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ActRelationship
Lvl Type, Domain name and/or Mnemonic code Concept ID Mnemonic Print Name Definition/Description
1 S: ActRelationshipOutcome (OUTC) 10324 OUTC has outcome An observation that should follow or does actually follow as a result or consequence of a condition or action (sometimes called "post-condition".) Target must be an observation as a goal, risk or any criterion. For complex outcomes a conjunction attribute
2   L:  (GOAL) 10325 GOAL has goal A goal that one defines given a patient's health condition. Subsequently planned actions aim to meet that goal. Source is an observation or condition node, target must be an observation in goal mood.
2   L:  (OBJC) 10327 OBJC has continuing objective A desired state that a service action aims to maintain. E.g., keep systolic blood pressure between 90 and 110 mm Hg. Source is an intervention service. Target must be an observation in criterion mood.
2   L:  (OBJF) 10326 OBJF has final objective A desired outcome that a service action aims to meet finally. Source is any service (typically an intervention.) Target must be an observation in criterion mood.
2   L:  (RISK) 10328 RISK has risk A noteworthy undesired outcome of a patient's condition that is either likely enough to become an issue or is less likely but dangerous enough to be addressed.
1 S: ActRelationshipPertains (PERT) 10329 PERT has pertinent information This is a very unspecific relationship from one item of clinical information to another. It does not judge about the role the pertinent information plays.
2   L:  (AUTH) 14019 AUTH Authorized by A relationship in which the target act authorizes or certifies the source act.
2   L:  (CAUS) 10332 CAUS is cause for An assertion that a new observation was assumed to be the cause for another existing observation. The assumption is attributed to the same actor who asserts the observation. This is stronger and more specific than the support link. For example, a growth of Staphylococcus aureus may be considered the cause of an abscess. The source (cause) is typically an observation, but may be any service, while the target must be an observation.
2   L:  (COVBY) 14894 COVBY Covered By A relationship in which the source act is covered by or is under the authority of a target act. A financial instrument such as an Invoice Element is covered by one or more specific instances of an Insurance Policy.
2   L:  (DRIV) 10334 DRIV is derived from A derivation link serves to explicitly associate a derived observation with its input parameters. Both, source and target must be observations, typically numerical observation. E.g., an anion-gap observation can be associated as being derived from given sodium-, (potassium-,) chloride-, and bicarbonate-observations.
2   L:  (EXPL) 10331 EXPL has explanation This is the inversion of support. Used to indicate that a given observation is explained by another observation or condition.
2   L:  (LIMIT) 14896 LIMIT Limited by A relationship that limits or restricts the source act by the elements of the target act. For example, an authorization may be limited by a financial amount (up to $500). Target Act must be in EVN.CRIT mood.
2   L:  (MFST) 10333 MFST is manifestation of An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation.
2   L:  (NAME) 10336 NAME assigns name Used to assign a "name" to a condition thread. Source is a condition node, target can be any service.
2   L:  (PREV) 14018 PREV has previous instance A relationship in which the target act is a predecessor instance to the source act. Generally each of these instances is similar, but no identical. In healthcare coverage it is used to link a claim item to a previous claim item that might have claimed for the same set of services.
2   L:  (REFR) 14020 REFR Refers to A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee.
2   L:  (REFV) 10335 REFV has reference values Reference ranges are essentially descriptors of a class of result values assumed to be "normal", "abnormal", or "critical." Those can vary by sex, age, or any other criterion. Source and target are observations, the target is in criterion mood. This link type can act as a trigger in case of alarms being triggered by critical results.
2   L:  (SPRT) 10330 SPRT has support Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post.)
2   L:  (SUMM) 15988 SUMM Summarized by An act that contains summary values for a list or set of subordinate acts. For example, a summary of transactions for a particular accounting period.
1 A: ActRelationshipPosts 14900 Codes that describe the relationship between an Act and a financial instrument such as a financial transaction, account or invoice element.
2   L:  (CHRG) 14904 CHRG has charge A relationship that provides an ability to associate a financial transaction (target) as a charge to a clinical act (source). A clinical act may have a charge associated with the execution or delivery of the service. The financial transaction will define the charge (bill) for delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.
2   L:  (COST) 14903 COST has cost A relationship that provides an ability to associate a financial transaction (target) as a cost to a clinical act (source). A clinical act may have an inherit cost associated with the execution or delivery of the service. The financial transaction will define the cost of delivery or performance of the service. Charges and costs are distinct terms. A charge defines what is charged or billed to another organization or entity within an organization. The cost defines what it costs an organization to perform or deliver a service or product.
2   L:  (CREDIT) 14902 CREDIT has credit A credit relationship ties a financial transaction to an account. A credit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account credit will decrease the account balance. A non-asset account credit will decrease the account balance.
2   L:  (DEBIT) 14901 DEBIT has debit A debit relationship ties a financial transaction (target) to an account (source). A debit, once applied (posted), may have either a positive or negative effect on the account balance, depending on the type of account. An asset account debit will increase the account balance. A non-asset account debit will decrease the account balance.
1 S: ActRelationshipPrecondition (PRCN) 10319 PRCN has pre-condition A requirement to be true before a service is performed. The target can be any service in criterion mood. For multiple pre-conditions a conjunction attribute (AND, OR, XOR) is applicable.
2   L:  (CIND) 10323 CIND has contra-indication A contraindication is just a negation of a reason, i.e. it gives a condition under which the action is not to be done. Both, source and target can be any kind of service, target service is in criterion mood. How the strength of a contraindication is expressed (e.g., relative, absolute) is left as an open issue. The priority_nmb attribute could be used.
2   L:  (RACT) 14892 RACT is required by A required act for a service or financial instrument such as an insurance plan or policy. The required act will typically be triggered by an event criterion Act. In other words, if a specific condition occurs (e.g. coverage limits are exceeded), then the required act must be performed (e.g. notify covered party).
2   L:  (RSON) 10321 RSON has reason The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action.
2   L:  (SUGG) 10322 SUGG suggests This is an inversion of the reason link, used to express recommendations or suggestions or recommendations, for example, recommendations given by a specialist at the end of a diagnostic report.
2   L:  (TRIG) 10320 TRIG has trigger A pre-condition that if true would permit, suggest, or demand the source service (action) to be executed. The target is in criterion mood. A delay between the trigger and the triggered action can be specified.
1 S: ActRelationshipReplacement (RPLC) 10338 RPLC replaces A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type.
2   L:  (SUCC) 11616 SUCC Succeeds A new order that adds to, but does not completely replace its predecessor.
1 S: ActRelationshipRevision (RVSN) 10337 RVSN is revision of A service description that is a modification of another service description. This includes revisions of protocols and orders.
2   S: ActRelationshipFulfills (FLFS) 10342 FLFS fulfills (order) A service that was done in fulfillment of an ordered service description. A fulfilled service may differ from an ordered (or planned) service description.
3     L:  (DISP) 10343 DISP dispensing for (ordrer) Links a medication service (order) with a supply service, representing the dispensing of the drug (as order or event.)
3     L:  (OCCR) 11614 OCCR Occurrence An Act performed (or intended to be performed) at a single time, in partial fullfillment of an order with multiple occurrences. The source Act.effective_time must consist of a single, non-repeating, non-interupted interval.
3     L:  (OREF) 11628 OREF references order Relates either an appointment request or an appointment to the order for the service being scheduled.
3     L:  (SCH) 11627 SCH schedules request Relates an apointment to an appointment request. There may be many appointment requests that either create or modify an appointment, but a request only applies to one appointment.
3     L:  (SCHE) 11629 SCHE schedules encounter Relates an encounter to an appointment. There may be an appointment without an encounter or an encounter without an appointment.
2   L:  (APND) 10339 APND is appendage An addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered.
2   L:  (GEN) 10348 GEN has generalization The generalization relationship can be used to express categorical knowledge about services (e.g., amilorid, triamterene, and spironolactone have the common generalization potassium sparing diuretic.)
2   L:  (GEVL) 10346 GEVL evaluates (goal) A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal o observation) can be "calculated" and need not be sent explicitly.
2   L:  (INST) 10341 INST instantiates (master) Used to capture the link between a potential service ("master" or plan) and an actual service, where the actual service instantiates the potential service. The instantiation may override the master's defaults.
2   L:  (ITGT) 13971 ITGT has interaction target Relates a Control_event to the Act (or acts) it relates to. May be used both when triggering the event, as well as to show previously triggered events. (e.g. list of previous events modifying the Act.)
2   L:  (MTCH) 10345 MTCH matches (trigger) A trigger-match links an actual service (e.g., an observation or procedure that took place) with a service in criterion mood. For example if the trigger is "observation of pain" and pain is actually observed, and if that pain-observation caused the trigger to fire, that pain-observation can be linked with the trigger.
2   L:  (REV) 14898 REV Reverses A relationship between two financial transactions that is used when a posted transaction is reversed and must be referenced by the subsequent reversal transaction. The source financial transaction is the transaction to be reversed and the target financial transaction is the transaction that is reversing.
2   L:  (SBST) 10344 SBST substitutes (brand product) A special link between medications indicating that the source is a generic for the target.
2   L:  (UPDT) 10340 UPDT updates (condition) A condition thread relationship specifically links condition nodes together to form a condition thread. The source is the new condition node and the target links to the most recent node of the existing condition thread.
1 A: DocumentRelationship 11610
2   S: ActRelationshipReplacement (RPLC) 10338 RPLC replaces A replacement source act replaces an existing target act. The state of the target act being replaced becomes obselete, but the act is typically still retained in the system for historical reference. The source and target must be of the same type.
3     L:  (SUCC) 11616 SUCC Succeeds A new order that adds to, but does not completely replace its predecessor.
2   L:  (APND) 10339 APND is appendage An addendum (source) to an existing service object (target), containing supplemental information. The addendum is itself an original service object linked to the supplemented service object. The supplemented service object remains in place and its content and status are unaltered.
2   L:  (XFRM) 11613 XFRM has transformation An act relationship in which a the target act is a transformation of the source act.
1 L:  (COMP) 10318 COMP has component A collection of sub-services as steps or subtasks performed for the source service. Services may be performed sequentially or concurrently. See Section 1 below for detail.
1 L:  (DOC) 11609 DOC documents The source act documents the target act.
1 L:  (OPTN) 10347 OPTN has option Multiple alternative options for an order, routing, or scheduling options and preferences may be specified for a planned (or ordered) service. The source (plan) is in either of the moods definition, intent, or order. The Service.priority_nmb attribute is used to weigh options as preferred over other options.
1 L:  (XFRM) 11624 XFRM Transformation Used when the target Act is a transformation of the source Act. (For instance, used to show that a CDA document is a transformation of a DICOM SR document.)

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