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Pathology Report Format (Illustrative)

The illustrative Pathology Report demonstrates the practical application of the Pathology Reporting Framework. Using standardized Healthcare Data Elements, the framework organizes pathology information into a consistent reporting structure while accommodating the specific documentation requirements of diagnostic services.

Pathology Report Format Document Architecture Diagram

Figure illustrates how standardized Healthcare Data Elements are organized into an illustrative Pathology Report. The selected Data Elements demonstrate one possible implementation of the proposed reporting framework and may be adapted for different diagnostic services while preserving a consistent reporting structure.

Diagnostic Report (Illustrative)

(A) Healthcare Organization
  • 035 Healthcare Facility
  • 176 Reporting Professional
(B) Patient Information
  • 001 UHID
  • 003 Patient Name
  • 007 Age
  • 008 Gender
  • 040 Referring Doctor
(C) Encounter Information
  • 170 Test Requested Date
  • 172 Collection Date
  • 177 Report Date
  • 050 Case Number
  • 179. Sample Bar Code
(D) Investigation and Essentials
  • 124 Laboratory Results
  • 174 Reference Range
  • 175 Critical Flag
  • 180. Interpretation
  • 181. Method
  • 182. Machine
(E) Authentication
  • 176 Reporting Professional
  • 138 Report Status
(F) Diagnostic Lab Contact Information (footer)

The illustrative Pathology Report demonstrates the practical application of the National Healthcare Reporting Framework. While the clinical content is specific to pathology services, the same standardized reporting structure can be applied to other healthcare departments and services, with each report organized using the same standardized document architecture.

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