10-144 C.M.R. ch. 253, § 3 - DATA ELEMENTS

Data elements which may be requested or recorded include, but are not limited to the following:

Patient's Last Name (including Maiden name)

Patient's First Name and Middle Initial

Medical Record Number

Social Security Number

Birth Date

Street Address

Mailing Address (if different from above)

City or Town of Residence

County of Residence

State of Residence and Zip Code

Sex

Race

Attending Physician

Referring Physician

ICD codes

Hospital Code

Date of Diagnosis

Date of Discharge

Occupation/Industry

Place/Address of Work

Notes

10-144 C.M.R. ch. 253, § 3