Tuberculosis and LTBI
Transcript of Tuberculosis and LTBI
Work Estimate Version - Document is Subject to Change
WORK ESTIMATE VERSION OF THE TUBERCULOSIS (TB) AND LATENT TB INFECTION MESSAGE MAPPING GUIDE (MMG)
This document can be used to assist states in determining the level of effort required to implement system upgrades to support the TB and LTBI MMG, in advance of the publishing of a final
version of the TB and LTBI MMG. This document should not be used to make changes to any public health surveillance system. The TB and LTBI MMG outlined in the following pages is subject to
change. The data elements, and the associated value sets, are subject to change. A final version of the TB and LTBI MMG is forthcoming and additional information will be provided.
WORK ESTIMATE VERSION - MMG IS SUBJECT TO CHANGE - NOT FOR IMPLEMENTATION PURPOSES
Work Estimate Version - Document is Subject to Change
DE Identifier
Sent in HL7
Message
DE Code
System Data Element Description
Data
Type
CDC
Priority
May
Repeat
Value Set Name (VADS
Hyperlink) Value Set Code HL7 Message Context
HL7
Data
Type
HL7
Usage
HL7
Cardinal
ity HL7 Implementation Notes
Repeating
Group
Element Sample Segment
Legacy
Variable
Legacy Variable
Code System
This document can be
used to assist states
determine the level of
effort required to
implement system
upgrades to support the
TB and LTBI MMG in
advance of a final
version of the TB and
LTBI MMG. This
document should not be
N/A: MSH-21 N/A Message Profile Identifiers provide a
literal value to use for the references
in MSH-21. MSH-21 will always
contain a reference to the notification
type in the "PHINProfileID"
namespace and a reference to the
implemented version of the Generic
MMG in the
Text R Y/3 N/A N/A MSH-21 EI R [3..3] CONFORMANCE STATEMENT:
Message Profile ID (MSH-21) for
this version of the MMG SHALL
contain the literal value:
‘NOTF_ORU_v3.0^PHINProfileID^
2.16.840.1.114222.4.10.3^ISO~Ge
neric_MMG_V2.0^PHINMsgMapID^
2.16.840.1.114222.4.10.4^ISO~TB
_Case_Map_v3.0^PHINMsgMapID
^2.16.840.1.114222.4.10.4^ISO.
NO MSH|^~\&|SendAppName^2.16.840.1.114222.TBD^IS
O|Sending-
Facility^2.16.840.1.114222.TBD^ISO|PHINCDS^2.16.8
40.1.114222.4.3.2.10^ISO|PHIN^2.16.840.1.114222^IS
O|20160630120030.1234-
0500||ORU^R01^ORU_R01|MESSAGE CONTROL
ID|D|2.5.1|||||||||NOTF_ORU_v3.0^PHINProfileID^2.16.8
40.1.114222.4.10.3^ISO~Generic_MMG_V2.0^PHINMs
gMapID^2.16.840.1.114222.4.10.4^ISO~
TB_MMG_V3.0^PHINMsgMapID^2.16.840.1.114222.4.
10.4^ISO
NOT115 PHINQUESTION
WORK ESTIMATE VERSION - MMG IS SUBJECT TO CHANGE - NOT FOR IMPLEMENTATION PURPOSESTB State Case Number INV1107 PHINQUESTION State case number for the case
specific to TB investigations (4 digit
report year + 2 letter state + 9 digit
alphanumeric number)
Text P N N/A N/A OBX segment with
OBX-3.1=INV1107
OBX-5=string up to 199
characters
ST RE [0..1] NO OBX|nn|ST|INV1107^TB State Case
Number^PHINQUESTION||2018GA745123956||||||F
INV173 PHINQUESTION
City or County Case
Number
INV1108 PHINQUESTION City or county case number assigned
to this case
Text P N N/A N/A OBX segment with
OBX-3.1=INV1108
OBX-5=string up to 199
characters
ST RE [0..1] NO OBX|nn|ST|INV1108^City or County Case
Number^PHINQUESTION||2018GAFULT54896||||||F
INV172 PHINQUESTION
Birth Sex 76689-9 LN What was the patient's sex at birth? Coded P N Sex (MFU) PHVS_Sex_MFU OBX segment with
OBX-3.1=76689-9
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|76689-9^Birth
Sex^LN||F^Female^HL70001||||||F
DEM114 PHINQUESTION
Previously Counted Case INV1109 PHINQUESTION (Proposed) Has this case already
been counted by another reporting
area?
Coded P N Case Count Status (TB) PHVS_CaseCountStatus
_TB
OBX segment with
OBX-3.1=INV1109
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1109^Previously Counted
Case^PHINQUESTION||PHC659^Verified Case:
Counted by another US area^CDCPHINVS||||||F
N/A N/A
Previously Reported
State Case Number
INV1110 PHINQUESTION (Proposed) If case previously
counted, provide the state case
number from the other reporting area.
Text P N N/A N/A OBX segment with
OBX-3.1=INV1110
OBX-5=string up to 199
characters
ST RE [0..1] NO OBX|nn|ST|INV1110^Previously Reported State Case
Number^PHINQUESTION||2018GA201710258||||||F
N/A N/A
Country of Verified Case INV1111 PHINQUESTION (Proposed) If the case was previously
reported by another country, specify
the country.
Coded P N Birth Country PHVS_BirthCountry_CD
C
OBX segment with
OBX-3.1=INV1111
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1111^Country of Verified
Case^PHINQUESTION||JPN^JAPAN^ISO3166_1||||||F
TB211 PHINQUESTION
Patient Address City N/A: PID -11.3 N/A Patient address city Text P N N/A N/A PID-11.3
Patient Address - City
ST RE [0..1] For unknown patient address city,
PID-11.3 MAY be populated with
'unknown'.
NO PID|1||LocalPatID1DEM197^^^SendAppNamelocalID&2
.16.840.1.114222.GENv2&ISO||~^^^^^^S||19620302|F||
2106-3^White^CDCREC~1002-5^American Indian or
Alaska
Native^CDCREC|^^Atlanta^18^47635^^^^18097|||||||||||2
135-2^Hispanic or Latino^CDCREC
TB080 PHINQUESTION
Inside City Limits INV1112 PHINQUESTION Is the patient's residence within city
limits?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1112
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1112^Inside City
Limits^PHINQUESTION||Y^Yes^HL70136||||||F
TB099 PHINQUESTION
Census Tract of Case-
Patient Residence
N/A: PID-11.10 N/A Census tract where the address is
located is a unique identifier
associated with a small statistical
subdivision of a county. Census tract
data allows a user to find population
and housing statistics about a specific
part of an urban area.
Coded P N N/A N/A PID-11.10
Patient Address - Census
Tract
IS RE [0..1] Census Tract information can be
searched using the American Fact
Finder Census Website -
http://factfinder2.census.gov/
Census tract should be populated
with the 11 character US Census
Bureau census tract designation
for the residence of the patient.
NO PID|1||LocalPatID1DEM197^^^SendAppNamelocalID&2
.16.840.1.114222.GENv2&ISO||~^^^^^^S||19620302|F||
2106-3^White^CDCREC~1002-5^American Indian or
Alaska
Native^CDCREC|^^^18^47635^^^^18097^1312100910
1|||||||||||2135-2^Hispanic or Latino^CDCREC
N/A N/A
Detailed Race DEM153 PHINQUESTION Provide the detailed race information
for the patient.
Coded P Y Detailed Race PHVS_Race_CDC OBX segment with
OBX-3.1=DEM153
OBX-5=value from value set
CWE RE [0..*] NO OBX|nn|CWE|DEM153^Detailed
Race^PHINQUESTION||1112-
2^Chickasaw^CDCREC||||||F
DEM153 PHINQUESTION
Date Arrived in US DEM2005 PHINQUESTION If country of birth is NOT United
States, regardless of citizenship,
indicate the date when the patient
first arrived in the US.
Date P N N/A N/A OBX segment with
OBX-3.1=DEM2005
OBX-5=date
DT RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
NO OBX|nn|DT|DEM2005^Date Arrived in
US^PHINQUESTION||20100101||||||F
DEM2005 PHINQUESTION
US Born DEM2003 PHINQUESTION Was the patient eligible for US
citizenship at birth?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=DEM2003
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|DEM2003^US
Born^PHINQUESTION||Y^Yes^HL70136||||||F
DEM2003 PHINQUESTION
Primary Guardian(s)
Country of Birth
INV1113 PHINQUESTION Indicates the birth country of the
primary guardian(s) of patient
(pediatric [<15 years old] cases only)
Coded P Y Birth Country PHVS_BirthCountry_CD
C
OBX segment with
OBX-3.1=INV1113
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..*] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1113^Primary Guardian(s) Country of
Birth^PHINQUESTION||ARG^ARGENTINA^ISO3166_1|
|||||F
TB217
TB218
PHINQUESTION
Work Estimate Version - Document is Subject to Change
Remain in US After
Report
INV1114 PHINQUESTION (Proposed) If not US reporting area,
did patient remain in the United
States for >= 90 days after report
date?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1114
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1114^Remain in US After
Report^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
Initial Reason for
Evaluation
INV1116 PHINQUESTION What was the initial reason the
patient was evaluated for TB?
Coded P N Primary Reason For
Evaluation (TB)
PHVS_PrimaryReasonF
orEvaluation_TB
OBX segment with
OBX-3.1=INV1116
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1116^Inital Reason for
Evaluation^PHINQUESTION||PHC680^TB
Symptoms^CDCPHINVS||||||F
TB254 PHINQUESTION
START: RVCT & TBLISS Laboratory Questions
START: RVCT & TBLISS Epidemiology Laboratory Repeating GroupTest Type INV290 PHINQUESTION Epidemiologic interpretation of the
type of test(s) performed for this
case. Please provide a response for
each of the main test types (culture,
smear, pathology/cytology, NAA,
TST, IGRA, HIV, diabetes) If test was
not done please indicate so.
Coded P N Lab Test Type (TB) PHVS_LabTestType_TB OBX segment with
OBX-3.1=INV290
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|INV290^Test
Type^PHINQUESTION|1|50941-4^Culture^LN||||||F
N/A N/A
Test Result INV291 PHINQUESTION Epidemiologic interpretation of the
results of the test(s) performed for
this case - This is a qualitative test
result. (e.g, positive, detected,
negative)
Coded P N Lab Test Interpretation
(TB)
PHVS_LabTestInterpreta
tion_TB
OBX segment with
OBX-3.1=INV291
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV291^Test
Result^PHINQUESTION|1|10828004^Positive^SCT||||||
F
TB108
TB109
TB110
TB113
TB119
TB235
TB250
PHINQUESTION
Date/Time of Lab Result 82773-3 LN Date result sent from reporting
laboratory. Time of result is an
optional addition to date.
DateTime P N N/A N/A OBX segment with
OBX-3.1=82773-3
OBX-4=obs sub-ID
OBX-5=date
TS RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
CHILD OBX|nn|TS|82773-3^Date/Time of Lab
Result^LN|1|20180101||||||F
TB225
TB233
TB240
PHINQUESTION
Specimen Source Site 31208-2 LN This indicates the anatomical source
of the specimen tested.
Coded P N Microscopic Exam
Culture Site (TB)
PHVS_MicroscopicExam
CultureSite_TB
OBX segment with
OBX-3.1=31208-2
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
CHILD OBX|nn|CWE|31208-2^Specimen Source
Site^LN|1|87612001^Blood^SCT||||||F
TB111
TB114
PHINQUESTION
Specimen Collection
Date/Time
68963-8 LN Date of collection of laboratory
specimen used for diagnosis of
health event reported in this case
report. Time of collection is an
optional addition to date.
DateTime P N N/A N/A OBX segment with
OBX-3.1=68963-8
OBX-4=obs sub-ID
OBX-5=date
TS RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
CHILD OBX|nn|TS|68963-8^Specimen Collection
Date/Time^LN|1|20180101||||||F
TB221
TB223
TB228
TB231
TB236
TB248
TB251
PHINQUESTION
Test Result Quantitative LAB628 PHINQUESTION Quantitative test result value Text P N N/A N/A OBX segment with
OBX-3.1=LAB628
OBX-4=obs sub-ID
OBX-5=string up to 199
characters
ST RE [0..1] CHILD OBX|nn|ST|LAB628^Test Result
Quantitative^PHINQUESTION|1|10||||||F
N/A N/A
Result Units LAB115 PHINQUESTION Units of measure for the Quantitative
Test Result Value
Coded P N Unit of Measure (TB) PHVS_UnitofMeasure_T
B
OBX segment with
OBX-3.1=LAB115
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LAB115^Result
Units^PHINQUESTION|1|mm||||||F
N/A N/A
END: RVCT & TBLISS Epidemiology Laboratory Repeating Group
START: RVCT & TBLISS Chest Study Repeating GroupType of Chest Study LAB677 PHINQUESTION (Proposed) Indicate the type of chest
study performed. Please provide a
response for each of the main test
types (plain chest radiograph, chest
CT Scan) and if test was not done
please indicate so.
Coded P N Type of Radiology Study PHVS_TypeofRadiology
Study_CDC
OBX segment with
OBX-3.1=LAB677
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|LAB677^Type of Chest
Study^PHINQUESTION|1|399208008^Plain Chest X-
Ray^SCT||||||F
N/A N/A
Result of Chest Study LAB678 PHINQUESTION Result of chest diagnostic testing Coded P N Result of Radiology
Study (TB)
PHVS_ResultofRadiolog
yStudy_TB
OBX segment with
OBX-3.1=LAB678
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LAB678^Result of Chest
Study^PHINQUESTION|1|PHC1873^Consistent with
TB^CDCPHINVS||||||F
TB116
TB245
PHINQUESTION
Evidence of Cavity LAB679 PHINQUESTION Did test show evidence of cavity? Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=LAB679
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LAB679^Evidence of
Cavity^PHINQUESTION|1|Y^Yes^HL70136||||||F
TB243
TB246
PHINQUESTION
Evidence of Miliary TB LAB680 PHINQUESTION Did test show evidence of miliary TB? Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=LAB680
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LAB680^Evidence of Miliary
TB^PHINQUESTION|1|UNK^Unknown^NULLFL||||||F
TB244
TB247
PHINQUESTION
Work Estimate Version - Document is Subject to Change
Date of Chest Study LAB681 PHINQUESTION (Proposed) Date of the chest
diagnostic study
DateTime P N N/A N/A OBX segment with
OBX-3.1=LAB681
OBX-4=obs sub-ID
OBX-5=date
TS RE [0..1] CHILD OBX|nn|TS|LAB681^Date of Chest
Study^PHINQUESTION|1|20180101||||||F
N/A N/A
END: RVCT & TBLISS Chest Study Repeating Group
START: RVCT & TBLISS Risk Factor Questions
START: RVCT & TBLISS Industry and Occupation Repeating GroupCurrent Occupation 85658-3 LN This data element is used to capture
the narrative text of a subject's
current occupation.
Text P N N/A N/A OBX segment with
OBX-3.1=85658-3
OBX-4=obs sub-ID
OBX-5=string up to 199
characters
ST RE [0..1] YES OBX|nn|ST|85658-3^Current Occupation^LN|1|Medical
Technologist||||||F
N/A N/A
Current Occupation
Standardized
85659-1 LN This data element is used to capture
the CDC NIOSH standard occupation
code based upon the narrative text of
a subject's current occupation.
(The National Institute for
Occupational Safety and Health
(NIOSH) has developed a web-based
software tool designed to translate
industry and occupation text to
standardized Industry and
Occupation codes. The NIOSH
Industry and Occupational
Computerized Coding System
(NIOCCS) is available here:
http://www.cdc.gov/niosh/topics/codin
g/overview.html
Coded P N Occupation CDC Census
2010
PHVS_Occupation_CDC
_Census2010
OBX segment with
OBX-3.1=85659-1
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] YES OBX|nn|CWE|85659-1^Current Occupation
Standardized^LN|1|3300^Clinical laboratory
technologists and technicians
[3300]^CDCOCCUPATION2010||||||F
N/A N/A
Current Industry 85078-4 LN This data element is used to capture
the narrative text of subject's current
industry.
Text P N N/A N/A OBX segment with
OBX-3.1=85078-4
OBX-4=obs sub-ID
OBX-5=string up to 199
characters
ST RE [0..1] YES OBX|nn|ST|85078-4^Current Industry^LN|1|Hospital
lab||||||F
N/A N/A
Current Industry
Standardized
85657-5 LN This data element is used to capture
the CDC NIOSH standard industry
code based upon the narrative text of
a subject's current industry.
(The National Institute for
Occupational Safety and Health
(NIOSH) has developed a web-based
software tool designed to translate
industry and occupation text to
standardized Industry and
Occupation codes. The NIOSH
Industry and Occupational
Computerized Coding System
(NIOCCS) is available here:
http://www.cdc.gov/niosh/topics/codin
g/overview.html
Coded P N Industry CDC Census
2010
PHVS_Industry_CDC_C
ensus2010
OBX segment with
OBX-3.1=85657-5
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] YES OBX|nn|CWE|85657-5^Current Industry
Standardized^LN|1|8190^Hospitals
[8190]^CDCINDUSTRY2010||||||F
N/A N/A
END: RVCT & TBLISS Industry and Occupation Repeating Group
START: RVCT & TBLISS Risk Factor Repeating GroupPatient Epidemiological
Risk Factors
INV1117 PHINQUESTION (Proposed) Exposed risk factors for
the patient - Please provide a
response for all risk factors in the
value set with an associated indicator
Coded P N Epidemiological Risk
Factors (TB)
PHVS_EpidemiologicalRi
skFactors_TB
OBX segment with
OBX-3.1=INV1117
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|INV1117^Patient Epidemiological Risk
Factors^PHINQUESTION|1|86933000^Heavy Alcohol
Use in the Past 12 Months^SCT||||||F
N/A N/A
Patient Epidemiological
Risk Factors Indicator
INV1118 PHINQUESTION (Proposed) Provide a response for
each value in the patient
epidemiological risk factors value set
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1118
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV1118^Patient Epidemiological Risk
Factors
Indicator^PHINQUESTION|1|Y^Yes^HL70136||||||F
TB128
TB130
TB148
TB149
TB150
PHINQUESTION
END: RVCT & TBLISS Risk Factor Repeating GroupType of Correctional
Facility
INV1119 PHINQUESTION If patient was a Resident of
Correctional Facility at Diagnostic
Evaluation, indicate the type of
correctional facility.
Coded P N Type of Correctional
Facility
PHVS_CorrectionalFacilit
yType_NND
OBX segment with
OBX-3.1=INV1119
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1119^Type of Correctional
Facility^PHINQUESTION||PHC26^State
Prison^CDCPHINVS||||||F
TB129 PHINQUESTION
Work Estimate Version - Document is Subject to Change
Type of Long-Term Care
Facility
INV1120 PHINQUESTION If patient was a Resident of Long
Term Care Facility at Diagnostic
Evaluation, indicate the type of long
term care facility.
Coded P N Type of Long Term Care
Facility
PHVS_LongTermCareFa
cilityType_NND
OBX segment with
OBX-3.1=INV1120
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1120^Type of Long-Term Care
Facility^PHINQUESTION||PHC221^Hospital-Based
Facility^CDCPHINVS||||||F
TB131 PHINQUESTION
Smoking Status 72166-2 LN (Proposed) What is the patient's
current tobacco smoking status?
Coded P N Smoking Status PHVS_SmokingStatus_C
DC
OBX segment with
OBX-3.1=72166-2
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|72166-2^Smoking
Status^LN||266919005^Never smoker^SCT||||||F
N/A N/A
Patient lived outside of
US for more than 2
months
INV1121 PHINQUESTION Residence or Travel in countries
other than the United States,
Canada, Australia, New Zealand, or
countries in northern or western
Europe for >60 consecutive days at
any point in the patient's lifetime.
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1121
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1121^Patient lived outside of US for
more than 2
months^PHINQUESTION||UNK^Unknown^NULLFL||||||F
TB215 PHINQUESTION
END: RVCT & TBLISS Risk Factor Questions
START: RVCT & TBLISS Source Case and Contact QuestionsIdentified During Contact
Investigation
INV1122 PHINQUESTION (Proposed) Was the patient identified
during the contact investigation
around the likely source case?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1122
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1122^Identified During Contact
Investigation^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
Evaluation During
Contact Investigation
INV1123 PHINQUESTION (Proposed) If patient was identified
during contact investigation, was the
patient evaluated for TB during the
contact investigation?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1123
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1123^Evaluation During Contact
Investigation^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
Linked Case Number INV1124 PHINQUESTION State case numbers for
epidemiologically linked cases
Text P Y N/A N/A OBX segment with
OBX-3.1=INV1124
OBX-5=string up to 199
characters
ST RE [0..*] NO OBX|nn|ST|INV1124^Linked Case
Number^PHINQUESTION||2018GA124598763||||||F
N/A N/A
END: RVCT & TBLISS Source Case and Contact Questions
START: RVCT & TBLISS Treatment Information QuestionsDate Treatment or
Therapy Started
86948-7 PHINQUESTION Date the initial treatment regimen was
started
Date P N N/A N/A OBX segment with
OBX-3.1=86948-7
OBX-5=date
DT RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
NO OBX|nn|DT|86948-7^Date Treatment or Therapy
Started^PHINQUESTION||20180102||||||F
TB147 PHINQUESTION
Treatment Administration
Type
55753-8 LN (Proposed) Choose all treatment
administration types that apply to the
case, such as DOT, eDOT, or SAT.
Coded P Y Treatment Administration
Type (TB)
PHVS_TreatmentAdmini
strationType_TB
OBX segment with
OBX-3.1=55753-8
OBX-5=value from value set
CWE RE [0..*] NO OBX|nn|CWE|55753-8^Treatment Administration
Type^LN||PHC1881^EDOT (Electronic DOT, via video
call or other electronic method)^CDCPHINVS||||||F
N/A N/A
Date Treatment or
Therapy Stopped
63939-3 LN Date treatment stopped Date P N N/A N/A OBX segment with
OBX-3.1=63939-3
OBX-5=date
DT RE [0..1] NO OBX|nn|DT|63939-3^Date Treatment or Therapy
Stopped^LN||20180302||||||F
TB176 PHINQUESTION
END: RVCT & TBLISS Treatment Information Questions
END: RVCT & TBLISS Questions
START: TBLISS Specific QuestionsTreatment Started INV1128 PHINQUESTION Was treatment started for LTBI? Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1128
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1128^Treatment
Started^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
Initial LTBI Drug
Regimen
INV1129 PHINQUESTION (Proposed) If treatment was started
indicate the initial LTBI drug regimen.
Coded P N LTBI Drug Regimen (TB) PHVS_LTBIDrugRegime
n_TB
OBX segment with
OBX-3.1=INV1129
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1129^Initial LTBI Drug
Regimen^PHINQUESTION||PHC1883^Isoniazid (6
months; 6H)^CDCPHINVS||||||F
N/A N/A
Primary Reason LTBI
Treatment Not Started
INV1130 PHINQUESTION If treatment was not started, what
was the primary reason LTBI
treatment was not started?
Coded P N Reason LTBI Not Started
(TB)
PHVS_ReasonLTBINotS
tarted_TB
OBX segment with
OBX-3.1=INV1130
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1130^Primary Reason LTBI
Treatment Not
Started^PHINQUESTION||105480006^Patient
Refused^SCT||||||F
N/A N/A
Reason LTBI Treatment
Stopped
INV1131 PHINQUESTION Reason LTBI treatment stopped Coded P N Reason LTBI Treatment
Stopped (TB)
PHVS_ReasonLTBITreat
mentStopped_TB
OBX segment with
OBX-3.1=INV1131
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1131^Reason LTBI Treatment
Stopped^PHINQUESTION||105480006^Patient
Choice^SCT||||||F
N/A N/A
NTSS State Case
Number
INV1132 PHINQUESTION If patient developed TB from LTBI, list
the NTSS state case number
Text P N N/A N/A OBX segment with
OBX-3.1=INV1132
OBX-5=string up to 199
characters
ST RE [0..1] NO OBX|nn|ST|INV1132^NTSS State Case
Number^PHINQUESTION||2018GA984565133||||||F
N/A N/A
Adverse Event Severity 64750-3 LN If treatment was stopped due to
adverse event from LTBI treatment
indicate the severity.
Coded P Y Adverse Event Severity
(TB)
PHVS_AdverseEventSev
erity_TB
OBX segment with
OBX-3.1=64750-3
OBX-5=value from value set
CWE RE [0..*] NO OBX|nn|CWE|64750-3^Adverse Event
Severity^LN||434081000124108^Hospitalized^SCT||||||F
N/A N/A
END: TBLISS Specific Questions
START: RVCT Specific Questions
Work Estimate Version - Document is Subject to Change
Case Verification
Category
INV1115 PHINQUESTION Indicates case verification criteria
result based on factors such as
culture results, smear results, major
and additional sites of the disease, x-
ray results, TST, IDR, reason therapy
was stopped.
Coded P N Case Verification (TB) PHVS_CaseVerification_
TB
OBX segment with
OBX-3.1=INV1115
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1115^Case Verification
Category^PHINQUESTION||PHC97^1 - Positive
Culture^CDCPHINVS||||||F
TB154 PHINQUESTION
Status at Diagnosis of
TB
TB101 PHINQUESTION Was the patient alive or dead at the
time of diagnostic evaluation?
Coded P N General Condition Status
(TB)
PHVS_GeneralCondition
Status_TB
OBX segment with
OBX-3.1=TB101
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|TB101^Status at Diagnosis of
TB^PHINQUESTION||438949009^Alive^SCT||||||F
TB101 PHINQUESTION
Site of Disease INV1133 PHINQUESTION What was the site of the patient's TB
disease?
Coded P Y Additional Site of
Disease (TB)
PHVS_AdditionalDisease
Site_TB
OBX segment with
OBX-3.1=INV1133
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..*] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1133^Site of
Disease^PHINQUESTION||14016003^Bone marrow
structure^SCT||||||F
TB205 PHINQUESTION
Contact Investigation INV1134 PHINQUESTION (Proposed) Was a contact
investigation conducted around this
case?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1134
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1134^Contact
Investigation^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
START: RVCT Previous Disease Repeating BlockDiagnosis Type INV1135 PHINQUESTION (Proposed) Previous TB or LTBI
Diagnosis - Provide only 1 response
for LTBI, multiple responses for TB
are allowed
Coded P N Diagnosis type (TB) PHVS_DiagnosisType_T
B
OBX segment with
OBX-3.1=INV1135
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] PRIMARY/PARENTOBX|nn|CWE|INV1135^Diagnosis
Type^PHINQUESTION|1|11999007^LTBI^SCT||||||F
N/A N/A
History of Previous
Illness
161413004 SCT Did the subject have a history of TB
or LTBI?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=161413004
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|161413004^History of Previous
Illness^SCT|1|Y^Yes^HL70136||||||F
TB102 PHINQUESTION
Date of Previous Illness 82758-4 LN Date of previous diagnosis Date P N N/A N/A OBX segment with
OBX-3.1=82758-4
OBX-4=obs sub-ID
OBX-5=date
DT RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
CHILD OBX|nn|DT|82758-4^Date of Previous
Illness^LN|1|200612||||||F
TB103 PHINQUESTION
Previous State Case
Number
INV1136 PHINQUESTION (Proposed) Previous TB or LTBI State
Case Number
Text P N N/A N/A OBX segment with
OBX-3.1=INV1136
OBX-4=obs sub-ID
OBX-5=string up to 199
characters
ST RE [0..1] CHILD OBX|nn|ST|INV1136^Previous State Case
Number^PHINQUESTION|1|2018TN451236579||||||F
N/A N/A
Completed Treatment for
Previous Diagnosis
INV1137 PHINQUESTION (Proposed) Completed Treatment for
Previous Diagnosis
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1137
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV1137^Completed Treatment for
Previous
Diagnosis^PHINQUESTION|1|Y^Yes^HL70136||||||F
N/A N/A
END: RVCT Previous Disease Repeating Block
START: RVCT Treatment QuestionsInitially Treated with
RIPE
INV1138 PHINQUESTION (Proposed) Was the patient initially
treated with the recommended four-
drug therapy (RIPE)?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1138
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1138^Initially Treated with
RIPE^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
Reason Not Treated with
RIPE
INV1139 PHINQUESTION (Proposed) If not initially treated with
RIPE, why not?
Coded P N Reason Not Treated with
RIPE (TB)
PHVS_ReasonNotTreate
dwithRIPE_TB
OBX segment with
OBX-3.1=INV1139
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1139^Reason Not Treated with
RIPE^PHINQUESTION||PHC1909^Suspected Drug
Resistance^CDCPHINVS||||||F
N/A N/A
Reason Therapy
Stopped
INV1140 PHINQUESTION Indicate the primary reason that
therapy was stopped or never started;
specify this data when the case is
closed.
Coded P N Reason Therapy
Stopped (TB)
PHVS_ReasonTherapyS
topped_TB
OBX segment with
OBX-3.1=INV1140
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1140^Reason Therapy
Stopped^PHINQUESTION||418646009^Dying
(treatment stopped due to imminent death)^SCT||||||F
TB177
TB290
PHINQUESTION
Reason Therapy
Extended
INV1141 PHINQUESTION Select the reason the therapy
extended beyond 12 months.
Coded P Y Therapy Extended
Reason (TB)
PHVS_TherapyExtended
Reason_TB
OBX segment with
OBX-3.1=INV1141
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..*] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1141^Reason Therapy
Extended^PHINQUESTION||PHC700^Inability to Use
Rifampin (Resistance, Intolerance,
etc.)^CDCPHINVS||||||F
TB291
TB292
PHINQUESTION
Final Disease Outcome INV1167 PHINQUESTION (Proposed) Final TB disease case
outcome
Coded P N Final Treatment
Outcome (TB)
PHVS_FinalTreatmentO
utcome_TB
OBX segment with
OBX-3.1=INV1167
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1167^Final Disease
Outcome^PHINQUESTION||371001000^Cured^SCT||||||
F
N/A N/A
START: RVCT Initial Drug Regimen Repeating BlockInitial Drug Regimen INV1143 PHINQUESTION (Proposed) Initial drug regimen for the
patient: Please provide a response
for each of the values in the value set
using the associated indicator.
Coded P N Medication (TB) PHVS_Medications_TB OBX segment with
OBX-3.1=INV1143
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|INV1143^Initial Drug
Regimen^PHINQUESTION|1|2551^Ciprofloxacin^RXN
ORM||||||F
TB263
TB265
PHINQUESTION
Work Estimate Version - Document is Subject to Change
Initial Drug Regimen
Indicator
INV1144 PHINQUESTION (Proposed) Indicator response for the
initial drug regimen question
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1144
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV1144^Initial Drug Regimen
Indicator^PHINQUESTION|1|N^No^HL70136||||||F
TB132 thru
TB146
TB260 thru
TB262
TB264
PHINQUESTION
END: RVCT Initial Drug Regimen Repeating Block
END: RVCT Treatment Questions
START: RVCT Genotyping and Susceptibility QuestionsIsolate Submitted for
Genotyping
INV1145 PHINQUESTION Was an isolate submitted for
genotyping?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1145
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1145^Isolate Submitted for
Genotyping^PHINQUESTION||Y^Yes^HL70136||||||F
TB266 PHINQUESTION
Accession Number for
Genotyping
INV1146 PHINQUESTION If an isolate was submitted for
genotyping to a CDC laboratory only,
list the accession number for
genotyping.
Text P N N/A N/A OBX segment with
OBX-3.1=INV1146
OBX-5=string up to 199
characters
ST RE [0..1] NO OBX|nn|ST|INV1146^Accession Number for
Genotyping^PHINQUESTION||2018TBTN4512657||||||F
TB267 PHINQUESTION
Phenotypic Drug
Susceptibility Completed
INV1147 PHINQUESTION Was phenotypic/growth-based drug
susceptibility testing done?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1147
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1147^Phenotypic Drug Susceptibility
Completed^PHINQUESTION||Y^Yes^HL70136||||||F
TB156
TB182
PHINQUESTION
Molecular Drug
Susceptibility Completed
INV1148 PHINQUESTION (Proposed) Was genotypic/molecular
drug susceptibility testing done?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1148
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1148^Molecular Drug Susceptibility
Completed^PHINQUESTION||N^No^HL70136||||||F
N/A N/A
START: RVCT Phenotypic Drug Susceptibility Testing Repeating BlockAntimicrobial
Susceptibility Test Type
LABAST6 PHINQUESTION Antimicrobial Susceptibility Test Type
of TB drugs. For the initial
susceptibility testing please send a
response for each values in the value
set. Changes in susceptibility should
be reported for each individual drug
when change is identified.
Coded P N Susceptibility Test Type
(TB)
PHVS_SusceptibilityTest
Type_TB
OBX segment with
OBX-3.1=LABAST6
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|LABAST6^Antimicrobial Susceptibility
Test Type^PHINQUESTION|1|18860-
7^Amikacin^LN||||||F
TB274
TB276
TB299
TB301
PHINQUESTION
Antimicrobial
Susceptibility Specimen
Collection Date
LABAST5 PHINQUESTION Antimicrobial Susceptibility Specimen
Collection Date
Date P N N/A N/A OBX segment with
OBX-3.1=LABAST5
OBX-4=obs sub-ID
OBX-5=date
DT RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
CHILD OBX|nn|DT|LABAST5^Antimicrobial Susceptibility
Specimen Collection
Date^PHINQUESTION|1|20180101||||||F
TB157
TB183
PHINQUESTION
Antimicrobial
Susceptibility Result
Reported Date
LABAST14 PHINQUESTION Antimicrobial susceptibility result
reported date
Date P N N/A N/A OBX segment with
OBX-3.1=LABAST14
OBX-4=obs sub-ID
OBX-5=date
DT RE [0..1] CHILD OBX|nn|DT|LABAST14^Antimicrobial Susceptibility
Result Reported
Date^PHINQUESTION|1|20180102||||||F
N/A N/A
Antimicrobial
Susceptibility Specimen
Type
LABAST3 PHINQUESTION Antimicrobial Susceptibility Specimen
Type (e.g. Exudate, Blood, Serum,
Urine)
Coded P N Microscopic Exam
Culture Site (TB)
PHVS_MicroscopicExam
CultureSite_TB
OBX segment with
OBX-3.1=LABAST3
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
CHILD OBX|nn|CWE|LABAST3^Antimicrobial Susceptibility
Specimen
Type^PHINQUESTION|1|87612001^Blood^SCT||||||F
TB268
TB269
TB293
TB294
PHINQUESTION
Antimicrobial
Susceptibility Test
Interpretation
LABAST8 PHINQUESTION Antimicrobial Susceptibility Test
Interpretation (e.g. Susceptible,
Resistant, Intermediate, Not tested)
Coded P N Susceptibility Test
Interpretation (TB)
PHVS_SusceptibilityTest
ResultQuantitative_TB
OBX segment with
OBX-3.1=LABAST8
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LABAST8^Antimicrobial Susceptibility
Test
Interpretation^PHINQUESTION|1|131196009^Suscepti
ble^SCT||||||F
TB158 thru
TB172
TB270 thru
TB273
TB275
TB184 thru
TB198
TB295 thru
TB298
TB300
PHINQUESTION
Antimicrobial
Susceptibility Test
Method
LABAST7 PHINQUESTION Antimicrobial Susceptibility Test
Method (e.g. E-Test, MIC, Disk
Diffusion)
Coded O N Susceptibility Test
Method (TB)
PHVS_SusceptibilityTest
Method_TB
OBX segment with
OBX-3.1=LABAST7
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
CHILD OBX|nn|CWE|LABAST7^Antimicrobial Susceptibility
Test Method^PHINQUESTION|1|359872008^Kirby-
Bauer/Disk Diffusion^SCT||||||F
N/A N/A
END: RVCT Phenotypic Drug Susceptibility Testing Repeating Block
START: RVCT Molecular Drug Susceptibility Testing Repeating Block
Work Estimate Version - Document is Subject to Change
Gene Identifier 48018-6 LN (Proposed) Gene identifier - Please
report the full test results for the
samples that have unique features,
such as specimen type (sputum or
another anatomic site), test type
(sequencing or non-sequencing) or
mutation (detected or not detected).
There is no need to report test results
that differ only by date or laboratory
and where all other aspects are
identical in regards to specimen type,
test type, and/or the results of
mutation.
Coded P N Gene Name (TB) PHVS_GeneName_TB OBX segment with
OBX-3.1=48018-6
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|48018-6^Gene
Identifier^LN|1|PHC1893^fabG1^CDCPHINVS||||||F
N/A N/A
Molecular Susceptibility
Specimen Collection
Date
LAB682 PHINQUESTION (Proposed) Molecular Susceptibility
Specimen Collection Date
DateTime P N N/A N/A OBX segment with
OBX-3.1=LAB682
OBX-4=obs sub-ID
OBX-5=date
TS RE [0..1] CHILD OBX|nn|TS|LAB682^Molecular Susceptibility Specimen
Collection Date^PHINQUESTION|1|20180101||||||F
N/A N/A
Molecular Susceptibility
Date Reported
LAB683 PHINQUESTION (Proposed) Molecular Susceptibility
Date Reported
DateTime P N N/A N/A OBX segment with
OBX-3.1=LAB683
OBX-4=obs sub-ID
OBX-5=date
TS RE [0..1] CHILD OBX|nn|TS|LAB683^Molecular Susceptibility Date
Reported^PHINQUESTION|1|20180102||||||F
N/A N/A
Molecular Susceptibility
Specimen Type
LAB684 PHINQUESTION (Proposed) Molecular Susceptibility
Specimen Type
Coded P N Microscopic Exam
Culture Site (TB)
PHVS_MicroscopicExam
CultureSite_TB
OBX segment with
OBX-3.1=LAB684
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
CHILD OBX|nn|CWE|LAB684^Molecular Susceptibility
Specimen
Type^PHINQUESTION|1|87612001^Blood^SCT||||||F
N/A N/A
Molecular Susceptibility
Test Result
LAB685 PHINQUESTION (Proposed) Molecular Susceptibility
Test Result
Coded P N Molecular Test Results
(TB)
PHVS_MolecularTestRes
ults_TB
OBX segment with
OBX-3.1=LAB685
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LAB685^Molecular Susceptibility Test
Results^PHINQUESTION|1|260373001^Mutation
Detected^SCT||||||F
N/A N/A
Molecular Susceptibility
Nucleic Acid Change
LAB686 PHINQUESTION (Proposed) Molecular Susceptibility
Nucleic Acid Change
Text P N N/A N/A OBX segment with
OBX-3.1=LAB686
OBX-4=obs sub-ID
OBX-5=string up to 199
characters
ST RE [0..1] CHILD OBX|nn|ST|LAB686^Molecular Susceptibility Nucleic
Acid Change^PHINQUESTION|1|AGC>ACC||||||F
N/A N/A
Molecular Susceptibility
Amino Acid Change
LAB687 PHINQUESTION (Proposed) Molecular Susceptibility
Amino Acid Change
Text P N N/A N/A OBX segment with
OBX-3.1=LAB687
OBX-4=obs sub-ID
OBX-5=string up to 199
characters
ST RE [0..1] CHILD OBX|nn|ST|LAB687^Molecular Susceptibility Amino
Acid Change^PHINQUESTION|1|Ser315Thr||||||F
N/A N/A
Molecular Susceptibility
Indel
LAB688 PHINQUESTION (Proposed) Molecular Susceptibility
Indel
Coded P N Molecular Indel (TB) PHVS_MolecularIndel_T
B
OBX segment with
OBX-3.1=LAB688
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|LAB688^Molecular Susceptibility
Indel^PHINQUESTION|1|PHC1904^Insertion^CDCPHI
NVS||||||F
N/A N/A
Molecular Susceptibility
Test Method
LAB689 PHINQUESTION (Proposed) Molecular Susceptibility
Test Method
Coded P N Molecular Test Methods
(TB)
PHVS_MolecularTestMet
hods_TB
OBX segment with
OBX-3.1=LAB689
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
CHILD OBX|nn|CWE|LAB689^Molecular Susceptibility Test
Method^PHINQUESTION|1|PHC1907^Sequencing^CD
CPHINVS||||||F
N/A N/A
END: RVCT Molecular Drug Susceptibility Testing Repeating Block
END: Genotyping and Susceptibility QuestionsCulture Conversion
Documented
INV1149 PHINQUESTION Did the patient's sputum become
culture negative?
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1149
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1149^Culture Conversion
Documented^PHINQUESTION||Y^Yes^HL70136||||||F
TB173 PHINQUESTION
Date of First Consistently
Negative Culture
INV1150 PHINQUESTION Date the first consistently negative
sputum culture was collected.
Date P N N/A N/A OBX segment with
OBX-3.1=INV1150
OBX-5=date
DT RE [0..1] For unknown date, OBX-5 MAY be
populated with '99999999'.
NO OBX|nn|DT|INV1150^Date of First Consistently
Negative Culture^PHINQUESTION||20180606||||||F
TB175 PHINQUESTION
Reason for Not
Documenting Sputum
Culture Conversion
INV1151 PHINQUESTION Indicate the one reason for not
documenting the sputum culture
conversion.
Coded P N Sputum Culture
Conversion Not
Documented Reason
PHVS_SputumCultureCo
nversionNotDocumented
Reason_TB
OBX segment with
OBX-3.1=INV1151
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1151^Reason for Not Documenting
Sputum Culture
Conversion^PHINQUESTION||399307001^Lost to
Follow Up^SCT||||||F
TB277
TB278
PHINQUESTION
Patient Move During TB
Therapy
TB279 PHINQUESTION Did the patient move during therapy? Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=TB279
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|TB279^Patient Move During TB
Therapy^PHINQUESTION||UNK^Unknown^NULLFL||||||
F
TB279 PHINQUESTION
Moved to Where INV1152 PHINQUESTION If the patient moved to a different
reporting area during TB therapy,
select all that apply to where the
patient moved.
Coded P Y Moved Where During
Therapy (TB)
PHVS_MovedWhereDuri
ngTherapy_TB
OBX segment with
OBX-3.1=INV1152
OBX-5=value from value set
CWE RE [0..*] NO OBX|nn|CWE|INV1152^Moved to
Where^PHINQUESTION||PHC246^Out of
State^CDCPHINVS||||||F
TB280 PHINQUESTION
Work Estimate Version - Document is Subject to Change
Out of State Move INV1153 PHINQUESTION If moved out of state, then specify the
new state jurisdiction.
Coded P N State PHVS_State_FIPS_5-2 OBX segment with
OBX-3.1=INV1153
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1153^Out of State
Move^PHINQUESTION||02^Alaska^FIPS5_2||||||F
TB286 PHINQUESTION
Out of Country Move INV1154 PHINQUESTION If moved out of country, then specify
the new country jurisdiction.
Coded P N Country PHVS_Country_ISO_316
6-1
OBX segment with
OBX-3.1=INV1154
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
NO OBX|nn|CWE|INV1154^Out of Country
Move^PHINQUESTION||AUT^AUSTRIA^ISO3166_1||||||
F
TB288 PHINQUESTION
Transnational Referral INV1155 PHINQUESTION If moved out of the US, indicate
whether a transnational referral was
made.
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1155
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1155^Transnational
Referral^PHINQUESTION||Y^Yes^HL70136||||||F
TB281 PHINQUESTION
END: RVCT Specific Questions
START: Multi-Drug Resistant (MDR) TB Supplemental QuestionsHistory of Treatment INV1156 PHINQUESTION History of treatment before current
episode with second-line TB drugs for
the treatment of TB disease (not
LTBI)
Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1156
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1156^History of
Treatment^PHINQUESTION||Y^Yes^HL70136||||||F
N/A N/A
Date MDR Treatment
Started
INV1157 PHINQUESTION Date MDR TB therapy started for
current episode
Date P N N/A N/A OBX segment with
OBX-3.1=INV1157
OBX-5=date
DT RE [0..1] NO OBX|nn|DT|INV1157^Date MDR Treatment
Started^PHINQUESTION||20180305||||||F
N/A N/A
START: MDR TB Previously Administered Drugs Repeating GroupDrug Used to Treat MDR
TB
INV1158 PHINQUESTION Drugs ever used for MDR TB
treatment, from MDR start date:
Please provide a response for each
medication in the value set with an
associated indicator. Medications
should be recorded as part of the
regimen beginning with the MDR TB
therapy start date.
Coded P N Medication (TB) PHVS_Medications_TB OBX segment with
OBX-3.1=INV1158
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|INV1158^Drug Used to Treat MDR
TB^PHINQUESTION|1|4110^Ethambutol^RXNORM||||||
F
N/A N/A
Length of Time Drug
Was Administered
INV1159 PHINQUESTION Indicate length of time drug was
taken or if it was not taken
Coded P N Length of Time Drug
Taken (TB)
PHVS_LengthofTimeDru
gTaken_TB
OBX segment with
OBX-3.1=INV1159
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV1159^Length of Time Drug Was
Administered^PHINQUESTION|1|PHC1915^<1
month^CDCPHINVS||||||F
N/A N/A
END: MDR TB Previously Administered Drugs Repeating GroupDate Injectable
Medication Stopped
INV1160 PHINQUESTION Date injectable medication stopped. If
no injectable drugs were used leave
blank.
Date P N N/A N/A OBX segment with
OBX-3.1=INV1160
OBX-5=date
DT RE [0..1] NO OBX|nn|DT|INV1160^Date Injectable Medication
Stopped^PHINQUESTION||20180606||||||F
N/A N/A
Surgery to Treat MDR TB INV1161 PHINQUESTION Surgery to Treat MDR TB Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1161
OBX-5=value from value set
CWE RE [0..1] NO OBX|nn|CWE|INV1161^Surgery to Treat MDR
TB^PHINQUESTION||N^No^HL70136||||||F
N/A N/A
Surgery to Treat MDR TB
Date
INV1162 PHINQUESTION Surgery to Treat MDR TB Date Date P N N/A N/A OBX segment with
OBX-3.1=INV1162
OBX-5=date
DT RE [0..1] NO OBX|nn|DT|INV1162^Surgery to Treat MDR TB
Date^PHINQUESTION||20180505||||||F
N/A N/A
START: MDR TB Side Effects from Treatment Repeating GroupAdverse Event
Description
42563-7 LN Did patient experience any of the
following side effects during
treatment that resulted in a
permanent discontinuation of
medication or at the end of treatment
were there any of the following side
effects related to MDR-TB treatment
present? Please provide a response
for all side effects in the value set
with an associated indicator.
Coded P N Side Effect of Treatment
(TB)
PHVS_SideEffectofTreat
ment_TB
OBX segment with
OBX-3.1=42563-7
OBX-4=obs sub-ID
OBX-5=value from value set
OBX-5.9=string up to 199
characters
CWE RE [0..1] OBX-5.9 MAY contain "Other,
please specify" text response.
PRIMARY/PARENTOBX|nn|CWE|42563-7^Adverse Event
Description^LN|1|57676002^Arthralgia^SCT||||||F
N/A N/A
Adverse Event Indicator INV1164 PHINQUESTION Side Effects of Treatment Indicator Coded P N Yes No Unknown (YNU) PHVS_YesNoUnknown_
CDC
OBX segment with
OBX-3.1=INV1164
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV1164^Adverse Event
Indicator^PHINQUESTION|1|Y^Yes^HL70136||||||F
N/A N/A
Adverse Event
Manifestation Time
INV1163 PHINQUESTION Did the side effect manifest during
treatment or at the end of treatment?
Coded P N Side Effect Time to
Onset (TB)
PHVS_SideEffectTimeto
Onset_TB
OBX segment with
OBX-3.1=INV1163
OBX-4=obs sub-ID
OBX-5=value from value set
CWE RE [0..1] CHILD OBX|nn|CWE|INV1163^Adverse Event Manifestation
Time^PHINQUESTION|1|PHC1919^Both^CDCPHINVS|
|||||F
N/A N/A
END: MDR TB Side Effects from Treatment Repeating Group
END: MDR TB Supplemental Questions
END: EPIDEMIOLOGIC INFORMATION SECTION
NOTE:
The Optional Laboratory Repeating Group is located in the document entitled “Laboratory Template” in the “MMG Related Documentation” section of the
HL7 Case Notification Resource Center at https://wwwn.cdc.gov/nndss/case-notification/related-documentation.html.