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Completing ADF96 Private Hospital Discharge Forms

This guide is also available as a PDF version (123 KB) and a Word version (581 KB)

The ADF96 form is available as a (PDF, 53 KB) This form can printed out and used in place of the forms supplied by NZHIS. A new interactive version of the ADF96 form is now available as a (PDF, 240 KB). This form can be filled in on screen and then printed out.

Contents

• Introduction
  - When to use ADF96 forms
  - Filling in the form
  - Sending completed forms
  - Other information
  - Some definitions

• Patient identification
  - National Health Index number (NHI)
  - Family name (mandatory field)
  - First given name (mandatory field)
  - Second given name
  - Third given name
  
  
• Patient information
  - Date of birth (mandatory field)
  - Gender (mandatory field)
  - NZ resident (mandatory field)
  - Ethnic group (mandatory field)
  - Patient's usual residential address
  - Domicile code
  
  
• Event information
  - Event type (mandatory field)
  - Health agency facility name (HAF) (mandatory field)
  - HAF code (mandatory field)
  - Admission date (mandatory field)
  - Discharge date (mandatory field)
  - Admission source (mandatory field)
  - Admission type (mandatory field)
  - Discharge type (mandatory field)
  - Principal purchaser (mandatory field)
  - Health agency (mandatory field)
  - Specialty code
  - Weight on admission (mandatory field for infants aged less than 29 days on admission)
  - Referral date (mandatory field in above cases)
  - First consultation date (mandatory field in above cases)
  - Waiting list date (mandatory field in above cases)
  - Surgical priority (provide if known)
  - Days on leave (provide if applicable)
  - Suppress
  
  
• Cancer patients
  - Occupation code (mandatory field for cancer patients)
  - Country of birth (mandatory field for cancer patients)
  - Morphology description
  - Morphology code
  - Basis
  - Stage
  - Laboratory code
  - Melanoma invasion level
  - Melanoma thickness
  
  
• Infants born in hospital
  - Birth weight (mandatory field)
  - Gestation period (mandatory field)
  - Birth status
  - Age of mother (mandatory field)
  - Birth location
  
  
• Diagnosis and procedure data
  - Principal diagnosis code
  - Principal diagnosis description (mandatory field)
  - Other diagnosis, procedure or external cause code (provide if applicable)
  
  
• Code tables
  - Complete occupation code list (in alphabetical order)
  - Health specialty codes (by hospital type)
  - Complete country of birth list (in alphabetical order)
  - Laboratory codes (by region)

 Introduction

Page last updated 11 May 2009


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