7.1. Inbound

7.1.1. Inbound Messages

7.1.1.1. ADT/ACK - Admit/Visit Notification (Event A01)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.1.1. Trigger Event

A remote HL7 Application notifies that a patient has arrived at a healthcare facility for an episode of care in which the patient is assigned to an inpatient bed. Such an episode is commonly referred to as “inpatient” care.

Field MSH-9 Message Type shall be valued ADT^A01^ADT_A01. The third component is optional for HL7 v2.3.1.

7.1.1.1.2. Supported Segments

The following segments are processed from an incoming ADT^A01^ADT_A01 message:

Table 7.1 Supported segments of ADT^A01^ADT_A01 (HL7 v2.3.1)

Segment	Meaning	HL7 Chapter
MSH - MSH - Message Header segment (HL7 v2.3.1)	Message Header	2
PID - PID - Patient Identification segment (HL7 v2.3.1)	Patient Identification	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.3.1)	Notes and Comments (for PID)	2

Table 7.2 Supported segments of ADT^A01^ADT_A01 (HL7 v2.5.1)

Segment	Meaning	Usage	Card.	HL7 chapter
MSH - MSH - Message Header segment (HL7 v2.5.1)	Message Header	R	[1..1]	2
PID - PID - Patient Identification segment (HL7 v2.5.1)	Patient Identification	R	[1..1]	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)	Notes and Comments (for PID)	O	[0..1]	2

7.1.1.1.3. Performed Actions

Patient IDs and other Patient Information are extracted from the PID segment of the received ADT message and mapped into corresponding DICOM attributes as defined in HL7 ADT mapping of PID segment to DICOM Patient Attributes. If a Patient record with the extracted primary Patient ID already exists in the database, that Patient record will get updated. If there is no such Patient record a new Patient record will be inserted into the database [1].

On retrieve of DICOM objects, the potentially updated DICOM attributes from the Patient record of the DB will be merged with the original DICOM attributes of the stored DICOM objects, so the changes in the Patient information are reflected in the retrieved DICOM objects.

[1] (1,2,3,4,5)

The creation of new Patient records will be suppressed for message types which are listed by configuration parameter HL7 No Patient Create Message Type(s) of dcm4che DICOM Archive 5.

7.1.1.2. ADT/ACK - Transfer a Patient (Event A02)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.2.1. Trigger Event

A remote HL7 Application notifies that a patient is being transferred from one location to another. The new location will be reflected in the institution’s bed census.

Field MSH-9 Message Type shall be valued ADT^A02^ADT_A02. The third component is optional for HL7 v2.3.1.

7.1.1.2.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.2.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.3. ADT/ACK - Discharge/End Visit (Event A03)

Supported HL7 version: 2.3.1, 2.5.1 (ITI-31)

7.1.1.3.1. Trigger Event

A remote HL7 Application notifies that a patient’s stay at a healthcare facility has ended. Inpatient encounters are generally closed by an A03. Outpatient encounters may or may not be closed by an A03, depending on the healthcare organization policies.

Field MSH-9 Message Type shall be valued ADT^A03^ADT_A03. The third component is optional for HL7 v2.3.1.

7.1.1.3.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.3.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.4. ADT/ACK - Register a Patient (Event A04)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.4.1. Trigger Event

A remote HL7 Application notifies that a patient has arrived at a healthcare facility for an episode of care in which the patient is not assigned to a bed. Examples of such episodes include outpatient visits, ambulatory care encounters, and emergency room visits.

Field MSH-9 Message Type shall be valued ADT^A04^ADT_A01. The third component is optional for HL7 v2.3.1.

7.1.1.4.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.4.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.5. ADT/ACK - Pre-Admit a Patient (Event A05)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.5.1. Trigger Event

A remote HL7 Application communicate information that has been collected about a patient to be admitted as an inpatient (or to be registered as an outpatient).

Field MSH-9 Message Type shall be valued ADT^A05^ADT_A05. The third component is optional for HL7 v2.3.1.

7.1.1.5.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.5.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.6. ADT/ACK - Change an Outpatient to an Inpatient (Event A06)

Supported HL7 version: 2.3.1, 2.5.1 (ITI-31)

7.1.1.6.1. Trigger Event

A remote HL7 Application notifies that it has been decided to admit a patient that was formerly in a non-admitted status, such as Emergency.

Field MSH-9 Message Type shall be valued ADT^A06^ADT_A06. The third component is optional for HL7 v2.3.1.

7.1.1.6.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.6.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.7. ADT/ACK - Change an Inpatient to an Outpatient (Event A07)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.7.1. Trigger Event

A remote HL7 Application notifies that a patient is no longer in an “admitted” status, but is still being seen for an episode of care..

Field MSH-9 Message Type shall be valued ADT^A07^ADT_A06. The third component is optional for HL7 v2.3.1.

7.1.1.7.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.7.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.8. ADT/ACK - Update Patient Information (Event A08)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.8.1. Trigger Event

A remote HL7 Application notifies that some non-movement-related information (such as address, date of birth, etc.) has changed for a patient. It is used when information about the patient has changed not related to any other trigger event.

Field MSH-9 Message Type shall be valued ADT^A08^ADT_A01. The third component is optional for HL7 v2.3.1.

7.1.1.8.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.8.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.9. ADT/ACK - Patient Arriving - Tracking (Event A10)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.9.1. Trigger Event

A remote HL7 Application sends this event when a patient arrives at a new location in the healthcare facility (inpatient or outpatient) (via trigger event A09).

Field MSH-9 Message Type shall be valued ADT^A10^ADT_A09. The third component is optional for HL7 v2.3.1.

7.1.1.9.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.9.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

Additionally, if configuration parameter HL7 Patient Arrival Message Type of dcm4che DICOM Archive 5 is configured as ADT^A10, SPS Status of any MWL items (which are in SCHEDULED status) associated with this patient shall be changed to ARRIVED.

7.1.1.10. ADT/ACK - Cancel Admit/Visit Notification (Event A11)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.10.1. Trigger Event

A remote HL7 Application cancels a previous notification that a patient has been admitted for an inpatient stay (via trigger event A01) or registered for an outpatient visit (via trigger event A04).

Field MSH-9 Message Type shall be valued ADT^A11^ADT_A09. The third component is optional for HL7 v2.3.1.

7.1.1.10.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.10.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.11. ADT/ACK - Cancel Transfer (Event A12)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.11.1. Trigger Event

A remote HL7 Application cancels a previous notification (via trigger event A02) that a patient was being moved from one location to another.

Field MSH-9 Message Type shall be valued ADT^A12^ADT_A12. The third component is optional for HL7 v2.3.1.

7.1.1.11.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.11.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.12. ADT/ACK - Cancel Discharge/End Visit (Event A13)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.12.1. Trigger Event

A remote HL7 Application cancels a previous notification (via trigger event A03) that a patient’s stay at a healthcare facility had ended.

Field MSH-9 Message Type shall be valued ADT^A13^ADT_A01. The third component is optional for HL7 v2.3.1.

7.1.1.12.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.12.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.13. ADT/ACK - Add Person or Patient Information (Event A28)

Supported HL7 version: 2.5 (ITI-30)

7.1.1.13.1. Trigger Event

A remote HL7 Application communicates the demographics of a new patient, as well as related information.

Field MSH-9 Message Type shall be valued ADT^A28^ADT_A05.

7.1.1.13.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.13.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.14. ADT/ACK - Update Person Information (Event A31)

Supported HL7 version: 2.5 (ITI-30)

7.1.1.14.1. Trigger Event

A remote HL7 Application updates the demographics of an existing patient.

Field MSH-9 Message Type shall be valued ADT^A31^ADT_A05.

7.1.1.14.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.14.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.15. ADT/ACK - Cancel Pre-Admit (Event A38)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-31)

7.1.1.15.1. Trigger Event

A remote HL7 Application cancels a previous notification (via trigger event A05) that a patient was to be updated to pre-admitted (or pre-registered) status.

Field MSH-9 Message Type shall be valued ADT^A38^ADT_A38. The third component is optional for HL7 v2.3.1.

7.1.1.15.2. Supported Segments

Same as specified in Section 7.1.1.1.2.

7.1.1.15.3. Performed Actions

Same as specified in Section 7.1.1.1.3.

7.1.1.16. ADT/ACK - Merge Patient - Patient Identifier List (Event A40)

Supported HL7 versions: 2.3.1, 2.5.1 (ITI-30)

7.1.1.16.1. Trigger Event

A remote HL7 Application notifies the merge of records for a patient that was incorrectly filed under two different identifiers. This message is only used to merge two patient identifiers of the same type, or two lists of patient identifiers. It is not used to update other patient demographics information. The A31 trigger event should be used for this purpose.

Field MSH-9 Message Type shall be valued ADT^A40^ADT_A39. The third component is optional for HL7 v2.3.1.

7.1.1.16.2. Supported Segments

The following segments are processed from an incoming ADT^A40^ADT_A39 message:

Table 7.3 Supported segments of ADT^A40^ADT_A39 (HL7 v2.3.1)

Segment	Meaning	HL7 Chapter
MSH - MSH - Message Header segment (HL7 v2.3.1)	Message Header	2
PID - PID - Patient Identification segment (HL7 v2.3.1)	Patient Identification	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.3.1)	Notes and Comments	2
MRG - MRG - Merge segment (HL7 v2.3.1)	Merge Information	3

Table 7.4 Supported segments of ADT^A40^ADT_A39 (HL7 v2.5.1)

Segment	Meaning	Usage	Card.	HL7 chapter
MSH - MSH - Message Header segment (HL7 v2.5.1)	Message Header	R	[1..1]	2
PID - PID - Patient Identification segment (HL7 v2.5.1)	Patient Identification	R	[1..1]	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)	Notes and Comments	O	[0..1]	2
MRG - MRG - Merge segment (HL7 v2.5.1)	Merge Information	R	[1..1]	3

The “incorrect supplier identifier” identified in the MRG segment (MRG-1 Prior Patient Identifier List) is to be merged with the required “correct target identifier” in the PID segment (PID-3 Patient Identifier List). The “incorrect supplier identifier” would then logically never be referenced in future transactions.

7.1.1.16.3. Performed Actions

Patient IDs and other Patient Information for the dominant Patient record are extracted from the PID segment of the received ADT message and mapped into corresponding DICOM attributes as defined in HL7 ADT mapping of PID segment to DICOM Patient Attributes. If a Patient record with the extracted primary Patient ID already exists in the database, that Patient record will get updated. If there is no such Patient record a new Patient record will be inserted into the database [1].

Patient ID and the Patient name for the old Patient record are extracted from the MRG segment of the received ADT message and mapped into corresponding DICOM attributes as defined in HL7 ADT mapping of MRG segment to DICOM Patient Attributes. If a Patient record with the extracted primary Patient ID already exists in the database, all associated Study, MPPS and MWL records will be moved to the Patient record with the Patient ID from the PID segment. If there is no such Patient record a new Patient record will be inserted into the database [1]. Therefore there will be always a Patient Record with the Patient ID from the MRG segment, which contains a reference to the dominant Patient Record with the Patient ID, marking them as merged.

Subsequently received HL7 messages referring a merged Patient by its Patient ID will be rejected, whereas DICOM objects to a merged Patient will be accepted. Particularly, if the Patient ID in the first received DICOM object of a Study matches the Patient ID of a merged Patient record in the database, the new Study record will be associated with the dominant Patient record, so the stale Patient Information in the received DICOM object will be replaced by the updated Patient Information in the dominant Patient record on retrieve of DICOM objects of that Study.

7.1.1.17. ADT/ACK - Change Patient Identifier List (Event A47)

Supported HL7 version: 2.5 (ITI-30)

7.1.1.17.1. Trigger Event

A remote HL7 Application notifies the change of a patient identifier list for a patient.

That is, a single PID-3 patient identifier list value has been found to be incorrect and has been changed. This message is not used to update other patient demographics information. The A31 trigger event should be used for this purpose.

Field MSH-9 Message Type shall be valued ADT^A47^ADT_A30.

7.1.1.17.2. Supported Segments

The following segments are processed from an incoming ADT^A47^ADT_A30 message:

Table 7.5 Supported Segments of ADT^A47^ADT_A30 (HL7 v2.5.1)

Segment	Meaning	Usage	Card.	HL7 chapter
MSH - MSH - Message Header segment (HL7 v2.5.1)	Message Header	R	[1..1]	2
PID - PID - Patient Identification segment (HL7 v2.5.1)	Patient Identification	R	[1..1]	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)	Notes and Comments	O	[0..1]	2
MRG - MRG - Merge segment (HL7 v2.5.1)	Merge Information	R	1..1]	3

The “incorrect supplier identifier” value is stored in the MRG segment (MRG-1 Prior Patient Identifier List) and is to be changed to the “correct target patient ID” value stored in the PID segment (PID-3 Patient Identifier List).

7.1.1.17.3. Performed Actions

The “correct” Patient IDs and other Patient Information for the Patient record are extracted from the PID segment of the received ADT message and mapped into corresponding DICOM attributes as defined in HL7 ADT mapping of PID segment to DICOM Patient Attributes. If a Patient record with the extracted primary Patient ID already exists in the database, the message will be rejected.

The “incorrect” Patient ID and the prior Patient name are extracted from the MRG segment of the received ADT message and mapped into corresponding DICOM attributes as defined in HL7 ADT mapping of MRG segment to DICOM Patient Attributes.

Further behavior depends on if HL7 Track Changed Patient ID is enabled/disabled by a correspondent configuration parameter of dcm4che DICOM Archive 5:

7.1.1.17.3.1. HL7 Track Changed Patient ID enabled

A new Patient record with Patient IDs and other Patient Information from the PID segment will be inserted into the database. If a Patient record with the prior Patient ID from the MRG segment already exists in the database, all associated Study, MPPS and MWL records will be moved to the Patient record with the Patient ID from the PID segment. If there is no such Patient record a new Patient record will be inserted into the database [1]. Therefore there will be always a Patient Record with the Patient ID from the MRG segment, which contains a reference to the dominant Patient Record with the Patient ID, marking them as merged.

Subsequently received HL7 messages referring a merged Patient by its Patient ID will be rejected, whereas DICOM objects to a merged Patient will be accepted. Particularly, if the Patient ID in the first received DICOM object of a Study matches the Patient ID of a merged Patient record in the database, the new Study record will be associated with the dominant Patient record, so the stale Patient Information in the received DICOM object will be replaced by the updated Patient Information in the dominant Patient record on retrieve of DICOM objects of that Study.

7.1.1.17.3.2. HL7 Track Changed Patient ID disabled

If a Patient record with the previous Patient ID from the MRG segment already exists in the database, it will be updated with the Patient IDs and other Patient Information from the PID segment. If there is no such Patient record a new Patient record with the Patient IDs and other Patient Information from the PID segment will be inserted into the database [1].

Consequently, subsequently received HL7 messages with the previous Patient ID will be accepted, causing the insert of a new Patient record in the database with the previous Patient ID. Also the receive of DICOM objects with the previous Patient ID will then cause the insert of a new Patient record, associated with the new received Study.

7.1.2. Inbound Message Segments

7.1.2.1. MSH - Message Header segment

Same as specified in MSH - Message Header segment (HL7 v2.3.1) or MSH - Message Header segment (HL7 v2.5.1)

7.1.2.2. PID - Patient Identification segment

Table 7.6 PID - Patient Identification segment (HL7 v2.3.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00104	SetID -Patient ID
2	20	CX	O		00105	Patient ID
3	20	CX	R		00106	Patient Identifier List
4	20	CX	O		00107	Alternate Patient ID
5	48	XPN	R		00108	Patient Name
6	48	XPN	O		00109	Mother’s Maiden Name
7	26	TS	R2		00110	Date/Time of Birth
8	1	IS	R	0001	00111	Sex
9	48	XPN	O		00112	Patient Alias
10	80	CE	R2	0005	00113	Race
11	1	06	XAD	R2	00114	Patient Address
12	4	IS	O		00115	County Code
13	40	XTN	O		00116	Phone Number - Home
14	40	XTN	O		00117	Phone Number - Business
15	60	CE	O	0296	00118	Primary Language
16	1	IS	O	0002	00119	Marital Status
17	80	CE	O	0006	00120	Religion
18	20	CX	C		00121	Patient Account Number
19	16	ST	O		00122	SSN Number – Patient
20	25	DLN	O		00123	Driver’s License Number - Patient
21	20	CX	O		00124	Mother’s Identifier
22	80	CE	O	0189	00125	Ethnic Group
23	60	ST	O		00126	Birth Place
24	1	ID	O	0136	00127	Multiple Birth Indicator
25	2	NM	O		00128	Birth Order
26	80	CE	O	0171	00129	Citizenship
27	60	CE	O	0172	00130	Veterans Military Status
28	80	CE	O		00739	Nationality
29	26	TS	O		00740	Patient Death Date and Time
30	1	ID	O	0136	00741	Patient Death Indicator

Table 7.7 PID - Patient Identification segment (HL7 v2.5.1)

SEQ	LEN	DT	Usage	Card.	TBL#	ITEM #	Element Name
1	4	SI	O	[0..1]		00104	Set ID - PID
2	20	CX	O	[0..0]		00105	Patient ID
3	250	CX	R	[1..*]		00106	Patient Identifier List
4	20	CX	O	[0..0]		00107	Alternate Patient ID - PID
5	250	XPN	R	[1..*]		00108	Patient Name
6	250	XPN	O	[0..1]		00109	Mother’s Maiden Name
7	26	TS	CE	[0..1]		00110	Date/Time of Birth
8	1	IS	CE	[1..1]	0001	00111	Administrative Sex
9	250	XPN	O	[0..1]		00112	Patient Alias
10	250	CE	O	[0..1]	0005	00113	Race
11	250	XAD	CE	[0..*]		00114	Patient Address
12	4	IS	X	[0..1]	0289	00115	County Code
13	250	XTN	O	[0..*]		00116	Phone Number - Home
14	250	XTN	O	[0..*]		00117	Phone Number - Business
15	250	CE	O	[0..1]	0296	00118	Primary Language
16	250	CE	O	[0..1]	0002	00119	Marital Status
17	250	CE	O	[0..1]	0006	00120	Religion
18	250	CX	C	[0..1]		00121	Patient Account Number
19	16	ST	X	[0..1]		00122	SSN Number - Patient
20	25	DLN	X	[0..1]		00123	Driver’s License Number - Patient
21	250	CX	O	[0..*]		00124	Mother’s Identifier
22	250	CE	O	[0..1]	0189	00125	Ethnic Group
23	250	ST	O	[0..1]		00126	Birth Place
24	1	ID	O	[0..1]	0136	00127	Multiple Birth Indicator
25	2	NM	O	[0..1]		00128	Birth Order
26	250	CE	O	[0..1]	0171	00129	Citizenship
27	250	CE	O	[0..1]	0172	00130	Veterans Military Status
28	250	CE	X	[0..0]	0212	00739	Nationality
29	26	TS	CE	[0..1]		00740	Patient Death Date and Time
30	1	ID	C	[0..1]	0136	00741	Patient Death Indicator
31	1	ID	CE	[0..1]	0136	01535	Identity Unknown Indicator
32	20	IS	CE	[0..*]	0445	01536	Identity Reliability Code
33	26	TS	CE	[0..1]		01537	Last Update Date/Time
34	241	HD	O	[0..1]		01538	Last Update Facility
35	250	CE	CE	[0..1]	0446	01539	Species Code
36	250	CE	C	[0..1]	0447	01540	Breed Code
37	80	ST	O	[0..1]		01541	Strain
38	250	CE	O	[0..2]		01542	Production Class Code
39	250	CWE	O	[0..*]		01840	Tribal Citizenship

Element names in bold indicates that the field is used by dcm4che DICOM Archive 5.

Patient IDs included in the PID-3 field shall include Assigning Authority (Component 4). The first subcomponent (namespace ID) of Assigning Authority shall be populated. If the second and third subcomponents (universal ID and universal ID type) are also populated, they shall reference the same entity as is referenced in the first subcomponent.

This field may be populated with various identifiers assigned to the patient by various assigning authorities.

7.1.2.3. NTE - Notes and Comments segment (for PID)

Table 7.8 NTE - Notes and Comments segment (for PID) (HL7 v2.3.1)

SEQ	LEN	DT	OPT	RP/#	TBL#	ITEM #	Element Name
1	4	SI	O			00096	SetID - NTE
2	4	ID	O		0105	00097	Source of Comment
3	64k	FT	O	Y		00098	Comment

Table 7.9 NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)

SEQ	LEN	DT	OPT	RP/#	TBL#	ITEM #	Element Name
1	4	SI	O			00096	SetID - NTE
2	4	ID	O		0105	00097	Source of Comment
3	65536	FT	O	Y		00098	Comment
4	250	CE	O		0364	01318	Comment Type

Element names in bold indicates that the field is used by dcm4che DICOM Archive 5.

7.1.2.4. MRG - Merge segment

Table 7.10 MRG - Merge segment (HL7 v2.3.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	20	CX	R		00211	Prior Patient Identifier List
2	20	CX	O		00212	Prior Alternate Patient ID
3	20	CX	O		00213	Prior Patient Account Number
4	20	CX	R2		00214	Prior Patient ID
5	20	CX	O		01279	Prior Visit Number
6	20	CX	O		01280	Prior Alternate Visit ID
7	48	XPN	R2		01281	Prior Patient Name

Table 7.11 MRG - Merge segment (HL7 v2.5.1)

SEQ	LEN	DT	Usage	Card.	TBL#	ITEM #	Element Name
1	250	CX	R	[1..*]		00211	Prior Patient Identifier List
2	250	CX	X	[0..0]		00212	Prior Alternate Patient ID
3	250	CX	O	[0..1]		00213	Prior Patient Account Number
4	250	CX	X		[0..0]	00214	Prior Patient ID
5	250	CX	X	[0..0]		01279	Prior Visit Number
6	250	CX	X	[0..0]		01280	Prior Alternate Visit ID
7	250	XPN	O	[0..*]		01281	Prior Patient Name

Element Names in bold indicates that the field is used by dcm4che DICOM Archive 5.

7.1.3. HL7 ADT to DICOM Mapping

Mappings between HL7 and DICOM are illustrated in the following manner:

• Element Name (HL7 item_number.component.sub-component #/ DICOM (group, element))

• The component / sub-component value is not listed if the HL7 element does not contain multiple components / sub-components.

Table 7.12 HL7 ADT mapping of PID segment to DICOM Patient Attributes

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Note
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	[2]
Patient Identification
Patient’s Name	(0010, 0010)	Patient Name	00108	PID:5
Patient ID	(0010, 0020)	Patient Identifier List	00106.1	PID:3.1	[5]
Issuer of Patient ID	(0010, 0021)	Patient Identifier List	00106.4.1	PID:3.4.1	[5]
Issuer of Patient ID Qualifiers Sequence	(0010, 0024)				[5]
>Item	(FFFE, E000)
>Universal Entity ID	(0040, 0032)	Patient Identifier List	00106.4.2	PID:3.4.2
>Universal Entity ID Type	(0040, 0033)	Patient Identifier List	00106.4.3	PID:3.4.3
Other Patient IDs Sequence	(0010, 1002)
>Patient ID	(0010, 0020)	Patient ID	00105.1	PID:2.1
>Issuer of Patient ID	(0010, 0021)	Patient ID	00105.4.1	PID:2.4.1	set to CHIP, if PID:2.4.1 empty
>Type of Patient ID	(0010, 0022)				set to RFID
>Issuer of Patient ID Qualifiers Sequence	(0010, 0024)
>>Universal Entity ID	(0040, 0032)	Patient Identifier List	00105.4.2	PID:2.4.2
>>Universal Entity ID Type	(0040, 0033)	Patient Identifier List	00105.4.3	PID:2.4.3
>Item	(FFFE, E000)
>Patient ID	(0010, 0020)	Alternate Patient ID - PID	00107.1	PID:4.1
>Issuer of Patient ID	(0010, 0021)	Alternate Patient ID - PID	00107.4.1	PID:4.4.1	set to TATTOO, if PID:4.4.1 empty
>Type of Patient ID	(0010, 0022)				set to BARCODE
>Issuer of Patient ID Qualifiers Sequence	(0010, 0024)
>>Universal Entity ID	(0040, 0032)	Patient Identifier List	00107.4.2	PID:4.4.2
>>Universal Entity ID Type	(0040, 0033)	Patient Identifier List	00107.4.3	PID:4.4.3
Patient’s Mother’s Birth Name	(0010, 1060)	Mother’s Maiden Name	00109	PID:6
Patient Demographic
Patient’s Birth Date	(0010, 0030)	Date/Time of Birth	00110	PID:7
Patient’s Sex	(0010, 0040)	Administrative Sex	00111.1	PID:8.1
Responsible Person	(0010, 2297)	Patient Alias	00112	PID:9
Responsible Person Role	(0010, 2298)				set to OWNER, if PID:9 is not empty
Patient’s Address	(0010, 1040)	Patient Address	00114	PID:11
Military Rank	(0010, 1080)	Veterans Military Status	00130	PID:27.2
Patient’s Primary Language Code Sequence	(0010, 0101)	Primary Language	00118	PID:15
Patient Species Description	(0010, 2201)	Species Code	01539.2	PID:35.2
Patient Species Code Sequence	(0010, 2202)
>Code Value	(0008, 0100)	Species Code	01539.1	PID:35.1
>Coding Scheme Designator	(0008, 0102)	Species Code	01539.3	PID:35.3
>Code Meaning	(0008, 0104)	Species Code	01539.2	PID:35.2
Patient Breed Description	(0010, 2292)	Breed Code	01540.2	PID:36.2
Patient Breed Code Sequence	(0010, 2293)
>Code Value	(0008, 0100)	Breed Code	01540.1	PID:36.1
>Coding Scheme Designator	(0008, 0102)	Breed Code	01540.3	PID:36.3
>Code Meaning	(0008, 0104)	Breed Code	01540.2	PID:36.2
Patient Comments	(0010, 4000)	Comment	00098	NTE:3
Patient Medical
Patient’s Sex Neutered	(0010, 2203)	Administrative Sex	00111.2	PID:8.2	‘Y’⇒’ALTERED’, ‘N’⇒’UNALTERED’

Table 7.13 HL7 ADT mapping of MRG segment to DICOM Patient Attributes

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Note
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	[2]
Patient Identification
Patient’s Name	(0010, 0010)	Prior Patient Name	01281	MRG:7
Patient ID	(0010, 0020)	Prior Patient Identifier List	00211.1	MRG:1.1	[5]
Issuer of Patient ID	(0010, 0021)	Prior Patient Identifier List	00211.4.1	MRG:1.4.1	[5]
Issuer of Patient ID Qualifiers Sequence	(0010, 0024)				[5]
>Universal Entity ID	(0040, 0032)	Prior Patient Identifier List	00211.4.2	MRG:1.4.2
>Universal Entity ID Type	(0040, 0033)	Prior Patient Identifier List	00211.4.3	MRG:1.4.3

7.1.4. HL7 ADT - Error Mapping

Following table gives an overview of error codes and messages sent by dcm4che DICOM Archive 5 for incoming HL7 ADT messages triggering error conditions.

Table 7.14 Error Codes Mapping and Usage

Error Code	Error Code Meaning	Error Location	User Message	Notes
Error Common
Same as Error Codes Mapping and Usage in Error Codes Mapping and Usage
Patient Management specific
101	Required Field Missing	PID^1^3^1^1	Missing patient identifier
		MRG^1^1^1^1	Missing prior patient identifier
204	Unknown Key Identifier	PID^1^3^1^1		[3]
		MRG^1^1^1^1		[3]
204	Unknown Key Identifier	PID^1^3^1^1	Missing patient identifier with trusted assigning authority	[6]
		MRG^1^1^1^1	Missing prior patient identifier with trusted assigning authority	[6]
205	Duplicate Key Identifier	PID^1^3	Either previous or new Patient ID has missing issuer and change patient id tracking is enabled. Disable change patient id tracking feature and retry update
		MRG^1^1^1^1	Prior patient identifier matches patient identifier
207	Application Internal Error			[4]

[2] (1,2)

HL7 DICOM Character Set if configured, is selected to specify Specific Character Set. Else, MSH-18 if present in the incoming HL7 message, Mapping of MSH-18-Character Set to (0008,0005) Specific Character Set is selected to specify Specific Character Set. If MSH-18 is absent, then HL7 Default Character Set is selected to specify Specific Character Set.

[3] (1,2)

Message stating respective patient identifier refers to an already merged patient record. Depends on configured HL7 Referred Merged Patient Policy <https://dcm4chee-arc-cs.readthedocs.io/en/latest/networking/config/archiveHL7Application.html#hl7referredmergedpatientpolicy>_.

[4]

User message in ERR:7 is set to exception message. This exception pertains to HL7 ADT message processing triggered internal application failure.

[5] (1,2,3,4,5,6)

Multiple patient identifiers separated by Repetition Separator ~ are included inside of Other Patient IDs Sequence (0010,1002). By default the first patient identifier pair is selected to be mapped to Patient ID (0010,0020), Issuer of Patient ID (0010,0021) and Issuer of Patient ID Qualifiers Sequence (0010,0024), unless any issuer value is configured in HL7 Primary Assigning Authority of Patient ID which shall be used to search primary qualified patient identifier in the list of identifiers in specified segment field.

[6] (1,2)

Message stating respective patient identifiers can not be identified by configured Trusted Issuer of Patient ID Pattern or by Trusted Issuer of Patient IDs