Domain
Enrollment, eligibility, demographics and plan attribution
2,833 member terms
A structured clinical documentation element capturing the patient's reported symptoms across body systems during a medical history review, following standard review of systems (ROS) methodology. Used in EHR encounter documentation to support diagnosis, coding accuracy, and medical necessity determination.
The version or iteration number indicating that a patient's clinical record, care plan, or administrative document has been updated from a prior version. Used in document management and audit trail workflows to track changes to patient records over time and maintain version history.
A quantified or categorized assessment of a patient's likelihood of adverse health outcomes, hospitalizations, or high-cost utilization, derived from clinical diagnoses, claims history, or predictive risk models. Used in care management programs to prioritize outreach and allocate care resources.
The method by which a medication or treatment is administered to the patient, such as oral, intravenous, intramuscular, or topical. Used in pharmacy dispensing records, medication administration logs, and clinical documentation to ensure safe and accurate drug delivery.
The calendar date on which a patient appointment, procedure, or clinical service is planned to occur. Used in scheduling systems and care coordination workflows to manage provider capacity, track no-shows, and measure appointment lag time.
The clock time at which a patient appointment or clinical service is planned to begin. Used alongside the scheduled date in scheduling systems to manage provider calendars, optimize patient throughput, and calculate wait times and appointment adherence.
A calculated numeric rating assigned to a patient based on clinical, behavioral, or risk algorithms in EHR and care management systems, such as HCC risk scores, HEDIS quality scores, or readmission risk indices. Used by data engineers in predictive modeling, population stratification, and value-based care reporting workflows.
Numeric ordering assigned to a patient record within EHR, claims, or enrollment systems to distinguish multiple occurrences of the same patient across encounters, submissions, or transactions. Critical for deduplication and longitudinal record linkage in data pipelines.
The calendar date on which a clinical service, procedure, or encounter was rendered to the patient. Used in EHR, medical claims, and pharmacy systems to establish timelines, validate claim windows, and support date-based analytics and adjudication logic.
Coded or scored measure of a patient's condition complexity or acuity level, sourced from EHR clinical assessments, DRG assignments, or risk stratification models. Used by data engineers to support case-mix analysis, quality reporting, and population health segmentation workflows.
The biological sex assigned to the patient at birth, typically recorded as male, female, or unknown. Used in clinical documentation, eligibility records, and claims processing to ensure appropriate care protocols, billing accuracy, and demographic reporting compliance.
Identifies the originating system, facility, referral channel, or data feed from which a patient record was received, such as EHR, ADT feed, HIE, or claims clearinghouse. Essential for data lineage tracking, master patient index matching, and source-system reconciliation in ETL pipelines.
The effective begin date marking when a patient's enrollment, treatment episode, care program, or coverage period commenced within EHR, PBM, or member enrollment systems. Used to calculate eligibility windows, episode durations, and program participation metrics in downstream analytics.
The clock time marking the beginning of a patient encounter, procedure, or clinical service. Captured in scheduling and clinical systems to calculate encounter duration, measure operational efficiency, and support accurate billing for time-based procedural codes.
The two-letter state or territory code representing the patient's residential address. Used in member enrollment, claims processing, and population health reporting to determine jurisdiction, apply state-specific benefit rules, and support geographic analysis of utilization.
Represents the current lifecycle state of a patient within pharmacy systems, such as active, inactive, deceased, transferred, or on-hold. Drives downstream dispensing eligibility, refill processing, PBM adjudication rules, and patient-level reporting in pharmacy data integrations and analytics platforms.
The primary street-level residential address of the patient, including house number and street name. Used in member enrollment records, claims adjudication, and care management workflows to verify eligibility, coordinate care, and deliver correspondence or home-based services.
The concentration or dose amount of an active ingredient in a medication prescribed or dispensed to the patient, such as 500mg or 10mg/mL. Recorded in pharmacy claims and medication administration records to ensure therapeutic accuracy and prevent dosing errors.
An intermediate sum of charges or payments attributable to the patient before final adjustments, taxes, or additional fees are applied. Used in billing and claims workflows to itemize patient financial responsibility across multiple services within a single encounter or billing period.
The calendar date on which a surgical procedure was performed on the patient. Recorded in clinical and claims data to support surgical episode tracking, post-operative care coordination, complication monitoring, and accurate procedure code billing on institutional and professional claims.