67869-8 Form Type Indicator

Term Description

Indicate the type of form being submitted for the patient.
Source: Regenstrief LOINC

Observation ID in Form

CMS-2728_A

Observation Required in Panel

Required

Fully-Specified Name

Component

Reason for medicare entitlement

Property

Type

Time

Pt

System

^Patient

Scale

Nom

Method

Basic Attributes

Class

SURVEY.ESRD

Type

Surveys

First Released

Version 2.38

Last Updated

Version 2.44

Survey Question

Text

Form Type Indicator

Source

ESRD.RQMT_292

Normative Answer List LL1911-8

Member of these Panels

Related Names

• ESRD
• ESRD survey
• Nominal
• Point in time
• Random
• Reason medicare entitlement
• Survey
• Typ

67870-6 Patient information

Fully-Specified Name

Component

Patient information - end stage renal disease form 2728

Property

-

Time

Pt

System

^Patient

Scale

-

Method

Basic Attributes

Class

PANEL.SURVEY.ESRD

Type

Surveys

First Released

Version 2.38

Last Updated

Version 2.44

Panel Type

Panel

Member of these Panels

Related Names

• Dis
• Diseases
• Dz
• End Stage Renal Disease (ESDR) pnl
• End-stage renal disease
• ESRD
• ESRD survey
• Kidney
• Pan
• Panel
• Panl
• Patient information - ESRD 2728
• Pnl
• Point in time
• Random
• Survey

45394-4 Patient Last (Family) name

Observation ID in Form

CMS-2728_A1

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Last name

Property

Pn

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Patient Last name

Basic Attributes

Class

ADMIN.PATIENT

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: LONG_COMMON_NAME: Added "Patient" to distinguish from the general "Last name" term that does not distinguish between various subjects (patient, provider, contact, etc.).; SHORTNAME: Added "Patient" to distinguish from the general "Last name" term that does not distinguish between various subjects (patient, provider, contact, etc.).;

Order vs. Observation

Both

HL7^® Attributes

HL7^® Field ID

PID-5.1

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• Nominal
• Past
• Person name
• Point in time
• Random

Related Codes

45392-8 Patient First (Given) name

Observation ID in Form

CMS-2728_A1

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

First name

Property

Pn

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Patient First name

Basic Attributes

Class

ADMIN.PATIENT

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.70

Change Reason

Release 2.70: LONG_COMMON_NAME: Added "Patient" to distinguish from the general "First name" term that does not distinguish between various subjects (patient, provider, contact, etc.).; SHORTNAME: Added "Patient" to distinguish from the general "First name" term that does not distinguish between various subjects (patient, provider, contact, etc.).;

Order vs. Observation

Both

HL7^® Attributes

HL7^® Field ID

PID-5.2

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• Given name
• Nominal
• Person name
• Point in time
• Random

Related Codes

45393-6 Middle initial

Observation ID in Form

CMS-2728_A1

Observation Required in Panel

Optional

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Middle initial

Property

Pn

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Middle initial

Basic Attributes

Class

ADMIN.PATIENT

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.66

Change Reason

Change PROPERTY from ID to Pn to match convention for other name terms

Order vs. Observation

Both

HL7^® Attributes

HL7^® Field ID

PID-5.3

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• Nominal
• Person name
• Point in time
• Random

Related Codes

45397-7 Medicare or comparable number

Observation ID in Form

CMS-2728_A2

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Medicare or comparable number

Property

ID

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Medicare or comparable #

Basic Attributes

Class

ADMIN.PATIENT.ID

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.66

Change Reason

Changed CLASS to ADMIN

Order vs. Observation

Both

HL7^® Attributes

HL7^® Field ID

PID-3

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• ADMIN.PATIENT.ID
• Ident
• Identifier
• Intradermal
• Medicare or comparable #
• No
• Nominal
• Num
• Point in time
• Random

Related Codes

45396-9 Social Security number [Identifier]

Observation ID in Form

CMS-2728_A3

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Social Security number

Property

ID

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Social Security #

Basic Attributes

Class

ADMIN.PATIENT.ID

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.73

Change Reason

Updated Class from SURVEY.MDS to ADMIN; Capitalized Security in Component

Order vs. Observation

Both

Common Test Rank Get Info

6170

HL7^® Attributes

HL7^® Field ID

PID-19

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• ADMIN.PATIENT.ID
• Ident
• Identifier
• Intradermal
• No
• Nominal
• Num
• Point in time
• Random
• Social Security #

Related Codes

21112-8 Birth date

Observation ID in Form

CMS-2728_A3

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Birth date

Property

TmStp

Time

Pt

System

^Patient

Scale

Qn

Method

Additional Names

Short Name

Birth date

Display Name

Birth date [Date/time]

Consumer Name Alpha Get Info

Birth date

Basic Attributes

Class

MISC

Type

Laboratory

First Released

Version 1.0m

Last Updated

Version 2.73

Order vs. Observation

Observation

Common Test Rank Get Info

1746

HL7^® Attributes

HL7^® Field ID

PID-7.1

Member of these Panels

Language Variants Get Info

Related Names

• Birthdate
• Date and time
• Date of birth
• DOB
• MISC
• Point in time
• QNT
• Quan
• Quant
• Quantitative
• Random
• Time stamp
• Timestamp

Example Units

Related Codes

67871-4 Patient demographics - end stage renal disease form 2728

Fully-Specified Name

Component

Patient demographics - end stage renal disease form 2728

Property

-

Time

Pt

System

^Patient

Scale

-

Method

Basic Attributes

Class

PANEL.SURVEY.ESRD

Type

Surveys

First Released

Version 2.38

Last Updated

Version 2.44

Panel Type

Panel

Member of these Panels

Related Names

• Demographic
• Dis
• Diseases
• Dz
• End Stage Renal Disease (ESDR) pnl
• End-stage renal disease
• ESRD
• ESRD survey
• Kidney
• Pan
• Panel
• Panl
• Patient demographics - ESRD 2728
• Pnl
• Point in time
• Random
• Survey

56799-0 Address

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Fully-Specified Name

Component

Address

Property

Addr

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Address

Basic Attributes

Class

ADMIN.PATIENT

Type

Clinical

First Released

Version 2.29

Last Updated

Version 2.73

Common Test Rank Get Info

8050

HL7^® Attributes

HL7^® Field ID

PID-11

Member of these Panels

Language Variants Get Info

Related Names

• Address
• ADMIN
• ADMIN.PATIENT
• Nominal
• Point in time
• Random

Related Codes

68997-6 Patient City (Mailing)

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Fully-Specified Name

Component

City

Property

Loc

Time

Pt

System

^Patient

Scale

Nom

Method

Basic Attributes

Class

SURVEY.ESRD

Type

Surveys

First Released

Version 2.38

Last Updated

Version 2.73

Common Test Rank Get Info

8343

Member of these Panels

Related Names

• ESRD
• ESRD survey
• Location
• Nominal
• Point in time
• Random
• Survey

46499-0 State of residence

Term Description

The state in which the patient is currently residing while receiving care.
Source: Regenstrief LOINC

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

State of residence

Property

Loc

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

State of residence

Basic Attributes

Class

ADMIN.PATIENT.DEMOG

Type

Clinical

First Released

Version 2.19

Last Updated

Version 2.73

Order vs. Observation

Both

Common Test Rank Get Info

7483

HL7^® Attributes

HL7^® Field ID

PID-11.4

Example Answer List LL3661-7

Externally Defined

Yes

Code System

CDC-PHIN

Code System OID

1.3.6.1.4.1.12009.10.1.2296

Link to External List

https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.830

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• ADMIN.PT.DEMOG
• Housing
• Living Arrangement
• Living Arrangements
• Location
• Nominal
• Point in time
• Random

Related Codes

45401-7 Postal code [Location]

Observation ID in Form

CMS-2728_A5

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Postal code

Property

Loc

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Postal code

Basic Attributes

Class

ADMIN.PATIENT.DEMOG

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.73

Change Reason

Updated Component name from "ZIP code" to "Postal code", the more universal nomenclature for this concept.

Order vs. Observation

Both

Common Test Rank Get Info

6911

HL7^® Attributes

HL7^® Field ID

PID-11.5

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• ADMIN.PT.DEMOG
• Location
• Nominal
• Point in time
• Random
• ZIP code

Related Codes

42077-8 Patient phone number

Term Description

The patient's telephone number.
Source: Regenstrief LOINC

Observation ID in Form

CMS-2728_A6

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Phone number

Property

Tele

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Phone #

Basic Attributes

Class

ADMIN.PATIENT

Type

Clinical

First Released

Version 2.16

Last Updated

Version 2.73

Change Reason

Revised description and removed NORMATIVE answer list, which only included results for unknown or no phone number available. The answer choices did not include entering the patient's phone number. This term was originally created for the NAACCR v11 tumor registry. The coding instructions in the term description and as part of the answer list are now available as Form Coding Instructions for the term in the instance of the NAACCR version 11 panel [LOINC: 49083-9].

Order vs. Observation

Observation

Common Test Rank Get Info

7124

HL7^® Attributes

HL7^® Field ID

PID-13

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• No
• Nominal
• Num
• Phone #
• Point in time
• Random
• Telecommunication number
• Telephone number

Related Codes

46098-0 Sex

Part Descriptions

LP101395-4   Sex
In LOINC, sex refers to the biological sex of an organism, which is most commonly determined based on anatomy and physiology or genetic (chromosome) analysis. Our definition is based on the World Health Organization's definition of sex and gender: sex (male, female) refers to biological and physiological characteristics, and gender (masculine, feminine) refers to socially constructed roles, behaviors, activities, and attributes. (http://www.who.int/gender/whatisgender/en) Source: Regenstrief LOINC, WHO: gender

Observation ID in Form

CMS-2728_A7

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component

Sex

Property

Type

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Sex

Basic Attributes

Class

ADMIN.PATIENT.DEMOG

Type

Clinical

First Released

Version 2.17

Last Updated

Version 2.73

Change Reason

Changed Component from 'Gender' to 'Sex' to align with the World Health Organization (WHO) definition of this concept.

Order vs. Observation

Both

Common Test Rank Get Info

2086

HL7^® Attributes

HL7^® Field ID

PID-8

Example Answer List LL1-9

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.PATIENT
• ADMIN.PT.DEMOG
• AOEObservation
• Gender
• Nominal
• Point in time
• Random
• Typ

Related Codes

54133-4 Ethnicity [USSG-FHT]

Observation ID in Form

CMS-2728_A8

Observation Required in Panel

Optional

Fully-Specified Name

Component

Ethnicity

Property

Type

Time

Pt

System

^Patient

Scale

Nom

Method

USSG-FHT

Basic Attributes

Class

SURVEY.USSGFHT

Type

Surveys

First Released

Version 2.26

Last Updated

Version 2.73

Common Test Rank Get Info

19111

HL7^® Attributes

HL7^® Field ID

PID-22

Normative Answer List LL628-9

Member of these Panels

Related Names

• FHH
• Nominal
• Point in time
• Random
• Survey
• SURVEY.USSGFHT
• Typ
• US Surgeon General
• US Surgeon General family health portrait

Related Codes

68329-2 Country of origin

Observation ID in Form

CMS-2728_A9

Observation Required in Panel

Conditional

Fully-Specified Name

Component

Country of origin

Property

Loc

Time

Pt

System

^Patient

Scale

Nom

Method

Basic Attributes

Class

SURVEY.ESRD

Type

Surveys

First Released

Version 2.38

Last Updated

Version 2.52

Member of these Panels

Related Names

• ESRD
• ESRD survey
• Location
• Nominal
• Point in time
• Random
• Survey

54134-2 Race [USSG-FHT]

Observation ID in Form

CMS-2728_A10

Observation Required in Panel

Required

Fully-Specified Name

Component

Race

Property

Type

Time

Pt

System

^Patient

Scale

Nom

Method

USSG-FHT

Basic Attributes

Class

SURVEY.USSGFHT

Type

Surveys

First Released

Version 2.26

Last Updated

Version 2.44

HL7^® Attributes

HL7^® Field ID

PID-10

Normative Answer List LL629-7

Member of these Panels

Related Names

• Ethnicity
• FHH
• Nominal
• Point in time
• Random
• Survey
• SURVEY.USSGFHT
• Typ
• US Surgeon General
• US Surgeon General family health portrait

Related Codes

67884-7 Tribal enrollment

Observation ID in Form

CMS-2728_A10a

Condition for Inclusion

American Indian selected for Race

Observation Required in Panel

Conditional

Fully-Specified Name

Component

Tribal enrollment

Property

Type

Time

Pt

System

^Patient

Scale

Nom

Method

Additional Names

Short Name

Tribal enrollment

Basic Attributes

Class

ADMIN.DEMOG

Type

Clinical

First Released

Version 2.38

Last Updated

Version 2.68

Change Reason

Release 2.68: COMPONENT: Updated Component to match current LOINC conventions

Example Answer List LL5596-3

Externally Defined

Yes

Code System

CDC-PHIN

Code System OID

1.3.6.1.4.1.12009.10.1.4413

Link to External List

https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.876

Member of these Panels

Language Variants Get Info

Related Names

• ADMIN
• ADMIN.DEMOG
• Nominal
• Point in time
• Random
• Typ

67872-2 Is the patient applying for ESRD Medicare coverage?

Observation ID in Form

CMS-2728_A11

Observation Required in Panel

Required

Fully-Specified Name

Component

Medicare end stage renal disease coverage requested

Property

Find

Time

Pt

System

^Patient

Scale

Ord

Method

Basic Attributes

Class

SURVEY.ESRD

Type

Surveys

First Released

Version 2.38

Last Updated

Version 2.44

Survey Question

Text

Is the patient applying for ESRD Medicare coverage?

Source

ESRD.RQMT_212

Normative Answer List LL361-7

Member of these Panels

Related Names

• Dis
• Diseases
• Dz
• End-stage renal disease
• ESRD
• ESRD survey
• Finding
• Findings
• Kidney
• Medicare ESRD coverage requested
• Ordinal
• Point in time
• QL
• Qual
• Qualitative
• Random
• Screen
• Survey

Third Party Copyright

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This material includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

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52556-8 Payment sources

Form Coding Instructions

Check all that apply

Fully-Specified Name

Component

Payment sources

Property

Type

Time

Pt

System

^Patient

Scale

Nom

Method

Basic Attributes

Class

SURVEY.CMS

Type

Surveys

First Released

Version 2.26

Last Updated

Version 2.63

Change Reason

Changed METHOD to methodless - generic term that does not orginate from just one method; Removed "Current" from component because it is conveyed by TIMING = Pt;Updated PROPERTY from Find to Type

Order vs. Observation

Both

Example Answer List LL544-8

Member of these Panels

Member of these Groups Get Info

Related Names

• Financing and insurance
• Nominal
• Payers
• Point in time
• Random
• SDOH
• Survey
• Typ

Related Codes