Data Element Title in System

Full Data Element Title

Definition/Description

FormatA-AlphaN-NumericM-MonthD-DayY-Year

System Source of information

Last Name

Last Name

Legal name that matches with identification

AAAAAAAAAAAAAAAA

Registration System

First Name

First Name

Full name, not nicknames or abbreviation

AAAAAAAAAAAAAAAA

Registration System

MI

Middle Initial

A

Registration System

MRN

Medical Record Number

The unique medical record number associated with all patient medical information. Leading zeroes included.

NN-NN-NN-NN-NN

Registration System

Street Address

Registration System

City

City

AAAAAAAAAAAAAAAA

Registration System

ST

State

Official State abbreviation [Add]

AA

Registration System

Zip Code

NNNNN-NNNN

Registration System

Telephone # (Cell)

Telephone Number

Area code and telephone number for cell telephone.

NNN-NNN-NNNN

Registration System

Telephone # (Other)

Area code and telephone number for other telephone.

NNN-NNN-NNNN

Registration System

MS

Marital Status Types

1: Presently Married2: Widowed3: Divorced4: Separated5: Never married/annulled6: Prefers not to answer

N

Registration System

DOB

Date of Birth

MM/DD/YYYY

Registration System

G

Gender

1: Female2: Male3: Transgender4: Other5: Prefer not to say

NN

Registration System

R

Race

1:  A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.2:  A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.3:  A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."4:  A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.5:   A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.6: Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, "Spanish origin", can be used in addition to "Hispanic or Latino".

NN

SSN#

Social Security Number

Social Security Number

NNN-NN-NNNN

Registration System

Site

Site where patient was seen or registered

Registration System

Level of Care

1: Inpatient2: Outpatient Surgery3: Emergency Department

1: Inpatient2: Outpatient Surgery3: Emergency Department

NN

Registration System

Data Element Title in System

Information for Each Patient in the Correct Database Format

If the information is unclear or not available, comment on the issue and your suggested plan of action to address the issue.

Last Name

First Name

MI

MRN

Street Address

City

ST

Zip Code

Telephone # (Cell)

Telephone # (Other)

MS

DOB

G

R

SSN#

Site

Level of Care