10 Provider Address The geographical location or mailing address of the provider's office or facility. Address must include street address, office or suite number (if applicable), city or town, state, and zip code. Need provider's contact information in to follow up appropriately for reportable event to ensure appropriate treatment, identify contact exposures, etc. 11 Facility ID Number Identification code for the facility (e.g., Facility NPI) Need provider's contact information in order to follow up appropriately for reportable event to ensure appropriate treatment, identify contact exposures, etc. 12 Facility Name The facility's name Need provider's contact information in order to follow up appropriately for reportable event to ensure appropriate treatment, identify contact exposures, etc. 13 Facility Type The type of facility where patient received or is receiving healthcare for the reportable condition (e.g., hospital, ambulatory, urgent care, etc.) Used to determine the type of care setting in which patient is receiving care for the reportable condition. 14 Facility Phone The facility's phone number with area code Need provider's contact information in to follow up appropriately for reportable event to ensure appropriate treatment, identify contact exposures, etc. 15 Facility Address The mailing address for the facility where patient received or is receiving healthcare for the reportable condition. Must include street address, city/town, county, state, and zip code. Need provider's contact information in order to follow up appropriately for reportable event to ensure appropriate treatment, identify contact exposures, etc. 16 Patient ID Number Patient social security number, medical record number, or identifying value as required or allowed under jurisdictional laws governing health data exchange. Identification and contact; jurisdictions may select which they can receive based on laws governing public health data exchange 17 Patient Name All names for the patient, including legal names and aliases. Must include the name type (i.e., legal or alias), first name, middle name, and last name. Identification and contact
18 Parent/Guardian Name All names for the patient’s parent or guardian, including legal names and aliases (if patient age is < 18 years). Must include name type (i.e., legal or alias), first name, middle name, and last name. For appropriate contact with minors 19 Patient or Parent/Guardian All phone numbers and phone number types for the patient or parent/guardian Contact Patient 20 Patient or Parent/Guardian Email The email address for the patient or the patient’s parent/guardian. Contact Patient 19 Patient or Parent/Guardian Phone All phone numbers and phone number types for the patient or parent/guardian Contact Patient 20 Patient or Parent/Guardian Email The email address for the patient or the patient’s parent/guardian. Contact Patient 21 Street Address All addresses for the patient, including current and residential addresses. Must include street address, apartment or suite number, city or town, county, state, zip code, and country. Case Assignment, analysis and visualization, Matching 22 Birth Date The patient's date of Appropriate identification, appropriate identification of minors, risk; Necessary to determine patient age; matching ELR 23 Patient Sex The patient's biological sex (not gender) Demographic reporting 24 Race The patient's race Demographic reporting 25 Ethnicity The patient's ethnicity Demographic reporting 26 Preferred Language The patient's preferred language Communication with Patient 27 Occupation The patient's occupation Identification of potential risk, transmission risk 28 Pregnant The patient's pregnancy status Appropriate treatment, follow-up, appropriate for scoring/risk ascertainment 29 Visit Date/Time Date and time of the provider's most recent encounter with the patient regarding the reportable condition Defines when the individual may have been ill; a point in time to which can link other potential cases of reportable event; necessary to ensure follow-up within key time frames/helps triage priority follow-up and ensure control measures are implemented in a timely way.
30 Admission Date/Time Date and time when the patient was admitted to the treatment facility; e.g., hospital. Key for epidemiologic investigation - important to know if hospitalized for severity of condition and to triage priority follow-up. 31 History of Present Illness Physician’s narrative of the history of the reportable event. Hopefully a place where we can get information such as travel, contacts, etc. if captured. Indicator of reportable condition - most important descriptor of condition/ epi information - supports epi investigation ; epidemiologic relevant information 32 Reason for Visit Provider’s interpretation for the patient’s visit for the reportable event. Indicator of reportable condition - most important descriptor of condition/ epi information - supports epi investigation 33 Date of Onset The date of symptoms for the reportable event. Helps determine possible exposure and illness- calculate incubation period 34 Symptoms (list) List of patient symptoms (structured) for the reportable We know if clinical symptoms signify a case of PH importance - confirm the need for PH follow up 35 Lab Order Code Ordered tests for the patient during the encounter Some lab test orders are reportable for suspected cases 36 Placer Order Number Identifier for the lab order for during the encounter Potential value to linking ELR reports to eICR; 37 Diagnoses The healthcare provider's diagnoses of the patient's health condition (all) Would include something that is potentially reportable 38 Date of Diagnosis The date of provider diagnosis We want to know when they're diagnosed; integral to epidemiological investigation 39 Medications Administered (list) List of medications administered for the reportable event To find treatments that were prescribed; prophylaxis; we know if they've already been treated, on the list for PH (priority) 40 Date The patient's date of death Patient follow-up and epidemiological purposes F07 Patient Class Whether patient is outpatient, inpatient, emergency, urgent care
16 Patient ID Number US Header (V3) This patientRole SHALL contain at least one [1..*] id 17 Patient Name US Header (V3) This patient SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: (CONF:1198-5284). 18 Parent/Guardian Name US Header (V3) This guardianPerson SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: (CONF:1198-5386). 19 Patient or Parent/Guardian Phone US Realm Header (V3) The guardian, if present, SHOULD contain zero or more [0..*] telecom (CONF:1198-5382). URL.scheme = tel 20 Patient or Parent/Guardian Email US Header (V3) The guardian, if present, SHOULD contain zero or more [0..*] telecom (CONF:1198-5382). URL.scheme = mailto 19 Patient or Parent/Guardian Phone US Header (V3) This patientRole contain at least one [1..*] telecom (CONF:1198-5280). URL.scheme = tel 20 Patient or Parent/Guardian Email US Realm Header (V3) This patientRole SHALL contain at least one [1..*] telecom (CONF:1198-5280). URL.scheme = mailto 21 Street Address US Realm Header (V3) This patientRole contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: (CONF:1198-5271).