| Num | Data Element | Description | Data Type | Value Set Code | 
	
		| 1 | Person ID | The jurisdictional identifier that uniquely identifies the person. | Text | N/A | 
	
		| 2 | Birth Date | Person’s date of birth | Date | N/A | 
	
		| 3 | Sex | Sex, from any data source. | Coded | PHVS_Sex_NNDSS (value set under construction. See subsequent tab) | 
	
		| 4 | Race Category | Race category - Major OMB Race Categories. Detailed race information would be rolled up to these major OMB race categories. | Coded | PHVS_RaceCategory_CDC_NullFlavor | 
	
		| 5 | Ethnic Group | Based on the self-identity of the person as Hispanic or Latino | Coded | PHVS_EthnicityGroup_CDC_Unk | 
	
		| 6 | Person Address County | County of residence of the person at time of calculated case counting date  (CCCD) | Coded | PHVS_County_FIPS_6-4 | 
	
		| 7 | Person Address State | State of residence of the person at time of calculated case counting date  (CCCD) | Coded | PHVS_State_FIPS_5-2 | 
	
		| 8 | Person Address ZIP Code | ZIP Code of residence of the person at time of calculated case counting date (CCCD) | Text | N/A | 
	
		| 9 | Symptomatic Indicator | Indicator that the person was symptomatic with symptoms associated with the condition being reported | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 10 | Symptom Onset Date | The earliest date of the onset of symptoms relevant to the reported condition. | Date | N/A | 
	
		| 11 | Clinical Diagnosis Date | The earliest date that the condition being reported to public health system was identified by a clinician as the final, suspected, or most likely diagnosis. | Date | N/A | 
	
		| 12 | Earliest Specimen Collection Date Associated with a Positive Lab Result | The earliest date a clinical specimen was collected from the person that produced a laboratory result that was positive or indicative of the disease or condition being reported to a public health agency. | Date | N/A | 
	
		| 13 | Earliest Result Date of a Positive Lab Result | The date on which the first result that was positive or indicative of the disease or condition was either generated or reported by the laboratory. | Date | N/A | 
	
		| 14 | Pregnancy Status | Indicator that the person is pregnant at the time of the calculated case counting date | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 15 | Hospitalized | Did person have a hospitalization associated with the condition? | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 16 | Person Deceased | Indicator that the person is deceased | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 17 | Deceased Date | Date and time at which the person's death occurred. | Date | N/A | 
	
		| 18 | Death Associated with Condition | Indicator that death was associated with the condition | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 19 | Condition Code | Condition or event that constitutes the reason the notification is being sent. | Coded | PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS | 
	
		| 20 | Case ID | The jurisdictional identifier that uniquely identifies the case. | Text | N/A | 
	
		| 21 | Calculated Case Counting Date | The calculated case counting date (CCCD) is the value of the earliest of the available component dates of Symptom Onset Date, Clinical Diagnosis Date, Earliest Specimen Collection Date Associated with a Positive Lab Result, Earliest Result Date of a Positive Lab Result, Date First Received by Public Health Agency, and Date Entered/Record Initiated | Date | N/A | 
	
		| 22 | Age | Person's age at time of calculated case counting date (CCCD) | Numeric | N/A | 
	
		| 23 | Age Units | Units for person's age at time of calculated case counting date (CCCD) | Coded | PHVS_AgeUnit_UCUM | 
	
		| 24 | Case Disease Imported Code | Indication of where the disease/condition was likely acquired. | Coded | PHVS_DiseaseAcquiredJurisdiction_NND | 
	
		| 25 | Gender Identity | Person-identified gender identity (i.e., an individual's personal sense of being a man, woman, or another gender, regardless of the sex that person was assigned at birth) | Coded | PHVS_DisabilityType_NNDSS (value set under construction. See subsequent tab) | 
	
		| 26 | Case Status | Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. | Coded | PHVS_CaseClassStatus_NND | 
	
		| 27 | Case Outbreak Name | A state-assigned name for an identified outbreak. | Text | N/A | 
	
		| 28 | Notification Result Status | Status of the notification | Coded | PHVS_ResultStatus_NND | 
	
		| 29 | Date First Received by Public Health Agency | The earliest date a report for the case was received by any public health agency, whether a state/territory or county/local agency, within the jurisdiction in which the case will be counted. Reports may include phone calls and any other mechanisms accepted by the agency. | Date | N/A | 
	
		| 30 | Date of Electronic Case Notification to CDC | Date/time this version of the electronic case notification was sent.  It will be the same value as NOT103 for the original notification.  For updates, this is the update/send date/time. | DateTime | N/A | 
	
		| 31 | MMWR Week | MMWR Week for which case information is to be counted for MMWR publication. MMWR Week to be based on calculated case counting date (CCCD). | Numeric | N/A | 
	
		| 32 | MMWR Year | MMWR Year (YYYY) for which case information is to be counted for MMWR publication. MMWR Year to be based on calculated case counting date (CCCD). | Date | N/A | 
	
		| 33 | National Reporting Jurisdiction | National jurisdiction reporting the notification to CDC | Coded | PHVS_NationalReportingJurisdiction_NND | 
	
		| 34 | Disability Type | Type of disability (vision, hearing, mobility, cognition, self-care, independent living, communication, or intellectual/developmental). | Coded | PHVS_DisabilityType_NNDSS (value set under construction. See subsequent tab) | 
	
		| 35 | Disability Type Indicator | Indicator representing whether or not the person had the disability in the corresponding instance of the repeating group | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 36 | Exposure | Was the person exposed to any of the following during the XX days prior to symptom onset? Note: If the symptom onset date is unknown, then the date that the patient first tested positive can be used as a proxy for symptom onset date. | Coded | PHVS_Exposure_NNDSS (value set under construction. See subsequent tab) | 
	
		| 37 | Exposure Indicator | Indicator representing whether or not the person had the exposure in the corresponding instance of the repeating group | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 38 | Exposure Comment | Use this field to communicate anything about the person's exposures for this condition. | LongText | N/A | 
	
		| 39 | Clinical Manifestation | Signs, symptoms, or other clinical manifestations associated with the condition being reported | Coded | N/A | 
	
		| 40 | Clinical Manifestation Indicator | Indicator representing whether or not the person had the clinical manifestation in the corresponding instance of the repeating group | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 41 | Clinical Manifestation Comment | Use this field to communicate anything about the person's signs, symptoms, or other clinical manifestations for this condition. | LongText | N/A | 
	
		| 42 | Underlying Health Condition | Pre-existing health conditions that may worsen the course or severity of the disease or health condition | Coded | N/A | 
	
		| 43 | Underlying Health Condition Indicator | Indicator representing whether or not the person had the underlying health condition in the corresponding instance of the repeating group | Coded | PHVS_YesNoUnknown_CDC | 
	
		| 44 | Underlying Health Condition Comment | Use this field to communicate anything about the person's underlying health conditions for this condition. | LongText | N/A | 
	
		| 45 | Current Occupation | This data element is used to capture the narrative text of a person's current occupation. | Text | N/A | 
	
		| 46 | Current Occupation Standardized | This data element is used to capture the CDC NIOSH standard occupation code based upon the narrative text of a person's current occupation. (The National Institute for Occupational Safety and Health (NIOSH) has developed a web-based software tool designed to translate industry and occupation text to standardized Industry and Occupation codes.  The NIOSH Industry and Occupational Computerized Coding System (NIOCCS) is available here:  https://csams.cdc.gov/nioccs/Default.aspx | CodedNoText | PHVS_Occupation_CDC_Census2010 | 
	
		| 47 | Current Industry | This data element is used to capture the narrative text of a person's current industry. | Text | N/A | 
	
		| 48 | Current Industry Standardized | This data element is used to capture the CDC NIOSH standard industry code based upon the narrative text of a person's current industry. (The National Institute for Occupational Safety and Health (NIOSH) has developed a web-based software tool designed to translate industry and occupation text to standardized Industry and Occupation codes.  The NIOSH Industry and Occupational Computerized Coding System (NIOCCS) is available here: https://csams.cdc.gov/nioccs/Default.aspx | CodedNoText | PHVS_Industry_CDC_Census2010 | 
	
		| 49 | Test Type | The lab test or analysis that was performed on the specimen | Coded | PHVS_LabTestName_CDC | 
	
		| 50 | Test Result Data Type | This field identifies the HL7 data type used for Test Result | Coded | To be SNOMED CT for coded values | 
	
		| 51 | Test Result | Qualitative or quantitative results for test performed. This can include various types of results such as numeric, coded, text, or other types relevant to the specific result. | None | N/A | 
	
		| 52 | Test Result Units | Units of measure for the quantitative test result value | Coded | PHVS_UnitsOfMeasure_CDC | 
	
		| 53 | Test Result Reference Range | Identifies the upper and lower limits or bounds of test result values for the quantitative test result value | Text | N/A | 
	
		| 54 | Specimen Type | This indicates the type of specimen tested. | Coded | PHVS_Specimen_CDC |