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Order Entry: General, Laboratory, Dietary, Supply, Blood Transfusion

Co-Chair:

Hans Buitendijk
Cerner Corporation

Co-Chair:

David Burgess
LabCorp

Co-Chair:

Lorraine Constable
HL7 Canada

Co-Chair:

Robert Hausam MD
Hausam Consulting

Co-Chair:

Patrick Loyd
ICode Solutions

Co-Chair:

Ken McCaslin
Accenture Federal

Chapter Co-Chair:

Riki Merrick
Vernetzt, LLC

Co-Chair:

J.D. Nolen
Children’s Mercy Hospital

Editor

Hans Buitendijk
Cerner Corporation

Sponsoring Committee:

Orders & Observations

List Server:

ord@lists.hl7.org


Purpose

The Order Entry transaction set provides for the transmission of orders or information about orders between applications that capture the order, by those that fulfill the order, and other applications as needed. An order is a request for material or services, usually for a specific patient. These services include medications from the pharmacy, clinical observations (e.g., vitals, I&Os) from the nursing service, tests in the laboratory, food from dietary, films from radiology, linens from housekeeping, supplies from central supply, an order to give a medication (as opposed to delivering it to the ward), etc.

Most orders are associated with a particular patient. However, the Standard also allows a department to order from another ancillary department without regard to a patient (e.g., floor stock), as well as orders originating in an ancillary department (i.e., any application may be the placer of an order or the filler of an order).

We refer to the person or entity who places the order as the placer. We refer to the person or entity that carries out the order as the filler (producer in ASTM terminology). In the case where the person or entity that carries out the order also requests the order, this person or entity is referred to as the filler and placer of the order. The filler may also request another application to assign a filler or placer order number.

This chapter defines the transactions at the seventh level, i.e., the abstract messages. Various schemes may be used to generate the actual characters that make up the messages according to the communications environment. The HL7 Encoding Rules will be used where there is not a complete Presentation Layer. This is described in Chapter 2, Section 2.6, "Message construction rules." The examples included in this chapter were constructed according to the HL7 Encoding Rules.

Preface (organization of this chapter)

This chapter has been organized into six major sections, General, Diet, Supply, Pharmacy, Vaccine and Transfusion Services. Each section contains the trigger events, message definitions, segments and examples for the specific type of order messages. Each section about a type of order is organized into background and overview, message structure, and message segments (that are specific to the order class in question). Special discussions of the use of fields, segments or messages, and examples are included. Segments are introduced in order of occurrence in a message. A list of allowable values for a field is included in the body of the text, along with the field definition for easier reference.

Section 4.3    refers the reader to Chapter 2 for an outline of the Quantity Timing (TQ) Data Type Definition.

Sections 4.4 to 4.6    'General' includes the triggers and segments for the clinical observations and diagnostic studies as well as the triggers and message segments that are common to all of the order entry messages. Orders for laboratory tests, bedside monitoring, diagnostic imaging, electrocardiograms, vital signs, etc., are subsumed under this order message set.

Sections 4.7 to 4.9    'Diet' includes all of the usual diet specifications including snacks and guest trays

Sections 4.10 to 4.12    'Supply' includes order messages for both Stock and No-stock orders. Supply orders are different in that they often are not patient-centered (e.g., requests to stock the ward supply room).

Sections 4.13 to 4.16    'Pharmacy / Treatment' includes all pharmacy and treatment related order messages. These sections additionally include triggers related to the dispensing, giving and administration of orders. In the development of the treatment order transaction set, the focus has been on medication treatments, but the same transaction set works well for total parenteral nutrition (TPN). There is hope that it is also sufficient for other kinds of treatment orders, such as those performed by the nursing service. But it has not yet been exercised in that context and may well need further development.

Sections 4.17 to 4.19    'Vaccine' includes triggers and segments specific to vaccination order messages. These sections also include RXA definitions specific to vaccination messages.

Sections 4.20 to 4.22    "Transfusion Service (Blood Bank)" includes triggers and segments specific to transfusion service messages.

Glossary

Filler:

The application responding to, i.e., performing, a request for services (orders) or producing an observation. The filler can also originate requests for services (new orders), add additional services to existing orders, replace existing orders, put an order on hold, discontinue an order, release a held order, or cancel existing orders

Observation segment:

An OBX segment defined in Chapter 7.

Order:

A request for a service from one application to a second application. The second application may in some cases be the same, i.e., an application is allowed to place orders with itself. In HL7 terms, an order is defined as an ORC segment in conjunction with a single order detail segment such as OBR, RXO or RXE.

Order detail segment:

One of several segments that can carry order information. Examples are OBR and RXO. Future ancillary-specific segments may be defined in subsequent releases of the Standard if they become necessary.

Placer:

The application or individual originating a request for services (order).

Placer order group:

A list of associated orders coming from a single location regarding a single patient.

Order Number:

An identifier that uniquely identifies an order as represented by an ORC segment and its matching order detail segment. Although traditionally called an order number, the identifier is not required to be all digits, it may contain alpha as well as numeric characters.

Examples:

Example 1

Order Number

Group Number

Parent

Parent Order

111

Bag One

123

1

111

Bag Two

234

1

111

Bag Three

345

1

111


Example 2

Order Number

Group Number

Med One

123

99 (script number)

Med Two

456

99 (script number)


Example 3

Order Number

Group Number

CBC

987

88 (requisition number)

Glucose

654

88 (requisition number)

Electrolytes

321

88 (requisition number)


Quantity/Timing (TQ) Data Type Definition

Note: With version 2.5, the definition and narrative for the TQ - Quantity/Timing data type has been moved to Chapter 2, Section 2.A.81. This section retained in v2.6 and later to maintain consistent section numbering for reference from other chapters.


General Trigger Events & Message Definitions

The triggering events that follow are all served by the OMG (General Clinical Order Message), OML (Laboratory Order Message, Laboratory Order for Multiple Orders Related to a Single Specimen, Laboratory Order for Multiple Orders Related to a Single Container of a Specimen, Specimen Shipment Centric Laboratory Order), OMI (Imaging Order Message), OPL (Population/Location-Based Laboratory Order Message), OSU (Order Status Update) and OMQ (General Order Message with Document Payload) message definitions along with the following acknowledgment messages served by the ORG (General Clinical Order Acknowledgement Message), ORL (General Laboratory Order Response Message to any OML message, Laboratory Order Response Message To A Multiple Order Related To Single Specimen OML message, Laboratory Order Response Message to a Single Container of a Specimen OML message, Specimen Shipment Centric Laboratory Order Response Message to Specimen Shipment OML message), ORI (Imaging Order Response Message to Any OMI message), OPR (Population/Location-Based Laboratory Order Acknowledgment Message) and ORX (General Order Message with Document Payload Acknowledgement Message) message definitions.

Each triggering event is listed below, along with the segments that comprise the messages. The notation used to describe the sequence, optionality, and repeating of segments is described in Chapter 2, "Format for defining abstract messages."

ORM – general order message

Attention: Retained for backwards compatibility only as of v2.4.and withdrawn as of v2.7. Refer to OMG, OML, OMD, OMS, OMN, OMI, and OMP instead.

ORR – general order response message response to any ORM

Attention: Retained for backwards compatibility only as of v2.5 and withdrawn as of v2.7. Refer to ORG, ORL, ORD, ORS, ORN, ORI, and ORP instead.

OSQ/OSR- query response for order

Attention: Retained for backwards compatibility only as of v2.4.and withdrawn as of v2.7. Refer to Chapter 5.

OMG – general clinical order message (event O19)

The function of this message is to initiate the transmission of information about a general clinical order that uses the OBR segment. OMG messages can originate also with a placer, filler, or an interested third party.

The trigger event for this message is any change to a general clinical order. Such changes include submission of new orders, cancellations, updates, patient and non-patient-specific orders, etc.

This trigger includes segments identified as being for 'previous results.' These segments allow the sending system to include demographic and/or result information from previous result reports when they are related to the current order.

For example:

  • Diagnostic laboratories referring tests to another lab for either confirmation of results (HIV, etc.) or due to not being equipped to do the tests (genetic testing, etc.).

  • Diagnostic laboratories sending test results to Knowledge Bases for the automated generation of diagnostic comments for inclusion into the lab report.

The CTD segment in this trigger is used to transmit temporary patient contact details specific to this order.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

OMG^O19^OMG_O19: General Clinical Order Message
HL7 MessageStructure Table - OMG_O19
Segment Cardinality Must Implement Status
OMG_O19
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
ARV 0..* B
GT1 0..1
AL1 0..*
OCCUPATIONAL_DATA_FOR_HEALTH 0..1
OH1 0..*
OH2 0..*
OH3 0..1
OH4 0..*
NEXT_OF_KIN 0..*
NK1 1..1 Yes
OH2 0..*
OH3 0..1
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
ORDER 1..* Yes
ORC 1..1 Yes
NTE 0..*
PRT 0..*
OBR 1..1 Yes
NTE 0..*
PRT 0..*
CTD 0..1
DG1 0..*
REL 0..1
SGH 0..1
SGT 0..1
FT1 0..*
CTI 0..*
BLG 0..1
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
NTE 0..*
SPECIMEN 0..*
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
CONTAINER 0..*
SAC 1..1 Yes
NTE 0..*
CONTAINER_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
PRIOR_RESULT 0..*
AL1 0..*
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
ARV 0..* B
PRT 0..*
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
CTD 0..1
TIMING_PRIOR 0..*
TQ1 1..1 Yes
TQ2 0..*
ORDER_DETAIL_PARTICIPATION_PRIOR 0..*
PRT 1..1 Yes
DEV 0..*
OBSERVATION_PRIOR 1..* Yes
OBX 1..1 Yes
PRT 0..*
NTE 0..*
DEVICE 0..*
DEV 1..1 Yes
OBX 0..*

Original Mode Acknowledgement Choreography for OMG^O19^OMG_O19

Send Application Ack: ORG^O20^ORG_O20

Enhanced Mode Acknowledgement Choreography for OMG^O19^OMG_O19

When the MSH-15 value of an OMG^O19^OMG_O19 message is AL or ER or SU, an ACK^O19^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OMG^O19^OMG_O19 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OMG^O19^OMG_O19 message is AL or ER or SU, an ORG^O20^ORG_O20 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OMG^O19^OMG_O19 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O19^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORG^O20^ORG_O20 or OSU^O52^OSU_O52
NE (none)

ORG – general clinical order acknowledgement message (event O20)

The function of this message is to respond to an OMG message. An ORG message is the application acknowledgment to an OMG message. See Chapter 2 for a description of the acknowledgment paradigm.

In ORG the PID and ORC segments are optional, particularly in case of an error response. However, ORC segments are always required in ORG when the OBR is present. For example, a response ORG might include only the MSH and MSA.

The function (e.g., cancel, new order) of both OMG and ORG messages is determined by the value in ORC-1-order control. (See the table of order control values for a complete list.)

ORG^O20^ORG_O20: General Clinical Order Acknowledgment Message
HL7 MessageStructure Table - ORG_O20
Segment Cardinality Must Implement Status
ORG_O20
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
NTE 0..*
PRT 0..*
ARV 0..* B
ORDER 1..* Yes
ORC 1..1 Yes
PRT 0..*
CTI 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_GROUP 0..1
OBR 1..1 Yes
PRT 0..*
NTE 0..*
SPECIMEN 0..*
SPM 1..1 Yes
SAC 0..*

Original Mode Acknowledgement Choreography for ORG^O20^ORG_O20

Send Immediate Ack: ACK^O20^ACK

Enhanced Mode Acknowledgement Choreography for ORG^O20^ORG_O20

When the MSH-15 value of an ORG^O20^ORG_O20 message is AL or ER or SU, an ACK^O20^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORG^O20^ORG_O20 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O20^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OML – laboratory order message (event O21)

The following message structure may be used for the communication of laboratory and other order messages and must be used for lab automation messages where it is required that the Specimen/Container information is within the ORC/OBR segment group.

The trigger event for this message is any change to a laboratory order. Such changes include submission of new orders, cancellations, updates, etc. OML messages can originate also with a placer, filler, or an interested third party.

Note: The additional patient information, which is sent after the OBR with the current order (the segments PID, PD1, PV1, PV2, etc, indicated below with words "previous result"), could have been transferred with the previous result because the patient demographics related to the previous result can differ from the demographics related to the current order. The current intent is to only allow references to the same patient as in the header PID.

The SAC segments included in the message allow the transfer of, e.g., a laboratory order with multiple containers and multiple test orders related to each container, or laboratory orders with test order requiring multiple containers.

Refer to Chapter 13, "Laboratory Automation" for examples of usage, particularly to clarify the use of two references to SAC segments in this one message.

The CTD segment in this trigger is used to transmit temporary patient contact details specific to this order.

The IPC segment in this trigger is used to transmit imaging process identifiers for observations that will result in DICOM information objects (e.g., slide images). Note that the IPC-1 Accession Identifier is the identifier assigned by the Order Filler for associating the DICOM results with other laboratory information and processes; it may or may not be the same as the SPM-30 Accession ID or the SAC-2 Accession Identifier.

In relationship to triggers O21, O33, O35, and O39 this message/trigger (O21) should be used where an order with multiple samples and optionally multiple containers per order item are to be communicated, but not against a complete specimen shipment (O39)

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

OML^O21^OML_O21: Laboratory Order Message
HL7 MessageStructure Table - OML_O21
Segment Cardinality Must Implement Status
OML_O21
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
ARV 0..* B
GT1 0..1
AL1 0..*
OCCUPATIONAL_DATA_FOR_HEALTH 0..1
OH1 0..*
OH2 0..*
OH3 0..1
OH4 0..*
NEXT_OF_KIN 0..*
NK1 1..1 Yes
OH2 0..*
OH3 0..1
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
ORDER 1..* Yes
ORC 1..1 Yes
NTE 0..*
PRT 0..*
FT1 0..*
CTI 0..*
BLG 0..1
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
TCD 0..1
NTE 0..*
PRT 0..*
CTD 0..1
DG1 0..*
REL 0..1
IPC 0..1
SGH 0..1
SGT 0..1
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
TCD 0..1
NTE 0..*
SPECIMEN 0..*
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
CONTAINER 0..*
SAC 1..1 Yes
NTE 0..1
CONTAINER_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
PRIOR_RESULT 0..*
AL1 0..*
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
OBSERVATION_PARTICIPATION_PRIOR 0..*
PRT 1..1 Yes
DEV 0..*
TIMING_PRIOR 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_PRIOR 1..* Yes
OBX 1..1 Yes
PRT 0..*
NTE 0..*
DEVICE 0..*
DEV 1..1 Yes
OBX 0..*

Original Mode Acknowledgement Choreography for OML^O21^OML_O21

Send Application Ack: ORL^O22^ORL_O22

Enhanced Mode Acknowledgement Choreography for OML^O21^OML_O21

When the MSH-15 value of an OML^O21^OML_O21 message is AL or ER or SU, an ACK^O21^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OML^O21^OML_O21 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OML^O21^OML_O21 message is AL or ER or SU, an ORL^O22^ORL_O22 or ORL^O53^ORL_O53 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OML^O21^OML_O21 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O21^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORL^O22^ORL_O22 or ORL^O53^ORL_O53 or OSU^O52^OSU_O52
NE (none)

ORL – general laboratory order response message to any OML

The function of this message is to respond to an OML message. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O21:

  • With patient segments

  • Optionally without patient segments

Patient Segments Required

ORL^O22^ORL_O22: General Laboratory Order Acknowledgment Message (Patient Required)
HL7 MessageStructure Table - ORL_O22
Segment Cardinality Must Implement Status
ORL_O22
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PID 1..1 Yes
PRT 0..*
ARV 0..* B
ORDER 0..*
ORC 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
PRT 0..*
SPECIMEN 0..*
SPM 1..1 Yes
SAC 0..*

Original Mode Acknowledgement Choreography for ORL^O22^ORL_O22

Send Immediate Ack: ACK^O22^ACK

Enhanced Mode Acknowledgement Choreography for ORL^O22^ORL_O22

When the MSH-15 value of an ORL^O22^ORL_O22 message is AL or ER or SU, an ACK^O22^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORL^O22^ORL_O22 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O22^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

Patient Segments Optional

ORL^O53^ORL_O53: General Laboratory Order Acknowledgment Message (Patient Optional)
HL7 MessageStructure Table - ORL_O53
Segment Cardinality Must Implement Status
ORL_O53
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..1
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
PRT 0..*
ORDER 0..*
ORC 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
PRT 0..*
SPECIMEN 0..*
SPM 1..1 Yes
SAC 0..*

Original Mode Acknowledgement Choreography for ORL^O53^ORL_O53

Send Immediate Ack: ACK^O53^ACK

Enhanced Mode Acknowledgement Choreography for ORL^O53^ORL_O53

When the MSH-15 value of an ORL^O53^ORL_O53 message is AL or ER or SU, an ACK^O53^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORL^O53^ORL_O53 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O53^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OML – Laboratory order for multiple orders related to a single specimen (event O33)

The trigger event for this message is any change to a laboratory order. Such changes include submission of new orders, cancellations, updates, etc., where multiple orders are associated with a single sample which may be carried in multiple containers. OML messages can originate also with a placer, filler, or an interested third party.

This allows for a Specimen-centric message with multiple orders per specimen grouped by the specimen.

The following message structure may be used for the communication of laboratory and other order messages and must be used for lab automation messages where the message requires Specimen/container information to group a number of orders.

The IPC segment in this trigger is used to transmit imaging process identifiers for observations that will result in DICOM information objects (e.g., slide images). Note that the IPC-1 Accession Identifier is the identifier assigned by the Order Filler for associating the DICOM results with other laboratory information and processes; it may or may not be the same as the SPM-30 Accession ID or the SAC-2 Accession Identifier.

In relationship to triggers O21, O33, and O35, this message/trigger (O33) should be used where a specimen, with optional multiple containers, may have multiple orders to be communicated.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

OML^O33^OML_O33: Laboratory Order – Multiple Order Per Specimen Message
HL7 MessageStructure Table - OML_O33
Segment Cardinality Must Implement Status
OML_O33
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
ARV 0..* B
GT1 0..1
AL1 0..*
OCCUPATIONAL_DATA_FOR_HEALTH 0..1
OH1 0..*
OH2 0..*
OH3 0..1
OH4 0..*
NEXT_OF_KIN 0..*
NK1 1..1 Yes
OH2 0..*
OH3 0..1
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
SPECIMEN 1..* Yes
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
SPECIMEN_CONTAINER 0..*
SAC 1..1 Yes
NTE 0..*
ORDER 1..* Yes
ORC 1..1 Yes
NTE 0..*
PRT 0..*
FT1 0..*
CTI 0..*
BLG 0..1
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
TCD 0..1
NTE 0..*
PRT 0..*
DG1 0..*
REL 0..1
IPC 0..1
SGH 0..1
SGT 0..1
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
TCD 0..1
NTE 0..*
PRIOR_RESULT 0..*
AL1 0..*
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
OBSERVATION_PARTICIPATION_PRIOR 0..*
PRT 1..1 Yes
DEV 0..*
TIMING_PRIOR 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_PRIOR 1..* Yes
OBX 1..1 Yes
PRT 0..*
NTE 0..*
DEVICE 0..*
DEV 1..1 Yes
OBX 0..*

Original Mode Acknowledgement Choreography for OML^O33^OML_O33

Send Application Ack: ORL^O34^ORL_O34

Enhanced Mode Acknowledgement Choreography for OML^O33^OML_O33

When the MSH-15 value of an OML^O33^OML_O33 message is AL or ER or SU, an ACK^O33^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OML^O33^OML_O33 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OML^O33^OML_O33 message is AL or ER or SU, an ORL^O34^ORL_O34 or ORL^O54^ORL_O54 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OML^O33^OML_O33 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O33^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORL^O34^ORL_O34 or ORL^O54^ORL_O54 or OSU^O52^OSU_O52
NE (none)

ORL – Laboratory order response message to a multiple order related to single specimen OML (Event O34 and O54)

The function of this message is to respond to an OML message where the original trigger event produced an OML with the Specimen Group segment above the ORC. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O34:

  • With patient segments

  • Optionally without patient segments

Patient Segments Required

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

Patient Segments Optional

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OML – Laboratory order for multiple orders related to a single container of a specimen (event O35)

The trigger event for this message is any change to a laboratory order. Such changes include submission of new orders, cancellations, updates, etc., where multiple orders are associated with a single sample which may be carried in multiple containers. OML messages can originate also with a placer, filler, or an interested third party.

This allows for a Specimen-centric message with multiple orders per specimen grouped by the specimen.

The following message structure may be used for the communication of laboratory and other order messages and must be used for lab automation messages where the message requires Specimen/container information to group a number of orders.

The IPC segment in this trigger is used to transmit imaging process identifiers for obsrevations that will result in DICOM information objects (e.g., slide images). Note that the IPC-1 Accession Identifier is the identifier assigned by the Order Filler for associating the DICOM results with other laboratory information and processes; it may or may not be the same as the SPM-30 Accession ID or the SAC-2 Accession Identifier.

In relationship to triggers O21, O33, and O35, this message/trigger (O35) should be used for laboratory orders where there is 1 or more Specimens with 1 to many containers and each container may have 1 to many orders with previous result(s) per container.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

OML^O35^OML_O35: Laboratory Order – Multiple Order Per Container of Specimen Message
HL7 MessageStructure Table - OML_O35
Segment Cardinality Must Implement Status
OML_O35
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
ARV 0..* B
GT1 0..1
AL1 0..*
OCCUPATIONAL_DATA_FOR_HEALTH 0..1
OH1 0..*
OH2 0..*
OH3 0..1
OH4 0..*
NEXT_OF_KIN 0..*
NK1 1..1 Yes
OH2 0..*
OH3 0..1
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
SPECIMEN 1..* Yes
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
SPECIMEN_CONTAINER 1..* Yes
SAC 1..1 Yes
NTE 0..*
ORDER 1..* Yes
ORC 1..1 Yes
NTE 0..*
PRT 0..*
FT1 0..*
CTI 0..*
BLG 0..1
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
TCD 0..1
NTE 0..*
PRT 0..*
DG1 0..*
REL 1..1 Yes
IPC 0..1
SGH 0..1
SGT 0..1
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
TCD 0..1
NTE 0..*
PRIOR_RESULT 0..*
AL1 0..*
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
OBSERVATION_PARTICIPATION 0..*
PRT 1..1 Yes
DEV 0..*
TIMING_PRIOR 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_PRIOR 1..* Yes
OBX 1..1 Yes
PRT 0..*
NTE 0..*
DEVICE 0..*
DEV 1..1 Yes
OBX 0..*

Original Mode Acknowledgement Choreography for OML^O35^OML_O35

Send Application Ack: ORL^O36^ORL_O36

Enhanced Mode Acknowledgement Choreography for OML^O35^OML_O35

When the MSH-15 value of an OML^O35^OML_O35 message is AL or ER or SU, an ACK^O35^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OML^O35^OML_O35 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OML^O35^OML_O35 message is AL or ER or SU, an ORL^O36^ORL_O36 or ORL^O55^ORL_O55 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OML^O35^OML_O35 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O35^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORL^O36^ORL_O36 or ORL^O55^ORL_O55 or OSU^O52^OSU_O52
NE (none)

ORL – Laboratory order response message to a single container of a specimen OML(Event O36 and O55)

The function of this message is to respond to an OML message where the original trigger event produced an OML with the Specimen Group segment above the ORC. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O36:

  • With patient segments

  • Optionally without patient segments

Patient Segments Required

ORL^O36^ORL_O36: Laboratory Order Acknowledgment Message – Multiple Order Per Container of Specimen (Patient Required)
HL7 MessageStructure Table - ORL_O36
Segment Cardinality Must Implement Status
ORL_O36
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PID 1..1 Yes
PRT 0..*
ARV 0..* B
SPECIMEN 1..* Yes
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
SPECIMEN_CONTAINER 1..* Yes
SAC 1..1 Yes
ORDER 0..*
ORC 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
PRT 0..*

Original Mode Acknowledgement Choreography for ORL^O36^ORL_O36

Send Immediate Ack: ACK^O36^ACK

Enhanced Mode Acknowledgement Choreography for ORL^O36^ORL_O36

When the MSH-15 value of an ORL^O36^ORL_O36 message is AL or ER or SU, an ACK^O36^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORL^O36^ORL_O36 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O36^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

Patient Segments Optional

ORL^O55^ORL_O55: Laboratory Order Acknowledgment Message – Multiple Order Per Container of Specimen (Patient Optional)
HL7 MessageStructure Table - ORL_O55
Segment Cardinality Must Implement Status
ORL_O55
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
PRT 0..*
SPECIMEN 1..* Yes
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
SPECIMEN_CONTAINER 1..* Yes
SAC 1..1 Yes
ORDER 0..*
ORC 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
PRT 0..*

Original Mode Acknowledgement Choreography for ORL^O55^ORL_O55

Send Immediate Ack: ACK^O55^ACK

Enhanced Mode Acknowledgement Choreography for ORL^O55^ORL_O55

When the MSH-15 value of an ORL^O55^ORL_O55 message is AL or ER or SU, an ACK^O55^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORL^O55^ORL_O55 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O55^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OML – Specimen shipment centric laboratory order (event O39)

The function of this message is to apply an order to all specimens in a shipment or a package within a shipment.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

OML^O39^OML_O39: Specimen Shipment Centric Laboratory Order Message
HL7 MessageStructure Table - OML_O39
Segment Cardinality Must Implement Status
OML_O39
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
ARV 0..* B
GT1 0..1
AL1 0..*
OCCUPATIONAL_DATA_FOR_HEALTH 0..1
OH1 0..*
OH2 0..*
OH3 0..1
OH4 0..*
NEXT_OF_KIN 0..*
NK1 1..1 Yes
OH2 0..*
OH3 0..1
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
ORDER 1..* Yes
ORC 1..1 Yes
NTE 0..*
PRT 0..*
FT1 0..*
CTI 0..*
BLG 0..1
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
TCD 0..1
NTE 0..*
PRT 0..*
CTD 0..1
DG1 0..*
REL 1..1 Yes
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
TCD 0..1
NTE 0..*
SPECIMEN_SHIPMENT 0..*
SHP 1..1 Yes
SHIPMENT_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
PACKAGE 1..* Yes
PAC 1..1 Yes
SPECIMEN_IN_PACKAGE 0..*
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
SPECIMEN_CONTAINER_IN_PACKAGE 0..*
SAC 1..1 Yes
NTE 0..*
CONTAINER_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
DEVICE 0..*
DEV 1..1 Yes
OBX 0..*

Original Mode Acknowledgement Choreography for OML^O39^OML_O39

Send Application Ack: ORL^O40^ORL_O40

Enhanced Mode Acknowledgement Choreography for OML^O39^OML_O39

When the MSH-15 value of an OML^O39^OML_O39 message is AL or ER or SU, an ACK^O39^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OML^O39^OML_O39 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OML^O39^OML_O39 message is AL or ER or SU, an ORL^O40^ORL_O40 or ORL^O56^ORL_O56 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OML^O39^OML_O39 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O39^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORL^O40^ORL_O40 or ORL^O56^ORL_O56 or OSU^O52^OSU_O52
NE (none)

ORL – Specimen shipment centric laboratory order response message to specimen shipment OML(Event O40 and O56)

The function of this message is to respond to an OML message. An ORL message is the application acknowledgment to an OML message. See Chapter 2 for a description of the acknowledgment paradigm.

Two message structures are available to acknowledge OML_O40:

  • With patient segments

  • Optionally without patient segments

Patient Segments Required

ORL^O40^ORL_O40: Specimen Shipment Centric Laboratory Order Acknowledgment Message (Patient Required)
HL7 MessageStructure Table - ORL_O40
Segment Cardinality Must Implement Status
ORL_O40
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
PRT 0..*
ARV 0..* B
ORDER 0..*
ORC 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
PRT 0..*
SPECIMEN_SHIPMENT 0..*
SHP 1..1 Yes
PACKAGE 1..* Yes
PAC 1..1 Yes
SPECIMEN_IN_PACKAGE 0..*
SPM 1..1 Yes
SPECIMEN_CONTAINER_IN_PACKAGE 0..*
SAC 1..1 Yes

Original Mode Acknowledgement Choreography for ORL^O40^ORL_O40

Send Immediate Ack: ACK^O40^ACK

Enhanced Mode Acknowledgement Choreography for ORL^O40^ORL_O40

When the MSH-15 value of an ORL^O40^ORL_O40 message is AL or ER or SU, an ACK^O40^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORL^O40^ORL_O40 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O40^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

Patient Segments Optional

ORL^O56^ORL_O56: Specimen Shipment Centric Laboratory Order Acknowledgment Message (Patient Optional)
HL7 MessageStructure Table - ORL_O56
Segment Cardinality Must Implement Status
ORL_O56
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
PRT 0..*
ORDER 0..*
ORC 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
PRT 0..*
SPECIMEN_SHIPMENT 0..*
SHP 1..1 Yes
PACKAGE 1..* Yes
PAC 1..1 Yes
SPECIMEN_IN_PACKAGE 0..*
SPM 1..1 Yes
SPECIMEN_CONTAINER_IN_PACKAGE 0..*
SAC 1..1 Yes

Original Mode Acknowledgement Choreography for ORL^O56^ORL_O56

Send Immediate Ack: ACK^O56^ACK

Enhanced Mode Acknowledgement Choreography for ORL^O56^ORL_O56

When the MSH-15 value of an ORL^O56^ORL_O56 message is AL or ER or SU, an ACK^O56^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORL^O56^ORL_O56 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O56^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OMI – Imaging Order Message (Event O23)

This message is used in communication between the information systems involved in the fulfillment of the request directed to the imaging department, such as a Radiology Information System (RIS) and a Picture Archiving and Communication System (PACS). For the purpose of the following discussion these systems will be identified as Imaging Department Information Systems (IDIS). Information contained in the Imaging Procedure Control (IPC) segment allows multiple IDIS to share the context of Imaging Studies (collections of images acquired, processed, stored, and interpreted) in Image Management tasks.

The order for the imaging service is communicated between the Order Placer (such as an Order Entry system) and the Order Filler (such as an RIS). In the imaging department environment, the Order Filler also identifies the set of procedures (studies) and sub-procedures (procedure steps) that have to be performed in the process of fulfilling the order. Each sub-procedure is performed using a single device (station). The Order Filler identifies the type of device and either a specific device or group of devices (for example, by geographic location) one of which is to be used in performing the procedure step. Thus, the system performs an aspect of workflow management in the department.

Another information system in the department may be managing storage and distribution of the images within the department as well as providing them to the enterprise. This system will have to operate within the same context as the system managing the workflow. This context includes identifiers, content of the order, and details of procedures and procedure steps that have to be performed to fulfill that particular order.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

It is expected that the OMI message will typically be used in communication between IDIS as depicted in figure 4-1.

The Device segment (DEV) provides additional device information for a device referenced in one or more of the PRT segments in the message (using PRT-10 Participation Device to match DEV-2 Unique Device Identifier or PRT-22 Participation Device Type using DEV-3 Device Type).

OMI^O23^OMI_O23: Imaging Order Message
HL7 MessageStructure Table - OMI_O23
Segment Cardinality Must Implement Status
OMI_O23
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
NTE 0..*
GT1 0..1
AL1 0..*
OCCUPATIONAL_DATA_FOR_HEALTH 0..1
OH1 0..*
OH2 0..*
OH3 0..1
OH4 0..*
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
ORDER 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
PRT 0..*
CTD 0..1
DG1 0..*
REL 1..1 Yes
IPC 1..* Yes
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
NTE 0..*
DEVICE 0..*
DEV 1..1 Yes
OBX 0..*

Original Mode Acknowledgement Choreography for OMI^O23^OMI_O23

Send Application Ack: ORI^O24^ORI_O24

Enhanced Mode Acknowledgement Choreography for OMI^O23^OMI_O23

When the MSH-15 value of an OMI^O23^OMI_O23 message is AL or ER or SU, an ACK^O23^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OMI^O23^OMI_O23 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OMI^O23^OMI_O23 message is AL or ER or SU, an ORI^O24^ORI_O24 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OMI^O23^OMI_O23 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O23^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORI^O24^ORI_O24 or OSU^O52^OSU_O52
NE (none)

ORI – Imaging Order Response Message to Any OMI (Event O24)

The function of this message is to respond to an OMI message. An ORI message is the application acknowledgment to an OMI message. See Chapter 2 for a description of the acknowledgment paradigm.

ORI^O24^ORI_O24: Imaging Order Acknowledgment Message
HL7 MessageStructure Table - ORI_O24
Segment Cardinality Must Implement Status
ORI_O24
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
ARV 0..* B
NTE 0..*
PRT 0..*
ORDER 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
PRT 0..*
IPC 1..* Yes
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*

Original Mode Acknowledgement Choreography for ORI^O24^ORI_O24

Send Immediate Ack: ACK^O24^ACK

Enhanced Mode Acknowledgement Choreography for ORI^O24^ORI_O24

When the MSH-15 value of an ORI^O24^ORI_O24 message is AL or ER or SU, an ACK^O24^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORI^O24^ORI_O24 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O24^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OPL – Population/Location-Based Laboratory Order Message (Event O37)

This message supports the use-case for submission of field level specimen and order data to diagnostic laboratories

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP"."

OPL^O37^OPL_O37: Population/Location-Based Laboratory Order Message
HL7 MessageStructure Table - OPL_O37
Segment Cardinality Must Implement Status
OPL_O37
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PRT 1..* Yes
GUARANTOR 0..1
GT1 1..1 Yes
NTE 0..*
ORDER 1..* Yes
NK1 1..* Yes
SGH 0..1
SGT 0..1
FT1 0..*
CTI 0..*
BLG 0..1
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
AL1 0..*
OBSERVATIONS_ON_PATIENT 0..*
OBX 1..1 Yes
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
SPECIMEN 1..* Yes
SPM 1..1 Yes
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
CONTAINER 0..*
SAC 1..1 Yes
CONTAINER_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
OBSERVATION_REQUEST 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
PRT 0..*
TCD 0..1
DG1 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
ORDER_RELATED_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
PRIOR_RESULT 0..1
NK1 1..* Yes
AL1 0..1
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
OBR 1..1 Yes
ORC 0..1
OBSERVATION_PARTICIPATION_PRIOR 0..*
PRT 1..1 Yes
DEV 0..*
TIMING 0..1
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_RESULT_GROUP 1..* Yes
OBX 1..1 Yes
PRT 0..*

Original Mode Acknowledgement Choreography for OPL^O37^OPL_O37

Send Application Ack: OPR^O38^OPR_O38

Enhanced Mode Acknowledgement Choreography for OPL^O37^OPL_O37

When the MSH-15 value of an OPL^O37^OPL_O37 message is AL or ER or SU, an ACK^O37^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OPL^O37^OPL_O37 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OPL^O37^OPL_O37 message is AL or ER or SU, an OPR^O38^OPR_O38 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OPL^O37^OPL_O37 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O37^ACK
NE (none)
MSH-16 AL, ER, SU application ack: OPR^O38^OPR_O38 or OSU^O52^OSU_O52
NE (none)

This structure represents the way that most orders to veterinary laboratories occur. There is a multi-tier hierarchy in which a single individual (usually a veterinarian or an owner of a production facility) submits one or more specimen samples from one or more animals or non-living entities, such as environmental specimens or feed, etc. There are often many interested participants referenced for each set of orders, which explains the need for the repeating PRT segment. These include individuals such as the government official that is responsible for monitoring the testing of an animal or animal group, the parent organization, etc. This grouped submission of specimens from multiple animal "patients" requires that orders pertaining to animal and non-animal specimens be accommodated. The primary structure of concern is the following:

{[PID]

{SPM

{ORC

OBR}

}

}

This allows for multiple specimens or animal or non-animal origin to have multiple requests associated with them. This is the usual process in field level sample collection from populations or environments.

OPR – Population/Location-Based Laboratory Order Acknowledgment Message (Event O38)

The function of this message is to respond to an OPL message. An OPR message is the application acknowledgment to an OPL message. See Chapter 2 for a description of the acknowledgment paradigm.

Note: Based upon general message/acknowledgment patterns, it would be expected that this message type would be ORP. However, when this message type was introduced, ORP was already in use as Pharmacy/Treatment Order Acknowledgment.

OPR^O38^OPR_O38: Population/Location-Based Laboratory Order Acknowledgment Message
HL7 MessageStructure Table - OPR_O38
Segment Cardinality Must Implement Status
OPR_O38
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
ORDER 1..* Yes
NK1 1..* Yes
PATIENT 0..1
PID 1..1 Yes
PRT 0..*
ARV 0..* B
SPECIMEN 0..*
SPM 1..1 Yes
SAC 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
OBSERVATION_REQUEST 0..*
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
PRT 0..*
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*

Original Mode Acknowledgement Choreography for OPR^O38^OPR_O38

Send Immediate Ack: ACK^O38^ACK

Enhanced Mode Acknowledgement Choreography for OPR^O38^OPR_O38

When the MSH-15 value of an OPR^O38^OPR_O38 message is AL or ER or SU, an ACK^O38^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OPR^O38^OPR_O38 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O38^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OSU - Order Status Update (Event O51)

This message is used to create simple order status updates for any type of order where the ORC is sufficient to communicate the order identifier and no other data changes. This is particularly necessary when status updates are not part of order acknowledgement messages, e.g., a status message occurs 2 days later.

Note that one also could send a regular order message using order control code “SC” (Status Changed). The choice to use one or the other is dependent on whether any of the other segments in the original message structure is necessary or not.

OSU^O51^OSU_O51: Order Status Update Message
HL7 MessageStructure Table - OSU_O51
Segment Cardinality Must Implement Status
OSU_O51
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PID 0..1
PRT 0..*
ARV 0..* B
ORDER_STATUS 1..* Yes
ORC 1..1 Yes
PRT 0..*

Original Mode Acknowledgement Choreography for OSU^O51^OSU_O51

Send Application Ack: OSU^O52^OSU_O52

Enhanced Mode Acknowledgement Choreography for OSU^O51^OSU_O51

When the MSH-15 value of an OSU^O51^OSU_O51 message is AL or ER or SU, an ACK^O51^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OSU^O51^OSU_O51 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OSU^O51^OSU_O51 message is AL or ER or SU, an OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OSU^O51^OSU_O51 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O51^ACK
NE (none)
MSH-16 AL, ER, SU application ack: OSU^O52^OSU_O52
NE (none)

OSU – Order Status Update Acknowledgement (Event O52)

This message is used to create simple order status updates, through an acknowledgement, for any type of order where the ORC is sufficient to communicate the order identifier and no other data updates are necessary. This is particularly relevant when a status update occurred in response to a new or updated order. The OSU structure allows it to be used instead of, but equivalent to the application level acknowledgement message, e.g., ORG.

OSU^O52^OSU_O52: Order Status Update Acknowledgement Message
HL7 MessageStructure Table - OSU_O52
Segment Cardinality Must Implement Status
OSU_O52
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PRT 0..*
ARV 0..* B
ORDER_STATUS 1..* Yes
ORC 1..1 Yes
PRT 0..*

Original Mode Acknowledgement Choreography for OSU^O52^OSU_O52

Send Immediate Ack: ACK^O52^ACK

Enhanced Mode Acknowledgement Choreography for OSU^O52^OSU_O52

When the MSH-15 value of an OSU^O52^OSU_O52 message is AL or ER or SU, an ACK^O52^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OSU^O52^OSU_O52 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O52^ACK
NE (none)
MSH-16 NE (none)

There is not supposed to be an Application Level acknowledgement to an Application Level Acknowledgement message. In Enhanced Mode, MSH-16 SHALL always be set to NE (Never).

OMQ – General Order Message with Document Payload (Event O57)

The purpose of this message is to enable communication of orders using a CDA document type to convey the content of the order (e.g., prescription, lab tests, etc.) while the message infrastructure enables appropriate state management.

It should be noted that, unless orders are communicated at the granular, fully decomposed test/medication/procedure/etc. level, state management can only happen at the group level, i.e., equal to all elements in the document. It also should be noted that identification of individual elements can only be achieved if the CDA document contains appropriate identification while the order numbers in ORC effectively act as a group number.

Once the order manager determines to initiate a new order using this message, then all subsequent state management messages must continue at the document level, forgoing detailed level state management.

When one wants to convey with the detailed order message a supporting document, such as a CDA, one can transmit that document using the OBX associated with the ORC/OBR(s) using OBX-11 = "O" Order Detail Description Only, using either OBX-2 = "ED" or "RP".

OMQ^O57^OMQ_O57: General Order Message with Document Payload
HL7 MessageStructure Table - OMQ_O57
Segment Cardinality Must Implement Status
OMQ_O57
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
NK1 0..*
ARV 0..* B
GT1 0..1
AL1 0..*
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
ORDER 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBX 1..1 Yes
PRT 0..*
TXA 1..1 Yes
CTD 0..1
DG1 0..*
FT1 0..*
CTI 0..*
BLG 0..1
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
NTE 0..*
PRIOR_RESULT 0..*
AL1 0..*
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
ARV 0..* B
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
CTD 0..1
TIMING_PRIOR 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_PARTICIPATION_PRIOR 0..*
PRT 1..1 Yes
DEV 0..*
OBSERVATION_PRIOR 1..* Yes
OBX 1..1 Yes
PRT 0..*
NTE 0..*

Original Mode Acknowledgement Choreography for OMQ^O57^OMQ_O57

Send Application Ack: ORX^O58^ORX_O58

Enhanced Mode Acknowledgement Choreography for OMQ^O57^OMQ_O57

When the MSH-15 value of an OMQ^O57^OMQ_O57 message is AL or ER or SU, an ACK^O57^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OMQ^O57^OMQ_O57 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OMQ^O57^OMQ_O57 message is AL or ER or SU, an ORX^O58^ORX_O58 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OMQ^O57^OMQ_O57 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O57^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORX^O58^ORX_O58 or OSU^O52^OSU_O52
NE (none)

ORX – General Order Message with Document Payload Acknowledgement Message (Event O58)

The function of this message is to respond to an OMQ message. An ORX message is the application acknowledgment to an OMQ message. See Chapter 2 for a description of the acknowledgment paradigm.

In ORX the PID and ORC segments are optional, particularly in case of an error response. However, ORC segments are always required in ORD when the OBR is present. For example, a response ORD might include only the MSH and MSA.

The function (e.g., cancel, new order) of both OMQ and ORX messages is determined by the value in ORC-1-order control. (See the table of order control values for a complete list.)

ORX^O58^ORX_O58: General Order Message with Document Payload Acknowledgement Message
HL7 MessageStructure Table - ORX_O58
Segment Cardinality Must Implement Status
ORX_O58
MSH 1..1 Yes
MSA 1..1 Yes
ARV 0..*
ERR 0..*
SFT 0..*
UAC 0..1
NTE 0..*
RESPONSE 0..1
PATIENT 0..1
PID 1..1 Yes
NTE 0..*
PRT 0..*
ARV 0..* B
ORDER 1..* Yes
ORC 1..1 Yes
PRT 0..*
TXA 1..1 Yes
CTI 0..*

Original Mode Acknowledgement Choreography for ORX^O58^ORX_O58

Send Immediate Ack: ACK^O58^ACK

Enhanced Mode Acknowledgement Choreography for ORX^O58^ORX_O58

When the MSH-15 value of an ORX^O58^ORX_O58 message is AL or ER or SU, an ACK^O58^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an ORX^O58^ORX_O58 message is NE, an immediate ack SHALL NOT be sent.

Never send an application ack in enhanced mode.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O58^ACK
NE (none)
MSH-16 NE (none)

OML – Laboratory Result Interpretation Request Message (Event O59)

This is a simplified fulfillment order representing a request for interpretation of a pre-existing result. The ORC and OBR are the new fulfillment order requesting confirmation of a previous result.

The REL segment (Ch. 12) establishes a relationship between the new order (source) and a previous order/result (target) requiring additional action such as confirmation of that order or result, or interpretation of that result. The REL segment includes a variety of fields defining a clinical relationship and the identity of the asserting party. For this use, the required fields are the relationship type (REL-2), the source identifier (REL-4, new order number in this message), and the target identifier (REL-5, previous order group, order, or result identifier included in a previous message). Targets may be represented using order or order group identifiers, in which case the target encompasses the entire order or order group and all results, or may include results identifiers (OBX-21, Observation Instance Identifier), in which case the target is restricted to the specific result.

OML^O59^OML_O59: Laboratory Order Message
HL7 MessageStructure Table - OML_O59
Segment Cardinality Must Implement Status
OML_O59
MSH 1..1 Yes
ARV 0..*
SFT 0..*
UAC 0..1
NTE 0..*
PATIENT 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
NTE 0..*
NK1 0..*
GT1 0..1
AL1 0..*
PATIENT_VISIT 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
INSURANCE 0..*
IN1 1..1 Yes
IN2 0..1
IN3 0..1
ORDER 1..* Yes
ORC 1..1 Yes
NTE 0..*
PRT 0..*
FT1 0..*
CTI 0..*
BLG 0..1
TIMING 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_REQUEST 0..1
OBR 1..1 Yes
TCD 0..1
NTE 0..*
PRT 0..*
CTD 0..1
DG1 0..*
REL 0..1
IPC 0..1
SGH 0..1
SGT 0..1
OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
TCD 0..1
NTE 0..*
SPECIMEN 0..*
SPM 1..1 Yes
NTE 0..*
SPECIMEN_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
CONTAINER 0..*
SAC 1..1 Yes
NTE 0..1
CONTAINER_OBSERVATION 0..*
OBX 1..1 Yes
PRT 0..*
PRIOR_RESULT 0..*
AL1 0..*
PATIENT_PRIOR 0..1
PID 1..1 Yes
PD1 0..1
PRT 0..*
PATIENT_VISIT_PRIOR 0..1
PV1 1..1 Yes
PV2 0..1
PRT 0..*
ORDER_PRIOR 1..* Yes
ORC 1..1 Yes
PRT 0..*
OBR 1..1 Yes
NTE 0..*
OBSERVATION_PARTICIPATION_PRIOR 0..*
PRT 1..1 Yes
DEV 0..*
TIMING_PRIOR 0..*
TQ1 1..1 Yes
TQ2 0..*
OBSERVATION_PRIOR 1..* Yes
OBX 1..1 Yes
PRT 0..*
NTE 0..*

Original Mode Acknowledgement Choreography for OML^O59^OML_O59

Send Application Ack: ORL^O22^ORL_O22

Enhanced Mode Acknowledgement Choreography for OML^O59^OML_O59

When the MSH-15 value of an OML^O59^OML_O59 message is AL or ER or SU, an ACK^O59^ACK message SHALL be sent as an immediate ack.

When the MSH-15 value of an OML^O59^OML_O59 message is NE, an immediate ack SHALL NOT be sent.

When the MSH-16 value of an OML^O59^OML_O59 message is AL or ER or SU, an ORL^O22^ORL_O22 or ORL^O53^ORL_O53 or OSU^O52^OSU_O52 message SHALL be sent as an application ack.

When the MSH-16 value of an OML^O59^OML_O59 message is NE, an application ack SHALL NOT be sent.

Field Value Send Response
MSH-15 AL, ER, SU immediate ack: ACK^O59^ACK
NE (none)
MSH-16 AL, ER, SU application ack: ORL^O22^ORL_O22 or ORL^O53^ORL_O53 or OSU^O52^OSU_O52
NE (none)

General Segments

The following segments (ORC and BLG) are common to many order messages.

ORC - Common Order Segment

The Common Order segment (ORC) is used to transmit fields that are common to all orders (all types of services that are requested).

There is some overlap between fields of the ORC and those in the order detail segments. These are described in the succeeding sections.

HL7 Attribute Table - ORC - Common Order Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
ORC
1 00215 Order Control SHALL [1..1] [2..2] ID
2

00216 Placer Order Number MAY
True:
False:
C
[1..1]
[0..1]
EI
3

00217 Filler Order Number MAY
True:
False:
C
[1..1]
[0..1]
EI
4 00218 Placer Order Group Number [0..1] EI
5 00219 Order Status [0..1] [1..2] ID
6 00220 Response Flag [0..1] [1..1] ID
7 00221 Quantity/Timing SHALL NOT W [0..0]
8 00222 Parent Order [0..*] EIP
9 00223 Date/Time of Order Event [0..1] DTM
10 00224 Entered By SHALL NOT W [0..0] XCN
11 00225 Verified By SHALL NOT W [0..0]
12 00226 Ordering Provider SHALL NOT W [0..0]
13 00227 Enterer's Location [0..1] PL
14 00228 Call Back Phone Number [0..2] XTN
15 00229 Order Effective Date/Time [0..1] DTM
16 00230 Order Control Code Reason [0..1] CWE
17 00231 Entering Organization SHALL NOT W [0..0]
18 00232 Entering Device SHALL NOT W [0..0]
19 00233 Action By SHALL NOT W [0..0]
20 01310 Advanced Beneficiary Notice Code [0..1] CWE
21 01311 Ordering Facility Name SHALL NOT W [0..0]
22 01312 Ordering Facility Address SHALL NOT W [0..0]
23 01313 Ordering Facility Phone Number SHALL NOT W [0..0]
24 01314 Ordering Provider Address SHALL NOT W [0..0]
25 01473 Order Status Modifier [0..1] CWE
26

01641 Advanced Beneficiary Notice Override Reason MAY
True:
False:
C
[1..1]
[0..1]
CWE
27 01642 Filler's Expected Availability Date/Time [0..1] DTM
28 00615 Confidentiality Code [0..1] CWE
29 01643 Order Type [0..1] CWE
30 01644 Enterer Authorization Mode [0..1] CNE
31 02287 Parent Universal Service Identifier SHALL NOT W [0..0]
32 02301 Advanced Beneficiary Notice Date [0..1] DT
33 03300 Alternate Placer Order Number [0..*] CX
34 03387 Order Workflow Profile [0..*] CWE
35 00816 Action Code [0..1] [2..2] ID
36 03509 Order Status Date Range [0..1] DR
37 03515 Order Creation Date/Time [0..1] DTM
38 02482 Filler Order Group Number [0..1] EI

ORC use notes

  1. placer order groups

The Standard supports a mechanism to collect several orders together in a group. Most often this is used to represent an "ordering session" for a single patient. A common use case is the grouping of laboratory batteries and tests ordered together by a physician for a patient with a common diagnostic goal (e.g. preoperative blood testing, diabetes follow-up, …).

An order group is a list of orders (ORCs) associated with an ORC-4-placer group number. A group is established when the placer supplies a placer group number with the original order or when the filler accessions the order group and supplies a filler group number with the received order. The order group may be identified by the placer or by the filler or by both applications. The order group consists of all the ORCs and order detail segments that have the same placer group number, or using the assign number/number assigned mechanism. Orders can be removed from the group using cancel, or added using the replacement or parent-child mechanisms. New orders cannot otherwise be added to the group.

  1. duplicate fields

The ORC is intended to uniformly define the fields that are common to all orders (i.e., requested services). Some ORC fields are duplicated in some order detail segments (e.g., OBR, RXO). For example, ORC-2-placer order number has the same meaning and purpose as OBR-2-placer order number field. This promotes upward compatibility with past versions and ASTM.

The rule for using these fields is that the value must appear in the order detail segment if it does not appear in the ORC. However, it is recommended to transmit the field value in both places to avoid confusion.

  1. parent/child – cancel, hold, discontinue

During transmission of a request to cancel, hold, or discontinue a parent order, the request is intended to apply recursively to the parent order and all associated child orders.

For example:

  1. An EKG application receives an order for three EKGs on successive mornings.

  2. The EKG application creates three child orders, one for each requested EKG..

  3. The first daily EKG has already been performed when a request is received to cancel the original parent order. (The parent is beyond the point of cancellation.)

  4. The remaining, unperformed, children are canceled as a result of the request.

  5. Date/Time Use Notes:

  6. Various dates are available in ORC that seem overlapping, but serve distinct purposes. The following provides use notes on these relationships, while the individual field definitions provide further details.

  7. ORC-7 Quantity/Timing - This field was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. The reader is referred to the TQ1 – Timing/Quantity and TQ2 – Timing/Quantity Relationship segments described in sections 4.5.4 and 4.5.5, respectively. The purpose of this field (and now these segments) is to capture Priority, Frequency, and Timing of the service being ordered. For example, an order for a unit of blood to be administered to a patient every morning for 3 days..

  8. ORC-9 Date/Time of Order Event – This field is the date/time when the action indicated in ORC-1 was initiated. Every time a new action, as indicated by ORC-1, occurs the date/time of that action should appear in ORC-9. This field is not equivalent to MSH-7 Date and Time of Message, which reflects the date/time of message generation.

  9. ORC-15 Order Effective Date/Time – The field focuses on when the information communicated is to take effect. It is most appropriate when used on an order that is by nature a “continuing” (or continuous) order. This field has a close relationship to ORC-9 and the TQ1, TQ2 segments in so much as the value in ORC-15 takes precedence over both. For example, an order is placed on June 1, for an activity that is to be performed over ten days as indicated in the TQ1 segment. The Filler then receives a cancel message on June 2 with the ORC-9 value of June 2, but the ORC-15 Order Effective Date/Time indicated the cancel is to be effective on June 7th. ORC-15 by taking precedence over TQ1 and ORC-9, would tell the Filler to continue to perform the order event until June 7, and cancel all remaining events (treatment, procedures etc.) after that time.

  10. ORC-27 Filler’s Expected Availability Date/Time – This field focuses on when the filler expects to complete the order, e.g., have the results available, the prescription ready, etc. This is a Filler assigned field and would typically only be sent from Filler to Placer on either application level acknowledgments or order status messages. (Could be delivered with result messag but would have little relevance at that time.)

  11. ORC-32 Advanced Beneficiary Notice Date – This field contains the date the patient gave consent to pay for potentially uninsured services or the date that the Advanced Beneficiary Notice Code (ORC-20) was collected.

  12. ORC-36 Order Status Range – This field is a Filler assigned date/time indicating a date range that the ORC-5 Order Status is intended to be effective. For example, if the Filler recommends an alternate test, and sets the ORC-5 status to “Hold”, this date/time reflects how long the Filler will keep the order in that status (barring additional communications from the Placer or Filler in regard to this order.)

  13. ORC-37 Order Creation Date/Time – focuses on the date that the order was originally created; whether as an electronic order or as an initial paper requisition. This date/time is designed to preserve the creation date/time from initial order to final result, and for all stages in-between. (Acknowledgments, Updates, Cancels, etc.)

ORC-1: Order Control (ID) 00215

Definition: Determines the function of the order segment. Refer to HL7 Table 0119 – Order Control Codes in Chapter 2C, Code Tables, for valid entries. Depending on the message, the action of the control code may refer to an order or an individual service. For example, the code CA in an OMP message cancels the order. The same code in an RDS message, cancels the dispense. Very detailed explanatory notes are given at the end of this section.

This field may be considered the "trigger event" identifier for orders. The codes fall roughly into the following three categories:

  1. event request – Codes like "NW" (new order) and "CA" (cancel order request) are used to initiate an event .

  2. event acknowledgment – Codes like "OK" (order accepted) and "CR" (canceled as requested) are used to reply to the event request .

  3. event notification – Codes like "OC" (order canceled) and "OD" (order discontinued) are used to notify other applications that an event has occurred. No application reply is necessary.

Event request codes are intended to initiate an event. Event acknowledgment codes are intended to reply to an application that requested an event. Event notification codes are intended to notify another application that, e.g., the filler has performed some action on an order that the other application, e.g., the placer, needs to know.

Fillers, placers, and other applications can use event requests, event acknowledgments, and event – notification-type trigger events interchangeably. However, certain order control codes can originate only from the filler (e.g., CR) and others can only originate from the placer (e.g., CA).

Refer HL7 Table 0119 – Order Control Codes in Chapter 2C, Code Tables.

ORC-2: Placer Order Number (EI) 00216

(Definition from ORC.2 in Ch. 4)

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

This field is a case of the Entity Identifier data type (See Section 2.A.28, "EI – Entity Identifier"). The first component is a string that identifies an individual order (i.e., ORC segment and associated order detail segment). It is assigned by the placer (ordering application). It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the application ID of the placing application in the same form as the HD data type (Section 2.A.36, "HD – Hierarchic designator"). The second component, namespace ID, is a user-defined coded value that will be uniquely associated with an application. A limit of six (6) characters is suggested but not required. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique application IDs. The components are separated by component delimiters.

There are three situations in which the true placer is somewhat arbitrary (and thus not unique):

  1. in ORC-1-order control value of RO, following an RU replacement;

  2. in ORC-1-order control value of CH (child orders); and

  3. in ORC-1-order control value of SN (send number).

See the Table Notes under ORC-1-order control for the details of how the ORC-2-placer order number is assigned in these cases.

The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third-party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the placer application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). Note that if both ORC-2 and OBR-2 are valued then they must be valued the same; as well, if both ORC-3 and OBR-3 are valued, then they must be valued the same. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number for the placer order number when a new order is placed or a unique number for the filler order number when an unsolicited result is initially communicated.

These rules apply to the few other fields that are present in both ORC and OBR for upward compatibility (e.g., quantity/timing, parent numbers, ordering provider, and ordering call back numbers).

(Definition from OBR.2 in Ch. 4)

Definition: This field is identical to ORC-2-Placer Order Number.

This field is a special case of the Entity Identifier data type (Chapter 2A, section 2.A.28). The first component is a string that identifies an individual order (i.e., ORC segment and associated order detail segment). A limit of fifteen (15) characters is suggested but not required. It is assigned by the placer (ordering application). An implementation is HL7 compliant when the number of characters for this field is increased to accommodate applications that require a greater number of characters for the Placer order number. It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the application ID of the placing application in the same form as the HD data type (section 2.A.36, "HD – Hierarchic designator"). The second component, namespace ID, is a user-defined coded value that will be uniquely associated with an application. A limit of six (6) characters is suggested but not required. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique application IDs. The components are separated by component delimiters.

See ORC-2-placer order number (section 4.5.1.2) for information on when this field must be valued.

A given institution or group of intercommunicating institutions should establish a list of applications that may be potential placers and fillers of orders and assign each a unique application ID. The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third-party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the placer application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

These rules apply to the few other fields that are present in both ORC and OBR for upward compatibility (e.g., quantity/timing, parent numbers, ordering provider, and ordering call back numbers).

(Definition from OBR.2 in Ch. 7)

Definition: This field is identical to ORC-2-Placer Order Number.

This field is a special case of the Entity Identifier data type (Chapter 2A, section 2.A.28). The first component is a string that identifies an individual order (i.e., ORC segment and associated order detail segment). A limit of fifteen (15) characters is suggested but not required. It is assigned by the placer (ordering application). An implementation is HL7 compliant when the number of characters for this field is increased to accommodate applications that require a greater number of characters for the Placer order number. It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the application ID of the placing application in the same form as the HD data type (section 2.A.36, "HD – Hierarchic designator"). The second component, namespace ID, is a user-defined coded value that will be uniquely associated with an application. A limit of six (6) characters is suggested but not required. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique application IDs. The components are separated by component delimiters.

See ORC-2-placer order number (section 4.5.1.2) for information on when this field must be valued.

A given institution or group of intercommunicating institutions should establish a list of applications that may be potential placers and fillers of orders and assign each a unique application ID. The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third-party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the placer application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

These rules apply to the few other fields that are present in both ORC and OBR for upward compatibility (e.g., quantity/timing, parent numbers, ordering provider, and ordering call back numbers).

(Definition from TXA.14 in Ch. 9)

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

This is a composite field. The first component is a string of characters that identifies an individual order (i.e., OBR). It is assigned by the placer (ordering application). It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the (filler) assigning authority of the placing application. The (filler) assigning authority is a string of characters that will be uniquely associated with an application. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique entity identifiers. The components are separated by component delimiters.

TXA-14 - Condition: If corresponding ORC and/or OBR segments are present in the message and ORC-2 or OBR-2 is valued, this field must be blank. If TXA-14 is valued while ORC-2 or OBR-2 is valued it shall be ignored. See message definitions including TXA for further guidance on which ORC/OBR pairs to consider.

(Definition from ARQ.24 in Ch. 10)

Definition: This field is the placer application's order number for the order associated with this scheduling request.

This field is described in detail in Chapter 4, section 4.5.1.2, "ORC-2 – Placer Order Number." It is an optional field, but if a Placer order number is present, then a Filler order number (ARQ-25 – Filler Order Number) must also be present.

(Definition from SCH.26 in Ch. 10)

Definition: This field is the placer application's order number for the order associated with this scheduling filler application response.

This field is described in detail in Section 4.5.1.2. It is an optional field, but if a Placer order number is present, then a Filler order number (Section 10.6.2.27) must also be present. Both this field and the Filler order number below may have been sent as part of the appointment request in the ARQ segment or they may be assigned by the scheduling filler application only.

ORC-3: Filler Order Number (EI) 00217

(Definition from ORC.3 in Ch. 4)

Definition: This field is the order number associated with the filling application. It is a case of the Entity Identifier data type (Section 2.A.28). Its first component is a string that identifies an order detail segment (i.e., ORC segment and associated order detail segment). It is assigned by the order filler (receiving) application. This string must uniquely identify the order (as specified in the order detail segment) from other orders in a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time.

The second through fourth components contain the filler application ID, in the form of the HD data type (see Section 2.A.36, "HD – hierarchic designator"). The second component is a user-defined coded value that uniquely defines the application from other applications on the network. A limit of six (6) characters is suggested but not required. The second component of the filler order number always identifies the actual filler of an order.

A given institution or group of intercommunicating institutions should establish a list of applications that may be potential placers and fillers of orders and assign each a unique application ID. The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third- party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the filler application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). Note that if both ORC-2 and OBR-2 are valued, then they must be valued the same; as well, if both ORC-3 and OBR-3 are valued, then they must be valued the same. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments. It is recommended that the initiating system should provide a unique number for the placer order number when a new order is placed or a unique number for the filler order number when an unsolicited result is initially communicated.

The filler order number (OBR-3 or ORC-3) also uniquely identifies an order and its associated observations. For example, suppose that an institution collects observations from several ancillary applications into a common database and this common database is queried by yet another application for observations. In this case, the filler order number and placer order number transmitted by the common database application would be that of the original filler and placer, respectively, rather than a new one assigned by the common database application.

Similarly, if a third-party application, not the filler or placer, of an order were authorized to modify the status of an order (say, cancel it), the third-party application would send the filler an ORM message containing an ORC segment with ORC-1-order control equal to "CA" and containing the original placer order number and filler order number, rather than assign either itself.

(Definition from OBR.3 in Ch. 4)

Definition: This field is the order number associated with the filling application. This is a permanent identifier for an order and its associated observations. It is a special case of the Entity Identifier data type (see Chapter 2, section 2.A.28, "EI – entity identifier").

The first component is a string that identifies an individual order segment (i.e., ORC segment and associated order detail segment). It is assigned by the order filling (receiving) application. It identifies an order uniquely among all orders from a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time.

The second through fourth components contain the filler application ID, in the form of the HD data type (see section 2.A.36, "HD – hierarchic designator"). The second component is a user-defined coded value that uniquely defines the application from other applications on the network. A limit of six (6) characters is suggested but not required. The second component of the filler order number always identifies the actual filler of an order.

See ORC-3-filler order number for information on when this field must be valued.

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

The filler order number (OBR-3 or ORC-3) also uniquely identifies an order and its associated observations. For example, suppose that an institution collects observations from several ancillary applications into a common database and this common database is queried by yet another application for observations. In this case, the filler order number and placer order number transmitted by the common database application would be that of the original filler and placer, respectively, rather than a new one assigned by the common database application.

Similarly, if a third-party application, not the filler or placer, of an order were authorized to modify the status of an order (say, cancel it), the third-party application would send the filler an ORM message containing an ORC segment with ORC-1-order control equal to "CA" and containing the original placer order number and filler order number, rather than assign either itself.

(Definition from FT1.23 in Ch. 6)

Definition: This field is used when the billing system is requesting observational reporting justification for a charge. This is the number used by a filler to uniquely identify a result. See Chapter 4 for a complete description.

(Definition from OBR.3 in Ch. 7)

Definition: This field is the order number associated with the filling application. This is a permanent identifier for an order and its associated observations. It is a special case of the Entity Identifier data type (see Chapter 2, section 2.A.28, "EI – entity identifier").

The first component is a string that identifies an individual order segment (i.e., ORC segment and associated order detail segment). It is assigned by the order filling (receiving) application. It identifies an order uniquely among all orders from a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time.

The second through fourth components contain the filler application ID, in the form of the HD data type (see section 2.A.36, "HD – hierarchic designator"). The second component is a user-defined coded value that uniquely defines the application from other applications on the network. A limit of six (6) characters is suggested but not required. The second component of the filler order number always identifies the actual filler of an order.

See ORC-3-filler order number for information on when this field must be valued.

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

The filler order number (OBR-3 or ORC-3) also uniquely identifies an order and its associated observations. For example, suppose that an institution collects observations from several ancillary applications into a common database and this common database is queried by yet another application for observations. In this case, the filler order number and placer order number transmitted by the common database application would be that of the original filler and placer, respectively, rather than a new one assigned by the common database application.

Similarly, if a third-party application, not the filler or placer, of an order were authorized to modify the status of an order (say, cancel it), the third-party application would send the filler an ORM message containing an ORC segment with ORC-1-order control equal to "CA" and containing the original placer order number and filler order number, rather than assign either itself.

(Definition from TXA.15 in Ch. 9)

Definition: This field is the order number associated with the filling application. Where a transcription service or similar organization creates the document and uses an internally unique identifier, that number should be inserted in this field. Its first component is a string of characters that identifies an order detail segment (i.e., OBR). This string must uniquely identify the order (as specified in the order detail segment) from other orders in a particular filling application (i.e., transcription service). This uniqueness must persist over time. Where a number is reused over time, a date can be affixed to the non-unique number to make it unique.

The second through fourth components contains the (filler) assigning authority. The (filler) assigning authority is a string of characters that uniquely defines the application from other applications on the network. The second through fourth components of the filler order number always identify the actual filler of an order.

TXA-15 - Condition: If corresponding ORC and/or OBR segments are present in the message and ORC-3 or OBR-3 is valued, this field must be blank. If TXA-14 is valued while ORC-3 or OBR-3 is valued it shall be ignored. See message definitions including TXA for further guidanceon which ORC/OBR pairs to consider.

For further details, please see the definitions provided in Chapter 4, "Orders".

(Definition from ARQ.25 in Ch. 10)

Definition: This field is the order number assigned by the filler application for the order associated with this scheduling request.

This field is described in detail in Chapter 4, section 4.5.1.3, "ORC-3 – Filler Order Number.” It is conditionally mandatory depending on the presence of the Placer order number (ARQ-24 – Placer Order Number). This conditionally mandatory requirement addresses the concern that a Scheduling system cannot and should not create or fill an order. Therefore, an order must have been accepted by the filler application before scheduling the resources associated with that order.

(Definition from SCH.27 in Ch. 10)

Definition: This field is the order number assigned by the filler application for the order associated with this scheduling filler response.

This field is described in detail in Chapter 4, Orders, section 4.5.1.3. It is conditionally mandatory depending on the presence of the placer order number (section 10.6.2.26). This conditionally mandatory requirement addresses the concern that a Scheduling system cannot and should not create or fill an order. Therefore, an order must have been accepted by the order filler application before scheduling the resources associated with that order.

ORC-4: Placer Order Group Number (EI) 00218

(Definition from ORC.4 in Ch. 4)

Definition: This field contains a unique identifier for an Order Group as referenced by the Placer application. An Order Group is a set of orders grouped together by the placer application.

The first component is a string that uniquely identifies all order groups from the placer application. A limit of fifteen (15) characters is suggested but not required.

The second through fourth components constitute a placer or filler application ID identical to the analogous components of ORC-3-filler order number . Order groups and how to use them are described in detail in Section 4.5.1, "ORC – Common Order Segment."

(Definition from ARQ.4 in Ch. 10)

Definition: This field contains a unique identifier for the Placer Group as referenced by the Placer application. A Placer Order Group is a set of appointments grouped together by the placer application, and subsequently identified by the placer application.

The second through fourth components contain the assigning authority identifying information.

(Definition from SCH.4 in Ch. 10)

Definition: This field contains a unique identifier for the Placer Group as referenced by the Placer application, the Filler application, or both. A Placer Group is a set of appointments grouped together by the placer application, and subsequently identified by the placer application and/or by the filler application.

Within each of the two subcomponents, the first component is a string that identifies a group of appointment requests. It is assigned by the Placer or Filler application, and it identifies an appointment group uniquely among all such groups of requests from a particular requesting application.

ORC-5: Order Status (ID) 00219

Definition: This field specifies the status of an order. Refer to HL7 Table 0038 – Order status in Chapter 2C, Code Tables, for valid entries. The purpose of this field is to report the status of an order either upon request (solicited), or when the status changes (unsolicited). It does not initiate action. It is assumed that the order status always reflects the status as it is known to the sending application at the time that the message is sent. Only the filler can originate the value of this field.

Although HL7 Table 0038 – Order status contains many of the same values contained in HL7 Table 0119 – Order control codes and their meaning, its purpose is different. Order status may typically be used in a message with an ORC-1-order control value of SR or SC to report the status of the order on request or to any interested party at any time.

ORC-6: Response Flag (ID) 00220

Definition: This field allows the placer (sending) application to determine the amount of information to be returned from the filler. Sometimes the requested level of response may not be possible immediately, but when it is possible, the filler (receiving) application must send the information. When the field is null, D is the default value of the field. Refer to HL7 Table 0121 – Response flag in Chapter 2C, Code Tables, for valid entries.

ORC-7: Quantity/Timing

(Definition from ORC.7 in Ch. 4)

Attention: The ORC-7 field was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. The reader is referred to the TQ1 and TQ2 segments described in sections 4.5.4 and 4.5.5, respectively.

(Definition from OBR.27 in Ch. 4)

Attention: The OBR-27 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

(Definition from RXE.1 in Ch. 4A)

Attention: The RXE-1 field was retained for backward compatibilty only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

(Definition from RXG.3 in Ch. 4A)

Attention: The RXG-3 field was retained for backward compatibilty only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

Note: The contents of fields 3-8 should be identical to the comparable fields in the RXE (RXE-2 thru 5).


(Definition from OBR.27 in Ch. 7)

Attention: The OBR-27 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

ORC-8: Parent Order (EIP) 00222

(Definition from ORC.8 in Ch. 4)

Definition: This field relates a child order to its parent order when a parent child order relationship exists. The parent child order mechanism is described in HL7 Table 0119 under order control code PA. This field uniquely identifies the parent order; no other information is required to link the child order with its parent order. It can be used to link the order to the results that triggered this order (e.g., a reflex order) or other order it relates to as an occurrence. This field repeats to allow linking to more than one parent, if necessary.

The first component has the same format as ORC-2-Placer Order Number (Section 4.5.3.2, "Placer Order Number (EI) 00216"). The second component has the same format as ORC-3-Filler Order Number (Section 4.5.3.3, "Filler Order Number (EI) 00217"). The components of the placer order number and the filler order number are transmitted in sub-components of the two components of this field.

Note that ORC-8 – Parent Order is equivalent to OBR-54 – Parent Order, but neither one is the same as OBR-29 – Result Observation Identifier.

Condition: Where the message has matching ORC/OBR pairs, ORC-8 and OBR-54 Must carry the same value.

(Definition from OBR.54 in Ch. 4)

Definition: This field relates a child order to its parent order when a parent child order relationship exists. The parent child order mechanism is described in HL7 Table 0119 – Order Control Codes in Chapter 2C, Code Tables, under order control code PA. This field uniquely identifies the parent orders; no other information is required to link the child order with its parent orders. It can be used to express that this order is a reflex being a consequence of original results referred here.

The first component has the same format as ORC-2-placer order number (Section 4.5.3.2, "Placer Order Number (EI) 00216"). The second component has the same format as ORC-3-filler order number (Section 4.5.3.3, "Filler Order Number (EI) 00217"). The components of the placer order number and the filler order number are transmitted in sub-components of the two components of this field.

Note that ORC-8 – Parent Order is equivalent to OBR-54-Parent Order, but neither one is the same as OBR-29-Parent Result Obersvation Identifier .

Condition: Where the message has matching ORC/OBR pairs, ORC-8 and OBR-54 must carry the same value.

(Definition from OBR.54 in Ch. 7)

Definition: This field relates a child order to its parent order when a parent child order relationship exists. The parent child order mechanism is described in HL7 Table 0119 – Order Control Codes in Chapter 2C, Code Tables, under order control code PA. This field uniquely identifies the parent orders; no other information is required to link the child order with its parent orders. It can be used to express that this order is a reflex being a consequence of original results referred here.

The first component has the same format as ORC-2-placer order number (Section 4.5.3.2, "Placer Order Number (EI) 00216"). The second component has the same format as ORC-3-filler order number (Section 4.5.3.3, "Filler Order Number (EI) 00217"). The components of the placer order number and the filler order number are transmitted in sub-components of the two components of this field.

Note that ORC-8 – Parent Order is equivalent to OBR-54-Parent Order, but neither one is the same as OBR-29-Parent Result Obersvation Identifier .

Condition: Where the message has matching ORC/OBR pairs, ORC-8 and OBR-54 must carry the same value.

ORC-9: Date/Time of Order Event (DTM) 00223

Definition: This field contains the date and time of the event that initiated the current transaction as reflected in ORC-1 Order Control Code. This field is not equivalent to MSH-7 Date and Time of Message, which reflects the date/time of message generation.

Examples: When ORC-1 is “NW” this date represents the date/time when the order was placed by the ordering provider; when ORC-1 is "CA" this date represents the date/time when request for a cancellation was made by the placer, while for a "CR" this date represents the date/time when the cancellation was accepted by the filler (e.g., the change request was applied). When an ORC is included in an ORU message and ORC-1 is "RE", then the date represents the date/time when the observation(s) on the transaction were made available by the source system.

ORC-10: Entered By

(Definition from NTE.5 in Ch. 2)

Definition: This field contains the identity of the person who actually keyed the comment into the application. It provides an audit trail in case the comment is entered incorrectly and the ancillary department needs to clarify the comment. By local agreement, either the ID number or name component MAY be omitted.

(Definition from ORC.10 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

(Definition from ACC.7 in Ch. 6)

Definition: This field identifies the person entering the accident information.

(Definition from MFE.7 in Ch. 8)

Definition: This field contains the identity of the person who actually keyed the master file entry into the application. It provides an audit trail in case the request is entered incorrectly and the ancillary department needs to clarify the request.

(Definition from OM7.20 in Ch. 8)

Note: This field is deprecated and retained for backward compatibility as of v 2.8.

Definition: This field contains the identity of the person who actually keyed the service item into the application. It provides an audit trail in case the request is entered incorrectly and the ancillary department needs to clarify the request.

ORC-11: Verified By

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

ORC-12: Ordering Provider

(Definition from ORC.12 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

(Definition from OBR.16 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred ot the PRT segment as described in Chapter 7.

(Definition from OBR.16 in Ch. 7)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred ot the PRT segment as described in Chapter 7.

ORC-13: Enterer's Location (PL) 00227

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

ORC-14: Call Back Phone Number (XTN) 00228

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

ORC-15: Order Effective Date/Time (DTM) 00229

Definition: This field focuses on when the information communicated is to take effect. It is most appropriate when used on an order that is by nature a “continuing” (or continuous) order. This field has a close relationship to ORC-9 and the TQ1, TQ2 segments in so much as the value in ORC-15 takes precedence over both. For example, an order is placed on June 1, for an activity that is to be performed over ten days as indicated in the TQ1 segment. The Filler then receives a cancel message on June 2 with the ORC-9 value of June 2, but the ORC-15 Order Effective Date/Time indicated the cancel is to be effective on June 7th. ORC-15 by taking precedence over TQ1 and ORC-9, would tell the Filler to continue to perform the order event until June 7, and cancel all remaining events (treatment, procedures etc..) after that time. If the order identified in the ORC has children, the children which have not started should be canceled; if there is a child in process, it should be discontinued; if a child has progressed beyond the point where it can be discontinued, its status is unaffected.

ORC-16: Order Control Code Reason (CWE) 00230

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

ORC-16-order control code reason is typically not valued when ORC-1-order control is NW, although it could be. In the case of a canceled order, for example, this field is commonly used to explain the cancellation. A Pharmacy system that canceled a drug order from a physician because of a well-documented allergy would likely report the fact of the allergy in this field.

If it canceled the order because of a drug interaction this field might contain at least the names (and codes, if needed) of the interacting substances, the text describing the interaction, and the level of severity of the interaction.

Refer HL7 Table 0949 – Order Control Code Reason in Chapter 2C, Code Tables.

ORC-17: Entering Organization

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7. Refer to Table 0666 - Entering Organization in Chapter 2C for valid values.

ORC-18: Entering Device

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7. Refer to Table 0668 - Entering Device in Chapter 2C for valid values.

ORC-19: Action By

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

ORC-20: Advanced Beneficiary Notice Code (CWE) 01310

(Definition from ORC.20 in Ch. 4)

Definition: This field indicates the status of the patient's or the patient's representative's consent for responsibility to pay for potentially uninsured services. This element is introduced to satisfy CMS Medical Necessity requirements for outpatient services. This element indicates (a) whether the associated diagnosis codes for the service are subject to medical necessity procedures, (b) whether, for this type of service, the patient has been informed that they may be responsible for payment for the service, and (c) whether the patient agrees to be billed for this service. The values for this field are drawn from User-Defined Table 0339 – Advanced Beneficiary Notice Code in Chapter 2C, Code Tables.

(Definition from FT1.27 in Ch. 6)

Definition: This field indicates the status of the patient's or the patient's representative's consent for responsibility to pay for potentially uninsured services. This element is introduced to satisfy CMS Medical Necessity requirements for outpatient services. This element indicates (a) whether the associated diagnosis codes for the service are subject to medical necessity procedures, (b) whether, for this type of service, the patient has been informed that they may be responsible for payment for the service, and (c) whether the patient agrees to be billed for this service. Refer to User-defined Table 0339 - Advanced Beneficiary Notice Code in Chapter 2C, Code Tables, for suggested values.

ORC-21: Ordering Facility Name

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

ORC-22: Ordering Facility Address

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

ORC-23: Ordering Facility Phone Number

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

ORC-24: Ordering Provider Address

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

ORC-25: Order Status Modifier (CWE) 01473

Definition: This field is a modifier or refiner of the ORC-5-Order status field. This field may be used to provide additional levels of specificity or additional information for the defined order status codes. Unlike the Order Status field, which is controlled by an HL7 defined table, this field is a CE data type allowing applications to support an unlimited library of Order Status Modifier codes.

Usage Rule: This field may only be populated if the ORC-5-Order Status field is valued.

Examples: An LIS processing an order with an order status of IP may send an update using the order status modifier to indicate the progress of the order through the laboratory or to indicate that the order has been sent to an external laboratory. Another example using the non-medical orders would be a case in which a phone has been ordered delivered to a patient's room but has been disconnected temporarily. The ORC-5-Order status indicates IP and the ORC-25-Order status modifier would indicate a disconnected status. A third example involves pharmacy dispenses. It is sometimes not enough to know that a prescription is being dispensed. The ORC-25-Order status modifier would indicate if a label had been printed, the prescription filled, or the prescription sold.

Refer HL7 Table 0950 – Order Status Modifier in Chapter 2C, Code Tables.

ORC-26: Advanced Beneficiary Notice Override Reason (CWE) 01641

Definition: This field contains the reason why the patient did not sign an Advanced Beneficiary Notice. The reason may be coded or it may be a free text entry. Refer to HL7 Table 0552 – Advanced beneficiary notice override reason in Chapter 2C, Code Tables.

Condition: This field is required if the value of ORC-20 Advanced Beneficiary Notice Code indicates that the notice was not signed. For example, additional qualifying or explanatory information would be justified if ORC-20 was populated with the values "3" or "4" in User-defined Table 0339 – Advanced Beneficiary Notice Code, or similar values in related external code tables.

ORC-27: Filler's Expected Availability Date/Time (DTM) 01642

Definition: This field specifies the date/time the Filler expects to complete the order, e.g., have the results available, the prescription ready, etc. This is a Filler assigned field and would typically only be sent from Filler to Placer on either application level acknowledgments or order status messages. (Could be delivered with result message, but would have little relevance at that time.)

ORC-28: Confidentiality Code (CWE) 00615

(Definition from ORC.28 in Ch. 4)

Definition: This field contains information about the level of security and/or sensitivity surrounding the order (e.g., highly sensitive, not sensitive, sensitive, etc.). Refer to HL7 Table 0177 – Confidentiality Code in Chapter 2C, Code Tables, for allowed values. The specific treatment of data with a particular confidentiality level is subject to site-specific negotiation.

(Definition from OM1.30 in Ch. 8)

Definition: This field contains the degree to which special confidentiality protection should be applied to the observation. For example, a tighter control may be applied to an HIV test than to a CBC. Refer to User-defined Table 0177 - Confidentiality Code in Chapter 2C, Code Tables, for suggested values.

ORC-29: Order Type (CWE) 01643

Definition: This field indicates whether the order is to be executed in an inpatient setting or an outpatient setting. If this field is not valued, the system default is assumed. Refer to HL7 Table 0482 – Order Type in Chapter 2C, Code Tables, for suggested values.

Examples: Before discharge an order is placed for follow-up physical therapy, or to pick up a prescription at a community pharmacy. The patient is an inpatient according to PV1, but the order is an outpatient order.

ORC-30: Enterer Authorization Mode (CNE) 01644

Definition: This field indicates the form of authorization a recorder had from the responsible practitioner to create or change an order. Refer to HL7 Table 0483 - Authorization Mode in Chapter 2C, Code Tables, for suggested values.

  • To be harmonized to Participation.mode_cd in version 3.

ORC-31: Parent Universal Service Identifier

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9.

ORC-32: Advanced Beneficiary Notice Date (DT) 02301

Definition: This field contains the date the patient gave consent to pay for potentially uninsured services or the date that the Advanced Beneficiary Notice Code (ORC-20) was collected.

ORC-33: Alternate Placer Order Number (CX) 03300

Definition: This field enables a shorter number to be communicated that is unique within other identifiers.

ORC-34: Order Workflow Profile (CWE) 03387

The Order Workflow Profile references/represents the information necessary to define the workflow variant when that is not fully described through the use of ORC-1 Order Control and MSH-21 Message Profile. This enables contributing systems to apply locally agreed to rules. See User-defined Table 0934 - Order Workflow Profile for a list of suggested values.

ORC-35: Action Code (ID) 00816

(Definition from OH1.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OH2.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OH3.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OH4.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from ORC.35 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when either ORC-2 and/or ORC 3 is valued with a unique identifier in accordance with Chapter 2, Section 2.10.4.2.

(Definition from OBR.55 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when either an OBR-2 and/or OBR-3 is valued with unique identifier in accordance with Chapter 2, Section 2.10.4.2.

(Definition from IPC.10 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when the combination of IPC-1, IPC-2, IPC-3, and IPC-4 represents a unique identifier according to Chapter 2, Section 2.10.4.2.

(Definition from BPX.22 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an BPX is uniquely identified sufficiently within the specific implementation using BPX-17 or BPX-6 as agreed to by the trading partners and in accordance with Chapter 2, Section 2.10.4.2.

(Definition from BTX.21 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an BTX is uniquely identified sufficiently within the specific implementation using BTX-20 or BTX-3 as agreed to by the trading partners in accordance with Chapter 2, Section 2.10.4.2.

(Definition from DON.34 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an DON is uniquely identified sufficiently within the specific implementation using DON-1 in accordance with Chapter 2, Section 2.10.4.2.

(Definition from BUI.13 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an BUI is uniquely identified sufficiently within the specific implementation using BUI-2 in accordance with Chapter 2, Section 2.10.4.2

(Definition from RXV.22 in Ch. 4A)

Definition: The intended handling by the receiver of the infusion order is represented by this segment. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from CDO.2 in Ch. 4A)

Definition: The Action Code indicates whether the cumulative dosage segment is intended to be added, deleted, updated, or did not change. If the field is not valued in any CDO segments for the order, the segments are considered to have been sent in snapshot mode. If some but not all CDO segments for the order do not have the action code valued, the default value is Add. Refer to HL7 Table 0206 - Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OBR.55 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an either OBR-2 and/or OBR-3 is valued with unique identifier in accordance with Chapter 2, Section 2.10.4.2.

(Definition from OBX.31 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an OBX-21 is valued in accordance with guidance in Chapter 2, Section 2.10.4.2.

(Definition from SPM.35 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an SPM-2 or SPM-31 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from PRT.2 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0287 – Problem/goal action code for valid values.

(Definition from CSR.17 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when CSR-1 and CSR-4, or CSR-2 and CSR-5 are valued as agreed to by the trading partners in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from CTI.4 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when CTI-1 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from SHP.12 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when SHP-1 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from PAC.9 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when PAC-2 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from GOL.1 in Ch. 12)

Definition: The action code field gives the intent of the problem or goal. Refer to HL7 Table 0287 – Problem/Goal Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from PRB.1 in Ch. 12)

Definition: This field contains the intent of the message. Refer to HL7 Table 0287 – Problem/Goal Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from PTH.1 in Ch. 12)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0287 – Problem/Goal Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from DEV.1 in Ch. 17)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0287 – Problem/goal action code for valid values.

ORC-36: Order Status Date Range (DR) 03509

Definition: This field is a Filler assigned date/time indicating a date range that the ORC-5 Order Status is intended to be effective. For example, if the Filler recommends an alternate test, and sets the ORC-5 status to “Hold”, this date/time reflects how long the Filler will keep the order in that status (Barring additional communications from the Placer or Filler in regard to this order.) When the date is outside the specified order status date range, ORC-5 (Order Status) should be considered an unspecified status, i.e., the status represented in ORC-5 would not necessarily be reflective of the actual status anymore.

ORC-37: Order Creation Date/Time (DTM) 03515

Definition: This field represents the official date/time when the order was originally created; whether as an electronic order or as an initial paper requisition. This may also be known as Prescription Date/Time. This date/time is designed to preserve the creation date/time from initial order to final result, and for all stages in-between. (Acknowledgments, Updates, Cancels, Results etc.). When ORC-1 Order Control Code is “NW” for a new order, this date/time, if valued, is typically expected to be the same as ORC-9 Date/Time of Order Event. An example where the ORC-37, Order Creation Date/Time, is not the same as ORC-9, Date/Time of Order Event, while ORC-1, Order Control Code, is “NW” is when the order originally was recorded and signed by a physician on paper (ORC-37), but not entered in a system until some time (ORC-9) thereafter.

As different date/times can be considered the initiation of the order (the first person entering it or a subsequent step), or data is not available (e.g., a paper request without a date/time when it was created), the system where the order was first documented determines which date/time it reflects according to the organization's policies and would represent that in ORC-37.
When an order is resulted (ORC-1 = “RE”) the value in ORC-37 does not change from the value supplied in the original order.

ORC-38: Filler Order Group Number (EI) 02482

Definition: This field contains a unique identifier for the Order Group as referenced by the Filler application. An Order Group is a set of orders grouped together by the placer application.

The first component is a string that uniquely identifies all order groups from the filler application. A limit of fifteen (15) characters is suggested but not required.

The second through fourth components constitute a filler application ID identical to the analogous components of ORC-3-filler order number . Order groups and how to use them are described in detail in Section 4.5.1, "ORC – Common Order Segment."

BLG - Billing Segment

The BLG segment is used to provide billing information, on the ordered service, to the filling application.

HL7 Attribute Table - BLG - Billing Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
BLG
1 00234 When to Charge [0..1] CCD
2 00235 Charge Type [0..1] [2..2] ID
3 00236 Account ID [0..1] CX
4 01645 Charge Type Reason [0..1] CWE

BLG-1: When to Charge (CCD) 00234

Definition: This field specifies when to charge for the ordered service. Refer to HL7 Table 0100 – Invocation event in Chapter 2C, Code Tables, for valid values.

BLG-2: Charge Type (ID) 00235

Definition: This field identifies someone or something other than the patient to be billed for this service. It is used in conjunction with BLG-3-account ID. Refer to HL7 Table 0122 – Charge Type in Chapter 2C, Code Tables, for valid values.

BLG-3: Account ID (CX) 00236

Definition: This field identifies the account to be billed. It is used in conjunction with BLG-2-charge type. Refer to HL7 Table 0061 – Check digit scheme in Chapter 2C, Code Tables.

BLG-4: Charge Type Reason (CWE) 01645

Definition: This field explains the choice of and provides the clinical rationale for the selected charge type identified in BLG-2. Refer to User-defined Table 0475 – Charge Type Reason in Chapter 2C, code Tables, for suggested values.

OBR - Observation Request Segment

General (taken from ASTM E1238)

The Observation Request (OBR) segment is used to transmit information specific to an order for a diagnostic study or observation, physical exam, or assessment.

The Observation Request segment defines the attributes of a particular request for diagnostic services (e.g., laboratory, EKG) or clinical observations (e.g., vital signs or physical exam). When a placer requests a given set of observations, always include an order segment. For lab tests, the information in the order segment usually applies to a single specimen. However, there is not a one-to-one relationship between specimen and tests ordered. Different test batteries will usually require their own order segments even when they can be performed on a single specimen. In this case, the specimen information must be duplicated in each of the order segments that employ that specimen. For other diagnostic studies, e.g., chest X-ray, a separate order segment will usually be generated for each diagnostic study.

Though multiple observation batteries can be ordered on a single order segment, the observation filler shall generate a separate order segment for each battery that it processes independently, e.g., electrolyte, CBC, vital signs. When reporting the observations, the filling service shall copy the appropriate order (specimen) information from the original order segment into each of the new order segments so that a separate "order" segment is returned to the placer as a "header" for each separate battery of observations.

In the event that an ordered battery of observations cannot be performed, e.g., because of hemolysis on a blood sample, an order segment will be returned to the placer with OBR-25-result status equal to X (to indicate that the study was not performed). In this case, no observation segments will be transmitted.

When observations are successfully completed, the message returned to the placer will include the order segment (OBR) followed by observation (OBX) segments for each distinct observation generated by the order (see Chapter 7). The number of such observation segments will depend upon the number of individual measurements performed in the process.

OBX segments can be sent by the placer along with an order to provide the filling service with clinical data needed to interpret the results. (See Chapter 7 for OBX details.)

HL7 Attribute Table - OBR - Observation Request Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
OBR
1 00237 Set ID – OBR [0..1] [1..4] SI
2

00216 Placer Order Number MAY
True:
False:
C
[1..1]
[0..1]
EI
3

00217 Filler Order Number MAY
True:
False:
C
[1..1]
[0..1]
EI
4 00238 Universal Service Identifier SHALL [1..1] CWE
5 00239 Priority SHALL NOT W [0..0]
6 00240 Requested Date/Time SHALL NOT W [0..0]
7

00241 Observation Date/Time # MAY
True:
False:
C
[1..1]
[0..1]
DTM
8 00242 Observation End Date/Time # [0..1] DTM
9 00243 Collection Volume * B [0..1] CQ
10 00244 Collector Identifier * B [0..*] XCN
11 00245 Specimen Action Code * [0..1] [1..1] ID
12 00246 Danger Code [0..1] CWE
13 00247 Relevant Clinical Information = [0..*] 300 CWE
14 00248 Specimen Received Date/Time * SHALL NOT W [0..0] DTM
15 00249 Specimen Source SHALL NOT W [0..0]
16 00226 Ordering Provider SHALL NOT W [0..0]
17 00250 Order Callback Phone Number [0..2] XTN
18 00251 Placer Field 1 = [0..1] 199 ST
19 00252 Placer Field 2 = [0..1] 199 ST
20 00253 Filler Field 1 + = [0..1] 199 ST
21 00254 Filler Field 2 + = [0..1] 199 ST
22

00255 Results Rpt/Status Chng – Date/Time + MAY
True:
False:
C
[1..1]
[0..1]
DTM
23 00256 Charge to Practice + [0..1] MOC
24 00257 Diagnostic Serv Sect ID [0..1] [2..3] ID
25

00258 Result Status + MAY
True:
False:
C
[1..1]
[0..1]
[1..1] ID
26 00259 Parent Result + [0..1] PRL
27 00221 Quantity/Timing SHALL NOT W [0..0]
28 00260 Result Copies To SHALL NOT W [0..0]
29 00261 Parent Results Observation Identifier [0..1] EIP
30 00262 Transportation Mode [0..1] [4..4] ID
31 00263 Reason for Study [0..*] CWE
32 00264 Principal Result Interpreter + SHALL NOT W [0..0]
33 00265 Assistant Result Interpreter + SHALL NOT W [0..0]
34 00266 Technician + SHALL NOT W [0..0]
35 00267 Transcriptionist + SHALL NOT W [0..0]
36 00268 Scheduled Date/Time + [0..1] DTM
37 01028 Number of Sample Containers * = [0..1] 16 NM
38 01029 Transport Logistics of Collected Sample * [0..*] CWE
39 01030 Collector's Comment * [0..*] CWE
40 01031 Transport Arrangement Responsibility [0..1] CWE
41 01032 Transport Arranged [0..1] [1..1] ID
42 01033 Escort Required [0..1] [1..1] ID
43 01034 Planned Patient Transport Comment [0..*] CWE
44 00393 Procedure Code [0..1] CNE
45 01316 Procedure Code Modifier [0..*] CNE
46 01474 Placer Supplemental Service Information [0..*] CWE
47 01475 Filler Supplemental Service Information [0..*] CWE
48

01646 Medically Necessary Duplicate Procedure Reason MAY
True:
False:
C
[1..1]
[0..1]
CWE
49 01647 Result Handling [0..1] CWE
50 02286 Parent Universal Service Identifier SHALL NOT W [0..0]
51 02307 Observation Group ID [0..1] EI
52 02308 Parent Observation Group ID [0..1] EI
53 03303 Alternate Placer Order Number [0..*] CX
54 00222 Parent Order [0..*] EIP
55 00816 Action Code [0..1] [2..2] ID

OBR-1: Set ID – OBR (SI) 00237

(Definition from OBR.1 in Ch. 4)

Definition: For the first order transmitted, the sequence number shall be 1; for the second order, it shall be 2; and so on.

(Definition from OBR.1 in Ch. 7)

Definition: For the first order transmitted, the sequence number shall be 1; for the second order, it shall be 2; and so on.

OBR-2: Placer Order Number (EI) 00216

(Definition from ORC.2 in Ch. 4)

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

This field is a case of the Entity Identifier data type (See Section 2.A.28, "EI – Entity Identifier"). The first component is a string that identifies an individual order (i.e., ORC segment and associated order detail segment). It is assigned by the placer (ordering application). It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the application ID of the placing application in the same form as the HD data type (Section 2.A.36, "HD – Hierarchic designator"). The second component, namespace ID, is a user-defined coded value that will be uniquely associated with an application. A limit of six (6) characters is suggested but not required. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique application IDs. The components are separated by component delimiters.

There are three situations in which the true placer is somewhat arbitrary (and thus not unique):

  1. in ORC-1-order control value of RO, following an RU replacement;

  2. in ORC-1-order control value of CH (child orders); and

  3. in ORC-1-order control value of SN (send number).

See the Table Notes under ORC-1-order control for the details of how the ORC-2-placer order number is assigned in these cases.

The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third-party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the placer application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). Note that if both ORC-2 and OBR-2 are valued then they must be valued the same; as well, if both ORC-3 and OBR-3 are valued, then they must be valued the same. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number for the placer order number when a new order is placed or a unique number for the filler order number when an unsolicited result is initially communicated.

These rules apply to the few other fields that are present in both ORC and OBR for upward compatibility (e.g., quantity/timing, parent numbers, ordering provider, and ordering call back numbers).

(Definition from OBR.2 in Ch. 4)

Definition: This field is identical to ORC-2-Placer Order Number.

This field is a special case of the Entity Identifier data type (Chapter 2A, section 2.A.28). The first component is a string that identifies an individual order (i.e., ORC segment and associated order detail segment). A limit of fifteen (15) characters is suggested but not required. It is assigned by the placer (ordering application). An implementation is HL7 compliant when the number of characters for this field is increased to accommodate applications that require a greater number of characters for the Placer order number. It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the application ID of the placing application in the same form as the HD data type (section 2.A.36, "HD – Hierarchic designator"). The second component, namespace ID, is a user-defined coded value that will be uniquely associated with an application. A limit of six (6) characters is suggested but not required. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique application IDs. The components are separated by component delimiters.

See ORC-2-placer order number (section 4.5.1.2) for information on when this field must be valued.

A given institution or group of intercommunicating institutions should establish a list of applications that may be potential placers and fillers of orders and assign each a unique application ID. The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third-party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the placer application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

These rules apply to the few other fields that are present in both ORC and OBR for upward compatibility (e.g., quantity/timing, parent numbers, ordering provider, and ordering call back numbers).

(Definition from OBR.2 in Ch. 7)

Definition: This field is identical to ORC-2-Placer Order Number.

This field is a special case of the Entity Identifier data type (Chapter 2A, section 2.A.28). The first component is a string that identifies an individual order (i.e., ORC segment and associated order detail segment). A limit of fifteen (15) characters is suggested but not required. It is assigned by the placer (ordering application). An implementation is HL7 compliant when the number of characters for this field is increased to accommodate applications that require a greater number of characters for the Placer order number. It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the application ID of the placing application in the same form as the HD data type (section 2.A.36, "HD – Hierarchic designator"). The second component, namespace ID, is a user-defined coded value that will be uniquely associated with an application. A limit of six (6) characters is suggested but not required. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique application IDs. The components are separated by component delimiters.

See ORC-2-placer order number (section 4.5.1.2) for information on when this field must be valued.

A given institution or group of intercommunicating institutions should establish a list of applications that may be potential placers and fillers of orders and assign each a unique application ID. The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third-party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the placer application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

These rules apply to the few other fields that are present in both ORC and OBR for upward compatibility (e.g., quantity/timing, parent numbers, ordering provider, and ordering call back numbers).

(Definition from TXA.14 in Ch. 9)

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

This is a composite field. The first component is a string of characters that identifies an individual order (i.e., OBR). It is assigned by the placer (ordering application). It identifies an order uniquely among all orders from a particular ordering application. The second through fourth components contain the (filler) assigning authority of the placing application. The (filler) assigning authority is a string of characters that will be uniquely associated with an application. A given institution or group of intercommunicating institutions should establish a unique list of applications that may be potential placers and fillers and assign unique entity identifiers. The components are separated by component delimiters.

TXA-14 - Condition: If corresponding ORC and/or OBR segments are present in the message and ORC-2 or OBR-2 is valued, this field must be blank. If TXA-14 is valued while ORC-2 or OBR-2 is valued it shall be ignored. See message definitions including TXA for further guidance on which ORC/OBR pairs to consider.

(Definition from ARQ.24 in Ch. 10)

Definition: This field is the placer application's order number for the order associated with this scheduling request.

This field is described in detail in Chapter 4, section 4.5.1.2, "ORC-2 – Placer Order Number." It is an optional field, but if a Placer order number is present, then a Filler order number (ARQ-25 – Filler Order Number) must also be present.

(Definition from SCH.26 in Ch. 10)

Definition: This field is the placer application's order number for the order associated with this scheduling filler application response.

This field is described in detail in Section 4.5.1.2. It is an optional field, but if a Placer order number is present, then a Filler order number (Section 10.6.2.27) must also be present. Both this field and the Filler order number below may have been sent as part of the appointment request in the ARQ segment or they may be assigned by the scheduling filler application only.

OBR-3: Filler Order Number (EI) 00217

(Definition from ORC.3 in Ch. 4)

Definition: This field is the order number associated with the filling application. It is a case of the Entity Identifier data type (Section 2.A.28). Its first component is a string that identifies an order detail segment (i.e., ORC segment and associated order detail segment). It is assigned by the order filler (receiving) application. This string must uniquely identify the order (as specified in the order detail segment) from other orders in a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time.

The second through fourth components contain the filler application ID, in the form of the HD data type (see Section 2.A.36, "HD – hierarchic designator"). The second component is a user-defined coded value that uniquely defines the application from other applications on the network. A limit of six (6) characters is suggested but not required. The second component of the filler order number always identifies the actual filler of an order.

A given institution or group of intercommunicating institutions should establish a list of applications that may be potential placers and fillers of orders and assign each a unique application ID. The application ID list becomes one of the institution's master dictionary lists that is documented in Chapter 8. Since third- party applications (those other than the placer and filler of an order) can send and receive ORM and ORR messages, the filler application ID in this field may not be the same as any sending and receiving application on the network (as identified in the MSH segment).

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). Note that if both ORC-2 and OBR-2 are valued, then they must be valued the same; as well, if both ORC-3 and OBR-3 are valued, then they must be valued the same. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments. It is recommended that the initiating system should provide a unique number for the placer order number when a new order is placed or a unique number for the filler order number when an unsolicited result is initially communicated.

The filler order number (OBR-3 or ORC-3) also uniquely identifies an order and its associated observations. For example, suppose that an institution collects observations from several ancillary applications into a common database and this common database is queried by yet another application for observations. In this case, the filler order number and placer order number transmitted by the common database application would be that of the original filler and placer, respectively, rather than a new one assigned by the common database application.

Similarly, if a third-party application, not the filler or placer, of an order were authorized to modify the status of an order (say, cancel it), the third-party application would send the filler an ORM message containing an ORC segment with ORC-1-order control equal to "CA" and containing the original placer order number and filler order number, rather than assign either itself.

(Definition from OBR.3 in Ch. 4)

Definition: This field is the order number associated with the filling application. This is a permanent identifier for an order and its associated observations. It is a special case of the Entity Identifier data type (see Chapter 2, section 2.A.28, "EI – entity identifier").

The first component is a string that identifies an individual order segment (i.e., ORC segment and associated order detail segment). It is assigned by the order filling (receiving) application. It identifies an order uniquely among all orders from a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time.

The second through fourth components contain the filler application ID, in the form of the HD data type (see section 2.A.36, "HD – hierarchic designator"). The second component is a user-defined coded value that uniquely defines the application from other applications on the network. A limit of six (6) characters is suggested but not required. The second component of the filler order number always identifies the actual filler of an order.

See ORC-3-filler order number for information on when this field must be valued.

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

The filler order number (OBR-3 or ORC-3) also uniquely identifies an order and its associated observations. For example, suppose that an institution collects observations from several ancillary applications into a common database and this common database is queried by yet another application for observations. In this case, the filler order number and placer order number transmitted by the common database application would be that of the original filler and placer, respectively, rather than a new one assigned by the common database application.

Similarly, if a third-party application, not the filler or placer, of an order were authorized to modify the status of an order (say, cancel it), the third-party application would send the filler an ORM message containing an ORC segment with ORC-1-order control equal to "CA" and containing the original placer order number and filler order number, rather than assign either itself.

(Definition from FT1.23 in Ch. 6)

Definition: This field is used when the billing system is requesting observational reporting justification for a charge. This is the number used by a filler to uniquely identify a result. See Chapter 4 for a complete description.

(Definition from OBR.3 in Ch. 7)

Definition: This field is the order number associated with the filling application. This is a permanent identifier for an order and its associated observations. It is a special case of the Entity Identifier data type (see Chapter 2, section 2.A.28, "EI – entity identifier").

The first component is a string that identifies an individual order segment (i.e., ORC segment and associated order detail segment). It is assigned by the order filling (receiving) application. It identifies an order uniquely among all orders from a particular filling application (e.g., clinical laboratory). This uniqueness must persist over time.

The second through fourth components contain the filler application ID, in the form of the HD data type (see section 2.A.36, "HD – hierarchic designator"). The second component is a user-defined coded value that uniquely defines the application from other applications on the network. A limit of six (6) characters is suggested but not required. The second component of the filler order number always identifies the actual filler of an order.

See ORC-3-filler order number for information on when this field must be valued.

The conditions which make this field required are divided into two main issues. The data in ORC-2 and OBR-2 are logically the same thing: a placer id. The data in ORC-3 and OBR-3 are logically the same thing: the filler id.

From that perspective, each message must have either a placer or a filler id with an exception for the case of a "Send Number" control code since its purpose is to request a placer id.

If both ORC and OBR are present in a message, then only one of the Segments must contain the value(s). If both segments contain either ORC-2/OBR-2 or ORC-3/OBR-3, then each pair must be a matching pair. The sending system can include both the filler and the placer number in both the ORC and OBR segments as long as the data is the same between the two segments.

It is recommended that the initiating system should provide a unique number when a new order or unsolicited result is initially communicated.

The filler order number (OBR-3 or ORC-3) also uniquely identifies an order and its associated observations. For example, suppose that an institution collects observations from several ancillary applications into a common database and this common database is queried by yet another application for observations. In this case, the filler order number and placer order number transmitted by the common database application would be that of the original filler and placer, respectively, rather than a new one assigned by the common database application.

Similarly, if a third-party application, not the filler or placer, of an order were authorized to modify the status of an order (say, cancel it), the third-party application would send the filler an ORM message containing an ORC segment with ORC-1-order control equal to "CA" and containing the original placer order number and filler order number, rather than assign either itself.

(Definition from TXA.15 in Ch. 9)

Definition: This field is the order number associated with the filling application. Where a transcription service or similar organization creates the document and uses an internally unique identifier, that number should be inserted in this field. Its first component is a string of characters that identifies an order detail segment (i.e., OBR). This string must uniquely identify the order (as specified in the order detail segment) from other orders in a particular filling application (i.e., transcription service). This uniqueness must persist over time. Where a number is reused over time, a date can be affixed to the non-unique number to make it unique.

The second through fourth components contains the (filler) assigning authority. The (filler) assigning authority is a string of characters that uniquely defines the application from other applications on the network. The second through fourth components of the filler order number always identify the actual filler of an order.

TXA-15 - Condition: If corresponding ORC and/or OBR segments are present in the message and ORC-3 or OBR-3 is valued, this field must be blank. If TXA-14 is valued while ORC-3 or OBR-3 is valued it shall be ignored. See message definitions including TXA for further guidanceon which ORC/OBR pairs to consider.

For further details, please see the definitions provided in Chapter 4, "Orders".

(Definition from ARQ.25 in Ch. 10)

Definition: This field is the order number assigned by the filler application for the order associated with this scheduling request.

This field is described in detail in Chapter 4, section 4.5.1.3, "ORC-3 – Filler Order Number.” It is conditionally mandatory depending on the presence of the Placer order number (ARQ-24 – Placer Order Number). This conditionally mandatory requirement addresses the concern that a Scheduling system cannot and should not create or fill an order. Therefore, an order must have been accepted by the filler application before scheduling the resources associated with that order.

(Definition from SCH.27 in Ch. 10)

Definition: This field is the order number assigned by the filler application for the order associated with this scheduling filler response.

This field is described in detail in Chapter 4, Orders, section 4.5.1.3. It is conditionally mandatory depending on the presence of the placer order number (section 10.6.2.26). This conditionally mandatory requirement addresses the concern that a Scheduling system cannot and should not create or fill an order. Therefore, an order must have been accepted by the order filler application before scheduling the resources associated with that order.

OBR-4: Universal Service Identifier (CWE) 00238

(Definition from OBR.4 in Ch. 4)

Definition: This field contains the identifier code for the requested observation/test/battery. The identifier can come from either a local coding system or industry standards. Examples may be LOINC (emerging as the global standard for observation identifiers), JLAC10, or SNOMED CT. Refer to Table 0612 - Universal Service Identifier in Chapter 2C for valid values.

(Definition from OBR.4 in Ch. 7)

Definition: This field contains the identifier code for the requested observation/test/battery. The identifier can come from either a local coding system or industry standards. Examples may be LOINC (emerging as the global standard for observation identifiers), JLAC10, or SNOMED CT. Refer to Table 0612 - Universal Service Identifier in Chapter 2C for valid values.

(Definition from OM7.2 in Ch. 8)

Definition: This field contains the producer's usual or preferred identification of the test or service.

(Definition from AIS.3 in Ch. 10)

Definition: This field contains an identifier code for a service to be scheduled. This field may contain a universal service identifier describing the observation/test/battery/procedure or other activity that is to be performed during the requested appointment, similar to the universal service identifier defined for the OBR segment in the Order Entry chapter (Chapter 4). This code can be based on local and/or universal codes. The use of universal codes is recommended.

(Definition from TCC.1 in Ch. 13)

Definition: This field identifies the test code that information is being transmitted about. The alternate elements represent the test code identifier that has been assigned by the manufacturer to this particular test code. Refer to Table 0787 - Universal Service Identifier in Chapter 2C for valid values.

(Definition from TCD.1 in Ch. 13)

Definition: This field identifies the test code that information is being transmitted about. Refer to Table 0789 - Universal Service Identifier in Chapter 2C for valid values.

OBR-5: Priority

(Definition from OBR.5 in Ch. 4)

Attention: The OBR-5 element was retained for backward compatibility only as of v 2.4 and the detail was withdrawn and removed from the standard as of v 2.7.

(Definition from OBR.5 in Ch. 7)

Attention: The OBR-5 element was retained for backward compatibility only as of v 2.4 and the detail was withdrawn and removed from the standard as of v 2.7.

OBR-6: Requested Date/Time

(Definition from OBR.6 in Ch. 4)

Attention: The OBR-6 element was retained for backward compatibility only as of v 2.4 and the detail was withdrawn and removed from the standard as of v 2.7.

(Definition from OBR.6 in Ch. 7)

Attention: The OBR-6 element was retained for backward compatibility only as of v 2.4 and the detail was withdrawn and removed from the standard as of v 2.7.

OBR-7: Observation Date/Time # (DTM) 00241

(Definition from OBR.7 in Ch. 4)

Definition: This field is the clinically relevant date/time of the observation. In the case of observations taken directly from a subject, it is the actual date and time the observation was obtained. In the case of a specimen-associated study, this field shall represent the date and time the specimen was collected or obtained. (This is a results-only field except when the placer or a third party has already drawn the specimen.) This field is conditionally required. When the OBR is transmitted as part of a report message, the field must be filled in. If it is transmitted as part of a request and a sample has been sent along as part of the request, this field must be filled in because this specimen time is the physiologically relevant date/time of the observation.

(Definition from OBR.7 in Ch. 7)

Definition: This field is the clinically relevant date/time of the observation. In the case of observations taken directly from a subject, it is the actual date and time the observation was obtained. In the case of a specimen-associated study, this field shall represent the date and time the specimen was collected or obtained. (This is a results-only field except when the placer or a third party has already drawn the specimen.) This field is conditionally required. When the OBR is transmitted as part of a report message, the field must be filled in. If it is transmitted as part of a request and a sample has been sent along as part of the request, this field must be filled in because this specimen time is the physiologically relevant date/time of the observation.

OBR-8: Observation End Date/Time # (DTM) 00242

(Definition from OBR.8 in Ch. 4)

Definition: This field contains the end date and time of a study or timed specimen collection. If an observation takes place over a substantial period of time, it will indicate when the observation period ended. For observations made at a point in time, it will be null. This is a results field except when the placer or a party other than the filler has already drawn the specimen.

(Definition from OBR.8 in Ch. 7)

Definition: This field contains the end date and time of a study or timed specimen collection. If an observation takes place over a substantial period of time, it will indicate when the observation period ended. For observations made at a point in time, it will be null. This is a results field except when the placer or a party other than the filler has already drawn the specimen.

OBR-9: Collection Volume * (CQ) 00243

(Definition from OBR.9 in Ch. 4)

Definition: Deprecated in version 2.9 in favor of SPM-12.

(Definition from OBR.9 in Ch. 7)

Definition: Deprecated in version 2.9 in favor of SPM-12.

OBR-10: Collector Identifier * (XCN) 00244

(Definition from OBR.10 in Ch. 4)

Definition: This field is retained for backward compatibility only as of v 2.7. The reader is referred to the PRT segment described in Chapter 7.

When a specimen is required for the study, this field will identify the person, department, or facility that collected the specimen. Either name or ID code, or both, may be present. If the person referenced in this field is also referenced in PRT segment, they must contain the same information. However, if there is a difference, then PRT segment takes precedence.

(Definition from OBR.10 in Ch. 7)

Definition: This field is retained for backward compatibility only as of v 2.7. The reader is referred to the PRT segment described in Chapter 7.

When a specimen is required for the study, this field will identify the person, department, or facility that collected the specimen. Either name or ID code, or both, may be present. If the person referenced in this field is also referenced in PRT segment, they must contain the same information. However, if there is a difference, then PRT segment takes precedence.

OBR-11: Specimen Action Code * (ID) 00245

(Definition from OBR.11 in Ch. 4)

Definition: This field identifies the action to be taken with respect to the specimens that accompany or precede this order. The purpose of this field is to further qualify (when appropriate) the general action indicated by the order control code contained in the accompanying ORC segment. For example, when a new order (ORC – "NW") is sent to the lab, this field would be used to tell the lab whether or not to collect the specimen ("L" or "O"). Refer to HL7 Table 0065 – Specimen Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OBR.11 in Ch. 7)

Definition: This field identifies the action to be taken with respect to the specimens that accompany or precede this order. The purpose of this field is to further qualify (when appropriate) the general action indicated by the order control code contained in the accompanying ORC segment. For example, when a new order (ORC – "NW") is sent to the lab, this field would be used to tell the lab whether or not to collect the specimen ("L" or "O"). Refer to HL7 Table 0065 – Specimen Action Code in Chapter 2C, Code Tables, for valid values.

OBR-12: Danger Code (CWE) 00246

(Definition from OBR.12 in Ch. 4)

Definition: This field contains the code and/or text indicating any known or suspected patient or specimen hazards, e.g., patient with active tuberculosis or blood from a hepatitis patient. Either code and/or text may be absent. However, the code is always placed in the first component position and any free text in the second component. Thus, free text without a code must be preceded by a component delimiter. Refer to Table 0613 - Danger Code in Chapter 2C for valid values.

(Definition from OBR.12 in Ch. 7)

Definition: This field contains the code and/or text indicating any known or suspected patient or specimen hazards, e.g., patient with active tuberculosis or blood from a hepatitis patient. Either code and/or text may be absent. However, the code is always placed in the first component position and any free text in the second component. Thus, free text without a code must be preceded by a component delimiter. Refer to Table 0613 - Danger Code in Chapter 2C for valid values.

OBR-13: Relevant Clinical Information (CWE) 00247

(Definition from OBR.13 in Ch. 4)

Definition: This field contains additional clinical information about the patient or specimen. This field is used to report the supporting and/or suspected diagnosis and clinical findings on requests for interpreted diagnostic studies where a simple text string or code is sufficient. This field could use all appropriate code sets including SNOMED to message Relevant Clinical Information. If more information is needed, such as date/time of the observation, who observed it, abnormal ranges, etc., or must be provided in further structured format, e.g., structured numeric with units of measure encoded, the Observation/Result group following the OBR should be used. Examples include reporting the amount of inspired carbon dioxide for blood gasses, the point in the menstrual cycle for cervical pap tests, and other conditions that influence test interpretations. Refer to HL7 Table 0916 – Relevant Clinical Information in Chapter 2C, Code Tables, for valid values.

(Definition from OBR.13 in Ch. 7)

Definition: This field contains additional clinical information about the patient or specimen. This field is used to report the supporting and/or suspected diagnosis and clinical findings on requests for interpreted diagnostic studies where a simple text string or code is sufficient. This field could use all appropriate code sets including SNOMED to message Relevant Clinical Information. If more information is needed, such as date/time of the observation, who observed it, abnormal ranges, etc., or must be provided in further structured format, e.g., structured numeric with units of measure encoded, the Observation/Result group following the OBR should be used. Examples include reporting the amount of inspired carbon dioxide for blood gasses, the point in the menstrual cycle for cervical pap tests, and other conditions that influence test interpretations. Refer to HL7 Table 0916 – Relevant Clinical Information in Chapter 2C, Code Tables, for valid values.

OBR-14: Specimen Received Date/Time *

(Definition from OBR.14 in Ch. 4)

Attention: The OBR-14 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. See SPM in Chapter 7.

(Definition from OBR.14 in Ch. 7)

Attention: The OBR-14 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. See SPM in Chapter 7.

(Definition from SPM.18 in Ch. 7)

Definition: The specimen received date/time is the time that the specimen is received at the diagnostic service facility. The actual time that is recorded is based on how specimen receipt is managed and may correspond to the time the sample is logged in. This is fundamentally different from SPM-17 Specimen Collection date/time.

OBR-15: Specimen Source

(Definition from OBR.15 in Ch. 4)

Attention: The OBR-15 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. See SPM in Chapter 7.

(Definition from OBR.15 in Ch. 7)

Attention: The OBR-15 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. See SPM in Chapter 7.

(Definition from SAC.6 in Ch. 13)

Attention: This field was deprecated and retained for backward compatibilityonly as of v2.5 and withdrawn and removed as of v2.7.

(Definition from TCC.3 in Ch. 13)

Attention: As of version 2.5 this field was deprecated and retained for backward compatibility only and withdrawn as of v2.7.

OBR-16: Ordering Provider

(Definition from ORC.12 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRT segment described in Chapter 7.

(Definition from OBR.16 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred ot the PRT segment as described in Chapter 7.

(Definition from OBR.16 in Ch. 7)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred ot the PRT segment as described in Chapter 7.

OBR-17: Order Callback Phone Number (XTN) 00250

(Definition from OBR.17 in Ch. 4)

Definition: This field contains the telephone number for reporting a status or a result using the standard format with extension and/or beeper number when applicable.

(Definition from OBR.17 in Ch. 7)

Definition: This field contains the telephone number for reporting a status or a result using the standard format with extension and/or beeper number when applicable.

OBR-18: Placer Field 1 (ST) 00251

(Definition from OBR.18 in Ch. 4)

Definition: This field is user field #1. Text sent by the placer will be returned with the results.

(Definition from OBR.18 in Ch. 7)

Definition: This field is user field #1. Text sent by the placer will be returned with the results.

OBR-19: Placer Field 2 (ST) 00252

(Definition from OBR.19 in Ch. 4)

Definition: This field is similar to placer field #1.

(Definition from OBR.19 in Ch. 7)

Definition: This field is similar to placer field #1.

OBR-20: Filler Field 1 + (ST) 00253

(Definition from OBR.20 in Ch. 4)

Definition: This field is definable for any use by the filler (diagnostic service).

(Definition from OBR.20 in Ch. 7)

Definition: This field is definable for any use by the filler (diagnostic service).

OBR-21: Filler Field 2 + (ST) 00254

(Definition from OBR.21 in Ch. 4)

Definition: This field is similar to filler field #1.

(Definition from OBR.21 in Ch. 7)

Definition: This field is similar to filler field #1.

OBR-22: Results Rpt/Status Chng – Date/Time + (DTM) 00255

(Definition from OBR.22 in Ch. 4)

Definition: This field specifies the date/time when the results were reported or status changed. This conditional field is required whenever the OBR-25 is valued. This field is used to indicate the date and time that the results are composed into a report and released, or that a status, as defined in ORC-5 order status, is entered or changed. (This is a results field only.) When other applications (such as office or clinical database applications) query the laboratory application for un-transmitted results, the information in this field may be used to control processing on the communications link. Usually, the ordering service would want only those results for which the reporting date/time is greater than the date/time the inquiring application last received results.

(Definition from OBR.22 in Ch. 7)

Definition: This field specifies the date/time when the results were reported or status changed. This conditional field is required whenever the OBR-25 is valued. This field is used to indicate the date and time that the results are composed into a report and released, or that a status, as defined in ORC-5 order status, is entered or changed. (This is a results field only.) When other applications (such as office or clinical database applications) query the laboratory application for un-transmitted results, the information in this field may be used to control processing on the communications link. Usually, the ordering service would want only those results for which the reporting date/time is greater than the date/time the inquiring application last received results.

OBR-23: Charge to Practice + (MOC) 00256

(Definition from OBR.23 in Ch. 4)

Definition: This field is the charge to the ordering entity for the studies performed when applicable. The first component is a dollar amount when known by the filler. The second is a charge code when known by the filler (results only).

(Definition from OBR.23 in Ch. 7)

Definition: This field is the charge to the ordering entity for the studies performed when applicable. The first component is a dollar amount when known by the filler. The second is a charge code when known by the filler (results only).

OBR-24: Diagnostic Serv Sect ID (ID) 00257

(Definition from OBR.24 in Ch. 4)

Definition: This field is the section of the diagnostic service where the observation was performed. If the study was performed by an outside service, the identification of that service should be recorded here. Refer to HL7 Table 0074 – Diagnostic Service Section ID in Chapter 2C, Code Tables, for valid entries.

(Definition from OBR.24 in Ch. 7)

Definition: This field is the section of the diagnostic service where the observation was performed. If the study was performed by an outside service, the identification of that service should be recorded here. Refer to HL7 Table 0074 – Diagnostic Service Section ID in Chapter 2C, Code Tables, for valid entries.

(Definition from OM1.49 in Ch. 8)

Definition: This field is the section of the diagnostic service where the observation was performed. If the study was performed by an outside service, the identification of that service should be recorded here. Refer to HL7 Table 0074 – Diagnostic Service Section ID in Chapter 2C, Code Tables, for valid entries. Same as OBR-24.

OBR-25: Result Status + (ID) 00258

(Definition from OBR.25 in Ch. 4)

Definition: This field contains the status of results for this order. This conditional field is required whenever the OBR is contained in a report message. It is not required as part of an initial order.

There are two methods of sending status information. If the status is that of the entire order, use ORC-15-order effective date/time and ORC-5-order status. If the status pertains to the order detail segment, use OBR-25-result status and OBR-22-results rpt/status chng – date/time. If both are present, the OBR values override the ORC values.

This field would typically be used in a response to an order status query where the level of detail requested does not include the OBX segments. When the individual status of each result is necessary, OBX-11-observ result status may be used. Refer to HL7 Table 0123 – Result Status in Chapter 2C, Code Tables, for valid entries.

(Definition from OBR.25 in Ch. 7)

Definition: This field contains the status of results for this order. This conditional field is required whenever the OBR is contained in a report message. It is not required as part of an initial order.

There are two methods of sending status information. If the status is that of the entire order, use ORC-15-order effective date/time and ORC-5-order status. If the status pertains to the order detail segment, use OBR-25-result status and OBR-22-results rpt/status chng – date/time. If both are present, the OBR values override the ORC values.

This field would typically be used in a response to an order status query where the level of detail requested does not include the OBX segments. When the individual status of each result is necessary, OBX-11-observ result status may be used. Refer to HL7 Table 0123 – Result Status in Chapter 2C, Code Tables, for valid entries.

OBR-26: Parent Result + (PRL) 00259

(Definition from OBR.26 in Ch. 4)

Definition: This field is defined to make it available for other types of linkages (e.g., toxicology). This important information, together with the information in OBR-29-Parent Result Obersvation Identifier and OBR-54 Parent Order, uniquely identifies the parent result's OBX segment related to this order. The value of this OBX segment in the parent result is the organism or chemical species about which this battery reports, or the specific result for which this order or observation is a reflex. For example, if the current battery is an antimicrobial susceptibility, the parent results identified OBX contains a result which identifies the organism on which the susceptibility was run. This indirect linkage is preferred because the name of the organism in the parent result may undergo several preliminary values prior to finalization. In the case of a reflex order, if it is necessary to point to the specific result value for which it is in response, OBR-26 enables pointing to that specific OBX segment.

The third component may be used to record the name of the microorganism identified by the parent result directly. The organism in this case should be identified exactly as it is in the parent culture.

We emphasize that this field does not take the entire result field from the parent. It is meant only for the text name of the organism or chemical subspecies identified. This field is included only to provide a method for linking back to the parent result for those systems that could not generate unambiguous Observation IDs and sub-IDs.

This field is present only when the parent result is identified by OBR-29- Result Observation Identifieror OBR-54, Parent Order, and the parent spawns child orders or results for each of many results. (See Chapter 7 for more details about this linkage.)

A second mode of conveying this information is to use a standard observation result segment (OBX). If more than one organism is present, OBX-4-observation sub-ID is used to distinguish them. In this case, the first OBX with subID N will contain a value identifying the Nth microorganism, and each additional OBX with subID N will contain susceptibility values for a given antimicrobial test on this organism.

(Definition from OBR.26 in Ch. 7)

Definition: This field is defined to make it available for other types of linkages (e.g., toxicology). This important information, together with the information in OBR-29-Parent Result Obersvation Identifier and OBR-54 Parent Order, uniquely identifies the parent result's OBX segment related to this order. The value of this OBX segment in the parent result is the organism or chemical species about which this battery reports, or the specific result for which this order or observation is a reflex. For example, if the current battery is an antimicrobial susceptibility, the parent results identified OBX contains a result which identifies the organism on which the susceptibility was run. This indirect linkage is preferred because the name of the organism in the parent result may undergo several preliminary values prior to finalization. In the case of a reflex order, if it is necessary to point to the specific result value for which it is in response, OBR-26 enables pointing to that specific OBX segment.

The third component may be used to record the name of the microorganism identified by the parent result directly. The organism in this case should be identified exactly as it is in the parent culture.

We emphasize that this field does not take the entire result field from the parent. It is meant only for the text name of the organism or chemical subspecies identified. This field is included only to provide a method for linking back to the parent result for those systems that could not generate unambiguous Observation IDs and sub-IDs.

This field is present only when the parent result is identified by OBR-29- Result Observation Identifieror OBR-54, Parent Order, and the parent spawns child orders or results for each of many results. (See Chapter 7 for more details about this linkage.)

A second mode of conveying this information is to use a standard observation result segment (OBX). If more than one organism is present, OBX-4-observation sub-ID is used to distinguish them. In this case, the first OBX with subID N will contain a value identifying the Nth microorganism, and each additional OBX with subID N will contain susceptibility values for a given antimicrobial test on this organism.

OBR-27: Quantity/Timing

(Definition from ORC.7 in Ch. 4)

Attention: The ORC-7 field was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7. The reader is referred to the TQ1 and TQ2 segments described in sections 4.5.4 and 4.5.5, respectively.

(Definition from OBR.27 in Ch. 4)

Attention: The OBR-27 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

(Definition from RXE.1 in Ch. 4A)

Attention: The RXE-1 field was retained for backward compatibilty only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

(Definition from RXG.3 in Ch. 4A)

Attention: The RXG-3 field was retained for backward compatibilty only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

Note: The contents of fields 3-8 should be identical to the comparable fields in the RXE (RXE-2 thru 5).


(Definition from OBR.27 in Ch. 7)

Attention: The OBR-27 element was retained for backward compatibility only as of v 2.5 and the detail was withdrawn and removed from the standard as of v 2.7.

OBR-28: Result Copies To

(Definition from OBR.28 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. Additional capabilities are now available through thePRT segment following the OBR using the "RCT" (Results Copy To) value in PRT-4 (Participation) from HL7 Table 912 - Participation in Chapter 2C, Code Tables, and referencing the appropriate participant information using other PRT Fields. The PRT segment is further described in Chapter 7 Section 7.3.4 "PRT – Participation Information Segment".

(Definition from OBR.28 in Ch. 7)

Definition: This field was retained for backward compatibility only as of v 2.7 and the detail was withdrawn and removed from the standard as of v 2.9. Additional capabilities are now available through thePRT segment following the OBR using the "RCT" (Results Copy To) value in PRT-4 (Participation) from HL7 Table 912 - Participation in Chapter 2C, Code Tables, and referencing the appropriate participant information using other PRT Fields. The PRT segment is further described in Chapter 7 Section 7.3.4 "PRT – Participation Information Segment".

OBR-29: Parent Results Observation Identifier (EIP) 00261

(Definition from OBR.29 in Ch. 4)

Definition: This field relates a child result to its parent result when a parent child result relationship exists. This field uniquely identifies the order number of the parent result; no other information is required to link the child result with its parent result.

(Definition from OBR.29 in Ch. 7)

Definition: This field relates a child result to its parent result when a parent child result relationship exists. This field uniquely identifies the order number of the parent result; no other information is required to link the child result with its parent result.

OBR-30: Transportation Mode (ID) 00262

(Definition from OBR.30 in Ch. 4)

Definition: This field identifies how (or whether) to transport a patient, when applicable. Refer to HL7 Table 0124 – Transportation Mode in Chapter 2C, Code Tables, for valid codes.

(Definition from OBR.30 in Ch. 7)

Definition: This field identifies how (or whether) to transport a patient, when applicable. Refer to HL7 Table 0124 – Transportation Mode in Chapter 2C, Code Tables, for valid codes.

OBR-31: Reason for Study (CWE) 00263

(Definition from OBR.31 in Ch. 4)

Definition: This field is the code or text using the conventions for coded fields given in the Control chapter (Chapter 2). This is required for some studies to obtain proper reimbursement.

Refer HL7 Table 0951 – Reason for Study in Chapter 2C, Code Tables.

(Definition from OBR.31 in Ch. 7)

Definition: This field is the code or text using the conventions for coded fields given in the Control chapter (Chapter 2). This is required for some studies to obtain proper reimbursement.

Refer HL7 Table 0951 – Reason for Study in Chapter 2C, Code Tables.

OBR-32: Principal Result Interpreter +

(Definition from OBR.32 in Ch. 4)

Definition: This field is retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9.. The reader is referred to the PRT segment described in Chapter 7.

(Definition from OBR.32 in Ch. 7)

Definition: This field is retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9.. The reader is referred to the PRT segment described in Chapter 7.

OBR-33: Assistant Result Interpreter +

(Definition from OBR.33 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9.. The reader is referred to the PRTsegment used relative to OBR as described in section 4.5.3.32, "Principal Result Interpreter."

(Definition from OBR.33 in Ch. 7)

Definition: This field was retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9.. The reader is referred to the PRTsegment used relative to OBR as described in section 4.5.3.32, "Principal Result Interpreter."

OBR-34: Technician +

(Definition from OBR.34 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRTsegment used relative to OBR as described in section 4.5.3.32, "Principal Result Interpreter."

(Definition from OBR.34 in Ch. 7)

Definition: This field was retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRTsegment used relative to OBR as described in section 4.5.3.32, "Principal Result Interpreter."

OBR-35: Transcriptionist +

(Definition from OBR.35 in Ch. 4)

Definition: This field was retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRTsegment used relative to OBR as described in section 4.5.3.32, "Principal Result Interpreter."

(Definition from OBR.35 in Ch. 7)

Definition: This field was retained for backward compatibility only as of v 2.6 and the detail was withdrawn and removed from the standard as of v 2.9. The reader is referred to the PRTsegment used relative to OBR as described in section 4.5.3.32, "Principal Result Interpreter."

OBR-36: Scheduled Date/Time + (DTM) 00268

(Definition from OBR.36 in Ch. 4)

Definition: This field is the date/time the filler scheduled an observation, when applicable (e.g., action code in OBR-11-specimen action code = "S"). This is a result of a request to schedule a particular test and provides a way to inform the placer of the date/time a study is scheduled (result only).

(Definition from OBR.36 in Ch. 7)

Definition: This field is the date/time the filler scheduled an observation, when applicable (e.g., action code in OBR-11-specimen action code = "S"). This is a result of a request to schedule a particular test and provides a way to inform the placer of the date/time a study is scheduled (result only).

OBR-37: Number of Sample Containers * (NM) 01028

(Definition from OBR.37 in Ch. 4)

Definition: This field identifies the number of containers for a given sample. For sample receipt verification purposes; may be different from the total number of samples which accompany the order.

(Definition from OBR.37 in Ch. 7)

Definition: This field identifies the number of containers for a given sample. For sample receipt verification purposes; may be different from the total number of samples which accompany the order.

OBR-38: Transport Logistics of Collected Sample * (CWE) 01029

(Definition from OBR.38 in Ch. 4)

Definition: This field is the means by which a sample reaches the diagnostic service provider. This information is to aid the lab in scheduling or interpretation of results. Possible answers: routine transport van, public postal service, etc. If coded, requires a user-defined table. Refer to Table 0614 - Transport Logistics of Collected Sample in Chapter 2C for valid values.

(Definition from OBR.38 in Ch. 7)

Definition: This field is the means by which a sample reaches the diagnostic service provider. This information is to aid the lab in scheduling or interpretation of results. Possible answers: routine transport van, public postal service, etc. If coded, requires a user-defined table. Refer to Table 0614 - Transport Logistics of Collected Sample in Chapter 2C for valid values.

OBR-39: Collector's Comment * (CWE) 01030

(Definition from OBR.39 in Ch. 4)

Definition: This field is for reporting additional comments related to the sample. If coded, requires a user-defined table. If only free text is reported, it is placed in the second component with a null in the first component, e.g., ^difficulty clotting after venipuncture and ecchymosis. Refer to Table 0619 - Collector's Comment in Chapter 2C for valid values.

(Definition from OBR.39 in Ch. 7)

Definition: This field is for reporting additional comments related to the sample. If coded, requires a user-defined table. If only free text is reported, it is placed in the second component with a null in the first component, e.g., ^difficulty clotting after venipuncture and ecchymosis. Refer to Table 0619 - Collector's Comment in Chapter 2C for valid values.

OBR-40: Transport Arrangement Responsibility (CWE) 01031

(Definition from OBR.40 in Ch. 4)

Definition: This field is an indicator of who is responsible for arranging transport to the planned diagnostic service. Examples: Requester, Provider, Patient. If coded, requires a user-defined table. Refer to Table 0620 - Transport Arrangement Responsibility in Chapter 2C for valid values.

(Definition from OBR.40 in Ch. 7)

Definition: This field is an indicator of who is responsible for arranging transport to the planned diagnostic service. Examples: Requester, Provider, Patient. If coded, requires a user-defined table. Refer to Table 0620 - Transport Arrangement Responsibility in Chapter 2C for valid values.

OBR-41: Transport Arranged (ID) 01032

(Definition from OBR.41 in Ch. 4)

Definition: This field is an indicator of whether transport arrangements are known to have been made. Refer to HL7 Table 0224 – Transport Arranged in Chapter 2C, Code Tables, for valid codes.

(Definition from OBR.41 in Ch. 7)

Definition: This field is an indicator of whether transport arrangements are known to have been made. Refer to HL7 Table 0224 – Transport Arranged in Chapter 2C, Code Tables, for valid codes.

OBR-42: Escort Required (ID) 01033

(Definition from OBR.42 in Ch. 4)

Definition: This field is an indicator that the patient needs to be escorted to the diagnostic service department. Note: The nature of the escort requirements should be stated in OBR-43-planned patient transport comment. See HL7 Table 0225 – Escort Required in Chapter 2C, Code Tables, for valid values.

(Definition from OBR.42 in Ch. 7)

Definition: This field is an indicator that the patient needs to be escorted to the diagnostic service department. Note: The nature of the escort requirements should be stated in OBR-43-planned patient transport comment. See HL7 Table 0225 – Escort Required in Chapter 2C, Code Tables, for valid values.

OBR-43: Planned Patient Transport Comment (CWE) 01034

(Definition from OBR.43 in Ch. 4)

Definition: This field is the code or free text comments on special requirements for the transport of the patient to the diagnostic service department. If coded, requires a user-defined table. Refer to Table 0621 - Planned Patient Transport Comment in Chapter 2C for valid values.

(Definition from OBR.43 in Ch. 7)

Definition: This field is the code or free text comments on special requirements for the transport of the patient to the diagnostic service department. If coded, requires a user-defined table. Refer to Table 0621 - Planned Patient Transport Comment in Chapter 2C for valid values.

OBR-44: Procedure Code (CNE) 00393

(Definition from OBR.44 in Ch. 4)

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to Externally-defined table 0088 – Procedure code in Chapter 2C, Code Tables, for suggested values. This field is a coded data type for compatibility with clinical and ancillary systems.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from FT1.25 in Ch. 6)

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to Externally-defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values. This field is a coded data type for compatibility with clinical and ancillary systems.

As of v 2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

Procedure Code Coding Systems (from HL7 Table 0396)

Code

Description

Comment / Source

C4

CPT-4

American Medical Association, P.O. Box 10946, Chicago IL 60610.

C5

CPT-5

(under development – same contact as above)

HCPCS

CMS (formerly HCFA) Common Procedure Coding System

HCPCS: contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

HPC

CMS (formerly HCFA )Procedure Codes (HCPCS)

Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

I10P

ICD-10 Procedure Codes

Procedure Coding System (ICD-10-PCS.) See http://www/hcfa.gov/stats/icd10.icd10.htm for more information.


(Definition from PR1.3 in Ch. 6)

Definition: This field contains a unique identifier assigned to the procedure. Refer to Externally-defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values. This field is a CNE data type for compatibility with clinical and ancillary systems.

(Definition from OBR.44 in Ch. 7)

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to Externally-defined table 0088 – Procedure code in Chapter 2C, Code Tables, for suggested values. This field is a coded data type for compatibility with clinical and ancillary systems.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from CDM.7 in Ch. 8)

Definition: This field contains the procedure code for procedure, if any, associated with this charge description. Repeating field allows for different procedure coding systems such as CPT4, ICD9. Coded entry made up of code plus coding schema. Refer to Externally-defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values.

(Definition from IIM.14 in Ch. 17)

Definition: This field contains a unique identifier assigned to the service item, if any, associated with the charge. In the United States this is often the HCPCS code. Refer to Externally Defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values. This field is a CNE data type for compatibility with clinical and ancillary systems.

As of v2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

Procedure Code Coding Systems

Coding System

Description

Comment

C4

CPT-4

American Medical Association, P.O. Box 10946, Chicago IL 60610.

C5

CPT-5

(under development – same contact as above)

HCPCS

CMS (formerly HCFA) Common Procedure Coding System

HCPCS: contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

HPC

CMS (formerly HCFA) Procedure Codes (HCPCS)

Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.


(Definition from ITM.27 in Ch. 17)

Definition: This field contains a unique identifier assigned to the service item, if any, associated with the charge. In the United States this is often the HCPCS code. Refer to Externally defined Table 0088 - Procedure code for suggested values. This field is a CNE data type for compatibility with clinical and ancillary systems. Refer to HL7 Table 0088 – Procedure Coding Systems in Chapter 2C, Code Tables, for valid values.

As of v2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

(Definition from SCD.32 in Ch. 17)

Definition: The unique identifier indicating the type of procedure performed on the patient with the supplies being sterilized.

Refer to HL7 Table 0088 – Procedure Code in Chapter 2C, Code Tables, for suggested values.

As of v2.6, the known applicable external coding systems include those in the referenced table. If the code set you are using is in this table, then you must use that designation.

OBR-45: Procedure Code Modifier (CNE) 01316

(Definition from OBR.45 in Ch. 4)

Definition: This field contains the procedure code modifier to the procedure code reported in OBR-44-procedure code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. In the USA, this is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally- defined table 0340 – Procedure code modifier in Chapter 2C, Code Tables, for suggested values.

Usage Rule: This field can only be used if OBR-44 – procedure code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from FT1.26 in Ch. 6)

Definition: This field contains the procedure code modifier to the procedure code reported in FT1-25 - Procedure Code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. This is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

Usage Rule: This field can only be used if FT1-25 - Procedure Code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.

As of v 2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

Procedure Code Modifier Coding Systems (From HL7 Table 0396)

Code

Description

Comment / Source

CPTM

CPT Modifier Code

Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

HPC

CMS (formerly HCFA )Procedure Codes (HCPCS)

Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

I10P

ICD-10 Procedure Codes

Procedure Coding System (ICD-10-PCS.) See http://www/hcfa.gov/stats/icd10.icd10.htm for more information.

I9C

ICD-9CM

Commission on Professional and Hospital Activities, 1968 Green Road, Ann Arbor, MI 48105 (includes all procedures and diagnostic tests).

ICD10AM

ICD-10 Australian modification

ICD10CA

ICD-10 Canada


(Definition from PR1.16 in Ch. 6)

Definition: This field contains the procedure code modifier to the procedure code reported in field 3, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

(Definition from OBR.45 in Ch. 7)

Definition: This field contains the procedure code modifier to the procedure code reported in OBR-44-procedure code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. In the USA, this is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally- defined table 0340 – Procedure code modifier in Chapter 2C, Code Tables, for suggested values.

Usage Rule: This field can only be used if OBR-44 – procedure code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from IIM.15 in Ch. 17)

Definition: This field contains the procedure code modifier to the procedure code reported in IIM-14 Procedure Code, when applicable. Procedure code modifiers are defined by USA regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. Refer to Externally defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

As of v2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

(Definition from ITM.28 in Ch. 17)

Definition: This field contains the procedure code modifier to the procedure code reported in ITM-27, Procedure Code, when applicable. Procedure code modifiers are defined by USA regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

OBR-46: Placer Supplemental Service Information (CWE) 01474

(Definition from OBR.46 in Ch. 4)

Definition: This field contains supplemental service information sent from the placer system to the filler system for the universal procedure code reported in OBR-4 Universal Service ID. This field will be used to provide ordering information detail that is not available in other specific fields in the OBR segment. Multiple supplemental service information elements may be reported. Refer to User-defined Table 0411 - Supplemental service information values in Chapter 2C, Code Tables.

This field can be used to describe details such as whether study is to be done on the right or left, for example, where the study is of the arm and the order master file does not distinguish right from left, or whether the study is to be done with or without contrast (when the order master file does not make such distinctions).

(Definition from OBR.46 in Ch. 7)

Definition: This field contains supplemental service information sent from the placer system to the filler system for the universal procedure code reported in OBR-4 Universal Service ID. This field will be used to provide ordering information detail that is not available in other specific fields in the OBR segment. Multiple supplemental service information elements may be reported. Refer to User-defined Table 0411 - Supplemental service information values in Chapter 2C, Code Tables.

This field can be used to describe details such as whether study is to be done on the right or left, for example, where the study is of the arm and the order master file does not distinguish right from left, or whether the study is to be done with or without contrast (when the order master file does not make such distinctions).

(Definition from AIS.11 in Ch. 10)

Definition: This field contains supplemental service and/or logistical information sent from the placer system to the filler system for the universal procedure code reported in field AIS-3. This field will be used to provide scheduling information detail that is not available in other, specific fields in the AIS segment. Multiple supplemental service information elements may be reported. Refer to User-defined Table 0411 – Supplemental Service Information Values in Chapter 2C, Code Tables, for valid values.

OBR-47: Filler Supplemental Service Information (CWE) 01475

(Definition from OBR.47 in Ch. 4)

Definition: This field contains supplemental service information sent from the filler system to the placer system for the procedure code reported in OBR-4 Universal Service ID. This field will be used to report ordering information detail that is not available in other specific fields in the OBR segment. Typically it will reflect the same information as was sent to the filler system in OBR-46-Placer supplemental service information unless the order was modified, in which case the filler system will report what was actually performed using this field. Multiple supplemental service information elements may be reported. Refer to User-Defined Table 0411 - Supplemental Service Information Values in Chapter 2C, Code Tables.

This field can be used to describe details such as whether study is to be done on the right or left, for example, where the study is of the arm and the order master file does not distinguish right from left, or whether the study is to be done with or without contrast (when the order master file does not make such distinctions).

(Definition from OBR.47 in Ch. 7)

Definition: This field contains supplemental service information sent from the filler system to the placer system for the procedure code reported in OBR-4 Universal Service ID. This field will be used to report ordering information detail that is not available in other specific fields in the OBR segment. Typically it will reflect the same information as was sent to the filler system in OBR-46-Placer supplemental service information unless the order was modified, in which case the filler system will report what was actually performed using this field. Multiple supplemental service information elements may be reported. Refer to User-Defined Table 0411 - Supplemental Service Information Values in Chapter 2C, Code Tables.

This field can be used to describe details such as whether study is to be done on the right or left, for example, where the study is of the arm and the order master file does not distinguish right from left, or whether the study is to be done with or without contrast (when the order master file does not make such distinctions).

(Definition from AIS.12 in Ch. 10)

Definition: This field contains supplemental service and/or logistical information sent from the filler system to the placer system for the procedure code reported in field AIS-3. This field will be used to report scheduling information details that is not available in other, specific fields in the AIS segment. Typically it will reflect the same information as was sent to the filler system in AIS-11-Placer Supplemental information unless the scheduling was modified in which case the filler system will report what was actually performed using this field. Multiple supplemental service information elements may be reported. Refer to User-defined Table 0411 - Supplemental service information values in Chapter 2C, Code Tables, for valid values..

OBR-48: Medically Necessary Duplicate Procedure Reason (CWE) 01646

(Definition from OBR.48 in Ch. 4)

Definition: This field is used to document why the procedure found in OBR-44 - Procedure Code is a duplicate of one ordered/charged previously for the same patient within the same date of service and has been determined to be medically necessary. The reason may be coded or it may be a free text entry.

This field is intended to provide financial systems information on who to bill for duplicate procedures.

Refer to User-Defined Table 0476 – Medically Necessary Duplicate Procedure Reason in Chapter 2C, Code Tables, for suggested values.

(Definition from FT1.28 in Ch. 6)

Definition: This field is used to document why the procedure found in FT1-25 - Procedure Code is a duplicate of one ordered/charged previously for the same patient within the same date of service and has been determined to be medically necessary. The reason may be coded or it may be a free text entry. This field is intended to provide financial systems information on who to bill for duplicate procedures. Refer to User-Defined Table 0476 – Medically Necessary Duplicate Procedure Reason in Chapter 2C, Code Tables, for suggested values.

(Definition from OBR.48 in Ch. 7)

Definition: This field is used to document why the procedure found in OBR-44 - Procedure Code is a duplicate of one ordered/charged previously for the same patient within the same date of service and has been determined to be medically necessary. The reason may be coded or it may be a free text entry.

This field is intended to provide financial systems information on who to bill for duplicate procedures.

Refer to User-Defined Table 0476 – Medically Necessary Duplicate Procedure Reason in Chapter 2C, Code Tables, for suggested values.

OBR-49: Result Handling (CWE) 01647

(Definition from OBR.49 in Ch. 4)

Definition: Transmits information regarding the handling of the result. For example, an order may specify that the result (e.g., an x-ray film) should be given to the patient for return to the requestor. Refer to HL7 Table 0507 - Observation Result Handling in Chapter 2C, Code Tables, for values. If this field is not populated or if it includes value "CC^Copies Requested", then routine handling is implied and PRT segments assocatied with this OBR with PRT-4 value of "RCT^Result Copies To" identify additional recipients for the results. When this field includes the value "BCC^Blind Copy", those PRT segments, which are included in the order message and in the observation result message sent to the requestor, shall not be included in the observation result messages sent to the copied recipients.

(Definition from OBR.49 in Ch. 7)

Definition: Transmits information regarding the handling of the result. For example, an order may specify that the result (e.g., an x-ray film) should be given to the patient for return to the requestor. Refer to HL7 Table 0507 - Observation Result Handling in Chapter 2C, Code Tables, for values. If this field is not populated or if it includes value "CC^Copies Requested", then routine handling is implied and PRT segments assocatied with this OBR with PRT-4 value of "RCT^Result Copies To" identify additional recipients for the results. When this field includes the value "BCC^Blind Copy", those PRT segments, which are included in the order message and in the observation result message sent to the requestor, shall not be included in the observation result messages sent to the copied recipients.

OBR-50: Parent Universal Service Identifier

(Definition from OBR.50 in Ch. 4)

Definition: This field is retained for backward compatibility only as of v 2.7 and withdrawn as of v2.9.

(Definition from OBR.50 in Ch. 7)

Definition: This field is retained for backward compatibility only as of v 2.7 and withdrawn as of v2.9.

OBR-51: Observation Group ID (EI) 02307

(Definition from OBR.51 in Ch. 4)

Definition: The Observation Group ID is the identifier assigned by the producer of a result to uniquely identify the results associated with this OBR segment. The Observation Group ID is intended to remain the same regardless of the change in status to the result (i.e., it is not a snapshot ID). This field is intended to promote forward compatibility with HL7 V3.

(Definition from OBR.51 in Ch. 7)

Definition: The Observation Group ID is the identifier assigned by the producer of a result to uniquely identify the results associated with this OBR segment. The Observation Group ID is intended to remain the same regardless of the change in status to the result (i.e., it is not a snapshot ID). This field is intended to promote forward compatibility with HL7 V3.

OBR-52: Parent Observation Group ID (EI) 02308

(Definition from OBR.52 in Ch. 4)

Definition: The Parent Observation Group ID field relates this child OBR to its parent OBR segment using the Observation Group ID of the parent result.

(Definition from OBR.52 in Ch. 7)

Definition: The Parent Observation Group ID field relates this child OBR to its parent OBR segment using the Observation Group ID of the parent result.

OBR-53: Alternate Placer Order Number (CX) 03303

(Definition from OBR.53 in Ch. 4)

Definition: This field enables a shorter number to be communicated that is unique within other identifiers.

(Definition from OBR.53 in Ch. 7)

Definition: This field enables a shorter number to be communicated that is unique within other identifiers.

OBR-54: Parent Order (EIP) 00222

(Definition from ORC.8 in Ch. 4)

Definition: This field relates a child order to its parent order when a parent child order relationship exists. The parent child order mechanism is described in HL7 Table 0119 under order control code PA. This field uniquely identifies the parent order; no other information is required to link the child order with its parent order. It can be used to link the order to the results that triggered this order (e.g., a reflex order) or other order it relates to as an occurrence. This field repeats to allow linking to more than one parent, if necessary.

The first component has the same format as ORC-2-Placer Order Number (Section 4.5.3.2, "Placer Order Number (EI) 00216"). The second component has the same format as ORC-3-Filler Order Number (Section 4.5.3.3, "Filler Order Number (EI) 00217"). The components of the placer order number and the filler order number are transmitted in sub-components of the two components of this field.

Note that ORC-8 – Parent Order is equivalent to OBR-54 – Parent Order, but neither one is the same as OBR-29 – Result Observation Identifier.

Condition: Where the message has matching ORC/OBR pairs, ORC-8 and OBR-54 Must carry the same value.

(Definition from OBR.54 in Ch. 4)

Definition: This field relates a child order to its parent order when a parent child order relationship exists. The parent child order mechanism is described in HL7 Table 0119 – Order Control Codes in Chapter 2C, Code Tables, under order control code PA. This field uniquely identifies the parent orders; no other information is required to link the child order with its parent orders. It can be used to express that this order is a reflex being a consequence of original results referred here.

The first component has the same format as ORC-2-placer order number (Section 4.5.3.2, "Placer Order Number (EI) 00216"). The second component has the same format as ORC-3-filler order number (Section 4.5.3.3, "Filler Order Number (EI) 00217"). The components of the placer order number and the filler order number are transmitted in sub-components of the two components of this field.

Note that ORC-8 – Parent Order is equivalent to OBR-54-Parent Order, but neither one is the same as OBR-29-Parent Result Obersvation Identifier .

Condition: Where the message has matching ORC/OBR pairs, ORC-8 and OBR-54 must carry the same value.

(Definition from OBR.54 in Ch. 7)

Definition: This field relates a child order to its parent order when a parent child order relationship exists. The parent child order mechanism is described in HL7 Table 0119 – Order Control Codes in Chapter 2C, Code Tables, under order control code PA. This field uniquely identifies the parent orders; no other information is required to link the child order with its parent orders. It can be used to express that this order is a reflex being a consequence of original results referred here.

The first component has the same format as ORC-2-placer order number (Section 4.5.3.2, "Placer Order Number (EI) 00216"). The second component has the same format as ORC-3-filler order number (Section 4.5.3.3, "Filler Order Number (EI) 00217"). The components of the placer order number and the filler order number are transmitted in sub-components of the two components of this field.

Note that ORC-8 – Parent Order is equivalent to OBR-54-Parent Order, but neither one is the same as OBR-29-Parent Result Obersvation Identifier .

Condition: Where the message has matching ORC/OBR pairs, ORC-8 and OBR-54 must carry the same value.

OBR-55: Action Code (ID) 00816

(Definition from OH1.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OH2.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OH3.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OH4.2 in Ch. 3)

Definition: This field contains a code defining the action to be taken for this segment. It allows this segment to be sent to delete or update, for example, previously sent information. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from ORC.35 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when either ORC-2 and/or ORC 3 is valued with a unique identifier in accordance with Chapter 2, Section 2.10.4.2.

(Definition from OBR.55 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when either an OBR-2 and/or OBR-3 is valued with unique identifier in accordance with Chapter 2, Section 2.10.4.2.

(Definition from IPC.10 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when the combination of IPC-1, IPC-2, IPC-3, and IPC-4 represents a unique identifier according to Chapter 2, Section 2.10.4.2.

(Definition from BPX.22 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an BPX is uniquely identified sufficiently within the specific implementation using BPX-17 or BPX-6 as agreed to by the trading partners and in accordance with Chapter 2, Section 2.10.4.2.

(Definition from BTX.21 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an BTX is uniquely identified sufficiently within the specific implementation using BTX-20 or BTX-3 as agreed to by the trading partners in accordance with Chapter 2, Section 2.10.4.2.

(Definition from DON.34 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an DON is uniquely identified sufficiently within the specific implementation using DON-1 in accordance with Chapter 2, Section 2.10.4.2.

(Definition from BUI.13 in Ch. 4)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an BUI is uniquely identified sufficiently within the specific implementation using BUI-2 in accordance with Chapter 2, Section 2.10.4.2

(Definition from RXV.22 in Ch. 4A)

Definition: The intended handling by the receiver of the infusion order is represented by this segment. Refer to HL7 Table 0206 – Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from CDO.2 in Ch. 4A)

Definition: The Action Code indicates whether the cumulative dosage segment is intended to be added, deleted, updated, or did not change. If the field is not valued in any CDO segments for the order, the segments are considered to have been sent in snapshot mode. If some but not all CDO segments for the order do not have the action code valued, the default value is Add. Refer to HL7 Table 0206 - Segment Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from OBR.55 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an either OBR-2 and/or OBR-3 is valued with unique identifier in accordance with Chapter 2, Section 2.10.4.2.

(Definition from OBX.31 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an OBX-21 is valued in accordance with guidance in Chapter 2, Section 2.10.4.2.

(Definition from SPM.35 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when an SPM-2 or SPM-31 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from PRT.2 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0287 – Problem/goal action code for valid values.

(Definition from CSR.17 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when CSR-1 and CSR-4, or CSR-2 and CSR-5 are valued as agreed to by the trading partners in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from CTI.4 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when CTI-1 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from SHP.12 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when SHP-1 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from PAC.9 in Ch. 7)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0206 - Segment Action Code for valid values.

The action code can only be used when PAC-2 is valued in accordance with the guidance in Chapter 2, Section 2.10.4.2.

(Definition from GOL.1 in Ch. 12)

Definition: The action code field gives the intent of the problem or goal. Refer to HL7 Table 0287 – Problem/Goal Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from PRB.1 in Ch. 12)

Definition: This field contains the intent of the message. Refer to HL7 Table 0287 – Problem/Goal Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from PTH.1 in Ch. 12)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0287 – Problem/Goal Action Code in Chapter 2C, Code Tables, for valid values.

(Definition from DEV.1 in Ch. 17)

Definition: This field reveals the intent of the message. Refer to HL7 Table 0287 – Problem/goal action code for valid values.

TQ1 - Timing/Quantity Segment

The TQ1 segment is used to specify the complex timing of events and actions such as those that occur in order management and scheduling systems. This segment determines the quantity, frequency, priority and timing of a service. By allowing the segment to repeat, it is possible to have service requests that vary the quantity, frequency and priority of a service request over time.

Use cases showing when TQ1 may need to repeat:

  1. Cardiac enzymes STAT and then q 4 hours.

  2. Streptokinase studies, draw 1st Stat and run Stat, then draw q 4 hours and run Stat.

  3. Gentamicin 100mg Now and 80mg q12h second dose (First 80mg dose) given exactly 12 hours after the 100mg dose. (Might be 2 service requests.)

  4. Activase 15mg bolus Stat then 50mg over 30 minutes, then 35mg over the next 60 minutes. (Might be 2 service requests.)

  5. Imodium 4mg (2 caps) po initially, then 2mg (1cap) after each unformed stool to a maximum of 16 mg per day. (Might be 2 service requests.)

  6. Zithromax 500mg (2tabs) po on the first day then 250mg (1tab) po qd for 5 days. (Might be 2 service requests.)

  7. Zyban (Bupropion) Start 150mg po qam x 3 days, then increase to 150mg po bid for 7 to 12 weeks.

  8. Colchicine 1mg (2 tabs) po now then 1 tablet q1 to 2 hours until pain relief or undesirable side effects (Diarrhea, GI upset). (Might be 2 service requests.)

  9. doxycylcine 100mg po bid on the first day then 100mg po qd.

  10. scopolamine, xxx mg, 1 hour before surgery. Relative time = -1^hour, priority = P (preop), or alternately repeat pattern = P1H^Preop, 1 Hour before Surgery^99LocalCode, Relative time would be empty and priority would be P (preop).

HL7 Attribute Table - TQ1 - Timing/Quantity Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
TQ1
1 01627 Set ID - TQ1 [0..1] [1..4] SI
2 01628 Quantity [0..1] CQ
3 01629 Repeat Pattern [0..*] RPT
4 01630 Explicit Time [0..*] TM
5 01631 Relative Time and Units [0..*] CQ
6 01632 Service Duration [0..1] CQ
7 01633 Start date/time [0..1] DTM
8 01634 End date/time [0..1] DTM
9 01635 Priority [0..*] CWE
10 01636 Condition text = [0..1] 250 TX
11 01637 Text instruction = [0..1] 250 TX
12

01638 Conjunction MAY
True:
False:
C
[1..1]
[0..1]
[1..1] ID
13 01639 Occurrence duration [0..1] CQ
14 01640 Total occurrences = [0..1] 10 NM

TQ1-1: Set ID - TQ1 (SI) 01627

Definition: For the first timing specification transmitted, the sequence number shall be 1; for the second timing specification, it shall be 2; and so on.

TQ1-2: Quantity (CQ) 01628

Definition: This field specifies the numeric quantity of the service that should be provided at each service interval. For example, if two blood cultures are to be obtained every 4 hours, the quantity would be '2', or if three units of blood are to be typed and cross-matched, the quantity would be '3'. The default value for this field is '1'.

If multiple identical services are to be requested, it is strongly recommended that multiple service requests be placed, giving each service request its own unique placer/filler number.

TQ1-3: Repeat Pattern (RPT) 01629

Definition: The repeating frequency with which the treatment is to be administered. It is similar to the frequency and SIG code tables used in order entry systems.

This field may be repeated to build up more complex repeat patterns. For example, daily at bedtime can be represent as "|QD~HS|".

When the quantity timing specification must change to a different repeat pattern after some period of time, a new TQ1 segment must be used to show the new repeat pattern. Note that the end date of the current TQ1 will show when the current timing specification ends, and the start date of the next TQ1 shows when the new timing specification begins. The Conjunction field, TQ1-12 determines if the next TQ1 segment is to be performed sequentially or in parallel.

TQ1-4: Explicit Time (TM) 01630

Definition: This field explicitly lists the actual times referenced by the code in TQ1-3. This field will be used to clarify the TQ1-3 in cases where the actual administration times vary within an institution. If the time of the service request spans more than a single day, this field is only practical if the same times of administration occur for each day of the service request. If the actual start time of the service request (as given by TQ1-7) is after the first explicit time, the first administration is taken to be the first explicit time after the start time. In the case where the patient moves to a location having a different set of explicit times, the existing service request may be updated with a new quantity/timing segment showing the changed explicit times.

Usage Note: This field is not valued if a Repeat Pattern is not present.

TQ1-5: Relative Time and Units (CQ) 01631

Definition: This field is used to define the interval between schedules for service request or bottle records. If this field contains a value, it overrides any value in the explicit time interval field. The units component of the CQ data type is constrained to units of time.

Examples:

TQ1|1|1|Q1H||60^min&&ANS+ - Q1H is defined with an interval between services of 60 minutes

TQ1|1|1|Q6H||6^hr&&ANS+ - Q6H is defined with an interval between services of 6 hours

TQ1|1|1|QD||1^d&&ANS+ - QD is defined with an interval between services of 1 day

TQ1-6: Service Duration (CQ) 01632

Definition: This field contains the duration for which the service is requested.

The quantity component of this field must be a positive, non-zero number. The unit's portion of this field is constrained to units of time.

Example: Whirlpool twenty minutes three times per day for 3 days. Three days is the service duration.

TQ1|1||TID|||3^d&&ANS+||||||20^min&&ANS+|9<cr>

TQ1-7: Start date/time (DTM) 01633

Definition: This field may be specified by the requester, in which case it indicates the earliest date/time at which the services should be started. In many cases, however, the start date/time will be implied or will be defined by other fields in the service request record (e.g., urgency - STAT). In such a case, this field will be empty.

The filling service will often record a value in this field after receipt of the service request, however, and compute an end time on the basis of the start date/time for the filling service's internal use.

TQ1-8: End date/time (DTM) 01634

Definition: When filled in by the requester of the service, this field should contain the latest date/time that the service should be performed. If it has not been performed by the specified time, it should not be performed at all. The requester may not always fill in this value, yet the filling service may fill it in on the basis of the instruction it receives and the actual start time.

Regardless of the value of the end date/time, the service should be stopped at the earliest of the date/times specified by either the duration or the end date/time.

TQ1-9: Priority (CWE) 01635

Definition: This field describes the urgency of the request. If this field is blank, the default is R. Refer to User-Defined Table 0485 – Extended Priority Codes in Chapter 2C, Code Tables, for suggested values.

TQ1-10: Condition text (TX) 01636

Definition: This is a free text field that describes the conditions under which the drug is to be given. For example, "PRN pain," or "to keep blood pressure below 110."

The presence of text in this field should be taken to mean that human review is needed to determine the how and/or when this drug should be given.

For complex codified conditions see the TQ2 segment below.

TQ1-11: Text instruction (TX) 01637

Definition: This field is a full text version of the instruction (optional).

TQ1-12: Conjunction (ID) 01638

Definition: This field indicates that a second TQ1 segment is to follow. Refer To HL7 Table 0472 – TQ Conjunction ID in Chapter 2C, Code Tables, for allowed values.

For continuous or periodic services, the point at which the service is actually stopped is determined by the field TQ1-8 end date/time and TQ1-6 duration, whichever indicates an earlier stopping time. Ordinarily, only one of these fields would be present.

Condition Rule: If the TQ1 segment is repeated in the message, this field must be populated with the appropriate Conjunction code indicating the sequencing of the following TQ1 segment.

TQ1-13: Occurrence duration (CQ) 01639

Definition: This field contains the duration for which a single performance of a service is requested. The quantity component of this field must be a positive, non-zero number when populated. The units component is constrained to be units of time.

Example: Whirlpool twenty minutes three times per day for three days. Twenty minutes is the occurrence duration.

TQ1|1||TID|||3^d&&ANS+||||||20^min&&ANS+|9<cr>

TQ1-14: Total occurrences (NM) 01640

Definition: This field contains the total number of occurrences of a service that should result from this service request. If both the end date/time (TQ1-8) and the total occurrences are valued and the occurrences would extend beyond the end date/time, then the end date/time takes precedence. Otherwise the number of occurrences takes precedence.

Example: Whirlpool twenty minutes three times per day for three days. The total occurrences would be 9.

TQ1|1||TID|||3^d&&ANS+||||||20^min&&ANS+|9<cr>

TQ2 - Timing/Quantity Relationship Segment

The TQ2 segment is used to form a relationship between the service request the TQ1/TQ2 segments are associated with, and other service requests. The TQ2 segment will link the current service request with one or more other service requests.

There are many situations, such as the creation of a service request for a group of intravenous (IV) solutions, where the sequence of the individual intravenous solutions (each a service in itself) needs to be specified, e.g., hyperalimentation with multi-vitamins in every third bottle.

There are other situations where part of the service request's instructions contains a results condition of some type, such as "PRN pain." There is currently a free text "condition" field of TQ1-10 - Condition text which allows any condition to be specified. However, to support a fully encoded version of service request sequencing, or results condition, the TQ2, Timing/Quantity Relationship segment has been defined.

HL7 Attribute Table - TQ2 - Timing/Quantity Relationship Segment