Category 3 Case 2 - NIST

2014 Edition Test Data for ?170.314.f.6 Transmission to cancer registries

Category 3

English Story Dr. Will Hert discusses systemic treatment options with the patient, Joan Gibson, for her stage 4 malignant melanoma of the right back. Ongoing problems that are currently being monitored include Alzheimer's Disease and malignant melanoma. Options include interferon-2, clinical trial or no treatment. After discussing potential benefits and side effects, patient elects to receive high-dose interferon-2. If the lung lesion does not respond or it progresses, the patient will be referred to a surgical oncologist for resection. The patient receives the first dose during the visit.

Data Tab Cat3 Case2

Category 3 Case 2

templateID 2.16.840.1.1138 83.10.20.3

2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3

Data Element

Header Date Case Report Exported Patient Last Name Patient Name Suffix Patient First Name Patient Middle Name Patient Maiden Name Patient Name Alias Patient Address Patient Street Address

City

State

1 | P a g e

Postal Code Country Start Date End Date Patient Street Address City

Code/Value

9/12/2012 GIBSON

JOAN SHANNON HAYES

5517 Main Street Hallandale FL 33008 USA 7/1/1988 2/28/2007 910 Western Street Altoona

Display Name United States

Code System OID

2.16.840.1.1138 83.6.92 2.16.840.1.1138 83.6.231 1.0.3166.1

Code System Name

FIPS 5-2 (State) US Postal Codes ISO 3166-1

Conformance

SHALL SHALL SHOULD SHALL SHALL SHOULD SHOULD SHALL SHALL SHALL SHALL SHALL SHALL SHALL SHALL SHALL SHALL

2014 Edition Test Data for ?170.314.f.6 Transmission to cancer registries

State

IA

Iowa

2.16.840.1.113883 .10.20.3

Postal Code

Country Address History: Start Date Address History: End Date Patient Telephone

50009 USA

3/1/2007

305-8882323

United States

2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3

2.16.840.1.113883 .10.20.3

Patient Sex/Gender Patient Date of Birth Patient Medical Record Number

F 3/29/1943

223212-9

Female

2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 1.3.6.1.4.1.19376. 1.7.3.1.1.14.1 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3 2.16.840.1.113883 .10.20.3

2.16.840.1.113883 2 | P a g e

Patient Social Security Number

Patient Race Patient Race (multiple) Patient Ethnicity Patient Birth Place Patient Marital Status Physician Name Physician ID (NPI) Physician Street Address

City

State

Postal Code Country

555-00-1434 2106-3

2135-2 CO W Will Hert 1723634995 12365 Juniper Court Altoona IA 50009 USA

White Hispanic or Latino Colorado Widowed

Iowa United States

2.16.840.1.1138 83.6.92 2.16.840.1.1138 83.6.231

1.0.3166.1

FIPS 5-2 (State)

US Postal Codes ISO 3166-1

SHALL

SHALL SHALL

SHALL

SHALL

HL7

2.16.840.1.1138 Administrative

83.5.1

Gender

SHALL SHALL

SHALL

2.16.840.1.1138 83.4.1 2.16.840.1.1138 83.6.238 2.16.840.1.1138 83.6.238 2.16.840.1.1138 83.6.238 2.16.840.1.1138 83.6.92 2.16.840.1.1138 83.5.2

United States Social Security Administration (SSA) Race & Ethnicity - CDC Race and Ethnicity - CDC Race and Ethnicity - CDC

FIPS 5-2 (State) HL7 Marital Status

SHALL

SHALL SHALL MAY SHALL SHALL SHALL

2.16.840.1.1138

83.4.6

NPI

SHALL SHALL

2.16.840.1.1138 83.6.92 2.16.840.1.1138 83.6.231

FIPS 5-2 (State) US Postal Codes

SHALL SHALL SHALL

1.0.3166.1

ISO 3166-1

SHALL SHALL

2014 Edition Test Data for ?170.314.f.6 Transmission to cancer registries .10.20.3

2.16.840.1.113883 Physician

.10.20.3

email

2.16.840.1.113883 Physician

.10.20.3

Telephone

5154399912

Hematology & Oncology

2.16.840.1.113883 Physician

.10.20.3

specialty

[Internal 207RH0003X Medicine]

Provider

2.16.840.1.113883 Organization

.10.20.3

ID

9871234466

Provider

2.16.840.1.113883 Organization

.10.20.3

Name

Prairie Meadows Clinic

Provider

2.16.840.1.113883 Organization 12365

.10.20.3

Street Address Juniper Court

2.16.840.1.113883

.10.20.3

City

Altoona

2.16.840.1.113883

.10.20.3

State

IA

2.16.840.1.113883

.10.20.3

Postal Code

50009

2.16.840.1.113883

.10.20.3

Country

USA

United States

Provider 2.16.840.1.113883 Organization

.10.20.3

Telephone

5154399912

2.16.840.1.113883 [Encompassin

.10.20.3

g Encounter]

Provider

1.3.6.1.4.1.19376. Referred From

1.4.1.3.1

ID (NPI)

Provider

1.3.6.1.4.1.19376. Referred From

1.4.1.3.1

Name

Provider

2.16.840.1.113883 Referred From

.10.20.3

Street Address

2.16.840.1.113883

.10.20.3

City

2.16.840.1.113883

.10.20.3

State

2.16.840.1.113883

.10.20.3

Postal Code

2.16.840.1.113883

.10.20.3

Country

3 | P a g e

NUCC Health

2.16.840.1.1138 Care Provider

83.6.101

Taxonomy

2.16.840.1.1138

83.4.6

NPI

SHALL SHALL

SHALL SHALL

SHALL

SHALL

2.16.840.1.1138 83.6.92 2.16.840.1.1138 83.6.231

FIPS 5-2 (State) US Postal Codes

SHALL SHALL SHALL

SHALL

SHALL SHALL

SHALL

SHALL

SHALL

2.16.840.1.1138 83.6.92 2.16.840.1.1138 83.6.231

FIPS 5-2 (State) US Postal Codes

SHALL SHALL SHALL

SHALL

2014 Edition

Test Data for ?170.314.f.6 Transmission to cancer registries

Provider

2.16.840.1.113883 Referred From

.10.20.3

Telephone

Coded Social

1.3.6.1.4.1.1937 History

6.1.5.3.1.3.16.1 Section

1.3.6.1.4.1.19376. 1.5.3.1.4.13.4 1.3.6.1.4.1.19376. 1.5.3.1.4.13.4 1.3.6.1.4.1.19376. 1.5.3.1.4.13.4 1.3.6.1.4.1.1937 6.1.5.3.1.1.5.3.7

Usual Occupation

4600

Usual Industry Smoking Status Payers Section

8470 4280410001 24106

Childcare workers Child day care services Current some day smoker

1.3.6.1.4.1.19376. 1.5.3.1.4.17

1.3.6.1.4.1.1937 6.1.7.3.1.3.14.1

1.3.6.1.4.1.19376. 1.7.3.1.3.14.1 1.3.6.1.4.1.19376. 1.7.3.1.4.14.1 1.3.6.1.4.1.19376. 1.7.3.1.4.14.1 1.3.6.1.4.1.19376. 1.7.3.1.4.14.1

1.3.6.1.4.1.19376. 1.7.3.1.4.14.1

Primary Payer at Diagnosis

Cancer Diagnosis Section

Narrative Cancer Diagnosis Entry Diagnosis Date Histologic Type

Behavior

61 MP

Stage 4 Malignant Melanoma of the trunk

8/15/2012 8720 M8720/3 2092003 3

Medicare Other Medicare Primary

Malignant Melanoma Malignant melanoma NOS Malignant Melanoma Malignant, Primary

1.3.6.1.4.1.19376. Diagnostic

1.7.3.1.4.14.1

confirmation 1

1.3.6.1.4.1.19376. 1.7.3.1.4.14.1

4 | P a g e

Primary Site

172.5

Positive Histology Malignant Melanoma of the trunk, except scrotum

2.16.840.1.1138 83.6.240 2.16.840.1.1138 83.6.310 2.16.840.1.1138 83.6.96

2.16.840.1.1138 83.3.221.5 2.16.840.1.1138 83.6.255

2.16.840.1.1138 83.6.43.1 2.16.840.1.1138 83.6.103 2.16.840.1.1138 83.6.96 2.16.840.1.1138 83.3.520.3.14 2.16.840.1.1138 83.3.520.3.3

2.16.840.1.1138 83.6.103

U.S. Census Occupation Code U.S. Census Industry Code SNOMEDCT

Source of Payment Typology (PHDSC) X12 Data Element 1336

ICD-O-3 ICD-9-CM SNOMEDCT NAACCR Behavior Code NAACCR Diagnostic Confirmation

ICD-9CM (diagnoses)

SHALL

SHALL SHALL SHALL SHALL SHALL

SHOULD SHOULD

SHALL

SHALL SHALL SHALL SHALL SHALL SHALL SHALL SHALL

SHALL

2014 Edition Test Data for ?170.314.f.6 Transmission to cancer registries

Entire skin of back (body 181492002 structure)

1.3.6.1.4.1.19376.

1.7.3.1.4.14.1

Laterality

1

1.3.6.1.4.1.19376. TNM Clinical

1.7.3.1.4.14.2

Stage Entry

1.3.6.1.4.1.19376. TNM Clinical

1.7.3.1.4.14.2

Stage Group IV

TNM Clinical

1.3.6.1.4.1.19376. Stage

1.7.3.1.4.14.2

Descriptor

0

1.3.6.1.4.1.19376.

1.7.3.1.4.14.2

TNM Edition 7

1.3.6.1.4.1.19376. 1.7.3.1.4.14.2 1.3.6.1.4.1.19376. 1.7.3.1.4.14.2 1.3.6.1.4.1.19376. 1.7.3.1.4.14.2 1.3.6.1.4.1.19376. 1.7.3.1.4.14.2 1.3.6.1.4.1.19376. 1.7.3.1.4.14.2

TNM Clinical

Staged By

3

TNM Clinical T T2b

Date/Time

9/12/2012

TNM Clinical N N0

Date/Time

9/12/2012

Right

None AJCC Staging Manual, 7th Edition Pathologist and managing physician

1.3.6.1.4.1.19376. 1.7.3.1.4.14.2 1.3.6.1.4.1.19376. 1.7.3.1.4.14.2

1.3.6.1.4.1.1937 6.1.5.3.1.3.6 1.3.6.1.4.1.19376. 1.5.3.1.4.5.2

TNM Clinical M

Date/Time Active Problems Section problem start date

M1 9/12/2012

5/22/2008

1.3.6.1.4.1.19376. 1.5.3.1.4.5.2 1.3.6.1.4.1.19376. 1.5.3.1.4.5.2 1.3.6.1.4.1.19376. 1.5.3.1.4.5.2 1.3.6.1.4.1.19376. 1.55.|3P.1.a4g.5e.2

problem stop date

Problem

Problem Status

331.0 26929004 ACTIVE

Alzheimer's disease Alzheimer's disease

2.16.840.1.1138 83.6.96 2.16.840.1.1138 83.3.520.3.1

2.16.840.1.1138 83.15.6 2.16.840.1.1138 83.3.520.3.10 2.16.840.1.1138 83.3.520.3.5 2.16.840.1.1138 83.3.520.3.4 2.16.840.1.1138 83.3.520.3.6

2.16.840.1.1138 83.3.520.3.7

2.16.840.1.1138 83.3.520.3.8

2.16.840.1.1138 83.6.103 2.16.840.1.1138 83.6.96

Body Site (SNOMEDCT) NAACCR Laterality at Diagnosis

TNM 7th Edition NAACCR TNM Clinical Stage Descriptor NAACCR TNM Edition Number NAACCR TNM Clinical Staged By NAACCR TNM Clinical Tumor

NAACCR TNM Clinical Node

NAACCR TNM Clinical Metastasis

ICD-9CM (diagnoses) SNOMEDCT

SHALL

SHALL SHOULD SHALL

SHALL

SHALL

SHALL SHALL SHALL SHALL SHALL

SHALL SHALL

SHALL SHALL SHALL (when Problem Status=complete d or aborted) SHALL NOT (when Problem Status does not = completed or aborted) SHALL SHALL SHALL

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download