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WORK ESTIMATE VERSION - MMG IS SUBJECT TO CHANGE - NOT FOR IMPLEMENTATION PURPOSES


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^

2.16.840.1.114222.4.10.3ÎSO~Ge

neric_MMG_V2.0^PHINMsgMapID^

2.16.840.1.114222.4.10.4ÎSO~TB

_Case_Map_v3.0^PHINMsgMapID

^2.16.840.1.114222.4.10.4ÎSO.

NO MSH|^~\&|SendAppName^2.16.840.1.114222.TBDÎS

O|Sending-

Facility^2.16.840.1.114222.TBDÎSO|PHINCDS^2.16.8

40.1.114222.4.3.2.10ÎSO|PHIN^2.16.840.1.114222ÎS

O|20160630120030.1234-

0500||ORU^R01ÔRU_R01|MESSAGE CONTROL

ID|D|2.5.1|||||||||NOTF_ORU_v3.0^PHINProfileID^2.16.8

40.1.114222.4.10.3ÎSO~Generic_MMG_V2.0^PHINMs

gMapID^2.16.840.1.114222.4.10.4ÎSO~

TB_MMG_V3.0^PHINMsgMapID^2.16.840.1.114222.4.

10.4ÎSO

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


OBX-3.1=INV1108


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


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.


OBX-3.1=INV1110


characters

ST RE [0..1] NO OBX|nn|ST|INV1110^Previously Reported State Case


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-5.9=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^JAPANÎSO3166_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~1002-5Âmerican Indian or

Alaska

Native^CDCREC|^Âtlanta^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


CWE RE [0..1] NO OBX|nn|CWE|INV1112Înside 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~1002-5Âmerican 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


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?


CDC

OBX segment with

OBX-3.1=DEM2003


CWE RE [0..1] NO OBX|nn|CWE|DEM2003ÛS

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



characters

CWE RE [0..*] OBX-5.9 MAY contain "Other,


NO OBX|nn|CWE|INV1113^Primary Guardian(s) Country of

Birth^PHINQUESTION||ARGÂRGENTINAÎSO3166_1|

|||||F

TB217

TB218

PHINQUESTION

https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.1038








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?


CDC

OBX segment with

OBX-3.1=INV1114


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



characters



NO OBX|nn|CWE|INV1116Înital 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



characters



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


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


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



characters



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.


OBX-3.1=68963-8

OBX-4=obs sub-ID

OBX-5=date

TS RE [0..1] For unknown date, OBX-5 MAY be


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


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


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



characters



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


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


CWE RE [0..1] CHILD OBX|nn|CWE|LAB679Êvidence 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


CWE RE [0..1] CHILD OBX|nn|CWE|LAB680Êvidence of Miliary

TB^PHINQUESTION|1|UNKÛnknown^NULLFL||||||F

TB244

TB247

PHINQUESTION
















Date of Chest Study LAB681 PHINQUESTION (Proposed) Date of the chest

diagnostic study


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.


OBX-3.1=85658-3

OBX-4=obs sub-ID


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


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.


OBX-3.1=85078-4

OBX-4=obs sub-ID


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


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



characters



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


CDC

OBX segment with

OBX-3.1=INV1118

OBX-4=obs sub-ID


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


CWE RE [0..1] NO OBX|nn|CWE|INV1119^Type of Correctional

Facility^PHINQUESTION||PHC26^State

Prison^CDCPHINVS||||||F

TB129 PHINQUESTION











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


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


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.


CDC

OBX segment with

OBX-3.1=INV1121


CWE RE [0..1] NO OBX|nn|CWE|INV1121^Patient lived outside of US for

more than 2

months^PHINQUESTION||UNKÛnknown^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?


CDC

OBX segment with

OBX-3.1=INV1122


CWE RE [0..1] NO OBX|nn|CWE|INV1122Îdentified 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?


CDC

OBX segment with

OBX-3.1=INV1123


CWE RE [0..1] NO OBX|nn|CWE|INV1123Êvaluation During Contact


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


characters

ST RE [0..*] NO OBX|nn|ST|INV1124^Linked Case


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


OBX-3.1=86948-7

OBX-5=date



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


CWE RE [0..*] NO OBX|nn|CWE|55753-8^Treatment Administration

Type^LN||PHC1881ÊDOT (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


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



characters



NO OBX|nn|CWE|INV1129Înitial LTBI Drug

Regimen^PHINQUESTION||PHC1883Îsoniazid (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



characters



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



characters



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


OBX-3.1=INV1132


characters

ST RE [0..1] NO OBX|nn|ST|INV1132^NTSS State Case


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


CWE RE [0..*] NO OBX|nn|CWE|64750-3Âdverse Event

Severity^LN||434081000124108^Hospitalized^SCT||||||F

N/A N/A

END: TBLISS Specific Questions

START: RVCT Specific Questions


















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


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


CWE RE [0..1] NO OBX|nn|CWE|TB101^Status at Diagnosis of

TB^PHINQUESTION||438949009Âlive^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



characters



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?


CDC

OBX segment with

OBX-3.1=INV1134


CWE RE [0..1] NO OBX|nn|CWE|INV1134^Contact


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


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?


CDC

OBX segment with

OBX-3.1=161413004

OBX-4=obs sub-ID


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



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


OBX-3.1=INV1136

OBX-4=obs sub-ID


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


CDC

OBX segment with

OBX-3.1=INV1137

OBX-4=obs sub-ID


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)?


CDC

OBX segment with

OBX-3.1=INV1138


CWE RE [0..1] NO OBX|nn|CWE|INV1138Înitially 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



characters



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



characters



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



characters



NO OBX|nn|CWE|INV1141^Reason Therapy

Extended^PHINQUESTION||PHC700Înability 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


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



characters



PRIMARY/PARENTOBX|nn|CWE|INV1143Înitial Drug

Regimen^PHINQUESTION|1|2551^Ciprofloxacin^RXN

ORM||||||F

TB263

TB265

PHINQUESTION





















Initial Drug Regimen

Indicator

INV1144 PHINQUESTION (Proposed) Indicator response for the

initial drug regimen question


CDC

OBX segment with

OBX-3.1=INV1144

OBX-4=obs sub-ID


CWE RE [0..1] CHILD OBX|nn|CWE|INV1144Înitial 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?


CDC

OBX segment with

OBX-3.1=INV1145


CWE RE [0..1] NO OBX|nn|CWE|INV1145Îsolate 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.


OBX-3.1=INV1146


characters

ST RE [0..1] NO OBX|nn|ST|INV1146Âccession Number for

Genotyping^PHINQUESTION||2018TBTN4512657||||||F

TB267 PHINQUESTION

Phenotypic Drug

Susceptibility Completed

INV1147 PHINQUESTION Was phenotypic/growth-based drug

susceptibility testing done?


CDC

OBX segment with

OBX-3.1=INV1147


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?


CDC

OBX segment with

OBX-3.1=INV1148


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



characters



PRIMARY/PARENTOBX|nn|CWE|LABAST6Ântimicrobial Susceptibility

Test Type^PHINQUESTION|1|18860-

7Âmikacin^LN||||||F

TB274

TB276

TB299

TB301

PHINQUESTION

Antimicrobial

Susceptibility Specimen

Collection Date

LABAST5 PHINQUESTION Antimicrobial Susceptibility Specimen

Collection Date


OBX-3.1=LABAST5

OBX-4=obs sub-ID

OBX-5=date



CHILD OBX|nn|DT|LABAST5Ântimicrobial Susceptibility

Specimen Collection

Date^PHINQUESTION|1|20180101||||||F

TB157

TB183

PHINQUESTION

Antimicrobial

Susceptibility Result

Reported Date

LABAST14 PHINQUESTION Antimicrobial susceptibility result

reported date


OBX-3.1=LABAST14

OBX-4=obs sub-ID

OBX-5=date

DT RE [0..1] CHILD OBX|nn|DT|LABAST14Ântimicrobial 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)


Culture Site (TB)


CultureSite_TB

OBX segment with

OBX-3.1=LABAST3

OBX-4=obs sub-ID



characters



CHILD OBX|nn|CWE|LABAST3Ântimicrobial 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)


ResultQuantitative_TB

OBX segment with

OBX-3.1=LABAST8

OBX-4=obs sub-ID


CWE RE [0..1] CHILD OBX|nn|CWE|LABAST8Ântimicrobial 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)


Method_TB

OBX segment with

OBX-3.1=LABAST7

OBX-4=obs sub-ID



characters



CHILD OBX|nn|CWE|LABAST7Ântimicrobial 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














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



characters



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


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


Date Reported


Date Reported


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


Specimen Type


Specimen Type


Culture Site (TB)


CultureSite_TB

OBX segment with

OBX-3.1=LAB684

OBX-4=obs sub-ID



characters



CHILD OBX|nn|CWE|LAB684^Molecular Susceptibility

Specimen

Type^PHINQUESTION|1|87612001^Blood^SCT||||||F

N/A N/A


Test Result


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


CWE RE [0..1] CHILD OBX|nn|CWE|LAB685^Molecular Susceptibility Test

Results^PHINQUESTION|1|260373001^Mutation

Detected^SCT||||||F

N/A N/A


Nucleic Acid Change


Nucleic Acid Change


OBX-3.1=LAB686

OBX-4=obs sub-ID


characters

ST RE [0..1] CHILD OBX|nn|ST|LAB686^Molecular Susceptibility Nucleic

Acid Change^PHINQUESTION|1|AGC>ACC||||||F

N/A N/A


Amino Acid Change


Amino Acid Change


OBX-3.1=LAB687

OBX-4=obs sub-ID


characters

ST RE [0..1] CHILD OBX|nn|ST|LAB687^Molecular Susceptibility Amino

Acid Change^PHINQUESTION|1|Ser315Thr||||||F

N/A N/A


Indel


Indel

Coded P N Molecular Indel (TB) PHVS_MolecularIndel_T

B

OBX segment with

OBX-3.1=LAB688

OBX-4=obs sub-ID


CWE RE [0..1] CHILD OBX|nn|CWE|LAB688^Molecular Susceptibility

Indel^PHINQUESTION|1|PHC1904Însertion^CDCPHI

NVS||||||F

N/A N/A


Test Method


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



characters



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?


CDC

OBX segment with

OBX-3.1=INV1149


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.


OBX-3.1=INV1150

OBX-5=date



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



characters



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


CWE RE [0..1] NO OBX|nn|CWE|TB279^Patient Move During TB

Therapy^PHINQUESTION||UNKÛnknown^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


CWE RE [0..*] NO OBX|nn|CWE|INV1152^Moved to

Where^PHINQUESTION||PHC246Ôut of

State^CDCPHINVS||||||F

TB280 PHINQUESTION

















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


CWE RE [0..1] NO OBX|nn|CWE|INV1153Ôut of State

Move^PHINQUESTION||02Âlaska^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



characters



NO OBX|nn|CWE|INV1154Ôut of Country

Move^PHINQUESTION||AUTÂUSTRIAÎSO3166_1||||||

F

TB288 PHINQUESTION

Transnational Referral INV1155 PHINQUESTION If moved out of the US, indicate

whether a transnational referral was

made.


CDC

OBX segment with

OBX-3.1=INV1155


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)


CDC

OBX segment with

OBX-3.1=INV1156


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


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



characters



PRIMARY/PARENTOBX|nn|CWE|INV1158^Drug Used to Treat MDR

TB^PHINQUESTION|1|4110Êthambutol^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


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.


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


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



characters



PRIMARY/PARENTOBX|nn|CWE|42563-7Âdverse Event

Description^LN|1|57676002Ârthralgia^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


CWE RE [0..1] CHILD OBX|nn|CWE|INV1164Âdverse 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


CWE RE [0..1] CHILD OBX|nn|CWE|INV1163Âdverse 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.














Tuberculosis and LTBI

Documents