Enhanced note   77601-3

LOINC Code


LOINC code77601-3
nameEnhanced note
descriptionAn enhanced note is generated by a provider at the end of an office visit, consult, or home health encounter with a patient. Enhanced encounters may involve face-to-face time with the patient or may fall under the auspices of tele-medicine visits. An enhanced note includes all sections relevant to the specific visit, except for details concerning procedures, operations or imaging performed during the encounter. The document is intended to support the entire contents of the medical record related to a specific encounter with a patient for the administrative or clinical exchange with a third party. This term was created for, but not limited in use to, the Enhanced Encounter Document level template included in the HL7 Implementation Guide for CDA® Release 2: Additional CDA R2 Templates - Clinical Documents for Payers - Set 1 (CPD1), Release 1.
statusTRIAL

Fully-Specified Name

componentEnhanced note
propertyFind  =  Finding
timePt  =  Point in time:  To identify measures at a point in time. This is a synonym for “spot” or “random” as applied to urine measurements.
system{Setting}
scaleDoc  =  Document:  A document that could be in many formats (XML, narrative, etc.)
method{Role}

Additional Names

short nameEnhanced note

Basic Attributes

classDOC.MISC
type2  Clinical
order vs. observationBoth

Ask At Order Entry

Ask at Order Entry (AOE) observations for a clinical observation or laboratory test. A LOINC term may represent a single AOE observation or a panel containing several AOE observations.

81243-8Enhanced encounter note - recommended CDP Set 1 R1.0 and R1.1 sections

Associated Observations

LOINC codes that represent optional associated observation(s) for a clinical observation or laboratory test. A LOINC term may represent a single associated observation or panel containing several associated observations.

History/Usage

first releasedY
last updated2.63
last change typeMIN  - change to field other than name
change reasonPrevious Releases: 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.;

Related Names

DOC.MISC
Document
Encounter
Evaluation and management
Evaluation and management note
Finding
Findings
MISC
notes
Point in time
Random
Visit note

Copyright © 2024 Regenstrief Institute, Inc. All Rights Reserved. To the extent included herein, the LOINC table and LOINC codes are copyright © 1995-2024, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. See https://loinc.org/license for the full LOINC copyright and license.

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