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HITSP C76 Case Report Pre-Populate Component


Type:Data Agreement
Start Date:2008-12-18
Scope:This section describes the contents of this specification and provides a high level definition of this Component and background information about the underlying standards that the Component is based on.
The HITSP Case Report Pre-Populate Component supports the Data Mapping needed for Public Health Case Reports including:
- Drug Safety
- Device Safety
- Drug Administration Management
- Vaccine Adverse Event Report
- Food Safety
- Reportable Disease Reports
- Health Associated Infection
Other Healthcare safety reports other than Infection (e.g. falls) (including sentinel events; all never-events, anything that may become a never-event; AHRQ)
This Component addresses pre-populating a form supported by HITSP/TP50 Retrieve Form for Data Capture. It supports only those data attributes that are universal or that pertain to drug safety reporting. For those attributes that are available in a CDA document this Component may be used in support of pre-populating the report. For those attributes that are universal for case reporting but not available in a CDA document refer to the Interoperability Specification for any further information or specific constraints. Other public health specific attributes will be addressed in subsequent releases.
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Relationship Organization Item
references HITSP HITSP C35 Lab Result Terminology Component Compare these items   
Relationship Organization Item
is composed of HITSP Administration of Treatment   
is composed of HITSP Admission Date   
is composed of HITSP Admission Date   
is composed of HITSP Age   
is composed of HITSP Birth Weight   
is composed of HITSP Common Device Name   
is composed of HITSP Concomitant Medical Product Name   
is composed of HITSP Contact Person   
is composed of HITSP Contact Phone Number   
is composed of HITSP Current Medications (Medwatch concomitant meds)   
is composed of HITSP Date of Administration of Treatment   
is composed of HITSP Date of Birth   
contains HITSP Date of Death   
is composed of HITSP Date of Event   
is composed of HITSP Date Report Sent   
is composed of HITSP Date Sent to FDA   
is composed of HITSP Date User Facility/ Importer Became Aware of Event   
is composed of HITSP Death   
is composed of HITSP Description of Event   
is composed of HITSP Diagnosis Type   
is composed of HITSP Diagnosis/ Injury Code   
is composed of HITSP Discharge Date   
is composed of HITSP Estimated Deliver Date   
is composed of HITSP Ethnicity   
is composed of HITSP Event Patient Problem Code   
is composed of HITSP Facility Identifier   
is composed of HITSP Facility/ Importer Name   
is composed of HITSP Gender   
is composed of HITSP Name of Condition   
is composed of HITSP Name of Treatment   
is composed of HITSP NDC# or Unique ID   
is composed of HITSP Number of Siblings   
is composed of HITSP Occupation of Reporter   
is composed of HITSP Patient Alias Name: First, Middle, Last (former names for management of adoptions and name changes)   
is composed of HITSP Patient Class   
is composed of HITSP Patient Country   
is composed of HITSP Patient Identifier   
is composed of HITSP Patient Name (first, MI, Last)   
is composed of HITSP Patient Telephone   
is composed of HITSP Pre-existing clinician diagnosed allergies, birth defects   
is composed of HITSP Pregnancy Status   
is composed of HITSP Previous Vaccine Date Given   
is composed of HITSP Previous Vaccine Lot #   
is composed of HITSP Previous Vaccine Manufacturer   
is composed of HITSP Previous Vaccine Route   
is composed of HITSP Previous Vaccine Type   
is composed of HITSP Product Dose   
is composed of HITSP Product Frequency   
is composed of HITSP Product Route Used   
is composed of HITSP Product Therapy Dates   
is composed of HITSP Race   
is composed of HITSP Report Date   
is composed of HITSP Report date/time   
is composed of HITSP Report sent to   
is composed of HITSP Report Source   
is composed of HITSP Reported Previously   
is composed of HITSP Reporter Address (street name, city, state, zip code)   
is composed of HITSP Reporter Email   
is composed of HITSP Reporter Name   
is composed of HITSP Responsible physician/ Health care provider name   
contains HITSP Result Unit   
is composed of HITSP Resulted Test   
is composed of HITSP Results Status   
is composed of HITSP State   
Relationship Organization Item
is a component of HITSP 17. Procedures   
is composed of HITSP DISCHARGE DIAGNOSIS SECTION   
is composed of HITSP HISTORY OF PRESENT ILLNESS SECTION   
is a component of HITSP Medication   
is composed of HITSP Personal Information   
is a component of HITSP Procedure   
Relationship Organization Item
is composed of HITSP Allergies/Adverse Event (Reaction)_VD   
is composed of HITSP Country_VD   
is composed of HITSP Diagnosis Type_VD   
is composed of HITSP Ethnicity_VD   
is composed of HITSP Medication Packaged Product Names_VD   
is composed of HITSP Medication Route_FDA _VD   
is composed of HITSP Medication Type_VD   
is composed of HITSP Patient Class V3 _VD   
is composed of HITSP Problem_VD   
is composed of HITSP Race_VD2   
is composed of HITSP State_VD   
is composed of HITSP Units of Measure_VD   
is composed of HITSP Vaccine Administered_VD   
is composed of HITSP Vaccine Manufacturer_VD   
HITSP Acronyms List
HITSP Harmonization Framework
HITSP Interoperability Specification Overview
HITSP TN 901 -Technical Note for Clinical Documents
Security and Privacy Technical Note
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