PHIN MESSAGING GUIDE FOR SYNDROMIC 

SURVEILLANCE

ADT MESSAGES A01, A03, A04, and A08

HL7 Version 2.5.1

(Version 2.3.1 Compatible)

Document Version ID: 1.4

Draft for Review

March 2011

Centers for Disease Control and Prevention
PHIN Messaging Guide for Syndromic Surveillance

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PHIN Messaging Guide for Syndromic Surveillance

Copyright and Trademarks

 HL7 Version 2.5.1 IG: Electronic Lab Reporting to Public Health, R1 (US Realm) © 2010 

Health Level Seven, International. All rights reserved.

 HL7 and Health Level Seven are registered trademarks of Health Level Seven, Inc. Reg. U.S. 

Pat & TM Off
PHIN Messaging Guide for Syndromic Surveillance

Acknowledgements

This guide was produced and developed through the efforts of a project designed to specify a 

messaging guide for the Syndromic Surveillance. A list of core data elements for Syndromic 

Surveillance was developed by the International Society for Disease Surveillance (ISDS) in 

collaboration with the Centers for Disease Control and Prevention (CDC), Office of Surveillance, 

Epidemiology and Laboratory Services (OSELS), Public Health Surveillance Program Office 

(PHSPO). The BioSense Program in PHSPO has provided funding to support these activities.

The CDC, OSELS, Public Health Informatics and Technology Program Office (PHITPO) have

been the principal author in the development of this messaging guide. A draft of the messaging 

specification was reviewed by many national and state public health organizations, standard 

development organizations and vendors, including the Joint Public Health Informatics Taskforce 

(JPHIT), Public Health Data Standards Consortium (PHDSC), Health Level 7 (HL7), and the 

American Health Information Management Association (AHIMA).

The contributing editors would also like to express gratitude to these reviewers for their

thoughtful comments and support during development of this guide.

In addition, special thanks needs to be expressed to the following groups:

ISDS Meaningful Use Workgroup:

 Michael A. Coletta, MPH (Workgroup Chair), Virginia

 Ryan Gentry, Indiana State Department of Health

 Julia E. Gunn, RN, MPH, Boston Public Health Commission

 Richard S. Hopkins, MD, MSPH, Florida Department of Health

 Amy Ising, MSIS, University of North Carolina Department of Emergency Medicine at 

Chapel Hill

 Geraldine S. Johnson, MS, New York State Department of Health

 Bryant T. Karras MD, State of Washington, Department of Health

 Karl Soetebier, Georgia Department of Community Health

 David Swenson, MEd, State of New Hampshire, Department of Public Health 

Services

ISDS Board of Directors

 David Buckeridge, MD, PhD, ISDS President, McGill University and Montreal Public 

Health Department

 John S. Brownstein, PhD, ISDS Vice-President, Harvard Medical School

 Howard Burkom, PhD, Johns Hopkins University Applied Physics Laboratory

 Wendy Chapman, PhD, University of California, San Diego School of Medicine, Division of 

Biomedical Informatics

 Jean-Paul Chretien, MD, PhD, Lieutenant Commander, US Navy

 Julia E. Gunn, RN, MPH, Boston Public Health Commission

 Bill Lober, MD, University of Washington

 Joseph S. Lombardo, PhD, Johns Hopkins Applied Physics Laboratory

 Marc Paladini, MPH, New York City Department of Health and Mental Hygiene
PHIN Messaging Guide for Syndromic Surveillance

ISDS Staff

 Charlie Ishikawa, MSPH

 Anne Gifford, MPH

 Rachel Viola

 Emily Cain, MPH

 HLN Consulting, LLC: Noam H. Arzt, PhD; Daryl Chertcoff; Maiko Minami

CDC, Office of Surveillance, Epidemiology and Laboratory Services (OSELS)

 Stephen B. Thacker, MD, MSc, USPHS, Director

 Seth Foldy, MD, MPH, Director, PHITPO

 Laura Conn, MPH, Associate Director for Information Science, PHITPO

 Nedra Garrett, MS, Director, Division of Informatics Practice, Policy and Coordination, 

PHITPO

 Robb Chapman, Sc.D, Acting Director, Division of Informatics Solutions and Operations, 

PHITPO

 James W. Buehler, MD, Director, PHSPO

 Samuel L. Groseclose, DVM, MPH, Dipl. ACVPM, Acting Director, Division of Healthcare 

Information, PHSPO

 Taha A. Kass-Hout, MD, MS, Deputy Director for Information Science and BioSense

Program Manager, Division of Healthcare Information, PHSPO and Syndromic 

Surveillance sub-group lead of the CDC Meaningful Use Advisory Group

Editorial Board

 Lead Co-Editor: Nikolay Lipskiy, MD, DrPH, CDC, PHITPO

 Lead Co-Editor: W. Ted Klein, MS, HL7

 Lead Co-Editor: Donald T. Mon, PhD, AHIMA, Vice-President

 Editor: Sondra R. Renly, MS, MLS, International Business Machines

 Editor: Anna Orlova, PhD, PHDSC

Group of Developers

 Adam Browning, Northrop Grumman, Contractor for OSELS

 Sundak Ganesan, MD, MS, Northrop Grumman, Contractor for OSELS

 Mary Hamilton, R.N., Northrop Grumman, Contractor for OSELS

 W. Ted Klein, MS, Klein Consulting, Contractor for OSELS

 Sergey Li, Northrop Grumman, Contractor for OSELS

 Sharon Lytle, MS, Northrop Grumman Contractor for OSELS

For Information about this Guide, contact: PHINtech@cdc.gov
PHIN Messaging Guide for Syndromic Surveillance

Table of Contents

1 BACKGROUND ......................................................................................9

2 INTRODUCTION ................................................................................. 11

2.1 PURPOSE ....................................................................................... 13

2.2 AUDIENCE....................................................................................... 13

2.3 SCOPE .......................................................................................... 13

2.4 COMPATIBILITY ................................................................................. 15

2.5 EXTENSIBILITY.................................................................................. 15

2.6 QUALIFICATIONS AND CAVEATS .............................................................. 16

3 HL7 MESSAGING FOR SYNDROMIC SURVEILLANCE............................ 17

3.1 BASIC HL7 TERMS ............................................................................. 17

3.2 SUPPORTED DATA TYPES FOR SYNDROMIC SURVEILLANCE .............................. 18

3.3 ENCODING RULES.............................................................................. 19

3.4 USE CASE MODEL ............................................................................. 20

3.4.1 Message Acknowledgements............................................................22

3.4.2 Dynamic Interaction Models..............................................................23

3.4.3 Interactions .................................................................................24

3.5 STATIC MODEL - MESSAGE STRUCTURE .................................................... 25

3.5.1 HL7 Message Structure Attributes ......................................................25

3.5.2 Constrained Message Types ............................................................26

3.5.3 Constrained Message Structure ADT_A01 ............................................27

3.5.4 Constrained Message Structure ADT_A03 ............................................28

3.5.5 Constrained Message Structure ACK ..................................................29

3.6 STATIC MODEL – MESSAGE SEGMENTS ..................................................... 30

3.6.1 Segment Profile Attributes ...............................................................30

3.6.2 Message Header (MSH) Segment ......................................................33

3.6.3 Event Type (EVN) Segment..............................................................37

3.6.4 Patient Identification (PID) Segment....................................................39

3.6.5 Patient Visit (PV1) Segment .............................................................50
PHIN Messaging Guide for Syndromic Surveillance

3.6.6 Patient Visit – Additional Information (PV2) Segment................................57

3.6.7 Observation/Result (OBX) Segment....................................................63

3.6.8 Diagnosis (DG1) Segment ...............................................................72

3.6.9 Procedures (PR1) Segment..............................................................76

3.6.10 Insurance (IN1) Segment................................................................78

3.6.11 Message Acknowledgement (MSA) Segment ........................................83

3.7 HL7 BATCH PROTOCOL ....................................................................... 84

3.7.1 HL7 Batch File Structure .................................................................84

3.7.2 File Header (FHS) Segment .............................................................85

3.7.3 File Trailer (FTS) Segment...............................................................87

3.7.4 Batch Header (BHS) Segment...........................................................88

3.7.5 Batch Trailer (BTS) Segment ............................................................90

4 DATA ELEMENTS OF INTEREST........................................................... 91

4.1 COLUMN DEFINITIONS FOR ELEMENTS OF INTEREST TABLE............................... 91

4.2 DATA ELEMENTS OF INTEREST FOR SYNDROMIC SURVEILLANCE......................... 92

4.2.1 Minimum Data Set.........................................................................92

4.2.2 Extended Data Elements for Further Consideration................................112

4.2.3 Future Data Elements for Further Consideration....................................115

5 EXAMPLES........................................................................................ 119

5.1 A04 EMERGENCY DEPARTMENT REGISTRATION; NO UPDATES; ACKNOWLEDGEMENT 

REQUESTED ...................................................................................119

5.2 A04 EMERGENCY DEPARTMENT REGISTRATION FOLLOWED BY A08 UPDATE..........120

5.3 A04 EMERGENCY DEPARTMENT REGISTRATION; A01 INPATIENT ADMISSION; A03

DISCHARGE INCLUDING PATIENT DEATH ....................................................121

5.4 A01 INPATIENT ADMISSION; NO UPDATES ..................................................124

5.5 BATCH EXAMPLE ..............................................................................125

5.6 SAMPLE INTERNATIONAL ADDRESS FORMATS: CONVERTED TO PID SEGMENTS .......126

5.6.1 Countries Bordering The United States ..............................................126

6 MISCELLANEOUS ............................................................................. 126

6.1 PHIN VOCABULARY SERVICES ..............................................................126

6.1.1 PHIN Vocabulary and Distribution System...........................................127
PHIN Messaging Guide for Syndromic Surveillance

6.1.2 PHIN Message Quality Framework ...................................................127
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1 BACKGROUND

On February 17, 2009, the President signed the American Recovery and Reinvestment 

Act of 2009 (Recovery Act). Title XIII of Division A and Title IV of Division B of the 

Recovery Act, together cited as the Health Information Technology for Economic and 

Clinical Health Act (HITECH Act), include provisions to promote meaningful use of 

health information technology (health IT) to improve the quality and value of American 

health care. In July 2010, the Center for Medicare and Medicaid Services released the 

following: Medicare and Medicaid Programs; Electronic Health Record Incentive

Program; Final Rule, July 28, 2010 (http://edocket.access.gpo.gov/2010/pdf/2010-

17207.pdf)

This final rule specifies the initial criteria that eligible providers, eligible hospitals and 

critical access hospitals must meet in order to qualify for an incentive payment, e.g., 

demonstrate meaningful use of certified EHR technology. Stage 1 criteria for meaningful 

use focus on electronically capturing health information in a coded format, using that 

information to track key clinical conditions, communicating that information for care 

coordination purposes, and initiating the reporting of clinical quality measures and public 

health information.

In addition, The Office of the National Coordinator for Health Information Technology 

(ONC) released a companion regulation that defined standards, specifications, and 

certification criteria to be used to meet the Meaningful Use objectives defined in the rule 

above. This rule can be found at Health Information Technology: Initial Set of 

Standards, Implementation Specifications, and Certification Criteria for Electronic 

Health Record Technology: Final Rule July 28, 2010 

(http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf)
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PHIN Messaging Guide for Syndromic Surveillance

The ONC final rule initially included an implementation specification for the Syndromic 

Surveillance meaningful use objective that would not support data exchange for

Syndromic Surveillance. Based on public health feedback, ONC agreed to retract the 

standard while retaining the objective1. Although there was not an implementation 

specification available as a replacement immediately, public health was encouraged to 

develop data recommendations and implementation specification that can be available 

to inform the implementation of Syndromic Surveillance in Stage 1. It was therefore 

deemed necessary to define EHR requirements that will support the core of 

contemporary public health Syndromic Surveillance practice.

In September 2010, the CDC supported the International Society for Disease 

Surveillance (ISDS) to recommend EHR requirements for core Syndromic Surveillance

business practices. As the prominent resource for current evidence, best practices, and 

lessons learned in Syndromic Surveillance, ISDS works to improve population health by 

advancing surveillance science and practice to support timely and effective prevention 

and response.

ISDS used a community consensus-driven process to develop its recommendation.

Input from a workgroup of local and state Syndromic Surveillance experts served as the 

basis for early recommendation iterations (i.e., Preliminary Recommendation on 

9/30/10, and a Provisional Recommendation on 12/1/10). Workgroup members 

represented key public health stakeholder professional organizations (e.g., Council of 

State and Territorial Epidemiologists, Association of State and Territorial Health 

 

1

45 CFR Part 170 RIN 0991–AB76, II. Discussion of the Interim Final Rule, A. Public Health 

Surveillance Implementation Specifications:

"For all of these reasons, we are revising 45 CFR 170.205(d)(2) to remove these particular adopted 

implementation specifications. We are also removing from 45 CFR 170.302(l) the text „„(and 

applicable implementation specifications)‟‟ to provide additional clarity and to remove the 

unnecessary and unwarranted burden on ONC–ATCBs and perhaps ONC–ACBs. In addition, we 

are removing the reference to the implementation specifications in 45 CFR 170.299(g) where it is 

incorporated by reference., 45 CFR 170.205(d)(2)"
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PHIN Messaging Guide for Syndromic Surveillance

Officials, National Association of County and City Health Officials, Joint Public Health 

Informatics Taskforce). Input from all Meaningful Use stakeholders on the provisional 

recommendation document was collected during a public comment period. Stakeholder 

input then informed ISDS‟s, “Final Recommendation: The Core Processes & EHR 

Requirements of Public Health Syndromic Surveillance”, published in January 2011. 

As the ISDS workgroup developed recommendations, CDC translated the business 

requirement recommendations to technical specifications.

To learn more about ISDS and the ISDS Meaningful Use Syndromic Surveillance

Workgroup activities and documents, refer to http://syndromic.org/projects/meaningfuluse.

In general, CDC is working to facilitate inclusion of Syndromic Surveillance standards in 

the national health IT efforts including: 

 Harmonization of Syndromic Surveillance standards with standards from other 

public health domains (such as laboratory reporting); 

 Expansion of existing testing tools for validation of Syndromic Surveillance

messages and participation in nationally recognized HIT testing laboratories 

(events), e.g., the Integrating the Healthcare Enterprise (IHE) Connectathon; 

 Develop processes and criteria for certifications of public health systems 

that support Syndromic Surveillance;

 Enable technical assistance to local, state, territorial and tribal public health 

agencies to deploy standards-based IT solutions for Syndromic Surveillance.

2 INTRODUCTION

The Public Health Information Network (PHIN) is defined as a national initiative to 

increase the capacity of public health to exchange data and information electronically 

across organizational and jurisdictional boundaries by promoting the use of standards 

and defining functional and technical requirements. A properly implemented PHIN 

compliant messaging allows for the consistent exchange of response, health, and 

disease tracking data between public health and healthcare partners. 

Public Health Syndromic Surveillance is the regular and systematic collection and 
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PHIN Messaging Guide for Syndromic Surveillance

analysis of near "real-time" patient data for timely assessments of population health. In 

conjunction with other core public health functions2, PHSS assists in event detection, 

situation awareness, and response management.

The PHIN Syndromic Surveillance Messaging Guide meets a national need for health 

data exchange standards among healthcare providers and U.S. public health 

authorities. The Guide provides the HL7 technical specifications necessary for 

exchanging health data elements that are core to public health Syndromic Surveillance

practice in accordance with the ISDS Final Recommendations: Core Processes and 

EHR Requirements for Public Health Syndromic Surveillance.

3

By retracting the proposed implementation specification for Syndromic Surveillance data 

in the ONC final rule, an urgent need exists for implementation guidance for the

Syndromic Surveillance (SS). To fulfill this need and lay a foundation for future work, 

ISDS, a resource for Syndromic Surveillance best practices and lessons learned, with 

the support of the CDC, convened a workgroup of public health surveillance experts to 

recommend guidelines. Specifically, this Meaningful Use Workgroup (MUWG) worked 

to:

 Describe the core business processes, inputs and critical task sets of 

contemporary Syndromic Surveillance practice

 Define the core EHR requirements for a Syndromic Surveillance message to a 

local or state public health authority

As ISDS developed its recommendations, CDC was concurrently developing messaging 

guidance to expedite the translation of ISDS‟s recommendations to technical 

specifications. This document is a product of that collaboration.

 

2 Committee for the Study of the Future of Public Health. The Future of Public Health: Summary & 

Recommendations. (1988) pg. 7

3

International Society for Disease Surveillance. Final Recommendation: Core Processes and EHR 

Requirements for Public Health Syndromic Surveillance. (2011)
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PHIN Messaging Guide for Syndromic Surveillance

2.1 PURPOSE

This PHIN Messaging Guide for Syndromic Surveillance contains the necessary 

specifications for data exchange from healthcare to public health for elements that are 

core to Syndromic Surveillance practice. Note that this guide does not contain 

specifications for the collective data elements needed to support current practice of

Syndromic Surveillance across all public health jurisdictions. In particular, this guide is 

based on Health Level Seven (HL7) version 2.5.1 messaging structures and vocabulary 

content and dynamics as described by ISDS in their document titled “Final 

Recommendation: The Core Processes and EHR Requirements of Public Health

Syndromic Surveillance,” available at: http://syndromic.org/projects/meaningful-use.

This messaging guide is intended to meet the anticipated needs and requirements for

implementation guidance in clinical care entities that will be described in the future 

stages of Health Information Technology (HIT) Meaningful Use legislation. In addition, 

this document addresses the needs of public health authorities for receiving core data

Syndromic Surveillance data in accordance with the HIT Meaningful Use legislation, 

replacing the previous documentation regarding Case Reporting. This guide does not

replace the need for documentation of the constraints of specific implementations.

2.2 AUDIENCE

This guide is designed for healthcare and public health information systems, data 

exchange, and data management staff and public health data analysts, who require

guidance on Syndromic Surveillance data elements and messaging specifications. 

Users of this guide must be familiar with the details of HL7 message construction and 

processing. This guide is NOT intended to be a tutorial on HL7. In addition, this 

document is NOT a substitute for the on-going business process documentation and 

requirements development process lead by CDC and ISDS.

2.3 SCOPE

This guide covers Syndromic Surveillance data exchange between clinical care 

professionals and local and state Public Health (PH) authorities. The original use case 

that was used for this guide is as follows:
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PHIN Messaging Guide for Syndromic Surveillance

“[T]he transmission of electronic health data from healthcare providers (senders) and 

reception by public health authorities (receiver) Health data transmitted are captured in 

a health information system during a patient‟s visit to a healthcare facility. 

Senders of data include Hospitals, emergency departments, urgent care centers, 

hospital corporations, corporate third party operators of information brokers, regional

data centers for hospitals, health information exchanges (HIE), and regional health 

information organizations (RHIO).

Receivers are state and local public health authorities, or a designated third party. A 

public health authority (PHA) is broadly defined as including agencies or authorities of 

the United States, states, territories, political subdivisions of states or territories, 

American Indian tribes, or an individual or entity acting under a grant of authority from 

such agencies and responsible for public health matters as part of an official mandate.”4

The Stage 1 Meaningful Use objectives assume the sending of data by hospitals and 

eligible professionals and the capability of local or/and state PH authorities for receiving 

this information. The current state business processes defined by the ISDS workgroup 

are primarily based on point-to-point data exchange of Admit Discharge Transfer (ADT) 

messages between healthcare and public health. Applicability of candidate HL7 

messages in other data exchange scenarios has yet to be determined and may vary by 

public health jurisdiction and data exchange partner.

The decision to use ADT message constructs instead of the ORU message construct 

was reviewed and approved by ISDS, Public Health Data Standards Consortium 

(PHDSC), and other CDC partners. Compared to ORU structure, the ADT structure 

provides more flexibility for message exchange that captures data from emergency 

department (ED) and urgent care (UC) patient visits, by health information systems,

sending to a public health authority in the scope of the ISDS recommendation. Health 

Information Systems (HIS) transmit ADT messages as part of their normal operation 

and configuration; they generally lack any function enabling transmission of observation 

related data via ORU messages. HIS systems typically are recipients of such 

 

4

International Society for Disease Surveillance, Final Recommendation: The Core Processes and 

EHR 
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PHIN Messaging Guide for Syndromic Surveillance

messages.5

2.4 COMPATIBILITY

This guide follows the HL7 Standard rules to ensure backward-compatibility of 

interfaces. As a result, properly implemented version 2.3.1 interfaces for Syndromic 

Surveillance reporting should be able to accept and process version 2.5.1 messages 

without producing errors. Section 4.2 describes the Minimum Data Elements. The 

format of this section has been designed to accommodate differences of HL7 versions

2.3.1 and 2.5.1. 

For instance, the Facility Identifier data element (Section 4.2.1, element #1) in HL7 

version 2.5.1 is best presented as follows the Event Type segment, 7th field. However, 

this field was not defined as part of version 2.3.1 for an Event Type segment. 

Therefore, this guide provides, in Section 4.2, a separate description of the Facility 

Identifier for versions 2.3.1 and 2.5.1. The flexibility of data element location defined in 

this guide may be considered to be fully compatible, in both format and data, with both 

2.3.1 and 2.5.1 systems.

2.5 EXTENSIBILITY

This guide has been developed using the business approach that potentially allows 

adding: 

 Optional data elements by state and local public health surveillance systems (see 

Section 4.2.2)

 New and optional data elements in the future (see Section 4.2.3)

The current data element requirements and data sources, as presented by ISDS, are 

best satisfied with the Admission and Discharge Transfer (ADT) messages described in 

this guide. Future versions of this message guide will be able accommodate needs of 

our partners for adding new and additional data elements (i.e., laboratory orders and 

 

5 Requirements of Public Health Syndromic Surveillance. Page 53, International Society for 

Disease Surveillance, Brighton, MA (January 2011); http://www.syndromic.org/project/meaningfuluse
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results, additional diagnostic procedures and more detailed demographic information,

etc.). Additional requirements gathering will be undertaken to determine the best 

strategy for new message types to meet new requirements. As the Meaningful Use 

regulations mature and further recommendations for new requirements emerge, it may 

become necessary to include additional data sources, messaging events and structures 

that are not currently defined in this release of this guide.

2.6 QUALIFICATIONS AND CAVEATS

The guidelines, information flow, and required / recommended data elements for the 

Meaningful Use regulations were under active development and revision by ISDS in 

parallel with the development of this guide. 

A number of compromises were made in the determination of the message definition for 

this guide. Although clinical information is of utmost importance for Syndromic 

Surveillance, the majority of outbound messages containing patient demographic and 

history information that are currently generated in the healthcare system in the US for 

every patient are administrative messages, sent mostly by hospital information systems. 

In order to produce a guide widely implementable by most systems in the US, without 

significant and substantial cost for new development, the most common ADT messages 

were constrained and enhanced to support the surveillance needs.
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3 HL7 MESSAGING FOR SYNDROMIC SURVEILLANCE

HL7 (Health Level Seven) version 2 is the most widely used standard for computer 

communication of patient information in the United States Healthcare industry today.

This guide is based on the HL7 version 2.5.1-messaging standard, published by Health 

Level Seven International, Inc., and approved as an ANSI standard on February 21, 

2007, as an update to the version 2.5 standard released in 2003. This section describes 

the messages to be used for Syndromic Surveillance reporting, and includes a very brief 

introduction to HL7 terms and concepts. The reader is referred to the full HL7 version 

2.5.1 Standard for complete information and details of this background.

3.1 BASIC HL7 TERMS

Profile Attributes

TABLE 3-1: BASIC HL7 TERMS

TERM DEFINITION

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. 

Segment A segment is a logical grouping of data fields. Segments within a defined message 

may be required or optional and 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. 

Field A field is a string of characters. Each field has an element name. Each field is 

identified by the segment it is in and its sequence within the segment. Usage and 

cardinality requirements are defined in the Segment Definitions. 

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 necessarily required to be populated. 

Datatype 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 HL7 data type is listed in each field definition. 
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TABLE 3-1: BASIC HL7 TERMS

TERM DEFINITION

Delimiters The delimiter values are defined in MSH-1 and MSH-2 and are used throughout the 

message. The default delimiters are: 

| - Field Separator 

^ - Component Separator 

& - Sub-Component Separator 

~ - Repetition Separator 

\ - Escape Character 

3.2 SUPPORTED DATA TYPES FOR SYNDROMIC SURVEILLANCE

The HL7 Standards define a large number of datatypes for use in HL7 messaging. Not 

all of these datatypes are required for the messages defined in this guide. Those that 

are used in this guide are defined in the table below and specified further below.

TABLE 3-2: DATA TYPES UTILIZED IN SYNDROMIC SURVEILLANCE

DATA TYPE DATA TYPE NAME

CE Coded Element 

CWE Coded with Exceptions 

CX Extended Composite ID with check Digit 

DTM Date/Time

EI Entity Identifier 

FN Family Name

HD Hierarchic Designator 

ID Coded Value for HL7-defined tables 

IS Coded Value for user-defined tables 

MSG Message Type
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TABLE 3-2: DATA TYPES UTILIZED IN SYNDROMIC SURVEILLANCE

DATA TYPE DATA TYPE NAME

NM Numeric 

PL Person Location

PT Processing Type 

SI Sequence Identifier 

ST String Data 

TX6Text Data

TS Timestamp 

VID Version Identifier 

XAD Extended Address 

XPN Extended Person Name 

3.3 ENCODING RULES

The following list details the encoding rules.

 Encode each segment in the order specified in the Message Structure.

 Begin each segment with the 3-letter segment ID (e.g., PID).

 End each segment with the carriage return terminator (hex 0D). Note that in the 

examples in this guide, this character is illustrated as “<cr>”. This character is a 

single ASCII character; the segment terminator is NOT the four-character 

sequence.

 Encode the data fields in the sequence given in the corresponding segment 

definition tables. 

 Encode each data field according to the data type format listed in this guide.

 

6

In this message specification, the only allowed escape sequences are those allowed in HL7 

Version 2.5.1, Chapter 2, and Section 2.7.4 - Special Characters. These are the escape 

sequences for the message delimiters (i.e., “|" = \F\, “^” = \S\, “~” = \R\, “&” = \T\, and “\” = \E\).
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PHIN Messaging Guide for Syndromic Surveillance

 Components, subcomponents or repetitions that are not valued at the end of a 

field need not be represented by component separators. Likewise, field separators 

are not required for empty fields at the end of a segment. 

For example, the data fields and segments below are equivalent: 

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

|ABC^DEF^^| is equal to |ABC^DEF|

 and

MSH|^~\&||Facillity_NPI^0131191934^NPI|||201009221330||ADT^A04|1|P

|2.3.1||||||||<cr> 

 is equal to

MSH|^~\&||Facility_NPI^0131191934^NPI|||201009221330||ADT^A04|1|P

|2.3.1<cr> 

 If a data segment is not documented in this guide, the Sender should not send 

the segment. However, if the segment is sent and the segment conforms to 

HL7 message structure for the message, the Receiver should ignore the 

undocumented segment. This “extraneous” data (segment) is best negotiated 

prior to transmission between the Sender and Receiver.

3.4 USE CASE MODEL

The use case model is derived from the ISDS Final Recomendation, Section 4.1, 

Transmission and Reception of Data.
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-4: USE CASE: ELECTRONIC HEALTH RECORD SYNDROMIC DATA TO PUBLIC

HEALTH

ITEM DETAIL

Description The Public Health Syndromic Surveillance Use Case focuses on the transmission 

of electronic health data from healthcare providers (senders) and reception by 

Public Health authorities (receiver). Health data transmitted are captured in a health 

information system during a patient‟s visit to a healthcare facility. 

Senders of data include, but are not limited to hospitals, emergency departments, 

urgent care centers, clinician networks, hospital corporations, corporate third party 

operators of information brokers, regional data centers for hospitals, health 

information exchanges (HIEs), and regional health information organizations 

(RHIOs).

Receivers are state and local public health authorities, or a designated third party. 

A public health authority (PHA) is broadly defined as including agencies or 

authorities of the United States, states, territories, political subdivisions of states or 

territories, American Indian tribes, or an individual or entity acting under a grant of 

authority from such agencies and responsible for public health matters as part of an 

official mandate.

The goal of the use case is to provide secure, reliable delivery of Syndromic 

Surveillance data to public health. If PHIN MS is used for transport, then use of the 

HL7 Acknowledgements may be unnecessary, although PHIN MS does not ensure 

that the payload conforms to HL7 formatting rules, it does provide safe and reliable 

transport. If another transport mechanism is chosen, consideration should be given 

for acknowledgement of messages, whether single or batch, and/or possible 

acknowledgement of payload prior to processing or consumption.

Actors

Patient - A person with symptoms of a health problem that seeks treatment

Senders of Syndromic Surveillance data include, but are not limited to: hospitals, 

emergency departments, urgent care centers, clinician networks, hospital 

corporations, corporate third party operators of information brokers, regional data 

centers for hospitals, health information exchanges (HIEs), and regional health 

information organizations (RHIOs).

The Syndromic Surveillance receiver perspective is from the state or local 

jurisdiction point of view. Data transmission to a federal authority is not explicitly 

addressed. Data transmission between local and state jurisdictions is also out of 

scope. 

Assumptions

The following assumptions are preconditions for the use of this profile:

Syndromic Surveillance data senders are responsible for the setup of their system 

with the code systems deemed appropriate to its jurisdiction.

Both sender and receiver of Syndromic data must agree to a facility registration 

process, allowing for transmission of data, prior to message transmission.

Business Rules The following Business Rule applies to the use of this profile:

Batch processing may optionally be used as described in section 3.8.

The Send Syndromic Surveillance Data Use Case Model has two primary participating 

actors, the Syndromic Data Sender and the Syndromic Data Receiver. The patient actor 
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PHIN Messaging Guide for Syndromic Surveillance

triggers the sending of the data initially from the original provider. See figure 3.4 below.

Figure 3.4 – Send Syndromic Surveillance Data Use Case Model

3.4.1 MESSAGE ACKNOWLEDGEMENTS

HL7 messages that are sent from a healthcare setting to Public Health may be 

acknowledged. The Acknowledgement type will be solely HL7 Original Mode – no 

Enhanced Mode Acknowledgements are supported. This means that the receiver at the 

public health department must assume responsibility for the Syndromic Surveillance

message before it sends the Acknowledgement message, i.e., it must commit the 

message to persistent storage and intend to process the message. The only conditions 

that are evaluated for the positive acknowledgement or a possible error rejection are

the:

 Message Type contained in MSH-9 is one that can be processed

 Processing ID contained in MSH-11 is appropriate for the communications and 

can be processed

 Version ID contained in MSH-12 is either 2.3.1 or 2.5.1 and can be processed.

Other types of possible errors in the message, especially in content, must result in 

downstream action after the acknowledgement message has been sent.

Note: Although the Original Model Acknowledgement is simplest and least costly to 

implement, it does not generally support syntactic validation of messages. Messages 

that are accepted with an Acknowledgement message may thus still be missing fields 

that are required. To do this more detailed level of Acknowledgement usually requires 

Enhanced Mode Accept Acknowledgement.
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PHIN Messaging Guide for Syndromic Surveillance

3.4.2 DYNAMIC INTERACTION MODELS

Figure 3.4.2.1 Activity Diagram for Send Syndromic Surveillance Data Use Case - Acknowledgement Required

Figure 3.4.2.2 Activity Diagram for Send Syndromic Surveillance Data Use Case – Without Acknowledgement

Figure 3.4.2.3 Activity Diagram for Send Syndromic Surveillance Data Use Case – Batch
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PHIN Messaging Guide for Syndromic Surveillance

3.4.3 INTERACTIONS

TABLE 3-4A: INTERACTIONS - INDIVIDUAL TRANSACTION WITH ACKNOWLEDGEMENTS

EVENT MESSAGE TYPE RECEIVER 

ACTION

SENDER DATA VALUES

Patient visits 

provider/facility

ADT^A01^ADT_A01 Accept, Reject, 

Error

SS Data 

Sender

MSH-9 = “ADT^A01^ADT_A01”

Patient is admitted to 

provider facility

ADT^A01^ADT_A01 Accept, Reject, 

Error

SS Data 

Sender

MSH-9 = “ADT^A01^ADT_A01”

Provider ends 

patient‟s visit

ADT^A03^ADT_A03 Accept, Reject, 

Error

SS Data 

Sender

MSH-9 = “ADT^A03^ADT_A03”

Patient is discharged 

from facility

ADT^A03^ADT_A03 Accept, Reject, 

Error

SS Data 

Sender

MSH-9 = “ADT^A03^ADT_A03”

Patient registers at 

provider facility

ADT^A04^ADT_A01 Accept, Reject, 

Error

SS Data 

Sender

MSH-9 = “ADT^A04^ADT_A01”

Patient record is 

updated

ADT^A08^ADT_A01 Accept, Reject, 

Error

SS Data 

Sender

MSH-9 = “ADT^A08^ADT_A01”

Accept message ACK message 

related to type of 

message sent

None SS Data 

Receiver

MSA-1 = „AA‟

Reject message ACK message 

related to type of 

message sent

None SS Data 

Receiver

MSA-1 = „AR‟

Error Message ACK message 

related to type of 

message sent

None SS Data 

Receiver

MSA-1 = „AE‟

TABLE 3-4B: INTERACTIONS - INDIVIDUAL TRANSACTION WITHOUT

ACKNOWLEDGEMENTS / BATCH

EVENT MESSAGE TYPE RECEIVER 

ACTION

SENDER DATA VALUES

Patient visits 

provider/facility

ADT^A01^ADT_A01 None SS Data 

Sender

MSH-9 = “ADT^A01^ADT_A01”

Patient is admitted 

to provider facility

ADT^A01^ADT_A01 None SS Data 

Sender

MSH-9 = “ADT^A01^ADT_A01”
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-4B: INTERACTIONS - INDIVIDUAL TRANSACTION WITHOUT

ACKNOWLEDGEMENTS / BATCH

EVENT MESSAGE TYPE RECEIVER 

ACTION

SENDER DATA VALUES

Provider ends 

patient‟s visit

ADT^A03^ADT_A03 None SS Data 

Sender

MSH-9 = “ADT^A03^ADT_A03”

Patient is discharged 

from facility

ADT^A03^ADT_A03 None SS Data 

Sender

MSH-9 = “ADT^A03^ADT_A03”

Patient registers at 

provider facility

ADT^A04^ADT_A01 None SS Data 

Sender

MSH-9 = “ADT^A04^ADT_A01”

Patient record is 

updated

ADT^A08^ADT_A01 None SS Data 

Sender

MSH-9 = “ADT^A08^ADT_A01”

3.5 STATIC MODEL - MESSAGE STRUCTURE

3.5.1 HL7 MESSAGE STRUCTURE ATTRIBUTES

The structure of the supported messages in this guide are described in tabular format 

(refer to the following section). The columns of those tables are used as described in 

the table below. 

TABLE 3-5. MESSAGE STRUCTURE ATTRIBUTES

ABBREVIATION DEFINITION

Segment Three-character code for the segment and the abstract syntax (e.g., the square and 

curly braces) 

If a segment is not documented in this guide, it should not be sent.

 [ XXX ] Optional

 { XXX } Repeating

 XXX Required

 [{ XXX }] Optional and Repeating

Name Name of the segment

Description Explanation of the use of the segment

Usage Use of the segment for Syndromic Surveillance

Indicates if the segment is required, optional, or conditional in a message
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-5. MESSAGE STRUCTURE ATTRIBUTES

ABBREVIATION DEFINITION

Legal values are:

 R – Required, Must always be populated

 RE – Required, but may be empty (segment is not sent). If the Sender has 

data, it must be sent. The Receiver must be capable of processing data if 

sent, and must not raise an error or warning if the data is not sent.

 O – Optional There is no specified conformance rules for either Sender or 

Receiver for this segment in this guide. As an implemented interface must 

follow known rules for populating segments, a specific interface for a 

particular Sender or Receiver must constrain this usage to either R, RE, C, 

CE, or X. This has been deliberately left unconstrained in this guide to 

support differing and sometimes mutually exclusive statutory requirements in 

different jurisdictions; this must be determined locally.

Cardinality Minimum and maximum number of times the segment may appear

 [0..1] Segment may be omitted and can have, at most, one occurrence.

 [1..1] Segment must have exactly one occurrence.

 [0..*] Segment may be omitted or repeat an unlimited number of times.

 [1..*] Segment must appear at least once, and may repeat unlimited number 

of times.

3.5.2 CONSTRAINED MESSAGE TYPES

The following HL7 ADT Messages have been identified for Syndromic Surveillance

reporting:

 ADT^A01 Admit / Visit Notification

 ACK^A01 General Acknowledgement

 ADT^A03 Discharge / End Visit

 ACK^A03 General Acknowledgement

 ADT^A04 Register a Patient

 ACK^A04 General Acknowledgement

 ADT^A08 Update Patient Information

 ACK^A08 General Acknowledgement

Message types that are NOT documented in this guide are considered NOT 

SUPPORTED. For more information on receiver usage of not supported, please see 
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PHIN Messaging Guide for Syndromic Surveillance

table 3-6.

The HL7 message formats sent to public health agencies will be constrained versions of 

the 2.5.1 abstract message (with backward compatibility to 2.3.1) formats. Only the 

segments necessary for carrying the Syndromic data, and certain structural message 

segments, are included. Because the message structure for the message types is 

similar, one table (Table 3-5A) was used to define the message structure for the ADT 

A01, A04, and A08 messages. Another table (Table 3-5B) was used for the A03 

message structure, as per the HL7 Standard. All of the General Acknowledgement

(ACK) messages have the same structure. All of the General Acknowledgement (ACK) 

messages were placed in the final table (Table 3-5C).

3.5.3 CONSTRAINED MESSAGE STRUCTURE ADT_A01

The abbreviated terms and their definitions used to describe the Message Profile are 

detailed in the following tables.

TABLE 3-5A: SIMPLE MESSAGE STRUCTURE: A01, A04, AND A08

SEG NAME DESCRIPTION USAGE CARDINALITY

MSH Message 

Header 

Information explaining how to parse and process 

the message

Information includes identification of message 

delimiters, sender, receiver, message type, 

timestamp, etc. 

R [1..1] 

EVN Event Type Trigger event information for receiving application R [1..1] 

PID Patient 

Identification 

Patient identifying and demographic information R [1..1] 

PV1 Patient Visit Information related to this visit at this facility 

including the nature of the visit, critical timing 

information and a unique visit identifier. 

R [1..1] 

[PV2] Patient Visit 

Additional 

Information 

Admit Reason information. RE [0..1] 

{OBX} Observation / 

Result

Information regarding the age, temperature, and 

other information

R [1..*]

[{DG1}] Diagnosis Admitting Diagnosis and, optionally, Working and 

Final Diagnosis information 

RE [0..*] 
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TABLE 3-5A: SIMPLE MESSAGE STRUCTURE: A01, A04, AND A08

SEG NAME DESCRIPTION USAGE CARDINALITY

[{PR1}] Procedures Information relative to various types of procedures 

performed

O [0..*]

[{IN1}] Insurance Information about insurance policy coverage 

information

O [0..*]

3.5.4 CONSTRAINED MESSAGE STRUCTURE ADT_A03

TABLE 3-5B: SIMPLE MESSAGE STRUCTURE: A03

SEG NAME DESCRIPTION USAGE CARDINALITY

MSH Message 

Header 

Information explaining how to parse and process 

the message

This information includes identification of message 

delimiters, sender, receiver, message type, 

timestamp, etc. 

R [1..1] 

EVN Event Type Trigger event information for receiving application R [1..1] 

PID Patient 

Identification 

Patient identification and demographic information R [1..1] 

PV1 Patient Visit Information related to this visit at this facility 

including the nature of the visit, critical timing 

information and a unique visit identifier.

R [1..1] 

[PV2] Patient Visit 

Additional 

Information 

Admit Reason information. RE [0..1] 

[{DG1}] Diagnosis Admitting Diagnosis and, optionally, Working and 

Final Diagnosis information

RE [0..*] 

[{PR1}] Procedures Information relative to various types of procedures 

performed

O [0..*]

{OBX} Observation / 

Result

Information regarding the age, temperature, and 

other information

R [1..*]

[{IN1}] Insurance Information about insurance policy coverage 

information

O [0..*]
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PHIN Messaging Guide for Syndromic Surveillance

3.5.5 CONSTRAINED MESSAGE STRUCTURE ACK

Note that the same Message Structure is used for ACK^A01, ACK^A03, ACK^A04, and 

ACK^A08.

TABLE 3-5C. SIMPLE MESSAGE STRUCTURE: ACK

SEG NAME DESCRIPTION USAGE CARDINALITY

MSH Message 

Header 

Information explaining how to parse and process 

the message. This includes identification of 

message delimiters, sender, receiver, message 

type, timestamp, etc. 

R [1..1] 

MSA Message 

Acknowledgement 

Acknowledgement information identifying the ability

of a receiver to accept a message transmitted

R [1..1] 
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PHIN Messaging Guide for Syndromic Surveillance

3.6 STATIC MODEL – MESSAGE SEGMENTS

3.6.1 SEGMENT PROFILE ATTRIBUTES

Fields or components that are NOT documented in this guide are considered NOT 

SUPPORTED. Inclusion of any field or component that is not supported should not 

result in failure of the entire message by the receiver, as per recommended receiver 

behaviors as defined in HL7.

The abbreviated terms and segment definitions used in the constrained message 

formats are detailed in the following table.

TABLE 3-6: SEGMENT PROFILE ATTRIBUTES

ABBREVIATION DEFINITION

Field Name Descriptive name of the data element

Sequence (Seq) Sequence of the elements as they are numbered in the HL7 segment

Datatype (DT) Data type used for HL7 element

Length (Len) Length of an element is calculated using the following rules:

Field length = (Sum of all supported component lengths) + (component 

number of the last-supported component) – 1.

Component length = (Sum of all supported sub-component lengths) + 

(sub-component number of the last-supported component) – 1.
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6: SEGMENT PROFILE ATTRIBUTES

ABBREVIATION DEFINITION

Sender Usage

Receiver Usage

Indicator of whether a data element is required, optional, or conditional 

in a message, set separately for Senders and Receivers. Legal values 

are:

 R - Required. Must always be populated by the Sender, and if 

not present he Receiver may reject the message.

 RE7- Required, but may be empty (no value). If the Sender has 

data, the data must be sent. The Receiver must be capable 

of processing data if sent, and must not raise an error or 

warning if the data is not sent.

 O – Optional-There are no specified conformance rules for either 

Sender or Receiver for this field in this guide. As an 

implemented interface must follow known rules for 

populated fields and components, a specific interface for a 

particular Sender or Receiver must constrain this usage to 

either R, RE, C, CE, or X. This value has been deliberately 

left unconstrained in this guide to support differing and 

sometimes mutually exclusive statutory requirements in 

different jurisdictions; this must be determined locally.

 C – Conditional - When conditionality predicate evaluates to 

„True‟, considered the same as „R‟. When condition 

evaluates to „False‟, Senders must not populate the field, 

and Receivers may raise an error if the field is present but 

must not raise an error if the field is not present.

 Syndromic Surveillance - When conditionality predicate 

evaluates to „True‟, behaves the same as „RE‟. When 

conditionality predicate evaluates to „False‟, the Sender 

should not populate the field, and the Receiver may raise 

an application error if the field is present.

 X - Not supported - Senders must not populate. Receivers may 

ignore the element if it is sent, or may raise an error if field 

is present.

Note: A required field in an optional segment does not mean the 

segment must be present in the message. It means that if the 

segment is present, the required fields within that segment must 

be populated. The same applies to required components of 

optional fields. If the field is being populated, then the required 

 

7

The element may be missing from the message, but must be sent by sending application if there is relevant 

data. A conforming sending application must be capable of providing all „RE‟ elements. If conforming 

sending application knows required values for the element, it must send that element. If conforming sending 

application does not know the required values, then that element will be omitted.
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TABLE 3-6: SEGMENT PROFILE ATTRIBUTES

ABBREVIATION DEFINITION

components must be populated. The same applies to required 

sub-components of optional components. If a component is 

being populated, then the required sub-components of that 

component must be populated.

Cardinality Minimum and maximum number of times the field may appear.

 [0..0] Field never present

 [0..1] Field may be omitted and can have, at most, one

occurrence.

 [1..1] Field must have exactly one occurrence

 [0..n] Field may be omitted or may repeat up to n times

 [1..n] Field must appear at least once, and may repeat up to n

time.

 [0..*] Field may be omitted or repeat an unlimited number of 

times.

 [1..*] Field must appear at least once, and may repeat unlimited 

number of times.

 [m..n] Field must appear at least m and at most n times.

Values / Value Set Link to value set or literal value of data expected to be populated in the 

field. Numbers in this field denote the related vocabulary in that HL7 

Table. Contains the name and/or the PHIN Value Set (accessible 

through PHIN VADS) when relevant as well as notes, condition rules 

(2.5.1 vs. 2.3.1) and recommendations.

 Fields shaded in yellow denote unsupported fields. The usage is also marked „X‟.

 Components and subcomponents of a single field are noted as a dotted decimal number.
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PHIN Messaging Guide for Syndromic Surveillance

3.6.2 MESSAGE HEADER (MSH) SEGMENT

The MSH Segment is used to define the intent, source, destination, and some specifics of the syntax of the message. This 

segment includes identification of message delimiters, sender, receiver, message type, timestamp, etc.

TABLE 3-6A: MESSAGE HEADER SEGMENT (MSH)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Field Separator 1 ST 1 R R [1..1] Default Value “|” (ASCII 124).

Encoding Characters 2 ST 4 R R [1..1] Default Values “^~\&” (ASCII 94,126,92, and 38).

Sending Application 3 HD 227 O O [0..1]

Sending Facility 4 HD 227 R R [1..1] Field that uniquely identifies the facility associated 

with the application that sends the message

If Acknowledgements are in use, this facility will 

receive any related Acknowledgement message. 

Namespace ID 4.1 IS 20 RE RE [0..1] 0362

Universal ID 4.2 ST 199 R R [1..1]

Universal ID Type 4.3 ID 6 R R [1..1] 0301

Receiving Application 5 HD 227 O O [0..1] 0361
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TABLE 3-6A: MESSAGE HEADER SEGMENT (MSH)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Receiving Facility 6 HD 227 O O [0..1] 0362

Date/Time Of Message 7 TS 26 R R [1..1]

Note: Date/Time the sending system created the 

message in the following format: 

YYYYMMDDHHMMSS[.S[S[S[S]]]]] [+/-ZZZZ] 

The minimum acceptable precision is to the nearest 

minute; seconds are desirable. 

If Coordinated Universal Time (UTC) offset is not 

sent, it is assumed to be offset of the receiver.

Security 8 ST 40 X X [0..1]

Message Type 9 MSG 15 R R [1..1] Note: All messages will be Admit-DischargeTransfer (ADT) message types. The triggering 

event is a real-world circumstance causing the 

message to be sent. 

Supported trigger events are A01 (Inpatient 

Admission), A04 (Emergency Department 

Registration) and A08 (Update). 

Message Code 9.1 ID 3 R R [1..1] Literal Value “ADT” or “ACK”
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TABLE 3-6A: MESSAGE HEADER SEGMENT (MSH)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Trigger Event 9.2 ID 3 R R [1..1] One of the following literal values: “A01”, “A03”, 

“A04”, or “A08”.

Message Structure 9.3 ID 7 R R [1..1] One of the following literal values: “ADT_A01” or 

“ADT_A03”, or “ACK”

Message Control ID 10 ST 199 R R [1..1] Note: This field is a number or other identifier that 

uniquely identifies the message.

Processing ID 11 PT 3 R R [1..1] Note: Indicates how to process the message as 

defined in HL7 processing rules

Literal values: “P” for Production, “D” for Debug or 

“T” for Training.

Version ID 12 VID 5 R R [1..1] Note: HL7 version number used to interpret format 

and content of the message. 

Literal value: “2.3.1” or “2.5.1”

Sequence Number 13 NM 15 X X [0..1]

Continuation Pointer 14 ST 180 X X [0..1]

Accept Acknowledgement Type 15 ID 2 X X [0..1] 0155 
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TABLE 3-6A: MESSAGE HEADER SEGMENT (MSH)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Application Acknowledgement

Type 

16 ID 2 X X [0..1] 0155 

Country Code 17 ID 3 X X [0..1] 0399 

Character Set 18 ID 16 X X [0..*] 0211 

Principal Language Of Message 19 CE 478 X X [0..1]

Alternate Character Set Handling 

Scheme 

20 ID 20 X X [0..1] 0356 

Message Profile Identifier 21 EI 427 O O [0..*]
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PHIN Messaging Guide for Syndromic Surveillance

3.6.3 EVENT TYPE (EVN) SEGMENT

The EVN segment is used to communicate trigger event information to receiving applications.

TABLE 3-6B: EVENT TYPE SEGMENT (EVN)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Event Type Code 1 ID 3 X X [0..0] 0003 

Recorded Date/Time 2 TS 26 R R [1..1] Note: Most systems default to the system 

Date/Time when the transaction was entered. 

YYYYMMDDHHMM[SS[.S[S[S[S]]]]] [+/-ZZZZ] 

The minimum acceptable precision is to the nearest 

minute; seconds and microseconds are desirable; 

the Coordinated Universal Time (UTC) offset is not 

required.

Date/Time Planned Event 3 TS 26 X X [0..1]

Event Reason Code 4 IS 3 X X [0..1] 0062 

Operator ID 5 XCN 309 X X [0..*] 0188 

Event Occurred 6 TS 26 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6B: EVENT TYPE SEGMENT (EVN)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Event Facility 7 HD 241 R R [0..1] Required if using HL7 version 2.5.1.

For HL7 version 2.3.1, use an OBX segment with a 

HD data type.

If populated, this element would be the facility 

where the original event occurred. In this case, the 

treating facility should be populated here.

Namespace ID 7.1 IS 20 RE RE [0..1] Name of originating facility

Universal ID 7.2 ST 199 R R [1..1] National Provider Identifier. (10-digit identifier)

Universal ID Type 7.3 ID 6 R R [1..1] Expecting Value “NPI”.
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3.6.4 PATIENT IDENTIFICATION (PID) SEGMENT

The PID Segment is used as the primary means of communicating patient identification information. This segment contains 

pertinent patient identifying and demographic information. 

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Set ID - PID 1 SI 4 O RE [0..1] Note: This Set ID numbers the repetitions of the 

segments. Only one patient per message is 

supported. 

Literal value: “1”. 

Patient ID 2 CX 20 X X [0..0]

Patient Identifier List 3 CX 478 R R [1..*] PID.3 is a repeating field that can accommodate 

multiple patient identifiers.

Note: Patient‟s unique identifier(s) from the facility 

that is submitting this report to public health officials 

Different jurisdictions use different identifiers and 

may often use a combination of identifiers to 

produce a unique patient identifier. Patient 

identifiers should be strong enough to remain a 

unique identifier across different data provider 

models, such as a networked data provider or State 
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TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

HIE.

ID Number 3.1 ST 15 R R [1..1] Note: A Unique Patient Identifier is required (such 

as Patient Account number or MPI Number). In 

addition, it is strongly recommended to submit the 

patient medical record number to facilitate 

identification of the patient in the event of a required 

follow-up investigation. Without it, the work required 

to follow up on the data provider is greatly 

increased.

Check Digit 3.2 ST 1 X X [0..1]

Check Digit Scheme 3.3 ID 3 X X [0..1] 0061

Assigning Authority 3.4 HD 227 O RE [0..1] 0363

Identifier Type Code 3.5 ID 5 R R [1..1] Identifier Type ( Syndromic Surveillance)

Note: Use the Identifier Type Code that 

corresponds to the type of ID Number specified in 

PID-3.1. For Medical Record Number, use literal 

value “MR”.

Assigning Facility 3.6 HD 227 O RE [0..1]
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TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Effective Date 3.7 DT 8 X X [0..1]

Expiration Date 3.8 DT 8 X X [0..1]

Assigning Jurisdiction 3.9 CWE 705 X X [0..1]

Assigning Facility 3.10 CWE 705 X X [0..1]

Alternate Patient ID - PID 4 CX 20 X X [0..0]

Patient Name 5 XPN 294 R R [1..*] Note: Syndromic Surveillance does not require the 

patient name. The Patient ID number will be used to

identify uniquely the patient. HL7 does require the 

patient name field for a PID segment. The patient 

name field must still be populated even when 

reporting de-identified data.

The first field name contains the primary or legal 

name of the patient. Therefore, the name type code 

(PID.5.7) should be “L “(Legal), when populated.

When the name of the patient is known, but not 

desired to be sent, HL7 recommends the following: 

|~^^^^^^S|. The "S" for the name type code 

(PID.5.7) in the second name field indicates that it is 
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TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

a pseudonym.

When the name of the patient is not known, HL7 

recommends the following: |~^^^^^^U|. The "U" for 

the name type code (PID.5.7) in the second name 

field indicates that it is unspecified.

Family Name 5.1 FN 194 O RE [0..1]

Given Name 5.2 ST 30 O RE [0..1]

Second Given Name or Initials 5.3 ST 30 O RE [0..1]

Suffix 5.4 ST 20 O RE [0..1]

Prefix 5.5 ST 20 O RE [0..1]

Degree 5.6 IS 6 X X [0..0] 0360

Name Type Code 5.7 ID 1 R R [0..1] 0200

Expected Values:

“L” (Legal) – used for patient legal name.

“S” (Pseudonym) – used for de-identification of 
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TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

patient name.

“U” (Unspecified) – used when patient name is not 

known.

Name Representation Code 5.8 ID 1 X X [0..1]

Name Context 5.9 CE 483 X X [0..1]

Name Validity Range 5.10 DR 53 X X [0..0]

Name Assembly Order 5.11 ID 1 X X [0..1] 0444

Effective Date 5.12 TS 26 X X [0..1]

Expiration Date 5.13 TS 26 X X [0..1]

Professional Suffix 5.14 ST 199 X X [0..1]

Mother‟s Maiden Name 6 XPN 294 X X [0..*]

Date/Time of Birth 7 TS 26 O O [0..1]

Administrative Sex 8 IS 1 RE RE [0..1] Gender ( Syndromic Surveillance)
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Patient Alias 9 XPN 294 X X [0..0]

Race 10 CE 478 RE RE [0..*] Race Category (CDC)

Note: Patient could have more than one race 

defined.

Identifier 10.1 ST 20 RE RE [0..1] Note: Standardized code for patient race category

Text 10.2 ST 199 O RE [0..1] Note: Standardized description associated with 

code in PID-10.1

Name of Coding System 10.3 ID 20 CE C [0..1] Condition Rule: Required if an identifier is provided 

in component 1.

Alternate Identifier 10.4 ST 20 X X [0..1]

Alternate Text 10.5 ST 199 X X [0..1]

Name of Alternate Coding 

System

10.6 ID 20 X X [0..1]

Patient Address 11 XAD 513 RE RE [0..1] Note: Expecting only the patient primary (current) 

address information in the supported components
Page 45

PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Street Address 11.1 SAD 184 O O [0..1]

Other Designation 11.2 ST 120 O O [0..1]

City 11.3 ST 50 O O [0..1]

State or Province 11.4 ST 50 RE RE [0..1] FIPS 5-2

ZIP or Postal Code 11.5 ST 12 RE RE [0..1] USPS

Country 11.6 ID 3 RE RE [0..1] ISO 3166-1

Address Type 11.7 ID 3 O O [0..1]

0190

Expecting value: „C‟ 

Other Geographic Designation 11.8 ST 50 O O [0..1]

County/Parish Code 11.9 IS 20 O O [0..1]

Census Tract 11.10 IS 20 X X [0..1]

Address Representation Code 11.11 ID 1 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Address Validity Range 11.12 DR 53 X X [0..0]

Effective Date 11.13 TS 26 X X [0..1]

Expiration Date 11.14 TS 26 X X [0..1]

County Code 12 IS 4 X X [0..0] 0289 

Phone Number - Home 13 XTN 250 X X [0..*]

Phone Number - Business 14 XTN 250 X X [0..*]

Primary Language 15 CE 478 X X [0..1] 0296 

Marital Status 16 CE 478 X X [0..1] 0002 

Religion 17 CE 478 X X [0..1] 0006 

Patient Account Number 18 CX 250 O O [0..1]

SSN Number - Patient 19 ST 16 X X [0..0]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Driver's License Number - Patient 20 DLN 64 X X [0..0]

Mother's Identifier 21 CX 250 X X [0..*]

Ethnic Group 22 CE 478 RE RE [0..*] Ethnicity Group (CDC)

Identifier 22.1 ST 20 RE RE [1..1] Note: Standardized code for patient ethnic group.

Text 22.2 ST 199 O O [0..1] Note: Standardized description associated with 

code in PID-22.1.

Name of Coding System 22.3 ID 20 CE C [0..1] Condition Rule: Required if an identifier is provided 

in component 1.

Alternate Identifier 22.4 ST 20 X X [0..1]

Alternate Text 22.5 ST 199 X X [0..1]

Name of Alternate Coding 

System

22.6 ID 20 X X [0..1]

Birth Place 23 ST 250 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Multiple Birth Indicator 24 ID 1 X X [0..1] 0136 

Birth Order 25 NM 2 X X [0..1]

Citizenship 26 CE 478 X X [0..*] 0171 

Veterans Military Status 27 CE 478 X X [0..1] 0172 

Nationality 28 CE 478 X X [0..0] 0212 

Patient Death Date and Time 29 TS 26 CE CE [0..1] If the patient expired, this field should contain the 

patient death date and time. (PV1-36 denotes 

patient expiration)

The minimum acceptable precision is to the nearest 

minute; seconds are desirable. If Coordinated 

Universal Time (UTC) offset is not sent, it is 

assumed to be offset of the receiver.

Patient Death Indicator 30 ID 1 CE CE [0..1] 0136

If the patient expired, this field should contain the 

patient death indicator. (PV1-36 denotes patient 

disposition)
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6C. PATIENT IDENTIFICATION SEGMENT (PID)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Identity Unknown Indicator 31 ID 1 X X [0..1] 0136 

Identity Reliability Code 32 IS 20 X X [0..*] 0445 

Last Update Date/Time 33 TS 26 O O [0..1]

Last Update Facility 34 HD 241 O O [0..1]

Species Code 35 CE 478 X X [0..1] 0446 

Breed Code 36 CE 478 X X [0..1] 0447 

Strain 37 ST 80 X X [0..1]

Production Class Code 38 CE 478 X X [0..1] 0429 

Tribal Citizenship 39 CWE 697 X X [0..*] 0171 
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PHIN Messaging Guide for Syndromic Surveillance

3.6.5 PATIENT VISIT (PV1) SEGMENT

The PV1 segment is used by Registration/Patient Administration applications to communicate information on a visit-specific 

basis.

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Set ID - PV1 1 SI 4 RE RE [0..1] Note: Set ID numbers the repetitions of the 

segments Only one patient per message is 

supported.

Literal value: “1”

Patient Class 2 IS 1 R RE [1..1] Patient Class ( Syndromic Surveillance)

Assigned Patient Location 3 PL 1220 O O [0..1]

Admission Type 4 IS 2 O O [0..1] 0007 

Pre-admit Number 5 CX 250 X X [0..1]

Prior Patient Location 6 PL 1220 X X [0..1]

Attending Doctor 7 XCN 309 X X [0..*] 0010 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Referring Doctor 8 XCN 309 X X [0..*] 0010 

Consulting Doctor 9 XCN 309 X X [0..0] 0010 

Hospital Service 10 IS 3 O O [0..1] 0069

Temporary Location 11 PL 1220 X X [0..1]

Preadmit Test Indicator 12 IS 2 X X [0..1] 0087 

Re-admission Indicator 13 IS 2 X X [0..1] 0092 

Admit Source 14 IS 6 O O [0..1] 0023 

Ambulatory Status 15 IS 2 O O [0..*] 0009 

VIP Indicator 16 IS 2 X X [0..1] 0099 

Admitting Doctor 17 XCN 309 X X [0..*] 0010 

Patient Type 18 IS 2 X X [0..1] 0018 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Visit Number 19 CX 478 R R [1..1]

ID Number 19.1 ST 15 R R [1..1] Note: Unique identifier for a patient visit

Check Digit 19.2 ST 1 X X [0..1]

Check Digit Scheme 19.3 ID 3 X X [0..1] 0061

Assigning Authority 19.4 HD 227 O RE [0..1] 0363

Identifier Type Code 19.5 ID 5 R R [0..1] Identifier Type

Note: Use the Identifier Type Code that 

corresponds to the type of ID Number specified in 

PV1-19.1.

Assigning Facility 19.6 HD 227 O RE [0..1]

Effective Date 19.7 DT 8 X X [0..1]

Expiration Date 19.8 DT 8 X X [0..1]

Assigning Jurisdiction 19.9 CWE 705 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Assigning Facility 19.10 CWE 705 X X [0..1]

Financial Class 20 FC 50 X X [0..*] 0064 

Charge Price Indicator 21 IS 2 X X [0..1] 0032 

Courtesy Code 22 IS 2 X X [0..1] 0045 

Credit Rating 23 IS 2 X X [0..1] 0046 

Contract Code 24 IS 2 X X [0..*] 0044 

Contract Effective Date 25 DT 8 X X [0..*]

Contract Amount 26 NM 12 X X [0..*]

Contract Period 27 NM 3 X X [0..*]

Interest Code 28 IS 2 X X [0..1] 0073 

Transfer to Bad Debt Code 29 IS 4 X X [0..1] 0110 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Transfer to Bad Debt Date 30 DT 8 X X [0..1]

Bad Debt Agency Code 31 IS 10 X X [0..1] 0021 

Bad Debt Transfer Amount 32 NM 12 X X [0..1]

Bad Debt Recovery Amount 33 NM 12 X X [0..1]

Delete Account Indicator 34 IS 1 X X [0..1] 0111 

Delete Account Date 35 DT 8 X X [0..1]

Discharge Disposition 36 IS 3 RE RE [0..1] NUBC – Patient Status (UB04 -Field 17 Codes)

Discharged to Location 37 DLD 47 X X [0..1] 0113 

Diet Type 38 CE 478 X X [0..1] 0114 

Servicing Facility 39 IS 2 X X [0..1] 0115 

Bed Status 40 IS 1 X X [0..0] 0116 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Account Status 41 IS 2 X X [0..1] 0117 

Pending Location 42 PL 1220 X X [0..1]

Prior Temporary Location 43 PL 1220 X X [0..1]

Admit Date/Time 44 TS 26 R R [1..1] Note: Date and time of the patient presentation. 

YYYYMMDDHHMM[SS[.S[S[S[S]]]]] [+/-ZZZZ] 

The minimum acceptable precision is to the nearest 

minute; seconds are desirable. If Coordinated 

Universal Time (UTC) offset is not sent, it is 

assumed to be offset of the receiver.

Discharge Date/Time 45 TS 26 RE RE [0..*] Note: Date and time of the patient discharge. 

YYYYMMDDHHMM[SS[.S[S[S[S]]]]] [+/-ZZZZ] 

The minimum acceptable precision is to the nearest 

minute; seconds are desirable. If Coordinated 

Universal Time (UTC) offset is not sent, it is 

assumed to be offset of the receiver.

Current Patient Balance 46 NM 12 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6D: PATIENT VISIT SEGMENT (PV1)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Total Charges 47 NM 12 X X [0..1]

Total Adjustments 48 NM 12 X X [0..1]

Total Payments 49 NM 12 X X [0..1]

Alternate Visit ID 50 CX 250 X X [0..1] 0203 

Visit Indicator 51 IS 1 X X [0..1] 0326 

Other Healthcare Provider 52 XCN 309 X X [0..0] 0010 
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PHIN Messaging Guide for Syndromic Surveillance

3.6.6 PATIENT VISIT – ADDITIONAL INFORMATION (PV2) SEGMENT

The PV2 segment is a continuation of visit-specific information and is the segment where the Admit Reason is passed. 

TABLE 3-6E: PATIENT VISIT – ADDITIONAL INFORMATION SEGMENT (PV2)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Prior Pending Location 1 PL 1220 X X [0..1]

Accommodation Code 2 CE 478 X X [0..1] 0129 

Admit Reason 3 CE 478 RE RE [0..1] ICD-9 Clinical Modification diagnosis code 

(including E-codes and V-codes)

Or

ICD-10 Clinical Modification diagnosis code

Or

SNOMED Disorder/ Disease domain

Identifier 3.1 ST 20 RE RE [0..1]

Text 3.2 ST 199 RE RE [0..1] It is strongly recommended that text be sent to 

accompany any identifier. 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6E: PATIENT VISIT – ADDITIONAL INFORMATION SEGMENT (PV2)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Name of Coding System 3.3 ID 20 C C [0..1] Condition Rule: Required if an identifier is provided 

in component 1.

Alternate Identifier 3.4 ST 20 X X [0..1]

Alternate Text 3.5 ST 199 X X [0..1]

Name of Alternate Coding 

System

3.6 ID 20 X X [0..1]

Transfer Reason 4 CE 478 X X [0..1]

Patient Valuables 5 ST 25 X X [0..*]

Patient Valuables Location 6 ST 25 X X [0..1]

Visit User Code 7 IS 2 X X [0..*] 0130 

Expected Admit Date/Time 8 TS 26 X X [0..1]

Expected Discharge Date/Time 9 TS 26 X X [0..1]

Estimated Length of Inpatient Stay 10 NM 3 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6E: PATIENT VISIT – ADDITIONAL INFORMATION SEGMENT (PV2)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Actual Length of Inpatient Stay 11 NM 3 X X [0..1]

Visit Description 12 ST 50 X X [0..1]

Referral Source Code 13 XCN 309 X X [0..*]

Previous Service Date 14 DT 8 X X [0..1]

Employment Illness Related 

Indicator 

15 ID 1 X X [0..1] 0136 

Purge Status Code 16 IS 1 X X [0..1] 0213 

Purge Status Date 17 DT 8 X X [0..1]

Special Program Code 18 IS 2 X X [0..1] 0214 

Retention Indicator 19 ID 1 X X [0..1] 0136 

Expected Number of Insurance 

Plans 

20 NM 1 X X [0..1]

Visit Publicity Code 21 IS 1 X X [0..1] 0215 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6E: PATIENT VISIT – ADDITIONAL INFORMATION SEGMENT (PV2)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Visit Protection Indicator 22 ID 1 X X [0..1] 0136 

Clinic Organization Name 23 XON 250 X X [0..*]

Patient Status Code 24 IS 2 X X [0..1] 0216 

Visit Priority Code 25 IS 1 X X [0..1] 0217 

Previous Treatment Date 26 DT 8 X X [0..1]

Expected Discharge Disposition 27 IS 2 X X [0..1] 0112 

Signature on File Date 28 DT 8 X X [0..1]

First Similar Illness Date 29 DT 8 X X [0..1]

Patient Charge Adjustment Code 30 CE 478 X X [0..1] 0218 

Recurring Service Code 31 IS 2 X X [0..1] 0219 

Billing Media Code 32 ID 1 X X [0..1] 0136 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6E: PATIENT VISIT – ADDITIONAL INFORMATION SEGMENT (PV2)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Expected Surgery Date and Time 33 TS 26 X X [0..1]

Military Partnership Code 34 ID 1 X X [0..1] 0136 

Military Non-Availability Code 35 ID 1 X X [0..1] 0136 

Newborn Baby Indicator 36 ID 1 X X [0..1] 0136 

Baby Detained Indicator 37 ID 1 X X [0..1] 0136 

Mode of Arrival Code 38 CE 478 X X [0..1] 0430 

Recreational Drug Use Code 39 CE 478 X X [0..*] 0431 

Admission Level of Care Code 40 CE 478 X X [0..1] 0432 

Precaution Code 41 CE 478 X X [0..*] 0433 

Patient Condition Code 42 CE 478 X X [0..1] 0434 

Living Will Code 43 IS 2 X X [0..1] 0315 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6E: PATIENT VISIT – ADDITIONAL INFORMATION SEGMENT (PV2)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Organ Donor Code 44 IS 2 X X [0..1] 0316 

Advance Directive Code 45 CE 478 X X [0..*] 0435 

Patient Status Effective Date 46 DT 8 X X [0..1]

Expected LOA Return Date/Time 47 TS 26 X X [0..1]

Expected Pre-admission Testing 

Date/Time 

48 TS 26 X X [0..1]

Notify Clergy Code 49 IS 20 X X [0..*] 0534 
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PHIN Messaging Guide for Syndromic Surveillance

3.6.7 OBSERVATION/RESULT (OBX) SEGMENT 

The OBX Segment in the ADT Message is used to transmit observations related to the patient and visit. In Section 4.2.1 if the 

data element is carried in an OBX and usage is „Required‟, the segment and its fields must be populated.

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Set ID - OBX 1 SI 4 O RE [0..1] Note: Set ID numbers the repetitions of the segments

Value Type 2 ID 3 R R [1..1] 0125

Note: Identifies the structure of data in observation 

value (OBX.5). 

Observation Identifier 3 CE 478 R R [1..1] Observation Identifier ( Syndromic Surveillance)

Note: Identifies data to be received in observation 

value (OBX.5)

Identifier 3.1 ST 20 R R [1..1]

Text 3.2 ST 199 O O [0..1]

Name of Coding System 3.3 ID 20 C C [0..1] Condition Rule: Required if an identifier is provided in 

component 1.
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Alternate Identifier 3.4 ST 20 X X [0..1]

Alternate Text 3.5 ST 199 X X [0..1]

Name of Alternate Coding 

System

3.6 ID 20 X X [0..1]

Observation Sub-ID 4 ST 20 X X [0..1]

Observation Value 5 varies 99999 RE RE [0..*] Note: Values received in observation value are defined 

by value type (OBX.2) and observation identifier 

(OBX.3).

Listed below are the supported fields for each of the 

supported value types.

Beginning of OBX-5 Observation Value Usage Based on Data Type in OBX-2

HD Data Type (2.3.1 Messaging Only)

Namespace ID 5.1 IS 20 RE RE [0..1] Name of originating facility.

Universal ID 5.2 ST 199 R R [1..1] National Provider Identifier. (10 digit identifier)
Page 65

PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Universal ID 5.3 ID 6 R R [1..1] Expecting Value “NPI”.

TS Data Type

Time 5.1 DTM 24 RE RE [0..1] Note: The minimum acceptable precision is to the 

nearest day.

Degree of Precision 5.2 ST 1 X X [0..0]

TX Data Type

Text Data 5.1 TX 65536 RE RE [0..1] Note: The TX data type is used to carry string data 

intended for display purposes. It can contain leading 

blanks (space characters).

NM Data Type

Numeric Value 5.1 ST 16 RE RE [0..1] Note: A numeric data type is a number represented as 

a series of ASCII numeric characters 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.
Page 66

PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

CWE Data Type

Identifier 5.1 ST 20 RE RE [0..1] Note: Implementers should check with their local 

jurisdiction for version of adopted coding system. 

Text 5.2 ST 199 RE RE [0..1] It is strongly recommended that text be sent to 

accompany any identifier. 

Name of Coding System 5.3 ID 20 C C [0..1] Condition Rule: Required if an identifier is provided in 

component 1. 

Alternate Identifier 5.4 ST 20 RE RE [0..1]

Alternate Text 5.5 ST 199 RE RE [0..1] It is strongly recommended that text be sent to 

accompany any identifier. 

Name of Alternate Coding 

System

5.6 ID 20 C C [0..1] Condition Rule: Required if an identifier is provided in 

component 4.

Coding System Version ID 5.7 ST 10 O O [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Alternate Coding System 

Version ID

5.8 ST 10 O O [0..1]

Original Text 5.9 ST 199 RE RE [0..1] Provide the richest text available in this field.

XAD Data Type

Street Address 5.1 SAD 184 O O [0..1]

 Street or Mailing Address 5.1.1 ST 120 O O [0..1] Note: This is the first subcomponent of the SAD data 

type. This has the same effect as being the first 

component of the field, while limiting the length based 

on other subcomponents that are not supported.

 Street Name 5.1.2 ST 50 O O [0..1]

 Dwelling Number 5.1.3 ST 12 O O [0..1]

Other Designation 5.2 ST 120 O O [0..1]

City 5.3 ST 50 O O [0..1]

State or Province 5.4 ST 50 O O [0..1] FIPS 5-2
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

ZIP or Postal Code 5.5 ST 12 O O [0..1] USPS

Country 5.6 ID 3 O O [0..1] ISO 3166-1

Address Type 5.7 ID 3 O O [0..1] 0190

Other Geographic Designation 5.8 ST 50 O O [0..1]

County/Parish Code 5.9 IS 20 O O [0..1]

Census Tract 5.10 IS 20 X X [0..1]

Address Representation Code 5.11 ID 1 X X [0..1]

Address Validity Range 5.12 DR 53 X X [0..0]

Effective Date 5.13 TS 26 X X [0..1]

Expiration Date 5.14 TS 26 X X [0..1]

End of OBX-5 Observation Value Usage Based on Data Type in OBX-2
Page 69

PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Units 6 CE 62 C C [0..1] Pulse Oximetry Unit

Temperature Unit

Age unit ( Syndromic Surveillance)

Note: Units are a conditional field. If numeric data is 

sent, the units field must define the units of the value 

used in observation value (OBX.5)

Identifier 6.1 ST 20 R R [1..1]

Text 6.2 ST 20 O O [0..1] Standardized description associated with code in OBX6.1.

Name of Coding System 6.3 ID 20 C C [0..1] Condition Rule: Required if an identifier is provided in 

component 1.

Alternate Identifier 6.4 ST 20 X X [0..1]

Alternate Text 6.5 ST 199 X X [0..1]

Name of Alternate Coding 

System

6.6 ID 20 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

References Range 7 ST 60 X X [0..1]

Abnormal Flags 8 IS 5 X X [0..*] 0078 

Probability 9 NM 5 X X [0..1]

Nature of Abnormal Test 10 ID 2 X X [0..*] 0080 

Observation Result Status 11 ID 1 R R [1..1] 0085

Expected value: „F‟

Effective Date of Reference 

Range 

12 TS 26 X X [0..1]

User Defined Access Checks 13 ST 20 X X [0..1]

Date/Time of the Observation 14 TS 26 O O [0..1]

Producer's ID 15 CE 478 X X [0..1]

Responsible Observer 16 XCN 309 X X [0..*]
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6F: OBSERVATION / RESULT SEGMENT (OBX)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set 

Observation Method 17 CE 478 X X [0..*]

Equipment Instance Identifier 18 EI 424 X X [0..*]

Date/Time of the Analysis 19 TS 26 X X [0..1]
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PHIN Messaging Guide for Syndromic Surveillance

3.6.8 DIAGNOSIS (DG1) SEGMENT

The DG1 segment contains patient diagnosis information of various types. Syndromic Surveillance supports Admitting, Working 

and Final Diagnosis types. 

TABLE 3-6G: DIAGNOSIS SEGMENT (DG1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Set ID - DG1 1 SI 4 R R [1..1] Note: Numbers the repetitions of the segments

Diagnosis Coding Method 2 ID 2 X X [0..1] 0053 

Diagnosis Code - DG1 3 CE 478 R R [0..1] ICD-9 Clinical Modification diagnosis code (including 

E-codes and V-codes)

Or

ICD-10 Clinical Modification diagnosis code

Or

SNOMED Disorder/ Disease domain

Identifier 3.1 ST 20 R RE [1..1] Note: Standardized code for diagnosis.

Text 3.2 ST 199 RE RE [1..1] Note: Standardized description associated with code 

in DG1-3.1.
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 3-6G: DIAGNOSIS SEGMENT (DG1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Name of Coding System 3.3 ID 20 C C [1..1] Condition Rule: Required if an identifier is provided in 

component 1.

Alternate Identifier 3.4 ST 20 X X [0..1]

Alternate Text 3.5 ST 199 X X [0..1]

Name of Alternate Coding 

System

3.6 ID 20 X X [0..1]

Diagnosis Description 4 ST 40 X X [0..0]

Diagnosis Date/Time 5 TS 26 O O [0..1]

Diagnosis Type 6 IS 2 R R [1..1] Diagnosis Type (HL7)

Note: Identifies the type of diagnosis being sent. 

Literal values: “A” for Admitting diagnosis, “W” for 

Working diagnosis or “F” for Final diagnosis. 

Major Diagnostic Category 7 CE 478 X X [0..0] 0118 

Diagnostic Related Group 8 CE 478 X X [0..0] 0055 
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TABLE 3-6G: DIAGNOSIS SEGMENT (DG1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

DRG Approval Indicator 9 ID 1 X X [0..0] 0136 

DRG Grouper Review Code 10 IS 2 X X [0..0] 0056 

Outlier Type 11 CE 478 X X [0..0] 0083 

Outlier Days 12 NM 3 X X [0..0]

Outlier Cost 13 CP 538 X X [0..0]

Grouper Version And Type 14 ST 4 X X [0..0]

Diagnosis Priority 15 ID 2 X X [0..1] 0359 

Diagnosing Clinician 16 XCN 309 X X [0..*]

Diagnosis Classification 17 IS 3 X X [0..1] 0228 

Confidential Indicator 18 ID 1 X X [0..1] 0136 

Attestation Date/Time 19 TS 26 X X [0..1]
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TABLE 3-6G: DIAGNOSIS SEGMENT (DG1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Diagnosis Identifier 20 EI 427 X X [0..1]

Diagnosis Action Code 21 ID 1 X X [0..1] 0206 
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3.6.9 PROCEDURES (PR1) SEGMENT

The PR1 segment is used to carry information relative to various types of procedures performed.

TABLE 3-6H. PROCEDURES SEGMENT (PR1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Set ID – PR1 1 SI 4 R R [1..1] Note: Numbers the repetitions of the segments.

Procedure Coding Method 2 IS 3 X X [0..1] 0089

Procedure Code 3 CE 478 R R [1..1] 0088

Procedure Description 4 ST 40 X X [0..0]

Procedure Date/Time 5 TS 26 R R [1..1]

Procedure Functional Type 6 IS 2 X X [0..1] 0230

Procedure Minutes 7 NM 4 X X [0..1]

Anesthesiologist 8 XCN 309 X X [0..0] 0010

Anesthesia Code 9 IS 2 X X [0..1] 0019
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TABLE 3-6H. PROCEDURES SEGMENT (PR1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Anesthesia Minutes 10 NM 4 X X [0..1]

Surgeon 11 XCN 309 X X [0..0] 0010

Procedure Practitioner 12 XCN 309 X X [0..0] 0010

Consent Code 13 CE 478 X X [0..1] 0059

Procedure Priority 14 ID 2 X X [0..1] 0418

Associated Diagnosis Code 15 CE 478 X X [0..1] 0051

Procedure Code Modifier 16 CE 478 X X [0..*] 0340

Procedure DRG Type 17 IS 20 X X [0..1] 0416

Tissue Type Code 18 CE 478 X X [0..*] 0417

Procedure Identifier 19 EI 427 X X [0..1]

Procedure Action Code 20 ID 1 X X [0..1] 0206
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3.6.10 INSURANCE (IN1) SEGMENT

The IN1 segment contains insurance policy coverage information necessary to produce properly pro-rated and patient and 

insurance bills.

TABLE 3-6I: INSURANCE SEGMENT (IN1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Set ID – PR1 1 SI 4 R R [1..1] Note: SET ID numbers the repetitions of the 

segments.

Insurance Plan ID 2 CE 478 R R [1..1] 0072 

Insurance Company ID 3 CX 250 R R [1..*]

Insurance Company Name 4 XON 250 X X [0..*]

Insurance Company Address 5 XAD 513 X X [0..*]

Insurance Co Contact Person 6 XPN 294 X X [0..*]

Insurance Co Phone Number 7 XTN 250 X X [0..*]

Group Number 8 ST 12 X X [0..1]

Group Name 9 XON 250 X X [0..*]
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TABLE 3-6I: INSURANCE SEGMENT (IN1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Insured_s Group Emp ID 10 CX 250 X X [0..*]

Insured_s Group Emp Name 11 XON 250 X X [0..*]

Plan Effective Date 12 DT 8 X X [0..1]

Plan Expiration Date 13 DT 8 X X [0..1]

Authorization Information 14 AUI 239 X X [0..1]

Plan Type 15 IS 3 O O [0..1] 0086 

Name Of Insured 16 XPN 294 X X [0..*]

Insured_ Relationship To Patient 17 CE 478 X X [0..1] 0063 

Insured_ Date Of Birth 18 TS 26 X X [0..1]

Insured_ Address 19 XAD 513 X X [0..*]

Assignment Of Benefits 20 IS 2 X X [0..1] 0135 
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TABLE 3-6I: INSURANCE SEGMENT (IN1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Coordination Of Benefits 21 IS 2 X X [0..1] 0173 

Coord Of Ben. Priority 22 ST 2 X X [0..1]

Notice Of Admission Flag 23 ID 1 X X [0..1] 0136 

Notice Of Admission Date 24 DT 8 X X [0..1]

Report Of Eligibility Flag 25 ID 1 X X [0..1] 0136 

Report Of Eligibility Date 26 DT 8 X X [0..1]

Release Information Code 27 IS 2 X X [0..1] 0093 

Pre-Admit Cert (PAC) 28 ST 15 X X [0..1]

Verification Date/Time 29 TS 26 X X [0..1]

Verification By 30 XCN 309 X X [0..*]

Type Of Agreement Code 31 IS 2 X X [0..1] 0098 
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TABLE 3-6I: INSURANCE SEGMENT (IN1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Billing Status 32 IS 2 X X [0..1] 0022 

Lifetime Reserve Days 33 NM 4 X X [0..1]

Delay Before L.R. Day 34 NM 4 X X [0..1]

Company Plan Code 35 IS 8 X X [0..1] 0042 

Policy Number 36 ST 15 X X [0..1]

Policy Deductible 37 CP 538 X X [0..1]

Policy Limit - Amount 38 CP 538 X X [0..0]

Policy Limit - Days 39 NM 4 X X [0..1]

Room Rate - Semi-Private 40 CP 538 X X [0..0]

Room Rate - Private 41 CP 538 X X [0..0]

Insured_ Employment Status 42 CE 478 X X [0..1] 0066 
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TABLE 3-6I: INSURANCE SEGMENT (IN1)

Field Name Seq DT Lengt

h

Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Insured_ Administrative Sex 43 IS 1 X X [0..1] 0001 

Insured_ Employer_s Address 44 XAD 513 X X [0..*]

Verification Status 45 ST 2 X X [0..1]

Prior Insurance Plan ID 46 IS 8 X X [0..1] 0072 

Coverage Type 47 IS 3 X X [0..1] 0309 

Handicap 48 IS 2 X X [0..1] 0295 

Insured_ ID Number 49 CX 250 X X [0..*]

Signature Code 50 IS 1 X X [0..1] 0535 

Signature Code Date 51 DT 8 X X [0..1]

Insured_ Birth Place 52 ST 250 X X [0..1]

VIP Indicator 53 IS 2 X X [0..1] 0099 
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3.6.11 MESSAGE ACKNOWLEDGEMENT (MSA) SEGMENT

The MSA segment is used by message receivers to acknowledge a correct receipt of a message.

TABLE 3-6J: MESSAGE ACKNOWLEDGEMENT SEGMENT (MSA)

Field Name Seq DT Len Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Acknowledgement Code 1 ID 2 R R [1..1] 0008

Message Control ID 2 ST 20 R R [1..1] Specifies the value in MSH-10 of the message 

being acknowledged

Text Message 3 ST 80 X X [0..1]

Expected Sequence Number 4 NM 15 X X [0..1]

Delayed Acknowledgement Type 5 X X [0..0] Note: The MSA-5 was deprecated as of v2.2 and the 

detail was withdrawn and removed from the standard 

as of version 2.5.

Error Condition 6 CE 250 RE RE [0..1] 0357
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3.7 HL7 BATCH PROTOCOL

The HL7 Batch Protocol can be used to allow for periodic reporting. The HL7 file and batch header and trailer segments are 

defined in exactly the same manner as the HL7 message segments; hence, the same HL7 message construction rules used for 

individual messages can be used to encode and decode HL7 batch files. One batch of messages per file is supported.

3.7.1 HL7 BATCH FILE STRUCTURE

The structure of the batch file is constrained as follows:

TABLE 3-7: BATCH SIMPLE FILE STRUCTURE

SEGMENT NAME DESCRIPTION USAGE CARDINALITY

FHS File Header Segment Information explaining how to parse and process the file. 

This information includes identification of file delimiters, 

sender, receiver, timestamp, etc. 

R [1..1] 

BHS Batch Header Segment Trigger event information for receiving application. One

batch per file is supported. 

R [1..1] 

{ HL7 messages } R [1..*] 

BTS Batch Trailer Segment R [1..1]

FTS File Trailer Segment R [1..1] 
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3.7.2 FILE HEADER (FHS) SEGMENT

This segment is used as the lead-in to a file (group of batches).

TABLE 3-7A: FILE HEADER SEGMENT (FHS)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

File Field Separator 1 ST 1 R R [1..1] Default Value “|” (ASCII 124).

File Encoding Characters 2 ST 4 R R [1..1] Default Values “^~\&” (ASCII 

94, 126, 92, and 38).

File Sending Application 3 HD 227 O O [0..1]

File Sending Facility 4 HD 227 O RE [0..1]

File Receiving Application 5 HD 227 O O [0..1]

File Receiving Facility 6 HD 227 O O [0..1]

File Creation Date/Time 7 TS 26 O RE [0..1]

File Security 8 ST 40 X X [0..1]
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File Name/ID 9 ST 20 O RE [0..1]

File Header Comment 10 ST 80 O O [0..1]

File Control ID 11 ST 199 O RE [0..1]

Reference File Control ID 12 ST 20 O RE [0..1]

Example: FHS|^~\&<cr>
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3.7.3 FILE TRAILER (FTS) SEGMENT

The FTS segment defines the end of a file (group of batches).

TABLE 3-7B. FILE TRAILER SEGMENT (FTS)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

File Batch Count 1 NM 10 R RE [0..1] The number of batches 

contained in this file. Since 

this interface is constrained 

to one batch per file, this 

number should always be 

„1‟.

File Trailer Comment 2 ST 80 O O [0..1]

Example: FTS|1<cr>
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3.7.4 BATCH HEADER (BHS) SEGMENT

The BHS segment is used to head a group of messages that comprise a batch.

TABLE 3-7C: BATCH HEADER SEGMENT (BHS)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Batch Field Separator 1 ST 1 R R [1..1] Default Value “|” (ASCII 

124).

Batch Encoding Characters 2 ST 4 R R [1..1] Default Values “^~\&” 

(ASCII 94,126,92, and 38).

Batch Sending Application 3 HD 227 R R [1..1]

Batch Sending Facility 4 HD 227 R R [1..1]

Batch Receiving Application 5 HD 227 R R [1..1]

Batch Receiving Facility 6 HD 227 R R [1..1]

Batch Creation Date/Time 7 TS 26 R R [1..1]

Batch Security 8 ST 40 X X [0..1]
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TABLE 3-7C: BATCH HEADER SEGMENT (BHS)

Field Name Seq DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Batch Name/ID 9 ST 20 O RE [0..1]

Batch Header Comment 10 ST 80 O RE [0..1]

Batch Control ID 11 ST 20 O RE [0..1]

Reference Batch Control ID 12 ST 20 O RE [0..1]

Example: BHS|^~\&|ER1^2.16.840.1.113883.19.3.1.1^ISO 

|CITY_GENERAL^2.16.840.1.113883.19.3.1^ISO|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.

2^ISO|20080723123558-0400<cr>
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3.7.5 BATCH TRAILER (BTS) SEGMENT

The BTS segment defines the end of a batch of messages.

TABLE 3-7D: BATCH TRAILER SEGMENT (BTS)

Field Name Sequence DT Length Sender 

Usage

Receiver 

Usage

Cardinality Values / Value Set

Batch Message Count 1 NM 10 R RE [0..1] The number of messages 

contained in the preceding batch.

Batch Comment 2 ST 80 O RE [0..1]

Batch Totals 3 NM 100 X X [0..*]

Example: BTS|100|Facility reporting for 2-1-2011<cr>
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4 DATA ELEMENTS OF INTEREST

4.1 COLUMN DEFINITIONS FOR ELEMENTS OF INTEREST TABLE

Table 4-1 contains the preliminary minimum set of data elements commonly used for public health Syndromic Surveillance.

This section describes the definitions of the table columns in Table 4-1.

TABLE 4-1: SYNDROMIC SURVEILLANCE COLUMN HEADINGS

COLUMN NAME DEFINITION

# Number of the core data set element as provided by ISDS

Data Element Name Name of the core data set element as provided by ISDS

Description of Field Description of the data element

Usage Refers to whether an element must appear in the message. The Usage codes are:

 R – Required Indicates that the field is a required field. A value must be present in the field in order for 

the message to be accepted.

 RE – Required, but can be empty: Indicates that the field is a required field. However, if there is no 

data captured in the field due to the setting (e.g. no chief complaint data for a trauma patient) and the 

field is blank, the message may be sent with the field containing no data.

 O – Optional: Optional for data to be sent in a message. Local jurisdictions must further constrain 

these elements for implementation.
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TABLE 4-1: SYNDROMIC SURVEILLANCE COLUMN HEADINGS

COLUMN NAME DEFINITION

Cardinality Minimum and maximum number of times the element may appear

Value Set OID / Name Value Set OID and Name of value set containing the values that define the data element. These may be 

used to populated the tables from which coded message fields are drawn

Notes Describes additional notes that are relevant to the rules and/or processing of the data element field

Recommended HL7 Location Recommended location of Data Element for HL7 message population 

4.2 DATA ELEMENTS OF INTEREST FOR SYNDROMIC SURVEILLANCE

The following section is derived from the ISDS Final Recommendation: The Core Processes and EHR Requirements of Public 

Health Syndromic Surveillance, Section 4, discussing data sets for core EHR requirements. In the following tables, columns 1-5 

are defined by the ISDS recommendations and columns 6-8 are provided to assist implementers of HL7 messaging.

4.2.1 MINIMUM DATA SET

The following table contains a minimum list of data elements commonly used by public health authorities to conduct Syndromic 

Surveillance. This list does not represent the entire list of data elements needed to support the current practice of Syndromic 

Surveillance across all public health jurisdictions. Therefore, the actual data elements and their specifications are subject to 

change in accordance with applicable state and local laws and practices.
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

Treatment Facility Identifiers

1 Facility 

Identifier 

(Treating)

Unique facility 

identifier of 

facility where 

the patient 

originally 

presented 

(original 

provider of the 

data)

R [1..1] Recommend the use of the 

National Provider Identifier 

Standard provided by Centers 

for Medicare and Medicaid 

Services. For more information 

about NPI, search for, or to 

apply for a NPI, click here.

Final Rule establishing NPI as 

standard unique health 

identifier for health care 

providers

NPI Final Rule

This number should be 

specific for each facility 

location (not a number 

representing an umbrella 

business)

It is recommended that 

National Provider Identifier 

(NPI) be used for the 

Facility Identifier.

HL7 Version 2.5.1: 

EVN-7.2

Example EVN-7:

|OTH_REG_MEDCTR^12

34567890^NPI|

HL7 Version 2.3.1:

OBX Segment (HD Data 

Type, 2nd Component of 

5

th field) with 

PHINQUESTION Code

(SS001) Observation 

Identifier
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

Example OBX Segment:

OBX|2|HD|SS001^TREATI

NG FACILITY 

IDENTIFIER^PHINQUESTI

ON||OTHER_REG_MEDC

TR^1234567890^NPI||||||F||

|201102171531<cr>

2 Facility 

Name

(Treating)

Name of facility 

where the 

patient 

originally 

presented 

(original 

provider of the 

data)

O [0..1] Recommend the use of the 

Organization Name Legal 

Business Name (LBN) 

associated with the National 

Provider Identifier Standard 

provided by Centers for 

Medicare and Medicaid 

Services. For more information 

about NPI, search for, or to 

apply for a NPI, click here.

Final Rule establishing NPI as 

standard unique health 

identifier for health care 

If this data element is 

captured and maintained as 

part of the facility 

registration process, it may 

not be sent with every 

message. See ISDS 

recommendations, section 

4.2, on Facility Registration 

ISDS.

HL7 Version 2.5.1: 

EVN-7.1

Example EVN-7:

|OTH_REG_MEDCTR^12

34567890^NPI|

HL7 Version 2.3.1:

OBX Segment (HD Data 

Type, 1st Component, 5th

field) with 

PHINQUESTION Code 
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

providers

NPI Final Rule

(SS001) Observation 

Identifier

Example OBX Segment:

OBX|2|HD|SS001^TREATI

NG FACILITY 

IDENTIFIER^PHINQUESTI

ON||OTHER REG MED 

CTR^1234567890^NPI||||||

F|||201102171531<cr>

3 Facility 

Location

(Treating)

– Street 

Address

Street address 

of treating 

facility location

O [0..1] If this data element is 

captured and maintained as 

part of the facility 

registration process, it may 

not be sent with every 

message. See ISDS 

recommendations, section 

4.2, on Facility Registration 

ISDS.

OBX Segment (XAD Data 

Type) with 

PHINQUESTION Code 

(SS002) Observation 

Identifier

The XAD Data Type has 

specific fields to 

accommodate the street 

address, city, county and 

state, so only a single 

OBX is required to pass 

4 Facility 

Location 

(Treating) 

City of treating 

facility location

O [0..1] The ISDS recommendations 

recommend free text City/Town 

If this data element is 

captured and maintained as 

part of the facility 
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

- City designations. registration process, it may 

not be sent with every 

message. See ISDS 

recommendations, section 

4.2, on Facility Registration 

ISDS.

the data.

Example OBX segment:

OBX|1|XAD|SS002^TREAT

ING FACILITY 

LOCATION^PHINQUESTI

ON||^^^13^30341^USA^C^

^DEKALB||||||F|||20110209

1114<cr>

This data can also be 

accommodated in the 

Facility Registration 

process as defined by 

ISDS.

5 Facility 

Location 

(Treating) 

– County

County of 

treating facility 

location

O [0..1] The ISDS recommendations 

allow free text County 

designations.

If this data element is 

captured and maintained as 

part of the facility 

registration process, it may 

not be sent with every 

message. See ISDS 

recommendations, section 

4.2, on Facility Registration 

ISDS.

6 Facility 

Location 

(Treating) 

– State

State of 

treating facility 

location 

O [0..1] 2.16.840.1.114222.4.11.830

PHVS_State_FIPS_5-2

If this data element is

captured and maintained as 

part of the facility 

registration process, it may 

not be sent with every 

message. See ISDS 

recommendations, section 

4.2, on Facility Registration 
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

ISDS.

7 Facility / 

Visit Type

Type of facility 

that the patient 

visited for 

treatment

RE [0..1] 2.16.840.1.114222.4.11.3401

PHVS_FacilityVisitType_Syndromic

Surveillance

Relevant facility/visit type 

values are defined in value 

set.

This data can also be 

accommodated in the 

Facility Registration process 

as defined by ISDS for 

facilities where a single 

facility/visit type is expected.

OBX Segment (CWE Data 

Type) with 

PHINQUESTION Code 

(SS003) Observation 

Identifier

Example OBX segment:

OBX|2|CWE|SS003^FACIL

ITY / VISIT 

TYPE^PHINQUESTION||11

08-0^EMERGENCY 

DEPARTMENT^HSLOC|||||

|F|||201102091114<cr>

8 Report 

Date/Time

Date and time 

of report 

transmission 

from original 

source (from 

treating facility)

R [1..1] If data flows through an 

intermediary or third 

party, the intermediary 

must keep the original 

date/time of transmission.

HL7 Date/Time Format:

YYYYMMDDHHMM[SS[.S[S

EVN-2

Example Report 

Date/Time:

1:01:59 AM EST on July 

4, 2011 

|20110704010159-0500|
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

[S[S]]]]] [+/-ZZZZ] 

Patient Demographics

9 Unique 

Patient 

Identifier

Unique 

identifier for 

the patient

R [1..*] 2.16.840.1.114222.4.11.3405

PHVS_IdentifierType_SyndromicS

urveillance

Unique Patient Identifiers 

related to individual 

identifiers based on HL7 

Table 0203.

PID-3

The Unique Patient 

Identifier occurs in the 1st

component of the CX data 

type. The 5th component, 

the Identifier Type Code, 

defines the type of identifier 

used in the 1st component.

Example PID-3 Fields:

Internal Identifier (PI)

|95101100001^^^^PI|

External Identifier (PT)

|E95101100001^^^^PT|

10 Medical 

Record #

Patient medical 

record number

O [0..1] 2.16.840.1.114222.4.11.3405

PHVS_IdentifierType_SyndromicS

It is recommended that data 

providers submit the patient 

medical record number to 

PID-3

The Medical Record # is a 
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

urveillance facilitate identification of the 

patient, in the event of a 

required follow-up 

investigation. Without the 

medical record number, the 

work required to follow-up 

on the records of interest 

greatly increases on the 

data provider and may 

cause unacceptable delays 

in public health response. In 

addition, the medical record 

number may aid in record 

de-duplication efforts and 

may often aid in the 

resolution of apparent 

transcription errors.

specific instance of a 

unique patient identifier. It 

occurs in the 1st component 

of the CX data type. The 

fifth component, the 

Identifier Type Code, 

defines the identifier as the 

Medical Record # (MR).

Example PID-3 Field:

|MR101100001^^^^MR|

11 Age Numeric value 

of patient age 

R [1..1] For OBX-3, please use :

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_Syndr

omicSurveillance

This element is represented 

by the LOINC code: 21612-

7 in the OBX observation 

identifier.

OBX Segment (NM Data 

Type, 1st Component, 5th

field) with LOINC Code 

(21612-7) Observation 

Identifier
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

The actual data value 

occurs in the 5th field of the 

same OBX segment and is 

Numeric as defined by the 

OBX Data Type NM.

Data providers and 

receivers should determine 

specific data restrictions for 

their jurisdiction. 

Example OBX Segment:

OBX|4|NM|21612-7^AGE 

TIME PATIENT 

REPORTED^LN||43|a^YEA

R^UCUM|||||F|||201102171

531<cr>

12 Age units Unit 

corresponding 

to numeric 

value of patient 

age (e.g. Days, 

Month or 

Years) 

R [1..1] For OBX-6 Please use:

2.16.840.1.114222.4.11.3402

PHVS_AgeUnit_SyndromicSurveill

ance

Relevant Age Unit values

are defined in value set. 

Unknown has been added 

to the value set to allow for 

instances where the patient 

age may not be obtainable.

OBX Segment (CE Data 

Type, 6th field) 

Example OBX Segment:

OBX|4|NM|21612-7^AGE 

TIME PATIENT 

REPORTED^LN||43|a^YEA

R^UCUM|||||F|||201102171

531<cr>
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TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

13 Gender Gender of 

patient

RE [0..1] 2.16.840.1.114222.4.11.3403 

PHVS_Gender_SyndromicSurveilla

nce

Relevant Gender values are 

defined in value set. 

PID-8

14 City/Town City/Town of 

patient 

residence

O [0..1] The ISDS recommendations 

allow free text City/Town 

designations.

PID-11.3

15 ZIP Code ZIP Code of 

patient 

residence

RE [0..1] Provide a minimum of 5 

digits for domestic ZIP 

codes.

Foreign postal codes should 

be supported.

PID-11.5

16 State State of patient

residence

RE [0..1] 2.16.840.1.114222.4.11.830

PHVS_State_FIPS_5-2

It is recommended that the 

2-digit (numeric) 

abbreviation be used for 

State of the patient domestic 

home address.

PID-11.4
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

17 Country Country of 

patient 

residence

RE [0..1] 2.16.840.1.114222.4.11.828

PHVS_Country_ISO_3166-1

It is recommended that the 

3-character country codes 

be used for Country of the 

patient home address.

PID-11.6

18 Race Race of patient RE [0..*] 2.16.840.1.114222.4.11.836

PHVS_RaceCategory_CDC

Relevant Race Category 

values are defined in value 

set.

PID-10

19 Ethnicity Ethnicity of 

patient

RE [0..*] 2.16.840.1.114222.4.11.837

PHVS_EthnicityGroup_CDC

Relevant Ethnicity values 

are defined in value set.

PID-22

Patient Health Indicators

20 Unique 

Visiting ID

Unique 

identifier for a 

R [1..1] 2.16.840.1.114222.4.11.3405

PHVS_IdentifierType_SyndromicSu

A visit is defined as a 

discrete or unique clinical 

PV1-19

The Unique Visiting ID 
Page 103

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

patient visit rveillance encounter within a service 

department or location.8

occurs in the 1st component 

of the CX data type. The 

5th component, the 

Identifier Type Code, 

defines the identifier as the 

Visit Number (VN).

Example PV1-19 Field:

|VN101100001^^^^VN|

21 Visit Date / 

Time

Date/Time of 

patient 

presentation

R [1..1] HL7 Date/Time Format:

YYYYMMDDHHMM[SS[.S[S

[S[S]]]]] [+/-ZZZZ]

PV1-44

Example Visit 

Date/Time:

2:06:59 PM EST on April 

1, 2011 

|20110401140659-0500|

 

8

The definition of a unique visit in this provisional recommendation differs from BioSense. BioSense rolls multiple visits within a 24-hour period into 

one visit.
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

22 Date of 

onset

Date that 

patient began 

having 

symptoms of 

condition being 

reported

RE [0..1] For PBX-3 Please use:

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_

Syndromic Surveillance

This element is represented 

by the LOINC code: 11368-

8 in the OBX observation 

identifier.

The actual data value 

occurs in the 5th field of the 

same OBX segment and is 

a Timestamp as defined by 

the OBX Data Type TS. 

OBX Segment (TS Data 

Type, 1st Component, 5th

field) with LOINC Code

(11368-8) Observation 

Identifier

Example OBX Segment:

OBX|7|TS|11368-

8^ILLNESS OR INJURY 

ONSET DATE AND 

TIME:TMSTP:PT:PATIENT

:QN^LN||20110215||||||F|||2

01102171658<cr>

23 Patient 

Class

Patient 

classification 

within facility

RE [0..1] 2.16.840.1.114222.4.11.3404 

PHVS_PatientClass_SyndromicSur

veillance

Relevant Patient Class

values are defined in value 

set.

PV1-2

24 Chief 

Complaint 

/ Reason 

for visit

Short 

description of 

the chief 

complaint or 

reason of 

RE [0..*] For OBX-3 Please use: 

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_Syndr

omicSurveillance

This element is represented 

by the LOINC code: 8661-1 

in the OBX observation 

identifier.

OBX Segment (CWE Data 

Type, 5th field) with LOINC 

Code (8661-1) 

Observation Identifier
Page 105

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

patient‟s visit, 

recorded when 

seeking care For OBX-5 Please use:

Free text

Or

2.16.840.1.114222.4.11.856

PHVS_AdministrativeDiagnosis_C

DC_ICD-9CM

Or

2.16.840.1.114222.4.11.3593

PHVS_CauseOfDeath_ICD10_CDC

Or

2.16.840.1.114222.4.11.909

PHVS_Disease_CDC

(SNOMED Based Valueset)

For further guidance refer to the

column – „Recommended HL7 

Location‟

The actual data value 

occurs in the 5th field of the 

same OBX segment and is 

Coded with Exception as 

defined by the OBX Data 

Type CWE. 

Using the CWE allows for 

the possibility of free text, 

while also allowing for the 

coded values listed.

If data flows through an 

intermediary or third 

party, the intermediary 

must keep the original 

text (CWE-9) of the 

transmission.

Note: Implementers should 

check with their local 

jurisdiction for version of 

adopted coding system.

Example OBX Segment 

(free text):

OBX|3|CWE|8661-

1^CHIEF 

COMPLAINT:FIND:PT:PAT

IENT:NOM:REPORTED^L

N||^^^^^^^^STOMACH 

ACHE||||||F|||20110217153

1<cr>

Example OBX Segment 

(coded and free text):

OBX|3|CWE|8661-

1^CHIEF 

COMPLAINT:FIND:PT:PAT

IENT:NOM:REPORTED^L

N||7804^Dizziness and 

giddiness 

[780.4]^I9CDX^^^^^^DIZZY

||||||F|||201102171531<cr>
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

25 Triage 

Notes

Triage notes 

for the patient 

visit

O [0..1] For OBX-3 Please use: 

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_Syndr

omicSurveillance

For OBX-5 Please use:

Free text

For further guidance refer to the 

column – „Recommended HL7 

Location‟

This element is represented 

by the LOINC code: 54094-

8 in the OBX observation 

identifier.

The actual data value 

occurs in the 5th field of the 

same OBX segment and is 

Text as defined by the OBX 

Data Type TX. 

Triage Notes should be sent 

as free text.

Triage notes may benefit 

from additional processing 

(e.g. negation processing, 

natural language 

processing, etc.) in order to 

maximize the utility of the 

data.

OBX Segment (TX Data 

Type, 5th field) with LOINC 

Code (54094-8) 

Observation Identifier

Example OBX Segment:

OBX|1|TX|54094-

8^TRIAGE 

NOTE:FIND:PT:EMERGEN

CY 

DEPARTMENT:DOC^LN||P

ain a recurrent cramping 

sensation.||||||F|||20110209

1114<cr>
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

26 Diagnosis 

/ Injury 

Code

Diagnosis or 

injury code of 

patient 

condition

RE [0..*] 2.16.840.1.114222.4.11.856

PHVS_AdministrativeDiagnosis_C

DC_ICD-9CM

Or

2.16.840.1.114222.4.11.3593

PHVS_CauseOfDeath_ICD10_CDC

Or

2.16.840.1.114222.4.11.909

PHVS_Disease_CDC

(SNOMED Based Valueset)

Data should be sent on a 

regular schedule and should 

not be delayed for diagnosis 

or verification procedures. 

Regular updating of data 

should be used to correct 

any errors or send data 

available later.

Include V-codes and Ecodes

This field is a repeatable 

field; multiple codes may be 

sent.

The first diagnosis code 

should be the primary / 

diagnosis.

DG1-3

27 Clinical 

Impression

Clinical 

impression 

(free text) of 

the diagnosis 

O [0..1] For OBX-3 Please use :

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_Syndr

omicSurveillance

This element is represented 

by the LOINC code: 44833-

2 in the OBX observation 

identifier.

OBX Segment (TX Data 

Type, 5th field) with LOINC 

Code (44833-2) 

Observation Identifier
Page 108

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

For OBX-5 Please use:

Free text

For further guidance refer to the 

column – „Recommended HL7 

Location‟

The actual data value 

occurs in the 5th field of the 

same OBX segment and is 

Text as defined by the OBX 

Data Type TX. 

Example OBX Segment:

OBX|1|TX|44833-

2^DIAGNOSIS.PRELIMINA

RY:IMP:PT:PATIENT:NOM

:^LN||Pain consist with 

appendicitis||||||F|||2011020

91114<cr>

28 Diagnosis 

Type

Qualifier for 

Diagnosis / 

Injury Code 

specifying type 

of diagnosis

RE [0..*] 2.16.840.1.114222.4.11.827

PHVS_DiagnosisType_HL7_2x

Relevant Ethnicity values 

are defined in value set.

DG1-6

29 Discharge 

Disposition

Patient's 

anticipated 

location or 

status following 

ED/UC visit

RE [0..1] 2.16.840.1.113883.3.88.12.80.3

3

UB-04/NUBC Current UB Data 

Specifications Manual - UB-04 

FL17 – Patient Status

This data set is not currently 

freely available due to licensing 

issues. The value set OID is 

It is expected that this field 

will update with multiple 

submissions.

PV1-36
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

shown for reference. For more 

information, visit the National 

Uniform Billing Committee 

website located here.

30 Disposition 

Date / Time

Date and time 

of disposition

RE [0..1] HL7 Date/Time Format:

YYYYMMDDHHMM[SS[.S[S

[S[S]]]]] [+/-ZZZZ]

Send this field as empty if 

the patient has not been 

discharged. Do not wait to 

send data until patient is 

discharged.

PV1-45

Example Disposition 

Date/Time:

4:45:12 PM EST on 

January 13, 2011 

|20110113164512-0500|

31 Initial 

Temperature

1

st recorded 

temperature, 

including units

RE [0..1] For OBX-3 Please use:

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_Syndr

omicSurveillance

OBX-6 Please use:

This element is represented 

by the LOINC code: 11289-

6 in the OBX observation 

identifier.

The actual data value 

occurs in the 5th field of the 

OBX Segment (NM Data 

Type, 1st Component, 5th

field) with LOINC Code 

(11289-6) Observation 

Identifier

Example OBX Segment:
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

2.16.840.1.114222.4.11.919

PHVS_TemperatureUnit_UCUM

same OBX segment and is 

Numeric as defined by the 

OBX Data Type NM.

Units of the temperature 

must also be included.

Fahrenheit and Celsius units 

of measure are included in 

the value set. 

OBX|3|NM|11289-6^BODY 

TEMPERATURE:TEMP:EN

CTRFIRST:PATIENT:QN^L

N||100.1|[degF]^FARENHE

IT^UCUM||A|||F|||20110217

145139<cr>

Units of measure (OBX-6, 

(CE Data Type) must be 

included defining the 

numeric value.

32 Initial 

Pulse 

Oximetry

1

st recorded 

pulse oximetry 

value

RE [0..1] For OBX-3 Please use:

2.16.840.1.114222.4.11.3589

PHVS_ObservationIdentifier_Syndr

omicSurveillance

For OBX-6 Please use:

2.16.840.1.114222.4.11.3590

PHVS_PulseOximetryUnit_UCUM

This element is represented 

by the LOINC code: 59408-

5 in the OBX observation 

identifier.

The actual data value 

occurs in the 5

th field of the 

same OBX segment and is 

numeric as defined by the 

OBX Data Type NM.

OBX Segment (NM Data

Type, 1st Component, 5th

field) with LOINC Code 

(59408-5) Observation 

Identifier

Example OBX Segment:

OBX|4|NM|59408-

5^OXYGEN 

SATURATION:MFR:PT:BL

DA:QN:PULSE 
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-1: MINIMUM DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

Units of measure must also 

be included. Percentage is 

the only value included in 

the value set.

OXIMETRY^LN||91|%^PE

RCENT^UCUM||A|||F|||201

10217145139<cr>

Units of measure (OBX-6, 

(CE Data Type) must be 

included defining the 

numeric value.
Page 112

PHIN Messaging Guide for Syndromic Surveillance

4.2.2 EXTENDED DATA ELEMENTS FOR FURTHER CONSIDERATION

Identified as Appendix A in the ISDS Final Recommendation, the extended data elements are fields that are recognized as 

currently in use by some jurisdictions, but not widespread enough to be included as part of the core minimum data set. These 

data elements are considered an optional extension of the core minimum data set for jurisdictions that wish to include them for 

implementation.

TABLE 4-2-2: EXTENDED DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

33 Pregnancy 

Status

Pregnancy 

status of the 

patient

O TBD Pregnancy status helps 

determine the risk factor for 

certain diseases or 

conditions, such as H1N1 

influenza, Arboviral, 

Brucellosis, gastroenteritis, 

Acute Hepatitis B, Acute 

Hepatitis C, Hepatitis D & 

E, Listeriosis, Lyme 

disease, Malaria, Q Fever, 

Relapsing Fever, Rubella, 

West Nile Virus, Yellow 

OBX Segment
Page 113

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-2: EXTENDED DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

Fever

34 Initial ED 

Acuity 

Assessment

Assessment of 

the severity of 

the patient‟s 

condition

O TBD This data element helps 

determine the severity of the 

patient‟s condition.

The triage nurse assesses 

the severity of the patient‟s 

condition and how many 

resources are required. An 

example of the assessment 

may be to use a scale of 1 to 

5 to indicate a range of 

severity.

OBX Segment

35 Laboratory 

Order data

set

Data elements 

related to the 

ordering of 

laboratory tests 

for the patient

O The individual data 

elements related to 

laboratory orders have 

not yet been determined. 

If used, the specific data 

elements should be 

specified and agreed 

upon by individual

jurisdictions and their 

Recommendation requires 

further analysis and has 

not yet been determined.
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PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-2: EXTENDED DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

data sharing partners.

Laboratory order data 

elements help identify 

possible health conditions 

of interest to public 

health. 

Due to the possible high 

volume of data, jurisdictions 

may wish to limit the type of 

laboratory order data that is 

transmitted.

36 Laboratory 

Results 

data set

Data elements 

related to the 

results of 

laboratory tests 

conducted on 

the patient

O The individual data 

elements related to 

laboratory results have 

not been determined. If 

used, the specific data 

elements should be 

specified and agreed 

upon by individual 

jurisdictions and their 

data sharing partners.

Laboratory results data 

elements help determine 

Recommendation requires 

further analysis and has 

not yet been determined.
Page 115

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-2: EXTENDED DATA ELEMENTS

# Data 

Element 

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

the proportion of positive 

results (denominator 

data) and the amount of 

testing being conducted 

at a given time. It may 

help in the ability to 

differentiate when a 

signal is due to 

procedural change or an 

outbreak.

Due to the possible high 

volume of data, jurisdictions 

may wish to limit the type of 

laboratory results data that is 

transmitted.

4.2.3 FUTURE DATA ELEMENTS FOR FURTHER CONSIDERATION

Also identified as Appendix A in the ISDS Final Recommendation, the future data set contains data elements that will be 

considered for inclusion into the core minimum data set for future iterations. These future data elements may or may not 

be currently used by jurisdictions. 
Page 116

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-3: FUTURE DATA ELEMENTS

# Data 

Element

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

37 Patient 

Street 

Address

Patient‟s street 

address of 

residence

O PID-11.1

38 Patient 

Date of 

Birth (DOB)

Patient‟s date 

of birth

O PID-7

39 Insurance 

Coverage

Patient‟s type 

of insurance 

coverage 

O TBD This data element is to 

capture a high-level 

description of insurance, 

such as Medicare, Medicaid, 

Private Insurance, and Selfpay.

IN1-15

40 Diagnosis 

Date/Time

Date/Time 

associated with 

the Diagnosis / 

Injury Code

O DG1-5
Page 117

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-3: FUTURE DATA ELEMENTS

# Data 

Element

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

41 Vital Signrelated 

data 

elements

Data elements 

that are related 

to the patient‟s 

vital sign 

measurements

O TBD Vital sign elements for 

consideration are heart rate, 

respiratory rate, blood 

pressure (SBP/DBP), BMI, 

pulse rate, height, and 

weight.

OBX Segment(s)

42 Observation, 

symptoms, 

and clinical 

findings

Data 

element(s) 

describing the 

observation, 

symptoms, and 

clinical findings 

for a patient‟s 

condition

O TBD This data element(s) has the 

potential to be large since it 

may be a full nurse / 

physician dictation.

This may be a group of data 

elements rather than a 

single data element.

OBX Segment(s)

43 Severity of 

illness 

related data 

elements

Data elements 

that are used 

to assess the 

severity of the 

O TBD Data elements for 

consideration include 

ventilated indicators, 

intubated indicators, and 

OBX Segment(s)
Page 118

PHIN Messaging Guide for Syndromic Surveillance

TABLE 4-2-3: FUTURE DATA ELEMENTS

# Data 

Element

Name

Description of 

Field

Usage Cardinality Value Set /Value Domain Implementation Notes Recommended HL7 

Location

patient‟s illness desaturation.

44 Highest 

Temperature

Highest 

recorded 

temperature, 

including units

O TBD Highest temperature may 

provide a more accurate 

value in classifying certain 

conditions, such as 

pandemic flu.

Units of the temperature 

should also be included.

OBX Segment

Units of measure (in the 

OBX-6) should be included 

defining the numeric value.

45 Procedure 

Code

Procedure 

code to identify 

the health 

intervention 

provided to the 

patient

O TBD Procedure code is useful in 

distinguishing whether the 

patient received a 

vaccination for a disease or 

treatment for the actual 

disease.

This is applicable to 

primary care settings. 

PR1-3
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PHIN Messaging Guide for Syndromic Surveillance

5 EXAMPLES

A minimal amount of data was intentionally used to provide emphasis on the Syndromic 

Surveillance data elements of interest.

5.1 A04 EMERGENCY DEPARTMENT REGISTRATION; NO UPDATES; 

ACKNOWLEDGEMENT REQUESTED

In the following example, a non-Hispanic white female, Ann A. Everyperson, 67 years old, 

visits the Midland Health Center emergency department with an infected abrasion on her 

forearm. The Medical Record Number, 20060012168, is sent for the patient identifier.

Since this is an Emergency Department visit, PV1-44 reflects the time the patient 

registered in the Emergency Department. The Admit Reason is coded in ICD-9. The 

original provider of the data, Midland Health Center, is captured in the EVN-7. The facility 

location and visit type was provided by Midland Health Center.

Midland Health Center has requested acknowledgement of the message by the State 

Public Health. A sample acknowledgement is included.

MSH|^~\&||MIDLAND HLTH 

CTR^9876543210^NPI|State_SS|State_Public_Health|201102091114||ADT^A04^ADT_A01|201102091114-

0078|P|2.5.1<cr> 

EVN||201102091114|||||MIDLAND HLTH CTR^9876543210^NPI<cr>

PID|1||20060012168^^^^MR^MIDLAND HLTH CTR&9876543210&NPI||EVERYPERSON^ANN^A^^^^L|||F||2106-

3^White^CDCREC|^^^13^30341^USA^C|||||||||||2186-5^Not Hispanic^CDCREC<cr> 

PV1||E||E||||||||||1|||||20110209_0064^^^^VN|||||||||||||||||||||||||20110217144208<cr> 

PV2|||9131^ABRASION FOREARM-INFECT^I9CDX<cr>

OBX|1|XAD|SS002^TREATING FACILITY 

LOCATION^PHINQUESTION||^^^13^30341^USA^C||||||F|||201102091114<cr>

OBX|2|CWE|SS003^FACILITY / VISIT TYPE^PHINQUESTION||1108-0^EMERGENCY 

DEPARTMENT^HSLOC||||||F|||201102091114<cr>

OBX|3|NM|21612-7^AGE TIME PATIENT REPORTED^LN||67|a^YEAR^UCUM|||||F|||201102091114<cr>
Page 120

PHIN Messaging Guide for Syndromic Surveillance

Continuing the example above, State Public Health needs to acknowledge successful receipt (AA 

– Application Accept) of the above message (Message ID - 201102091114-0078) from Midland

Health Center.

MSH|^~\&|State_SS|State_Public_Health||MIDLAND HLTH 

CTR^9876543210^NPI|201102091119||ACK^A04^ACK|ACK-201102091119-0001|P|2.5.1<cr>

MSA|AA|201102091114-0078<cr>

5.2 A04 EMERGENCY DEPARTMENT REGISTRATION FOLLOWED BY A08 

UPDATE 

In the next example, a non-Hispanic black male, 52 years old, visits the City General 

Hospital emergency department with cough and ear pain. City General Hospital does not 

transmit Medical Record Number, so it uses a unique patient identifier of 95101100001, 

in PID-3. The chief complaint was sent as free text and an admitting diagnosis was sent 

in the DG1 segment, coded in ICD-9.

MSH|^~\&||CITY GENL HOSP^0133195934^NPI|||20110217144317||ADT^A04^ADT_A01|E100648329|P|2.5.1<cr>

EVN||20110217144317|||||CITY GENL HOSP^0133195934^NPI<cr> 

PID|1||95101100001^^^^PI||~^^^^^^U|||M||2054-5^Black or African American^CDCREC|^^^29^65101|||||||||||2186-

5^Not Hispanic^CDCREC<cr> 

PV1||E||E||||||||||1|||||8399193^^^^VN|||||||||||||||||||||||||20110217144208<cr> 

OBX|1|NM|21612-7^AGE TIME PATIENT REPORTED^LN||52|a^YEAR^UCUM|||||F|||201102171443<cr>

OBX|2|CWE|8661-1^CHIEF COMPLAINT:FIND:PT:PATIENT:NOM:REPORTED^LN||^^^^^^^^HEADACHE FOR 2 

DAYS<cr> 

DG1|1||4739^CHRONIC SINUSITIS NOS^I9CDX||A<cr> 

Continuing the example above, a non-Hispanic black male, 52 years old, visits the City General 

Hospital emergency department with cough and ear pain. City General Hospital wants to update 
Page 121

PHIN Messaging Guide for Syndromic Surveillance

the receiving system with new information about the same patient and the same visit. 

The Visit Number and Admit Date/Time have not changed; but, the Message Date/Time and 

Message Control ID have. So, an A08 message is used to transmit the additional information:

Temperature, Blood Oxygen Level, and Final Diagnosis.

MSH|^~\&||CITY GENL HOSP^0133195934^NPI|||20110217145139||ADT^A08^ADT_A01|E100648353|P|2.5.1<cr> 

EVN||20110217144317|||||CITY GENL HOSP^0133195934^NPI<cr> 

PID|1||95101100001^^^^PI^CITY GENL HOSP&0133195934&NPI||~^^^^^^U|||M||2054-5^Black or African 

American^CDCREC|^^^29^65101|| |||||||||2186-5^Not Hispanic^CDCREC<cr>

PV1||E||E||||||||||1|||||8399193^^^^VN|||||||||||||||||||||||||20110217144208<cr> 

OBX|1|NM|21612-7^AGE TIME PATIENT REPORTED^LN||52|a^YEAR^UCUM|||||F|||20110217145139<cr>

OBX|2|CWE|8661-1^CHIEF COMPLAINT:FIND:PT:PATIENT:NOM:REPORTED^LN||^^^^^^^^HEADACHE FOR 2 

DAYS<cr> 

OBX|3|NM|11289-6^BODY 

TEMPERATURE:TEMP:ENCTRFIRST:PATIENT:QN^LN||100.1|[degF]^FARENHEIT^UCUM||A|||F|||201102171451

39<cr>

OBX|4|NM|59408-5^OXYGEN SATURATION:MFR:PT:BLDA:QN:PULSE 

OXIMETRY^LN||91|%^PERCENT^UCUM||A|||F|||20110217145139<cr>

DG1|1||4739^CHRONIC SINUSITIS NOS^I9CDX|||A<cr> 

DG1|2||04100^STREPTOCOCCUS UNSPECF^I9CDX|||F<cr> 

5.3 A04 EMERGENCY DEPARTMENT REGISTRATION; A01 INPATIENT 

ADMISSION; A03 DISCHARGE INCLUDING PATIENT DEATH 

In the next example, a non-Hispanic white female, 43 years old, visits the Other Regular 

Medical Center emergency department with a chief complaint of a stomachache. The 

chief complaint was sent as free text.
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MSH|^~\&||OTHER REG MED 

CTR^1234567890^NPI|||201102171531||ADT^A04^ADT_A01|201102171531956|P|2.3.1<cr> 

EVN||201102171531<cr>

PID|1||FL01059711^^^^PI||~^^^^^^U|||F||2106-3^White^CDCREC|^^^12^33821|||||||||||2186-5^Not 

Hispanic^CDCREC<cr>

PV1||E||E||||||||||7|||||V20220217-00274^^^^VN|||||||||||||||||||||||||201102171522<cr> 

PV2|||78907^ABDOMINAL PAIN, GENERALIZED^I9CDX<cr>

OBX|1|HD|SS001^TREATING FACILITY IDENTIFIER^PHINQUESTION||OTHER REG MED 

CTR^1234567890^NPI||||||F|||201102171531<cr>

OBX|2|CWE|8661-1^CHIEF COMPLAINT:FIND:PT:PATIENT:NOM:REPORTED^LN||^^^^^^^^STOMACH 

ACHE||||||F|||201102171531<cr> 

OBX|3|NM|21612-7^AGE TIME PATIENT REPORTED^LN||43|a^YEAR^UCUM|||||F|||201102171531<cr>

DG1|1||78900^ABDMNAL PAIN UNSPCF SITE^I9CDX|||A<cr>

Continuing the example, the same non-Hispanic white female, 43 years old, visits the 

Other Regular Medical Center emergency department with a chief complaint of a 

stomach ache. The patient is suspect for appendicitis and is admitted as an inpatient.

The patient has also reported that she has had a stomach ache since the 15th of 

February. The patient class (PV1.2) is changed to Inpatient. Admit Date/Time (PV1.44) is 

updated with the admission date and time.

In this particular case, visit number (PV1.19) has remained the same. However, it is 

recognized that some insurance companies require the visit number to be changed when 

a patient is admitted from the Emergency Department. 

MSH|^~\&||OTHER REG MED 

CTR^1234567890^NPI|||201102171658||ADT^A01^ADT_A01|201102171658076|P|2.3.1<cr>

EVN||201102171658<cr> 

PID|1||FL01059711^^^^PI||~^^^^^^U|||F||2106-3^White^CDCREC|^^^12^33821|||||||||||2186-5^Not 

Hispanic^CDCREC<cr>
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PV1||I||E||||||||||7|||||V20220217-00274^^^^VN|||||||||||||||||09||||||||201102171656<cr> 

PV2|||78907^ABDOMINAL PAIN, GENERALIZED^I9CDX<cr>

OBX|1|HD|SS001^TREATING FACILITY IDENTIFIER^PHINQUESTION||OTHER REG MED 

CTR^1234567890^NPI||||||F|||201102171531<cr>

OBX|2|CWE|8661-1^CHIEF COMPLAINT:FIND:PT:PATIENT:NOM:REPORTED^LN||^^^^^^^^STOMACH 

ACHE||||||F|||201102171531<cr> 

OBX|3|NM|21612-7^AGE TIME PATIENT REPORTED^LN||43|a^YEAR^UCUM|||||F|||201102171531<cr>

OBX|4|NM|11289-6^BODY 

TEMPERATURE:TEMP:ENCTRFIRST:PATIENT:QN^LN||99.1|[degF]^FARENHEIT^UCUM||A|||F|||201102171658<

cr>

OBX|5|NM|59408-5^OXYGEN SATURATION:MFR:PT:BLDA:QN:PULSE 

OXIMETRY^LN||95|%^PERCENT^UCUM||A|||F|||201102171658<cr>

OBX|6|TS|11368-8^ILLNESS OR INJURY ONSET DATE AND 

TIME:TMSTP:PT:PATIENT:QN^LN||20110215||||||F|||201102171658<cr>

DG1|1||78900^ABDMNAL PAIN UNSPCF SITE^I9CDX|||A<cr>

DG1|2||5409^ACUTE APPENDICITIS NOS^I9CDX|||W<cr>

Continuing the example, the same non-Hispanic white female, 43 years old, visits the 

Other Regular Medical Center emergency department with a chief complaint of a 

stomach ache. The patient has expired and this is indicated in PV1.36 (Code=20). A final 

diagnosis is also sent. It is also indicated by the “Y” in PID-30 and the Date and Time of 

Death in PID-29. The discharge date/time (PV1.45) is sent with the A03 message type.

MSH|^~\&| |OTHER REG MED 

CTR^1234567890^NPI|||201102172334||ADT^A03^ADT_A03|201102172334640|P|2.3.1<cr> 

EVN||201102172334 

PID|1||FL01059711^^^^PI||~^^^^^^U|||F||2106-3^White^CDCREC|^^^12^33821|||||||||||2186-5^Not 

Hispanic^CDCREC|||||||201102172334|Y<cr> 
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PV1||I||E||||||||||7|||||V20220217-00274^^^^VN|||||||||||||||||20||||||||201102171656|201102172334<cr> 

PV2|||78907^ABDOMINAL PAIN, GENERALIZED^I9CDX<cr>

OBX|1|HD|SS001^TREATING FACILITY IDENTIFIER^PHINQUESTION||OTHER REG MED 

CTR^1234567890^NPI||||||F|||201102171531<cr>

OBX|2|CWE|8661-1^CHIEF COMPLAINT:FIND:PT:PATIENT:NOM:REPORTED^LN||^^^^^^^^STOMACH 

ACHE||||||F|||201102171531<cr> 

OBX|3|NM|21612-7^AGE TIME PATIENT REPORTED^LN||43|a^YEAR^UCUM|||||F|||201102171531<cr>

OBX|4|NM|11289-6^BODY 

TEMPERATURE:TEMP:ENCTRFIRST:PATIENT:QN^LN||99.1|[degF]^FARENHEIT^UCUM||A|||F|||201102171658<cr>

OBX|5|NM|59408-5^OXYGEN SATURATION:MFR:PT:BLDA:QN:PULSE 

OXIMETRY^LN||95|%^PERCENT^UCUM||A|||F|||201102171658<cr>

OBX|6|TS|11368-8^ILLNESS OR INJURY ONSET DATE AND 

TIME:TMSTP:PT:PATIENT:QN^LN||20110215||||||F|||201102171658<cr>

DG1|1||78900^ABDMNAL PAIN UNSPCF SITE^I9CDX|||A<cr> 

DG1|2||5409^ACUTE APPENDICITIS NOS^I9CDX|||W<cr> 

DG1|3||5400^AC APPEND W PERITONITIS^I9CDX|||F<cr> 

5.4 A01 INPATIENT ADMISSION; NO UPDATES 

In the following example, a Hispanic white male, age currently 20, is admitted as an 

inpatient to the Mid-Co Health Center emergency department after falling down the stairs.

The Medical Record Number is sent for the patient identifier and the patient account 

number is sent for the visit number.

MSH|^~\&||MID-CO HLTH CTR^9876543210^NPI|||201110090314||ADT^A01^ADT_A01|201110090314-

0017|P|2.3.1<cr> 

EVN||201110090314<cr> 
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PID|1||MD01059711^^^ADMITTING^MR^MID-CO HLTH CTR^9876543210^NPI||~^^^^^^U|||M||2106-

3^White^CDCREC|^^^24^21502|||||||||||2135-2^Hispanic or Latino^CDCREC<cr>

PV1||I||E||||||||||6|||||20111009_0034^^^^AN^MID-CO HLTH CTR&9876543210&NPI 

|||||||||||||||||||||||||20111009025915<cr>

OBX|1|NM|21612-7^AGE PATIENT QN REPORTED^LN||20|a^YEAR^UCUM|||||F|||201102171531<cr>

OBX|2|HD|SS001^TREATING FACILITY IDENTIFIER^PHINQUESTION||MID-CO HLTH 

CTR^9876543210^NPI||||||F|||201102171531<cr>

DG1|1||E8809^FALL ON STAIR/STEP NEC^I9CDX|||A<cr> 

5.5 BATCH EXAMPLE

In the following example, Mid-Co Health Center sends their syndromic data to their state 

public health authority. Mid-Co sends the messages that have gathered over the last 12 

hour period in batch message format. There are 240 messages. 

FHS|^~\&<cr>

BHS|^~\&|ER1|MIDCO_HLTH_CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.2^ISO|201

10123123558<cr>

MSH|^~\&|ER1|MID-CO HLTH 

CTR^9876543210^NPI|SS_APP^2.16.840.1.113883.19.3.2.1^ISO|SPH^2.16.840.1.113883.19.3.2^ISO

|20110123003938||ADT^A01^ADT_A01|ER1-20110123-001|P|2.5.1<cr>

... (Continue 240 messages)...

BTS|240|Mid-Co reporting 1-23-2011: 0000 – 1200 hrs<cr>

FTS|1<cr>
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5.6 SAMPLE INTERNATIONAL ADDRESS FORMATS: CONVERTED TO PID 

SEGMENTS

5.6.1 COUNTRIES BORDERING THE UNITED STATES

5.6.1.1 Mexico

Super Manzana 3 - 403 [street name + building number - apartment number]

Puerto Juarez [village]

77520 CANCUN, Q. ROO [postcode + locality name, province abbreviation]

MEXICO [country name]

Example PID segment:

PID|1||MX01059711||~^^^^^^U|||M|||Super Manzana 3 - 403^Puerto Juarez^CANCUN^Q. ROO^77520^MEX<cr>

5.6.1.2 Canada

111 FAIRFORD STREET EAST

MOOSE JAW SK S6H 2X1

CANADA

Example PID Segment:

PID|1||CA01059711||~^^^^^^U|||M|||111 FAIRFORD STREET EAST^^MOOSE JAW^SK^S6H 2X1^CAN<cr>

6 MISCELLANEOUS

6.1 PHIN VOCABULARY SERVICES

Public Health Information Network (PHIN) Vocabulary Services seek to promote the use of 

standards-based vocabulary within PHIN systems and foster the use and exchange of 

consistent information among public health partners. The PHIN Vocabulary Access and 

Distribution System (VADS) and the PHIN Message Quality Framework (MQF) support these 

standards. 

PHIN MQF and PHIN VADS will be integrated to support the real time validation of electronic 

messages supporting Syndromic Surveillance Meaningful Use Measures.
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The vocabulary codes that are carried in CE and CWE fields in the HL7 message have their 

terminology indicated by the appropriate HL7 Table 0396 entry, the complete list of which may 

be accessed at http://www.hl7.org/Special/committees/vocab/table_0396/index.cfm.

Vocabulary that is carried in fields of datatype IS and ID does not have a code system carried 

in the message instance; these codes are intended to be populated in the identified tables. In 

order to facilitate the maintenance of these tables, PHIN VADS may be used for the content of 

these tables, each of which is associated with a PHIN value set. The names of these value 

sets are included in the data element references above.

6.1.1 PHIN VOCABULARY AND DISTRIBUTION SYSTEM 

PHIN VADS is a Web-based enterprise vocabulary system for accessing, searching, and 

distributing value sets associated with HL7 implementation guides. Vocabulary associated with

Syndromic Surveillance messaging guide can be downloaded from PHIN VADS at

http://phinvads.cdc.gov.

A link is provided for the Syndromic Surveillance view here: Syndromic Surveillance

6.1.2 PHIN MESSAGE QUALITY FRAMEWORK 

The Message Quality Framework (MQF) is a flexible framework of services and utilities 

designed to assist public health partners with preparing and communicating quality, standard 

electronic messages as defined by the applicable messaging, vocabulary, and programmatic 

standards. PHIN MQF can be accessed at https://phinmqf.cdc.gov/