HILLS^CA^90210^^H||^PRN^PH^^^888^5555555~^PRN^CP^^^888^3333333||ENG^English^HL70296|||||||2186-5^ not Hispanic or Latino^CDCREC||Y|2
At minimum, submit the administering provider Last Name, First Name, and Professional Suffix. If RXA-10.1 is populated, RXA-10.9 and RXA-10.13 are required:
RXA-10.1 = ID Number (Employee ID, NPI, etc.)
RXA-10.2 = Last name
RXA-10.3 = First Name
RXA-10.9 = Assigning Authority (Location Acronym, CMS, CAA, etc.) RXA-10.13 = Identifier Type Code (EI, NPI, AN, etc.)
RXA-10.21 = Professional Suffix (MD, DO, RN, MA, etc.)
Examples: |^GOMEZ^MARCIA^^^^^^^^^^^^^^^^^^RN|
|1234^GOMEZ^MARCIA^^^^^^LA_HOSP^^^^EI^^^^^^^^RN|
Manufacturer | RXA-17
All valid MVX codes can be found at CDC Code Set ā MVX.
RXA-17.1 = MVX Code RXA-17.2 = Text
RXA-17.3 = MVX
Examples: |SKB^GlaxoSmithKline^MVX|
|PFR^Pfizer, Inc^MVX|
|MOD^Moderna US, Inc.^MVX|
Vaccine Route | RXR-1
Either NCIT or HL7 Table 0162 codes are accepted. RXR-1.1 = Identifier
RXR-1.2 = Text
RXR-1.3 = Name of Coding System
Examples: |C28161^Intramuscular^NCIT|
|IM^Intramuscular^HL70162|
Administering Body Site | RXR-2
HL7 Table 0163 codes are accepted. RXR-1.1 = Code
RXR-1.2 = Text
RXR-1.3 = HL70163
Example: |LD^Left Deltoid^HL70163|
Are there any other data elements that are helpful to report?
Yes, if your site is submitting data manually in CAIR2, ensure all staff record all data elements (Patient Information and Vaccine Information) completely and accurately.
If your site submits data electronically, ensure the following data elements are sent to CAIR2. Complete, accurate, and properly formatted data help prevent duplicate patients and assist in the patient match and merge process, among other benefits.
Patient Phone Number / Email | PID-13
CAIR2 can store both Home Phone and Cell Phone as shown below. However, for Cell Phone to be properly populated, PID-13.3 must use type code CP. If the patientās cell/mobile phone number is captured in your EHR, please specify PID-13.3 = CP. If valid emails are being captured, this can be sent in PID-13 as well.
Phone number
PID-13.2 = PRN
PID-13.3 = PH (home) or CP (cell phone)
PID-13.6 = area code
PID-13.7 = telephone number
Email address
PID-13.2 = NET
PID-13.3 = Internet or X.400
PID-13.4 = valid email address only
Examples:
|^PRN^PH^^^888^5555555~^PRN^CP^^^888^3333333~^NET^Internet^valid_email[@]email[.]com|
|^PRN^PH^^^888^5555555~^PRN^CP^^^888^3333333|
|^PRN^CP^^^888^3333333|
Ordering Authority | ORC-12
CAIR2 is often used a supplementary data source for incentive programs and quality improvement programs/partnerships. Please populate ORC-12 with the Ordering Authority NPI.
ORC-12.1 = NPI #
ORC-12.2 = Last Name ORC-12.3 = First Name
ORC-12.9 = Assigning Authority ORC-12.13 = NPI
ORC-12.21 = MD (or other professional suffix; optional field)
Example: |1234567891^LASTname^FIRSTname^^^^^^CMS_NPPES^^^^NPI^^^^^^^^MD|
Vaccine Eligibility | OBX Segment
There may be additional COVID-19 reporting requirements for Vaccine Funding Program Eligibility and/or Funding Source. Ensure Vaccine Eligibility is recorded for all administered doses.
āV01
| ānot VFC eligible (Private Pay/Insurance)
| āPrivate
|
āV02
| āVFC eligible ā Medi-Cal/Medi-Cal Managed Care
| āVFC
|
āV03
| āVFC eligible ā Uninsured
| āVFC
|
āV04
| āVFC eligible ā American Indian/Alaskan Native
| āVFC
|
| V05ā | āVFC eligible ā Underinsured
| āVFC
|
āV07
| āPublic vaccine ā State-specific eligibility [317 Special Funds]
| ā317
|
āCAA01
| State General Fund Vaccines
| āState General Fund
|
Examples:
OBX|1|CE|64994-7^VACCINE FUND PGM ELIG CAT^LN|1|V01^Private^HL70064||||||F|||20201215|
OBX|1|CE|64994-7^VACCINE FUND PGM ELIG CAT^LN|1|V07^State-specific eligibility [317 Special Funds]^HL70064||||||F|||20201215|
Motherās Maiden Name | PID-6
For patients 18 and younger, please submit Mother's Maiden Name. PID-6.1 = Maiden Last Name
PID-6.2 = First Name
PID-6.7 = Name Type Code (M = Maiden or can be null)
Examples:
|MILLER^^^^^^M|
|MILLER^MARTHA^^^^^M|
|^MARTHA^^^^^|
Next of Kin | NK1 Segment
If the site is capturing Next of Kin information, please submit this information via the NK1 segment. NK1-1 = Set ID
NK1-2 = Name
NK1-3 = Relationship NK1-4 = Address
NK1-5 = Phone number
Example: NK1|1|JONES^MARTHA^^^^^L|MTH^Mother^HL70063|1234 W FIRST ST^^BEVERLY HILLS^CA^90210^^H|^PRN^PH^^^555^5555555|
Who can I contact if I have questions?
If your site enters data manually in CAIR2, contact your Local CAIR Representative.
If your site submits data electronically via an EHR, email CAIRDataExchange@cdph.ca.gov.