ADT^A03 — Discharge / End Visit

The patient leaves the facility: A03 closes the encounter, triggers billing and shuts down the clinical workflows attached to the stay.

Purpose

A03 broadcasts when the patient leaves the facility: home discharge, inter-hospital transfer (a fresh A01 will fire elsewhere), nursing-facility placement, rehab transfer, discharge against medical advice, or death (with disposition EX).

A03 freezes the encounter on the HIS side: any PR1, DG1 or OBX emitted afterwards is post-discharge data and may be rejected by downstream billing systems if it arrives too late.

Segment structure

ADT_A03
  MSH                    Message Header (mandatory)
  [ SFT ]                Software Segment (optional)
  EVN                    Event Type (mandatory)
  PID                    Patient Identification (mandatory)
  [ PD1 ]                Patient Additional Demographics (optional)
  [ { ROL } ]            Role (optional, repeatable)
  PV1                    Patient Visit (mandatory)
  [ PV2 ]                Patient Visit - Additional Info (optional)
  [ { DB1 } ]            Disability (optional, repeatable)
  [ { AL1 } ]            Allergy (optional, repeatable)
  [ { DG1 } ]            Diagnosis (optional, repeatable)
  [ DRG ]                Diagnosis Related Group (optional)
  [ { PR1 [ { ROL } ] } ] Procedure (optional, repeatable)
  [ { OBX } ]            Observation (optional, repeatable)
  [ PDA ]                Patient Death and Autopsy (optional)

MSH — EVN

• MSH-9: ADT^A03^ADT_A03.
• EVN-2: effective discharge timestamp.
• EVN-6: real clinical discharge timestamp.

PID — Patient

PID is unchanged versus the admitting A01. Identity attributes (name, DOB, sex) must stay consistent to preserve the integrity of the longitudinal patient record.

PV1 — Patient Visit (discharge fields)

• PV1-19: visit number — identical to A01.
• PV1-36: Discharge Disposition (table 0112). Typical values: 01 Home, 02 Transfer to another short-term general hospital, 03 Transfer to skilled nursing facility, 20 Expired (death).
• PV1-37: Discharged to Location (DLD) — destination address / facility if relevant.
• PV1-44: admission date/time — preserved.
• PV1-45: Discharge Date/Time. Length of stay = PV1-45 − PV1-44.

Real-world example

Home discharge (HOM) on 18 May 2026 at 17:30 for patient John A. Doe:

MSH|^~\&|HIS|HOSP01|EHR|CLINIC02|20260518173000||ADT^A03^ADT_A03|MSG00005002|P|2.5.1|||AL|NE
EVN|A03|20260518173000|||DRJONES^Jones^Sarah^^^DR.
PID|1||MRN567890^^^HOSP^MR||DOE^JOHN^A^^MR.||19720515|M|||100 MAIN ST^^ANYTOWN^CA^90210^USA||(555)555-1234|||S||ACCT123456|123-45-6789
PV1|1|I|MED^205^B^HOSP01|EM|||DRSMITH^Smith^James^A^^DR.|||MED|||1|||DRSMITH^Smith^James^A^^DR.|ADM|||||||||||||||||||HOSP01|HOM|||||20260514102530|20260518173000
DG1|1||I21.9^Acute myocardial infarction, unspecified^I10|||F

• PV1-36: HOM — home discharge.
• PV1-44 / PV1-45: admission 2026-05-14 10:25, discharge 2026-05-18 17:30 — 4 days 7 hours.
• DG1: principal discharge diagnosis I21.9 (acute MI).

Acknowledgment (ACK)

MSH|^~\&|EHR|CLINIC02|HIS|HOSP01|20260518173001||ACK^A03^ACK|ACK00005002|P|2.5.1
MSA|AA|MSG00005002

Common errors

• A03 without preceding A01: invalid. Always respect the sequence.
• Missing PV1-45: discharge date/time is required for billing; absence skews ALOS KPIs.
• Death not encoded: if the patient dies during the stay, PV1-36 must be EX (Expired) and the PDA segment may be added. Sending HOM is a serious error that distorts mortality statistics.
• DG1 absent: the discharge diagnosis must accompany A03 for DRG / PMSI grouping. Without DG1, the stay cannot be priced.

Related ADT events

See also: ADT^A01, ADT^A13, and FHIR Encounter.