This file contains patient specific problems entered by the various providers of service. The PATIENT NAME field (.02) is a backward pointer to the IHS PATIENT file. This file contains one record for each problem for each patient, therefore, the KEY field (.01) is duplicated. As of March 17, 1986 the FACILITY must be entered prior to the NUMBER. If the NUMBER is entered without previously entering the FACILITY the "AA" index is created with no FACILITY pointer.
.01diagnosis(+)0;1POINTER80BThis is the ICD coded diagnosis of the narrative entered describing this problem.
.02patient name(+)0;2POINTER9000001ACThis is the patient for whom this problem has been observed and recorded.
.03date last modified(+)0;3DATE-TIMEThis is the last date/time this problem was changed.
This flag is used by the IHS Problem List to indicate if this problem is documented for historical purposes.
.05provider narrative(+)0;5POINTER9999999.27This contains the actual text used by the provider to describe this problem.
.06facility(+)0;6POINTER9999999.06This is the facility at which this problem was originally observed and documented.
.07nmbr(+)0;7NUMERICThis is a number which, together with the Patient (#.02) and Facility (#.06) fields, serves as a unique identifier for this problem. Up to 2 decimal places may be used to indicate that a problem is a result of, or related to, another problem.
.08date entered(+)0;8DATE-TIMEThis is the date this problem was entered into this file.
.12status(+)0;12SET OF CODESA:ACTIVE
This is the current activity status of this problem, whether active or inactive; if more detail is needed, a notation may be filed with this problem.
.13date of onset0;13DATE-TIMEThis is the approximate date this problem appeared, as precisely as known.
1.01problem1;1POINTER757.01CThis field contains the standardized text stored in the Clinical Lexicon for this problem.
This reflects the current condition of this entry, whether transcribed by a clerk from the paper chart, entered or verified by a provider, or marked as removed from the patient's list.
1.03entered by1;3POINTER200This is the user who actually entered this problem into this file.
1.04recording provider1;4POINTER200This is the provider who first recorded this problem, either on the paper chart or online.
1.05responsible provider1;5POINTER200This is the provider currently responsible for treating this problem.
1.06service1;6POINTER49This is the service primarily involved in the treatment of this problem; the DHCP Problem List defaults this field to the service defined in File #200 for the Recording Provider of this problem, upon entry of the problem. It may later be used to categorize problems for screening and sorting.
1.07date resolved1;7DATE-TIMEThis is the date this problem was resolved or inactivated, as precisely as known.
1.08clinic1;8POINTER44This is the clinic in which this patient is being seen for this problem. The problem list may be screened based on this value, to change one's view of the list.
1.09date recorded1;9DATE-TIMEThis is the date this problem was originally recorded, either online or in the paper chart; it may be the same as, or earlier than, the Date Entered.
1.1service connected1;10BOOLEAN1:YES
If the patient has service connection on file in the DHCP Patient file #2, this problem specifically may be flagged as being service connected.
1.11agent orange exposure1;11BOOLEAN1:YES
If this problem is related to a patient's exposure to Agent Orange, it may be flagged here.
1.12ionizing radiation exposure1;12BOOLEAN1:YES
If this problem is related to a patient's exposure to ionizing radiation, it may be flagged here.
1.13persian gulf exposure1;13BOOLEAN1:YES
If this problem is related to a patient's service in the Persian Gulf, it may be flagged here.
1.14priority1;14SET OF CODESA:ACUTE
This is a flag to indicate how critical this problem is for this patient; problems marked as Acute will be flagged on the Problem List display.
1.15head and/or neck cancer1;15BOOLEAN1:YES
If this problem is related to the treatment of head and/or neck cancer associated with nose or throat radium treatments, it may be flagged here.
1.16military sexual trauma1;16BOOLEAN1:YES
If this problem is related to the treatment of military sexual trauma, it may be flagged here.
1.17combat veteran1;17BOOLEAN1:YES
1.18shipboard hazard & defense1;18BOOLEAN1:YES
1101note facility11;0MULTIPLE9000011.11This is the location at which the notes in this multiple originated.
80001snomed ct concept code800;1FREE TEXTASCTA clinical idea to which a unique ConceptID has been assigned in SNOMED CT. Each Concept is represented by a row in the Concepts Table.
80002snomed ct designation code800;2FREE TEXTA single SNOMED Concept may have multiple Designations, where a Designation may be considered an alternate way of expressing the concept. Synonyms, lexical variants, abbreviations are all different types of designations. In many cases, a problem (as reported by the patient) and a finding indicating a problem will share the same concept and concept code (e.g., abdominal pain), but will have different designation codes (i.e., the generic "abdominal pain and "abdominal pain (finding) share the concept code 21522001, but they have the designation codes 36112013 and 750827015 respectively.
80003vhat concept vuid (future)800;3FREE TEXTVHA Unique ID (VUID) for the VHAT Concept. A unique meaningless integer assigned to a corresponding concept VHA wide. This field is being implemented to allow a more rapidly extensible vocabulary for VA, while international normative standard coding systems continue to evolve more slowly. The precise definition of the concept Polytrauma may prove to be a useful example. Although the term has become common among US Military and VA physicians to describe a seriously injured (i.e., Injury Severity Score (ISS) >= 16) soldier with multiple traumatic injuries, it is not yet available as a coded concept in either SNOMED CT, ICD-9-CM, or ICD-10-CM. Allowing the definition and deployment of VHAT Concept/Designation VUID pairs to identify such problems in advance of their acceptance by the international medical community will help to provide coded, computable documentation in a much more timely manner than waiting for inclusion in SNOMED CT or ICD. When the infrastructure in VA's Enterprise Terminology Server (ETS) & New Term Rapid Turn-around (NTRT) service are ready to deploy VHAT Concepts, this field will allow us to store patient problems encoded with them.
80004vhat designation vuid (future)800;4FREE TEXTVHA Unique ID (VUID) for the VHAT Designation. A unique meaningless integer assigned to a corresponding designation VHA wide. VHAT Concept/Designation Code pairs function in a manner identical to that of SNOMED CT Concept/Designation Codes (i.e., they support the unique identification of clinical concepts, along with the many alternative ways in which a given concept may be expressed).
80005snomed ct-to-icd map status800;5SET OF CODES0:N/A
This Set of Codes type field is set to PENDING when an unmapped Clinical Finding is selected as a patient's problem. It is updated programmatically to COMPLETE when NTRT deploys a new SNOMED CT to ICD mapping for the problem in question. NOTE: THIS FIELD SHOULD NEVER BE UPDATED BY AN END USER.
80101unique new term requested801;1SET OF CODES0:False
Indicates whether the user requested a new term during the process of entering a freetext problem. It should only be populated automatically by program code. NOTE: THIS FIELD SHOULD NEVER BE UPDATED BY AN END USER.
80102unique term request comment801;2FREE TEXTPlease provide clarification of the new term request. For example, if the requested term is an acronym or abbreviation, the comment field accommodates the fully specified name, etc.
80201date of interest802;1DATE-TIMEThis is the date when the DIAGNOSIS (#.01) and CODING SYSTEM (#80202) fields were filed or modified. This allows proper resolution of the code, irrespective of code set versions, etc.
80202coding system802;2FREE TEXTThis identifies the Coding System to which the Code belongs. It corresponds to the Coding System Abbreviation in the ICD Coding Systems File, to optimize internal/external API calls for resolving codes, independent of their code set version, and to facilitate transition from ICD-9-CM to ICD-10-CM. Examples include: CODING SYS ABBREV NOMENCLATURE ICD FILE --------------------------------------------- 10D ICD-10-CM ICD Diagnosis ICD ICD-9-CM ICD Diagnosis
80300mapping targets803;0MULTIPLE9000011.803This multiple includes mapped expressions: complications, comorbidities, and compound diagnoses. e.g., the single SNOMED CT concept Diabetic neuropathy (230572002) is mapped to two ICD-9-CM diagnoses: DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED (250.60) and POLYNEUROPATHY IN DIABETES (357.2).

Referenced by 3 types

  1. PROBLEM LIST AUDIT (125.8) -- problem
  2. TIU PROBLEM LINK (8925.9) -- problem
  3. V POV (9000010.07) -- problem list entry