0. INTRODUCTION
1. SCOPE
   1. Functional definition
   2. Field of application
   3. Principles
2. REFERENCES
3. TERMS AND DEFINITIONS
   1. Standard terms and definitions
4. MESSAGE DEFINITION
   1. Data segment clarification
   2. Data segment index (alphabetical sequence)
   3. Message structure
      1. Segment table

This specification provides the definition of the Medical service report message (MEDRPT) to be used in Electronic Data Interchange (EDI) between trading partners involved in administration, commerce and transport.

A Medical Service Report message is sent from a service provider to the service requester to report new results on performed investigations, to modify a previous result item or a complete result report or to cancel a previous result report.

The Medical service report message may be used for both national and international applications. It is based on universal practice related to administration, commerce and transport, and is not dependent on the type of business or industry.

The message fulfils the requirements of the European pre-standard concerning messages for exchange of laboratory information within clinical chemistry, clinical biochemistry, toxicology, clinical immunology, immunohaematology, haematology and clinical microbiology. The message may, however, also be used for other purposes as long as the user requirements are met.

The CEN prENV New Laboratory Service Report message and the CEN prENV Laboratory Service Report Cancellation message may be considered as special cases of the CEN prENV Laboratory Service Report Modification message. The Laboratory Service Report Modification message may contain a mixture of new, change, cancel and other service types for the report itself and for the various result items whereas the New Laboratory Service Report message only contains the new service type for the report itself and the various result items and the Laboratory Service Report Cancellation message only contains the cancel service type for a complete report.

The overall structure of the message is:

• One message may include one or more service reports.
• Every report may relate to zero, one or more service orders.
• Every service report may contain one or more result items for the subject of investigation, each result item may be composed of zero, one or more other result items.
• Every service report is related to one main subject of investigation (patient, animal or material), but may also include information about related subjects of investigation.
• One message may report on one or more samples (from the same subject of investigation) or the subject of investigation itself.
• An investigation may be connected to one or more samples or to the subject of investigation itself.
• Every investigation may have one result.
• Every result item may have zero, one or more related service providers.

Most of the information sent from the requester to the receiving service provider may be returned to the requester in this message.

With the exception of information in FTX segments, all information should primarily be expressed as codes.

See UNTDID, Part 4, Chapter 2.6 UN/ECE UNSM - General Introduction, Section 1.

See UNTDID, Part 4, Chapter 2.6 UN/ECE UNSM - General Introduction, Section 2.

This section should be read in conjunction with the Segment Table which indicate mandatory, conditional and repeating requirements.

0010 UNH, Message header

A service segment starting and uniquely identifying a message. The message type code for the Medical service report message is MEDRPT.

Note: Medical service report messages conforming to this document must contain the following data in segment UNH, composite S009:

0020 BGM, Beginning of message

A segment for unique identification of the message and specification of its function.

0030 DTM, Date/time/period

A segment identifying the date and/or time of message generation and/or other dates and/or times concerning the whole message.

0040 FTX, Free text

A segment giving free text information, in coded or clear form, for specifying information concerning the whole message.

0050 Segment Group 1: PNA-ADR-COM-FTX-RFF-SEQ-LAN-SPR-QUA-EMP

A group of segments giving information about involved healthcare parties like the service requester, the service provider, parties to get copies of the results, related service providers, origin of clinical information, supervising healthcare party, healthcare administrative information, sample collector, sample collector location and/or other parties related to the message.

0060 PNA, Party identification

A segment for specifying the identification, name and address of involved healthcare organisations or professionals.

0070 ADR, Address

A segment for specifying the address of the actual healthcare party.

0080 COM, Communication contact

A segment giving communication numbers for the actual healthcare party.

0090 FTX, Free text

A segment with free text information, in coded or clear form, for specifying unstructured telecommunication numbers of the actual healthcare party including electronic mail address.

0100 RFF, Reference

A segment for specifying alternative identification numbers of the actual healthcare party assigned by the involved healthcare parties.

This segment also keeps a reference to another party if the current party is related to another party such as department in a hospital, a physician in a department, etc.

0110 SEQ, Sequence details

A segment for allocating a sequence number to the individual healthcare party allowing each healthcare party to be referenced from within the message.

0120 LAN, Language

A segment for specifying the language used by the actual healthcare party.

0130 SPR, Organisation classification details

A segment for specifying the type and medical speciality of a healthcare organisation.

0140 QUA, Qualification

A segment for specifying the professional medical qualifications of a person.

0150 EMP, Employment details

A segment for specifying the type, medical speciality and the position or military rank of a healthcare professional.

0160 Segment Group 2: IRQ-GIS-RFF-DTM-STS-PTY-LAN-FTX-TEM-SG3-SG4-

SG6 A group of segments giving information concerning a medical

0170 IRQ, Information required

A segment for specifying the requirements concerning acknowledgment of the report.

0180 GIS, General indicator

A segment for specifying the service type of the actual report, i.e. whether this is a new report, a modification to a previously issued report, etc.

0190 RFF, Reference

A segment for specifying the identification of the service report as provided by the service provider.

This segment also keeps a reference to a healthcare party related to this service report which is specified in segment group 1.

0200 DTM, Date/time/period

A segment for specifying the issue date and/or time of the report and/or other dates and/or times relevant to the report.

0210 STS, Status

A segment for specifying the status of the service report, i.e. whether it is a partial report, a complete report, etc.

0220 PTY, Priority

A segment for specifying the reporting priority of the service report.

0230 LAN, Language

A segment specifying the language of the actual report.

0240 FTX, Free text

A segment with free text information, in coded or clear form, for specifying the comments of the service provider concerning the complete report and/or the reason for cancellation.

0250 TEM, Test method

A segment for specifying the reason for cancellation of the complete report.

0260 Segment Group 3: RFF-DTM

A group of segments for specifying a reference to another service report.

0270 RFF, Reference

A segment for specifying the identification number of the referenced service report.

0280 DTM, Date/time/period

A segment specifying the issue date and/or time of the referenced service report.

0290 Segment Group 4: FCA-RFF-GIS-DTM-PTY-CIN-FTX-TEM-SG5

A group of segments specifying a service order related to the actual service report.

0300 FCA, Financial charges allocation

A segment giving information concerning payment category for this order.

0310 RFF, Reference

A segment for specifying the identification number of the order allocated by various healthcare parties, such as service requester, service provider, etc.

The segment is also used for referencing a related healthcare party specified in segment group 1.

0320 GIS, General indicator

A segment to provide the service type of the service order, i.e. new order, order modification, etc.

0330 DTM, Date/time/period

A segment specifying the dates and/or times concerning the order such as issue date of order, date of receipt, due date of report, etc.

0340 PTY, Priority

A segment specifying the requested reporting priority for the whole order.

0350 CIN, Clinical information

A segment for specifying the reason for request as well as comments from the requester as a diagnosis concerning this order.

0360 FTX, Free text

A segment with free text information, in coded or clear form, for specifying the reason for request as well as comments from the requester concerning this order.

0370 TEM, Test method

A segment for specifying the reason for the request.

0380 Segment Group 5: DOC-RFF-DTM

A group of segments for specifying a reference to another service order.

0390 DOC, Document/message details

A segment for specifying the document name.

0400 RFF, Reference

A segment for specifying the identification number of the referenced order.

0410 DTM, Date/time/period

A segment for specifying the issue date and/or time of the referenced order.

0420 Segment Group 6: ATT-RFF-ADR-COM-REL-IMD-FTX-PNA-DTM-PDI-

NAT-LAN-HAN-CCI-SG7-SG8-SG14-SG16 A group of segments specifying the subject of investigation.

0430 ATT, Attribute

A segment for specifying the type of subject of investigation.

0440 RFF, Reference

A segment for specifying the identification numbers of the actual subject of investigation.

0450 ADR, Address

A segment for specifying the address details of the subject of investigation.

0460 COM, Communication contact

A segment providing a telecommunication number of the subject or investigation.

0470 REL, Relationship

A segment for specifying the association between subjects of investigation such as donor, foetus, etc. as well as the relationship of a related person to the patient.

0480 IMD, Item description

A segment for specifying the description of the material being investigated if the subject of investigation is a material.

0490 FTX, Free text

A segment with free text information, in coded or clear form, for specifying additional information about the material as well as an unstructured telecommunication number of the subject of investigation.

0500 PNA, Party identification

A segment for identifying the patient and related person or name by specifying various patient name details and official patient ID.

0510 DTM, Date/time/period

A segment for specifying relevant date and/or times for the patient such as date of birth, date of death, etc.

0520 PDI, Person demographic information

A segment for specifying demographic information such as sex, marital status and religion.

0530 NAT, Nationality

A segment for specifying the nationality of a person.

0540 LAN, Language

A segment for specifying the language used by the person.

0550 HAN, Handling instructions

A segment for specifying the confidentiality constraints on patient data.

0560 CCI, Characteristic/class id

A segment for specifying the species or breed of an animal.

0570 Segment Group 7: PAS-LOC-DTM-RFF

A group of segments for specifying healthcare administrative information concerning the actual subject of investigation.

0580 PAS, Attendance

A segment for specifying patient administrative information such as administrative status concerning actual hospital stay or out-patient visit or ward stay related to the subject of investigation.

0590 LOC, Place/location identification

A segment for specifying the physical patient care location in terms of ward, room, bed, etc.

0600 DTM, Date/time/period

A segment for specifying admission and/or discharge date and time or start and/or end date and time of a ward stay.

0610 RFF, Reference

This segment keeps a reference to a healthcare party for specifying healthcare administrative information such as hospital, department, etc. where patient is admitted, located, etc.

0620 Segment Group 8: CAV-CIN-LAN-DTM-FTX-RFF-SG9-SG12

A group of segments giving information about a clinical observation including the origin of the clinical information. The clinical information may be a symptom, physical sign, anamnesis (medical history), clinical observation, diagnosis, etc.

0630 CAV, Characteristic value

A segment for specifying the type of clinical information.

0640 CIN, Clinical information

A segment for specifying the type of clinical observation, description of the clinical observation itself as well as the degree of certainty concerning the clinical observation.

0650 LAN, Language

A segment for specifying the language related to the clinical observation.

0660 DTM, Date/time/period

A segment for specifying date and times related to the clinical information, the clinical observation itself and the origin of clinical information.

0670 FTX, Free text

A segment with free text information, in coded or clear form, for description of the clinical information.

0680 RFF, Reference

This segment keeps a reference to a healthcare party for specifying origin of clinical information.

0690 Segment Group 9: STS-SEQ-GIS-RSL-CCI-CIN-DTM-FTX-RFF-

SG10-SG11 A group of segments for specifying a clinical investigation result item and the clinical investigation itself.

0700 STS, Status

A segment for specifying the status of the clinical investigation, e.g. preliminary results, final results, etc.

0710 SEQ, Sequence details

A segment for allocating a sequence number to a clinical investigation result item to allow referencing from within this message to a specific clinical investigation result item.

0720 GIS, General indicator

A segment for specifying the service type of the clinical investigation result item, e.g. new result item.

0730 RSL, Result

A segment for specifying the numerical value or a coded text value of a clinical investigation result item including unit of measurement, arithmetic comparator and the deviating result indicator.

0740 CCI, Characteristic/class id

A segment for identifying the clinical investigation and to describe specifications to the clinical investigation.

0750 CIN, Clinical information

A segment giving a text value of a clinical investigation result item as well as a comment to the clinical investigation result item as a diagnosis.

0760 DTM, Date/time/period

A segment for specifying relevant date and times concerning the investigation such as date and time for investigation performed, last status change and a date value of a clinical observation.

0770 FTX, Free text

A segment with free text information, in coded or clear form, for specifying the text value of a clinical investigation as well as comments to the clinical investigation and the investigation result item.

0780 RFF, Reference

This segment keeps a reference to the "parent" clinical investigation result item if needed.

0790 Segment Group 10: RSL-FTX-CCI

A group of segments giving the reference limits of a clinical investigation result item.

0800 RSL, Result

A segment for specifying the numerical reference interval of an investigation result item and the type of reference interval.

0810 FTX, Free text

A segment with free text information, in coded or clear form, for specifying the textual reference limits of an investigation result item.

0820 CCI, Characteristic/class id

A segment for specifying a reference population, e.g. age, sex, smokers, etc.

0830 Segment Group 11: REL-RFF

A group of segments for identifying the persons and/or organisations involved in producing an investigation result.

0840 REL, Relationship

A segment for specifying the type of relationship of a related healthcare service provider to the clinical investigation result item.

0850 RFF, Reference

A segment for specifying a reference to healthcare parties in segment group 1 where the related healthcare professional or organisation is identified.

0860 Segment Group 12: CLI-SG13

A group of segments for specifying a clinical intervention.

0870 CLI, Clinical intervention

A segment for specifying the type of intervention and the intervention itself.

0880 Segment Group 13: IMD-DSG-FTX-INP

A group of segments to describe interventions involving drugs.

0890 IMD, Item description

A segment for identifying a drug.

0900 DSG, Dosage administration

A segment for specifying the dosage and administration specifications of a drug.

0910 FTX, Free text

A segment with free text information, in coded or clear form, for specifying dosage and administration specification of a drug.

0920 INP, Parties and instruction

A segment for specifying the dosage regime.

0930 Segment Group 14: SEQ-IMD-PRC-RFF-QTY-DTM-PAC-FTX-TDT-

HAN-LOC-ADR-SG15 A group of segments containing information about the samples collected or to be collected concerning the requested investigation.

0940 SEQ, Sequence details

A segment for allocating a sequence number to the sample to allow referencing from within this message to a specific sample.

0950 IMD, Item description

A segment for specifying the characteristics of a sample like type of sample, anatomical origin and sample preservation material.

0960 PRC, Process identification

A segment for specifying information about type of collection procedure and subsequent handling of the sample.

0970 RFF, Reference

A segment for specifying the identification numbers of the actual sample allocated by service requester and service provider.

This segment also keeps a reference to healthcare parties related to this actual sample such as the sample collector and sample collection location.

This segment in addition keeps a reference to the "parent" sample if this sample is part of or derived from another sample.

0980 QTY, Quantity

A segment for specifying information about sample volume or weight.

0990 DTM, Date/time/period

A segment for specifying relevant dates and times concerning the sample such as start and/or end date and time or period for sample collection, sample receipt date and time, etc.

1000 PAC, Package

A segment specifying the number of sample containers this sample consists of.

1010 FTX, Free text

A segment with free text information, in coded or clear form, expressing the comments of the sample collector, the comments of the requester or service provider to the sample, anatomical origin of sample, sample location description, etc.

1020 TDT, Details of transport

A segment for specifying the transport logistics of the collected sample.

1030 HAN, Handling instructions

A segment for specifying sample handling warning.

1040 LOC, Place/location identification

A segment for specifying the location for sample collection in terms of hospital ward, room and bed number.

1050 ADR, Address

A segment for specifying the address for the sample collection.

1060 Segment Group 15: CLI-IMD-DSG-DTM-FTX-QTY-INP

A group of segments for specifying the pre-treatment performed relating to a sample.

1070 CLI, Clinical intervention

A segment for describing the pre-treatment administered.

1080 IMD, Item description

A segment for specifying the substance administered for pre-treatment.

1090 DSG, Dosage administration

A segment for specifying the route of administration of the pre-treatment.

1100 DTM, Date/time/period

A segment for specifying relevant date and times for the pre-treatment like start, end or duration of administration.

1110 FTX, Free text

A segment with free text information, in coded or clear form, for describing the pre-treatment.

1120 QTY, Quantity

A segment for specifying amount of substance administered.

1130 INP, Parties and instruction

A segment for specifying the dosage regime.

1140 Segment Group 16: LIN-GIS-RSL-CCI-CIN-SEQ-STS-DTM-FTX-

MOA-RFF-EQD-SG17-SG18 A group of segments for specifying a requested investigation and the result of this investigation.

1150 LIN, Line item

A segment for specifying the line number of the laboratory investigation result item.

1160 GIS, General indicator

A segment for specifying the service type of the result of this investigation, e.g. new result, corrected result, etc.

1170 RSL, Result

A segment for specifying the numerical value or a coded text value of an investigation result item including unit of measurement, arithmetic comparator and the deviating result indicator.

1180 CCI, Characteristic/class id

A segment for specifying the characteristics of the investigation. The characteristics may concern system, component or property examined as well as method of measurement, etc.

1190 CIN, Clinical information

A segment for specifying the result of an investigation or comments to a result item as a diagnosis.

1200 SEQ, Sequence details

A segment for allocating a sequence number to this result item to allow for referencing from within this message to a specific result item.

1210 STS, Status

A segment for specifying the status of an investigation or investigation result item, e.g. unverified result, preliminary result, etc.

1220 DTM, Date/time/period

A segment for specifying date and times relevant for this investigation result item such as date and time of investigation performed, status change, etc.

The segment may also carry the result of an investigation if this is expressed as a date or period such as clinical dates.

1230 FTX, Free text

A segment with free text information, in coded or clear form, for specifying a result item as a text value as well as comments to the result item or the investigation itself.

1240 MOA, Monetary amount

A segment for specifying the type of cost, the amount of cost and possibly currency unit used concerning the investigation.

1250 RFF, Reference

This segment keeps a reference to one or more samples related to this actual result item such as the sample(s) involved in obtaining this result item.

This segment also keeps a reference to another investigation result item related to this actual investigation result item such as the investigation result item which this investigation result item is part of.

1260 EQD, Equipment details

A segment for specifying the measuring equipment used for obtaining this investigation result item.

1270 Segment Group 17: REL-RFF

A group of segments for specifying a related laboratory service provider involved in producing this investigation result item.

1280 REL, Relationship

A segment for specifying the type of relationship a service provider has to the produced investigation result item.

1290 RFF, Reference

This segment keeps a reference to a healthcare party (healthcare professional or healthcare organisation) which is identified in segment group 1 for specifying a related person or organisation.

1300 Segment Group 18: RSL-FTX-CCI

A group of segments for specifying the reference limits of an investigation result item.

1310 RSL, Result

A segment for specifying the reference interval for the investigation and the type of reference interval such as physiological, therapeutical, etc.

1320 FTX, Free text

A segment with free text information, in coded or clear form, for specifying textual reference limits concerning the investigation.

1330 CCI, Characteristic/class id

A segment for specifying the reference population.

1340 Segment Group 19: AUT-DTM

A group of segments for specifying authentication details.

1350 AUT, Authentication result

A segment for specifying results of an authentication procedure.

1360 DTM, Date/time/period

A segment for specifying the date and time for the validity of the authentication.

1370 UNT, Message trailer

A service segment ending a message, giving the total number of segments in the message and the control reference number of the message.