NEW ZEALAND HEALTH INFORMATION SERVICE
Home > technical documentation > guide to ADF96 form
Completing ADF96 Private Hospital Discharge Forms
Patient Information
Date of birth (mandatory field)
The patient’s date of birth (entered as DDMMYYYY).
Gender (mandatory field)
The patient’s gender (sex) – ‘M’ (male) or ‘F’ (female).
NZ resident (mandatory field)
Is the patient a resident of New Zealand? – ‘Y’ (yes) or ‘N’ (no).
- A person is judged to be a resident of New Zealand for reporting purposes if they are a New Zealand citizen or classified as ‘ordinarily resident in New Zealand’.
The patient’s ethnicity. A two-digit code from the list below or a description in the empty space to the right of the ‘Ethnic group’ fields.
- The patient may identify the ethnic groups they feel they belong to. Up to three may be reported on the ADF96 form.
10 European not further defined
11 NZ European
12 Other European (stated ethnicity not listed)
21 NZ Māori
30 Pacific Island not further defined
31 Samoan
32 Cook Island Maori
33 Tongan
34 Niuean
35 Tokelauan
36 Fijian
37 Other Pacific Island (stated ethnicity not listed)
40 Asian not further defined
41 South East Asian
42 Chinese
43 Indian
44 Other Asian (stated ethnicity not listed)
51 Middle Eastern
52 Latin American / Hispanic
53 African
99 Not stated
______________________________________________________
Patient’s usual residential address
The patient’s address where they have been, or plan to be, living for three months or more. Provide the address as completely as possible.
Domicile code
This is not required to be completed by the hospital.
- NZHIS staff derive the domicile code from the address information you provide together with an automated coding programme on the NHI.