Field Definitions (No PHI)
QI CSV Field Definitions
Use these definitions for the downloadable QI CSV template. Please do not enter PHI (no names, MRNs, DOBs, phone numbers, addresses).
Use a private local_patient_key that only you can map locally.
| Column | Definition |
|---|---|
| record_id | Unique ID for the row (UUID). Auto-generate if possible. Do not use PHI. |
| case_source | Where the record came from: app_generated | manual_entry. |
| local_patient_key | A private code you choose (e.g., PN-014). Do NOT use name, DOB, MRN, phone, address. |
| local_patient_key_type | Optional label describing the key: study_id | clinic_code | resident_case | other. |
| clinic_site_label | Optional: clinic/site label (e.g., UW Derm). Keep non-identifying. |
| learner_role | Optional: MS1–MS4 | PGY1+ | Fellow | Attending | Staff. |
| date_pa_submitted | Date the PA was submitted (YYYY-MM-DD). |
| state | Two-letter state abbreviation (e.g., WA). |
| insurer | Insurer name (e.g., Premera). |
| plan_type | Commercial | Medicare | Medicaid | Other/Unknown. |
| drug_brand | Brand name (e.g., Dupixent). |
| drug_generic | Generic name (e.g., dupilumab). |
| indication | Condition (e.g., Atopic Dermatitis, Prurigo Nodularis). |
| policy_id | Insurer policy identifier if known (e.g., 5.01.575). |
| policy_effective_date | Policy effective date (YYYY-MM-DD) if known. |
| policy_last_revised | Policy last revised date (YYYY-MM-DD) if known. |
| rule_yaml_id | Internal rule/YAML id used by the app, if applicable. |
| rule_version | Rule version number in YAML, if applicable. |
| age_group | adult | pediatric | unknown. |
| severity_measure_type | What you used to document severity: bsa_percent | nodule_count | pasi | iga | other. |
| severity_measure_value | Numeric value corresponding to the severity_measure_type (e.g., 12 for BSA%). |
| special_site_involvement | yes | no | unknown (e.g., face/genital/hands involvement that affects policy criteria). |
| step_therapy_completed | yes | no | partial | unknown. |
| step_therapy_details | Free text summary of prior therapy tried (no PHI). |
| prescriber_specialty | Dermatologist | Allergy/Immunology | Primary care | Other. |
| pa_outcome | approved | denied | pended | withdrawn | unknown. |
| pa_outcome_date | Date of insurer decision (YYYY-MM-DD). |
| denial_reason_category | step_therapy | severity_not_met | missing_documentation | noncovered_indication | quantity_limit | other | (blank if approved). |
| denial_reason_free_text | Optional non-PHI details from denial letter (keep brief). |
| appeal_submitted | yes | no | unknown. |
| appeal_outcome | approved | denied | pending | n/a. |
| appeal_outcome_date | Date appeal decision known (YYYY-MM-DD). |
| medication_received | yes | no | unknown. ‘Yes’ = patient obtained first fill/administered dose. |
| medication_received_date | Date first dose in-hand/administered (YYYY-MM-DD). |
| received_source | specialty_pharm | ehr_dispense | infusion_admin | patient_report | other. |
| received_notes | Optional non-PHI notes about how ‘received’ was confirmed. |
| app_generated_pa_note_used | yes | no. Did you use the app-generated documentation/note/checklist? |
| documentation_complete_flag | yes | no | unknown. Was required documentation complete at submission? |
| notes_nonphi | Optional free text reflections (no PHI). |
Tip: Defining “Medication Received”
For QI, the most meaningful endpoint is when the patient actually gets the medication (first fill in-hand or first administered dose).
Confirm via specialty pharmacy delivery, EHR dispense/admin record, or patient report, and note the source in received_source.