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3.2.40 ADT/ACK - merge patient - internal ID (event A40)

A merge has been done at the internal identifier level. That is, two PID-3-patient ID (internal ID) identifiers have been merged into one.

An A40 event is used to signal a merge of records, for a patient that was incorrectly filed under two different internal IDs. The "incorrect source internal ID" identified in the MRG segment (MRG-1-prior patient ID (internal) is to be merged with the required "correct target internal ID" of the same ""identifier type code" component identified in the PID segment (PID-3-patient ID (internal ID)). The "incorrect source internal ID" would then logically never be referenced in future transactions. It is noted that some systems may still physically keep this "incorrect identifier" for audit trail purposes or other reasons associated with database index implementation requirements.

The internal IDs involved in identifying the patients may or may not have accounts, which may or may not have visits. An A40 (merge patient - internal ID) event, is intended for merging patient records without merging other subordinate identifiers. Any other subordinate identifiers that were previously associated with the "incorrect source internal ID" are now associated with the "correct target internal ID". Specification of these other subordinate identifiers is not required to be provided.

This event and the message syntax do, however, allow for the specification of any other "new subordinate identifiers" (in addition to the PID-3-patient ID (internal ID) identifier). For those environments that may require changes to these other subordinate identifiers because of the A40 (merge patient - internal ID) event, it is required that the old and new identifiers be a "tightly coupled" pair.

Each superior identifier associated with this internal identifier level should have the same value in both the PID and MRG segments.

See Section 3.5.2, "Merging patient/person information," for a discussion of issues related to the implementation of merge messages.

All data associated with the "correct target internal ID" are treated as updated information.

ADT     ADT Message        Chapter
MSH      Message Header         2
EVN     Event Type         3
{  PID    Patient Identification       3
   [ PD1]   Additional Demographics      3
   MRG     Merge Information        3
   [ PV1]   Patient Visit        3
}
ACK     General Acknowledgment     Chapter
MSH     Message Header        2
MSA     Message Acknowledgment      2
[ ERR ]    Error          2

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