6 - Document Ontology

This section describes our approach to creating a set of document type codes. This work began as a collaboration between the LOINC committee and the HL7® document ontology task force, with initial contributions from Stan Huff, Pavla Frazier, Bob Dolin, and Clem McDonald. The background and initial development of the ontology was described by Frazier et al.1 Over time, we have continued to make many refinements to this ontology. In particular, we have received exceptional contributions from colleagues at Columbia University and the U.S. Department of Veterans Affairs.

6.1 Introduction to the use of LOINC document type codes

In creating and maintaining document type codes, it is important to distinguish between the purpose of local document names and the names represented by the document type code. Document type codes are created to provide consistent semantics for the names of documents when they are shared or exchanged between independent facilities or enterprises. The names and codes that are used locally within an enterprise are entirely under the control of the local enterprise, and these names are valuable to the workflow and access of information within the enterprise. It is assumed that the exact local name for the document will be retained in the system that created the document, and that the local name can be sent along with the document type code when the document is sent to an external organization. The document type code should only express the meaning in a document name that can be shared between independent organizations.

For example, it is appropriate to have local document names like “Dr. Smith’s Tuesday Pain Clinic Note” or “Albuquerque VA General Medicine Consult Note” for use within an enterprise. However, some parts of these very specific local names are not meaningful outside of the originating enterprise. Thus, proper document type codes would have names like “Outpatient Pain Clinic Note,” or “General Internal Medicine Consult Note.”

Possible local terms Document type codes
Albuquerque VA General Medicine Consult Note General Internal Medicine Consult Note

The naming rules in this Document Ontology apply primarily to “clinical notes.” For purpose of this Users’ Guide, a clinical note is a clinical document (as defined by the HL7 CDA Standard), where clinical professionals and trainees produced the document either spontaneously (e.g., I write my admitting note) or in response to a request for consultation. “Clinical Notes” provides a better description of the process.

“Clinical Notes” are to be distinguished from patient reports such as radiology reports, pathology reports, laboratory reports, cardiac catheterization reports, etc., that are generated in response to an order for a specific procedure. Names for most of these later concepts are accommodated well by the clinical LOINC naming structure, and many such codes already exist within the LOINC database.

We must also emphasize that the names constructed in LOINC are based on the expected information content of the document, rather than the document format. This is to say that the same LOINC code would be used to represent a given document type regardless of whether it was in PDF, text document, JPG, XML, or HTML formats – if the information content contained by those documents were the same.

6.2 Relationship to other standards

6.2.1 HL7

HL7 will use LOINC codes for clinical document codes, and will not develop an independent document code system for clinical documents. At its option, HL7 may choose to limit its domain to a subset of LOINC codes.

The HL7 document type code domain will overlap with similar concepts found in HL7 V2.x (user defined table 0270 Document Types; user defined table 0496 Consent Types). Our approach to manage this overlap is:

  • Create a mapping from LOINC codes to HL7 V2.x document codes.
  • Continue to develop LOINC codes to meet the needs of the HL7 V3 domain that are not present in the V2.x tables.

Many of the document terms (Document Ontology and Radiology) should have one or more AssociatedObservations values that represent the related HL7 C-CDA "recommended sections" panel term, as well as the appropriate values in the HL7_ATTACHMENT_STRUCTURE and ValidHL7AttachmentRequest fields. These fields are needed for information exchange between payers/providers and were developed in conjunction with the HL7 Payer/Provider Information Exchange (PIE) Work Group.

6.3 Elements of document type codes

In the following, synonymy or equivalent terms are designated by parenthesis. Document codes are defined by their component parts. The first list of axis values was published in 2003, and served as the basis for an initial set of LOINC codes.

Through both empiric analysis and expert review, we have continued evaluating and refining this list. The following listing contains the current set of axis values for the elements of document type codes that have been vetted by the LOINC Committee. We are in the process of carefully harmonizing our existing Document terms with these new values.

6.3.1 Kind of Document

Description: Characterizes the general structure of the document at a macro level. Document types are differentiated based on the need to define distinct document headers.

Allowed Values:

Part Number Part Name
LP173387-4 Administrative note
LP173388-2 Against medical advice note
LP173389-0 Agreement
LP412176-2 Controlled substance agreement
LP173390-8 Certificate
LP173391-6 Birth certificate
LP173392-4 Death certificate
LP173393-2 Evaluation of mental and physical incapacity certificate
LP267921-7 Proof of encounter certificate
LP173394-0 Consent
LP173395-7 Abortion consent
LP436850-4 Organ &or tissue donation consent
LP173396-5 Anesthesia consent
LP267939-9 Blood or blood product transfusion consent
LP173397-3 Hysterectomy consent
LP267417-6 Long-term opioid therapy for pain consent
LP173398-1 Organ donation consent
LP173399-9 Procedure consent
LP173400-5 Release of information consent
LP416139-6 Research study consent
LP173401-3 Sterilization consent
LP173402-1 Surgical operation consent
LP173403-9 Contract
LP193873-9 Driver license
LP173404-7 Health insurance card
LP173405-4 Health insurance-related form
LP173406-2 Health record cover sheet
LP173407-0 Legal document
LP200113-1 Legal letter
LP416137-0 Portable medical order form
LP173408-8 Power of attorney
LP248740-5 Medical clearance note
LP181089-6 Request
LP181085-4 Prescription request
LP173409-6 Advance directives
LP173410-4 Do not resuscitate
LP173411-2 Rescinded do not resuscitate
LP173412-0 Living will
LP173413-8 Rescinded advance directive
LP200111-5 Checklist
LP267279-0 Discharge checklist
LP173414-6 Diagram
LP173415-3 Flowsheet
LP181112-6 Form
LP204180-6 Mandatory reporting form
LP416138-8 Medical history screening form
LP416137-0 Portable medical order form
LP181116-7 Instructions
LP181119-1 Action plan
LP173754-5 ADHD action plan
LP420133-3 Adrenal insufficiency emergency action plan
LP173755-2 Anaphylaxis action plan
LP173756-0 Asthma action plan
LP173757-8 Autism action plan
LP173758-6 Complex medical conditions action plan
LP173759-4 Cystic fibrosis action plan
LP173765-1 Diabetes type I action plan
LP173766-9 Diabetes type II action plan
LP173760-2 Heart disease action plan
LP173761-0 Inflammatory bowel disease action plan
LP173762-8 Multiple sclerosis action plan
LP173763-6 Muscular dystrophy action plan
LP173764-4 Seizure disorder action plan
LP173118-3 Discharge instructions
LP173417-9 Letter
LP200113-1 Legal letter
LP436846-2 End of treatment letter
LP204161-6 List
LP181534-1 Prescription list
LP173418-7 Note
LP173419-5 Adverse event note
LP436851-2 Repository initial evaluation note
LP173420-3 Alert
LP434808-4 Appointment reminder
LP436847-0 Arrival notification note
LP436848-8 Comprehensive plan of care note
LP181207-4 Order
LP416137-0 Portable medical order form
LP181204-1 Prescription
LP181529-1 Prescription for diagnostic or specialist care
LP181530-9 Prescription for durable medical equipment attachment
LP181190-2 Prescription for eyewear
LP181531-7 Prescription for medical equipment or product
LP181532-5 Prescription for medication
LP181533-3 Prescription for rehabilitation
LP181534-1 Prescription list
LP181231-4 Photographic image
LP173421-1 Report
LP183503-4 Case report
LP183502-6 Registry report
LP436849-6 Laboratory report
LP436854-6 Synoptic report for adrenal gland cancer
LP436852-0 Synoptic report for lung cancer
LP436855-3 Synoptic report for rectum cancer
LP436853-8 Synoptic report for stomach cancer
LP436856-1 Synoptic report for sarcoma cancer
LP436982-5 Scanned Laboratory Result
LP439904-6 FHIR previous cancer therapy medical record
LP436981-7 FHIR resource patient medical record
LP437011-2 Implant card

Further explanation of LOINC’s use of "Note" (i.e., a Clinical Note, also known as "Clinical Document") versus "Report": In LOINC, a Note is a document generated by a clinician as part of patient care and includes notes written at the initiative of “individual clinic and consulting clinicians.” In contrast, a Report is usually generated in response to an order, e.g., radiology, pathology, and cardiac catheterization reports. In general, we will not make two distinct LOINC codes for concepts that have all of the same attributes except that one is a Note and one is a Report. Requests for such pairs of codes (or a request for a note when a report term exists or vice versa) will be reviewed on a case by case basis.

Clinical documents meet five criteria, as defined in CDA 1.0: wholeness, stewardship, authentication, persistence, and human readability.

6.3.2 Type of Service

Description: Characterizes the kind of service or activity provided to/for the patient (or other subject of the service) as described in the note. Common subclasses of service would be evaluations, consultations, and summaries. The notion of time sequence, e.g., at the beginning (admission) or at the end (discharge), is subsumed in this axis.

Allowed Values:

Part Number Part Name
LP173107-6 Communication
LP173099-5 Conference
LP173109-2 Case conference
LP173110-0 Consultation
LP173111-8 Confirmatory consultation
LP418143-6 Coronavirus Disease 2019 (COVID-19)
LP173100-1 Counseling
LP173113-4 Group counseling
LP173112-6 Individual counseling
LP173114-2 Daily or end of shift signout
LP173115-9 Diagnostic study
LP173116-7 Inhalation challenge test
LP173117-5 Education
LP173120-9 Discharge teaching
LP173121-7 Preoperative teaching
LP173122-5 Evaluation and management
LP173129-0 Care
LP437010-4 Goals, preferences, and priorities for care experience
LP310260-7 Care management
LP173130-8 Crisis intervention
LP263715-7 Suicide prevention
LP173131-6 Disease staging
LP173132-4 Disability examination
LP173133-2 Social security administration compensation examination
LP173134-0 Compensation and pension examination
LP173135-7 VA C&P exam.acromegaly
LP173136-5 VA C&P exam.aid and attendance &or housebound
LP173137-3 VA C&P exam.arrhythmias
LP173138-1 VA C&P exam.miscellaneous arteries &or veins
LP173139-9 VA C&P exam.audio
LP173140-7 VA C&P exam.bones
LP173105-0 VA C&P exam.bones fractures &or bone disease
LP173141-5 VA C&P exam.brain &or spinal cord
LP173142-3 VA C&P exam.chronic fatigue syndrome
LP173143-1 VA C&P exam.cold injury protocol
LP173144-9 VA C&P exam.cranial nerves
LP173145-6 VA C&P exam.Cushings syndrome
LP173146-4 VA C&P exam.dental &or oral
LP173147-2 VA C&P exam.diabetes mellitus
LP173148-0 VA C&P exam.miscellaneous digestive conditions
LP173149-8 VA C&P exam.ear disease
LP173150-6 VA C&P exam.mental health eating disorders
LP173151-4 VA C&P exam.miscellaneous endocrine diseases
LP173152-2 VA C&P exam.epilepsy &or narcolepsy
LP173153-0 VA C&P exam.esophagus &or hiatal hernia
LP173168-8 VA C&P exam.extremity joints
LP173154-8 VA C&P exam.eye
LP173155-5 VA C&P exam.feet
LP173156-3 VA C&P exam.fibromyalgia
LP173157-1 VA C&P exam.general medical
LP173158-9 VA C&P exam.genitourinary
LP173159-7 VA C&P exam.disability in gulf war veterans
LP173160-5 VA C&P exam.gynecological conditions &or disorders of the breast
LP173161-3 VA C&P exam.hand &or thumb &or fingers
LP173162-1 VA C&P exam.heart
LP173163-9 VA C&P exam.hemic disorders
LP173164-7 VA C&P exam.HIV-related illness
LP173165-4 VA C&P exam.hypertension
LP173166-2 VA C&P exam.infectious &or immune &or nutritional disabilities
LP173167-0 VA C&P exam.large &or small intestines
LP173169-6 VA C&P exam.liver &or gall bladder &or pancreas
LP173170-4 VA C&P exam.lymphatic disorders
LP173171-2 VA C&P exam.general mental disorders
LP173172-0 VA C&P exam.mouth &or lips &or tongue
LP173173-8 VA C&P exam.multiple exam
LP173174-6 VA C&P exam.muscles
LP173175-3 VA C&P exam.miscellaneous neurological disorders
LP173176-1 VA C&P exam.nose &or sinus &or larynx &or pharynx
LP173177-9 VA C&P exam.peripheral nerves
LP173178-7 VA C&P exam.initial evaluation post-traumatic stress disorder
LP173179-5 VA C&P exam.review evaluation post-traumatic stress disorder
LP173180-3 VA C&P exam.prisoner of war protocol
LP173181-1 VA C&P exam.pulmonary tuberculosis &or mycobacterial diseases
LP173182-9 VA C&P exam.rectum &or anus
LP173183-7 VA C&P exam.residuals of amputations
LP173184-5 VA C&P exam.miscellaneous respiratory diseases
LP173185-2 VA C&P exam.obstructive &or restrictive &or interstitial respiratory diseases
LP173186-0 VA C&P exam.scars
LP173187-8 VA C&P exam.sense of smell &or taste
LP173188-6 VA C&P exam.skin diseases other than scars
LP173106-8 VA C&P exam.social &or industrial survey
LP173189-4 VA C&P exam.spine
LP173190-2 VA C&P exam.stomach &or duodenum &or peritoneal adhesions
LP173191-0 VA C&P exam.thyroid &or parathyroid diseases
LP173124-1 Evaluation
LP173123-3 Annual evaluation
LP173125-8 Functional status assessment
LP173198-5 History and physical
LP173199-3 Annual history and physical
LP173200-9 Admission history and physical
LP173202-5 Labor and delivery admission history and physical
LP173201-7 Comprehensive history and physical
LP173203-3 Targeted history and physical
LP173204-1 Initial evaluation
LP173205-8 Admission evaluation
LP428833-0 Pain assessment
LP173126-6 Readiness for military duty assessment
LP270301-7 Reevaluation
LP173127-4 Risk assessment and screening
LP173128-2 Fall risk assessment
LP204157-4 Safety issue assessment
LP173192-8 Evaluation and management of a specific problem
LP173193-6 Evaluation and management of anticoagulation
LP173194-4 Evaluation and management of hyperlipidemia
LP173195-1 Evaluation and management of hypertension
LP267443-2 Evaluation and management of radiation exposure
LP173197-7 Evaluation and management of smoking cessation
LP208913-6 Evaluation and management of workers compensation
LP269262-4 Fluid management
LP204160-8 Medical equipment or product
LP173206-6 Plan
LP173209-0 Plan of care
LP173213-2 Progress
LP173211-6 Restraint
LP427038-7 Stroke prevention
LP173214-0 Surgical operation
LP173215-7 Postoperative evaluation and management
LP173216-5 Preoperative evaluation and management
LP173103-5 Summary
LP173218-1 Antepartum summary
LP173221-5 Discharge summary
LP222264-6 Immunization summary
LP173223-1 Labor and delivery summary
LP173222-3 Maternal discharge summary
LP175732-9 Population summary
LP173225-6 Summary of death
LP200117-2 Summary of encounters
LP173224-9 Summary of episode
LP173226-4 Transfer summary
LP189614-3 Weight management summary
LP438240-6 Appointment summary
LP173227-2 Transplant candidate evaluation
LP173228-0 Transplant donor evaluation
LP173229-8 Well child visit
LP173230-6 Exercise testing
LP263510-2 Immunization
LP204160-8 Medical equipment or product
LP173231-4 Medication management
LP207306-4 Medication administration
LP266264-3 Parenteral therapy
LP173232-2 Medication reconciliation
LP203673-1 Notification
LP203034-6 Admission notification
LP428834-8 Arrival notification
LP428837-1 Departure notification
LP203035-3 Discharge notification
LP204130-1 Visit notification
LP173233-0 Outreach
LP173234-8 Procedure
LP267418-4 Cardiopulmonary resuscitation
LP269244-2 Conscious sedation procedure
LP410764-7 Emergency procedure
LP411573-1 Mechanical circulatory support
LP173235-5 Interventional procedure
LP418371-3 Intubation
LP173236-3 Pathology procedure
LP173237-1 Autopsy
LP421048-2 Quality
LP421047-4 Gaps in care
LP173238-9 Referral
LP173240-5 Respite
LP173104-3 Supervisory
LP173242-1 Triage

6.3.3 Setting

Description: Setting is a modest extension of CMS’s coarse definition of settings, which have well-defined meanings. Setting is not equivalent to location, which typically has more locally defined meanings and is reported in other parts of the message. Setting would be limited to one of the following categories (with some future extensions possible).

Most clinical report names would include a setting (at least at the top level) to avoid confusion between important classes of reports. For example, The Admission H&P is usually taken to be the Hospital Admission H&P, but it could be confused with the nursing home H&P if not distinguished by the setting. Setting is not a required component of the name.

Allowed Values:

Part Number Part Name
LP173041-7 Ambulance
LP173042-5 Birthing center
LP173043-3 Emergency department
LP173065-6 Hospital
LP173045-8 Intensive care unit
LP173046-6 Long term care facility
LP173047-4 Custodial care facility
LP173048-2 Nursing facility
LP173049-0 Skilled nursing facility
LP173050-8 Unskilled nursing facility
LP222061-6 Observation unit
LP173051-6 Outpatient
LP266261-9 Adult day care center
LP173052-4 Ambulatory surgical center
LP173053-2 Office
LP173054-0 Outpatient hospital
LP173055-7 Urgent care center
LP173056-5 Patient's home
LP220237-4 Pharmacy
LP248736-3 Recovery room
LP173057-3 Rehabilitation hospital
LP173058-1 Telehealth
LP248737-1 Teleimaging
LP173059-9 Telephone encounter

6.3.4 Subject Matter Domain (SMD)

Description: Characterizes the subject matter domain of a note.

Allowed Values:

Part Number Part Name
LP263512-8 Addiction medicine
LP172912-0 Addiction psychiatry
LP172915-3 Aerospace medicine
LP345051-9 Allergy
LP172918-7 Anesthesiology
LP172981-5 Pain medicine
LP248728-0 Sleep medicine
LP172919-5 Audiology
LP439903-8 Child life
LP172923-7 Chiropractic medicine
LP172933-6 Critical care medicine
LP172934-4 Dentistry
LP172935-1 Dermatology
LP172924-5 Clinical and laboratory dermatological immunology
LP172936-9 Dermatopathology
LP172987-2 Pediatric dermatology
LP172940-1 Emergency medicine
LP172957-5 Medical toxicology
LP172988-0 Pediatric emergency medicine
LP173027-6 Sports medicine
LP183499-5 Trauma
LP265794-0 Polytrauma
LP173035-9 Undersea and hyperbaric medicine
LP172942-7 Ethics
LP176905-0 Exercise physiology
LP172943-5 Family medicine
LP172913-8 Adolescent medicine
LP172947-6 Geriatric medicine
LP248728-0 Sleep medicine
LP173027-6 Sports medicine
LP172894-0 Forensic medicine
LP172944-3 Forensic psychiatry
LP172946-8 General medicine
LP433455-5 Hospitalist
LP431539-8 Hospice care
LP345043-6 Immunology
LP172925-2 Clinical and laboratory immunology
LP342846-5 Integrative medicine
LP172911-2 Acupuncture
LP172952-6 Internal medicine
LP172913-8 Adolescent medicine
LP172921-1 Cardiovascular disease
LP172927-8 Clinical cardiac electrophysiology
LP269425-7 Heart failure
LP172953-4 Interventional cardiology
LP269424-0 Transplant cardiology
LP172941-9 Endocrinology
LP172938-5 Diabetology
LP173032-6 Thyroidology
LP172945-0 Gastroenterology
LP172950-0 Hepatology
LP172947-6 Geriatric medicine
LP175685-9 Hematology
LP417851-5 Bone Marrow Transplant
LP172951-8 Infectious disease
LP183500-0 HIV
LP175686-7 Medical Oncology
LP172962-5 Nephrology
LP263511-0 Dialysis
LP418387-9 Therapeutic apheresis
LP173015-1 Pulmonary disease
LP173023-5 Rheumatology
LP248728-0 Sleep medicine
LP417852-3 Solid organ transplant
LP173027-6 Sports medicine
LP439901-2 Vascular Access
LP172956-7 Medical genetics
LP172926-0 Clinical biochemical genetics
LP172928-6 Clinical cytogenetics
LP172929-4 Clinical genetics
LP172930-2 Clinical molecular genetics
LP172959-1 Molecular genetic pathology
LP268361-5 Pharmacogenomics
LP172958-3 Mental health
LP345044-4 Eating disorders
LP173011-0 Psychiatry
LP172912-0 Addiction psychiatry
LP172922-9 Child and adolescent psychiatry
LP172944-3 Forensic psychiatry
LP172948-4 Geriatric psychiatry
LP173013-6 Psychosomatic medicine
LP173012-8 Psychology
LP248501-1 Child and adolescent psychology
LP248729-8 Neuropsychology
LP172960-9 Multi-specialty program
LP345048-5 Aerodigestive medicine
LP263714-0 Brain injury
LP420041-8 Breastfeeding
LP345049-3 Cleft and Craniofacial
LP345044-4 Eating disorders
LP417672-5 Medical Aid in Dying
LP265794-0 Polytrauma
LP417852-3 Solid organ transplant
LP172897-3 Multidisciplinary
LP172963-3 Neurological surgery
LP345042-8 Spinal surgery
LP172964-1 Neurology
LP263714-0 Brain injury
LP172931-0 Clinical neurophysiology
LP248726-4 Epilepsy
LP172965-8 Neurology neurodevelopmental disabilities
LP172898-1 Neurology w special qualifications in child neuro
LP172981-5 Pain medicine
LP248728-0 Sleep medicine
LP173038-3 Vascular neurology
LP172968-2 Nuclear medicine
LP172899-9 Nutrition and dietetics
LP345044-4 Eating disorders
LP269243-4 Obesity medicine
LP172971-6 Obstetrics and gynecology
LP221284-5 Gynecology
LP202989-2 Gynecologic oncology
LP172955-9 Maternal and fetal medicine
LP221283-7 Obstetrics
LP173020-1 Reproductive endocrinology and infertility
LP172973-2 Occupational therapy
LP172901-3 Oncology
LP202989-2 Gynecologic oncology
LP175686-7 Medical Oncology
LP172991-4 Pediatric hematology-oncology
LP173016-9 Radiation oncology
LP207940-0 Surgical oncology
LP172974-0 Ophthalmology
LP172975-7 Optometry
LP172902-1 Oral and maxillofacial surgery
LP434806-8 Orthopaedic surgery
LP172977-3 Orthopedic sports medicine
LP345042-8 Spinal surgery
LP173029-2 Surgery of the hand
LP434870-4 Orthopaedic
LP172979-9 Orthotics prosthetics
LP434767-2 Osteopathic medicine
LP172980-7 Otolaryngology
LP172967-4 Neurotology
LP172994-8 Pediatric otolaryngology
LP173007-8 Plastic surgery within the head and neck
LP248728-0 Sleep medicine
LP172982-3 Palliative care
LP172983-1 Pastoral care
LP172984-9 Pathology
LP208907-8 Anatomic pathology
LP172936-9 Dermatopathology
LP208906-0 Clinical pathology
LP172920-3 Blood banking and transfusion medicine
LP418387-9 Therapeutic apheresis
LP208902-9 Chemical pathology
LP172959-1 Molecular genetic pathology
LP208903-7 Pathology - Medical microbiology
LP241974-7 Toxicologic pathology
LP173002-9 Pediatrics
LP172913-8 Adolescent medicine
LP345048-5 Aerodigestive medicine
LP172922-9 Child and adolescent psychiatry
LP248501-1 Child and adolescent psychology
LP172937-7 Developmental-behavioral pediatrics
LP172950-0 Hepatology
LP172957-5 Medical toxicology
LP172961-7 Neonatal perinatal medicine
LP192135-4 Birth defects
LP172985-6 Pediatric cardiology
LP172986-4 Pediatric critical care medicine
LP172987-2 Pediatric dermatology
LP172989-8 Pediatric endocrinology
LP172988-0 Pediatric emergency medicine
LP172990-6 Pediatric gastroenterology
LP173000-3 Pediatric transplant hepatology
LP172991-4 Pediatric hematology-oncology
LP417851-5 Bone Marrow Transplant
LP172992-2 Pediatric infectious diseases
LP172993-0 Pediatric nephrology
LP172994-8 Pediatric otolaryngology
LP172995-5 Pediatric pulmonology
LP172996-3 Pediatric radiology
LP172997-1 Pediatric rehabilitation medicine
LP172998-9 Pediatric rheumatology
LP172999-7 Pediatric surgery
LP248728-0 Sleep medicine
LP173027-6 Sports medicine
LP173003-7 Pharmacology
LP220238-2 Clinical pharmacology
LP268361-5 Pharmacogenomics
LP173004-5 Physical medicine and rehabilitation
LP263714-0 Brain injury
LP172954-2 Kinesiotherapy
LP172981-5 Pain medicine
LP172997-1 Pediatric rehabilitation medicine
LP265794-0 Polytrauma
LP173026-8 Spinal cord injury medicine
LP173040-9 Vocational rehabilitation
LP173005-2 Physical therapy
LP173006-0 Plastic surgery
LP268363-1 Burn management
LP173007-8 Plastic surgery within the head and neck
LP173029-2 Surgery of the hand
LP173008-6 Podiatry
LP433456-3 Chiropody
LP173009-4 Preventive medicine
LP172957-5 Medical toxicology
LP172972-4 Occupational medicine
LP173035-9 Undersea and hyperbaric medicine
LP173010-2 Primary care
LP173014-4 Public health
LP204156-6 Community health care
LP267441-6 Environmental health
LP173018-5 Radiology
LP172939-3 Diagnostic radiology
LP172896-5 Interventional radiology
LP172969-0 Nuclear radiology
LP172996-3 Pediatric radiology
LP173016-9 Radiation oncology
LP173017-7 Radiological physics
LP173037-5 Vascular and interventional radiology
LP173019-3 Recreational therapy
LP173021-9 Research
LP173022-7 Respiratory therapy
LP173025-0 Speech-language pathology
LP173028-4 Surgery
LP248500-3 Bariatric surgery
LP268363-1 Burn management
LP172932-8 Colon and rectal surgery
LP172999-7 Pediatric surgery
LP173029-2 Surgery of the hand
LP173030-0 Surgical critical care
LP207940-0 Surgical oncology
LP173031-8 Thoracic and cardiac surgery
LP207300-7 Cardiac surgery
LP173033-4 Transplant surgery
LP417852-3 Solid organ transplant
LP183499-5 Trauma
LP265794-0 Polytrauma
LP434807-6 Trauma Surgery
LP173039-1 Vascular surgery
LP269976-9 Thromboembolism
LP173034-2 Tumor board
LP173036-7 Urology
LP173001-1 Pediatric urology
LP248732-2 Womens health
LP185997-6 Wound care management
LP268363-1 Burn management
LP412351-1 Wound, Ostomy, and Continence Care

6.3.5 Role

Description: Characterizes the training or professional level of the author or the party responsible for the content in the document. The role category is a high-level classification that does not get as detailed as specialty or subspecialty so as to avoid potential overlap with the subject matter domain axis.

Allowed Values:

Part Number Part Name
LP173066-4 Assistant
LP269965-2 Attending
LP173067-2 Case manager
LP173068-0 Clerk
LP269966-0 Consultant
LP173069-8 Counselor
LP264605-9 Device
LP269967-8 Fellow
LP412180-4 Healthcare navigator
LP173071-4 Hygienist
LP173072-2 Interdisciplinary
LP173073-0 Team
LP203036-1 Rapid response team
LP269968-6 Intern
LP173074-8 Medical assistant
LP221282-9 Midwife
LP173079-7 Nurse midwife
LP173075-5 Nurse
LP173076-3 CRNA
LP173077-1 Certified nursing assistant
LP173078-9 Clinical nurse specialist
LP173079-7 Nurse midwife
LP173080-5 Nurse practitioner
LP173081-3 Licensed practical nurse
LP173082-1 Registered nurse
LP173083-9 Patient
LP181523-4 Pharmacist
LP173084-7 Physician
LP269965-2 Attending
LP269966-0 Consultant
LP269967-8 Fellow
LP269968-6 Intern
LP269969-4 Resident
LP173090-4 Physician assistant
LP269969-4 Resident
LP269801-9 Social worker
LP173091-2 Student
LP173092-0 Medical student
LP173093-8 Nursing student
LP173094-6 Technician
LP173095-3 Therapist

* Physician subsumes medical physicians and osteopathic physicians.

6.4 Rules for creating clinical notes from multiple attributes

Names for required clinical notes would be constructed by picking entries from the Kind of Document axis and at least one of the other four axes (see exceptions in Section 7.4.1). The LOINC committee will create LOINC codes for all required combinations (not all possible combinations).

The original Document Ontology terms were created only for the document type of “note” and with the general naming pattern:

<Subject Matter Domain> : <Training / Professional Level>: <Setting>: <Type> : Note

As we have revised and refined the elemental axes in the Document Ontology, simple names would be constructed and ordered as follows:

Component Property Time System Scale Method Class
<Type of Service> <Kind of Document> Find Pt <Setting> Doc <SMD>.<Role> DOC.ONTOLOGY

n general, combinations from within an axis are allowed in a term name where they make sense (typically, SMD and Service), but are disallowed where they do not (typically, Role and Setting). Combinations will be represented with a plus (+), so as to distinguish from elements containing “and” or “&”. Where a particular element is not defined for a given term and leaves a LOINC axis blank, the LOINC name will include the {} naming convention. For example, if a Setting is not designated, the System will be {Setting}. Where neither the SMD nor Role is specified, {Role} is used in the Method (as of LOINC version 2.54).

LOINC codes for clinical notes designed according to this model and are assigned a Class of DOC.ONTOLOGY. The Class name was changed in LOINC version 2.50 from DOC.CLINRPT to DOC.ONTOLOGY, a more representative name for all types of documents (not just clinical reports) included in the LOINC Document Ontology.

Example LOINC codes in the Document Ontology include:

Component Property Time System Scale Method Class
Group counseling note Find Pt Hospital Doc {Role} DOC.ONTOLOGY
Note Find Pt Outpatient Doc {Role} DOC.ONTOLOGY
Admission evaluation note Find Pt {Setting} Doc General medicine DOC.ONTOLOGY
History and physical note Find Pt {Setting} Doc {Role} DOC.ONTOLOGY

For every clinical note term we create with a designated Setting, SMD, and/or Role, we will also create a general “roll-up” term where the Setting, SMD and Role are not specified, i.e. they are defined as {Setting} and {Role}. The LOINC Committee has agreed not to create a general document code in some cases, including:

  1. The Component contains only one axis value, either a Type of Service or Kind of Document. Such a generic code (absent the other attributes) would violate the current policy to include the Kind of Document plus at least one other axis value.
  2. The general type of clinical document is not likely to ever exist.

Example LOINC codes that do not have a general clinical note term include:

Component Property Time System Scale Method Class
Anesthesia consent Find Pt {Setting} Doc Patient DOC.ONTOLOGY
Organ donation consent Find Pt {Setting} Doc Patient DOC.ONTOLOGY
Health insurance card Find Pt {Setting} Doc Patient DOC.ONTOLOGY
Triage+Care note Find Pt Emergency department Doc Nurse DOC.ONTOLOGY
Prescription request Find Pt Pharmacy Doc Pharmacist DOC.ONTOLOGY

6.4.1 Exceptions to rules for creating clinical notes

As noted above, the current policy for creating clinical notes is to include the Kind of Document plus at least one other axis value. The LOINC Committee has agreed to make exceptions to the Document Ontology rules for cases where only Kind of Document is commonly designated (e.g. Driver license).

Example LOINC codes that are approved exceptions containing only a Kind of Document:

Component Property Time System Scale Method Class
Anesthesia consent Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Asthma action plan Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Birth certificate Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Case report Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Death certificate Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Do not resuscitate Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Driver license Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Photographic image Find Pt {Setting} Doc {Role} DOC.ONTOLOGY
Prescription list Find Pt {Setting} Doc {Role} DOC.ONTOLOGY

The LOINC Committee also recognizes the need for terms with only a general Kind of Document (e.g. Letter, Note, Report) designated. We have agreed to create such terms, however, they will have a status of “discouraged” to caution users. If these general terms are used, we strongly recommend that they are used in a post-coordinated manner in conjunction with one of the LOINC terms included in the LOINC Document Ontology associated observations panel (LOINC: 80582-0) to carry the relevant attribute specifications.

6.5 Document Ontology content in the LOINC distribution

Beginning with LOINC version 2.44 (June 2013), a delimited text file containing the relationships between clinical document terms (i.e. those within the Class of DOC.ONTOLOGY) and their associated ontology axis values is available as part of the LOINC download from http://loinc.org. The document ontology axis values have been assigned LOINC Part identifiers and classified according to their document ontology axis. This file defines the relationships between a given LOINC term and its ontology axis values through these fields: LoincNumber, PartNumber, PartTypeName, PartSequenceOrder, PartName. These fields are largely self-explanatory, but of note is that the PartTypeName corresponds to the Document Ontology axis, and the PartSequenceOrder is relevant for terms that combine axis values from within an axis (see Section 7.4).

Beginning with LOINC version 2.68, a computable format of the LOINC document ontology hierarchies and the relationships of all ontology parts to LOINC terms has been available in a Web Ontology Language (OWL) format. Since OWL is a standard format for representing ontological information, it is possible to query that knowledge, build visual representations, and make inferences if you have the right tools. The OWL file along with further information can be downloaded at https://loinc.org/document-ontology/owl/.

6.6 Future work

We continue active development and refinement of the Kind of Document axis. As we continue this work, we intend to develop equally specific definitive documents for other kinds of health care associated documents.

6.7 Proposing new LOINC document terms

New LOINC document type codes can be proposed using the process described in Appendix D. In general, new term proposals that contain allowed combinations of existing axis values will be made expeditiously by Regenstrief staff. Requests for document titles containing new axis values to be added to the ontology will be reviewed by the LOINC committee, and thus their final modeling may take a bit longer.

In LOINC, a Note is a document generated by a clinician as part of patient care and includes notes written at the initiative of “individual clinic and consulting clinicians.” In contrast, a Report is usually generated in response to an order, e.g., radiology, pathology, and cardiac catheterization reports. In general, we will not make two distinct LOINC codes for concepts that have all of the same attributes except that one is a Note and one is a Report. Requests for such pairs of codes (or a request for a note when a report term exists or vice versa) will be reviewed on a case by case basis.

  1. Frazier P, Rossi-Mori A, Dolin RH, Alschuler L, Huff SM. The creation of an ontology of clinical document names. Stud Health Technol Inform. 2001;84(Pt1):94-8. PubMed: 11604713.

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