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Virtual Medical Record for Clinical Decision Support panel HL7.VMR-CDS https://s.details.loinc.org/LOINC/74028-2.html?sections=ComprehensiveThis appendix make use of aspects from "HL7 Version 2 Implementation Guide: Implementing the

Table of Contents

A9.1 Introduction

The HL7v2 Virtual Medical Record (VMR) is a way to implement a structured information atomically in a series of HL7 OBX segments following a template methodology.

It is based upon the HL7 Publication "HL7 Version 2 Implementation Guide: Implementing the Virtual Medical Record for Clinical Decision Support (vMR-CDS), Release 1 " (you may need an account with HL7 International to download).

...

Suggested

OBX-5 Observation value

or

Value Set or Constraint

...

Refer to that document for a deeper understanding and discussion of the methodology. This appendix will simply provide a prescription for its implementation in a simple way.

The HL7v2 Virtual Medical Record is also defined by the LOINC as "Virtual Medical Record for Clinical Decision Support panel HL7.VMR-CDS" (74028-2). The panel definition can be viewed at the following URL: https://s.details.loinc.org/LOINC/74028-2.html?sections=Comprehensive

A9.2 Implementing the HL7v2 Virtual Medical Record with OBX segments

A9.2.1 Specifying the HL7v2 VMR is in use.

When using the HL7v2 VMR a header OBX must be present which indicates that a report template is in use. In the header, OBX-3 field must have the value "74028-2^Report template ID^LN", and the template that is in use OBX-5 must, and also specify an OBX-4 sub-ID which must be a dotted decimal value (for simplicity "1" has been specified as the root sub ID). This header OBX must have a OBX-2 Datatype field value of "RP" (See 3.20 RP - Reference Pointer). OBX-5 must be valued as "HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream".

Subsequently all other OBX segments present that form part of the HL7.VMR must have dotted sub id based on this OBX-4 sub-ID this header OBX.

Therefore as an example, the first OBX is static and must be as follows:

Code Block
OBX\|1\|RP\|74028-2^Report template ID^LN\|1\|HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream\|\|\|\|\|\|F

A9.2.2 Implementing each element of the HL7v2 VMR

The HL7v2 VMR OBX implementation table below defines the elements of the VMR and provides values that must be used in various OBX fields as indicated by the column headings.

Each VMR element must be implemented as an OBX, the values of which will be discussed following the table.

When the row in the table has a VMR Datatype column of ENTRY, SECTION, STRUCTURAL, COLLECTION then the prescribed values in the table must be used.

Technically, OBX for VMR Data SECTIOHTTPAccessControlAllowOriginManagerN, STRUCTURAL and COLLECTION are optional as the structure is implied by the dotted decimal structured OBX-4 Observation sub-ID. However, including these OBX segments can be useful to viewers of the atomic data but non-essential for computed interpretation of the actual content.

A9.2.2.1 HL7v2 VMR OBX implementation table

Refer to the legend table that follows after this table which explains the colours used. The colours are redundant and are indicative of certain values in the VMR Datatype column.

Anchor
A9.T.1
A9.T.1
A9.T.1 HL7v2 VMR OBX implementation table

Chief Complaint

_{Section Heading or Element}	_{OBX-2 DataType}	_{OBX-3 Value}	_{OBX-4 Observation sub-ID}	_Suggested _{OBX-5 Observation value} _or _{Value Set or Constraint}	_{OBX-14 Date/time of the observation is valued} _{(Y=Yes, N=No)}	_OCCURENCES	_{VMR DATATYPE}
_{Report template ID}	_RP		₁	_{HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream}		₁	_ENTRY
_{History of Presenting Complaint}	_CWE	_73983-9^^LN	_1.1	_{34046-3^History of Presenting Complaint^LN}		_0..1	_SECTION
_{Chief Complaint}	_CWE	_{10154-3^Chief Complaint^LN}	_1.1.1	_{Constraint (Child of Snomed-CT term 404684003 \| Clinical finding (finding))}		_0..1	_CODEDVALUE
_{Date of Onset}	_TS	_{11368-8^Date of Onset^LN}	_1.1.2			_0..1	_DATETIME
_Notes	_FT	_{8251-1^Notes^LN}	_1.1.3			_0..1	_STRING
_{History of Past Illness}	_CWE	_73983-9^^LN	_1.2	_{11348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT}		_0..1	_SECTION
_{Past Illness^†}	_-		_{1.2.1.RepeatOf[CLUSTER -- Past Illness]}			_0..*	_STRUCTURAL
_{Past Illness}	_CWE	_{11349-8^Past Illness^LN}	_{1.2.1.RepeatOf[CLUSTER -- Past Illness].1}	_{Constraint (Child of Snomed-CT term 404684003 \| Clinical finding (finding))}		_0..1	_CODEDVALUE
_{Temporal Context}	_CWE	_{408731000^Temporal Context^SCT}	_{1.2.1.RepeatOf[CLUSTER -- Past Illness].2}	_{Value Set (} _{15240007^Current^SCT} _{410511007^Current or past^SCT} _{410587003^Past - specified^SCT} _{410588008^Past - unspecified^SCT} _{410589000^All times past^SCT} _{6493001^Recent^SCT} ₎ _{If the temporal context is unspecified, then 410511007^Current or past^SCT is the assumed value.}		_0..1	_CODEDVALUE
_{Illness Dates}	_DR	_{11368-8^Illness Dates^LN}	_{1.2.1.RepeatOf[CLUSTER -- Past Illness].3}			_0..1	_DATERANGE
_{Notes on Illness}	_FT	_{8251-1^Notes on Illness^LN}	_{1.2.1.RepeatOf[CLUSTER -- Past Illness].4}			_0..1	_STRING
_Procedures	_CWE	_73983-9^^LN	_1.3	_{47519-4^^LN^416940007}		_0..1	_SECTION
_{Procedure^†}	_-	_{71388002^Procedure^SCT}	_{1.3.1.RepeatOf[CLUSTER -- Procedure]}			_0..*	_STRUCTURAL
_{Procedure Performed}	_CWE	_{29300-1^Procedure Performed^LN}	_{1.3.1.RepeatOf[CLUSTER -- Procedure].1}	_{Constraint (Child of Snomed-CT term 71388002 \| Procedure (procedure) \|)}	_Y	_0..1	_CODEDVALUE
_{Notes on Procedure}	_FT	_{8251-1^Notes on Procedure^LN}	_{1.3.1.RepeatOf[CLUSTER -- Procedure].2}			_0..1	_STRING
_{Family History}	_CWE	_73983-9^^LN	_1.4	_{10157-6^Family History^LN}		_0..1	_SECTION
_{Patients Family Tree ID}	_ST	_{74027-4^Patients Family Tree ID^LN}	_1.4.1			_0..1	_STRING
_{Natural Father ID}	_ST	_{74026-6^Natural Father ID^LN}	_1.4.2			_0..1	_STRING
_{Natural Mother ID}	_ST	_{74025-8^Natural Mother ID^LN}	_1.4.3			_0..1	_STRING
_Relatives	_CWE	_73983-9^^LN	_1.4.4	_{224086007^Relatives^SCT}		_0..1	_SECTION
_Relative^†	_-		_{1.4.4.1.RepeatOf[CLUSTER -- Relative]}			_0..*	_STRUCTURAL
_{Relative Name}	_ST	_{54138-3^Relative Name^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].1}			_0..1	_STRING
_Relationship	_CWE	_{44767-2^Relationship^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].2}	_{Constraint (HL7 v3 FamilyMember Value set = Child of Role Code _PersonalRelationshipRoleType FAMMEMB)} _{Use "ROLECODE" for Name of Coding System component of CWE} _{See Table HL7 v3 FamilyMember Value set below}		_0..1	_CODEDVALUE
_{Relative ID}	_ST	_{74024-1^Relative ID^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].3}			_0..1	_STRING
_{Natural Father ID}	_ST	_{74026-6^Natural Father ID^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].4}			_0..1	_STRING
_{Natural Mother ID}	_ST	_{74025-8^Natural Mother ID^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].5}			_0..1	_STRING
_{deceasedEstimatedAge}	_ST	_{39016-1^Deceased Estimated Age^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].6}			_0..1	_REAL
_{LivingEstimatedAge}	_ST	_{21612-7^Living Estimated Age^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].7}			_0..1	_REAL
_{Clinical Genomic Choice}	_CWE	_73983-9^^LN	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice]}			_0..*	_COLLECTION
_{Clinical Observation}	_CWE	_{74023-3^Clinical Observation^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].1}			_1..1	_CODEDVALUE
_{Negation Indicator}	_CWE	_{74022-5^Negation Indicator^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].2}	_{Value Set (} _{31874001^True^SCT} _{64100000^False^SCT} _{64957009^Uncertain^SCT} ₎		_0..1

SECTIONLN

_BOOLEAN
_{Cause of Death}	_CWE

10154-3Chief Complaint

_{74044-9^Cause of Death^LN}

_1.4.

1.1Constraint (Child of Snomed-CT term 404684003 | Clinical finding (finding))

_{4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].3}

_{Value Set (}

_{31874001^True^SCT}

_{64100000^False^SCT}

_{64957009^Uncertain^SCT}

₎

_0..1

CODEDVALUEDate of OnsetTS11368-8Date of OnsetLN1.1.2

	_BOOLEAN
_{DataEstimatedAge}	_ST	_{21611-9^Data Estimated Age^LN}	_{1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].4}			_0..1

DATETIME

_REAL

Notes

_{Genetic Loci}

FT1.1.3

_ST

8251-1NotesLN

_{48018-6^Genetic Loci^LN}

_{1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].5.RepeatOf[ELEMENT -- Genetic Loci]}

_0..

1

_*

_STRING

History of Past Illness

_{Genetic Risks}

_CWE

_73983-9

LN

_^^LN

_1.4.

211348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT

₅

_{106221001^Genetic Risks^SCT}

_0..1

_SECTION

Past Illness

_{Pedigree Analysis Results ^†}

_-

_{47708004^Pedigree Analysis Results^SCT}

_1.

2.1.RepeatOf[CLUSTER -- Past Illness] 0..*STRUCTURALPast IllnessCWE11349-8Past IllnessLN1.2.

_{4.5.1.RepeatOf[CLUSTER --}

Past Illness].1Constraint (Child of Snomed-CT term 404684003 | Clinical finding (finding))

_{Pedigree Analysis Results]}

_0..

1Temporal Context

_*

CODEDVALUESCT

_STRUCTURAL
_{Genetic Disease Assessed}	_CWE

408731000Temporal Context

_{51967-8^Genetic Disease Assessed^LN}

_1.4.

2

_{5.1.RepeatOf[CLUSTER --}

Past Illness].2

Value Set (

15240007^Current^SCT

410511007^Current or past^SCT

410587003^Past - specified^SCT

410588008^Past - unspecified^SCT

410589000^All times past^SCT

6493001^Recent^SCT

)

If this field is unvalued, then 410511007^Current or past^SCT is the assumed value.

_{Pedigree Analysis Results].1}

_0..1

_CODEDVALUE

Illness Dates

_{Input Parameters}

DRLN

_CWE

11368-8Illness Dates

_73983-9^^LN

_1.4.

2

_{5.1.RepeatOf[CLUSTER --}

Past Illness

_{Pedigree Analysis Results].}

3 1.2

₂

_{73983-9^Input Parameters^LN}

_0..1

DATERANGENotes on IllnessFT8251-1Notes on IllnessLN

_SECTION
_{Genetic Algorithm Used}	_CWE	_{74021-7^Genetic Algorithm Used^LN}	_{1.4.5.1.RepeatOf[CLUSTER --}

Past Illness].4

_{Pedigree Analysis Results].2.1}

_0..1

STRING

_CODEDVALUE

Procedures

_Sensitivity

CWE

_NM

73983

_74020-9

LN1.347519-4^^LN^416940007Procedure^†- 1.3

_{^Sensitivity^LN}

_{1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.2}

_0..1

_{PHYSICALQUANTITY}

SECTION

_{Probability of Disease}

_ST

_{74019-1^Probability of Disease^LN}

_{1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].3.RepeatOf[ELEMENT --}

Procedure

_{Probability of Disease]}

_0..*

STRUCTURAL

_REAL

Procedure PerformedLN

_{Pregnancy History}

_CWE

29300-1Procedure Performed

_73983-9^^LN

_1.

3.1.RepeatOf[CLUSTER -- Procedure].1Constraint (Child of Snomed-CT term 71388002 | Procedure (procedure) |)Y

₅

_{11449-6^Pregnancy History^LN}

_0..1

CODEDVALUE

_SECTION

Notes on Procedure

_Gravida

FT

_NM

8251-

_{11996-6^Gravida^LN}

_1.5.1

Notes on Procedure

LN

1

_0.

3.1.RepeatOf[CLUSTER -- Procedure]

_.1	_INTEGER
_Parity	_NM	_{11977-6^Parity^LN}	_1.5.2			_0..1

STRING

_INTEGER

Family History

_Miscarriages

CWELN

_NM

73983-9

_{11614-5^Miscarriages^LN}

_1.5.

410157-6^Family History^LN1.4.1

₃

_0..1

SECTIONPatients Family Tree IDST74027-4Patients Family Tree IDLNNatural Father IDST74026-6Natural Father IDLN1.4.2

_INTEGER
_Terminations	_NM	_{11613-7^Terminations^LN}	_1.5.4			_0..1

STRING

_INTEGER
_{Social History}	_CWE	_73983-9^^LN	_1.6	_{29762-2^Social History^LN}	_0..1	_SECTION
_{Social Situation}	_FT	_{10166-7^Social Situation^LN}	_1.6.1		_0..1	_STRING

Natural Mother IDST74025-8Natural Mother IDLN1.4.3

_{Substance Use}

_CWE

_73983-9^^LN

_1.7

_{18663-5^Substance Use^LN}

_0..1

STRING

_SECTION

Relatives

_{Smoking History}

_CWE

_73983-9

_^^LN

LN

_1.

4

_7.

4224086007^Relatives^SCT

₁

_{11367-0^Smoking History^LN}

_0..1

_SECTION

Relative^†-


_{Tobacco use and exposure}	_CWE	_{63638-1^Tobacco use and exposure^LN}	_1.

4

_7.

4

_1.1

.RepeatOf[CLUSTER -- Relative]

_{Value Set (}

_{8517006^Ex-smoker^SCT}

_{43381005^Passive smoker^SCT}

_{77176002^Smoker^SCT}

_{8392000^Non-smoker^SCT}

₎

_0..

*1.4.4.1.RepeatOf[CLUSTER -- Relative].1

₁

STRUCTURALRelative NameST54138-3Relative NameLN

_CODEDVALUE
_{Tobacco smoking consumption}	_NM	_{63858-5^Tobacco smoking consumption^LN}	_1.7.1.2			_0..1

STRING

_{PHYSICALQUANTITY}

Relationship

_{Lifetime Intake}

CWELN

_NM

44767-2Relationship

_{74011-8^Lifetime Intake^LN}

_1.

4.4

_7.1.

RepeatOf[CLUSTER -- Relative].2

Constraint (HL7 v3 FamilyMember Value set = Child of Role Code _PersonalRelationshipRoleType FAMMEMB)

Use "ROLECODE" for Name of Coding System component of CWE

See Table HL7 v3 FamilyMember Value set below

₃

_0..1

CODEDVALUE

_{PHYSICALQUANTITY}

Relative ID

_{Date Ceased}

ST1.4.4.1.RepeatOf[CLUSTER -- Relative].3

_DT

74024-1Relative IDLNLN

_{74010-0^Date Ceased^LN}

_1.7.1.4

_0..1

STRINGNatural Father IDST74026-6Natural Father ID

_DATETIME
_{Alcohol Intake}	_CWE	_73983-9^^LN	_1.

4.4.1.RepeatOf[CLUSTER -- Relative].4 Natural Mother IDST74025-8Natural Mother IDLN

_7.2

_{11330-8^Alcohol Intake^LN}

_0..1

STRING

_SECTION
_{Alcohol Intake}	_CWE	_{11331-6^Alcohol Intake^LN}	_1.

4

_7.

4

_2.1

.RepeatOf[CLUSTER -- Relative].5

_{Value Set (}

_{82581004^Ex-drinker^SCT}

_{105542008^Non - drinker^SCT}

_{219006^Current drinker^SCT}

₎

_0..1

STRING

_CODEDVALUE

deceasedEstimatedAge

_{Last Drank Alcohol}

STLN

_DT

39016-1deceasedEstimatedAge

_{74014-2^Last Drank Alcohol^LN}

_1.

4

_7.

4.1.RepeatOf[CLUSTER -- Relative].6LivingEstimatedAgeST LivingEstimatedAgeLN

_2.2

_0..1

REAL

_DATETIME
_{30 day quantity and frequency}	_CWE	_73983-9^^LN	_1.

4

_7.

4.1.RepeatOf[CLUSTER -- Relative].7

_2.3

_{030301^30 day quantity and frequency^PHENX}

_0..1

REALClinical Genomic ChoiceCWE74042-3Clinical Genomic ChoiceLN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice]

_SECTION
_{Number of days alcohol consumed}	_NM	_{63597-9^Number of days alcohol consumed^LN}	_1.7.2.3.1			_0..

*Clinical ObservationCWE74023-3Clinical ObservationLN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].1

₁

COLLECTION

_INTEGER
_{Standard drinks per day on a drinking day in last 30 days}	_NM	_{63598-7^Standard drinks per day on a drinking day in last 30 days^LN}	_1.7.2.3.2

1

_0..1

CODEDVALUENegation IndicatorCWE74022-5Negation IndicatorLN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].2

_INTEGER
_{Average Daily Alcohol Intake}	_NM	_{74013-4^Average Daily Alcohol Intake^LN}	_1.7.2.4			_0..1

BOOLEANCause of DeathCWE74044-9Cause of DeathLN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].3

_{PHYSICALQUANTITY}
_{Maximum Daily Standard Drinks}	_NM	_{63591-2^Maximum Daily Standard Drinks^LN}	_1.7.2.5			_0..1

BOOLEAN

_{PHYSICALQUANTITY}

DataEstimatedAge

_{Years Alcohol Consumed}

STLN

_NM

21611-9DataEstimatedAge

_{74012-6^Years Alcohol Consumed^LN}

_1.

4

_7.

4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].4

_2.6

_0..1

REALGenetic LociST48018-6Genetic LociLN1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].5.RepeatOf[ELEMENT -- Genetic Loci]

_{PHYSICALQUANTITY}

_{Alcohol abuse or dependence (e.g. DSM IV)}

_CWE

_{74043-1^Alcohol abuse or dependence (e.g. DSM IV)^LN}

_1.7.2.7

_{Value Set (}

_{31874001^True^SCT}

_{64100000^False^SCT}

_{64957009^Uncertain^SCT}

₎

_0..

*Genetic Risks

₁

STRING

_BOOLEAN
_{Other substance Use}	_CWE	_73983-9

_^^LN

LN

_1.

4

_7.

5106221001^Genetic Risks^SCT

₃

_{11342-3^Other substance Use^LN}

_0..1

_SECTION

Pedigree Analysis Results ^†-

_{Drug misuse details}

_CWE

_{228366006^Drug misuse details^SCT}

_1.

4

_7.

5

_{3.1.RepeatOf[}

CLUSTER

_{ELEMENT --}

Pedigree Analysis Results] 0..*STRUCTURALGenetic Disease AssessedCWE51967-8Genetic Disease AssessedLN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].1

_{Drug misuse details]}

_{Value Set (}

_{428659002^Amphetamine misuse^SCT}

_{429179002^Antidepressant misuse^SCT}

_{428623008^Barbiturate misuse^SCT}

_{428823006^Cannabis misuse^SCT}

_{429782000^Cocaine misuse^SCT}

_{307052004^Illicit drug use^SCT}

_{228376009^Inhales drugs^SCT}

_{226034001^Injecting drug user^SCT}

_{70545002^Narcotic drug user^SCT}

_{105546006^Occasional drug abuser^SCT}

_{228372006^Poly-drug misuser^SCT}

_{428495004^Solvent misuse^SCT}

_{228381000^Sniffs drugs^SCT}

_{429512006^Methadone misuse^SCT}

₎

_0..

1

_*	_CODEDVALUE

Input Parameters

_{Exercise History}

_CWE

_73983-9

LN

_^^LN

_1.

4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].273983-9^Input Parameters^LN

₈

_{266930008^Exercise History^SCT}

_0..1

_SECTION

Genetic Algorithm UsedLN

_{Currently Exercising}

_CWE

74021-7Genetic Algorithm Used

74008-4^Exercise intensity^LN

_1.

4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.1

_8.1

_{Value Set (}

_{160635005^Exercise grading unknown^SCT}

_{160633003^Enjoys heavy exercise^SCT}

_{160645007^Enjoys intermediate exercise^SCT}

_{228446001^Gets little exercise^SCT}

_{228445002^Gets no exercise^SCT}

_{160631001^Enjoys light exercise^SCT}

_{160632008^Enjoys moderate exercise^SCT}

_{102533007^Excessive exercise^SCT}

₎

_0..1

_CODEDVALUE

Sensitivity

_{Exercise Type}

NMLN

_CWE

74020-9Sensitivity

55410-5^Exercise Type^LN

_1.

4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].2.2

_8.2

_{Value Set (}

_{229072005^Aerobic^SCT}

₎

_0..1

PHYSICALQUANTITYProbability of DiseaseST74019-1Probability of DiseaseLN1.4.5.1.RepeatOf[CLUSTER -- Pedigree Analysis Results].3.RepeatOf[ELEMENT -- Probability of Disease]

_CODEDVALUE
_{Time Spent Exercising}	_NM	_{74009-2^Time Spent Exercising^LN}	_1.8.3			_0..

*

₁

REAL

_{PHYSICALQUANTITY}

Pregnancy History

_Vitals

_CWE

_73983-9

LN

_^^LN

_1.

5

₉

11449

_8716-

6^Pregnancy History^LN

_3^Vitals^LN

_0..1

_SECTION

Gravida

_{Blood Pressure}

NM

_CWE

11996

_73983-

6GravidaLN

_9^^LN

_1.

5

_9.1

_{.RepeatOf[CLUSTER -- Blood Pressure]}

_{55417-0^Blood Pressure^LN}

_0..

1

_*

INTEGER

_COLLECTION

Parity

_{Systolic Pressure}

_NM

11977

_8480-6

ParityLN1.5.2

_{^Systolic Pressure^LN}

_{1.9.1.RepeatOf[CLUSTER -- Blood Pressure].1}

_Y

_0..1

INTEGER

_{PHYSICALQUANTITY}

Miscarriages

_{Diastolic Pressure}

_NM

11614

_8462-

5MiscarriagesLN1.5.3

_{4^Diastolic Pressure^LN}

_{1.9.1.RepeatOf[CLUSTER -- Blood Pressure].2}

_0..1

INTEGER

_{PHYSICALQUANTITY}

Terminations

_{Patient Position}

NM

_CWE

11613

_8361-

7TerminationsLN1.5.4

_{8^Patient Position^LN}

_{1.9.1.RepeatOf[CLUSTER -- Blood Pressure].3}

_{Value Set (}

_{33586001^Sitting^SCT}

_{102538003^Lying^SCT}

_{272580008^Semi-recumbent^SCT}

_{10904000^Standing^SCT}

₎

_0..1

INTEGER

_CODEDVALUE

Social History

_{Pulse rate}

CWE

_NM

73983-9 LN1.629762-2^Social History^LN

_{8893-0^Pulse rate^LN}

_{1.9.2.RepeatOf[ELEMENT -- Pulse rate]}

_Y

_0..

1

_*

SECTION

_{PHYSICALQUANTITY}

Social Situation

_Weight

FT

_NM

10166

_29463-7

Social SituationLN

_^Weight^LN

_1.9.

6.1

_{3.RepeatOf[ELEMENT -- Weight]}

_Y

_0..

1

_*

STRING

_{PHYSICALQUANTITY}

Substance Use

_BMI

CWE

_NM

73983-9 LN1.718663-5^Substance Use^LN

_{39156-5^BMI^LN}

_{1.9.4.RepeatOf[ELEMENT -- BMI]}

_Y

_0..

1SECTIONSmoking HistoryCWE73983-9 LN1.7.111367-0^Smoking History^LN

_*	_{PHYSICALQUANTITY}
_{Oxygen Saturation}	_NM	_{59408-5^Oxygen Saturation^LN}	_{1.9.5.RepeatOf[ELEMENT -- Oxygen Saturation]}		_Y	_0..

1LN

_*

SECTIONTobacco use and exposureCWE63638-1Tobacco use and exposure

_{PHYSICALQUANTITY}
_Height	_NM	_{8302-2^Height^LN}	_1.

7

_9.

1.1

Suggested Value Set (

8517006^Ex-smoker^SCT

43381005^Passive smoker^SCT

77176002^Smoker^SCT

8392000^Non-smoker^SCT

)

0..1CODEDVALUETobacco smoking consumptionNM63858-5Tobacco smoking consumptionLN1.7.1.2 0..1PHYSICALQUANTITYLifetime IntakeNM74011-8Lifetime IntakeLN1.7.1.3

_{6.RepeatOf[ELEMENT -- Height]}		_Y	_0..*	_{PHYSICALQUANTITY}
_Temperature	_NM	_{8310-5^Temperature^LN}	_{1.9.7.RepeatOf[ELEMENT -- Temperature]}		_Y	_0..*	_{PHYSICALQUANTITY}
_{Respiratory rate}	_NM	_{9279-1^Respiratory rate^LN}	_{1.9.8.RepeatOf[ELEMENT -- Respiratory rate]}			_0..

1

_*	_{PHYSICALQUANTITY}

Date Ceased

_Alerts

DTLN

_CWE

74010-0Date Ceased

_73983-9^^LN

_1.

7.1.4

₁₀

_{44944-7^Alerts^LN}

_0..1

DATETIME73983-9

_SECTION

Alcohol IntakeCWE

_Alert

_-

LN

_1.10.

7.211330-8^Alcohol Intake^LN

_{1.RepeatOf[CLUSTER -- Alert]}

_0..

1

_*

SECTION

_STRUCTURAL

Alcohol IntakeLN

_{Alert Type}

_CWE

11331-6Alcohol Intake

_{74018-3^Alert Type^LN}

_1.10.

7.2

_{1.RepeatOf[CLUSTER -- Alert].1}

Suggested

_{Value Set (}

82581004^Ex-drinker^SCT

105542008^Non - drinker^SCT

219006^Current drinker^SCT

_{129697009^Psychosocial^SCT}

_{307824009^Administrative^SCT}

_{281694009^Clinical^SCT}

_{102487004^Environmental^SCT}

_{78648007^Infection risk^SCT}

_{405145004^Safety and security^SCT}

_{363871006^Special Mental Health^SCT}

_{315638005^Special needs and/or preferences^SCT}

₎

_0..1

_CODEDVALUE

Last Drank Alcohol

_Active

DTLN

_CWE

74014-2Last Drank Alcohol

_{74017-5^Active^LN}

_1.10.

7.2.2

_{1.RepeatOf[CLUSTER -- Alert].2}

_{Value Set (}

_{31874001^True^SCT}

_{64100000^False^SCT}

_{64957009^Uncertain^SCT}

₎

_0..1

DATETIME30 day quantity and frequencyLN

_BOOLEAN
_{Specific Alert}	_CWE

73983-9

_{44944-7^Specific Alert^LN}

_1.

7

_10.

2.373983-9^30 day quantity and frequency^LN 0..1SECTIONNumber of days alcohol consumedNM63597-9Number of days alcohol consumedLN1.7.2.3.1 Standard drinks per day on a drinking day in last 30 daysNM63598-7Standard drinks per day on a drinking day in last 30 daysLN1.7.2.3.2 0..1INTEGERAverage Daily Alcohol IntakeNM74013-4Average Daily Alcohol IntakeLN1.7.2.4

_{1.RepeatOf[CLUSTER -- Alert].3}

_{Suggested Value Set (}

_{40739000^Has difficulty swallowing^SCT}

_{224331001^Known to police^SCT}

_{224347004^Has enduring power of attorney^SCT}

_{310301000^Has advance health directive^SCT}

₎

_0..1

INTEGERMaximum Daily Standard DrinksNM63591-2Maximum Daily Standard DrinksLN1.7.2

_CODEDVALUE

_{Reported by}

_CWE

_{48766-0^Reported by^LN}

_{1.10.1.RepeatOf[CLUSTER -- Alert].4}

_{Value Set (}

_{116154003^Subject of care^SCT}

_{229774002^Carer^SCT}

_{223366009^Health worker^SCT}

_{307982007^Social services provider^SCT}

_{14406004^Police^SCT}

_{303071001^Family member^SCT}

_{113163005^Friend^SCT}

₎

_0..1

PHYSICALQUANTITY

_CODEDVALUE
_{Recorded date}	_DT	_{74015-9^Recorded date^LN}	_{1.10.1.RepeatOf[CLUSTER -- Alert].5}			_0..1

PHYSICALQUANTITYYears Alcohol ConsumedNM74012-6Years Alcohol ConsumedLN1.7.2.6 0..1PHYSICALQUANTITYAlcohol abuse or dependence (eg DSM IV)CWE74043-1Alcohol abuse or dependence (eg DSM IV)LN1.7.2.7 0..1BOOLEANOther substance UseCWE73983-9 LN1.7.311342-3^Other substance Use^LN 0..1SECTIONDrug misuse detailsCWE228366006Drug misuse detailsSCT1.7.3.1.RepeatOf[ELEMENT -- Drug misuse details]

Suggested Value Set (

428659002^Amphetamine misuse^SCT

429179002^Antidepressant misuse^SCT

428623008^Barbiturate misuse^SCT

428823006^Cannabis misuse^SCT

429782000^Cocaine misuse^SCT

307052004^Illicit drug use^SCT

228376009^Inhales drugs^SCT

226034001^Injecting drug user^SCT

70545002^Narcotic drug user^SCT

105546006^Occasional drug abuser^SCT

228372006^Poly-drug misuser^SCT

428495004^Solvent misuse^SCT

228381000^Sniffs drugs^SCT

429512006^Methadone misuse^SCT

)

0..*CODEDVALUEExercise HistoryCWE73983-9 LN1.8266930008^Exercise History^SCT 0..1SECTIONCurrently ExercisingCWE74008-4Currently ExercisingLN1.8.1

Suggested Value Set (160635005^Exercise grading unknown^SCT

160633003^Enjoys heavy exercise^SCT

160645007^Enjoys intermediate exercise^SCT

228446001^Gets little exercise^SCT

228445002^Gets no exercise^SCT

160631001^Enjoys light exercise^SCT

160632008^Enjoys moderate exercise^SCT

102533007^Excessive exercise^SCT

)

0..1CODEDVALUEExercise TypeCWE73986-2Exercise TypeLN1.8.2

Suggested value Set (

229072005^Aerobic^SCT

)

0..1CODEDVALUETime Spent ExercisingNM74009-2Time Spent ExercisingLN1.8.3 0..1PHYSICALQUANTITYVitalsCWE73983-9 LN1.98716-3^Vitals^LN 0..1SECTIONBlood PressureCWE73983-9 LN1.9

_DATETIME

Legend:

Item Type	Row Colour
Element	White
Section	Blue
Structural Node	Red
Collection Node	Yellow

A9.2.2.2 OBX-2 DataType (ID)

Each OBX must have it's OBX-2 value as specified exactly as per the HL7v2 VMR OBX implementation table.

A9.2.2.3 OBX-3 Observation Identifier (CE)

The OBX-3 values used by the HL7v2 VMR are defined by the LOINC Virtual Medical Record for Clinical Decision Support panel HL7.VMR-CDS (74028-2). The panel definition can be viewed at the following URL: https://s.details.loinc.org/LOINC/74028-2.html?sections=Comprehensive

A9.2.3.4 OBX-4 Observation sub-ID (ST)

In the table A9.T.1 OBX-4 subIDs are dotted decimals that start with "1" which is the root OBX-4 subID for all elements of the HL7v2 Virtual Medical Record. The root value "1" has been specified in the above table to aid in simplicity. Theoretically other subID root values could be used instead of "1", but this value must be practical in most cases.

Observations which are not specified by the HL7v2 VMR must not have a OBX-4 subID sharing the same root.

Rows marked VMR DATATYPE column as STRUCTURAL (red rows) must not be written to OBX segments and are present in the table are purely virtual and are to assist with understanding the hierarchy. They must be allocated a dotted subID however, on which all child elements must be prefixed with this subID.

A9.2.3.4.1 Example of use of Past Illness VMR elements

By example consider the history of past illness from the above table. Here is the subset for convenience.

Section Heading or Element	OBX-2 DataType	OBX-3 Value	OBX-4 Observation sub-ID	OCCURENCES	VMR DATATYPE
History of Past Illness	CWE	73983-9^^LN	1.2	0..1	SECTION
Past Illness^†	-		1.2.1.RepeatOf[CLUSTER -- Past Illness]	0..*	STRUCTURAL
Past Illness	CWE	11349-8^Past Illness^LN	1.2.1.RepeatOf[CLUSTER --

...

Past Illness].1

0..

...

Suggested Value Set (

33586001^Sitting^SCT

102538003^Lying^SCT

272580008^Semi-recumbent^SCT

10904000^Standing^SCT

)

...

Suggested Value Set (

129697009^Psychosocial^SCT

307824009^Administrative^SCT

281694009^Clinical^SCT

102487004^Environmental^SCT

78648007^Infection risk^SCT

405145004^Safety and security^SCT

363871006^Special Mental Health^SCT

315638005^Special needs and/or preferences^SCT

)

...

1

...

CODEDVALUE

For items in the table with occurrences with an upper bound > 1 (e.g. 0..*) that element will have "RepeatOf[]" specified in the OBX-4 Observation sub-ID. The "RepeatOf[]" must be substituted with the repeat index integer of the element/structural/section group. All child elements for the repeat index must be prefixed with this sub-ID value.

For example, the first instance of a past illness the OBX-4 sub-ID must be 1.2.1.1, for the second 1.2.1.2.

Based on this the Past Illness OBXes for the first illness must have a OBX-4 sub-ID value of 1.2.1.1.1, and for the second illness, the OBX-4 sub-ID value must be 1.2.1.2.1.

Code Block

title	Example of OBX segments with subIDs indicating 2 past illnesses

OBX|6|CE|70949-3^^LN|1.2|11348-0^History of Past Illness^LN^417662000^History of Past Illness^SCT||||||F
OBX|7|CE|11349-8^Past Illness^LN|1.2.1.1.1|50711007^Viral hepatitis C^SCT||||||F
OBX|8|CE|408731000^Temporal Context^SCT|1.2.1.1.2|410584005^Current - specified^SCT||||||F
OBX|9|DR|11368-8^Illness Dates^LN|1.2.1.1.3|20090107||||||F
OBX|10|CE|11349-8^Past Illness^LN|1.2.1.2.1|6142004^Influenza^SCT||||||F
OBX|11|CE|408731000^Temporal Context^SCT|1.2.1.2.2|410587003^Past - specified^SCT||||||F
OBX|12|DR|11368-8^Illness Dates^LN|1.2.1.2.3|20170131^20170318||||||F

OBXs with OBX-1 Set ID of 7,8,9 are part of the first illness as their OBX-4 subID is prefixed with 1.2.1.1.

OBX with OBX-1 Set ID 10,11,12 are part of the second illness as their OBX-4 subID is prefixed with 1.2.1.2.

A9.2.3.4.2 Use of complex OBX-4 with multiple nested repeating elements

Structures may repeat at multiple levels. A complex example is the Genetic Loci element which may have many 0.* for each of the repeating Clinical Genomic Choice collection (0...*) for each relative. For convenience see the subset of the table here:

Section Heading or Element	OBX-2 DataType	OBX-3 Value	OBX-4 Observation sub-ID	OCCURENCES	VMR DATATYPE
Relatives	CWE	73983-9^^LN	1.4.4	0..1	SECTION
Relative^†	-		1.4.4.1.RepeatOf[CLUSTER --

...

Relative]

0..

...

Suggested Value Set (

40739000^Has difficulty swallowing^SCT

224331001^Known to police^SCT

224347004^Has enduring power of attorney^SCT

310301000^Has advance health directive^SCT

)

...

*	STRUCTURAL
...
Clinical Genomic Choice	CWE	73983-9^^LN	1.4.4.1.RepeatOf[CLUSTER --

...

Relative]

...

Suggested Value Set (

116154003^Subject of care^SCT

229774002^Carer^SCT

223366009^Health worker^SCT

307982007^Social services provider^SCT

14406004^Police^SCT

303071001^Family member^SCT

113163005^Friend^SCT

)

...

.8.RepeatOf[CLUSTER -- Clinical Genomic Choice]	0..*	COLLECTION
Clinical Observation	CWE	74023-3^Clinical Observation^LN	1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER -- Clinical Genomic Choice].1	1..1	CODEDVALUE

...

Genetic Loci

...

ST

48018-6^Genetic Loci^LN

1.4.4.1.RepeatOf[CLUSTER -- Relative].8.RepeatOf[CLUSTER --

...

Clinical Genomic Choice].5

...

.RepeatOf[ELEMENT -- Genetic Loci]

0..

...

Nodes marked VMR STRUCTURAL should not be written to OBX segments and are present in the table to assist with understanding the hierarchy.

The Report Template OBX must be specified and its OBX-4 column SubID must be a dotted decimal value, for this profile "1" has been specified as the root sub ID. All other HL7.VMR OBX subID should have dotted sub id based on this.

The first OBX is static and should be as follows:

Code Block
OBX\|1\|RP\|74028-2^Report template ID^LN\|1\|HL7V2-VMR.v1^HL7V2 VMR&99A-9AAC5A649D18B6F2&L^TX^Octet-stream\|\|\|\|\|\|F

Code Block
OBX\|2\|CWE\|73983-9^^LN^CLUSTER^^EN 13606\|1.1\|^History of Presenting Complaint\|\|\|\|\|\|F

...

*

...

STRING

As an example the OBX-4 sub-ID value for the fourth Genetic Loci for the second relative's third clinical genomic choice would be (note the variable parts of the sub-ID are indicated bold): 1.4.4.1.2.8.3.5.4

A9.2.3.5 OBX-5 Observation value (*)

OBX-5 is a variable datatype and the datatype used in each instance as specified in OBX-2.

OBX-5 value domains in table A9.T.1 are suggested and recommended. Howevervalues only, sending systems should must use the values that they have available in their systems. If common standard terminologies are available, then those can be supplied as alternative code components of the CE/CWE/CNE if a standard terminology isn't used aren't the primary coding system. Where no codes is available then only the text component must be populated.

A9.3 Value Domain Tables

Anchor
Table-FAMMEMB
Table-FAMMEMB
Table HL7 v3 FamilyMember Value set

Level	Code	Display	Definition
1	(_PersonalRelationshipRoleType) *Abstract*
2	FAMMEMB	family member	A relationship between two people characterizing their "familial" relationship
3	CHILD	child	The player of the role is a child of the scoping entity.
4	CHLDADOPT	adopted child	The player of the role is a child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.
5	DAUADOPT	adopted daughter	The player of the role is a female child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.
5	SONADOPT	adopted son	The player of the role is a male child taken into a family through legal means and raised by the scoping person (parent) as his or her own child.
4	CHLDFOST	foster child	The player of the role is a child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.
5	DAUFOST	foster daughter	The player of the role is a female child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.
5	SONFOST	foster son	The player of the role is a male child receiving parental care and nurture from the scoping person (parent) but not related to him or her through legal or blood ties.
4	DAUC	daughter	Description: The player of the role is a female child (of any type) of scoping entity (parent)
5	DAUADOPT
5	DAUFOST
5	DAU	natural daughter	The player of the role is a female offspring of the scoping entity (parent).
5	STPDAU	stepdaughter	The player of the role is a daughter of the scoping person's spouse by a previous union.
4	NCHILD	natural child	The player of the role is an offspring of the scoping entity as determined by birth.
5	DAU
5	SON	natural son	The player of the role is a male offspring of the scoping entity (parent).
4	SONC	son	Description: The player of the role is a male child (of any type) of scoping entity (parent)
5	SONADOPT
5	SONFOST
5	SON
5	STPSON	stepson	The player of the role is a son of the scoping person's spouse by a previous union.
4	STPCHLD	step child	The player of the role is a child of the scoping person's spouse by a previous union.
5	STPDAU
5	STPSON
3	EXT	extended family member	Description: A family member not having an immediate genetic or legal relationship e.g. Aunt, cousin, great grandparent, grandchild, grandparent, niece, nephew or uncle.
4	AUNT	aunt	The player of the role is a sister of the scoping person's mother or father.
5	MAUNT	maternal aunt	Description: The player of the role is a biological sister of the scoping person's biological mother.
5	PAUNT	paternal aunt	Description: The player of the role is a biological sister of the scoping person's biological father.
4	COUSN	cousin	The player of the role is a relative of the scoping person descended from a common ancestor, such as a grandparent, by two or more steps in a diverging line.
5	MCOUSN	maternal cousin	Description: The player of the role is a biological relative of the scoping person descended from a common ancestor on the player's mother's side, such as a grandparent, by two or more steps in a diverging line.
5	PCOUSN	paternal cousin	Description: The player of the role is a biological relative of the scoping person descended from a common ancestor on the player's father's side, such as a grandparent, by two or more steps in a diverging line.
4	GGRPRN	great grandparent	The player of the role is a parent of the scoping person's grandparent.
5	GGRFTH	great grandfather	The player of the role is the father of the scoping person's grandparent.
6	MGGRFTH	maternal great-grandfather	Description: The player of the role is the biological father of the scoping person's biological mother's parent.
6	PGGRFTH	paternal great-grandfather	Description: The player of the role is the biological father of the scoping person's biological father's parent.
5	GGRMTH	great grandmother	The player of the role is the mother of the scoping person's grandparent.
6	MGGRMTH	maternal great-grandmother	Description: The player of the role is the biological mother of the scoping person's biological mother's parent.
6	PGGRMTH	paternal great-grandmother	Description: The player of the role is the biological mother of the scoping person's biological father's parent.
5	MGGRPRN	maternal great-grandparent	Description: The player of the role is a biological parent of the scoping person's biological mother's parent.
6	MGGRFTH
6	MGGRMTH
5	PGGRPRN	paternal great-grandparent	Description: The player of the role is a biological parent of the scoping person's biological father's parent.
6	PGGRFTH
6	PGGRMTH
4	GRNDCHILD	grandchild	The player of the role is a child of the scoping person's son or daughter.
5	GRNDDAU	granddaughter	The player of the role is a daughter of the scoping person's son or daughter.
5	GRNDSON	grandson	The player of the role is a son of the scoping person's son or daughter.
4	GRPRN	grandparent	The player of the role is a parent of the scoping person's mother or father.
5	GRFTH	grandfather	The player of the role is the father of the scoping person's mother or father.
6	MGRFTH	maternal grandfather	Description: The player of the role is the biological father of the scoping person's biological mother.
6	PGRFTH	paternal grandfather	Description: The player of the role is the biological father of the scoping person's biological father.
5	GRMTH	grandmother	The player of the role is the mother of the scoping person's mother or father.
6	MGRMTH	maternal grandmother	Description: The player of the role is the biological mother of the scoping person's biological mother.
6	PGRMTH	paternal grandmother	Description: The player of the role is the biological mother of the scoping person's biological father.
5	MGRPRN	maternal grandparent	Description: The player of the role is the biological parent of the scoping person's biological mother.
6	MGRFTH
6	MGRMTH
5	PGRPRN	paternal grandparent	Description: The player of the role is the biological parent of the scoping person's biological father.
6	PGRFTH
6	PGRMTH
4	INLAW	inlaw	A relationship between an individual and a member of their spousal partner's immediate family.
5	CHLDINLAW	child-in-law	The player of the role is the spouse of scoping person's child.
6	DAUINLAW	daughter in-law	The player of the role is the wife of scoping person's son.
6	SONINLAW	son in-law	The player of the role is the husband of scoping person's daughter.
5	PRNINLAW	parent in-law	The player of the role is the parent of scoping person's husband or wife.
6	FTHINLAW	father-in-law	The player of the role is the father of the scoping person's husband or wife.
6	MTHINLAW	mother-in-law	The player of the role is the mother of the scoping person's husband or wife.
5	SIBINLAW	sibling in-law	The player of the role is: (1) a sibling of the scoping person's spouse, or (2) the spouse of the scoping person's sibling, or (3) the spouse of a sibling of the scoping person's spouse.
6	BROINLAW	brother-in-law	The player of the role is: (1) a brother of the scoping person's spouse, or (2) the husband of the scoping person's sister, or (3) the husband of a sister of the scoping person's spouse.
6	SISINLAW	sister-in-law	The player of the role is: (1) a sister of the scoping person's spouse, or (2) the wife of the scoping person's brother, or (3) the wife of a brother of the scoping person's spouse.
4	NIENEPH	niece/nephew	The player of the role is a child of scoping person's brother or sister or of the brother or sister of the scoping person's spouse.
5	NEPHEW	nephew	The player of the role is a son of the scoping person's brother or sister or of the brother or sister of the scoping person's spouse.
5	NIECE	niece	The player of the role is a daughter of the scoping person's brother or sister or of the brother or sister of the scoping person's spouse.
4	UNCLE	uncle	The player of the role is a brother of the scoping person's mother or father.
5	MUNCLE	maternal uncle	Description: The player of the role is a biological brother of the scoping person's biological mother.
5	PUNCLE	paternal uncle	Description: The player of the role is a biological brother of the scoping person's biological father.
3	PRN	parent	The player of the role is one who begets, gives birth to, or nurtures and raises the scoping entity (child).
4	ADOPTP	adoptive parent	The player of the role (parent) has taken the scoper (child) into their family through legal means and raises them as his or her own child.
5	ADOPTF	adoptive father	The player of the role (father) is a male who has taken the scoper (child) into their family through legal means and raises them as his own child.
5	ADOPTM	adoptive mother	The player of the role (father) is a female who has taken the scoper (child) into their family through legal means and raises them as her own child.
4	FTH	father	The player of the role is a male who begets or raises or nurtures the scoping entity (child).
5	ADOPTF
5	FTHFOST	foster father	The player of the role (parent) who is a male state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary. The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.
5	NFTH	natural father	The player of the role is a male who begets the scoping entity (child).
6	NFTHF	natural father of fetus	Indicates the biologic male parent of a fetus.
5	STPFTH	stepfather	The player of the role is the husband of scoping person's mother and not the scoping person's natural father.
4	MTH	mother	The player of the role is a female who conceives, gives birth to, or raises and nurtures the scoping entity (child).
5	ADOPTM
5	GESTM	gestational mother	The player is a female whose womb carries the fetus of the scoper. Generally used when the gestational mother and natural mother are not the same.
5	MTHFOST	foster mother	The player of the role (parent) who is a female state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary. The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.
5	NMTH	natural mother	The player of the role is a female who conceives or gives birth to the scoping entity (child).
6	NMTHF	natural mother of fetus	The player is the biologic female parent of the scoping fetus.
5	STPMTH	stepmother	The player of the role is the wife of scoping person's father and not the scoping person's natural mother.
4	NPRN	natural parent
5	NFTH
5	NMTH
4	PRNFOST	foster parent	The player of the role (parent) who is a state-certified caregiver responsible for the scoper (child) who has been placed in the parent's care. The placement of the child is usually arranged through the government or a social-service agency, and temporary. The state, via a jurisdiction recognized child protection agency, stands as in loco parentis to the child, making all legal decisions while the foster parent is responsible for the day-to-day care of the specified child.
5	FTHFOST
5	MTHFOST
4	STPPRN	step parent	The player of the role is the spouse of the scoping person's parent and not the scoping person's natural parent.
5	STPFTH
5	STPMTH
3	SIB	sibling	The player of the role shares one or both parents in common with the scoping entity.
4	BRO	brother	The player of the role is a male sharing one or both parents in common with the scoping entity.
5	HBRO	half-brother	The player of the role is a male related to the scoping entity by sharing only one biological parent.
5	NBRO	natural brother	The player of the role is a male having the same biological parents as the scoping entity.
6	TWINBRO	twin brother	The scoper was carried in the same womb as the male player and shares common biological parents.
7	FTWINBRO	fraternal twin brother	The scoper was carried in the same womb as the male player and shares common biological parents but is the product of a distinct egg/sperm pair.
7	ITWINBRO	identical twin brother	The male scoper is an offspring of the same egg-sperm pair as the male player.
5	STPBRO	stepbrother	The player of the role is a son of the scoping person's stepparent.
4	HSIB	half-sibling	The player of the role is related to the scoping entity by sharing only one biological parent.
5	HBRO
5	HSIS	half-sister	The player of the role is a female related to the scoping entity by sharing only one biological parent.
4	NSIB	natural sibling	The player of the role has both biological parents in common with the scoping entity.
5	NBRO
5	NSIS	natural sister	The player of the role is a female having the same biological parents as the scoping entity.
6	TWINSIS	twin sister	The scoper was carried in the same womb as the female player and shares common biological parents.
7	FTWINSIS	fraternal twin sister	The scoper was carried in the same womb as the female player and shares common biological parents but is the product of a distinct egg/sperm pair.
7	ITWINSIS	identical twin sister	The female scoper is an offspring of the same egg-sperm pair as the female player.
5	TWIN	twin	The scoper and player were carried in the same womb and shared common biological parents.
6	TWINBRO
6	TWINSIS
6	FTWIN	fraternal twin	The scoper and player were carried in the same womb and share common biological parents but are the product of distinct egg/sperm pairs.
7	FTWINBRO
7	FTWINSIS
6	ITWIN	identical twin	The scoper and player are offspring of the same egg-sperm pair.
7	ITWINBRO
7	ITWINSIS
4	SIS	sister	The player of the role is a female sharing one or both parents in common with the scoping entity.
5	HSIS
5	NSIS
5	STPSIS	stepsister	The player of the role is a daughter of the scoping person's stepparent.
4	STPSIB	step sibling	The player of the role is a child of the scoping person's stepparent.
5	STPBRO
5	STPSIS
3	SIGOTHR	significant other	A person who is important to one's well being; especially a spouse or one in a similar relationship. (The player is the one who is important)
4	DOMPART	domestic partner	The player of the role cohabits with the scoping person but is not the scoping person's spouse.
4	FMRSPS	former spouse	Player of the role was previously joined to the scoping person in marriage and this marriage is now dissolved and inactive. Usage Note: This is significant to indicate as some jurisdictions have different legal requirements for former spouse to access the patient's record, from a general friend.
4	SPS	spouse	The player of the role is a marriage partner of the scoping person.
5	HUSB	husband	The player of the role is a man joined to a woman (scoping person) in marriage.
5	WIFE	wife	The player of the role is a woman joined to a man (scoping person) in marriage.

Version	Old Version 32	New Version Current
Changes made by	Former user	Former user
Saved on	Jul 17, 2017	Apr 23, 2021

Versions Compared

Key

A9.1 Introduction

A9.2 Implementing the HL7v2 Virtual Medical Record with OBX segments

A9.2.1 Specifying the HL7v2 VMR is in use.

A9.2.2 Implementing each element of the HL7v2 VMR

A9.2.2.1 HL7v2 VMR OBX implementation table

Anchor
A9.T.1
A9.T.1
A9.T.1 HL7v2 VMR OBX implementation table

A9.2.2.2 OBX-2 DataType (ID)

A9.2.2.3 OBX-3 Observation Identifier (CE)

A9.2.3.4 OBX-4 Observation sub-ID (ST)

A9.2.3.4.1 Example of use of Past Illness VMR elements

A9.2.3.4.2 Use of complex OBX-4 with multiple nested repeating elements

A9.2.3.5 OBX-5 Observation value (*)

A9.3 Value Domain Tables

Anchor
Table-FAMMEMB
Table-FAMMEMB
Table HL7 v3 FamilyMember Value set

Page Comparison

Versions Compared

Key

A9.1 Introduction

A9.2 Implementing the HL7v2 Virtual Medical Record with OBX segments

A9.2.1 Specifying the HL7v2 VMR is in use.

A9.2.2 Implementing each element of the HL7v2 VMR

A9.2.2.1 HL7v2 VMR OBX implementation table

AnchorA9.T.1A9.T.1A9.T.1 HL7v2 VMR OBX implementation table

A9.2.2.2 OBX-2 DataType (ID)

A9.2.2.3 OBX-3 Observation Identifier (CE)

A9.2.3.4 OBX-4 Observation sub-ID (ST)

A9.2.3.4.1 Example of use of Past Illness VMR elements

A9.2.3.4.2 Use of complex OBX-4 with multiple nested repeating elements

A9.2.3.5 OBX-5 Observation value (*)

A9.3 Value Domain Tables

AnchorTable-FAMMEMBTable-FAMMEMBTable HL7 v3 FamilyMember Value set

Anchor
A9.T.1
A9.T.1
A9.T.1 HL7v2 VMR OBX implementation table

Anchor
Table-FAMMEMB
Table-FAMMEMB
Table HL7 v3 FamilyMember Value set