
returned in response to this message. See HL7 Table 0155 - Accept/Application
acknowledgment conditions for values.
In this interface, this field is Not Supported. Rather than using application-level acknowledgement, the
acknowledgments are at the transport layer of the Public Health Information Network Messaging System.
MSH.17 Country Code (ID-2, Optional) 00017
Definition: This field contains the country of origin for the message. It will be used primarily to
specify default elements, such as currency denominations. The values to be used are those of
ISO 3166,.1. The ISO 3166 table has three separate forms of the country code: HL7 specifies that
the 3-character (alphabetic) form be used for the country code.
MSH.18 Character Set (ID-10, Optional) 00692
Definition: This field contains the character set for the entire message. Refer to HL7 Table 0211 -
Alternate character sets for valid values.
In this interface, this field is not supported.
MSH.19 Principal language of message (CE-60, Not supported) 00693
Definition: This field contains the principal language of the message. Codes come from ISO 639.
MSH.20 Alternate character set handling scheme (ID-20, Not supported) 01317
Definition: When any alternative character sets are used (as specified in the second or later
iterations of MSH-18 character sets), and if any special handling scheme is needed, this component
is to specify the scheme used, according to HL7 Table 0356- Alternate character set handling
scheme.
1 Available from ISO 1 Rue de Varembe, Case Postale 56, CH 1211, Geneve, Switzerland

3.2 PATIENT ADMINISTRATION MESSAGE SEGMENTS

3.2.1 Patient Identification (PID) Segment
Used by all applications as the primary means of communicating patient identification information.
This segment contains patient identifying and demographic information that, for the most part, is not likely
to change frequently. For ELR, only one PID segment is expected per message.
PID Attributes
HL7 NBS HL7 HL7 HL7 HL7
SEQ HL7 DT ELEMENT NAME ELR Usage
LEN LEN R/O RP# TBL# ITEM#
1 4 N/A SI O 00104 Set ID - PID Set to ‘1’
2 20 270 CX B 00105 Patient ID (External) See PID-3 – may be sent
here as backward
compatible but will have the
same format and field
lengths
3 20 270 CX R Y 00106 Patient identifier list DOCUMENT VARIANCE
3.1 100 Patient ID
3.2 N/A Check Digit
3.3 N/A Check Scheme
3.4 N/A Assigning Authority
3.4.1 N/A Assigning Authority Name
3.4.2 N/A Assigning Authority ID
3.4.3 N/A Assigning Authority ID Type
3.5 N/A ID Type Code
3.6 Assigning Facility
3.6.1 100 Assigning Facility Name
3.6.2 20 Assigning Facility ID
3.6.3 50 Assigning Facility ID Type Code
4 20 270 CX B Y 00107 Alternate patient ID - PID See PID-3 – may be sent
here as backward
compatible but will have the
same format and field
lengths
5 48 230 XPN R Y 00108 Patient name Supported
5.1 50 Patient Last Name DOCUMENT VARIANCE
5.2 50 Patient First Name may be 250
5.3 50 Patient Middle Initial/Middle
Name
5.4 20 Patient Name Suffix
5.5 20 Patient Name Prefix
5.6 20 Patient Degree
5.7 20 Name Type Code
5.8 N/A Name Representation Code
6 48 50 XPN O Y 00109 Mother's maiden name Supported, but not as an
extended person name –
entire name is mapped as
an atribute on the
MI_Person table
7 26 26 TS O 00110 Date/time of birth Date of birth used
8 1 1 IS O 0001 00111 Sex Supported
9 48 230 XPN O Y 00112 Patient alias Supported – format same as
Patient Name
10 80 20 CE O Y 0005 00113 Race
10.1 10 Race category code Supported – ELR values
map to OMB Race Category
codes in NBS
10.2 100 Race description text
10.3 N/A Coding System Assumed to be HL7
11 106 550 XAD O Y 00114 Patient address Supported. County rarely if
ever sent with ELR.
11.1 100 Patient Street Address
11.2 100 Patient Address Line 2
11.3 100 City
11.4 20 State
11.5 10 ZIP/Postal Code

HL7 NBS HL7 HL7 HL7 HL7

SEQ HL7 DT ELEMENT NAME ELR Usage
LEN LEN R/O RP# TBL# ITEM#
11.6 100 Country (Description)
11.7 20 Address Type
11.8 N/A Other geog. Designation
11.9 100 County
11.10 N/A Census tract
12 4 N/A IS B 0289 00115 County code Not supported from this
field– see PID-11
13 40 230 XTN O Y 00116 Phone number - home supported in the XTN format
(not in the first field)
13.1 N/A Home Phone Number Formatted phone number in
this field is not accepted
13.2 20 Telecom use code
13.3 50 Telecom equipment type
13.4 100 Email Address
13.5 N/A Country Code
13.6 3 Area Code Expecting 3 digit area code
here
13.7 17 Phone Number Expecting unformatted
phone number here
13.8 20 Extension
13.9 20 Any Text
14 40 230 XTN O Y 00117 Phone number - business supported in the XTN format
(not in the first field)
15 60 N/A CE O 0296 00118 Primary language Not Supported
16 80 120 CE O 0002 00119 Marital status Supported
16.1 20 Identifier Expecting code value only
16.2 100 Text Will map description if
received
16.3 N/A Name of coding system Assumed to be HL7
16.4 N/A Alternate Identifier Not Supported
16.5 N/A Alternate Text Not Supported
16.6 N/A Alternate Name of coding Not Supported
system
17 80 N/A CE O 0006 00120 Religion Not Supported
18 20 CX O 00121 Patient account number see PID-3
19 16 ST B 00122 SSN number - patient see PID-3
20 25 DLN O 00123 Driver's license number - see PID-3
patient
21 20 CX O N 00124 Mother's identifier Supported
22 80 CE O Y 0189 00125 Ethnic group Requested if available
22.1 20 Identifier Expecting code value H/N/U
only
22.2 100 Text Will map description if
received
system
23 60 ST O 00126 Birth place Mapped as Country of Birth
if sent
24 1 1 ID O 0136 00127 Multiple birth indicator Supported
25 2 2 NM O 00128 Birth order Supported
26 80 N/A CE O Y 0171 00129 Citizenship Not Supported
27 60 N/A CE O 0172 00130 Veterans military status Not Supported
28 80 N/A CE O 0212 00739 Nationality Not Supported
29 26 26 TS O 00740 Patient death date and time Supported
30 1 1 ID O 0136 00741 Patient death indicator Supported
Example:
PID|||10543^^^^PI^Columbia Valley Memorial

Hospital&01D0355944&CLIA~95101100001^^^^PT^MediLabCo-
Seattle&45D0470381&CLIA~423523049^^^^SS^SSA||Doe^John^Q^Jr^^^L|Clemmons^^^^^^M|19841004|

M||W|2166 Wells DrÂpt B^Seattle^WA^98109||^^^^^206^6793240^^call after 5:00 pm only ~

^^^^^206^6795772|||S^single^HL70002||||DOE J34556057^WA^20011101||N|||||||| <hex 0D0A>
This example segment shows that the patient named John Q. Doe, Jr., is a white male born on October
4th, 1984. All the patient identifiers and demographic details such as address, phone number, Social
Security number, driver’s license numbers, etc., are included in this segment. Please note that the Social
Security Number is sent in the PID-3 segment as the third identifier, as designated by the second tilde (~).
PID field definitions
Usage Notes: We do not anticipate that several PID fields (PID-23 to 28) will be used for
electronic laboratory reporting purposes; but the definitions are provided below.
PID.1 Set ID - PID (SI-4, Optional) 00104
Definition: The Set ID field numbers the repetitions of the PID segment (i.e., multiple patient
reports). For the first occurrence of the segment, the sequence number shall be one, for the
second occurrence, the sequence number shall be two, etc.
SI data type is a non-negative integer in the form of an NM field. The uses of this data type are defined in
the chapters defining the segments and messages in which it is used.
For laboratory-based reporting, it is strongly recommended that information for only one patient be sent
per message, in other words one PID per MSH. Thus PID-1 may be left blank or appear as:
|1|
PID.2 Patient ID (CX-20, Conditional) 00105
Definition: This field has been retained for backward compatibility only. With HL7 Version
2.3.1, the arbitrary term of “external ID” has been removed from the name of this field. The
repetition, assigning authority, facility, and identifier type code attributes of PID-3-patient identifier
list allow for distinctive identifier representation.
In our examples, we have not valued this field.
PID.3 Patient identifier list (CX-20, Required, Repeating) 00106
Definition: This field contains the list of identifiers (one or more) used by the facility to uniquely
identify a patient (e.g., medical record number, billing number, birth registry, etc.)
Components are defined as follows:

(1) ID number (ST).
(2) Check digit (ST). Defined as in the CK data type except as a ST. The check digit is part of the
identifying number used in the sending application. If the sending application does not include a
self-generated check digit in the identifying number, this component should be valued null.
(3) Code identifying check digit scheme employed (ID). Refer to HL7 Table 0061 - Check digit
scheme for valid values.
(4) Assigning authority (HD).
Subcomponents of (4): <namespace ID (IS)> & <universal ID (ST)> & <universal ID type (ID
(5) Identifier type code (IS). A code corresponding to the type of identifier. This code may be used as
a qualifier to the ‘Assigning authority’ component. Refer to User-defined Table 0203 - Identifier
type for suggested values.
(6) Assigning facility (HD). The place or location identifier where the identifier was first assigned to
the patient-part of the history of the identifier.
Subcomponents of (6): <namespace ID (IS)>&<universal ID (ST)>&<universal ID type (ID)>

HL7 Version 2.3 provided a field to record the patient’s Social Security number in PID-19 - SSN - patient.
With Version 2.3.1, HL7 recommends using PID-3-patient identifier list for all patient identifiers along with
the appropriate identifier type code (User-defined Table 0203 - Identifier type).
Laboratory-based reporting will use this field for the patient identifiers. For example, an isolate from the
Columbia Valley Memorial Hospital laboratory is sent to a reference laboratory named MediLabCo, and the
result is reported to public health officials by MedilabCo. In the laboratory reporting scenario described,
the unique patient identifier from MediLabCo would always appear first with the typecode “PI”, along with
name and CLIA number for MediLabCo as the assigning authority. Repetitions of the field allow a
reporting laboratory also to provide the medical record number and other patient identifiers assigned at the
original institution that submitted a specimen for testing (i.e., Columbia Valley Memorial Hospital). The
type code for the Columbia Valley Hospital identifier will be PT for Patient external identifier.
For example:
|95101100001^^^^PI^MediLabCo-Seattle&45D0470381&CLIA ~ 10543^^^^PT^Columbia Valley Memorial
Hospital&01D0355944&CLIA|
Since HL7 allows users to define the subcomponents of the HD data type, the <assigning facility> has the
following definition for the laboratory-based reporting message:
namespace ID Name of originating laboratory

universal ID Unique CLIA number of originating laboratory
universal ID type “CLIA”
If a hospital laboratory will be reporting the result (and thus there will be only one hospital involved in
collection and processing of the specimen), then the hospital laboratory’s patient identifier and the hospital
CLIA ID will appear with typecode PI; no information will appear as an external ID. Likewise, if a reference
laboratory receives a specimen from a doctor’s office and no preceding originating laboratory is used, then
the reference laboratory’s patient identifier and reference laboratory CLIA ID will appear with the typecode
PI; no information will appear as an external ID.
If a hospital laboratory is reporting the results of a test performed at a reference laboratory, the following
scenario would apply. Columbia Valley Memorial Hospital has sent a specimen to MediLabCo for testing.
The test is performed and the results are sent back to Columbia Valley Memorial Hospital, which then
electronically transmits the results to a public health agency. The unique patient identifier from Columbia
Valley Memorial Hospital would appear with typecode PI, internal patient ID, and the unique patient
identifier from MediLabCo would appear next after the repeat delimiter with typecode PT, external patient
ID. Identification of the outside laboratory performing the test will appear in OBX-15 (i.e., Producer’s ID).
As an example, if Columbia Valley Memorial Hospital is reporting the results of a test performed at
MediLabCo, then the identifiers would appear as:
|10543^^^^PI^Columbia Valley Memorial Hospital&01D0355944&CLIA ~

95101100001^^^^PT^MediLabCo-Seattle&45D0470381&CLIA|
This field is listed as a required field by HL7 2.3.1. Although uncommon, some laboratories may not
currently collect information which may be used for either PID-3 or PID-5. It is strongly recommended that
either a personal identifier unique to the testing laboratory (PID-3) or the patient name (PID-5) be
provided; however, if neither is available the message for reporting should still be sent with the
following populating the field:
|nodata|
Anonymous Identifiers
Anonymous identifiers are occasionally used for protecting patient identity in reporting certain results. For
instance, a state health department may choose to use a scheme for generating an anonymous identifier
for reporting a patient that has had a positive human immunodeficiency virus antibody test. That scheme
may use various contributing data for generating the identifier, such as parts of the Social Security number,

date of birth, and other features. Anonymous identifiers can be used in PID-2, 3, and 4 by replacing the
medical record number or other non-anonymous identifier. The type code for an anonymous identifier will
appear as ANON. It is important that the receiver of the data be able to determine that the identifier is in
fact created through some anonymizing scheme. This is done by placing the creator of the scheme in the
sub-component for the "Assigning Authority". For example, a laboratory using a scheme regulated by the
Arizona state health department for reporting HIV results creates an anonymous identifier. The message
would appear as:
|56850125M7^^^ÂNONÂZDOH_HIV|
Note: There is no standard scheme for generating anonymous identifiers and there is no current list of
assigning facilities that generate anonymizing schemes.
PID.4 Alternate Patient ID (CX-20, Backward Compatibility, Not expecting repeats) 00107
Definition: This field has been retained for backward compatibility only. PID-3-patient
identifier list should be used for all patient identifiers.
In our examples, we valued this field in PID-3. This interface is not expecting repeats of APN id type
PID.5 Patient name (XPN-48, Required, Not expecting repeats) 00108
Definition: The current, assumed legal name of the patient should be sent in this field. The name
type code in this field should always be "L - Legal." All other names for the patient should be sent
in PID-9-patient alias. Repetition of this field is allowed only for representing the same name in
different character sets, a situation that will rarely arise. Therefore, for practical purposes this field
should be considered not repeating.
For valid values, refer to User-defined Table 0360 - Degree for the degree component, to HL7 Table 0200 -
Name type for the name type code, and to HL7 Table 4000 - Name/address representation for the name
representation code.
For example:
|Doe^John^Q^Jr^^^L|
This field is listed as a required field by HL7 2.3.1. Although uncommon, some laboratories may not
currently collect information which may be used for either PID-3 or PID-5. It is strongly recommended that
either a personal identifier unique to the testing laboratory (PID-3) or the patient name (PID-5) be
provided; however, if neither is available the message for reporting should still be sent with the
following populating the field:
|nodata|
PID.6 Mother's maiden name (XPN-48, Optional) 00109
Definition: This field contains the family name under which the mother was born (i.e., before
marriage). It is used to distinguish between patients with the same last name. The name type
code should be valued "M" for "Maiden Name." If a system needs additional information about the
mother, the NK1 segment should be used.
For example: |Clemmons^^^^^^M|
PID.7 Date/time of birth (TS-26, Optional) 00110
Definition: This field contains the patient's date and time of birth.
Time stamp (TS) data type must be in the format:

YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][ ]

The user values the field only as far as needed. When a system has only a partial date, e.g.,
month and year, but not day, the missing values may be interpreted as zeros. The time zone is
assumed to be that of the sender.
For example: October 04, 1984 would appear as:
|19841004|
If DOB is not available, patient’s age may be sent in OBX-3 & OBX-5. See description in section
OBX.3.3.3 of this document.
PID.8 Sex (IS-1, Optional) 00111
Definition: This field contains the patient's sex. Refer to User-defined Table 0001 - Sex for valid
values.
PID.9 Patient alias (XPN-48, Optional, Repeating) 00112
Definition: This field contains names by which the patient has been known at some time.
It is recommended that data be sent if available. The name type code recommended is ‘A’ per
HL7 Standard.
PID.10 Race (CE-80, Optional, Repeating) 00113
Definition: This field identifies the patient's race. Refer to User-defined Table 0005 - Race for
suggested values.
PID.11 Patient address (XAD-106, Optional, Not expected to repeat for this interface) 00114
Definition: This field lists the mailing address of the patient. Multiple addresses for the same
person may be sent in the following sequence: the primary mailing address must be sent first in
the sequence; if the mailing address is not sent, then a repeat delimiter must be sent in the first
sequence.
For valid values in these components, refer to User-defined Table 0212 - Nationality for country codes,
HL7 Table 0190 - Address type for address type codes, User-defined Table 0289 - County/parish for
county/parish codes, User-defined Table 0288 - Census Tract for census tract codes, and HL7 Table 4000
- Name/address representation for address representation codes.
For example: |2166Wells DrÂpt B^Seattle^WA^98109ÛSA^M^^King^Â|
This information is of great importance to public health agencies as it allows health officials to notify local
agencies of potential public health problems in their jurisdictions.
PID.12 County Code (IS-4, Not expected for this interface) 00115
Definition: This field has been retained for backward compatibility. This field contains the
patient’s county code. The county can now be supported in the county/parish code component of
the XAD data type (PID-11-patient address).
In our examples, we have not valued this field. It is sent as part of the extended address datatype in PID-
11 Patient Address.
PID.13 Phone number - home (XTN-40, Optional, Not expecting repeats) 00116

Definition: The patient's personal phone numbers. Repetitions are permitted with the standard but
this interface expects only one home phone number.
Refer to HL7 Table 0201 - Telecommunication use code and HL7 Table 0202 - Telecommunication
equipment type for valid values.
For example:
|^^^^^206^6795772|
PID.14 Phone number - business (XTN-40, Optional, Not expecting repeats) 00117
Definition: Patient's business phone number. Repetitions are permitted with the standard but this
interface expects only one business number. It is not always collected to send in Laboratory
Information Systems.
PID.15 Primary language (CE-60, Optional) 00118
Definition: Patient's primary language. Refer to User-defined Table 0296 - Language (ISO 639) for
suggested values.
In our examples, we have not valued this field as the laboratory results do not contain this element.
PID.16 Marital status (CE-80, Optional) 00119
Definition: This field contains the patient’s marital status. Refer to user-defined table 0002 -
Marital status for suggested values.
For example: |S^single^HL70002|
The laboratory results generally do not contain this element, but it will process to the database if sent.
PID.17 Religion (CE-80, Optional) 00120
Definition: This field contains the patient’s religion, for example, Baptist, Catholic, Methodist, etc.
User-defined table 0006 - Religion from HL7 standard Version 2.3 is used as the HL7 identifier for
the user-defined table of values for this field.
In our examples, we have not valued this field. If it is sent by a lab, the field will be skipped by the
interface processor.
PID.18 Patient account number (CX-20, Optional) 00121
Definition: This field contains the patient account number assigned by accounting to which all
charges, payments, etc., are recorded. It is used to identify the patient’s account. If an account
number is sent, the entire number including the check digit will be considered the patient account
number and no edits occur on the field. The identifier type code for account numbers is “AN”.
PID.19 Social Security Number - Patient (ST-60, Backward Compatible but Optional) 00122
Definition: This field has been retained for backward compatibility only. It is recommended to
use PID-3-patient identifier list for all patient identifiers. However, in order to maintain backward
compatibility, this field may also be populated. When used for backward compatibility, this field
contains the patient’s Social Security number. This number may also be a RR retirement number.

For example: |423523049| is acceptable in PID-19; if sent in PID-3, should appear as

|423523049^^^SS^SSA&Social Security Administration|.
PID.20 Driver's license number – patient (DLN-25, Optional) 00123
Definition: This field contains the patient’s driver’s license number. The default of the second
component is the state in which the patient’s license is registered.
DLN data type components: <license number (ST)> ^ <issuing state, province, country (IS)> ^ <expiration
date (DT)>
For example: |DOEJ34556057^WA^20051101|
This field does not move to PID-3, as the datatype does not conform to the CX datatype.
PID.21 Mother's identifier (CX-20, Optional, No expecting repeats) 00124

Definition: This field is used as a link field for newborns, for example. Typically a patient
ID or account number may be used. This field can contain multiple identifiers for the same
mother.
PID.22 Ethnic group (CE-80, Optional, Not expecting repeats as the field as we use it is mutually
exclusive) 00125
Definition: This field further defines patient ancestry.
PID.23 Birth place (ST-60,Optional) 00126

Definition: This field indicates the patient’s birth country only. The actual address is reported in
PID.11 with an identifier of "N".
If the result message has this field populated, the birth country field will be stored.
PID.24 Multiple birth indicator (ID-1, Optional) 00127

Definition: This field indicates whether the patient was part of a multiple birth. Refer to HL7 Table
0136 - Yes/No Indicator for valid values.
If the result message has this field populated, the multiple birth indicator field will be stored.
PID.25 Birth order (NM-2, Optional) 00128

Definition: When a patient was part of a multiple birth, a value (number) indicating the patient’s
birth order is entered in this field.
If the result message has this field populated, the birth order numeral will be stored.
PID.26 Citizenship (CE-80, Optional) 00129

Definition: This field contains the patient’s country of citizenship. HL7 recommends using ISO
table 3166 as the suggested values in User-defined Table 0171 - Citizenship.
Not valued for this interface.
PID.27 Veterans military status (CE-60, Optional) 00130

Definition: This field contains the military status assigned to a veteran. Refer to User-defined
Table 0172 - Veterans military status for suggested values.
PID.28 Nationality (CE-80, Optional) 00739

Definition: It is recommended to refer to PID-10 - Race, PID-22 - Ethnic group and PID-26 -
Citizenship. This field contains a code that identifies the nation or national grouping to which the
person belongs. This information may be different from a person’s citizenship in countries in
which multiple nationalities are recognized (for example, Spain: Basque, Catalan, etc.).
PID.29 Patient death date and time (TS-26, Optional) 00740
Definition: This field contains the date and time at which the patient death occurred. This field
should only be valued if PID-30 is valued ‘yes.’
If the result message has this field populated, the patient date date/time will be stored.
PID.30 Patient death indicator (ID-1, Optional) 00741
Definition: This field indicates whether or not the patient is deceased. Refer to HL7 Table 0136 -
Yes/No indicator for valid values.
If the result message has this field populated, the patient death indicator will be stored.
.

3.2.2 Next of Kin/Associated Parties (NK1) Segment

Contains information about the patient's next of kin, emergency contact, or other associated or
related parties. At this time, only one NK1 is supported; additional NK1 segments will be skipped. The
NK1 is an optional segment.
NK1 Attributes
1 4 SI R 00190 Set ID - NK1 NK1 is created regardless of
whether any Contact info was
present.
2 48 230 XPN O Y 00191 Next of Kin/Emergency Supported
Contact Name
2.1 50 Next of Kin Last Name
2.2 50 Next of Kin First Name
2.3 50 Next of Kin Middle
Initial/Middle Name
2.4 20 Next of Kin Name Suffix
2.5 20 Next of Kin Name Prefix
2.6 20 Next of Kin Degree
2.7 20 Name Type Code “L” for legal is defaulted
2.8 N/A Name Representation
Code
3 60 CE O 0063 00192 Relationship These come from HL7 table
0063. If no relationship is
available to pass here, the
generic relationship ‘NOK’ is
mapped.
3.1 20 Identifier Expecting code value H/N/U only
3.2 100 Text Will map description if received
system
4 106 XAD O Y 00193 Address Supported
4.1 100 NOK/EC Street Address
4.2 100 NOK/EC Address Line 2
4.3 100 NOK/EC City
4.4 20 NOK/EC State
4.5 10 NOK/EC ZIP/Postal Code
4.7 20 Address Type
4.9 100 County
5 40 230 XTN O Y 00194 Phone number Supported
5.1 N/A Home Phone Number Formatted phone number in this
field is not accepted
5.6 3 Area Code Expecting 3 digit area code here
5.7 17 Phone Number Expecting unformatted phone
number here
5.8 20 Extension
5.9 20 Any Text
6 40 N/A XTN O Y 00195 Business phone number NK1-6 through end of segment
are not supported
7 60 N/A CE O 0131 00196 Contact role Not Supported
8 8 N/A DT O 00197 Start date Not Supported
9 8 N/A DT O 00198 End date Not Supported
10 60 N/A ST O 00199 Next of kin/AP job title Not Supported
11 20 N/A JCC O 0327/ 00200 Next of kin/AP job Not Supported
0328 code/class


12 20 N/A CX O 00201 Next of kin/AP employee Not Supported
number
13 90 N/A XON O Y 00202 Organization name - NK1 Not Supported
14 80 N/A CE O 0002 00119 Marital status Not Supported
15 1 N/A IS O 0001 00111 Sex Not Supported
16 26 N/A TS O 00110 Date/time of birth Not Supported
17 2 N/A IS O Y 0223 00755 Living dependency Not Supported
18 2 N/A IS O Y 0009 00145 Ambulatory status Not Supported
19 80 N/A CE O Y 0171 00129 Citizenship Not Supported
20 60 N/A CE O 0296 00118 Primary language Not Supported
21 2 N/A IS O 0220 00742 Living arrangement Not Supported
22 80 N/A CE O 0215 00743 Publicity code Not Supported
23 1 N/A ID O 0136 00744 Protection indicator Not Supported
24 2 N/A IS O 0231 00745 Student indicator Not Supported
25 80 N/A CE O 0006 00120 Religion Not Supported
26 48 N/A XPN O Y 00746 Mother's maiden name Not Supported
27 80 N/A CE O 0212 00739 Nationality Not Supported
28 80 N/A CE O Y 0189 00125 Ethnic group Not Supported
29 80 N/A CE O Y 0222 00747 Contact reason Not Supported
30 48 N/A XPN O Y 00748 Contact person's name Not Supported
31 40 N/A XTN O Y 00749 Contact person's Not Supported
telephone number
32 106 N/A XAD O Y 00750 Contact person's address Not Supported
33 32 N/A CX O Y 00751 Next of kin/AP's Not Supported
identifiers
34 2 N/A IS O 0311 00752 Job status Not Supported
35 80 N/A CE O Y 0005 00113 Race Not Supported
36 2 N/A IS O 0295 00753 Handicap Not Supported
37 16 N/A ST O 00754 Contact person SSN Not Supported
Example:
NK1|1|Doe^Jane^Lee^^^^L|MTH^mother^HL70063|2166 Wells DrÂpt
B^Seattle^WA^98109ÛSA^M^^King^Â|^^^^^206^ 6793240|<hex 0D0A>
This example segment shows the reported data for the patient’s mother, Jane Lee Doe, as the next of kin.
The mother’s contact information such as home address and phone number is shown here.
NK1 field definitions
The NK1 segment provides standard fields for those described as ZLR fields 6-9 in the previous guidelines
using Version 2.3.z, entitled, “Health Level Seven Specifications for Electronic Laboratory-Based
Reporting of Public Health Information,” February 28, 2003.
NK1.1 Set ID (SI-4, Required) 00190
Definition: The Set ID field numbers the repetitions of the segment within its association with the
PID- For the first occurrence of the segment, the sequence number shall be one, for the second
occurrence, the sequence number shall be two, etc.
The SI data type is a non-negative integer. The uses of this data type are defined in the chapters defining
the segments and messages in which it is used.
1 indicates that this segment is the first set of next of kin data, and 2 indicate that this is the second set of
next of kin data.
NK1.2 Name (XPN-48, Optional, Not expecting Repeats) 00191
Definition: This field gives the name of the next of kin or associated party. Multiple names for the
same person are allowed, but the legal name must be sent in the first sequence. If the legal name
is not sent, then the repeat delimiter must be sent in the first sequence.

For example: |Doe^Jane^Lee^^^^L|
NK1.3 Relationship (CE-60, Optional) 00192
Definition: This field defines the personal relationship of the next of kin. User-defined Table 0063 -
Relationship gives suggested values from HL7.
For example: |MTH^mother^HL70063|
NK1.4 Address (XAD-106, Optional, Not expecting Repeats) 00193
Definition: This field lists the mailing address of the next of kin/associated party identified above.
Multiple addresses for the same person may be sent in the following sequence: the primary
mailing address must be sent first in the sequence; if the mailing address is not sent, then a
repeat delimiter must be sent in the first sequence. If there is only one repetition of this field and
an address type is not given, it is assumed to be the primary mailing address.
For example: |2166 Wells DrÂpt B^Seattle^WA^98109|
When sending multiple addresses, the appropriate type code must be indicated.
NK1.5 Phone number (XTN-40, Optional, Not expecting Repeats) 00194
Definition: The next of kin/associated party's personal phone numbers. All personal phone
numbers for the next of kin/associated party are sent in this sequence. The first sequence is
considered the primary number. If the primary number is not sent, then a repeat delimiter is sent
in the first sequence.
XTN data type format and components: [NNN] [(999)]999-9999[X99999][B99999][C any

text]^<telecommunication use code (ID)>^<telecommunication equipment type (ID)>^<email address
(ST)>^<country code (NM)>^<area/city code (NM)>^<phone number (NM)>^<extension (NM)>^<any text
(ST)>
For example: |^^^^^206^6793240|
NK1.6 Business phone number (XTN-40, Optional, Not expecting Repeats) 00195
Definition: Next of kin/associated party's business phone numbers. The first sequence is the
primary number. If the primary number is not sent, then a repeat delimiter is sent in the first
sequence.
NK1.7 Contact role (CE-60, Optional) 00196

Definition: This field indicates the specific relationship role (next of kin, employer, emergency
contact, etc.). Refer to User-defined Table 0131 - Contact role for suggested values. This field
specifies the role that the next of kin/associated parties plays with regard to the patient. Examples
might include an employer, emergency contact, next of kin, insurance company, state agency,
federal agency, etc.
NK1.8 Start date (DT-8, Optional) 00197

Definition: This field contains the start date of the contact role.
NK1.9 End date (DT-8, Optional) 00198

Definition: This field contains the end date of the contact role.
NK1.10 Next of kin / associated parties job title (ST-60, Optional) 00199
Definition: This field contains the title of the next of kin/associated parties at their place of
employment. However, if the contact role is the patient’s employer, this field contains the title of
the patient at their place of employment.
NK1.11 Next of kin / associated parties job code/class (JCC-20, Optional) 00200
Definition: This field contains the employer’s job code and the employee classification used for
the next of kin/associated parties at their place of employment. However, if the contact role is the
patient’s employer, this field contains the job code/class of the patient at their place of
employment. Refer to User-defined Table 0327 - Job code and User-defined Table 0328 -
Employee classification for suggested values.
Components: <job code (IS)> ^ <employee classification (IS)>

NK1.12 Next of kin / associated parties employee number (CX-20, Optional) 00201
Definition: For backward compatibility, the ST data type can be sent; however HL7 recommends
that the CX data type be used for new implementations. This field contains the number that the
employer assigns to the employee that is acting as next of kin/associated parties. However, if the
contact role is the patient’s employer, this field contains the employee number of the patient at
their place of employment. The assigning authority and identifier type code are strongly
recommended for all CX data types.
Components: <ID (ST)> ^ <check digit (ST)> ^ <code identifying the check digit scheme employed
NK1.13 Organization name - NK1 (XON-90, Optional) 00202

Definition: This field contains the name of the organization that serves as a next of kin/associated
party or as the next of kin of the patient. This field may also be used to communicate the name of
the organization at which the associated party works. Multiple names for the same organization
may be sent. If multiple names are sent, the legal name must be sent in the first sequence. If the
legal name is not sent, then a repeat delimiter must be sent in the first sequence.
NK1.14 Marital status (CE-80, Optional) 00119

Definition: This field contains the next of kin/associated party’s marital status. Refer to User-
defined Table 0002 - Marital status for suggested values.

NK1.15 Administrative sex (IS-1, Optional) 00111

Definition: This field contains the next of kin/associated party’s sex. Refer to User-defined Table
0001 - Administrative sex for suggested values.
NK1.16 Date/time of birth (TS-26, Optional) 00110

Definition: This field contains the next of kin/associated party’s birth date and time.
NK1.17 Living dependency (IS-2, Optional) 00755

Definition: This field identifies specific living conditions (e.g., spouse dependent on patient, walk-
up) that are relevant to an evaluation of the patient’s healthcare needs. This information can be
used for discharge planning. Examples might include Spouse Dependent, Medical Supervision
Required, and Small Children Dependent. This field repeats because, for example, "spouse
dependent" and "medical supervision required" can apply at the same time. Refer to User-defined
Table 0223 - Living dependency for suggested values.
NK1.18 Ambulatory status (IS-2, Optional) 00145

Definition: This field identifies the transient rate of mobility for the next of kin/associated party.
Refer to User-defined Table 0009 - Ambulatory status for suggested values.
NK1.19 Citizenship (CE-80, Optional) 00129

Definition: This field contains the code to identify the next of kin/associated party’s citizenship.
HL7 recommends using ISO 3166 as the suggested values in User-defined Table 0171 -
Citizenship.
NK1.20 Primary language (CE-60, Optional) 00118

Definition: This field identifies the next of kin/associated party’s primary speaking language. HL7
recommends using ISO 639 as the suggested values in User-defined Table 0296 - Language.
NK1.21 Living arrangement (IS-2, Optional) 00742

Definition: This field identifies the situation that the associated party lives in at his/her residential
address. Refer to User-defined Table 0220 - Living arrangement for suggested values. Examples
of living arrangements might include Alone, Family, Institution, etc.
NK1.22 Publicity code (CE-80, Optional) 00743

Definition: This field indicates what level of publicity is allowed (e.g., No Publicity, Family Only) for
the next of kin/associated party. Refer to User-defined Table 0215 - Publicity code for suggested
values.

NK1.23 Protection indicator (ID-1, Optional) 00744

Definition: This field identifies that next of kin/associated party’s protection that determines, in
turn, whether access to information about this person should be kept from users who do not have
adequate authority. Refer to HL7 Table 0136 - Yes/no indicator for valid values.
NK1.24 Student indicator (IS-2, Optional) 00745

Definition: This field identifies whether the next of kin/associated party is currently a student or
not, and whether the next of kin/associated party is a full- or a part-time student. This field does
not indicate the degree (high school, college) of the student or the field of study. Refer to User-
defined Table 0231 - Student status for suggested values.
NK1.25 Religion (CE-80, Optional) 00120

Definition: This field indicates the type of religion practiced by the next of kin/associated party.
Refer to User-defined Table 0006 - Religion for suggested values.
NK1.26 Mother’s maiden name (XPN-48, Optional) 00109

Definition: This field indicates the maiden name of the next of kin/associated party’s mother.
NK1.27 Nationality (CE-80, Optional) 00739

Definition: This field identifies the nation or national group to which the next of kin/associated
party belongs. This information may be different than the person’s citizenship in countries in
which multiple nationalities are recognized (e.g., Spain: Basque, Catalan, etc.). Refer to User-
defined Table 0212 - Nationality for suggested values.
NK1.28 Ethnic group (CE-80, Optional) 00125

Definition: This field contains the next of kin/associated party’s ethnic group. Refer to User-
defined Table 0189 - Ethnic group for suggested values. The second triplet of the CE data type
for ethnic group (alternate identifier, alternate text, and name of alternate coding system) is
reserved for governmentally assigned codes. In the US, a current use is to report ethnicity in line
with US federal standards for Hispanic origin.
NK1.29 Contact reason (CE-80, Optional) 00747

Definition: This field identifies how the contact should be used (e.g., contact employer if patient is
unable to work). Refer to User-defined Table 0222 - Contact reason for suggested values.

NK1.30 Contact person’s name (XPN-48, Optional) 00748

Definition: This field contains the names of the people to contact, depending on the value of the
relationship defined in NK1-3 - relationship. This field is typically needed when the NK1 is an
organization. The legal name should be sent first in the sequence. Refer to HL7 Table 0200 -
Name type for valid values.
NK1.31 Contact person’s telephone number (XTN-40, Optional) 00749

Definition: This field contains the telephone numbers of the contact person depending on the
value of the relationship defined in NK1-3 - relationship. This field is typically needed when the
NK1 is an organization. The primary telephone number must be sent in the first sequence. If the
primary telephone number is not sent, then a repeat delimiter must be sent in the first sequence.
Refer to HL7 Table 0201 -Telecommunication use code and HL7 Table 0202 - Telecommunication
NK1.32 Contact person’s address (XAD-106, Optional) 00750

Definition: This field contains the addresses of the contact person depending on the value of the
relationship defined in NK1-3 - relationship. This field is typically used when the NK1 is an
organization. When multiple addresses are sent, the mailing address must be sent first in the
sequence.
NK1.33 Next of kin/associated party’s identifiers (CX-32, Optional) 00751

Definition: This field contains the identifiers for the next of kin/associated party, for example,
Social Security Number, driver’s license, etc. The assigning authority and identifier type code are
strongly recommended for all CX data types.\
NK1.34 Job status (IS-2, Optional) 00752

Definition: This field identifies the next of kin/associated party’s job status. Refer to User-defined
Table 0311 - Job status for suggested values.
NK1.35 Race (CE-80, Optional) 00113

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (IS)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^
<name of alternate coding system (IS)>
Definition: This field identifies the race of the next of kin/associated party. Refer to User-defined
Table 0005 - Race for suggested values. The second triplet of the CE data type for race (alternate
identifier, alternate text, and name of alternate coding system) is reserved for governmentally
assigned codes.
NK1.36 Handicap (IS-2, Optional) 00753

Definition: This field contains the code that describes an associated party’s disability. Refer to
User-defined Table 0295 - Handicap for suggested values.
NK1.37 Contact person social security number (ST-16, Optional) 00754

Definition: In the US, this field contains the contact person’s social security number. This number
may also be a RR retirement number. For the Social Security number of the associated party, see
NK1-33 - next of kin/associated party’s identifiers.

3.3 SEGMENTS COMMON TO ALL ORDERS

This table is updated to reflect the implementation requirements specific to ELR. There are also
comments for message requirements for use with the NEDSS Base System.
3.3.1 Common Order (ORC) Segment

Used to transmit fields that are common to all orders (all types of services that are requested).
Since the Ordering Provider address or the Ordering Facility information are required for the ELR
message, the ORC is a required segment.
ORC Attributes
1 2 N/A ID O 0119 00215 Order Control Not Supported – variance
from HL7 Standard
2 22 N/A EI C 00216 Placer Order Number Not Supported
3 22 N/A EI C 00217 Filler Order Number Not Supported
4 22 N/A EI O 00218 Placer Group Number Not Supported
5 2 N/A ID O 0038 00219 Order Status Not Supported
6 1 N/A ID O 0121 00220 Response Flag Not Supported
7 200 N/A TQ O 00221 Quantity/Timing Not Supported
8 200 N/A CM O 00222 Parent Not Supported
9 26 N/A TS O 00223 Date/Time of Transaction Not Supported
10 120 N/A XCN O Y 00224 Entered By Not Supported
11 120 N/A XCN O Y 00225 Verified By Not Supported
12 120 N/A XCN O Y 00226 Ordering Provider Not Supported
13 80 N/A PL O 00227 Enterer’s Location Not Supported
14 40 N/A XTN O Y/2 00228 Call Back Phone Number Not Supported
15 26 N/A TS O 00229 Order Effective Date/Time Not Supported
16 200 N/A CE O 00230 Order Control Code Reason Not Supported
17 60 N/A CE O 00231 Entering Organization Not Supported
18 60 N/A CE O 00232 Entering Device Not Supported
19 120 N/A XCN O Y 00233 Action By Not Supported
20 40 N/A CE O 0339 01310 Advanced Beneficiary Notice Not Supported
Code
21 60 120 XON O Y 01311 Ordering Facility Name Need either an Ordering
Provider or an Ordering
Facility in the message for it
to be migrated to NBS;
preferably both are present.
21.1 100 ST Organization Name
21.2 20 IS Organization Name Type Defaults A for Alias name
21.3 N/A NM ID Number None expected/none
mapped
21.4 N/A NM Check digit Not supported
21.5 N/A ID Check digit scheme ID Not supported
21.6 N/A HD Assigning authority Not supported
21.7 N/A IS Identifier Type Code None expected/none
mapped
21.8 N/A HD Assigning facility ID Not supported
21.9 N/A ID Name Representation Code Not supported
22 106 540 XAD O Y 01312 Ordering Facility Address Supported
22.1 100 Facility Street Address
22.2 100 Facility Address Line 2
22.3 100 Facility City
22.4 20 Facility State
22.5 10 Facility ZIP/Postal Code
22.9 100 County
23 48 XTN O Y 01313 Ordering Facility Phone Supported
Number


23.1 N/A Home Phone Number Formatted phone number in
this field is not accepted
here
phone number here
23.8 20 Extension
23.9 20 Any Text
24 106 XAD O Y 01314 Ordering Provider Address Supported
24.1 50 Ordering Provider Street
Address
24.2 50 Ordering Provider Other
Designation
24.3 20 Ordering Provider City
24.4 20 Ordering Provider State
24.5 10 Ordering Provider Zip or
Postal Code
24.8 N/A Other geog. Designation Not supported
24.9 100 County County description would
map if sent
24.10 N/A Census tract Not supported
Example:
ORC|||||||||||||||||||||MediLabCo - Northwest Pathology Ltd., CentralCampus^^45D0470381^^^CLIA|
2217 Rainier Way^^Renton^WA^98002ÛSA^M^^Black Hawk^Â|^^PH^[email protected]^^206^
5549097|115 Pike Plaza^Suite 2100^Seattle^WA^98122ÛSA^^^^Â|<hex 0D0A>
This example segment shows the name, address, phone number, email address and CLIA identifier for
MediLabCo., the ordering facility.
ORC field definitions
This segment is used to replace ZLR fields 1-4 as described in the 2.3.z Electronic Laboratory
Reporting Implementation Guide that uses the HL7 Version 2.3 Standard. The 2.3.z message contains the
single Site-Defined (z) Laboratory Reporting segment. When the interface at the laboratory site finds
messages in the local directory at the laboratory, ZLR fields 1 through 4 are converted to ORC fields 21-
24. The remaining fields in this segment are not populated for the same reason. Any field that is often
populated in both the ORC and the OBR are populated in the OBR with the original message.
ORC.1 Order Control (ID-2, Optional) 00215
Definition: Determines the function of the order segment. Refer to HL7 Table 0119 – Order control
codes and their meaning for valid entries.
Not supported for this interface.
ORC.2 Placer order number (EI-22, Conditional) 00216

Definition: This field is the placer application’s order number.

ORC.3 Filler order number (EI-22, Conditional) 00217

Definition: This field is the order number associated with the filling application. It is a case of the
Entity Identifier data type (Section 2.8.13). Its first component is a string that identifies an order
detail segment (e.g., OBR). A limit of fifteen (15) characters is suggested but not required. An
implementation is HL7 compliant when the number of characters for this field is increased to
accommodate applications that require a greater number of characters for the Filler order number.
It is assigned by the order filler (receiving) application. This string must uniquely identify the order
(as specified in the order detail segment) from other orders in a particular filling application (e.g.,
clinical laboratory). This uniqueness must persist over time.
ORC.4 Placer group number (EI-22, Optional) 00218

Definition: This field allows an order placing application to group sets of orders together and
subsequently identify them. It is a case of an Entity Identifier data type (2.8.13).
ORC.5 Order status (ID-2, Optional) 00219

Definition: This field specifies the status of an order. Refer to HL7 Table 0038 - Order status for
valid entries. The purpose of this field is to report the status of an order either upon request
(solicited), or when the status changes (unsolicited). It does not initiate action. It is assumed that
the order status always reflects the status as it is known to the sending application at the time that
the message is sent. Only the filler can originate the value of this field.
ORC.6 Response flag (ID-1, Optional) 00220

Definition: This field allows the placer (sending) application to determine the amount of
information to be returned from the filler. Sometimes the requested level of response may not be
possible immediately, but when it is possible, the filler (receiving) application must send the
information. When the field is null, D is the default value of the field. Refer to HL7 Table 0121 -
Response flag for valid entries.
ORC.7 Quantity/timing (TQ-200, Optional) 00221

Definition: This field determines the priority, quantity, frequency, and timing of an atomic service.
Order segments should be thought of as describing an atomic service. It is a composite field .
ORC.8 Parent (CM-200, Optional) 00222

ORC.9 Date/time of transaction (TS-26, Optional) 00223

Definition: This field contains the date and time of the event that initiated the current transaction
as reflected in ORC-1 Order Control Code. This field is not equivalent to MSH-7 Date and Time of
Message which reflects the date/time of the physical message.
ORC.10 Entered by (XCN-120, Optional) 00224

Definition: This field contains the identity of the person who actually keyed the request into the
application. Note that this refers to the current transaction as reflected in ORC-1 Order Control
Code. It provides an audit trail in case the request is entered incorrectly and the ancillary
department needs to clarify the request. By local agreement, either the ID number or name
component may be omitted.
ORC.11 Verified by (XCN-120, Optional) 00225

Definition: This field contains the identity of the person who verified the accuracy of the entered
request. Note that this refers to the current transaction as reflected in ORC-1 Order Control Code.
It is used in cases where the request is entered by a technician and needs to be verified by a
higher authority (e.g., a nurse). By local agreement, either the ID number or name component
may be omitted.
ORC-12 Ordering provider (XCN-120, Optional) 00226

Definition: This field contains the identity of the person who is responsible for creating the request
(i.e., ordering physician).
ORC-12-ordering provider is the same as OBR-16-ordering provider. If the ordering provider is

not present in the ORC, it must be present in the associated OBR. (This rule is the same for other
identical fields in the ORC and OBR and promotes upward and ASTM compatibility.) This is
particularly important when results are transmitted in an ORU message. In this case, the ORC is
not required and the identifying filler order number must be present in the OBR segments.
ORC.13 Enterer’s location (PL-80, Optional) 00227

Definition: This field specifies the location (e.g., nurse station, ancillary service location, clinic,
and floor) where the person who entered the request was physically located when the order was
entered. Note that this refers to the current transaction as reflected in ORC-1 Order Control Code.
Only those subcomponents relevant to enterer’s location should be valued (commonly nursing
unit; facility; building; floor). The person who entered the request is defined in ORC-10-entered by.

ORC.14 Call back phone number (XTN-40, Optional) 00228
Definition: This field contains the telephone number to call for clarification of a request or other
information regarding the order. ORC-14-call back phone number is the same as OBR-17-order
callback phone number.

ORC.15 Order effective date/time (TS-26, Optional) 00229

Definition: This field contains the date/time that the changes to the request took effect or are
supposed to take effect.

ORC.16 Order control code reason (CE-200, Optional) 00230
Definition: This field contains the explanation (either in coded or text form) of the reason for the
order event described by the order control code (HL7 Table 0119). Whereas an NTE after the
order-specific segment (e.g., RXO, ORO, and OBR) would provide a comment for that specific
segment, the purpose of the order control code reason is only to expand on the reason for the
order event.

ORC.17 Entering organization (CE-60, Optional) 00231
Definition: This field identifies the organization that the enterer belonged to at the time he/she
enters/maintains the order, such as medical group or department. The person who entered the
request is defined in ORC-10 -entered by.
ORC.18 Entering device (CE-60, Optional) 00232

Definition: This field identifies the physical device (terminal, PC) used to enter the order.
ORC.19 Action by (XCN-120, Optional) 00233

Definition: This field contains the identity of the person who initiated the event represented by the
corresponding order control code. For example, if the order control code is CA (cancel order
request), this field represents the person who requested the order cancellation. This person is
typically a care provider but may not always be the same as ORC-12 ordering provider.
ORC.20 Advanced beneficiary notice code (CE-40, Optional) 01310

Definition: This field indicates the status of the patient’s or the patient’s representative’s consent
for responsibility to pay for potentially uninsured services. This element is introduced to satisfy
HCFA Medical Necessity requirements for outpatient services. This element indicates (a) whether
the associated diagnosis codes for the service are subject to medical necessity procedures, (b)
whether, for this type of service, the patient has been informed that they may be responsible for
payment for the service, and (c) whether the patient agrees to be billed for this service. The
values for this field are drawn from User-defined Table 0339 – Advanced beneficiary notice code.
ORC-21 Ordering facility name (XON-60, Optional, Repeating) 01311
Definition: Periodically, tests are ordered from facilities without specifying an ordering provider. For
instance, an outpatient surgical facility may send biopsy tissue for pathologic examination without
specifying the surgeon that actually performed the biopsy. In the case where no ordering provider
is identified, knowledge of the ordering facility allows public health officials to follow-up on positive
tests to obtain further clinical and epidemiologic information. Information on the ordering facility is
most relevant to cancer registries.
The facility’s CLIA identifier should be placed in the third component <ID number (NM)> if there is one
available, and “CLIA” should appear in <assigning authority (HD)> indicating that the ID number used here

to identify the laboratory has been assigned by CLIA. If the Ordering Facility is not a laboratory, the name
of the Ordering Facility will suffice.
For example: |MediLabCo - Northwest Pathology Ltd., Central Campus^^45D0470381^^^CLIA|

or
|Northwest Correctional Facility|
ORC.22 Ordering facility address (XAD-106, Optional, Repeating) 01312
Definition: This field contains the address of the facility placing the order.
XAD data type components: <street address (ST)> ^ <other designation (ST)> ^ <city (ST)> ^ <state or
province (ST)> ^ <zip or postal code(ST)> ^ <country (ID)> ^ < address type (ID)> ^ <other geographic
designation (ST)> ^ <county/parish code (IS)> ^ <census tract (IS)> ^ <address representation code (ID)>
For valid values in these components, refer to User-defined Table 0212 - Nationality for country codes,
HL7 Table 0190 - Address type for address type codes, User-defined Table 0289 - County/parish for
county/parish codes, User-defined Table 0288 - Census Tract for census tract codes, and HL7 Table 4000
- Name/address representation for address representation codes.
For example: |2217 Rainier Way^^Renton^WA^98002ÛSA^M^^Black Hawk^Â|
ORC.23 Ordering facility phone number (XTN-48, Optional, Repeating) 01313
Definition: This field contains the telephone number of the facility placing the order. This field
further identifies the laboratory identified in ORC-21.
For example: |ÂSN^PH^[email protected]^^206^5549097|

or |^^^^^206^5549097|

ORC.24 Ordering provider address (XAD-106, Optional, Repeating) 01314
Definition: This field contains the address of the care provider requesting the order. This field
contains relevant address information for the ordering provider described in OBR-16.
For example: |115 Pike Plaza^Suite 2100^Seattle^WA^98122ÛSA^^^^Â|

or more likely |115 Pike Plaza^Suite 2100^Seattle^WA^98122|

3.3.2 Observation Request Segment (OBR)

The Observation Request (OBR) segment is used to transmit information specific to an order for a
diagnostic study or observation, physical exam, or assessment. The OBR defines the attributes of a
particular request for diagnostic services or clinical observations. For laboratory-based reporting, the OBR
defines the attributes of the original request for laboratory testing. Essentially, the OBR describes a
battery or panel of tests that is being requested or reported. The OBR is somewhat analogous to a
generic lab slip that is filled out when physician requests a lab test. The individual test names and results
for the panel of tests performed are reported in OBX segments, which are described below. As defined by
the ORU syntax, there can be many OBX’s per OBR, and there can be many OBR’s per PID-
OBR Attributes
HL7 NBS HL7 HL7 HL7R HL7 HL7
LEN LEN DT R/O P# TBL# ITEM#
1 4 N/A SI O 00237 Set ID – OBR
2 22 N/A EI C 00216 Placer Order Number Not supported – not
expecting for ELR
3 22 18 EI R 00217 Filler Order Number + DOCUMENT VARIANCE
3.1 18 ST Entity identifier
3.2 N/A IS Namespace ID
3.3 N/A ST Universal ID
3.4 N/A ID Universal ID Type
4 200 340 CE R 00238 Universal Service ID DOCUMENT VARIANCE
4.1 50 ST Code (LOINC)
4.2 100 ST Description (LOINC)
4.3 20 ST ID Type (LOINC)
4.4 50 ST Code (Local)
4.5 100 ST Description (Local)
4.6 20 ST ID Type (Local)
5 2 N/A ID X 00239 Priority Not supported
6 26 N/A TS X 00240 Requested Date/Time Not supported
7 26 26 TS R 00241 Observation Date/Time # Required – “effective start
date/time”
8 26 26 TS O 00242 Observation End Date/Time # Supported if sent but not
generally used with Public
Health ELR
9 20 20 CQ O 00243 Collection Volume * Supported if sent but not
generally used with Public
Health ELR
10 60 XCN O Y 00244 Collector Identifier * One instance supported
10.1 100 ST ID Number
10.2 50 ST family name
10.3 50 ST Given Name
10.4 50 ST Middle Name/Initial
10.5 20 ST Suffix
10.6 20 ST Prefix
10.7 20 IS Degree
11 1 ID O 0065 00245 Specimen Action Code * Not supported
12 60 CE O 00246 Danger Code Not supported
13 300 ST O 00247 Relevant Clinical Info. Optional text input
supported
14 26 TS C 00248 Specimen Received Supported as “activity start
Date/Time * date/time”
15 300 1270 CM O 0070 00249 Specimen Source *
15.1 Specimen Source Name or
Code
15.1.1 50 CE identifier
15.1.2 100 ST text
15.1.3 N/A ST name of coding system Assumed to be HL7 – no
place to store in ODS if
other system
15.1.4 N/A CE alternate identifier Not supported
15.1.5 N/A ST alternate text Not supported


15.1.6 N/A ST alternate coding system Not supported
15.2 N/A TX Additives
15.3 1000 TX Freetext
15.4 CE Body site
15.4.1 20 ST identifier
15.4.2 100 ST text
other system
15.5 N/A CE Site modifier
15.5.1 N/A ST identifier
15.5.2 N/A ST text
other system
15.6 N/A CE Collection Method Identifier
code
15.6.1 N/A ST identifier
15.6.2 N/A ST text
other system
15.6.4 N/A ST alternate identifier Not supported
16 80 XCN O Y 00226 Ordering Provider One instance supported
16.1 100 ST Ordering Provider ID
16.2 50 ST Provider Last Name
16.3 50 ST Provider First Name
16.4 50 ST Provider Middle Initial
16.5 20 ST Provider Suffix
16.6 20 ST Provider Prefix
16.7 20 IS Provider Degree
17 40 230 XTN O Y/2 00250 Order Callback Phone One instance supported
Number
17.1 N/A Formatted Phone Number Phone number in this field
is not processed
here
phone number here (7
digits)
17.8 20 Extension
17.9 20 Any Text
18 60 N/A ST O 00251 Placer Field 1 Not Supported
19 60 N/A ST O 00252 Placer Field 2 Not Supported
20 60 N/A ST O 00253 Filler Field 1 + Not Supported
21 60 N/A ST O 00254 Filler Field 2 + Not Supported
22 26 26 TS C 00255 Results Rpt/Status Chng- “activity end date/time”
Date/Time +
23 40 N/A CM O 00256 Charge to Practice + Not Supported
24 10 N/A ID O 0074 00257 Diagnostic Serv Sect ID Not Supported
25 1 ID R 0123 00258 Result Status + Used to relay entire report
status
26 400 CM O 00259 Parent Used for Micros


26.1 100 CE OBX-3 Observation identifier
26.1 20 ST identifier
26.2 100 ST text
26.3 N/A ST name of coding system Assumed to be HL7
26.4 N/A ST alternate identifier Not supported
26.5 N/A ST alternate text Not supported
26.6 N/A ST alternate coding system Not supported
26.2 ST OBX-4 sub-id of parent result
26.3 TX part of OBX-5 observation
result from parent
100 Filler order number (generally, this is what is
received for sensitivity
orders on cultures. It is
used for processing act
relationships but not
mapped again from this
field)
27 200 TQ O Y 00221 Quantity/Timing Not Supported
28 150 XCN O Y/5 00260 Result Copies To Supported but rarely sent
29 200 CM O 00261 Parent * Supported for micros
29.1 100 Placer order number
29.2 100 Filler order number (generally, this is what is
received for sensitivity
orders on cultures. It is
used for processing act
relationships but not
mapped again from this
field)
30 20 ID O 0124 00262 Transportation Mode Not Supported
31 300 CE O Y 00263 Reason for Study Supported as ICD codes
Note that alternate
identifiers are not
supported but several ICD-
9 codes are supported if
sent.
31.2 100 ST text
31.3 N/A ST name of coding system Assumed to be HL7 – no
other system
32 200 CM O 00264 Principal Result Interpreter + Supported but not sent
32.1 100 CN Name component only

32.11 100 ST ID
32.12 50 ST Last Name
32.13 50 ST First Name
32.14 50 ST Middle Initial
32.15 20 ST Suffix
32.16 20 ST Prefix
32.17 20 IS Degree
33 200 CM O Y 00265 Assistant Result Interpreter + Supported but not sent
32.11 100 ST ID
32.15 20 ST Suffix
32.16 20 ST Prefix
32.17 20 IS Degree
34 200 CM O Y 00266 Technician + Supported but not sent


34.11 100 ST ID
34.15 20 ST Suffix
34.16 20 ST Prefix
34.17 20 IS Degree
35 200 CM O Y 00267 Transcriptionist + Supported but not sent
35.11 100 ST ID
35.15 20 ST Suffix
35.16 20 ST Prefix
35.17 20 IS Degree
36 26 N/A TS O 00268 Scheduled Date/Time + Not Supported
37 4 N/A NM O 01028 Number of Sample Not Supported
Containers *
38 60 N/A CE O Y 01029 Transport Logistics of Not Supported
Collected Sample *
39 200 N/A CE O Y 01030 Collector's Comment * Not Supported
40 60 N/A CE O 01031 Transport Arrangement Not Supported
Responsibility
41 30 N/A ID O 0224 01032 Transport Arranged Not Supported
42 1 N/A ID O 0225 01033 Escort Required Not Supported
43 200 N/A CE O Y 01034 Planned Patient Transport Not Supported
Comment
44 80 N/A CE O 0088 00393 Procedure Code Not Supported
45 80 N/A CE O Y 0340 01316 Procedure Code Modifier Not Supported
Examples:
For pertussis reporting:
OBR|1||MICR9700342|^^^654324^Throat culture^L|||200011270930||||||||
THRT&Throat&HL70070|1234567^Welby^M^J^Jr^Dr^MD|^^^^^206^4884144||||||||F<hex 0D0A>
This segment specifies that a report identified as MICR9700342 was processed on November 27, 2000, at
9:30 am. The report was a throat culture requested by Dr. M.J. Welby, Jr., MD, whose phone number is
(206) 488-4144. This is the final result.
For Hepatitis A virus testing:
OBR|1||SER122145|^^^78334^Hepatitis Panel, Measurement^L|||200003210830||||||||BLDV&Blood

venous&HL70070|1234567^Welby^M^J^Jr^Dr^MD|^^^^^206^4884144||||||||F<hex 0D0A>
This segment shows that a report identified by SER122145 for a hepatitis panel was conducted on blood
and was processed on March 21, 2000, at 8:30 am. The battery was ordered by Dr. M.J. Welby, Jr., MD,
whose phone number is (206) 488-4144. This is the final result.
For blood lead testing:
OBR|5||CH96779|^^^3456543^Blood lead test^L|||200101210730||||||||BLDC^Blood

capillary|3456789Êverett^C^Sr^Dr^MD |^^^^206^4880911||||||||F<hex 0D0A>

This segment shows that a report identified by CH96779 for a blood capillary lead test was processed
on January 21, 2001, at 7:30 am. The test was ordered by Dr. C. Everett, MD, whose phone number
is (206) 488-0911. This is the final result.
OBR field definitions
For electronic laboratory purposes, the Placer and Filler are defined as follows:
The placer is the person or service that requests (places order for) an observation battery, e.g., the
physician, the practice, clinic, or ward service, that orders a lab test, X-ray, vital signs, etc. The meaning is
synonymous with, and used interchangeably with, requestor. See ORC-2-placer order number, “Placer
order number.”
The filler is the person or service that produces the observations (fills the order) requested by the
requestor. The word is synonymous with "producer" and includes diagnostic and clinical services and care
providers who report observations about their patients. The clinical laboratory is a producer of lab test
results (filler of a lab order), the nursing service is the producer of vital signs observations (the filler of
orders to measure vital signs), and so on. See ORC-3-filler order number, Section 4.3.5.3, “Filler order
number.”
The daggered (+) items in the OBR attribute table above are known to the filler, not the placer. They are
valued by the filler as needed when the OBR segment is returned as part of a report. The starred (*) fields
are only relevant when an observation is associated with a specimen. These are completed by the placer
when the placer obtains the specimen. They are completed by the filler when the filler obtains the
specimen, and usually are not passed as part of the ORU result message. OBR-7-observation date/time
and OBR-8-observation end date/time (flagged with #) are the physiologically relevant times. In the case
of an observation on a specimen, they represent the start and end of the specimen collection. In the case
of an observation obtained directly from a subject (e.g., BP, Chest X-ray), they represent the start and end
time of the observation.
OBR.1 Set ID (SI-4, Optional) 00237
Definition: This field identifies the sequence number of one of multiple OBR’s under one PID- For
the first order transmitted, the sequence number shall be 1; for the second order, it shall be 2; and
so on. For example, the second OBR under a single PID would appear as:
|2|
OBR.2 Placer order number (EI-22, Conditional) 00216
Definition: This field identifies an order number uniquely among all orders from a particular
ordering application. This field should not contain the accession number for a specimen. The first
component is a string that identifies an individual order. A limit of fifteen (15) characters is
suggested but not required. It is assigned by the placer (ordering application). The second
through fourth components contain the application ID of the placing application in the same form
as the HD data type.
This field is not expected for this resultsinterface.
OBR.3 Filler order number (EI-22, Conditional) 00217
Definition: This field is the order number associated with the filling application. It is assigned by
the order filler (receiving) application. This string must uniquely identify the order (as specified in
the order detail segment) from other orders in a particular filling application (e.g., clinical
laboratory). This uniqueness must persist over time. For laboratory based reporting, this field will
be used to report the laboratory specimen accession number. This filler number coupled with the

laboratory identifier acts as a unique identifier across various systems that could happen to use
the same filler number to track specimens.
EI data type components: <entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID (ST)> ^
<universal ID type (ID)>
Example: |MICR9700342|
NOTE: this example assumes that the Sending Facility is the assigning authority for this Filler number, if
not otherwise indicated.
The second through fourth components could contain the filler application ID. The second component of
the filler order number always identifies the actual filler of an order. A given institution or group of
intercommunicating institutions should establish a list of applications that may be potential placers and
fillers of orders and assign each a unique application ID. The application ID list becomes part of the
institution’s master dictionary, as documented in HL7’s Chapter 8. If the filler order number is not present
in the ORC, it must be present in the associated OBR. (This rule is the same for other identical fields in
the ORC and OBR and promotes upward and ASTM compatibility.) This is particularly important when
results are transmitted in an ORU message. In this case, the ORC is not required and the identifying filler
order number must be present in the OBR segments. The filler order number (OBR-3 or ORC-3) uniquely
identifies an order and its associated observations.
OBR.4 Universal service ID (CE-200, Required) 00238
Definition: This field is the identifier code for the requested observation/test/battery.
The CE data type transmits codes and the text associated with the code. This type has six components
arranged in two groups as follows:
<identifier (ST)>^<text (ST)>^<name of coding system (ST)>^<alternate identifier (ST)>^<alternate text
(ST)> ^<name of alternate coding system (ST)>
CE data type components are defined as follows:

(1) Identifier (ST). The code that uniquely identifies the item being referenced by the <text>. Different
coding schemes will have different elements here.
(2) Text (ST). Name or description of the item in question.
(3) Name of coding system (ST). Identifies the coding system used. The combination of the identifier
and the name of the coding system components will be a unique code for a data item.
(4-6) Three components analogous to 1-3 for the alternate or local coding system.
An example valuing all of the CE data type components for a report of antimicrobial susceptibility would
appear as:
|625-4^MICROORGANISM IDENTIFIED^LN^874634ÔRGANISM^L|
No coding recommendation for laboratory-based reporting has been made for OBR-4 since the field
describes the originally requested order (e.g., a hepatitis panel or antimicrobial susceptibility testing
battery). The value of OBR-4 will be continued from the original order, since this is a required field, but the
information in OBR-4 is only be used to identify the original Ordered Test. The “informative field” for
laboratory-based reporting is OBX-3, described below. OBX-3 should be used to provide an
unambiguous, specific test name and OBX-5 should provide the result to the test. Examples of
messages for different laboratory-reportable findings are given in Appendix A.
An example for a report of a hepatitis panel would appear just as ordered:
|^^^78334^Hepatitis Panel, Measurement^L|

Here the code is a user-defined “local” code, as indicated by the <L> in the sixth subcomponent. Note that
the “Universal Service ID” is a code that often represents the battery or collection of tests that make up a
routine laboratory panel. The individual results of the different components of the hepatitis panel are
reported in the OBX segments described below. For most laboratory tests that are reportable to public
health officials, the description of the test and result is sufficiently given in OBX and does not need
repetition here. Information in OBR-4 will not be used routinely in public health reporting. An example of
this is given in Appendix A for blood lead reporting.
OBR.5 Priority - OBR (ID-2) 00239

Definition: This field has been retained for backward compatibility only. It is not supported.
OBR.6 Requested date/time (TS-26, Not supported) 00240
Definition: This field has been retained for backward compatibility only. Previously
requested date/time. That information is now carried in the fourth component of the OBR-27-
quantity/timing, but that information is not carried forward from the original Order message.
OBR.7 Observation date/time (TS-26, Required for Results Reporting) 00241
Definition: This field is the clinically relevant date/time of the observation. In the case of
observations taken directly from a subject, it is the actual date and time the observation was
obtained. In the case of a specimen-associated study, this field shall represent the date and time
the specimen was collected or obtained. (This is a results-only field except when the placer or a
third party has already drawn the specimen.) This field is conditionally required. When the OBR is
transmitted as part of a report message, the field must be filled in. If it is transmitted as part of a
request and a sample has been sent along as part of the request, this field must be filled in
because this specimen time is the physiologically relevant date-time of the observation.
For example: |200011270930|
OBR.8 Observation end date/time (TS-26, Optional) 00242

Definition: This field is the end date and time of a study or timed specimen collection. If an
observation takes place over a substantial period of time, it will indicate when the observation
period ended. For observations made at a point in time, it will be null. This is a results field
except when the placer or a party other than the filler has already drawn the specimen.
This field is supported for this interface although timed specimen collection is generally not received for
Public Health reporting.
OBR.9 Collection volume (CQ-20, Optional) 00243

Definition: For laboratory tests, the collection volume is the volume of a specimen. The default
unit is ML. Specifically, units should be expressed in the ISO Standard unit abbreviations
(ISO-2955, 1977). This is a results-only field except when the placer or a party has already drawn
the specimen. (See Chapter 7 of the HL7 2.3.1 Standard for full details about units.)
This field is supported for this interface but is generally not received with results.
OBR.10 Collector identifier (XCN-60, Optional) 00244

Definition: When a specimen is required for the study, this field will identify the person,
department, or facility that collected the specimen. Either name or ID code, or both, may be
present.
This field is supported for this interface but is generally not received.
OBR.11 Specimen action code (ID-1, Optional) 00245

Definition: This field is the action to be taken with respect to the specimens that accompany or
precede this order. The purpose of this field is to further qualify (when appropriate) the general

action indicated by the order control code contained in the accompanying ORC segment. For
example, when a new order (ORC - “NW”) is sent to the lab, this field would be used to tell the lab
whether or not to collect the specimen (“L” or “O”). Refer to HL7 Table 0065 - Specimen action
code for valid values.
This field is not expected for this interface.
OBR.12 Danger code (CE-60, Optional) 00246

Definition: This field is the code and/or text indicating any known or suspected patient or
specimen hazards, e.g., patient with active tuberculosis or blood from a hepatitis patient. Either
code and/or text may be absent. However, the code is always placed in the first component
position and any free text in the second component. Thus, free text without a code must be
preceded by a component delimiter.
OBR.13 Relevant clinical information (ST-300, Optional) 00247
Definition: This field contains any additional clinical information about the patient or specimen.
This field is used to report the suspected diagnosis and clinical findings on requests for interpreted
diagnostic studies. Examples include reporting the amount of inspired carbon dioxide for blood
gasses, the point in the menstrual cycle for cervical pap tests, and other conditions that influence
test interpretations. Relevant epidemiologically important information (e.g., day care center
attendee, food handler, or nursing home patient) can be placed here; however there are no
recommendations for specific use of this field for laboratory-based reporting. ICD codes used to
support testing and reimbursement should be provided in OBR-31 (Reason for Study).
OBR.14 Specimen received date/time (TS-26, Required for ELR) 00248
Definition: For observations requiring a specimen, the specimen received date/time is the actual
login time at the diagnostic service. This field must contain a value when the order is
accompanied by a specimen, or when the observation required a specimen and the message is a
report.
OBR.15 Specimen source (CM-300, Optional) 00249
Definition: This field identifies the site where the specimen should be obtained or where the
service should be performed.
The first component contains the specimen source name or code (as a CE data type component). (Even
in the case of observations whose name implies the source, a source may be required, e.g., blood culture
– heart blood.) Refer to HL7 table 0070 - Specimen source codes for valid entries.
The second component should include free text additives to the specimen such as Heparin, EDTA, or
Oxlate, when available.
The third is a free text component describing the method of collection when that information is a part of the
order. When the method of collection is logically an observation result, it should be included as a result
segment.
The fourth component specifies the body site from which the specimen was obtained, and the fifth is the
site modifier. For example, the site could be antecubital fossa, and the site modifier “right.” The
components of the CE fields become subcomponents.

Refer to HL7 Table 0163 – Body site. Since the fields on this HL7 table already contain a modifier, there
has not been a need to date to use the Body Site Modifier component.
The fifth component indicates whether the specimen is frozen as part of the collection method. Suggested
values are F (Frozen); R (Refrigerated). If the component is blank, the specimen is assumed to be at
room temperature.
Refer to HL7 Table 0070 – Specimen source codes.
An example for an isolate from a blood culture is:

|BLDV&Blood venous&HL70070^^^T-D8400&Antecubital Region&SNM^LACF&Left Antecubital
Fossa&HL70163|
where
<BLDV> is the code, <Blood venous> is the text of the code, and HL7 0070 is the table from which the
code and text were drawn.
An example for a specimen from a finger stick collection for blood lead testing where the specimen source
is provided from an HL7 table of values:
|BLDC&Blood Capillary&HL70070|
An example for a stool specimen which yielded a reportable enteric organism is:
|STL&Stool=Fecal&HL70070|
It is strongly recommended that actual specimen sources be provided in OBR-15 and not
surrogate descriptions such as “lavender-top” or “serum-separator tube”.
Non-Coded Specimen Sources:

If coded text is not available, then the information is provided in the freetext field. The first two
components would be blank, followed by the free-text specimen source.
A non-coded, free text specimen source in a field of a CE data type would appear as:
|^^Blood|
OBR.16 Ordering provider (XCN-80, Optional, Not expecting repeats) 00226
Definition: This field identifies the provider who ordered the test. Either the ID code or the name,
or both, may be present. This is the same as ORC-12-ordering provider, but the interface expects
the Ordering Provider in OBR-16. The ORC segment is created from a ZLR segment that comes
with 2.3.z version Public Health Electronic Laboratory Reports. This field is optional only if the
Ordering Facility information is provided in the message. Generally, both Ordering
Provider and Ordering Facility are received.
For example: |1234567^Welby^M^J^Jr^Dr^MD|
Note: Ordering Provider Address appears in ORC-24. Public health agencies may request that the
ordering provider’s address also be provided so that health officials can contact providers to obtain
additional information during public health investigations.
OBR.17 Order callback phone number (XTN-40, Optional, Not expecting repeats) 00250
Definition: This field is the telephone number for reporting a status or a result using the standard
format with extension and/or beeper number when applicable.
For example: |^WPN^PH^^^206^2770908^^call before 5:00 pm only~ÂSN^PH^^^206^5620767|

or

|^^^^^206^2770908|
This field is optional only if the Ordering Facility’s phone number is provided in the message.
Generally, both Ordering Provider and Ordering Facility are received.
OBR.18 Placer field 1 (ST-60, Optional) 00251

Definition: This field is user field #1. Text sent by the placer will be returned with the results.
Not supported with this interface.
OBR.19 Placer field 2 (ST-60, Optional) 00252

Definition: This field is similar to placer field #1.
OBR.20 Filler field 1 (ST-60, Optional) 00253

Definition: This field is definable for any use by the filler (diagnostic service).
OBR.21 Filler field 2 (ST-60, Optional) 00254

Definition: This field is similar to filler field #1.
OBR.22 Results rpt/status change - date/time (TS-26, Optional) 00255

Definition: This field specifies the date/time results reported or the report status changed. This
field is used to indicate the date and time that the results are composed into a report and
released, or that a status, as defined in ORC-5-order status, is entered or changed.
For Electronic Laboratory Reporting, the actual report time is pulled from OBX-14, Date/time of the
Observation.
OBR.23 Charge to practice (CM-40, Optional) 00256

Definition: This field is the charge to the ordering entity for the studies performed when
applicable. The first component is a dollar amount when known by the filler. The second is a
charge code when known by the filler (results only).
This field is not valued with this interface.
OBR.24 Diagnostic serv sect ID (ID-10, Optional) 00257

Definition: This field is the section of the diagnostic service where the observation was performed.
If the study was performed by an outside service, the identification of that service should be
recorded here. Refer to HL7 Table 0074 - Diagnostic service section ID for valid entries.
This field is not valued with this interface.
OBR.25 Result status (ID-1, Conditional) 00258

Definition: This field is the status of results for this order. Refer to HL7 table 0123 - Result status
for valid entries. Some public health agencies may want to have preliminary results for certain
tests. The decision to transmit final versus preliminary results may vary from state to state.

Corrected results are also processed if sent, based on the use of the same accession/filler
number in OBR-3.
Example:
|C| (this is a corrected report)
OBR.26 Parent result (CM-400, Optional) 00259
Definition: This field provides linkages to messages describing previously performed tests. This
important information, together with the information in OBR-29-parent (the identifiers associated
with the parent placer and filler), uniquely identifies the OBX segment from the previously
performed test that is related to this order (description of OBX segment provided below). The
value reported in this OBX segment in the parent result is the organism or chemical species about
which this battery reports. For example, if the current battery (as designated in OBR-4) is an
antimicrobial susceptibility test, the parent result in OBR-26 contains a result from a previously
performed antimicrobial susceptibility test, which identified the organism on which the current
susceptibility was run. HL7 specifies here the OBX-5 data will only show the text, or second
component of the CE data type used in the previous message. However, for electronic laboratory
reporting, all of the CE data type components of field OBX-5 from the previous parent message
appear in this field of the present OBR, using subcomponent delimiters. This indirect linkage is
preferred because the name of the organism in the parent result may undergo several preliminary
values prior to finalization. This is an exception to the HL7 description for this component.
An example is:
|600-7&Microorganism identified&LN^^L-25116&Streptococcus pneumoniae&SNM|
In this example, <600-7> is the code for a microbial culture that appeared in a previous OBX-3;
<Microorganism identified> is the text describing the code; and <LN> represents the name of the coding
system, LOINC®. The second component of this field is not supported in this message and remains blank.
The third component has the code for Streptococcus pneumoniae, the text name of the organism, and the
code representing the name of the coding system, SNOMED®. The third component was the OBX-5 that
appeared in the parent result. The report of the antimicrobial susceptibility testing performed on the
previously identified Streptococcus pneumoniae will be given in the OBX segment described below. Most
laboratory findings that will be reported will not require the “parent result” field to be populated. A notable
exception is the reporting of antimicrobial susceptibility testing results.
For laboratories that develop an HL7 message for laboratory-based reporting only and do not use HL7
within their institution, the parent result field should be used to report the name of the organism on which
sensitivities were performed. OBR-26 would therefore appear as:
|^^L-25116&Streptococcus pneumoniae&SNM|
HL7 2.3.1 states that OBR-26 should only be present when the parent result is identified by OBR-29-
parent number; however, as discussed, the parent result may not always be present when a laboratory
uses HL7 for transmission of public health information only. For this reason, OBR-26 should be populated
with information in the absence of a parent number. This is a deviation from the HL7 2.3.1 specifications,
but is necessary to interpret data required for laboratory-based reporting.
Below is an example of using 2 OBR’s to accomplish this:
OBR|1||05099009500|630-4^Microorganism Identified^LN^008086Ûrine Culture,

Comprehensive^L|||200002181000|||||||200002220901||3^Ray^Tony^^^^MD|(336) 585-5000||||||||F <hex
0D0A>
OBX|1|CE|630-4^Microorganism Identified^LN^997191^Result 1^L|1|L-26201^Vibrio
cholerae^SNM^M520^Vibrio Cholerae^L|||A|||F|||20000222|^LABCORP BURLINGTON^CLIA|||<hex

0D0A> OBR|2||05099009500|^^^997191^RESULT 1^L|||200002181000|||||||200002220901||

3^RAY^TONY^^^^MD|(336)585-5000||||||||F|630-4&Microorganism
Identified&LN&997191&RSLT#1&L^1^Vibrio cholerae|||^05099009500|<hex 0D0A>
OBR.27 Quantity/timing (TQ-400, Optional, Not supported) 00221
Definition: This field contains information about how many services to perform at one service time
and how often the service times are repeated, and to establish the duration of the request. See
Section 4.4 of the HL7 standard, Version 2.3.1, “Quantity/Timing (TQ) Definition.”
OBR.28 Result copies to (XCN-150, Optional, Repeating/5) 00260
Definition: This field is the people who are to receive copies of the results. By local convention,
either the ID number or the name may be absent.
For example: |1234567^Welby^M^J^Jr^Dr^MD ~ 4567891^Parsons^Melvin^C^^Dr^MD|

This field is not expected but Copy-to Provider information will be displayed if sent.
OBR.29 Parent (CM-200, Optional) 00261
Definition: This field relates a child to its parent when a parent/child relationship exists. The field
is optional; however, it is recommended that the field be sent if available for laboratory-based
reporting. This field may be sent when a parent result is provided. Reporting of antimicrobial
susceptibility data requires that the parent result be populated with the name of the organism for
which testing was performed (OBR-26). See OBR-26 for further description.
For example a parent result with no filler number would appear as:
|MB980167|
OBR.30 Transportation mode (ID-20, Optional) 00262

Definition: This field identifies how (or whether) to transport a patient, when applicable. Refer to
HL7 Table 0124 - Transportation mode for valid codes.
This field is not expected for this results interface.
OBR.31 Reason for study (CE-300, Optional, Repeating) 00263
Definition: For public health reporting, ICD-9-CM codes used to support testing and
reimbursement should be used here. This field can repeat to accommodate multiple diagnoses.
Refer to website http://www.cdc.gov/nchs/icd9.htm for information on ICD-9-CM codes.
The field would appear as:
OBR|…..||099.41Ôther Venereal DiseasesÎ9C~483.1^Pneumonia due to other specified

organismÎ9C~V02.61^Carrier or Suspected carrier of infectious diseases Î9C~070.41^VIRAL
HEPATITISÎ9C~070.42^Viral HepatitisÎ9C|
The version of International Classification of Disease (ICD) does not impact the storage of these codes
and descriptions.
OBR.32 Principal result interpreter (CM-200, Optional) 00264

Definition: This field identifies the physician or other clinician who interpreted the observation and
is responsible for the report content.

This field is rarely sent but is supported. Principal result interpreter is preferable to the use of OBX-16,
Responsible Observer.
OBR.33 Assistant result interpreter (CM-200, Optional) 00265

Definition: This field identifies the clinical observer who assisted with the interpretation of this
study.
This field is rarely sent but is supported.
OBR.34 Technician (CM-200, Optional) 00266

Definition: This field identifies the performing technician.
OBR.35 Transcriptionist (CM-200, Optional) 00267

Definition: This field identifies the report transcriber.
OBR.36 Scheduled - date/time (TS-26, Optional) 00268

Definition: This field is the date/time the filler scheduled an observation, when applicable (e.g.,
action code in OBR-11-specimen action code = “S”). This is a result of a request to schedule a
particular test and provides a way to inform the Placer of the date/time a study is scheduled (result
only).
Not expected for this interface.
OBR.37 Number of sample containers (NM-4, Optional) 01028

Definition: This field identifies the number of containers for a given sample. For sample receipt
verification purposes; may be different from the total number of samples which accompany the
order.
OBR.38 Transport logistics of collected sample (CE-60, Optional) 01029

Definition: This field is the means by which a sample reaches the diagnostic service provider.
This information is to aid the lab in scheduling or interpretation of results. Possible answers:
routine transport van, public postal service, etc. If coded, requires a user-defined table.
OBR.39 Collector's comment (CE-200, Optional) 01030

Definition: This field is for reporting additional comments related to the sample. If coded, requires
a user-defined table. If only free text is reported, it is placed in the second component with a null in
the first component, e.g., ^difficult clotting after venipuncture and ecchymosis.
OBR.40 Transport arrangement responsibility (CE-60, Optional) 01031

Definition: This field is an indicator of who is responsible for arranging transport to the planned
diagnostic service. Examples: Requester, Provider, Patient. If coded, requires a user-defined
table.
OBR.41 Transport arranged (ID-30, Optional) 01032

Definition: This field is an indicator of whether transport arrangements are known to have been
made. Refer to HL7 Table 0224 - Transport arranged for valid codes.
OBR.42 Escort required (ID-1, Optional) 01033

Definition: This field is an indicator that the patient needs to be escorted to the diagnostic service
department. Note: The nature of the escort requirements should be stated in the OBR-43-planned
patient transport comment field. See HL7 Table 0225 - Escort required for valid values.
OBR.43 Planned patient transport comment (CE-200, Optional) 01034

OBR.44 Procedure code (CE-80, Optional) 00393

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with
the Universal Service ID reported in field 4. This field is a CE data type for compatibility with
clinical and ancillary systems. This field will usually contain the HCFA Common Procedure Coding
System (HCPCS) codes associated with the order. The HCPCS codes and modifiers of level II
can be found at http://www.hcfa.gov/stats/anhcpcdl.htm.
OBR.45 Procedure code modifier (CE-80, Optional, Repeating) 01316
Definition: This field contains the procedure code modifier to the procedure code reported in field
44, when applicable. Procedure code modifiers are defined by regulatory agencies such as HCFA
and the AMA. Multiple modifiers may be reported. The HCPCS codes and modifiers of level II can
be found at http://www.hcfa.gov/stats/anhcpcdl.htm.

3.3.3 Observation/Result (OBX) Segment.

The OBX segment is used to transmit a single observation or observation fragment. It represents the
smallest indivisible unit of a report. Its principal mission is to carry information about observations in report
messages. While OBR gives general information about the order for the test and ORC gives information
on all services that are requested, the OBX segment gives the specific, individual tests performed (OBX-3)
and the specific results for each test (OBX-5). Laboratory-based reporting to public health agencies
focuses on OBX-3 and OBX-5 as the most informative elements of the message; thus, every effort
should be made to make OBX-3 and OBX-5 as informative and unambiguous as possible.
OBX Attributes
1 4 N/A SI R 00569 Set ID-OBX
2 3 N/A ID C 0125 00570 Value type SN, CE, TX, ST
3 80 2700 CE R 00571 Observation identifier* CHECK NEW
LENGTHS
3.1 50 Identifier Code LOINC Code
3.2 1000 Text LOINC description
3.3 300 Name of Coding System ‘LN’
3.4 50 Alternate Identifier Local code here
3.5 1000 Text Local description here
3.6 300 Alternate Coding System “L”
4 20 N/A ST C 00572 Observation sub-ID Used for processing
but not mapped
1 2
5 65536 **CE C Y 00573 Observation value* If CE data type in OBX-
2, prefer SNOMED
result code.
**For SN data in this
field, the length is
9(11,5) for each
numeric value. For TX
or ST data in this field,
the length is 2000.
5.1 20 20 Result Code (SNOMED) SNOMED Code
5.2 100 300 Result Text (SNOMED) SNOMED Description
5.3 3 300 ID Type (SNOMED) ‘SNM’
5.4 20 20 Alt. Result Code (Local) Local code here
5.5 100 300 Alt. Description (Local) Local description here
5.6 3 300 Alt. ID Type (Local) “L”
6 60 20 CE O 00574 Units ISO Unit codes
7 60 20 high ST O 00575 Reference ranges Associated with SN
20 low and CE results.
8 5 20 ID O Y/5 0078 00576 Abnormal flags
9 5 N/A NM O 00577 Probability Not supported
10 2 N/A ID O Y 0080 00578 Nature of abnormal test Not supported
11 1 1 ID R 0085 00579 Observation result status Required
12 26 N/A TS O 00580 Date last Obs normal Not supported
values
13 20 N/A ST O 00581 User defined access Not supported
checks
14 26 26 TS R 00582 Date/time of the Required
observation
15 60 CE O 00583 Producer's ID Supported
15.2 100 ST text
15.3 N/A ST name of coding system
16 80 N/A XCN O Y 00584 Responsible observer Not supported
17 60 CE O Y 00936 Observation method Supported
17.2 100 ST text
17.3 N/A ST name of coding system


* For laboratory-based reporting, LOINC® is strongly recommended for OBX-3, and SNOMED® is strongly recommended
for OBX-5 when results are coded and CE data types are used.
** The data type for OBX-5 can vary and is determined by OBX-2.
1 The length of the observation value field is variable, depending upon value type. See OBX-2-value type.
2 Standard specifies that OBX-5 may repeat for multipart, single answer results with appropriate data types, e.g., CE,
TX, and FT data types. Not expecting repeats in the result values; would prefer to use additional OBXs tied together
with Observation sub-ids as described below.

Examples:
For Hepatitis A Virus reporting:
OBX|3|CE|5182-1^Hepatitis A Virus IgM Serum Antibody EIA^LN||G-A200^Positive^SNM||||||F|||

200312161330|45D0480381|<hex 0D0A>
This segment specifies that a third item in the report of a test for hepatitis A had a positive culture.
This is the final result and was observed on December 16, 2003, at 1:30 p.m.
For Blood Lead reporting:
OBX|2|SN|10368-9^Quantitative Blood Lead ^LN||^45|:g/dL|||||F|||20040121800|45D0480382|<hex

0D0A>
This segment specifies that on January 21, 2004, at 8:00 a.m., the test for blood lead level resulted in 45
µg/dL. This is the final result.
For patient age and employment:
OBR|2|||^ Additional Patient Demographics| <hex 0D0A>

OBX|1|NM|21612-7^reported patient age^LN||47|yr^yearÂNSI+||<hex 0D0A>
OBX|2|TX|11294-6^Current employment^LN||laboratory technician||<hex 0D0A>
OBX field definitions
OBX.1 Set ID - observation simple (SI-4, Optional) 00569
Definition: This field contains the sequence number. There can be many OBX’s per OBR. The
set ID allows the receiver to maintain the relational aspects of the message.
This field can be used to track a number of results within one test panel. For example,
OBR|1||Hepatitis Panel||...
OBX|1|NM|LOINC Code for result 1||...
OBX|2|NM|LOINC Code for result 2||...
OBX.2 Value type (ID-3, Conditional) 00570
Definition: This field contains the data type that defines the format of the observation value in
OBX-5. An explanation of possible data types is given in Appendix D.
The value of an ID data type follows the formatting rules for an ST data type except that it is drawn from a
table of HL7 legal values.
This field contains the data type of the observation value reported in OBX-5. For instance, if the value in
OBX-2 is “CE”, then the result reported in OBX-5 must be a coded element. When the value type is TX or
FT, then the results in OBX-5 are bulk text. The choices allowed for the value type of an observation are
listed in HL7 Table 0125 - Value type. All HL7 data types are valid in this field except CM, CQ, SI and ID.
TX should not be used except to send large amounts of text. ST should be used to send short, and
possibly encodable, text strings. For laboratory-based reporting, the CE and SN data types should be
used whenever possible so that results can be interpreted easily
When no standard format for the reported result is available, it is recommended to use: (see OBX-5 for
additional explanation)
1) CE with subsequent NTE for non-standard coded results where the result is a text blob

2) TX for results that are truly free text
Observations that are usually reported as numbers will sometimes have the string (ST) data type because
non-numeric characters are often reported as part of the result, e.g., “<0.06" to indicate the result was
lower than detected by the present mechanism. In the example, "<0.06," "<" is a text symbol and the digit,
“0.06" is considered a numeric value. However, this usage of the ST type should be discouraged since the
SN (structured numeric) data type now accommodates such reporting. The SN data type is described
under OBX-5 below.
OBX.3 Observation identifier (CE-590, Required) 00571
Definition: This field contains a unique identifier for the result being reported.
For reporting of laboratory results, OBX-3 is the specific test that has been performed. Because OBX-3 is
designated as a coded element, different coding schemes can be used to describe the test or observation
in OBX-3. The description in OBX-3 essentially “points” to a master observation table that may provide
other attributes of the observation to be used by the receiving system to process the message. For
laboratory-based reporting, it is necessary for the observation to have a code in OBX-3 that can be easily
interpreted by the public health application receiving the message. For this reason, the laboratory-
based reporting message strongly recommends that LOINC® (discussed below) be used as the
coding system in OBX-3 for reporting tests that identify cases of illness that are reportable to
public health agencies. This decision was made to minimize any ambiguity in reporting test results.
Thus, whenever possible, OBX-3 should be used as the informative element of the ORU, the focal point of
the report. In other words, it is strongly recommended that OBX-3 be populated with as specific a LOINC®
code as possible to prevent any misinterpretation of reported results.
Following this method, the first component of the field is the Logical Observation Identifiers Names and
Codes® (LOINC®) code for a test which has been performed and which will have its individual results
reported in the OBX segment described later. The second component is the name of the test as it
appears in the LOINC® coding system. The third component is a code representing the name of the
coding system that has the table where the codes and names of the tests can be found e.g., LN is the
code for LOINC®. Coding systems other than LOINC®, such as SNOMED® (the Systematized
Nomenclature of Human and Veterinary Medicine) or local codes can be used for OBR-4. The codes for
identifying coding systems are found in the HL7 Standard Version 2.3.1 at section 7.5.4. Codes that we
anticipate for use in public health reporting are shown in Appendix C, User Table 0396.
®
LOINC (Logical Observation Identifier Names and Codes) is a collection of tables which provide sets
®
of universal names and ID codes for identifying laboratory and clinical test results. The LOINC codes
are not intended to transmit all possible information about a test. They are only intended to identify
®
the test result. The level of detail in the LOINC definitions was intended to distinguish tests that are
usually distinguished as separate test results within the master file of existing laboratory systems. For
®
laboratory-based reporting of public health information, a subset of LOINC codes has been selected
®
and will be made available at the CDC web site. General information about LOINC codes can be
found at: http://www.regenstrief.org
LOINC® codes are not recommended for pathology reports for cancer registries.
Some reports currently cannot be described with OBX-3 alone, for instance, the initial identification of an
organism may have an OBX-3 which is general, such as “Microbial Culture.” In this setting, OBX-5 would
identify the specific organism that has triggered a report to be sent to a public health agency, such as
“Neisseria meningitidis”. Another example would be reporting of antimicrobial sensitivity results where it is
necessary to use OBR-26 (Parent Result) which identifies the organism on which testing was performed.
However, it is still strongly recommended to use LOINC® codes for OBX-3 even if the chosen term is not
organism-specific.
An example for a Hepatitis A Virus result is:

|5182-1^Hepatitis A Virus IgM Serum Antibody EIA^LN|
where <5182-1> is the identifier from the LOINC® table for the Enzyme Immunoassay for Hepatitis A Virus
IgM antibody, <Hepatitis A Virus IgM Serum Antibody EIA> is the text name as it appears in the table, and
<LN> is the name of the coding system. Any further description of the testing may appear in OBX-17
Observation method but is not required. For antimicrobial susceptibility testing, the antimicrobial test for
which minimum inhibitory concentrations (MICs) have been performed may appear as:
|524-9^Vancomycin Susceptibility MIC^LN|
where <524-9> is the identifier from the LOINC® table for the vancomycin MIC test,
<Vancomycin Susceptibility MIC> is the text name as it appears in the table, and <LN> represents the
name of the coding system.
An example for coding a report of lead level from a capillary blood specimen:
|10368-9^Quantitative Blood Lead^LN|
For reporting an isolate of Neisseria meningitidis, OBX-3 would have the test which yielded the isolate.
The result of the culture (i.e., the growth of Neisseria meningitidis) would be reported in OBX-5 below.
OBX-3 would appear as:
|600-7^Microorganism identified, Blood Culture^LN|
For public health reporting, patient age is sometimes needed when the birth date may not be available.
The PID segment in HL7 Version 2.3.1 has only a field for date of birth, not for patient age. Many
applications compute patient age based on birth date. In the absence of birth date, patient age may be
recorded within an ORU message in an additional OBR/OBX combination of segments. This usage is
shown in the example of a complete ORU message in Appendix A. The suggested data type for patient
age is NM, which is recorded in OBX-2. The LOINC® code for age is represented in OBX-3 and actual
age is represented in OBX-5. Patient age can be ‘reported age’ at the time of diagnosis (LOINC® code
21612-7) or ‘estimated age’ (LOINC® code 21611-9). For situations where birth date is unknown, age may
be estimated by a third party on the basis of physical evidence.
A similar method may be used to record employment information that is not otherwise available in an ORU
message. Several different LOINC® codes identifying History of Occupation, Usual Occupation, Current
Employment, Age at Diagnosis, Industry etc., are available. The appropriate LOINC® code should be
represented when sending patient employment information. This usage is shown in the example of a
complete ORU message on page A-1 of Appendix A.
OBX.4 Observation sub-ID (ST-20, Conditional) 00572
Definition: This field is used to distinguish between multiple OBX segments with the same
observation ID organized under one OBR. For example, a blood culture may have three different
organisms growing or a chest X-ray report might include three separate diagnostic impressions.
The standard requires three OBX segments, one for each impression. By recording 1 in the Sub-
ID of the first of these OBX segments, 2 in the second, and 3 in the third, each OBX segment can
be uniquely identified for editing or replacement. The sub-identifier can be further extended by
adding decimals (e.g., 2.1, 2.2). It is strongly recommended that numeric values be used for
laboratory-based reporting so that receiving applications can maintain easily the relational quality
of the data.
The sub-identifier is also used to group related components in reports such as surgical pathology. It is
traditional for surgical pathology reports to include all the tissues taken from one surgical procedure in one
report. Consider, for example, a single surgical pathology report that describes the examination of
gallbladder and appendix tissue. This report would be transmitted roughly as shown below.

Example of sub-identifier usage:
OBR|1|||88304&Surg Path Report...

OBX|1|CE|88304&ANT|1|T57000^GallBladder^SNM...
OBX|2|TX|88304&GDT|1|This is a normal gallbladder...
OBX|3|TX|88304&MDT|1|Microscopic exam shows histologically normal gallbladder...
OBX|4|CE|88304&IMP|1|M-00100^NML^SNM...
OBX|5|CE|88304&ANT|2|T66000Âppendix^SNM...
OBX|6|TX|88304&GDT|2|This is a red, inflamed, swollen, boggy appendix …
OBX|7|TX|88304&MDT|2|Infiltration with many PMN's – Indicating inflamatory change...
OBX|8|CE|88304&IMP|2|M-40000ÎnflammationNOS^SNM...
The example above has two segments for each component of the report, one for each of the two tissues,
the gall bladder and the appendix. Thus, there are two |88304&ANT| segments; there are two
|88304&GDT| segments, and there are two |88304&MDT| segments. Segments that apply to the
gallbladder all have the sub-identifier 1. Segments that apply to the appendix all have sub-identifier 2.
The use of the sub ID to distinguish repeating OBXs for the same observation ID is really a special case of
using the sub ID to group related subdivisions of information within the overall observation category. Its
use must be carefully structured to avoid introducing ambiguities.
Refer to the 2.3.1 Microbiology Implementation Specifications for an explanation of how to use OBR-26 to
link information reported under OBR|1| to the parent results from OBX-3, 4, and 5.
OBX.5 Observation value (*Data type varies, User-assigned, Conditional, Not Supporting
Repeats 00573
Definition: The results of the test appear here. For laboratory-based reporting, SNOMED® is
strongly recommended for OBX-5 whenever the CE data type is indicated in OBX-2.
If CE appears in OBX-2, it is assumed that the result in OBX-5, components 1,2,and 3, is coded using
SNOMED®. For numeric results, the SN data type is preferred for OBX-2, and thus, SNOMED® is not
required. OBX-5 may have either the SNOMED® code for “positive” or the SNOMED®-specific names of
organisms identified in the tests described in OBX-3. It is strongly recommended that the SNOMED® code
be used for the modifiers “positive,” “negative,” and “indeterminate.” Other modifiers should be avoided
such as “limited findings,” “insufficient specimen,” “patient not at bedside,” or “see technician.”, especially
since these modifiers are more internal to the Laboratory Information System Further information on
SNOMED® can be found at the SNOMED® Internet site at http://www.snomed.org.
For reporting to public health jurisdictions, the Centers for Disease Control and Prevention (CDC)
will authorize and distribute a subset of SNOMED® codes to third party reporting entities. An
authorization to use these codes without charge can be obtained from CDC by contacting the
Integrated Health Information Systems Office at 404-639-7438.
For example, when a Hepatitis A Virus IgM antibody has been identified in a reference laboratory, a report
for a public health agency is triggered. The OBX-3 would contain the code for the Hepatitis A IgM test and
OBX-5 would indicate that the test was positive. The OBX segment would appear as:
OBX|1|CE|5182-1^Hepatitis A Virus IgM Serum Antibody EIA^LN||G-A200^Positive^SNM|...
where OBX-3 uses a LOINC® code and OBX-5 uses a SNOMED® code.
For antimicrobial susceptibility testing, the OBX segment would appear as:
OBX|1|SN|7059-9^Vancomycin Susceptibility, Gradient Strip^LN||<^1|...
where OBX-3 uses a LOINC® code and OBX-5 has a numeric value. The value type listed in
OBX-2 determines the structure of the reported result here (i.e., SN) and thus, SNOMED® is not

recommended in this example. The SN data type has the following structure:
<comparator> ^ <num1(NM)> ^ <separator or suffix> ^ <num2 (NM)>
Some examples of the SN representation are:

|>^100| Greater than 100
|^100^-^200| equal to range of 100 through 200
|^1^:^228| ratio of 1 to 128 (e.g., the results of a serological test)
|^2^+| categorical response (e.g., an interpretation of occult blood positivity)
For results of a culture that yielded Neisseria meningitides, OBX-2 would be listed as a coded element
(CE) and OBX-5 would appear as:
|L-22202^Neisseria meningitidis^SNM|
It is strongly recommended that the data types CE and SN be used whenever possible to minimize
ambiguity in reporting. In those cases where laboratories have a local code which represents a canned
comment, the local code can be placed in OBX5 as a CE data type, and the canned comment can be
placed in an NTE directly following the OBX segment. For example:
OBX|1|CE|600-7^Microorganism identified, Blood Culture^LN||^^^SALMPRES^^L|...

NTE|1|L|Numerous colonies of Salmonella were present on culture. A sub-
NTE|2|L|culture was inoculated and sent for further species identification.
For true free text results, i.e., those for which no local code is available, the TX data type should be used.
For example:
OBX|1|TX|600-7^Microorganism identified, Blood Culture^LN|1|Many colonies of Neisseria|…

OBX|2|TX|600-7^Microorganism identified, Blood Culture^LN|1|meningitidis were found on|…
OBX|3|TX|600-7^Microorganism identified, Blood Culture^LN|1|organism-specific culture|…
OBX|1|TX|600-7^Microorganism identified, Blood Culture^LN|1|media|…
An example of a complete OBX segment coded for reported age of the patient at the time of diagnosis
would appear as:
OBX|1|NM|21612-7^reported patient age^LOINC||47|yr^yearÂNSI+||<hex 0D0A>
Similarly, a complete OBX segment for patient employment would appear as:
OBX|2|TX|11294-6^Current employment^LN||coal miner||||||F<hex 0D0A>
OBX.6 Units (CE-60, Optional) 00574
Definition: This field contains the units for the observation value in OBX-5. The default value is an
ISO+abbreviation. The ISO+ and ANSI+ customary units are shown in Section 7.3.2.6.2 of the
HL7 Version 2.3.1 standard.
For example: |µg/mL^microgram/milliliterÎSO+|
The units for age would be yr, wk, mo, d (in ANSI+ standards representation) in OBX-6.
For example:
|mo^monthÂNSI+|
OBX.7 References range (ST-60, Optional) 00575

Definition: When the observation quantifies the amount of a toxic substance, then the upper limit
of the range identifies the toxic limit. If the observation quantifies a drug, the lower limits identify
the lower therapeutic bounds and the upper limits represent the upper therapeutic bounds above
which toxic side effects are common.
If numeric, the values of this field may report several values in one of the following three formats:
lower limit-upper limit when both lower and upper limits are defined,
e.g., for potassium "3.5 - 4.5"
> lower limit if no upper limit, e.g., ">10"
< upper limit if no lower limit, e.g., "<15"
If alphabetical, the normal value may be reported in OBX-7. For instance, the normal result on an assay
may be “pink”.
For example:
|1.1-8.0| portrays a normal (acceptable) range for an adult blood lead in certain states.
OBX.8 Abnormal flags (ID-5, Optional, Repeating not supported) 00576
Definition: This field contains the microbiology sensitivity interpretations. Refer to HL7 Table
0078 - Abnormal flags for valid entries.
Abnormal flags should be used for reporting microbiology sensitivity data. Abnormal flags for antimicrobial
sensitivity reporting should conform to the recommendations of National Committee of Clinical Laboratory
Standards (NCCLS, http://www.nccls.org). For most reported findings, the allowable values are S, I, or R,
and should be provided in addition to the numeric value in OBX-5. For ELR, when findings other than
susceptibility results are sent, the abnormal flag should be valued (e.g., "H", "N", or "A") to distinguish
between tests that are interpreted as normal and those that are interpreted as abnormal.
This field is not expected in this interface.
OBX.9 Probability (NM-5, Optional) 00577
Definition: This field contains the probability of a result being true for results with categorical
values. It mainly applies to discrete coded results. It is a decimal number represented as an
ASCII string that must be between 0 and 1, inclusive.
OBX.10 Nature of abnormal test (ID-2, Optional, Repeating) 00578
Definition: This field contains the nature of the abnormal test.
OBX.11 Observation result status (ID-1, Required) 00579
Definition: This field contains the observation result status. Refer to HL7 Table 0085 -
Observation result status codes interpretation for valid values. This field reflects the current
completion status of the results for data contained in the OBX-5-observation value field. It is a
required field. Previous versions of HL7 stated this implicitly by defining a default value of “F”
indicating that the result has been verified to be correct and final.
Example:
|OBX|1|…|C| portrays a corrected result in OBX-11.
OBX.12 Date last observation normal values (TS-26, Optional) 00580

Definition: This field contains the changes in the observation methods that would make values
obtained from the old method not comparable with those obtained from the new method. Null if
there are no normals or units. If present, a change in this date compared to date-time recorded,
the receiving system’s test dictionary should trigger a manual review of the results to determine
whether the new observation ID should be assigned a new ID in the local system to distinguish the
new results from the old.
OBX.13 User defined access checks (ST-20, Optional) 00581
Definition: This field permits the producer to record results-dependent codes for classifying the
observation at the receiving system. For ELR, this field should be populated with the reportable
condition if available.
OBX.14 Date-time of the observation (TS-26, Optional) 00582
Definition: Records the time of the observation. It is the physiologically relevant date-time or the
closest approximation to that date-time of the observation. This field is required in two
circumstances. The first is when the observations (OBX’s) reported beneath one report header
(OBR) have different dates, for instance when one measurement within a battery may have a
different time/date than another measurement.
For example: |200012161330| is the date/time when the result was read by the laboratory.
OBX.15 Producer's ID (CE-60, Optional) 00583
Definition: Contains a unique identifier of the responsible producing service. It should be included
for all ELR messages that are reported to public health agencies. For most reports the CLIA
identifier here will be identical to the CLIA identifier listed as the assigning facility in PID-3 (Patient
ID, Internal). When the test results are produced at outside laboratories, the CLIA identifier for the
laboratory that performed the test should appear here and will be different from the CLIA identifier
listed as the assigning facility in PID-3.
For example: |01D0301145^MediLabCo^CLIA|

or
|01D0301145|
OBX.16 Responsible observer (XCN-80, Optional, Repeating) 00584
Definition: This field contains the identifier of the individual directly responsible for the observation
(the person who either performed or verified it).
This field is not expected in the ELR message. A responsible observer would be listed in OBR - 31
OBX.17 Observation method (CE-60, Optional, Repeating) 00936
Definition: This field could be used to transmit the method or procedure by which an observation
was obtained when the sending system wishes to distinguish among one measurement obtained
by different methods and the distinction is not implicit in the test ID. There are no
recommendations for a code set to use.


3.3.4 Notes and Comments (NTE) Segment

The NTE segment is a common format for sending notes and comments. This optional, repeating
segment may be inserted after any of the OBX segments in the ORU message. The NTE segment
applies to the information in the segment that immediately precedes it, i.e., the observation
reported in the preceding OBX segment. The NTE segment is not further defined by HL7.
NTE attributes
SEQ HL7 NBS HL7 HL7 HL7 HL7 HL7 ELEMENT NAME ELR Usage
LEN LEN DT OPT RP/# TBL ITEM #
#
1 4 N/A SI O 00096 Set ID – NTE Supported
2 8 N/A ID O 0105 00097 Source of Comment Not used
3 64k FT O Y 00098 Comment Supported
4 60 N/A CE O 01318 Comment Type Not Supported
NTE field definitions
NTE.1 Set ID (SI-4, Optional) 00096
Definition: This field may be used where multiple NTE segments are included in a message.
Their numbering must be described in the application message definition.
NTE.2 Source of comment (ID-8, Optional) 00097
Definition: This field is used when source of comment must be identified. HL7-defined table 0105
Source of Comment may be extended locally during implementation.
NTE.3 Comment (FT-64k, Optional) 00098
Definition: This field contains the comment contained in the segment.
NTE.4 Comment type (CE-60, Optional) 01318
Definition: This field contains a value to identify the type of comment text being sent in the specific
comment record. Allowable values are given in User-defined table 0364 – Comment Type.

4 HL7 Batch Protocol

There are instances when it is convenient to transfer a batch of HL7 messages for reporting to public
health agencies. Such a batch could be sent online using a common FTP protocol, or offline via tape or
diskette.
4.1 HL7 batch file structure

A batch of HL7 messages may be sent online using a common file transfer protocol or offline via tape or
diskette. If needed, a group of batches may be sent using the file header and trailer segments. The FHS
and FTS are optional and need not be sent if the transaction is one batch of records. The file/batch syntax
follows:
[FHS] (file header segment)

{ [BHS] (batch header segment)
{ [MSH (zero or more HL7 messages)
PID
OBR
....
] }
[BTS] (batch trailer segment)
}
[FTS] (file trailer segment)
The sequence numbering protocol has a natural application in batch transfers. See the discussion
of batch acknowledgments that follows. A batch for reporting to public health agencies will consist of a
single type of message (i.e., ORU). Batches should usually contain at least one HL7 message. There are
only two cases in which an HL7 batch file may contain zero HL7 messages:
a) a batch containing zero HL7 messages may be sent to meet a requirement for periodic submission of
batches when there are no messages to send,
b) a batch containing zero negative acknowledgment messages may be sent to indicate that all the
HL7 messages contained in the batch being acknowledged are implicitly acknowledged. The attribute
tables and field definitions for batch-related segments are given below.
Related Segments and Data Usage
The following segments relate to the HL7 Batch Protocol: 1) BHS - Batch Header, 2) BTS -Batch Trailer, 3)
FHS - File Header, and 4) FTS - File Trailer. The BTS segment contains a field, BTS-3-batch totals, which
may have one or more totals drawn from fields within the individual messages. The method for computing
such totals resides with the sending facility.
All four of the File and Batch Header and Trailer segments are required when sending batches without
going through the PHIN-MS interface that resides on the Laboratory Trading Partners’ servers. If the
batch segments are sent through PHIN-MS translators, the interface will provide the appropriate segments
and batch counts that are used for processing the message through its transport lifecycle.
4.2 Acknowledging Batches

In general, the utility of sending batches of data is that the data is accepted all at once, with errors
processed on an exception basis. However, it is a permissible application of HL7 to acknowledge all
messages. Several options for acknowledgment are given in the HL7 2.3.1 standard document and are
not addressed further here.

4.3 Batch Segments

4.3.1 File Header (FHS) Segment
The FHS segment is used to head a file (group of batches). Ideally, a single sending facility, for instance a
regional laboratory could send a group of batches of reportable findings from separate laboratories within
the consortium. In this setting, each separate BHS would have a different CLIA identifier. The FHS would
have a different CLIA number as well, or would have the same CLIA number as the one batch that was
performed at the sending facility. This complexity of message processing is not common yet, either at
laboratories or public health agencies. The description of batch reporting in this guide demonstrates
reporting from a single facility and thus the CLIA number is the same for MSH, BHS, and FHS.
FHS Attributes
SEQ LEN DT R/O RP# TBL# ITEM# ELEMENT NAME ELR Usage
1 1 ST R 00067 File field separator Supported
2 4 ST R 00068 File encoding Supported
characters
3 15 ST O 00069 File sending Supported
application
4 20 ST O 00070 File sending facility Supported
5 15 ST O 00071 File receiving Supported

application
6 20 ST O 00072 File receiving facility Supported
7 26 TS O 00073 File creation Supported
date/time
8 40 ST O 00074 File security Not used
9 20 ST O 00075 File name/ID/type Supported
10 80 ST O 00076 File comment Not used
11 20 ST O 00077 File control ID Not used
12 20 ST O 00078 Reference file Not used
control ID
File header field definitions
Usage notes: FHS fields 1-8 have the same definitions as the corresponding fields in the MSH segment
and are not repeated here.
FHS.9 File name/ID (ST-20, Optional) 00075
Definition: This field can be used by the application processing file. Its use is not further
specified.
FHS.10 File header comment (ST-80, Optional) 00076
Definition: This field contains the free text field, the use of which is not further specified.
FHS.11 File control ID (ST-20, Optional) 00077
Definition: This field is used to identify a particular file uniquely. Use Timestamp plus a counter
similar to MSH-10 to uniquely identify the file here. It can be echoed back in FHS-12-reference
file control ID.
FHS.12 Reference file control ID (ST-20, Optional) 00078

Definition: This field contains the value of FHS-11-file control ID when this file was originally
transmitted. Not present if this file is being transmitted for the first time.
4.3.2 File Trailer (FTS)

Used to define the end of a file.
FTS Attributes
ELEMENT ELR Usage
SEQ LEN DT R/O RP# TBL# ITEM#
NAME
1 10 NM O 00079 File batch count Supported
2 80 ST O 00080 File trailer Not used
comment
FTS field definitions
FTS.1 File batch count (NM-10, Optional) 00079
Definition: This field contains the number of batches contained in the file.
FTS.2 File trailer comment (ST-80, Optional) 00080
Definition: The use of this free text field is not further defined in the HL7 protocol.
4.3.3 Batch Header (BHS) Segment

Used to define the start of a batch of ORU Unsolicited Laboratory Result messages being sent from a
Laboratory to a specific state.
BHS Attributes
SEQ LEN DT R/O RP# TBL# ITEM# ELEMENT NAME ELR Usage
1 1 ST R 00067 Batch field Supported
separator
2 4 ST R 00068 Batch encoding Supported
characters
3 15 ST O 00069 Batch sending Supported
application
4 20 ST O 00070 Batch sending Supported
facility
5 15 ST O 00071 Batch receiving Supported
application
6 20 ST O 00072 Batch receiving Supported
facility
7 26 TS O 00073 Batch creation Supported
date/time
8 40 ST O 00074 Batch security Not Used
9 20 ST O 00075 Batch name/ID/type Supported
10 80 ST O 00076 Batch comment Not used
11 20 ST O 00077 Batch control ID Not used
12 20 ST O 00078 Reference batch Not used
control ID
Batch Header field definitions

Usage notes: BHS fields 1-8 have the same definitions as the corresponding fields in the MSH segment
and are not repeated here. BHS segment was not shown in the examples, but the field definitions are
provided below for reference.
BHS.9 Batch name/ID/type (ST-20, Optional) 00089
Definition: This field can be used by the application processing the batch. It can have extra
components if needed.
BHS.10 Batch comment (ST-80, Optional) 00090
Definition: This field is a comment field that is not further defined in the HL7 protocol.
BHS.11 Batch control ID (ST-20, Optional) 00091
Definition: This field is used to uniquely identify a particular batch. Use Timestamp and a counter
similar to MSH-10 to uniquely identify the batch. It can be echoed back in BHS-12-reference
batch control ID if an answering batch is needed.
BHS.12 Batch reference batch control ID (ST-20, Optional) 00092
Definition: This field contains the value of BHS-11-batch control ID when this batch was originally
transmitted. This field is not valued if this batch is being sent for the first time.
4.3.4 Batch Trailer (BTS) Segment

Used to define the end of a batch.
BTS Attributes
SEQ LEN DT R/O RP# TBL# ITEM# ELEMENT NAME
1 10 ST O 00093 Batch message count
2 80 ST O 00094 Batch comment
3 100 NM O Y 00095 Batch totals
BTS field definitions
Usage notes: BTS segment was not shown in the examples, but the field definitions are provided below
for reference.
BTS.1 Batch message count (ST-10, Optional) 00093
Definition: This field contains the count of the individual messages contained within the batch.
BTS.2 Batch comment (ST-80, Optional) 00094
Definition: This field is a comment field that is not further defined in the HL7 protocol.
BTS.3 Batch totals (NM-100, Optional, Repeating) 00095
Definition: This field contains the batch total. The numbers of messages should be counted and
represented here to allow recipients to have simple batch level auditing.

5 APPENDIX A. HL7 Examples of Report Messages

Example messages for laboratory-based reporting of findings of public health importance.
Example 1: Hepatitis A Virus
MSH|^~\&||MediLabCo-Seattle^45D0470381^CLIA|WADOH|WA|199605171830||ORU^R01|
199605170123|P|2.3.1 <hex 0D0A>
PID|||10543^^^^^Columbia Valley Memorial Hospital&01D0355944&CLIA|95101100001^^^^^
MediLabCo- Seattle&45D0470381&CLIA||Doe^John^Q^Jr|Clemmons||M||W| 2166 Wells Dr
ÂptB^Seattle^WA^98109ÛSA^^^King||^PRN^PH^^^206^6793240|||M|||423523049|
DOEJ34556057^WA^19970801||N <hex 0D0A>
NK1|1|Doe^Jane^Lee^^^^L|SPO^spouse^HL70063|2166 Wells DrÂpt B^Seattle^WA^98109^
USA^M^^King^Â|^PRN^PH^^^206^6793240|<hex 0D0A>
ORC|||||||||||||||||||||MediLabCo - Northwest Pathology Ltd., Central Campus^^45D0470381^^^CLIA|2217
Rainier Way^^Renton^WA^98002ÛSA^M^^Black Hawk^Â|
^WPN^PH^[email protected]^^206^5549097 |115 Pike Plaza^Suite
2100^Seattle^WA^98122ÛSA^^^^Â|<hex 0D0A>
OBR|1||SER122145|^^^78334^Hepatitis Panel, Measurement^L|||199603210830 ||||||||BLDV|
^Welby^M^J^Jr^Dr^MD|^WPN^PH^^^206^4884144||||||||F <hex 0D0A>
OBX||CE|5182-1^Hepatitis A Virus, Serum Antibody EIA^LN||G-A200^Positive^SNM||||||F||
|199603241500|45D0480381 <hex 0D0A>
OBR|2|||Âdditional patient demographics|<hex 0D0A>
OBX|1|NM|21612-7^reported patient age^LN||47|yr^yearÂNSI+||<hex 0D0A>
OBX|2|TX|11294-6^Current employment^LN||food handler||<hex 0D0A>
Example 2: Lead
MSH|^~\&||MediLabCo-Seattle^45D0470381^CLIA|WADOH|WA|200112171830|
|ORU^R01|200112170897|P|2.3.1 <hex 0D0A>
PID|||10543^^^^^Columbia Valley Memorial Hospital&01D0355944&CLIA~95101100001^^^^^
MediLabCo-Seattle&45D0470381&CLIA||Doe^Jared^Q^Jr|Clemmons|19900602|M||W||
2166WellsDrÂptB^Seattle^WA^98109||^^^^^206^6793240|||M|||423523049|||N <hex 0D0A>
NK1|1|Doe^Jane^Lee^^^^L|MTH^Mother^HL70063|2166 Wells DrÂpt B^Seattle^WA^98109^
USA^M^^King^Â|^PRN^PH^^^206^6793240|<hex 0D0A>
ORC|||||||||||||||||||||MediLabCo - Northwest Pathology Ltd., Central Campus^^45D0470381^^^CLIA|2217
Rainier Way^^Renton^WA^98002ÛSA^M^^Black
HawkÂ|^WPN^PH^[email protected]^^206^5549097|115 Pike Plaza^Suite
2100^Seattle^WA ^98122ÛSA^^^Â|<hex 0D0A>
OBR|1||CHEM9700122|^^^3456543^Blood lead test^L|||200111270930||||||||BLDC^Blood capillary
|^Welby^M^J^Jr^Dr^MD|^WPN^PH^^^206^4884144||||||||F <hex 0D0A>
OBX||SN|10368-9^Quantitative Blood Lead^LN||^45|µg/dL|||||F|||200111300800|
45D0480381<hex 0D0A>

6 APPENDIX B: Code Tables

NOTE: Where only selected values are listed for HL7 tables, please refer to the HL7 Standard for
complete listings. In this appendix, values are selected from standard codes where available. Values that
are assigned by NIP are italicized.
User-defined Table 0001 - Sex [values suggested by HL7] (use in PID-8, NK1-15)
Value Description
F Female
M Male
H Hermaphrodite, Undetermined
T Transsexual
O Other
U Unknown
User-defined Table 0002 – Marital Status (use in PID-16)
Value Description
A Separated
D Divorced
M Married
S Single
W Widowed
User-defined Table 0005 - Race [These values are compliant with OMB directive for combined
format] (use in PID-10)
Value Description
I American Indian or Alaska Native
A Asian
P Native Hawaiian or Other Pacific Islander
B Black or African-American
W White
H Hispanic or Latino
O Other
U Unknown
User-defined Table 0063 - Relationship (From HL7 standard, Version 2.3.1) (use in NK1-3, NK1-31,
IN1-17, IN2-62)
Value Description
ASC Associate
BRO Brother
CGV Care giver
CHD Child
DEP Handicapped dependent
DOM Life partner
EMC Emergency contact
EME Employee
EMR Employer
EXF Extended family
FCH Foster child
FND Friend
Value Description
FTH Father
GCH Grandchild
GRD Guardian
GRP Grandparent
MGR Manager
MTH Mother
NCH Natural child
NON None
OAD Other adult
OTH Other
OWN Owner
PAR Parent
SCH Stepchild
SEL Self
SIB Sibling
SIS Sister
SPO Spouse
TRA Trainer
UNK Unknown
WRD Ward of court
HL7-defined Table 0070 – Specimen Source Codes (use in OBR-15)
Value Description
ABS Abscess
AMN Amniotic fluid
ASP Aspirate
BPH Basophils
BIFL Bile fluid
BLDA Blood arterial
BBL Blood bag
BLDC Blood capillary
BPU Blood product unit
BLDV Blood venous
BON Bone
BRTH Breath (use EXHLD)
BRO Bronchial
BRN Burn
CALC Calculus (=Stone)
CDM Cardiac muscle
CNL Cannula
CTP Catheter tip
CSF Cerebral spinal fluid
CVM Cervical mucus
CVX Cervix
COL Colostrum
CBLD Cord blood
CNJT Conjunctiva
CUR Curettage
CYST Cyst
DIAF Dialysis fluid
DOSE Dose med or substance
DRN Drain
Value Description
DUFL Duodenal fluid
EAR Ear
EARW Ear wax (cerumen)
ELT Electrode
ENDC Endocardium
ENDM Endometrium
EOS Eosinophils
RBC Erythrocytes
EYE Eye
EXHLD Exhaled gas (=breath)
FIB Fibroblasts
FLT Filter
FIST Fistula
FLU Body fluid, unsp
GAS Gas
GAST Gastric fluid/contents
GEN Genital
GENC Genital cervix
GENL Genital lochia
GENV Genital vaginal
HAR Hair
IHG Inhaled Gas
IT Intubation tube
ISLT Isolate
LAM Lamella
WBC Leukocytes
LN Line
LNA Line arterial
LNV Line venous
LIQ Liquid NOS
LYM Lymphocytes
MAC Macrophages
MAR Marrow
MEC Meconium
MBLD Menstrual blood
MLK Milk
MILK Breast milk
NAIL Nail
NOS Nose (nasal passage)
ORH Other
PAFL Pancreatic fluid
PAT Patient
PRT Peritoneal fluid /ascites
PLC Placenta
PLAS Plasma
PLB Plasma bag
PLR Pleural fluid (thoracentesis fld)
PMN Polymorphonuclear neutrophils
PPP Platelet poor plasma
PRP Platelet rich plasma
PUS Pus
RT Route of medicine
Value Description
SAL Saliva
SEM Seminal fluid
SER Serum
SKN Skin
SKM Skeletal muscle
SPRM Spermatozoa
SPT Sputum
SPTC Sputum - coughed
SPTT Sputum - tracheal aspirate
STON Stone (use CALC)
STL Stool = Fecal
SWT Sweat
SNV Synovial fluid (Joint fluid)
TEAR Tears
THRT Throat
THRB Thrombocyte (platelet)
TISS Tissue
TISG Tissue gall bladder
TLGI Tissue large intestine
TLNG Tissue lung
TISPL Tissue placenta
TSMI Tissue small intestine
TISU Tissue ulcer
TUB Tube NOS
ULC Ulcer
UMB Umbilical blood
UMED Unknown medicine
URTH Urethra
UR Urine
URC Urine clean catch
URT Urine catheter
URNS Urine sediment
USUB Unknown substance
VOM Vomitus
BLD Whole blood
BDY Whole body
WAT Water
WICK Wick
WND Wound
WNDA Wound abscess
WNDE Wound exudate
WNDD Wound drainage
XXX To be specified

HL7-defined Table 0078 - Abnormal flags (use in OBX-8)
Value Description
L Below low normal
H Above high normal
LL Below lower panic limits
HH Above upper panic limits
< Below absolute low-off instrument scale
> Above absolute high-off instrument scale
N Normal (applies to non-numeric results)
A Abnormal (applies to non-numeric results)
AA Very abnormal (applies to non-numeric units, analogous to panic limits for numeric units)
null No range defined, or normal ranges don't apply
U Significant change up
D Significant change down
B Better--use when direction not relevant
W Worse--use when direction not relevant
For microbiology susceptibilities only:
S Susceptible*
R Resistant*
I Intermediate*
MS Moderately susceptible*
VS Very susceptible*
HL7-defined Table 0085 - Observation result status codes interpretation (use in OBX-11)
Value Description
C Record coming over is a correction and thus replaces a final result
D Deletes the OBX record
F Final results; Can only be changed with a corrected result
I Specimen in lab; results pending
N Not asked; used to affirmatively document that the observation identified in the OBX was
not sought when the universal service ID in OBR-4 implies that it would be sought
O Order detail description only (no result)
P Preliminary results
R Results entered - not verified
S Partial results
X Results cannot be obtained for this observation
U Results status change to Final without re-transmitting results already sent as 'preliminary.'
e.g., radiology changes status from preliminary to final
W Post original as wrong; e.g., transmitted for wrong patient
HL7-defined Table 0103 - Processing ID (use in MSH-11)
Value Description
D Debugging
P Production
T Training
HL7-defined Table 0104 - Version ID (use in MSH-12)
Value Description
2.0 Release 2.0 September 1988
2.0D Demo 2.0 October 1988
2.1 Release 2.1 March 1990
2.2 Release 2.2 December 1994
2.3 Release 2.3 March 1997
2.3.1 Release 2.3.1May 1999
2.3.1 Release 2.3.1 October 2000
HL7-defined Table 0105 - Source of comment (use in NTE-2)
Value Description
L Ancillary (filler) department is source of comment
P Orderer (placer) is source of comment
O Other system is source of comment
HL7- Defined Table 0123 – Result Status (use in OBR-25)
Value Description
O Order received; specimen not yet received
I No results available; specimen received, procedure incomplete
S No results available; procedure scheduled, but not done
A Some, but not all, results available
P Preliminary: A verified early result is available, final results not yet obtained
C Correction to results
C Correction to results
R Results stored; not yet verified
F Final results; results stored and verified. Can only be changed with a corrected result.
X No results available; Order canceled.
Y No order on record for this test. (Used only on queries)
Y No order on record for this test. (Used only on queries)
Z No record of this patient. (Used only on queries)
HL7-defined Table 0125 – Value Type (use in OBX-2)

Value type Description
AD Address
CE Coded Entry
CF Coded Element With Formatted Values
CK Composite ID With Check Digit
CN Composite ID And Name
CP Composite Price
CX Extended Composite ID With Check Digit
DT Date
ED Encapsulated Data
FT Formatted Text (Display)
MO Money
NM Numeric
PN Person Name
RP Reference Pointer
SN Structured Numeric
ST String Data.
TM Time
TN Telephone Number
TS Time Stamp (Date & Time)
TX Text Data (Display)
XAD Extended Address
Value type Description
XCN Extended Composite Name And Number For Persons

XON Extended Composite Name And Number For Organizations
XPN Extended Person Name
XTN Extended Telecommunications Number
HL7-defined Table 0136 - Yes/No indicator (use in PID-24,30)
Value Description
Y Yes
N No
“”<null> Not obtained (when used by immunization registries as defined in PD1-12)
HL7-defined Table 0163 - Administrative Site [only selected values listed] (use in RXR-2)
Value Description
LT Left Thigh
LA Left Arm
LD Left Deltoid
LG Left Gluteous Medius
LVL Left Vastus Lateralis
LLFA Left Lower Forearm
RA Right Arm
RT Right Thigh
RVL Right Vastus Lateralis
RG Right Gluteous Medius
RD Right Deltoid
RLFA Right Lower Forearm
User-defined Table 0189 - Ethnic Group [These values are compliant with the OMB directive] (use in
PID-22)
Value Description
H Hispanic or Latino
NH not Hispanic or Latino
U Unknown
HL7-defined Table 0190 - Address type (use in all XAD data types; including PID-11)
Value Description
C Current or Temporary
P Permanent
M Mailing
B Firm/Business
O Office
H Home
N Birth (nee)
F Country of Origin
L Legal Address
BLD Birth delivery location [use for birth facility]
BR Residence at birth [use for residence at birth]
RH Registry home
BA Bad address

HL7-defined Table 0200 - Name type (use in all XCN, XPN data types; including PID-5,6,9)
Value Description
A Alias Name
L Legal Name
D Display Name
M Maiden Name
C Adopted Name
B Name at Birth
P Name of Partner/Spouse
U Unspecified
HL7-defined Table 0201 - Telecommunication use code (use in all XTN data types; including PID-
13,14)
Value Description
PRN Primary Residence Number
ORN Other Residence Number
WPN Work Number
VHN Vacation Home Number
ASN Answering Service Number
EMR Emergency Number
NET Network (email) Address
BPN Beeper Number
HL7-defined Table 0202 - Telecommunication equipment type (use in all XTN data types; including
PID-13, 14)
Value Description
PH Telephone
FX Fax
MD Modem
CP Cellular Phone
BP Beeper
Internet Internet Address: Use Only if Telecommunication Use Code is NET
X.400 X.400 email address: Use Only if Telecommunication Use Code is NET
User-defined Table 0203 - Identifier type [values suggested by HL7; with NIP-suggested additions] (use
in all CX, XCN type codes; including PID-2,3,4,18,21)
Value Description
AM American Express
AN Account Number
ANON Anonymous Identifier
BR Birth Registry Number
DI Diner's Club Card
DL Driver's License Number
DN Doctor Number
DS Discover Card
EI Employee Number
EN Employer Number
FI Facility Identifier
GI Guarantor Internal Identifier
GN Guarantor External Identifier

Value Description
LN License Number
LR Local Registry ID
MS MasterCard
MA Medicaid Number
MC Medicare Number
MR Medical Record Number
NE National Employer Identifier
NH National Health Plan Identifier
NI National Unique Individual Identifier
NPI National Provider Identifier
PI Patient Internal Identifier
PN Person Number
PRN Provider Number
PT Patient External Identifier
RRI Regional Registry ID
RR Railroad Retirement Number
SL State License
SR State Registry ID
SS Social Security Number
U Unspecified
UPIN Medicare/HCFA's Universal Physician ID Numbers
VS VISA
VN Visit Number
WC WIC Identifier
XX Organization Identifier
VEI Vaccinator Employee Number
OEI Orderer Employee Number
REI Recorder Employee Number
User-defined Table 0204 - Organizational name type [values suggested by HL7] (use in all XON data
types)
Value Description
A Alias Name
L Legal Name
D Display Name
SL Stock Exchange Listing Name
HL7-defined Table 0207 - Processing mode (use in MSH-11)
Value Description
A Archive
R Restore from archive
I Initial load
<blank> Not present (the default, meaning current processing)
User-defined Table 0289 - County/parish (use in all XAD; including PID-11)

A complete list of FIPS 6-4 county codes is available at <www.itl.nist.gov/div897/pubs/fip6-4.htm>.
According to the FIPS guidance, the 2-letter state code (available at <www.itl.nist.gov/div897/pubs/fip5-
2.htm>) plus the numeric county code should be used (e.g., AZ001 represents Apache County, Arizona
and AL001 represents Autauga County, Alabama).
User-defined Table 0360 - Degree [selected values suggested by HL7; with NIP-suggested additions]
(use in all XPN data types, including PID-5,6,9)
Value Description
PN Advanced Practice Nurse
AA Associate of Arts
AAS Associate of Applied Science
AS Associate of Science
BA Bachelor of Arts
BN Bachelor of Nursing
BS Bachelor of Science
BSN Bachelor of Science in Nursing
CER Certificate
CANP Certified Adult Nurse Practitioner
CMA Certified Medical Assistant
CNP Certified Nurse Practitioner
CNM Certified Nurse Midwife
CNA Certified Nurse’s Assistant
CRN Certified Registered Nurse
CNS Certified Nurse Specialist
CPNP Certified Pediatric Nurse Practitioner
DIP Diploma
PHD Doctor of Philosophy
MD Doctor of Medicine
DO Doctor of Osteopathy
EMT Emergency Medical Technician
EMT-P Emergency Medical Technician - Paramedic
FPNP Family Practice Nurse Practitioner
HS High School Graduate
JD Juris Doctor
LPN Licensed Practical Nurse
MA Master of Arts
MBA Master of Business Administration
MPH Master of Public Health
MS Master of Science
MSN Master of Science – Nursing
MDA Medical Assistant
MT Medical Technician
NG Non-Graduate
NP Nurse Practitioner
PharmD Doctor of Pharmacy
PA Physician Assistant
PHN Public Health Nurse
RMA Registered Medical Assistant
RN Registered Nurse
RPH Registered Pharmacist
SEC Secretarial Certificate
TS Trade School Graduate
User-defined Table 0361 – Sending/receiving application (use in MSH-3, MSH-5, FHS-3, FHS-5,
BHS-3, BHS-5) [locally-defined]
User-defined Table 0364 – Comment Type (use in NTE-4)
Value Description
PI Patient Instructions
AI Ancillary Instructions
GI General Instructions
1R Primary Reason
2R Secondary Reason
GR General Reason
RE Remark
DR Duplicate/Interaction Reason
User-defined Table 0396 – Coding System [Only selected values listed] [From HL7 Standard, Version
2.3.1] (Use in OBR-4, 26, OBX-3, 5,17)
Value Description
99zzz or L Local general code (where z is an alphanumeric character)
ART WHO Adverse Reaction Terms
C4 CPT-4
C5 CPT-5
CDCA CDC Analyte Codes
CDCM CDC Methods/Instruments Codes
CDS CDC Surveillance
CPTM CPT Modifier Code
CST COSTART
CVX CDC Vaccine Codes
E EUCLIDES
E5 Euclides quantity codes
E6 Euclides Lab method codes
E7 Euclides Lab equipment codes
ENZC Enzyme Codes
HB HIBCC
HCPCS HCFA Common Procedure Coding System
HHC Home Health Care
HL7nnnn HL7 Defined Codes where nnnn is the HL7 table number
HPC HCFA Procedure Codes (HCPCS)
I10 ICD-10
I10P ICD-10 Procedure Codes
I9 ICD9
I9C ICD-9CM
ISOnnnn ISO Defined Codes where nnnn is the ISO table number
LB Local billing code
LN Logical Observation Identifier Names and Codes (LOINC®)
MCD Medicaid
MCR Medicare
MEDR Medical Dictionary for Drug Regulatory Affairs (MEDDRA)
MVX CDC Vaccine Manufacturer Codes
NDC National drug codes
NPI National Provider Identifier
SNM Systemized Nomenclature of Medicine (SNOMED®)
SNM3 SNOMED International
SNT SNOMED topology codes (anatomic sites)
UML Unified Medical Language
UPC Universal Product Code
UPIN UPIN
W1 WHO record # drug codes (6 digit)
W2 WHO record # drug codes (8 digit)
W4 WHO record # code with ASTM extension
WC WHO ATC

HL7-defined Table 4000 - Name/address representation (use in all XPN, XAD data types) (PID-
5,6,9,11)
Value Description
I Ideographic (e.g., Kanji)
A Alphabetic (e.g., Default or some single-byte)
P Phonetic (e.g., ASCII, Katakana, Hirigana, etc.)

7 APPENDIX C: Data Types used in this Implementation
HL7 Data Description Notes

Ref# Type
2.8.3 CE - coded This data type transmits codes and the text associated with the code. For HL7-defined tables, the
element To allow all six components of a CE data type to be valued, the third component, name of
with suggested length of a field of this data type is at least 60. coding system, is constructed
formatted by appending the table
values Components: number to the string “HL7.”
<identifier (ST)>^<text (ST)>^<name of coding system (ST)>^ For example, the HL7 table
<alternate identifier (ST)>^<alternate text (ST)> ^<name of alternate number 0163 would be
coding system (ST)> designated in the “name of
Components are defined as follows: coding system” component
(1) Identifier (ST). The code that uniquely identifies the item as “HL70163.”
being referenced by the <text>. Different coding schemes will
have different elements here. The second set of codes
(2) Text (ST). Name or description of the item in question. must carry the same
Name of coding system (ST). Identifies the coding system meaning as the first set. For
used. The combination of the identifier and the name of the example, for immunization
coding system components will be a unique code for a data data, a first set using CVX
item. codes followed by a second
(4-6) Three components analogous to 1-3 for the alternate or local set using CPT codes may be
coding system. used to record the
administration of a single
vaccine.
The presence of two sets of

equivalent codes in this data
type is semantically different
from a repetition of a CE-type
field. With repetition, several
distinct codes (with distinct
meanings) may be
transmitted.
2.8.5 CK - Components: <ID number (NM)>^<check digit (NM)>^<code This data type is used for
composite identifying the check digit scheme employed (ID)>^<assigning certain fields that commonly
ID with authority (HD)> contain check digits, e.g.,
check digit Components are defined as follows: PID-3-Patient identifier list. If
(1) ID number (NM). a user is not using check
(2) Check digit (NM). This is the check digit that is part of the digits for a CK field, the
identifying number used in the sending application. If the second and third components
sending application does not include a self-generated check are not valued.
digit in the identifying number, this component should be
valued null.
(3) Code identifying the check digit scheme employed (ID).
Check digit scheme codes are defined in HL7 Table 0061 -
Check digit scheme. Note: Mod 10 and Mod 11 check digit
algorithms are defined in the HL7 Standard Section 2.8.5.3.
CN - Components: <ID number (ST)> ^ <family name (ST)> ^ <given name
2.8.7 Composite (ST)> ^ <middle initial or name (ST)> ^ <suffix (e.g., JR or III) (ST)> ^
ID number <prefix (e.g., DR) (ST)> ^ <degree (e.g., MD) (ST)> ^ <source table
and name (IS)> ^ <assigning authority (HD)>
2.8.6 CM - A field that is a combination of other meaningful data fields. Each The CM data type is
composite portion is called a component. The specific components of CM fields maintained strictly for
are defined within the field descriptions. backward compatibility and
may not be used for the
definition of new fields.
2.8.9 CP - Components: <price (MO)>^<price type (ID)>^<from value (NM)>^<to See HL7 Standard for
composite value (NM)>^<range units (CE)>^<range type (ID)> component definitions.
price
2.8.10 CQ - Components: <quantity (NM)>^<units (CE)> Future use of this data type
composite will be avoided because the
quantity same information can be sent
with units as a CE data type.

Ref# Type
2.8.12 CX - Components: <ID (ST)>^<check digit (ST)>^<code identifying the Refer to User-defined Table
extended check digit scheme employed (ID)>^<assigning authority 0203 - Identifier type for
composite (HD)>^<identifier type code (IS)>^<assigning facility (HD)> suggested values for
ID with Components are defined as follows: component 5.
check digit (1) ID (ST).
(2) Check digit (ST). Defined as in the CK data type except as a
The check digit used in this data type is not an add-on produced
by the message processor. It is the check digit that is part of
the identifying number used in the sending application. If the
sending application does not include a self-generated check digit
in the identifying number, this component should be valued null.
Subcomponents of (4):
<application identifier 1 (ID)> & <application identifier 2 (ID)> &
<application identifier 3 (ID)> & <application identifier 4 (ID)> &
<application identifier 5 (ID)> & <application identifier 6 (ID)>
(5) Identifier type code (IS). A code corresponding to the type of
identifier. This code may be used as a qualifier to the “Assigning
authority” component. Refer to User-defined Table 0203 -
Identifier type for suggested values.
(6) Assigning facility (HD). The place or location identifier where the
identifier was first assigned to the patient part of the history of
the identifier.
Subcomponents of (6):
<namespace ID (IS)>&<universal ID (ST)>&<universal ID type
(ID)>
2.8.13 DLN - Components: <license number (ST)>^<issuing state, province, This data type gives the
driver's country (IS)>^<expiration date (DT)> driver's license information.
license See HL7 Standard for
number component definitions and
tables to use.
2.8.15 DT - date Format: YYYY[MM[DD]] The precision of a date may

be expressed by limiting the
number of digits used with
the format specification
YYYY[MM[DD]].
2.8.17 EI - entity Components: <entity identifier (ST)>^<namespace ID The entity identifier defines a
identifier (IS)>^<universal ID (ST)>^<universal ID type (ID)> given entity within a specified
Components are defined as follows: series of identifiers.
(1) Entity identifier (ST). This component is usually defined to be
unique within the series of identifiers created by the assigning
authority, defined by a hierarchic designator, represented by
components (2) through (4). (These are as defined here at
2.8.20, “HD - hierarchic designator.”)
2.8.18 FC - Components: <financial class (IS)>^<effective date (TS)> Used in immunization

financial Components are defined as follows: registries to classify VFC
class (1) Financial class (IS). The financial class assigned to a person. eligibility.
Refer to User-defined Table 0064 - Financial class for suggested
values.
(2) Effective date (TS). The effective date/time of the person's
assignment to the financial class specified in the first
component.
2.8.19 FT - This data type is derived from the string data type by allowing the
formatted addition of embedded formatting instructions. These instructions are
text data limited to those that are intrinsic and independent of the
circumstances under which the field is being used. The FT field is of
arbitrary length (up to 64K) and may contain formatting commands
enclosed in escape characters.
2.8.20 HD - A unique name that identifies the system which was the source of the Used in fields that formerly
hierarchic data. The HD is designed to be used either as a local version of a site- used the IS data type. When

Ref# Type
designator defined application identifier or a publicly-assigned UID. Syntactically, only the first HD component
the HD is a group of two application identifiers: one defined by the first is valued, it looks like a
component, and one defined by the second and third components. simple IS data type.
Components: <namespace ID (IS)>^ <universal ID (ST)>^<universal Designed to be an

ID type (ID)> application identifier, either
Components are defined as follows: as a local version of a site-
(1) Namespace ID (IS). Refer to User-defined Table 0300 - defined application identifier
Namespace ID for suggested values. or a publicly-assigned
(2) Universal ID (ST). The UID is a string formatted according to universal ID (UID). The HD
the scheme defined by the third component, UID type. The UID is a group of two application
is intended to be unique over time within the UID type. It is identifiers: one defined by
rigorously defined by the scheme constructing it. The UID must the first component, and one
follow the syntactic rules of the particular scheme defined in the defined by the second and
third component. third components.
(3) Universal ID type (ID). Governs the interpretation of the second
component of the HD. If it is a known UID, refer to HL7 Table If the first component is
0301 - Universal ID type for valid values. present, the second and third
components are optional.
The second and third
components must either both
be valued (both non-null), or
both be not valued (both
null).
2.8.21 ID - coded The value of such a field follows the formatting rules for an ST field This data type should be
value for except that it is drawn from a table of legal values. Examples of ID used only for HL7 tables.
HL7- fields include MSH-12-Version ID and PD1-12-Protection indicator. The reverse is not true, since
defined in some circumstances, it is
tables more appropriate to use the
CE data type for HL7 tables.
2.8.22 IS - coded The value of such a field follows the formatting rules for an ST field This data type should be
value for except that it is drawn from a site-defined (or user-defined) table of used only for user-defined
user- legal values. An example of an IS field is PID-8-Sex. tables. The reverse is not
defined true, since in some
tables circumstances, it is more
appropriate to use the CE
data type for user-defined
tables.
2.8.23 JCC - job Format: <job code (IS)>^<job class (IS)> See HL7 Standard for
code/class component definitions and
tables to use.
2.8.26 NM - A number represented as a series of ASCII numeric characters

numeric consisting of an optional leading sign (+ or -), the digits and an
optional decimal point. In the absence of a sign, the number is
assumed to be positive. If there is no decimal point, the number is
assumed to be an integer. Leading zeros, or trailing zeros after a
decimal point, are not significant.
2.8.31 PT - Components: <processing ID (ID)>^<processing mode (ID)>

processing Components are defined as follows:
type (1) Processing ID (ID). A value that defines whether the message is
part of a production, training, or debugging system. Refer to
HL7 Table 0103 - Processing ID for valid values.
(2) Processing mode (ID). A value that defines whether the
message is part of an archival process or an initial load. Refer
to HL7 Table 0207 - Processing mode for valid values. The
default (blank) means current processing.
2.8.38 SI - A non-negative integer in the form of an NM field. The uses of this data type
sequence are defined in the chapters
ID defining the segments and
messages in which it is used.


Ref# Type
2.8.39 SN - <comparator (ST)> ^ <num1 (NM)> ^ <separator/suffix (ST)> ^ <num2
Structured (NM)>
numeric
2.8.40 ST - string Any printable ASCII characters except the defined delimiter The ST data type is intended
data characters. To include any HL7 delimiter character (except the for short strings (less than
segment terminator) within a string data field, use the appropriate HL7 200 characters). For longer
escape sequence. String data is left justified with trailing blanks strings, the TX or FT data
optional. types should be used.
2.8.41 TM - time Format: HH[MM[SS[.S[S[S[S]]]]]][+/-ZZZZ] The time is understood to

refer to the local time of the
Precision of a time is expressed by limiting the number of digits used sender.
within the format, using a 24-hour clock notation. Thus, HH is used to
specify precision only to hour.
2.8.44 TS - time Contains the exact time of an event, including the date and time. The optional degree of
stamp precision component is
Format: YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/-ZZZZ]^ <degree retained only for backwards
of precision> compatibility. Immunization
registries will not value this
The date portion of a time stamp follows the rules of a date field (DT) component. Instead, the
and the time portion follows the rules of a time field (TM). HL7 precision of the data may be
recommends, but does not require, that all systems routinely send the indicated by limiting the
time zone offset. number of digits valued.
2.8.45 TX - text String data meant for user display (on a terminal or printer). Not
data necessarily left justified. Leading spaces may contribute to clarity of
the presentation to the user.
2.8.47 VID - Components: <version ID (ID)>^<internationalization code

version (CE)>^<international version ID (CE)>
identifier Components are defined as follows:
(1) Version ID (ID). Used to identify the HL7 version. Refer to HL7
Table 0104 - Version ID for valid values.
(2) Internationalization code (CE). Used to identify the international
affiliate country code. ISO 3166 provides a list of country
codes that may be used (see User-defined Table 0212 -
Nationality).
(3) International version ID (CE). Used when the international
affiliate has more than a single local version associated with a
single U.S. version.
2.8.48 XAD - Components: <street address (ST)>^ <other designation (ST)>^<city HL7 Table 0190 - Address
extended (ST)>^<state or province (ST)>^<zip or postal code (ST)>^<country type allows user to designate
address (ID)>^<address type (ID)>^<other geographic designation the type of address (e.g.,
(ST)>^<county/parish code (IS)>^<census tract (IS)>^<address mailing, residence at birth,
representation code (ID)> birth delivery location).
Components are defined as follows: When this field is allowed to
(1) Street address (ST). The street or mailing address of a person repeat, several addresses
or institution. can be recorded in the field,
(2) Other designation (ST). Second line of address (e.g., Suite 555, with each type noted.
or Fourth Floor).
(3) City (ST).
(4) State or province (ST). State or province should be represented
by the official postal service codes for that country.
(5) Zip or postal code (ST). Zip or postal codes should be
represented by the official codes for that country. In the U.S., the
zip code takes the form 99999[-9999], while the Canadian postal
codes take the form A9A-9A9.
(6) Country (ID). Defines the country of the address. ISO 3166
provides a list of country codes that may be used (see User-
defined Table 0212 - Nationality).
(7) Address type (ID). Type is optional and defined by HL7 Table
0190 - Address type.
(8) Other geographic designation (ST). Other geographic
designation includes county, bioregion, SMSA, etc.
(9) County/Parish Code (IS). This component should not duplicate

Ref# Type
component 8. Refer to User-defined Table 0289 - County/Parish
for values.
(10) Census Tract (IS). Refer to User-defined Table 0288 - Census
tract for values.
(11) Address representation code (ID). See HL7 Table 4000 -
Name/address representation.
2.8.49 XCN - Components: <ID number (ST)>^<family name (ST)>&<last name

extended prefix (ST)>^<given name (ST)>^<middle initial or name (ST)>^<suffix
composite (e.g., Jr. or III) (ST)>^<prefix (e.g., Dr.) (ST)>^<degree (e.g., MD)
ID number (IS)>^<source table (IS)>^<assigning authority (HD)>^<name type
and name code (ID)>^<identifier check digit (ST)>^<code identifying the check
for persons digit scheme employed (ID)>^<identifier type code (IS)>^<assigning
facility ID (HD)>^<name representation code (ID)>
(1) ID number. This string refers to the coded ID according to a
User-defined table. If the first component is present, either the source
table or the assigning authority must be valued.
(2) family name/last name
(3) given name/first name
(4) second and further given names or initials
(5) suffix
(6) prefix
(7)degree
(8) Source table (IS). Refer to user-defined table 0297 - CN ID
Source for suggested values. Used to delineate the first component.
Subcomponents of (9): <namespace ID (IS)>&<universal ID
(ST)> & <universal ID type (ID)>
(10) Name type code (ID). Refer to User-defined Table 0200 - Name
type for valid values.
(11) Identifier check digit (ST).
(13) Identifier type code (IS). Refer to user-defined table 0203 -
Identifier type for valid values.
(14) Assigning facility (HD).
15) Name representation code (ID). See HL7 Table 4000 -
Name/address representation for valid values.
2.8.50 XON - Components: <organization name (ST)>^<organization name type See CK (1-3) for XON
extended code (IS)>^<ID number (NM)>^<check digit (NM)>^<code identifying components (3-5).
composite the check digit scheme employed (ID)>^<assigning authority
name and (HD)>^<identifier type code (IS)>^<assigning facility ID (HD)>^<name
identificatio representation code (ID)>
n number Components are defined as follows:
for (1) Organization name (ST). The name of the specified
organizatio organization.
ns (2) Organization name type code (IS). Refer to User-defined Table
0204 - Organizational name type.
(3-5)Defined as in CK (1-3).
(7) Identifier type code (IS). Refer to user-defined table 0203 -
Identifier type for valid values.
(8) Assigning facility (HD).
(9) Name representation code (ID). See HL7 Table 4000 -
Name/address representation for valid values.
2.8.51 XPN - Components: <family name (ST)>&<last name prefix (ST)>^<given

extended name (ST)>^<middle initial or name (ST)>^<suffix (e.g., Jr. or III)
person (ST)>^<prefix (e.g., Dr.) (ST)>^<degree (e.g., MD) (IS)>^<name type
name code (ID)>^<name representation code (ID)>

Ref# Type
(1) family name/last name
(2) given name/first name
(3) second and further given names or initials
(5) suffix
(6) prefix
(7) (7)degree
(7) Name type code (ID). Refer to HL7 Table 0200 - Name
type for valid values. Name representation code (ID). Refer to HL7
Table 4000 - Name/address representation for valid values.
2.8.52 XTN - Format and Components: [NNN] [(999)]999-9999[X99999][B99999][C Note: To interoperate with
extended any text]^<telecommunication use code (ID)>^<telecommunication CEN's Telecommunication
telecommu equipment type (ID)>^<email address (ST)>^<country code data attribute group, HL7
nication (NM)>^<area/city code (NM)>^<phone number (NM)>^<extension allows use of the second
number (NM)>^<any text (ST)> component for email
addresses. When used for
For codes, refer to HL7 Table 0201 - Telecommunication use code an Internet address, the first
and HL7 Table 0202 - Telecommunication equipment type. component will be null; the
second component will have
the code NET, and the type
of Internet address is
specified with Internet or
X.400 in the third component.
When used for an Internet
address, the first component
of the XTN data type will be
null. If the @-sign is being
used as a subcomponent
delimiter, the HL7
subcomponent escape
sequence may be used (See
Section 2.9 of the HL7
Standard).

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Implementation Guide for Transmission of Laboratory-Based Reporting using HL7 2.3.

Implementation Guide for Transmission of

Implementation Guide Update

Centers for Disease Control and Prevention

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2.1 HL7 Definitions

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the transaction is termed an unsolicited update.

2.2 Basic Message Construction Rules

- Place the Segment ID first in the segment.

- Precede each data field with the field separator.

- End each segment with the segment terminator.

^XXX&YYY&&^ is equal to ^XXX&YYY^

Encoding Rules for Receiving

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2.3 Unsolicited Observation Message (ORU)/ Event R01

ORU - unsolicited transmission of an observation message (event R01)

ORU^R01 Observational Results (Unsolicited) Chapter

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Example: Laboratory Report of Bordetella Pertussis

2.4 HL7 Standard Segment Usage

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2.5 Segment Attribute Table Abbreviations

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3.1.1 Message Header (MSH) Segment

11 3 20 PT R 00011 Processing ID Generally, ‘T’ Test or ‘P’

Example segment of MSH:

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MSH field definitions

MSH.1 Field separator (ST-1, Required) 00001

MSH.2 Encoding characters (ST-4, Required) 00002

Definition: Four characters in the following order:

Note that the characters in MSH-2 appear as:

|10543^^^^^Columbia Valley Memorial Hospital&01D0355944&CLIA|

MSH.3 Sending application (HD-180, Optional) 00003

MSH.4 Sending facility (HD-180, Required for this implementation) 00004

For example: |MediLabCo-Seattle^45D0470381^CLIA|

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MSH.5 Receiving application (HD-180, Optional) 00005

For example: |WADOH^1644^WA|

MSH.6 Receiving facility (HD-180, Required for this implementation) 00006

For example: |WA|

MSH.7 Date/time of message (TS-26, Required for this implementation) 00007

Definition: Date/time the sending system created the message.

Time stamp (TS) data type must be in the format:

MSH.8 Security (ST-40, Optional) 00008

MSH.9 Message type (CM-7, Required) 00009

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The unsolicited transmission of an observation message would appear as:

MSH.10 Message control ID (ST-20, Required) 00010

MSH.11 Processing ID (PT-3, Required) 00011

PT data type components: <processing ID (ID)>^<processing mode (ID)>

For Example: |P|

MSH.12 Version ID (VID-60, Required) 00012

VID data type components: <version ID (ID)>^<internationalization code (CE)>^<international version ID

In these messages, the HL7 version is 2.3.1.

MSH.13 Sequence number (NM-15, Optional) 00013