ADT A28
ADT A28: Create a new medical record
Overview
This message will either create or update a medical record in PKB. If the specified medical record (identified by the PID segment) is not found, it will be created. Otherwise, it will be updated.
If an update is performed, then the entire set of medications, allergies or diagnoses sent by your Organisation will be replaced, depending on what is sent. Note - this includes any medications, allergies or diagnoses added by a Professional from your Organisation. For example, if a Professional from your Organisation manually adds an allergy, but then a different allergy is provided in an A28 message from your Organisation, the entry manually added by the Professional will be replaced.
If you provide an email address in the message then this will be added to the record and the patient will be sent an email invitation to register (unless they have already registered, in which case they are sent a request to confirm the newly added email address). You are able to provide an email address in both PID-13 and PID-14, but a maximum of 1 from each field can be accepted. See here for more information on how PKB handles email addresses.
When creating a new patient, the following fields need be included in your HL7 message:
at least 1 identifier (either National ID, Organisation Level ID, or Team Level ID)
first name
last name
Date of Birth
Gender (sex at birth)
Relevant entities
Patient demographic information is used to populate [[Patient]] entities, including [[Contact]], [[National ID]], [[Organisation Level ID]] and [[Team Level ID]] entities. [[National ID Type]], [[Organisation Level ID Type]] and [[Team Level ID Type]] must match pre-agreed information; new types cannot be created via HL7 messaging.
Allergy information is used to populate [[Allergy]] entities
Diagnosis information is used to populate [[Diagnosis]] entities
Medication information is used to populate [[Medication]] entities
Please click through to the Data Model to explore the presentation of these entities in the web interface.
Definition
Segment | Field | Opt | RP/# | Component | Description | Example | Data Model |
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MSH |
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| Message header. This conforms to PKB's standard definition. |
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PID |
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| Patient identification. This conforms to PKB's standard definition. |
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| Allergy information. When creating or updating a medical record you can specify allergy information for the patient. The AL1 segment has no fields to indicate source; to include the provider who entered the allergy, use a NTE segment following it. When updating - the specified information replaces any existing allergy information from the sender. Duplicate allergies within the AL1 set will result in the entire message being rejected. An allergy is identified as being duplicate if AL1-3 (allergen) and AL1-6 (identification date) match that of another AL1 segment within the message. The duplicate check within AL1-3 (allergen) gives precedence to the uniqueness of either AL1-3.1 (code) or AL1-3.5 (alternate coding). When coding values are not supplied in AL1-3 then the check references AL1-3.2 (text) or AL1-3.5 (alternate text) instead. The duplicate check is conducted versus the other AL1 segments in the message. |
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| AL1-3 | R |
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| Allergen. Read V2 codes can be mapped to privacy labels if sent in AL1-3. See the coded data page for more information. Although each component is optional individually, at least one of AL1-3.1 or AL1-3.2 must be provided. |
| [[Allergy.Allergen]] |
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| AL1-3.1 | Allergen code | A_01 |
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| AL1-3.2 | Allergen text | Paracetamol |
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| AL1-3.3 | Allergen coding system |
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| AL1-3.4 | Allergen alternate code | A.1 |
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| AL1-3.5 | Allergen alternate text | Paracetamol |
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| AL1-3.6 | Allergen alternate coding system | INT |
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| AL1-4 | O |
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| Allergen severity |
| [[Allergy.Severity]] |
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| AL1-4.1 | Allergen severity code | S_01 |
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| AL1-4.2 | Allergen severity text | Mild |
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| AL1-4.3 | Allergen severity coding system | HOSP |
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| AL1-4.4 | Allergen severity alternate code | RS.M |
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| AL1-4.5 | Allergen severity alternate text | Mild |
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| AL1-4.6 | Allergen severity alternate coding system |
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| AL1-5 | O | Y |
| Allergy reaction |
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| AL1-5.1 | Allergy reaction code | Coughing, Sneezing | [[Allergy.Reactions]] |
| AL1-6 | O |
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| Identification date |
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| AL1-6.1 | Identification date | 201408310408 | [[Allergy.Onset Timestamp]] |
[ NTE ] |
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| An NTE can be optionally included after an AL1 to specify source information. |
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| NTE-5 | O |
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| Source information. |
| [[Allergy->Source.Source Text]] |
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| NTE-5.2 | Family name | Foster |
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| NTE-5.3 | Given name | John |
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| NTE-5.4 | Middle names | Harry |
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| NTE-5.6 | Prefix | Dr |
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{ [ DG1 ] } |
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| Diagnosis information. When creating or updating a medical record you can specify diagnosis information for the patient. When updating - the specified information replaces any existing diagnosis information from the sender. Duplicate diagnosis within the DG1 set will result in the entire message being rejected. A diagnosis is identified as being duplicate if DG1-3 (diagnosis) and DG1-5 (diagnosis timestamp) match that of another DG1 segment within the message. The duplicate check within DG1-3 (diagnosis) gives precedence to the uniqueness of either DG1-3.1 (code) or DG1-3.5 (alternate coding). When coding values are not supplied in DG1-3 then the check references DG1-3.2 (text) or DG1-3.5 (alternate text) instead. The duplicate check is conducted versus the other DG1 segments in the message. |
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| DG1-3 | R |
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| Diagnosis. Read V2 codes can be mapped to privacy labels if sent in DG1-3. See the coded data page for more information. Although each component is optional individually, at least one of DG1-3.1 or DG1-3.2 must be provided. |
| [[Diagnosis.Diagnosis]] |
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| DG1-3.1 | Diagnosis code | D01 |
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| DG1-3.2 | Diagnosis text | Asthma |
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| DG1-3.3 | Diagnosis coding system | HOSP |
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| DG1-3.4 | Diagnosis alternate code | D.100 |
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| DG1-3.5 | Diagnosis alternate text | Asthma |
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| DG1-3.6 | Diagnosis alternate coding system |
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| DG1-5 | O |
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| Diagnosis timestamp |
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| DG1-5.1 | Diagnosis timestamp | 201408310408 | [[Diagnosis.Start Timestamp]] |
| DG1-16 | O |
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| Diagnosing clinician. |
| [[Diagnosis->Source.Source Text]] |
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| DG1-16.2 | Family name | Foster |
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| DG1-16.3 | Given name | John |
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| DG1-16.4 | Middle names | Harry |
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| DG1-16.6 | Prefix | Dr |
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{ [ ZRX ] } |
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| Medication information. When creating or updating a medical record you can specify the medication information for the patient. When updating - the specified information replaces any existing medication information from the sender. Duplicate medications within the ZRX set will result in the entire message being rejected. A medication is identified as being duplicate if ZRX-2 (give code), ZRX-1.4 (start timestamp) and ZRX-1.5 (end timestamp) match that of another ZRX segment within the message. The duplicate check within ZRX-2 (give code) gives precedence to the uniqueness of either ZRX-2.1 (code) or ZRX-2.4 (alternate coding). When coding values are not supplied in ZRX-2 then the check references ZRX-2.2 (text) or ZRX-2.5 (alternate text) instead. The duplicate check is conducted versus the other ZRX segments in the message. This custom segment is based on an RXE v2.4 segment. |
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| ZRX-1 | O |
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| Quantity/timing. |
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| ZRX-1.2 | Repeat pattern | Once A Day | [[Medication.Frequency Text]] |
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| ZRX-1.4 | Start timestamp | 201409020909 | [[Medication.Start Timestamp]] |
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| ZRX-1.5 | End timestamp. If null (or in the future), this is considered a current medication; otherwise, it's medication history. | 201409160909 | [[Medication.End Timestamp]] |
| ZRX-2 | R |
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| Give code. |
| [[Medication.Substance]] |
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| ZRX-2.1 | Medication code | 13968911000001194 |
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| ZRX-2.2 | Medication text | Paracetamol |
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| ZRX-2.3 | Medication coding system | Dm+d |
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| ZRX-2.4 | Medication alternate code | 13968911000001194 |
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| ZRX-2.5 | Medication alternate text | Paracetamol |
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| ZRX-2.6 | Medication alternate coding system | Dm+d |
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| ZRX-3 | O |
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| Dose quantity |
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| ZRX-3.1 | Dose quantity | 1 | [[Medication.Dose Value]] |
| ZRX-5 | O |
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| Give units |
| [[Medication.Dose Units]] |
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| ZRX-5.1 | Unit code | U01 |
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| ZRX-5.2 | Unit text | Tablet |
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| ZRX-5.3 | Unit coding system | HOSP_1 |
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| ZRX-5.4 | Unit alternate code | U02 |
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| ZRX-5.5 | Unit alternate text | Tablets |
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| ZRX-5.6 | Unit alternate coding system | HOSP_2 |
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| ZRX-7 | O | Y |
| Instructions. For multiple lines of instructions -- separate lines with the HL7 repeat character (~), or include HL7-escaped linebreaks directly (using \.br\) |
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| ZRX-7.2 | Instruction text | Instructions | [[Medication.Instructions]] |
| ZRX-13 | O |
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| Source information. |
| [[Medication->Source.Source Text]] |
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| ZRX-13.2 | Family name | Foster |
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| ZRX-13.3 | Given name | John |
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| ZRX-13.4 | Middle names | Harry |
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| ZRX-13.6 | Prefix | Dr |
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[ ZTM ] |
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| This is a custom PKB team segment. If you have agreed some source aliases with PKB then you can specify 1 or more of those aliases in this ZTM segment. When creating or updating a medical record this segment will contribute to determining which teams the patient should be linked to. Note: You cannot use the ZTM segment to exclude the Team which would have otherwise been used. See our guidance on Team membership for more information. |
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| ZTM-1 | O | Y |
| Alias |
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| ZTM-1.1 | Alias | first_alias~second_alias |
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| ZTM-2 | O | Y | ZTM-2.1 | Alias | first_alias |
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Examples
Create a new patient with these IDs, demographics, medications list, allergies, and diagnoses.
MSH|^~\&|SendingApp|SendingFacility|HL7API|PKB|20160102101112||ADT^A28|ABC0000000001|P|2.4
PID|||9999999999^^^NHS^NH||Smith^John^Joe^^Mr||19700101|M|||Flat name^1, The Road^London^London^SW1A 1AA^GB-ENG||01234567890^PRN~07123456789^PRS|^NET^^john.smith@company.com~01234098765^WPN||||||||||||||||N|
AL1|1||^Paracetamol^|^Mild^|Coughing|201408310408
NTE|||||^Foster^John^Harry^^Dr|
DG1|1||^Asthma^||201408310408|||||||||||^Foster^John^Harry^^Dr|
ZRX|^Once A Day^^201409020909^201409160909|^Paracetamol^|1||^Tablet^||^Instructions||||||^Foster^John^Harry^^Dr|
ZTM|first_alias~second_alias~third_alias|first_alias|
Response
PKB will respond with a standard HL7 acknowledgement.