00 CP/MIH Visit Number The CP/MIH visit number when multiple visits are provided to the same patient for the same referral case number. 9902005 9923001 9903007 7701001 7701003 CP/MIH Stage of Visit The stage of visit for this CP/MIH program encounter. 9902009 9923001 9903007 22902001 22902003 22902005 22902007 22902009 22902011 22902013 22902015 22902017 22902019 22902021 7701001 7701003 Crew Member National EMS ID The National EMS ID associated with the crew member. This number must be 12 characters issued by the NREMT and is available for all EMS personnel. This number is populated from dPersonnel.901. This is not the same number as the national registry number. 9902009 9923001 9903005 7701001 7701003 7701005 Best Way to Contact the Patient The best way(s) to contact the patient. 9902009 9923003 9903007 25901001 25901003 25901005 25901007 25901009 25901011 7701001 7701003 Best Time of Day to Contact the Patient The best time(s) of the day to contact the patient. 9902009 9923003 9903007 25902001 25902003 25902005 7701001 7701003 Best Day of Week to Contact the Patient The best day(s) of the week to contact the patient. 9902009 9923003 9903007 25903001 25903003 25903005 25903007 25903009 25903011 25903013 7701001 7701003 Closest Relative/Guardian Relationship The relationship of the patient's closest relative or guardian. 9902009 9923001 9903007 2632023 2632025 2632027 2632029 2632031 US Military Service Indicates if the patient or patient's spouse served in the US military. 9902009 9923001 9903007 26901001 26901003 26901005 26901007 VA Benefits/Services Indicates if the patient or patient's spouse is eligible for VA benefits/services. 9902009 9923001 9903007 26902001 26902003 26902005 26902007 26902009 Closest Relative/Guardian/Alternate Contact Email The email address of the patient's closest relative or guardian or alternate contact. Use NEMSIS data type EmailAddress. 9902007 9923003 9903007 The Patient's Type of Immunization The immunization type of the patient. 9902009 9923001 9903007 9910055 Recent Travel Prior to symptom onset, did the patient travel outside their community? The time frame "prior to symptom onset" and the term "community" are defined by state or local jurisdictions. 9902009 9923001 9903007 9922001 9922003 9922005 8801019 8801021 8801023 Recent Local Travel Document all places and locations the patient has traveled to that might have posed a significant threat of exposure prior to symptom onset. The time frame "prior to symptom onset" is defined by state or local jurisdictions. 9902009 9923003 9903007 8801019 8801021 8801023 Recent Exposure to Infectious Disease Prior to symptom onset, has the patient had close contact with someone with similar symptoms or a confirmed diagnosis of the illness for which you are screening? The time frame "prior to symptom onset" is defined by state or local jurisdictions. 9902009 9923001 9903007 9922001 9922003 9922005 8801019 8801021 8801023 Recent International Travel Document all the countries (outside the US) the patient has traveled to prior to symptom onset. The time frame "prior to symptom onset" is defined by state or local jurisdictions. Use NEMSIS data type ANSICountryCode. 9902007 9923003 9903007 8801019 8801021 8801023 Recent State Travel Document all the states the patient has traveled to prior to symptom onset. The time frame "prior to symptom onset" is defined by state or local jurisdictions. Use NEMSIS data type ANSIStateCode. 9902007 9923003 9903007 8801019 8801021 8801023 Recent City Travel Document all the cities the patient has traveled to prior to symptom onset. The time frame "prior to symptom onset" is defined by state or local jurisdictions. Use NEMSIS data type CityGnisCode. 9902007 9923003 9903007 8801019 8801021 8801023 Patient's Practitioner Type The type of the patient's practitioner. This can also include a referring practitioner for CP/MIH services. 9902009 9923003 9903007 31907001 31907003 31907005 31907007 Patient's Practitioner Phone Number The phone number of the patient's practitioner. Use NEMSIS data type PhoneNumber. 9902007 9923003 9903007 Patient's Practitioner Email Address The email address of the patient's practitioner. Use NEMSIS data type EmailAddress. 9902007 9923003 9903007 Patient's Practitioner Most Recent Visit Date The date of the patient's most recent visit with the patient's practitioner. 9902003 9923001 9903007 Patient's Practitioner Most Recent Visit Reason The reason for the patient's most recent visit with the patient's practitioner. 9902009 9923001 9903007 Temperature Method The method used to obtain the patient's body temperature. 9902009 9923001 9903007 3325019 Richmond Agitation-Sedation Scale (RASS) The Richmond Agitation-Sedation Scale (RASS) score measuring the agitation or sedation level of the patient. 9902005 9923001 9903007 4 3 2 1 0 -1 -2 -3 -4 -5 COWS - Resting Pulse Rate Resting Pulse Rate in beats per minute, measured after patient is sitting or lying for one minute, for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 4 COWS - Sweating Sweating, over past half hour not accounted for by room temperature or patient activity, for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 3 4 COWS - Restlessness Restlessness observation for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 3 5 COWS - Pupil Size Pupil size observation for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 5 COWS - Bone or Joint Aches Bone or joint aches for the Clinical Opiate Withdrawal Scale (COWS). If patient was having pain previously, only the additional component attributed to opiates withdrawal is scored. 9902005 9923001 9903007 0 1 2 4 COWS - Runny Nose or Tearing Runny nose or tearing observation, not accounted for by cold symptoms or allergies, for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 4 COWS - GI Upset GI upset, over the last half hour, for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 3 5 COWS - Tremor Tremor, upon observation of outstretched hands, for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 4 COWS - Yawning Yawning observation for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 4 COWS - Anxiety or Irritability Anxiety or irritability observation for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 1 2 4 COWS - Gooseflesh Skin Gooseflesh skin observation for the Clinical Opiate Withdrawal Scale (COWS). 9902005 9923001 9903007 0 3 5 Total COWS Score The total score for the Clinical Opiate Withdrawal Scale (COWS). 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; more than 36 = severe withdrawal. 9902005 9923001 9903007 8801001 8801019 8801023 Medication Complication Any complication (abnormal effect on the patient) associated with the administration of the medication to the patient by EMS. 9902009 9923001 9903007 3708047 Medication Dose Number The dosing number for medications requiring a series of administrations. 9902005 9923001 9903007 1 2 3 4 Medication Manufacturer The pharmaceutical manufacturer of the medication administered. 9902009 9923001 9903007 AstraZeneca Janssen Moderna US, Inc. Novavax, Inc. Pfizer, Inc. Medication Lot Number The lot number of the medication administered. 9902009 9923001 9903007 Medication Expiration Date The expiration date of the medication administered. 9902003 9923001 9903007 Blood Product Unit Number The Unit Number or Donation Identification Number (DIN) of the blood being transfused. It is a federally required unique identifier that allows hospitals and blood banks to know exactly where a blood donation came from. It should be exactly 13 characters. 9902009 9923001 9903007 Blood Donor Type (ABO) The blood type of the blood being transfused. 9902009 9923001 9903007 37906001 37906003 37906005 37906007 7701001 7701003 7701005 Blood Donor Rh Factor The Rh Factor of the blood being transfused. 9902009 9923001 9903007 37907001 37907003 7701001 7701003 7701005 Date/Time Medication Stopped The date/time the medication administration was stopped. 9902003 9923001 9903007 7701001 7701003 7701005 Blood Facility ID Number (FIN) The code assigned by ICCBBA that identifies the blood collection facility that supplied the blood being transfused. It should be exactly 5 characters. 9902009 9923001 9903007 Medication Status at Patient Transfer of Care The status of the medication administration at the time of patient transfer of care. 9902009 9923001 9903007 37910001 37910003 37910005 37910007 37910009 37910011 37910013 Procedure Complication Any complication (abnormal effect on the patient) associated with the performance of the procedure on the patient. 9902009 9923001 9903007 3907053 Type of Destination The type of destination the patient was delivered or transferred to 9902009 9923001 9903007 4221043 Destination Team Pre-Arrival Alert or Activation Indication that an alert (or activation) was called by EMS to the appropriate destination healthcare facility team. The alert (or activation) should occur prior to the EMS Unit arrival at the destination with the patient. 9902009 9923001 9903007 4224021 Leave-behind Naloxone (Narcan) Kit For this encounter, was a naloxone (Narcan) opioid antagonist left at the scene? 9902009 9923001 9903007 42901001 42901003 42901005 42901007 42901009 42901011 Reason for Discharge/Removal from CP/MIH Program The reason the patient was discharged or removed from the CP/MIH program. 9902009 9923001 9903007 7701001 7701003 Referral Source The referral source for the patient associated with the CP/MIH referral case number 9902009 9923001 9903007 43901001 43901003 43901005 43901007 43901009 43901011 43901013 43901015 43901017 43901019 43901021 43901023 Patient Readmission in 30 Days Indicates the patient was readmitted to the CP/MIH program within 30 days after this encounter for continued CP/MIH treatment. 9902009 9923001 9903007 9923001 9923003 7701001 7701003 Personal Protective Equipment Used The personal protective equipment which was used by EMS personnel during this EMS patient contact. 9902009 9923001 9903007 4503025 4503027 4503029 CP/MIH Funding Source The funding source for the CP/MIH program. 9902009 9923003 9903007 10901001 10901003 10901005 10901007 10901009 10901011 10901013 10901015 EMS Personnel's Immunization Status The type of immunization status. 9902009 9923001 9903007 9910055 EMS Personnel's National EMS ID The National EMS ID associated with the personnel. This number must be 12 characters issued by the NREMT and is available for all EMS personnel. This number is used to populate eCrew.901. This is not the same number as the national registry number. 9902009 9923001 9903005 7701001 7701003 7701005 Type of Facility The type of facility (healthcare or other) that the EMS agency transports patients to or from. 9902009 9923001 9903007 1701037 NEMSIS Technical Assistance Center