DemographicsPatient Identification Numbers or Cards (SS#, Medical Record Number, Drivers License)Full NameStreet AddressCity, State, Zip CodePhone NumberFax NumberE-mail addressURLs and IP AddressesGenderRaceReligionDate of BirthPhotographsSpouse InformationBeneficiary InformationParent/Guardian InformationEmergency Contact InformationVehicle Identification NumberBiometric Identifiers (including finger and voice prints)

Insurance InformationFinancial InformationInsurance CarrierInsurance Group NumbersCopy of Insurance CardGuarantor (Responsible Party)Billing AddressEmployerPrimary Care ProviderTotal ChargesClaim FormsPayment HistoryPre-certifications or Prior Authorizations

Example of Medical Record Elements

Medical Information (continued)ProceduresOrders or RequestsPatient HistoryPersonal HabitsWeightHeightAgeTemperaturePulseHistory of Present IllnessDictationSymptomsPhysical FindingsFamily Medical HistoryDischarge StatusMedicationsBarriers to CommunicationMode of ArrivalAllergies/Untoward Reactions to DrugsReason for EncounterRequest for ConsultationCPT CodesICD-9 CodesDate of Death

Medical InformationPatient ComplaintsDates of ServiceAdmission and Discharge DatesTreating or Referring Physician, Clinic, HospitalDiagnosisTreatment PlanImmunization RecordPsychotherapy Note InformationLab TestsBlood Type

DemographicsPatient Identification Numbers or Cards (SS#, Medical Record Number, Drivers License)Full NameStreet AddressCity, State, Zip CodePhone NumberFax NumberE-mail addressURLs and IP AddressesGenderRaceReligionDate of BirthPhotographsSpouse InformationBeneficiary InformationParent/Guardian InformationEmergency Contact InformationVehicle Identification NumberBiometric Identifiers (including finger and voice prints)

Insurance InformationFinancial InformationInsurance CarrierInsurance Group NumbersCopy of Insurance CardGuarantor (Responsible Party)Billing AddressEmployerPrimary Care ProviderTotal ChargesClaim FormsPayment HistoryPre-certifications or Prior Authorizations

Limited Data Set

Medical Information (continued)ProceduresOrders or RequestsPatient HistoryPersonal HabitsWeightHeightAgeTemperaturePulseHistory of Present IllnessDictationSymptomsPhysical FindingsFamily Medical HistoryDischarge StatusMedicationsBarriers to CommunicationMode of ArrivalAllergies/Untoward Reactions to DrugsReason for EncounterRequest for ConsultationCPT CodesICD-9 CodesDate of Death

Medical InformationPatient ComplaintsDates of ServiceAdmission and Discharge DatesTreating or Referring Physician, Clinic, HospitalDiagnosisTreatment PlanImmunization RecordPsychotherapy Note InformationLab TestsBlood Type

*Provided no name, patient identifier numbers, group numbers or other specific identifiers are included (i.e., "facial identifiers").

DemographicsPatient Identification Numbers or Cards (SS#, Medical Record Number, Drivers License)Full NameStreet AddressCity, State, Zip CodePhone NumberFax NumberE-mail addressURLs and IP AddressesGenderRaceReligionDate of BirthPhotographsSpouse InformationBeneficiary InformationParent/Guardian InformationEmergency Contact InformationVehicle Identification NumberBiometric Identifiers (including finger and voice prints)

Insurance InformationFinancial InformationInsurance CarrierInsurance Group NumbersCopy of Insurance CardGuarantor (Responsible Party)Billing AddressEmployerPrimary Care ProviderTotal ChargesClaim FormsPayment HistoryPre-certifications or Prior Authorizations

DE-IDENTIFIED DATA

Medical Information (continued)ProceduresOrders or RequestsPatient HistoryPersonal HabitsWeightHeightAgeTemperaturePulseHistory of Present IllnessDictationSymptomsPhysical FindingsFamily Medical HistoryDischarge StatusMedicationsBarriers to CommunicationMode of ArrivalAllergies/Untoward Reactions to DrugsReason for EncounterRequest for ConsultationCPT CodesICD-9 CodesDate of Death

*Medical InformationPatient ComplaintsDates of ServiceAdmission and Discharge DatesTreating or Referring Physician, Clinic, HospitalDiagnosisTreatment PlanImmunization RecordPsychotherapy Note InformationLab TestsBlood Type

*No individually identifiable health information included.