Version 2.78

Fully-Specified Name

Component
Summarization of encounter note
Property
Hx
Time
Pt
System
{Setting}
Scale
Nar
Method
{Role}

Additional Names

Short Name
Summ of encounter note

Survey Question

Text
The narrative of the patient care report (PCR)
Source
ENarrative.01

Basic Attributes

Class
NEMSIS
Type
Clinical
First Released
Version 2.40
Last Updated
Version 2.54
Change Reason
Based on Clinical LOINC Committee decision during the September 2014 meeting, {Provider} was changed to {Author Type} to emphasize a greater breadth of potential document authors. At the September 2015 Clinical LOINC Committee meeting, the Committee decided to change {Author Type} to {Role} to align with the 'Role' axis name in the LOINC Document Ontology.

Member of these Panels

LOINC Long Common Name
82315-3 Level 3 emergency medical services patient care report - recommended CDA R1 and R2 sections
84429-0 Level 3 emergency medical services patient care report - recommended CDA R1 and R2 set
84428-2 National EMS Information System - version 3 set

Language Variants Get Info

Tag Language Translation
es-MX Spanish (Mexico) Resumen de la nota del encuentro:Hx:Punto temporal:{Configuración}:Narrativo:{Role}
it-IT Italian (Italy) Riepilogo dell'incontro, note:Hx:Pt:{Setting}:Nar:{Role}
Synonyms: National EMS Information System data - dati del Si Punto nel tempo (episodio) Ruolo non specificato Storia;Anamnesi
nl-NL Dutch (Netherlands) samenvatting van contact:voorgeschiedenis:moment:{instelling}:tekstueel:{rol}
Synonyms: anamnese
zh-CN Chinese (China) 就医记录摘要:历史记录:时间点:{环境}:叙述型:{角色}
Synonyms: National Emergency Medical Services Information System;美国国家急救医疗服务信息系统;国家急救医疗服务信息系统;全国急救医疗服务信息系统;全美急救医疗服务信息系统 事件发生的地方;场景;环境;背景 历史;史;病史 叙述;叙述性文字;报告;报告型;文字叙述;文本叙述型;文本描述;文本描述型 就医（就医过程、就诊、邂逅、就诊过程、接触过程、接触、遭遇、遭遇过程、医患交互、医患互动、医患相互作用、医患接触过程）记录摘要;就医过程记录摘要;就医记录概要;就医记录概括;就医记录总汇;就医记录小结;就医记录总结 时刻;随机;随意;瞬间 未加明确说明的角色 笔记;按语;注释;说明;票据;单据;证明书

LOINC Terminology Service (API) using HL7® FHIR® Get Info

CodeSystem lookup
https://fhir.loinc.org/CodeSystem/$lookup?system=http://loinc.org&code=67781-5