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Data Elements Collected per Circular Letter DHCQ 08-03-483 and additional data elements Field Name(R)equiredNon-Trauma Centers Trauma Centers?(C)onditionally?RequiredFilingOrgId RXXSiteOrgID RXXInter-Facility Transfer RXXSiteOrgID of Transferring Hospital C1XXDischarge Time from Transferring Hospital Retired June 2016XXEMS Unit Departure Time from Scene and Transferring Hospital RXXED/Hospital Admission Date RXXED/Hospital Admission Time RXXLocation of Direct Admission Retired June 2016XXMedical Record NumberRXXSocial Security Number RXXDate of Birth RXXGender RXXPatient’s Home Street Address RXXPatient’s Home City RXXPatient’s Home Zip/Postal Code RXXInjury Incident Date RXXInjury Incident Time RXXWork-related RXXIncident City RXXIncident State RXXTransport ModeRXXAlcohol Use Indicator C2?XDrug Use Indicator C3?XPrimary Ecode ICD-9-CM RXXICD-10-CM Primary External Cause code RXXLocation Ecode ICD-9-CM RXXICD-10-CM Location External Cause Code RXXInitial ED/Hospital Glasgow Eye Component in EDC4?XInitial ED/Hospital Glasgow Verbal Component in EDC5?XInitial ED/Hospital Glasgow Motor Component in EDC6?XGlasgow Coma Score Total in the EDC7?XGlasgow Coma Score Assessment Qualifier in the EDC8?XRespiration Rate RXXSystolic Blood Pressure RXXPulse Rate RXXICD-9-CM Diagnosis CodeRXXICD-10-CM Diagnosis Code RXXAIS (numerical identifier for predot code and severity code)R?XAIS Version R?XProtective Devices R?XChild Specific restraint C9?XAirbag Deployment C10?XCo-Morbid Conditions R?XComplications R?XPatient's Home Country C11XXPatient's Home County C12XXAlternate Home Residence RXXAge RXXAge Units RXXRace RXXEthnicity RXXPatient's Occupational Industry C13?XPatient's Occupation C14XXICD-9 Additional External Cause Code Not being added?XICD-10-CM Additional External Cause Code R?XIncident Location Zip/Postal Code RXXIncident Country R?XIncident County R?XReport of Physical Abuse RXXInvestigation of Physical Abuse C15?XCaregiver at Discharge C16?XEMS Dispatch Date RXXEMS Dispatch Time RXXEMS Unit Arrival Date at Scene or Transferring FacilityRXXEMS Unit Arrival Time at Scene or Transferring FacilityRXXEMS Unit Departure Date from Scene or Transferring FacilityRXXOther Transport ModeR?XInitial Field Systolic Blood PressureR?XInitial Field Pulse RateR?XInitial Field Respiratory RateR?XInitial Field Oxygen SaturationR?XInitial Field GCS - EyeR?XInitial Field GCS - VerbalR?XInitial Field GCS - MotorR?XInitial Field GCS - TotalR?XTrauma Center CriteriaR?XVehicular, Pedestrian, Other Risk InjuryR?XPre-Hospital Cardiac ArrestRXXInitial ED/Hospital TemperatureR?XInitial ED/Hospital Respiratory AssistanceR?XInitial ED/Hospital Oxygen SaturationR?XInitial ED/Hospital Supplemental OxygenR?XInitial ED/Hospital HeightR?XInitial ED/Hospital WeightR?XED Discharge Disposition RXXSigns of LifeR?XED Discharge DateRXXED Discharge TimeRXXICD-9 Hospital ProceduresNot being added?XICD-10-CM Hospital ProceduresR?XHospital Procedure Start DateR?XHospital Procedure Start TimeR?XTotal ICU Length of StayR?XTotal Ventilator DaysR?XHospital Discharge DateRXXHospital Discharge TimeC17?XHospital Discharge DispositionRXXPrimary Method of PaymentRXXDPH Facility Identification Numbers RXXService LevelR?XNOT APPICABLE may be coded as 1 in designated fieldsNOT KNOWN/UNKNOWN/NOT RECORDED may be coded as 2 in designated fieldsNOTE: EXPLANATION OF CONDITIONAL STATUS DATA ELEMENTS1. SiteOrgID of Transferring Hospital: Fill in when Inter-facility Transfer=1, 2. Alcohol Use Indicator: Not always known, 3. Drug Use Indicator: Not always known, 4. Initial Glasgow Eye Component in ED: Should be recorded within 30 minutes or less of arrival with first set of vitals, 5. Initial Glasgow Verbal:Component in ED: Should be recorded within 30 minutes or less of arrival with first set of vitals, 6. Initial Glasgow Motor Component in ED: Should be recorded within 30 minutes or less of arrival with first set of vitals, 7. Glasgow Coma Score Total in the ED: Should be recorded within 30 minutes or less of arrival with first set of vitals, 8. Glasgow Coma Score Assessment Qualifier in the ED: Glasgow not always recorded. 9. Child Specific restraint: Only for pediatric patientsAnd protective devices=6; 10. Airbag Deployment: Only for patients involved in Motor Vehicle crashes and ProtectiveDevices=8. 11. Patient’s Home Country: Fill in when patient zip code is known, 12. Patient’s Home County: Fill in when US only, 13. Patient’s Occupational Industry: Fill in when Work-related field=1, 14. Patient’s Occupation: Fill in when Work-related field=1, 15. Investigation of Physical Abuse: Fill in when Report of Physical Abuse=1, 16. Caregiver at Discharge:Fill in when Report of Physical Abuse=1, 17. Hospital Discharge Time: Fill in when ED Discharge Disposition = 1-3, 7, 8, 12-14 ................
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