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Req-976Record well-child data elements2013 FormatThe system MAY record values for an accepted list of well-child data elements through locally structured sets of values.Well Child/Preventive CareNormative Statementsno
Req-657Record vaccine refusal reasons2013 Format
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You are viewing the Abridged Children's EHR Format. To view the Full Children's EHR Format, you must first agree to the HL7 License Agreement.
ImmunizationsNormative Statementsno
Req-943Record umbilical cord blood gas2013 FormatThe system SHALL allow the recording of the umbilical cord blood gas results if available.Birth InformationNormative Statementsno
Req-929Record tocolytics administration2013 FormatThe system SHALL record whether mother received tocolytics and, if so, which one(sBirth InformationNormative Statementsno
Req-801Record time when mandated point-of-service testing occurred2013 Format
The system SHALL record the date and time with precision no less than the nearest clock hour when a mandated non-blood spot newborn screening occurred, as well as the specific modality and the results of...
The system SHALL record the date and time with precision no less than the nearest clock hour when a mandated non-blood spot newborn screening occurred, as well as the specific modality and the results of the screen using standard codified terms (e.g., SNOMED-CT Presently, this is only newborn hearing screening. Multiple screenings at multiple times may occur.
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Newborn ScreeningNormative Statementsno
Req-900Record singleton, twin, or multiple gestation2013 FormatThe system SHALL record whether the infant is a singleton, twin, or multiple gestation.Birth InformationNormative Statementsno
Req-812Record reporting of newborn screening results to the state health department2013 FormatThe system SHALL record that the diagnosis for those with an out-of-range or insufficient newborn screening result was provided to the state public health department according to their guidelines.Newborn ScreeningNormative Statementsno
Req-803Record refusal of point-of-service testing2013 FormatThe system SHALL capture refusal of non-blood spot newborn screening (e.g., newborn hearing screening if such screening is refused by the child's legal guardian.Newborn ScreeningNormative Statementsno
Req-802Record refusal of newborn dried blood spot testing2013 FormatThe system SHALL capture refusal of newborn dried blood spot if such screening is refused by the child's legal guardian.Newborn ScreeningNormative Statementsno
Req-980Record preventive procedures independently2013 FormatThe system SHALL record values for age-appropriate preventive procedures in a way that enables them to be retrieved independent of other history.Well Child/Preventive CareNormative Statementsno
Req-813Record parental notification of newborn screening diagnosis2013 FormatThe system SHALL record that the child's legal guardians were notified of any newborn screening-related diagnosis.Newborn ScreeningNormative Statementsno
Req-936Record mechanism of delivery2013 FormatThe system SHALL record the mechanism of delivery (Spontaneous Vaginal Delivery or SVD, Assisted Vaginal Delivery, Precipitous Vaginal Delivery, Emergent Cesarean section, Elective Cesarean sectionBirth InformationNormative Statementsno
Req-981Record locally structured values for preventive procedures2013 FormatThe system MAY record values for age-appropriate preventive procedures through locally structured sets of values.Well Child/Preventive CareNormative Statementsno
Req-848Record head circumference precisely2013 FormatThe system SHALL record head circumference at least to the half centimeter, or quarter inch, based on user preference, and record the date of measure.Growth Data, Well Child/Preventive CareNormative Statementsno
Req-811Record final diagnosis for abnormal newborn screening results2013 FormatThe system SHALL record the final diagnosis for those with out-of-range or insufficient newborn screening results. This includes 'Normal' or the particular diagnosis.Newborn ScreeningNormative Statementsno
Req-815Record diagnoses on patient problem summary list2013 FormatThe system SHOULD include all diagnoses resulting from newborn screening other than 'Normal' on a patient problem summary list.Newborn ScreeningNormative Statementsno
Req-957Record delivery room procedures2013 FormatThe system SHALL record any procedures performed in the delivery room including intubation, thoracocentesis, line placement, etc., and their timing.Birth InformationNormative Statementsno
Req-937Record delivery assistance2013 FormatThe system SHALL record if any delivery assistance was required (No Assistance, Forceps, Mid Forceps, High Forceps, or Vacuum ExtractionBirth InformationNormative Statementsno
Req-935Record color of amniotic fluid2013 FormatThe system SHALL record the color of amniotic fluid (clear, cloudy, bloody, light meconium, moderate meconium, thick meconium, terminal meconiumBirth InformationNormative Statementsno
Req-861Record clothes/diaper status when weighed2013 FormatThe system SHALL record whether clothes or diaper were on when weighed.Growth Data, Well Child/Preventive CareNormative Statementsno
Req-979Record age-appropriate preventive procedures2013 FormatThe system SHALL enable users to record age-appropriate preventive procedures as specified in an accepted source.Well Child/Preventive CareNormative Statementsno
Req-974Record age-appropriate interim/initial history2013 FormatThe system SHALL enable users to record an age-appropriate interim/initial history as cited in an accepted source.Well Child/Preventive CareNormative Statementsno
Req-984Record age-appropriate Anticipatory Guidance2013 FormatThe system SHALL enable users to record age-appropriate anticipatory guidance as specified in an accepted source.Well Child/Preventive CareNormative Statementsno
Req-106Record Management2013 Format
For those functions related to data capture, data may be captured using standardized code sets or nomenclature, depending on the nature of the data, or captured as unstructured data. Care-setting dependent data is entered by...
For those functions related to data capture, data may be captured using standardized code sets or nomenclature, depending on the nature of the data, or captured as unstructured data. Care-setting dependent data is entered by a variety of caregivers. Details of who entered data and when it was captured should be tracked. Data may also be captured from devices or other tele-health applications.
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Birth Information, Child Welfare, Genetic information, Growth Data, Immunizations, Parents and Guardians and Family Relationship Data, Patient Identifier, Patient Portals...
Birth Information, Child Welfare, Genetic information, Growth Data, Immunizations, Parents and Guardians and Family Relationship Data, Patient Identifier, Patient Portals - PHR, Prenatal Screening, Primary Care Management, Well Child/Preventive Care
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Headerno
Req-986Record Anticipatory Guidance through locally structured values2013 FormatThe system SHOULD record values for anticipatory guidance through locally structured sets of values, enabling additional or modified guidance.Well Child/Preventive CareNormative Statementsno
Req-985Record Anticipatory Guidance independently2013 FormatThe system SHOULD record values for anticipatory guidance in a way that enables the history of provision of guidance to be retrieved (individually and collectively independent of other history, subject to practice preferences.Well Child/Preventive CareNormative Statementsno
Req-690Recommend required immunizations per schedules2013 FormatThe system SHALL provide the ability to recommend required immunizations, and when they are due, during an encounter based on widely accepted immunization schedules.EPSDT, ImmunizationsNormative Statementsno
Req-1238Re-prescribe medications2013 Format
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You are viewing the Abridged Children's EHR Format. To view the Full Children's EHR Format, you must first agree to the HL7 License Agreement.
Medication ManagementNormative Statementsyes
Req-1258Questionnaires with flow logic and validation rules2013 FormatThe system SHOULD have the ability to create questionnaires that incorporate flow logic and validation rules.
Well Child/Preventive CareNormative Statementsno
Req-426Provide unit conversions calculation and display during data entry and display2013 FormatThe system SHALL provide unit conversions calculation and display during data entry and display (e.g. lbs/kgGrowth DataNormative Statementsno
Req-814Provide educational material from health department for newborn screening conditions2013 FormatThe system SHOULD provide parent educational material available from the state public health department regarding the appropriate newborn screening-related condition.Newborn ScreeningNormative Statementsno
Req-1077Provide access to order sets, provider/patient educational materials, and preventative care referrals2013 FormatThe system SHALL provide access to age specific order sets relevant to proposed preventive careWell Child/Preventive CareNormative Statementsno
Req-810Provide ACT sheets to clinicians after out-of-range newborn screening result2013 FormatThe system SHOULD provide guidance to clinicians about the management of an out-of-range newborn screening result by providing the HRSA-funded ACT sheets.Newborn ScreeningNormative Statementsno
Req-684Propagate identical data for related patients2013 FormatIF related patients register with any identical data, THEN the system SHOULD provide the ability to propagate that data to all their records.Parents and Guardians and Family Relationship DataNormative Statementsno
Req-1089Prompts to discuss health risks2013 FormatThe system MAY prompt the care provider to discuss additional health matters identified by the health risk assessment or history.Well Child/Preventive CareNormative Statementsno
Req-1088Prompts to discuss additional health matters2013 FormatThe system MAY prompt the care provider to discuss additional health matters potentially related to the anticipated activity for which clearance is sought.Activity Clearance, Well Child/Preventive CareNormative Statementsno
Req-98Prompts for safety interventions2013 FormatThe system SHOULD prompt the care provider to recommend specific safety interventions such as warm-up exercises and or equipment based on sport or activity.Activity ClearanceNormative Statementsno
Req-983Prompts for re-screening2013 FormatThe system SHOULD provide prompts regarding re-screening.EPSDT, Well Child/Preventive CareNormative Statementsno
Req-89Prompts for local neonatal screening2013 FormatThe system SHALL have the ability to prompt the care provider to perform all locally required neonatal screening tests.Newborn ScreeningNormative Statementsno
Req-1122Produce completed forms from EHR data2013 FormatThe system SHOULD produce paper and electronic forms (e.g. for camp, school, or child care and complete them with information from the patient record (both examination and immunization recordImmunizations, Well Child/Preventive CareNormative Statementsno
Req-267Produce a Summary Record of Care2013 Format
STATEMENT: Present a summarized review of a patient's comprehensive EHR, subject to jurisdictional laws and organizational policies related to privacy and confidentiality.
DESCRIPTION: Create summary views and reports at the conclusion of an episode of...
STATEMENT: Present a summarized review of a patient's comprehensive EHR, subject to jurisdictional laws and organizational policies related to privacy and confidentiality.
DESCRIPTION: Create summary views and reports at the conclusion of an episode of care. Create service reports at the completion of an episode of care such as, but not limited to, discharge summaries and public health reports, without additional input from clinicians.
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Primary Care Management, Well Child/Preventive CareFunctionno
Req-1249Problem-specific age of consent2013 FormatThe system SHALL record the age of consent for specific problems and/or diagnosis.Security and ConfidentialityNormative Statementsno
Req-1085Prioritized list of recommended preventive care2013 FormatThe system SHOULD provide a prioritized list of recommended age specific preventive care based on a patient's previously completed preventive care, documented risk factors, and interest in specific preventive care.EPSDT, Well Child/Preventive CareNormative Statementsno
Req-1137Printed Vaccine Information Statement Sheet2013 FormatThe system SHALL provide the ability to produce official paper Vaccine Information Statement Sheets as required by Federal Law to be given to caregivers or patients at the point and time of vaccine administration.ImmunizationsNormative Statementsno
Req-630Print growth chart2013 Format
Lorem, ipsum, dolor, sit, amet, consectetur, adipiscing, elit, Ut, egestas, dolor, nec, ipsum, luctus, non, varius, felis, blandit, Quisque, facilisis, pellentesque, nisi, Sed, rutrum, sodales, nisl, Duis, mattis, ipsum, a, laoreet, pharetra, quam, eros, porta, nisl, eget, pellentesque, augue, purus, eu, nunc
You are viewing the Abridged Children's EHR Format. To view the Full Children's EHR Format, you must first agree to the HL7 License Agreement.
Growth DataNormative Statementsno
Req-667Preserve concept interpretations across terminology versions2013 Format
Lorem, ipsum, dolor, sit, amet, consectetur, adipiscing, elit, Ut, egestas, dolor, nec, ipsum, luctus, non, varius, felis, blandit, Quisque, facilisis, pellentesque, nisi, Sed, rutrum, sodales, nisl, Duis, mattis, ipsum, a, laoreet, pharetra, quam, eros, porta, nisl, eget, pellentesque, augue, purus, eu, nunc
You are viewing the Abridged Children's EHR Format. To view the Full Children's EHR Format, you must first agree to the HL7 License Agreement.
Special Terminology and InformationNormative Statementsno
Req-1158Preserve codification of maternal data2013 FormatMaternal data, when captured into the child's chart, SHOULD preserve codification when codified in the maternal chart.Prenatal ScreeningNormative Statementsno
Req-1261Present questionnaire results to medical staff2013 FormatThe system SHALL be able to present questionnaire results to the medical staff in a usable format which includes both individual data elements and aggregate scores.
Well Child/Preventive CareNormative Statementsno
Req-1265Present questionnaire results like lab data2013 FormatThe system SHALL present questionnaire results in lab-like format indicating values that are outside the range of normal.Well Child/Preventive CareNormative Statementsno
Req-1269Present patient/caregiver questionnaires within the EHR2013 FormatThe system SHOULD have the ability to present patient/caregiver questionnaires to clinicians within the EHR.Well Child/Preventive CareNormative Statementsno
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