- 已装运
- 2026年8月25日 17:35 UTC
- 作者
- Kamo
- 提交
- 3db9226
DiagnosticReport keeps the report AND its Observations, because results arrive as a report and are acted on as individual values and both views have to be true at once. A CBC is one report with fourteen Observations: the haemoglobin trend needs the fourteen, the PDF the patient reads needs the one. abnormalFlag and criticalFlag are separate because the obligations are — abnormal is reviewed, critical is ACTED ON, and conflating them buries the second in the first. releasedToPatientAt is separate from issuedAt because Information Blocking makes release the default and the timing provable; withholding needs a recorded reason, so "not released yet" can never quietly mean the practice prefers to call first. Immunization treats a refusal as a RECORD, not an absence. not-done with a reason is what distinguishes a patient who decoderd from a patient nobody asked, and only the second is a care gap. CVX is the key because that is what state registries speak, but the lot number is indexed on its own: a recall is issued against a LOT, and "who did we give this lot to" is a phone-calls-that-afternoon question. The VIS edition date is statutory under the NCVIA and there is no reconstructing it later. Procedure keeps the SNOMED code as clinical truth and carries CPT beside it as what was CODED. Deriving the chart from the claim produces a chart describing what was reimbursable rather than what happened, and loses every non-billable procedure entirely. notBilled with a reason makes a deliberate non-charge distinguishable from an oversight — the difference between a policy and the single largest recoverable loss in most practices, which is invisible precisely because a missing charge row raises nothing. MedicationStatement is the list of what the patient is ACTUALLY taking, and it is not the prescription list. A prescription says what a clinician intended; a statement says what the patient reports doing, including other practices' drugs, OTCs, interacting supplements, and the drug they stopped three weeks ago without telling anyone. Reconciliation is the act of comparing the two and cannot happen if they are one table. adherence carries the finding that changes management: an unresponsive blood pressure means something entirely different when the drug is not being taken. And taking-not-as-directed still counts as taking, because half a dose is still a drug in the body. DiagnosticReport dropped its encounter index rather than take a fourth distributed write per result — the chart loads by patient and filters. 1757 tests green.