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IndexSegmentSetComponentTitle Requirement for anonymous reporting (no PII)Requirement for fully identified reporting (includes PII)Removed during de-identification by hubComment FHIR CardinalityFHIR OptionalityFHIR Profile PathAt-Home MappingAt-Home element descriptionFHIR IG Dev Notes
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3MSH13.1Sending system namespace Required Required {name of App, <20 char} 0..1MSMessageHeader.source.nameMessageHeader-at-home-in-vitro-test-results.source.nameSending system namespace (name of app)
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4MSH13.2Sending system OID Required Required See 'Obtaining App Specific Identifiers' 0..1MSMessageHeader.source.idMessageHeader-at-home-in-vitro-test-results.source.idSending system OID
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6MSH14.1Sending facility name Required Required See 'Obtaining App Specific Identifiers' 0…1MSMessageHeader.sender(Organization).nameMessageHeader-at-home-in-vitro-test-results.sender(US Core Organization).nameUS Core: Name used for the organization
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7MSH14.2Sending facility ID Required Required See 'Obtaining App Specific Identifiers' 0..1MSMessageHeader.sender(Organization).identifier.valueMessageHeader-at-home-in-vitro-test-results.sender(US Core Organization).identifier:CLIA.valueUS Core: Clinical Laboratory Improvement Amendments (CLIA) Number for laboratoriesReferences US Core Organization profile, no use-case specific description
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8MSH14.3Sending facility ID type Required Required “CLIA” 0..1MSMessageHeader.sender(Organization).identifier.systemMessageHeader-at-home-in-vitro-test-results.sender(US Core Organization).identifier.systemUS Core: The namespace for the identifier value
Fixed Value: urn:oid:2.16.840.1.113883.4.7
References US Core Organization profile, no use-case specific description
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9MSH15.1Receiving system namespace Required Required To be provided by receiving system0..1MSMessageHeader.destination.nameMessageHeader-at-home-in-vitro-test-results.destination.nameReceiving system namespace (name of destination application)
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10MSH15.2Receiving system OID Required Required To be provided by receiving system0..1MSMessageHeader.destination.idMessageHeader-at-home-in-vitro-test-results.destination.idReceiving system OID
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12MSH16.1Receiving facility name Required Required To be provided by receiving system1…1MSMessageHeader.destination.receiver(Organization).nameMessageHeader-at-home-in-vitro-test-results.receiver(US Core Organization).nameUS Core: Name used for the organizationReferences US Core Organization profile, no use-case specific description
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13MSH16.2Receiving facility ID Required Required To be provided by receiving system0..1MSMessageHeader.destination.receiver(Organization).identifier.valueMessageHeader-at-home-in-vitro-test-results.receiver(US Core Organization).identifier.valueUS Core: Identifies this organization across multiple systems (the value that is unique)
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1..1MSMessageHeader.destination.receiver(Organization).identifier.systemMessageHeader-at-home-in-vitro-test-results.receiver(US Core Organization).identifier.systemUS Core: Identifies this organization across multiple systems (the namespace for the identifier value)NOT IN V2
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15MSH17Date and time of message Required Required {"YYYYMMDDHHMMSS+ZZZZ” (where ZZZZ is the time zone offset); For example: |19760704010159-0500| is 1:01:59 on July 4, 1976 in the Eastern Standard Time zone (USA)} 1..1MSBundle.timestampBundleAtHomeInVitroTest.timestampWhen the bundle was assembled
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25SFT11Software Vendor Organization Required Required  0..1MSMessageHeader.source.extensionMessageHeader-at-home-in-vitro-test-results.source.extension[Extension-at-home-in-vitro-test-source-software-info.vendorOrganization]Source software vendor organization
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26SFT12Software Certified Version or Release Number Required Required  0..1MSMessageHeader.source.versionMessageHeader-at-home-in-vitro-test-results.source.versionSoftware certified version or release number 
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27SFT13Software Product Name Required Required  0..1MSMessageHeader.source.softwareMessageHeader-at-home-in-vitro-test-results.source.softwareSoftware product name
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28SFT14Software Binary ID Required Required  0..1MessageHeader.source.extensionMessageHeader-at-home-in-vitro-test-results.source.extension[Extension-at-home-in-vitro-test-source-software-info.softwareBinaryID]Source software binary ID
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29SFT16Software Install Date Required Required {YYYYMMDD}0..1MessageHeader.source.extensionMessageHeader-at-home-in-vitro-test-results.source.extension[Extension-at-home-in-vitro-test-source-software-info.softwareInstallDate]Source software install date
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31PID13.1Patient ID Required Required Unique ID assigned to patient by App provider 1..1MSPatient.identifier.valueUS Core Patient.identifier.valueUS Core: An identifier for this patient: the value that is unique within the system
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32PID13.4.2Patient ID assigner Required Required See 'Obtaining App Specific Identifiers' (same as MSH-3.2) 1..1MSPatient.identifier.systemUS Core Patient.identifier.systemUS Core: An identifier for this patient: namespace for the identifier valueAssuming this is the system: namespace for the identifier value
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35PID15.1Patient last name Do not includeRequired Yes 0..1MSPatient.name.familyUS Core Patient.name.family US Core: Family name (often called 'Surname')
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36PID15.2Patient first name Do not includeRequired Yes 0..1MSPatient.name.givenUS Core Patient.name.givenUS Core: Given names (not always 'first'). Includes middle names
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37PID15.3Patient middle name Do not includeOptional Yes 0..1MSPatient.name.givenUS Core Patient.name.givenUS Core: Given names (not always 'first'). Includes middle names
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38PID17Patient DOB Do not includeRequired Yes{YYYYMMDD}0..1MSPatient.birthDateUS Core Patient.birthDateUS Core: The date of birth for the individual
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39PID18Patient sex Optional Required https://www.hl7.org/fhir/v2/0001/ 1..1MSPatient.genderUS Core Patient.genderUS Core: male | female | other | unknown
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40PID110.1Patient race code Optional Optional https://www.hl7.org/fhir/v2/0005/ 0..1MSPatient.us-core-raceUS Core Patient.us-core-raceUS Core Race Extension
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41PID110.2Patient race description Conditional Conditional When PID-10.1 is valued: https://www.hl7.org/fhir/v2/0005/ 0..1MSPatient.us-core-raceUS Core Patient.us-core-raceUS Core Race Extension
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42PID110.3Patient race code system Conditional Conditional When PID-10.1 is valued: "HL70005" 0..1MSPatient.us-core-raceUS Core Patient.us-core-raceUS Core Race Extension
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43PID110.7Patient race code system version Conditional Conditional When PID-10.1 is valued: "2.5.1" 0..1MSPatient.us-core-raceUS Core Patient.us-core-raceUS Core Race Extension
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44PID111.1Patient street address Do not includeOptional Yes 0..*MSPatient.address.lineUS Core Patient.address.lineUS Core: Street name, number, direction & P.O. Box etc.
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45PID111.2Patient street address 2 Do not includeOptional Yes 0..*MSPatient.address.lineUS Core Patient.address.lineUS Core: Street name, number, direction & P.O. Box etc.
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46PID111.4Patient city Do not includeRequired Yes 0..1MSPatient.address.cityUS Core Patient.address.cityUS Core: Name of city, town etc.
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47PID111.5Patient zip code See commentRequired 
See comment
For anonymous reporting, only include initial three digits of zip code unless zip code is restricted. See here: https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html#zip0..1MSPatient.address.postalCodeUS Core Patient.address.postalCodeUS Core: US Zip Codes
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48PID111.9Patient County Do not includeRequired Yeshttps://phinvads.cdc.gov/vads/ViewValueSet.action?id=FA221794-C665-E811-98FD-0017A477041A0..1Patient.address.districtn/aBase address data element includes disctrict - not specifically called out in US Core Patient but can be used
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49PID113.3Patient phone telecom equipment code Do not includeOptional Yes"PH" for phone number, "Internet" for email address 1..1MSPatient.telecom.systemUS Core Patient.telecom.systemUS Core: phone | fax | email | pager | url | sms | other
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50PID113.4Patient email Do not includeOptional Yes 0..1MSPatient.telecom[system='email'].valueUS Core Patient.telecom[system=email].valueUS Core: The actual contact point details
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51PID113.6Patient phone area code Do not includeRequired Yes{nnn} 0..1MSPatient.telecom[system='phone'].valueUS Core Patient.telecom[system=phone].valueUS Core: The actual contact point details
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52PID113.7Patient local phone Do not includeRequired Yes{NNNNNNN} 0..1MSPatient.telecom[system='phone'].valueUS Core Patient.telecom[system=phone].valueUS Core: The actual contact point details
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53PID122.1Patient ethnicity code Optional Optional https://www.hl7.org/fhir/v2/0189/ 0..1Patient.us-core-ethnicityUS Core Patient.us-core-ethnicityUS Core ethnicity Extension
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54PID122.2Patient ethnicity description Conditional Conditional When PID-22.1 is valued: https://www.hl7.org/fhir/v2/0189/ 0..1Patient.us-core-ethnicityUS Core Patient.us-core-ethnicityUS Core ethnicity Extension
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55PID122.3Patient ethnicity code system Conditional Conditional When PID-22.1 is valued: "HL70189" 0..1Patient.us-core-ethnicityUS Core Patient.us-core-ethnicityUS Core ethnicity Extension
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56PID122.7Patient ethnicity code system version Conditional Conditional When PID-22.1 is valued: "2.5.1" 0..1Patient.us-core-ethnicityUS Core Patient.us-core-ethnicityUS Core ethnicity Extension
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90OBR17.1Observation result date Required Required {Same as SPM-17.1}1..1MSObservation.effective[x].dateTimeObservation-at-home-in-vitro-test-result.effective[x].dateTimeThe effectiveTime SHALL be precise to at least the minute and SHALL include a time zone offset
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97OBR122.1Test result date releasedRequiredRequired{"YYYYMMDDHHMMSS+ZZZZ}0..1MSObservation.issuedObservation-at-home-in-vitro-test-result.issuedTest result date released - when test item is done (in the at-home setting will mostly be the same as the Observation.effective[x], could be different when a proctor is involved - when the proctor releases the result) - mapped to OBR 22 because it is the required field in the message.
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98OBR125Result statusRequiredRequired"F" 1..1MSObservation.Status (=final)Observation-at-home-in-vitro-test-result.status=final
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101OBX13.1Test performed code Required Required https://www.cdc.gov/csels/dls/sars-cov-2-livd-codes.html; LOINC Mapping Tab - column F 0..1MSObservation.code.coding.codeObservation-at-home-in-vitro-test-result.code.coding.codeAt Home Tests: Symbol in syntax defined by the system
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102OBX13.2Test performed description Required Required https://www.cdc.gov/csels/dls/sars-cov-2-livd-codes.html; LOINC Mapping Tab - column G 0..1MSObservation.code.displayObservation-at-home-in-vitro-test-result.code.coding.displayAt Home Tests: Representation defined by the system
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103OBX13.3Test performed code system Required Required "LN" 0..1MSObservation.code.coding.systemObservation-at-home-in-vitro-test-result.code.coding.systemAt Home Tests: Identity of the terminology system
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104OBX13.7Test Performed code system version Required Required Use most common LOINC version available (Currently "2.71") 0..1Observation.code.coding.versionObservation-at-home-in-vitro-test-result.code.coding.versionAt Home Tests: Version of the system - if relevant
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105OBX15.1Test result code Required Required "260373001" if positive, "260415000" if negative, "455371000124106" if invalid, "125154007" if unsatisfactory 0..1MSObservation.value.coding.codeObservation-at-home-in-vitro-test-result.value.coding.codeAt-Home Test Result Value
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106OBX15.2Test result description Required Required "Detected" if positive, "Not detected" if negative, "Invalid result" if invalid, “Specimen unsatisfactory for evaluation" if unsatisfactory 0..1MSObservation.value.coding.displayObservation-at-home-in-vitro-test-result.value.coding.displayAt-Home Test Result Value
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107OBX15.3Test result code system Required Required "SCT" 0..1Observation.value.coding.systemObservation-at-home-in-vitro-test-result.value.coding.systemAt-Home Test Result Value
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108OBX111Test result status Required Required "F" 1..1MSObservation.Status=finalObservation-at-home-in-vitro-test-result.status=final
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109OBX115.1Test Producer's ID Required Required "00Z0000014" for OTC, "00Z0000015" for Prescription n/a
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110OBX117.1Device identifier Required Required https://www.cdc.gov/csels/dls/sars-cov-2-livd-codes.html; LOINC Mapping tab - {value from column M}“_”{value from column N}  Observation.device.reference (Device)Device.udiCarrier.deviceIdentifier
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113OBX119Test analysis date Required Required {YYYYMMDDHHMMSS[+/-ZZZZ]}, Date of mobile device interpretation 1..1MSObservation.effective.dateTime
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114OBX123.1Test Performing organization name Required Required "SA.OverTheCounter" or "SA.Prescription" n/a
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149OBX33.1Symptomatic assessment code Conditional Conditional When OBX-5 (Set 3) is valued: "95419-8" 1..1MSObservation.code.coding.codeObservation - Patient Question Answer.code.coding.codeThis particular question is required - add constraints to IG to enforce this
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150OBX33.2Symptomatic assessment code description Conditional Conditional When OBX-5 (Set 3) is valued: "Whether the patient has symptoms related to condition of interest" 0..1MSObservation.code.coding.displayObservation - Patient Question Answer.code.coding.display
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151OBX33.3Symptomatic assessment code system Conditional Conditional When OBX-5 (Set 3) is valued: "LN" 1..1MSObservation.code.coding.systemObservation - Patient Question Answer.code.coding.system
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152OBX33.7Symptomatic assessment code system version Optional Optional Use most common LOINC version available (Currently "2.71") 0..1MSObservation.code.coding.versionObservation - Patient Question Answer.code.coding.version
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153OBX35Symptomatic assessment result Optional Optional "Y^Yes^HL70136" if yes, "N^no^HL70136" if no, "UNK^Unknown^NULLFL" if unknown 1..1MSObservation.valueCodeableConcept.coding.code
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156OBX323.1Symptomatic assessment Performing organization name Required Required "SA.OverTheCounter" or "SA.Prescription" n/a
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157OBX323.6.2
Symptomatic assessment Performing Organization ID Assigner OID 
Required Required "2.16.840.1.113883.4.7" n/a
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158OBX323.6.3
Symptomatic assessment Performing Organization Assigner ID type 
Required Required "ISO" n/a
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159OBX323.7Symptomatic assessment Performing Organization ID Type Required Required "XX" n/a
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160OBX323.1Symptomatic assessment Performing Organization identifier Required Required "00Z0000014" for OTC, "00Z0000015" for Prescription n/a
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161OBX324.1Symptomatic assessment Performing organization street address Required Required "11 Fake AtHome Test Street" for OTC, "12 Fake AtHome Test Street" for Prescription n/a
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162OBX324.3Symptomatic assessment Performing Organization City Required Required "Yakutat" n/a
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163OBX324.4Symptomatic assessment Performing Organization State Required Required "AK" n/a
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164OBX324.5Symptomatic assessment Performing Organization Zip code Required Required "99689" n/a
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165OBX324.9Symptomatic assessment Performing Organization County Required Required "02282" n/a
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166OBX329Symptomatic assessment Observation type Required Required "QST" n/a
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167OBX41Set ID Conditional Conditional When OBX-5 (Set 4) is valued: "4" 
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168OBX42Illness onset date value type Conditional Conditional When OBX-5 (Set 4) is valued: "DT" MSExtension: Observation.reasonReference.Reference.USCoreCondition.onsetDateTime
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169OBX43.1Illness onset date code Conditional Conditional When OBX-5 (Set 4) is valued: "65222-2" Extension: Observation.reasonReference.Reference.USCoreCondition.onsetDateTime
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170OBX43.2Illness onset date code description Conditional Conditional When OBX-5 (Set 4) is valued: "Date and time of symptom onset" 0..1MSExtension: Observation.reasonReference.Reference.USCoreCondition.code
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171OBX43.3Illness onset date code system Conditional Conditional When OBX-5 (Set 4) is valued: "LN" Extension: Observation.reasonReference.Reference.USCoreCondition.code
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172OBX43.7Illness onset date code system version Optional Optional Use most common LOINC version available (Currently "2.71") 
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173OBX45Illness onset date result Conditional Conditional When OBX-5 (Set 3) is valued: {YYYYMMDDHHMMSS[+/-ZZZZ]}
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174OBX46.7Unit code system version Optional Optional Use most common UCUM version available (currently "2.1") 
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175OBX411Illness onset date result status Conditional Conditional When OBX-5 (Set 4) is valued: "F" 
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189SPM12.2.1Specimen ID Required Required {Unique ID assigned to every test by app manufacturer}0..1MSObservation.specimen.reference(Specimen).Specimenidentifier.IdentifierSpecimen-at-home-in-vitro-test.identifierIs this the same ID as the test?
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190SPM12.2.3Specimen ID Assigner OID Required Required See 'Obtaining App Specific Identifiers' (same as MSH-3.2) 0..1MSObservation.specimen.reference(Specimen).Specimen.identifier.Identifier.uri
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191SPM12.2.4Specimen ID assigner ID type Required Required "ISO" 0..1MSObservation.specimen.reference(Specimen).Specimen.identifier.Identifier.type
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192SPM14.1Specimen type code Required Required https://www.cdc.gov/csels/dls/sars-cov-2-livd-codes.html 0..1MSObservation.specimen.reference(Specimen).Specimen.type.codableConceptSpecimen-at-home-in-vitro-test.type.coding.codeSafe to bind to SNOMED in framework profile? i.e. this will always be a SNOMED code? Or should we just leave it open and it will be bound to a value set at the use case level? (Going with latter option for now).
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193SPM14.2Specimen type description OptionalOptionalhttps://www.cdc.gov/csels/dls/sars-cov-2-livd-codes.html 0..1MSObservation.specimen.reference(Specimen).Specimen.type.codableConceptSpecimen-at-home-in-vitro-test.type.textThe specimen text description.Assuming this is a textual description of the specimen type? (Could be a longer description than the SNOMED term or could just be the SNOMED term)
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194SPM14.3Specimen type code system Required Required "SCT" 0..1MSObservation.specimen.reference(Specimen).Specimen.type.codableConceptSpecimen-at-home-in-vitro-test.type.coding.system
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195SPM14.7Specimen type code system version Required Required "20210301" 
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196SPM117.1Specimen collected date Required Required {YYYYMMDDHHMMSS[+/-ZZZZ]}1..1MSObservation.specimen.reference(Specimen).Specimen.collection.collected.dateTimeSpecimen-at-home-in-vitro-test.collectedDateTime
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Organization that issues the UDI for this testNot included in V2 IGNot included in V2 IG0..1MSDevice.udiCarrier.issuer
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Expiration date of the test kitNot included in V2 IGNot included in V2 IG0..1MSDevice.expirationDate
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Lot number of the test kitNot included in V2 IGNot included in V2 IG0..1MSDevice.lotNumber
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Serial number of the test kitNot included in V2 IGNot included in V2 IG0..1MSDevice.serialNumber
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Not included in V2 IGNot included in V2 IG0..1DiagnosticReport.media
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Not included in V2 IGNot included in V2 IGV2 - could be Responsible Observer (OBX16)Proctor
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