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11.5.1 RF1 - referral information segment

This segment represents information that may be useful when sending referrals from the referring provider to the referred-to provider.

Figure 11-2. RF1 attributes

SEQ

LEN

DT

OPT

RP/#

TBL#

ITEM#

ELEMENT NAME

1

200

CE

O


0283

01137

Referral Status

2

200

CE

O


0280

01138

Referral Priority

3

200

CE

O


0281

01139

Referral Type

4

200

CE

O

Y

0282

01140

Referral Disposition

5

200

CE

O


0284

01141

Referral Category

6

30

EI

R



01142

Originating Referral Identifier

7

26

TS

O



01143

Effective Date

8

26

TS

O



01144

Expiration Date

9

26

TS

O



01145

Process Date

10

200

CE

O

Y

0336

01228

Referral Reason

11

30

EI

O

Y


01229


11.5.1.0 RF1 - field definitions

11.5.1.1 Referral status (CE) 01137

Components: <identifier (ID)> ^ <text (ST)> ^ <name of coding system (ST)>^<alternate identifier (ID)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the status of the referral as defined by either the referred-to or the referred-by provider. Refer to user-defined table 0283 - Referral status for suggested values.

User-defined Table 0283 - Referral status

Value

Description

A

Accepted

P

Pending

R

Rejected

E

Expired

11.5.1.2 Referral priority (CE) 01138

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the urgency of the referral. Refer to user-defined table 0280 - Referral priority for suggested values.

User-defined Table 0280 - Referral priority

Value

Description

S

STAT

A

ASAP

R

Routine

11.5.1.3 Referral type (CE) 01139

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the type of referral. It is loosely associated with a clinical specialty or type of resource. Refer to user-defined table 0281 - Referral type for suggested values.

User-defined Table 0281 - Referral type

Value

Description

LAB

Laboratory

RAD

Radiology

MED

Medical

SKN

Skilled Nursing

PSY

Psychiatric

HOM

Home Care

11.5.1.4 Referral disposition (CE) 01140

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the type of response or action that the referring provider would like from the referred-to provider. Refer to user-defined table 0282 - Referral disposition for suggested values.

User-defined Table 0282 - Referral disposition

Value

Description

WR

Send Written Report

RP

Return Patient After Evaluation

AM

Assume Management

SO

Second Opinion

11.5.1.5 Referral category (CE) 01141

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the location at which the referral will take place. Refer to user-defined table 0284 - Referral category for suggested values.

User-defined Table 0284 - Referral category

Value

Description

I

Inpatient

O

Outpatient

A

Ambulatory

E

Emergency

11.5.1.6 Originating referral identifier (EI) 01142

Components: <entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID)>

Definition: This field contains the originating application’s permanent identifier for the referral. This is a composite field.

The first component is a string of up to 15 characters that identifies an individual referral. It is assigned by the originating application, and it identifies a referral, and the subsequent referral transactions, uniquely among all such referrals from a particular processing application.

The second component contains the application identifier for the originating application. The application identifier is a string of up to 15 characters that is uniquely associated with an application. A given healthcare provider facility, or group of intercommunicating healthcare provider facilities, should establish a unique list of applications that may be potential originators and recipients, and then assign unique application identifiers to each of those applications. This list of application identifiers becomes one of the healthcare provider facility’s master dictionary lists. Since applications fulfilling different application roles can send and receive referral messages, the assigning authority application identifier may not identify the application sending or receiving a particular message. Data elements on the Message Header (MSH) segment are available to identify the actual sending and receiving applications.

11.5.1.7 Effective date (TS) 01143

Definition: This field contains the date that the referral is effective.

11.5.1.8 Expiration date (TS) 01144

Definition: This field contains the date that the referral expires.

11.5.1.9 Process date (TS) 01145

Definition: This field contains the date that the referral originated. It is used in cases of retroactive approval.

11.5.1.10 Referral reason (CE) 01228

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the reason for which the referral will take place. Refer to user-defined table 0336 - Referral reason for suggested values.

User-defined Table 0336 - Referral reason

Value

Description

S

Second Opinion

P

Patient Preference

O

Provider Ordered

W

Work Load

11.5.1.11 External referral identifier (EI) 01229

Components: <entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID)>

Definition: This field contains an external application’s permanent identifier for the referral. That is, this referral identifier does not belong to the application which originated the referral and assigned the originating referral identifier.

The first component is a string of up to 15 characters that identifies an individual referral. It is typically assigned by the referred-to provider application responding to a referral originating from a referring provider application, and it identifies a referral, and the subsequent referral transactions, uniquely among all such referrals for a particular referred-to provider processing application. For example, when a primary care provider (referring provider) sends a referral to a specialist (referred-to provider), the specialist’s application system may accept the referral and assign it a new referral identifier which uniquely identifies that particular referral within the specialist’s application system. This new referral identifier would be placed in the external referral identifier field when the specialist responds to the primary care physician.

The second component contains the application identifier for the originating application. The application identifier is a string of up to 15 characters that is uniquely associated with an application. A given healthcare provider facility, or group of intercommunicating healthcare provider facilities, should establish a unique list of applications that may be potential originators and recipients, and then assign unique application identifiers to each of those applications. This list of application identifiers becomes one of the healthcare provider facility’s master dictionary lists. Since applications fulfilling different application roles can send and receive referral messages, the assigning authority application identifier may not identify the application sending or receiving a particular message. Data elements on the Message Header (MSH) segment are available to identify the actual sending and receiving applications.

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