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