78026-2

LOINC 2.82

Diagnosis present on admission

Definition

  • Indicates whether or not the diagnosis was present on admission (POA) when the patient was admitted into the hospital as an inpatient. This term was created for, but not limited in use to, the Present on Admission observation in the HL7 Implementation Guide for CDA® Release 2: National Health Care Surveys Release 1. Whether or not a specific condition was present at the time a patient was admitted. Note that the concept of "diagnosis" is different than a "condition". Conditions include symptoms, diseases, injuries, and non-pathologic states, while diagnoses are specifically identified by a provider as the source of a patient's signs and symptoms. For example, a patient admitted to the hospital with conditions that include abdominal pain, fever, and vomiting may be diagnosed with appendicitis by a provider based on the history, physical exam, and various test results. To report whether a condition was present on admission, use [LOINC: 89251-3].

Component

  • Diagnosis present on admission

Specimen / system

  • ^Patient

Class

  • SURVEY.NHCS

Property

  • Find

Scale

  • Ord

Related names

  • Dx; Dx pres on admission; Finding; Findings; Ordinal; Point in time; QL; Qual; Qualitative; Random; Screen; Survey; SURVEY.NHCS

Index terms

  • Dx
  • Dx pres on admission
  • Finding
  • Findings
  • Ordinal
  • Point in time
  • QL
  • Qual
  • Qualitative
  • Random
  • Screen
  • Survey
  • SURVEY.NHCS