Indiana Emergency Medical Services...The EMS Commission's "ongoing review" is designed to evaluate EMS systems in . Indiana. This is accomplished by "compiling data and statistics"

Indiana Department of Homeland Security

Emergency Medical Services (EMS)

Data Dictionary &

National EMS Information System (NEMSIS) Data Elements

January 2009

For more information about the Indiana EMS Data Registry dictionary and or the ACS/FireHouse Software transfer specification, please contact the Indiana Department of Homeland Security (DHS) / EMS Data Registry Program Manager at (317) 233-4283. or write to: IN DHS/EMS Data Registry Program Manager 302 W. Washington Street, Room E-239

Indianapolis IN 46204-2722

or e-mail to: [email protected]

mailto:[email protected]

INDEX Title Page # Indiana EMS Commission Data Registry NEMSIS Reporting System . . . . . . . 1 Indiana EMS Reporting Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Indiana EMS Private Software Vendor Certification Process . . . . . . . . . . . . . . . 5 Appendixes Appendix 1 - Indiana NEMSIS Data Element List Appendix 2 - Indiana NEMSIS Data Element Definitions Appendix 3 - Indiana Homeland Security (IN DHS) Districts and Counties List Appendix 4 - Indiana FIPS County Codes Appendix 5 - Indiana County, Township & State List Appendix 6 - Indiana Hospital Destination /Facility List & Codes Appendix 7 – NEMSIS National EMS Information Agency Project

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Indiana EMS Commission Data Registry NEMSIS Reporting System

1. Authority:

A. Indiana statute prescribes the authority to collect data for review by the Indiana EMS Commission. B. IC 16-31-2-11 states: "The commission shall develop procedures for ongoing review.....

The commission may review any pre-hospital... report record regarding an emergency patient.... However, those records shall remain confidential and may be used solely for the purpose of compiling data and statistics."

C. 836 IAC 1-2-3 states: "All ambulance service providers shall participate...Collecting all data elements prescribed...Reporting that information according to procedures and schedules prescribed by the commission."

2. Purpose:

A. The EMS Commission's "ongoing review" is designed to evaluate EMS systems in Indiana. This is accomplished by "compiling data and statistics". The collection of run data enables the commission to evaluate each component of the EMS system. B. Through database linking software program, crash reports, EMS run and ED hospital data are linked to determine type of vehicle crash, injuries, treatments, and cost outcomes. This data linkage will allow opportunities to influence Indiana citizens’ lives through Awareness and Prevention Programs, Driver’s Safety Programs, and roadway safety.

3. NEMSIS Data Elements:

A. The Indiana EMS Commission has adopted the National EMS Information System (NEMSIS) and 103 of the 400+ NEMSIS data elements that would collect at a minimum the "essential data elements" to serve as a completed EMS run for a data registry entry. Eight-five (85) Silver elements and an additional eighteen (18) Indiana specific NEMSIS data elements. See Attachment 1.

B. The NEMSIS program is set for accepting a variety of runs such as cancelled runs, no patient runs, patient refused treatment runs, patient used other transportation runs, and patient transported by EMS.

C. There are two national software certification classes:

(1) Gold, all NEMSIS data points (400 +). (2) Silver, the minimum of the 85 required NEMSIS basic data points.

4. Reporting: The EMS Commission launched a project that has defined the "essential data elements" needed to collect and report to the EMS Registry. The commission's directive about developing reporting methods was to encompass every Certified EMS Provider in the state. The commission approved the following two methods of reporting data to the EMS Registry via the NEMSIS data code set. All BLS Non-Transport providers are requested to download their monthly EMS run data to the State Fire Marshall NFIRS Program.

A. State Software:

(1) The state EMS office contracted with a software vendor that is NEMSIS Gold compliant and certified by the University of Utah, the NEMSIS development

center.

(2) Indiana EMS providers are to use the 85 required elements, “Silver compliant”, plus 18 NEMSIS data elements required by the Indiana EMS Commission. One hundred and three (103) NEMSIS data points are the Indiana Data Registry minimum "essential data elements". (See Appendix 1.)

(3) The state software program allows EMS providers to collect their data for reporting to the EMS Data Registry and to evaluate their own individual system by using the report writing program capabilities.

(4) The state software also allows users to use more data elements beyond the 103 data points for their own in-house EMS run tracking and statistical reporting.

(5) The providers are responsible to transfer their information monthly to the EMS Data Registry by the 15th of the following month in the NEMSIS XML format. (6) Data transfers will be in electronic format either by diskette, CD, downloads as attachments to e-mails or by on-line using the state web server.

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B. Independent Software:

(1) Indiana EMS providers may choose to collect the "essential data elements" prescribed by the Indiana EMS Commission on a private vendor software

program that is NEMSIS compliant.

(2) Those Indiana EMS providers are to use 103 of the 400+ NEMSIS data elements that would collect at a minimum the "essential data elements". See Attachment 1.

(3) The providers are responsible to transfer their information to the EMS Data Registry by the 15th of the following month in the NEMSIS XML format.

(4) Data transfers will be in electronic format either by diskette, CD, or by downloads as attachments to e-mails.

(5) The data dictionary and transfer specs are available to accomplish that transfer. Please contact the EMS Data Registry Program Manager at (317) 233-4283.

C. EMS Run Data Elements:

(1) The following types of EMS runs are to be reported to the EMS Data Registry:

(a) Cancelled (b) No Patient Found / Gone on Arrival (c) Patient Refused Care (d) Patient Treated, Transferred Care (e) Patient Treated, Transported by Law Enforcement (f) Dead at Scene (g) No Treatment Required (h) Treated and Released (i) Treated, Transported by EMS to ED or Urgent Care Center (j) Treated, Transported by EMS from one ED or Urgent Care Center to another ED or Urgent Care Center (k) Treated, Transported by Private Vehicle

(2) The following types of EMS runs are not to be reported to the EMS Data

Registry:

(a) Transports to doctor’s office or an outpatient care center (b) Transports to a rehabilitation facility (c) Transports to a nursing home, or skilled nursing or extended care facilities (d) Transports to industrial or hospital clinics (e) Transports to a private residence

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5. Reporting Implementation

A. The Indiana EMS Data Registry will phase implementation for the NEMSIS data set. Starting in January 2009, a six-month implementation period will be used to ease the transition to the new NEMSIS data set.

B. Users of third-party software may continue to use the original data set until their

software is ready to upgrade to NEMSIS. (See the IN DHS / EMS website Private Vendor Software List.)

C. The long-range goal is to have all private vendors with Indiana EMS Provider

customers become NEMSIS certified and using the Indiana NEMSIS data set (103 elements).

D. The Indiana EMS Data Registry, in January 2009, will start the EMS and NFIRS (fire

incident reports) on-line, web-based data entry system using the NEMSIS data set.

E. All BLS Non-Transport providers are requested to download their monthly EMS run data to the State Mire Marshall NFIRS program.

Indiana Data Registry NEMSIS Certification Instructions

for Private Vendor Software Companies

with Indiana EMS Customers

1. Authority:

The Indiana EMS Commission and Indiana statute prescribes the NEMSIS data element XML format for Indiana EMS Provider EMS data run monthly reporting. See Indiana NEMSIS Reporting System, page 1, A through C.

2. Purpose: A. To ensure all private software vendor companies are nationally NEMSIS certified as either Gold or Silver compliant by the University of Utah NEMSIS Program Center. B. The seamless transfer of Indiana EMS Provider data runs to the Indiana EMS Data Registry using the standard NEMSIS XML format.

3. State Testing Format: Starting in January 2009, all private vendor software companies must submit the following for state NEMSIS certification:

A. Each vendor must submit a test batch file of ten (10) runs in the NEMSIS XML format using the 103 Indiana NEMSIS elements. See Appendixes 1 through 6.

B. The runs should include at least one of the following types of emergency runs:

(1) Cancelled (2) No patient (3) Patient refused treatment (4) Patient treated but not transported by EMS service. (5) Patient treated and transported by EMS service.

C. Once the private vendor software is Indiana NEMSIS certified, the vendor’s Indiana

EMS customers may begin downloading their data to the state data registry.

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4. State Contact: Please contact the Indiana EMS Data Registry if you have questions about the process:

Mark Nelson EMS Data Registry Program Manager at (317) 233-4283.

or write to: IN DHS/EMS Data Registry Program Manager

302 W. Washington Street, Room E-239 Indianapolis IN 46204-2722

or e-mail to: [email protected]

mailto:[email protected]

Appendix 1

Indiana NEMSIS Data Element List

NEMSIS Demographic Dataset (From D01 – D09): 1. EMS Agency Number. 2. EMS Agency State. 3. EMS Agency County. 4. Level of Service (e.g. Paramedic, ALS, BLS, etc.). 5. Organizational type (e.g. county, hospital, fire department. etc.). 6. Organization Status (e.g. volunteer, paid, combination). 7. Statistical Year (current calendar year). 8. Total Service Area (in square miles). 9. Total Service Area Population. 10. 911 Call Volume per Year. 11. EMS Dispatch Volume per Year. 12. EMS Transport per Year. 13. EMS Patient Contact Volume per Year. 14. EMS Agency Time Zone. 15. National Provider Identifier (assigned by The National Plan & Provider Enumeration Sys). 16. Agency Contact Zip Code. NEMSIS EMS Dataset (From E00 – E23): 17. Patient Care Report Number. 18. Software Creator (i.e. company name). 19. Software Name. 20. Software Version. 21. EMS Agency Number (in patient record field). 22. Incident Number. 23. EMS Unit (Vehicle) Response Number (i.e. vehicle number) 24. Type of Service Requested. 25. Primary Role of the Unit. 26. Type of Dispatch Delay. 27. Type of Response Delay. 28. Type of Scene Delay. 29. Type of Transport Delay. 30. Type of Turn-Around Delay. 31. EMS Unit Call Sign (i.e. radio number). 32. Response Mode to Scene. 33. Complaint Reported by Dispatch.

34. EMD Performed. 35. EMD Card Number. 36. Crew Member ID (Commission certification number). 37. Incident on Onset Date/Time (i.e. the date/time the injury occurred, or the symptoms, or problem started). 38. PSAP Call Date/Time (e.g. when call came into 911). 39. Unit Notified by Dispatch Date/Time. 40. Unit Enroute Date/Time. 41. Unit Arrived on Scene Date/Time. 42. Unit Arrived at Patient Date/Time. 43. Unit Left Scene Date/Time. 44. Patient Arrived at Destination Date/Time. 45. Unit Back in Service Date/Time. 46. Unit Cancelled Date/Time. 47. Unit Back at Home Location Date/Time. 48. Patient Last Name. 49. Patient’s Home Zip Code. 50. Gender. 51. Race. 52. Ethnicity. 53. Age. 54. Age Units (e.g. hours, days, months, years). 55. Date of Birth (MMDDYYYY) 56. Primary Method of Payment. 57. CMS Service Level. (Medicare Service Level) 58. Condition Code Number. 59. Number of Patients at Scene. 60. Mass Casualty Incident (yes or no). 61. Incident Location Type (e.g. work, residence, retail establishment). 62. Scene Zone Number (Indiana Homeland Security District number). 63. Incident County. 64. Incident State of Indiana. 65. Incident Zip Code. 66. Prior Aid (i.e. aid rendered prior to arrival of unit). 67. Prior Aid Performed by. 68. Outcome of Prior Aid. 69. Possible injury. 70. Chief Complaint. 71. Chief Complaint Anatomic Location. 72. Chief Complaint Organ System. 73. Primary Symptom. 74. Other Associated Symptoms. 75. Providers Primary Impression. 76. Providers Secondary Impression.

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77. Cause of Injury. 78. Intent of the injury (e.g. self-inflicted) 79. Mechanism of injury. 80. Use of Occupant Safety Equipment. 81. Cardiac Arrest. 82. Cardiac Arrest Etiology. 83. Resuscitation Attempted. 84. Barriers to Patient Care. 85. Medical/Surgical History. 86. Alcohol/Drug Use Indicators. 87. Medication Given. 88. Procedure. 89. Number of Procedure Attempts. 90. Procedure Successful. 91. Procedure Complication 92. Destination/Transferred To, Name. 93. Destination/Transferred To, Code. 94. Destination Zip Code. 95. Destination Zone Code (Indiana Homeland Security District number). 96. Incident/Patient Disposition. 97. Transport Mode from Scene. 98. Reason for Choosing Destination. 99. Type of Destination. 100. Emergency Department Disposition. 101. Hospital Disposition. 102. Research Survey Field. 103. Medication Complication

Appendix 2 - IN NEMSIS DATASET

NEMSIS ID

NEMSIS Selection Name

NEMSIS Code NEMSIS Data Element

NEMSIS Data Dictionary Data Type

NEMSIS National Element

Current Indiana

Data Element

New Indiana

Data Element

D01 Agency Gen. Info. D01_01 EMS Agency Number [text] National Element YES

D01 Agency Gen. Info. D01_03 EMS Agency State [combo] multiple-choice National Element YES

D01 Agency Gen. Info. D01_04 EMS Agency County [combo] multiple-choice National Element YES

D01 Agency Gen. Info. D01_07 Level of Service [combo] single-choice National Element YES D01 Agency Gen. Info. D01_08 Organizational Type [combo] single-choice National Element YES D01 Agency Gen. Info. D01_09 Organization Status [combo] single-choice National Element YES D01 Agency Gen. Info. D01_10 Statistical Year [date/time] National Element YES D01 Agency Gen. Info. D01_12 Total Service Size Area [number] National Element YES D01 Agency Gen. Info. D01_13 Total Service Area Population [number] National Element YES D01 Agency Gen. Info. D01_14 911 Call Volume per Year [number] National Element YES D01 Agency Gen. Info. D01_15 EMS Dispatch Volume per Year [number] National Element YES D01 Agency Gen. Info. D01_16 EMS Transport Volume per Year [number] National Element YES D01 Agency Gen. Info. D01_17 EMS Patient Contact Volume per Year [number] National Element YES D01 Agency Gen. Info. D01_19 EMS Agency Time Zone [text] National Element YES D01 Agency Gen. Info. D01_21 National Provider Identifier [text] National Element YES D02 Agency Contact Info. D02_07 Agency Contact Zip Code [text] National Element YES E01 Record Information E01_01 Patient Care Report Number [text] National Element YES E01 Record Information E01_02 Software Creator [text] National Element YES E01 Record Information E01_03 Software Name [text] National Element YES E01 Record Information E01_04 Software Version [text] National Element YES E02 Unit/ Agency Info. E02_01 EMS Agency Number [text] National Element YES E02 Unit/ Agency Info. E02_02 Incident Number [text] YES E02 Unit/ Agency Info. E02_03 EMS Unit (Vehicle) Response Number [text] YES E02 Unit/ Agency Info. E02_04 Type of Service Requested [combo] single-choice National Element YES E02 Unit/ Agency Info. E02_05 Primary Role of the Unit [combo] single-choice National Element YES

E02 Unit/ Agency Info. E02_06 Type of Dispatch Delay [combo] multiple-choice National Element YES

E02 Unit/ Agency Info. E02_07 Type of Response Delay [combo] multiple-choice National Element YES

E02 Unit/ Agency Info. E02_08 Type of Scene Delay [combo] multiple-choice National Element YES

E02 Unit/ Agency Info. E02_09 Type of Transport Delay [combo] multiple-choice National Element YES

E02 Unit/ Agency Info. E02_10 Type of Turn-Around Delay [combo] multiple-choice National Element YES

E02 Unit/ Agency Info. E02_12 EMS Unit Call Sign (Radio Number) [combo] single-choice National Element YES E02 Unit/ Agency Info. E02_20 Response Mode to Scene [combo] single-choice National Element YES E03 Unit/ Call Info. E03_01 Complaint Reported by Dispatch [combo] single-choice National Element YES E03 Unit/ Call Info. E03_02 EMD Performed [combo] single-choice National Element YES E03 Unit/ Call Info. E03_03 EMD Card Number [text] E04 Unit/ Personnel Info. E04_01 Crew Member ID [text] YES E05 Times E05_01 Incident or Onset Date/Time [date/time] YES E05 Times E05_02 PSAP Call Date/Time [date/time] National Element YES E05 Times E05_04 Unit Notified by Dispatch Date/Time [date/time] National Element YES E05 Times E05_05 Unit En Route Date/Time [date/time] National Element YES E05 Times E05_06 Unit Arrived on Scene Date/Time [date/time] National Element YES E05 Times E05_07 Arrived at Patient Date/Time [date/time] National Element YES

E05 Times E05_09 Unit Left Scene Date/Time [date/time] National Element YES E05 Times E05_10 Patient Arrived at Destination Date/Time [date/time] National Element YES E05 Times E05_11 Unit Back in Service Date/Time [date/time] National Element YES E05 Times E05_12 Unit Cancelled Date/Time [date/time] YES

E05 Times E05_13 Unit Back at Home Location Date/Time [date/time] National Element YES E06 Patient E06_01 Last Name [text] YES E06 Patient E06_08 Patient's Home Zip Code [text] National Element YES E06 Patient E06_11 Gender [combo] single-choice National Element YES E06 Patient E06_12 Race [combo] single-choice National Element YES E06 Patient E06_13 Ethnicity [combo] single-choice National Element YES E06 Patient E06_14 Age [number] National Element YES E06 Patient E06_15 Age Units [combo] single-choice National Element YES E06 Patient E06_16 Date of Birth [date] YES E07 Billing E07_01 Primary Method of Payment [combo] single-choice National Element YES E07 Billing E07_34 CMS Service Level [combo] single-choice National Element YES

E07 Billing E07_35 Condition Code Number [combo] multiple-choice National Element YES

E08 Scene E08_05 Number of Patients at Scene [combo] single-choice National Element YES E08 Scene E08_06 Mass Casualty Incident [combo] single-choice National Element YES E08 Scene E08_07 Incident Location Type [combo] single-choice National Element YES E08 Scene E08_09 Scene Zone Number ()IN DHS District Number) [combo] single-choice E08 Scene E08_13 Incident County [combo] single-choice YES E08 Scene E08_14 Incident State [combo] single-choice YES E08 Scene E08_15 Incident ZIP Code [text] National Element YES

E09 Situation E09_01 Prior Aid [combo] multiple-choice National Element YES

E09 Situation E09_02 Prior Aid Performed by [combo] multiple-choice National Element YES

E09 Situation E09_03 Outcome of the Prior Aid [combo] single-choice National Element YES

E09 Situation E09_04 Possible Injury [combo] single-choice National Element YES E09 Situation E09_05 Chief Complaint [text] YES E09 Situation E09_11 Chief Complaint Anatomic Location [combo] single-choice National Element YES E09 Situation E09_12 Chief Complaint Organ System [combo] single-choice National Element YES E09 Situation E09_13 Primary Symptom [combo] single-choice National Element YES

E09 Situation E09_14 Other Associated Symptoms [combo] multiple-choice National Element YES

E09 Situation E09_15 Providers Primary Impression [combo] single-choice National Element YES E09 Situation E09_16 Provider’s Secondary Impression [combo] single-choice National Element YES E10 Situation/ Trauma E10_01 Cause of Injury [combo] single-choice National Element YES E10 Situation/ Trauma E10_02 Intent of the Injury [combo] single-choice

E10 Situation/ Trauma E10_03 Mechanism of Injury [combo] multiple-choice YES

E10 Situation/ Trauma E10_08 Use of Occupant Safety Equipment [combo] multiple-choice YES

E11 Situation/ CPR E11_01 Cardiac Arrest [combo] single-choice National Element YES E11 Situation/ CPR E11_02 Cardiac Arrest Etiology [combo] single-choice National Element YES

E11 Situation/ CPR E11_03 Resuscitation Attempted [combo] multiple-choice National Element YES

E12 Medical History E12_01 Barriers to Patient Care [combo] multiple-choice National Element YES

E12 Medical History E12_10 Medical/Surgical History [combo or text] multiple-choice YES

E12 Medical History E12_19 Alcohol/Drug Use Indicators [combo] multiple-choice National Element YES

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E18 Intervention/ Medication E18_03 Medication Given [combo] single-choice National Element YES

E18 Intervention/ Medication E18_08 Medication Complication

[combo] multiple-choice National Element YES

E19 Intervention/ Procedure E19_03 Procedure [combo] single-choice National Element YES E19 Intervention/ Procedure E19_05 Number of Procedure Attempts [number] National Element YES E19 Intervention/ Procedure E19_06 Procedure Successful [combo] single-choice National Element YES

E19 Intervention/ Procedure E19_07 Procedure Complication [combo] multiple-choice National Element YES

E20 Disposition E20_01 Destination/Transferred To, Name [text] YES E20 Disposition E20_02 Destination/Transferred To, Code [text] YES E20 Disposition E20_07 Destination Zip Code [text] National Element YES E20 Disposition E20_09 Destination Zone Number (IN DHS Dsitrict Number) [combo] single-choice E20 Disposition E20_10 Incident/Patient Disposition [combo] single-choice National Element YES E20 Disposition E20_14 Transport Mode from Scene [combo] single-choice National Element YES E20 Disposition E20_16 Reason for Choosing Destination [combo] single-choice National Element YES E20 Disposition E20_17 Type of Destination [combo] single-choice National Element YES E22 Outcome and Linkage E22_01 Emergency Department Disposition [combo] single-choice National Element YES E22 Outcome and Linkage E22_02 Hospital Disposition [combo] single-choice National Element YES E23 Miscellaneous E23_09 Research Survey Field [text] YES

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NEMSIS ID NEMSIS Definition

D01 The state-assigned provider number of the responding agency D01 The state in which the Agency provides services D01 The county(s) for which the agency formally provides service

D01 The highest credentialed personnel's level of service which the agency provides for every EMS encounter if requested. In a tiered response system, this is the highest level of service which could be sent to any specific call.

D01 The organizational structure from which EMS services are delivered (fire, hospital, county, etc.) D01 The primary organizational status of the agency. The definition of Volunteer or Non-Volunteer is based on state or local terms. D01 The year to which the information pertains D01 The total square miles in the agency's service area

D01 The total population in the agency's service area based on year 2000 census data (if possible). This number does not include population changes associated with daily work flow or seasonal movements

D01 The number of 911 EMS calls for the calendar year D01 The number of EMS dispatches for the calendar year D01 The number of EMS transports for the calendar year D01 The number of EMS patient contacts for that calendar year D01 The time zone for the EMS Agency D01 The National Provider Identifier associated with National Provider System (NPS) and used in all standard HIPAA transactions such as electronic claim filing. D02 The ZIP code of the Agency contact's mailing address. E01 The unique number automatically assigned by the EMS agency for each patient care report (PCR). This is a unique number to the EMS agency for all of time. E01 The name of the software vendor by whom the data collection software was developed E01 The name of the software package with which the data was collected by the agency E01 The version of the software used by the agency to collect the data E02 The state-assigned provider number of the responding agency E02 The incident number assigned by the 911 Dispatch System E02 The internal EMS response number which is unique for each EMS unit’s (vehicles) response to an incident within an agency. E02 The type of service or category of service requested of the EMS service responding for this specific EMS incident. E02 The primary role of the EMS service which was requested for this specific EMS incident. E02 The dispatch delays, if any, associated with the dispatch of the EMS unit to the patient encounter E02 The response delays, if any, of the unit associated with the patient encounter E02 The scene delays, if any, of the unit associated with the patient encounter E02 The transport delays, if any, of the unit associated with the patient encounter E02 The turn-around delays, if any, associated with the EMS unit associated with the patient encounter E02 The EMS unit number used to dispatch and communicate with the unit. This may be the same as the EMS Unit/Vehicle Number in many agencies. E02 Indication whether or not lights and/or sirens were used on the vehicle on the way to the scene E03 The complaint dispatch reported to the responding unit. E03 Indication of whether EMD was performed for this EMS event. E03 The EMD card number reported by dispatch, consisting of the card number, dispatch level, and dispatch mode E04 The State Certification/Licensure ID number assigned to the crew member E05 The date/time the injury occurred, or the date/time the symptoms or problem started E05 The date/time the phone rings (911 call to public safety answering point or other designated entity) requesting EMS services. E05 The date the responding unit was notified by dispatch E05 The date/time the unit responded; that is, the time the vehicle started moving E05 The date/time the responding unit arrived on the scene; that is, the time the vehicle stopped moving E05 The date/time the responding unit arrived at the patient's side

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E05 The date/time the responding unit left the scene (started moving) E05 The date/time the responding unit arrived with the patient at the destination or transfer point E05 The date/time the unit back was back in service and available for response (finished with call, but not necessarily back in home location) E05 The date/time if the unit's call was cancelled

E05 The date/time the responding unit was back in their service area. In agencies who utilized Agency Status Management, home location means the service area as assigned through the agency status management protocol.

E06 The patient's last (family) name E06 The patient's home ZIP code of residence E06 The patient's gender E06 The patient's race as defined by the OMB (US Office of Management and Budget) E06 The patient's ethnicity as defined by the OMB (US Office of Management and Budget) E06 The patient's age (either calculated from date of birth or best approximation) E06 The units which the age is documented in (Hours, Days, Months, Years) E06 The patient's date of birth E07 The primary method of payment or type of insurance associated with this EMS encounter E07 The CMS service level for this EMS encounter.

E07 The condition codes are used to better describe the service and patient care delivery by an EMS service. Please consult CMS documentation for detailed descriptions of these condition codes and their use.

E08 Indicator of how many total patients were at the scene E08 Indicator if this event would be considered a mass casualty incident (overwhelmed existing EMS resources) E08 The kind of location where the incident happened E08 Geographic zone representing the location of the scene E08 The county or parish where the patient was found or to which the unit responded (or best approximation) E08 The state, territory, or province where the patient was found or to which the unit responded (or best approximation) E08 The ZIP code of the incident location E09 Any care which was provided to the patient prior to the arrival of this unit. E09 The type of individual who performed the care prior to the arrival of this unit. E09 What was the outcome or result of the care performed prior to the arrival of the unit?

E09 Indicates that the reason for the EMS encounter was related to an injury or traumatic event. This data element provides documentation to classify the EMS Reason for Encounter as either injury or non-injury related based on mechanism and not on actual injury

E09 The statement of the problem by the patient or the history provider in one or two words E09 The primary anatomic location of the chief complaint as identified by EMS personnel E09 The primary organ system of the patient injured or medically affected. This is to be completed by EMS personnel with a minimum of an EMT-Paramedic level of credentialing. E09 The primary sign and symptom present in the patient or observed by EMS personnel E09 Other symptoms identified by the patient or observed by EMS personnel

E09 The EMS personnel’s impression of the patient’s primary problem or most significant condition which led to the management given to the patient (treatments, medications, or procedures).

E09 The EMS personnel’s impression of the patient’s secondary problem or which led to the management given to the patient (treatments, medications, or procedures). E10 The category of the reported/suspected external cause of the injury E10 The intent of the individual inflicting the injury E10 The mechanism of the event which caused the injury. E10 Safety equipment in use by the patient at the time of the injury E11 Indication of the presence of a cardiac arrest at any time associated with the EMS evert. E11 Indication of the etiology or cause of the cardiac arrest (classified as cardiac, non-cardiac, etc.) E11 Indication of an attempt to resuscitate the patient who is in cardiac arrest (attempted, not attempted due to DNR, etc.) E12 Indication of whether or not there were any patient specific barriers to serving the patient at the scene E12 The patient’s pre-existing medical and surgery history of the patient E12 Indicators for the potential use of Alcohol or Drugs by the patient.

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E18 The medication given to the patient E18 Any complication (abnormal effect on the patient) associated with the administration of the medication to the patient by EMS E19 The procedure performed on the patient. E19 The number of attempts taken to complete a procedure or intervention regardless of success E19 Indication of whether or not the procedure performed on the patient was successful E19 Any complication associated with the performance of the procedure on the patient E20 The destination the patient was delivered or transferred to E20 The code of the destination the patient was delivered or transferred to, if present and available E20 The destination zip code in which the patient was delivered or transferred to E20 The zone number of the destination the patient was delivered or transferred to E20 Type of disposition treatment and/or transport of the patient. E20 Indication whether or not lights and/or sirens were used on the vehicle while leaving scene E20 The reason the unit chose to deliver or transfer the patient to the destination E20 The type of destination the patient was delivered or transferred to E22 The known disposition of the patient from the Emergency Department (ED) E22 Indication of how the patient was dispositioned from the hospital, if admitted. E23 A customizable field to be used by local agencies for additional documentation or research.

Appendix 3

Indiana Department of Homeland Security Districts and County List

District # Counties in District

District 1 Jasper, Lake, LaPorte, Newton, Porter, and Jasper District 2 Elkhart, Fulton, Kosciusko, Marshall, Pulaski, St. Joseph, and Starke District 3 Adams, Allen, DeKalb, Huntington, LaGrange, Miami, Noble, Steuben, Wabash, Wells and Whitley District 4 Benton, Carroll, Cass, Clinton, Fountain, Montgomery, Tippecanoe, Warren, and White District 5 Boone, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, and Shelby District 6 Blackford, Delaware, Fayette, Grant, Henry, Howard, Jay, Madison, Randolph, Rush, Tipton, Union, and Wayne District 7 Clay, Greene, Owen, Parke, Putnam, Sullivan, Vermillion, and Vigo District 8 Bartholomew, Brown, Jackson, Lawrence, Monroe, Orange, and Washington District 9 Clark, Decatur, Dearborn, Floyd, Franklin, Harrison, Jefferson, Jennings, Ohio, Ripley, Scott, and Switzerland District 10 Crawford, Daviess, Dubois, Gibson, Knox, Martin, Perry, Pike, Posey, Spencer, Vanderburgh, and Warrick.

Appendix 4

Indiana FIPS County Codes

INDIANA FIPS COUNTY CODES COUNTY FIPS COUNTY FIPS COUNTY FIPS CODE CODE CODEUnspecified 18000 Jackson 18071 Scott 18143 Adams 18001 Jasper 18073 Shelby 18145 Allen 18003 Jay 18075 Spencer 18149 Bartholomew 18005 Jefferson 18077 Starke 18149 Benton 18007 Jennings 18079 Steuben 18151 Blackford 18009 Johnson 18081 Sullivan 18153 Boone 18011 Knox 18083 Switzerland 18155 Brown 18013 Kosciusko 18085 Tippecanoe 18157 Carroll 18015 LaGrange 18087 Tipton 18159 Cass 18017 Lake 18089 Union 18161 Clark 18019 LaPorte 18091 Vanderburgh 18163 Clay 18021 Lawrence 18093 Vermillion 18165 Clinton 18023 Madison 10095 Vigo 18167 Crawford 18025 Marion 18097 Wabash 18169 Daviess 18027 Marshall 18099 Warren 18171 Dearborn 18029 Martin 18101 Warrick 18173 Decatur 18031 Miami 18103 Washington 18175 Dekalb 18033 Monroe 18105 Wayne 18177 Delaware 18035 Montgomery 18107 Wells 18179 Dubois 18037 Morgan 18109 White 18181 Elkhart 18039 Newton 18111 Whitley 18183 Fayette 18041 Noble 18113 IL 17000 Floyd 18043 Ohio 18115 KY 21000 Fountain 18045 Orange 18117 MI 26000 Franklin 18047 Owen 18119 MO 29000 Fulton 18049 Parke 18121 OH 39000 Gibson 18051 Perry 18123 Grant 18053 Pike 18125 Greene 18055 Porter 18127 Hamilton 18057 Posey 18129 Hancock 18059 Pulaski 18131 Harrison 18061 Putnam 18133 Hendricks 18063 Randolph 18135 Henry 18065 Ripley 18137 Howard 18067 Rush 18139 Huntington 18069 Saint Joseph 18141

Appendix 5 Indiana Department of Homeland Security

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Adams 0101 Blue Creek Township Bartholomew 0301 Clay Township 0102 French Township 0302 Clifty Township 0103 Hartford Township 0303 Columbus Township 0104 Jefferson Township 0304 Flat Rock Township 0105 Kirkland Township 0305 German Township 0106 Monroe Township 0306 Harrison Township 0107 Preble Township 0307 Haw Creek Township 0108 Root Township 0308 Jackson Township 0109 St. Mary’s Township 0309 Ohio Township 0110 Union Township 0310 Rock Creek Township 0111 Wabash Township 0311 Sand Creek Township 0112 Washington Township 0312 Wayne Township Allen 0201 Aboite Township Benton 0401 Bolivar Township 0202 Adams Township 0402 Center Township 0203 Cedar Creek Township 0403 Gilboa Township 0204 Eel River Township 0404 Grant Township 0205 Jackson Township 0405 Hickory Grove Township 0206 Jefferson Township 0406 Oak Grove Township 0207 Lafayette Township 0407 Parish Grove Township 0208 Lake Township 0408 Pine Township 0209 Madison Township 0409 Richland Township 0210 Marion Township 0410 Union Township 0211 Maumee Township 0411 York Township 0212 Milan Township 0213 Monroe Township 0214 Perry Township 0215 Pleasant Township Blackford 0501 Harrison Township 0216 St. Joseph Township 0502 Jackson Township 0217 Scipio Township 0503 Licking Township 0218 Springfield Township 0504 Washington Township 0219 Washington Township 0220 Wayne Township

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Boone 0601 Center Township Cass 0901 Adams Township 0602 Clinton Township 0902 Bethlehem Township 0603 Eagle Township 0903 Boone Township 0604 Harrison Township 0904 Clay Township 0605 Jackson Township 0905 Clinton Township 0606 Jefferson Township 0906 Deer Creek Township 0607 Marion Township 0907 Eel Township 0608 Perry Township 0908 Harrison Township 0609 Sugar Creek Township 0909 Jackson Township 0610 Union Township 0910 Jefferson Township 0611 Washington Township 0911 Miami Township 0612 Worth Township 0912 Noble Township 0913 Tipton Township 0914 Washington Township Brown 0701 Hamblen Township 0702 Jackson Township 0703 Van Buren Township Clark 1001 Bethlehem Township 0704 Washington Township 1002 Carr Township 1003 Charlestown Township 1004 Jeffersonville Township 1005 Monroe Township Carroll 0801 Adams Township 1006 Oregon Township 0802 Burlington Township 1007 Owen Township 0803 Carrollton Township 1008 Silver Creek Township 0804 Clay Township 1009 Union Township 0805 Deer Creek Township 1010 Utica Township 0806 Democrat Township 1011 Washington Township 0807 Jackson Township 1012 Wood Township 0808 Jefferson Township 0809 Liberty Township 0810 Madison Township 0811 Monroe Township 0812 Rock Creek Township 0813 Tippecanoe Township 0814 Washington Township

2

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Clay 1101 Brazil Township Daviess 1401 Barr Township 1102 Cass Township 1402 Bogard Township 1103 Dick Johnson Township 1403 Elmore Township 1104 Harrison Township 1404 Harrison Township 1105 Jackson Township 1405 Madison Township 1106 Lewis Township 1406 Reeve Township 1107 Perry Township 1407 Steele Township 1108 Posey Township 1408 Van Buren Township 1109 Sugar Ridge Township 1409 Veale Township 1110 Van Buren Township 1410 Washington Township 1111 Washington Township Clinton 1201 Center Township Dearborn 1501 Caesar Creek Township 1202 Forest Township 1502 Center Township 1203 Jackson Township 1503 Clay Township 1204 Johnson Township 1504 Harrison Township 1205 Kirklin Township 1505 Hogan Township 1206 Madison Township 1506 Jackson Township 1207 Michigan Township 1507 Kelso Township

1208 Owen Township 1508 Lawrenceburg Township

1209 Perry Township 1509 Logan Township 1210 Ross Township 1510 Manchester Township 1211 Sugar Creek Township 1511 Miller Township 1212 Union Township 1512 Sparta Township 1213 Warren Township 1513 Washington Township 1214 Washington Township 1514 York Township Crawford 1301 Boone Township Decatur 1601 Adams Township 1302 Jennings Township 1602 Clay Township 1303 Johnson Township 1603 Clinton Township 1304 Liberty Township 1604 Fugit Township 1305 Ohio Township 1605 Jackson Township 1306 Patoka Township 1606 Marion Township 1307 Sterling Township 1607 Salt Creek Township 1308 Union Township 1608 Sand Creek Township 1309 Whiskey Run Township 1609 Washington Township

3

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP De Kalb 1701 Butler Township Dubois 1907 Harrison Township 1702 Concord Township 1908 Jackson Township 1703 Fairfield Township 1909 Jefferson Township 1704 Franklin Township 1910 Madison Township 1705 Grant Township 1911 Marion Township 1706 Jackson Township 1912 Patoka Township 1707 Keyser Township 1708 Newville Township Elkhart 2001 Baugo Township 1709 Richland Township 2002 Benton Township 1710 Smithfield Township 2003 Cleveland Township 1711 Spencer Township 2004 Clinton Township 1712 Stafford Township 2005 Concord Township 1713 Troy Township 2006 Elkhart Township 1714 Union Township 2007 Harrison Township 1715 Wilmington Township 2008 Jackson Township 2009 Jefferson Township 2010 Locke Township 2011 Middlebury Township Delaware 1801 Center Township 2012 Olive Township 1802 Delaware Township 2013 Osolo Township 1803 Hamilton Township 2014 Union Township 1804 Harrison Township 2015 Washington Township 1805 Liberty Township 2016 York Township 1806 Monroe Township 1807 Mount Pleasant Township Fayette 2101 Columbia Township 1808 Niles Township 2102 Connersville Township 1809 Perry Township 2103 Fairview Township 1810 Salem Township 2104 Harrison Township 1811 Union Township 2105 Jackson Township 1812 Washington Township 2106 Jennings Township 2107 Orange Township 2108 Posey Township 2109 Waterloo Township Dubois 1901 Bainbridge Township 1902 Boone Township Floyd 2201 Franklin Township 1903 Cass Township 2202 Georgetown Township 1904 Columbia Township 2203 Greenville Township 1905 Ferdinand Township 2204 Lafayette Township 1906 Hall Township 2205 New Albany Township

4

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Fountain 2301 Cain Township Gibson 2601 Barton Township 2302 Davis Township 2602 Center Township 2303 Fulton Township 2603 Columbia Township 2304 Jackson Township 2604 Johnson Township 2305 Logan Township 2605 Montgomery Township 2306 Millcreek Township 2606 Patoka Township 2307 Richland Township 2607 Union Township 2308 Shawnee Township 2608 Wabash Township 2309 Troy Township 2609 Washington Township 2310 Van Buren Township 2610 White River Township 2311 Wabash Township Franklin 2401 Bath Township Grant 2701 Center Township 2402 Blooming Grove Township 2702 Fairmount Township 2403 Brookville Township 2703 Franklin Township 2404 Butler Township 2704 Green Township 2405 Fairfield Township 2705 Jefferson Township 2406 Highland Township 2706 Liberty Township 2407 Laurel Township 2707 Mill Township 2408 Metamora Township 2708 Monroe Township 2409 Posey Township 2709 Pleasant Township 2410 Ray Township 2710 Richland Township 2411 Salt Creek Township 2711 Sims Township 2412 Springfield Township 2712 Van Buren Township 2413 Whitewater Township 2713 Washington Township Fulton 2501 Aubbeenaubbee Township 2502 Henry Township Greene 2801 Beech Creek Township 2503 Liberty Township 2802 Cass Township 2504 Newcastle Township 2803 Center Township 2505 Richland Township 2804 Fairplay Township 2506 Rochester Township 2805 Grant Township 2507 Union Township 2806 Highland Township 2508 Wayne Township 2807 Jackson Township 2807 Jackson Township 2808 Jefferson Township 2809 Richland Township

5

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Greene 2810 Smith Township Hendricks 3201 Brown Township 2811 Stafford Township 3202 Center Township 2812 Stockton Township 3203 Clay Township 2813 Taylor Township 3204 Eel River Township 2814 Washington Township 3205 Franklin Township 2815 Wright Township 3206 Guilford Township 3207 Liberty Township Hamilton 2901 Adams Township 3208 Lincoln Township 2902 Clay Township 3209 Marion Township 2903 Delaware Township 3210 Middle Township 2904 Fall Creek Township 3211 Union Township 2905 Jackson Township 3212 Washington Township 2906 Noblesville Township 2907 Washington Township 2908 Wayne Township Henry 3301 Blue River Township 2909 White River Township 3302 Dudley Township 3303 Fall Creek Township Hancock 3001 Blue River Township 3304 Franklin Township 3002 Brandywine Township 3305 Greensboro Township 3003 Brown Township 3306 Harrison Township 3004 Buck Creek Township 3307 Henry Township 3005 Center Township 3308 Jefferson Township 3006 Green Township 3309 Liberty Township 3007 Jackson Township 3310 Prairie Township 3008 Sugar Creek Township 3311 Spiceland Township 3009 Vernon Township 3312 Stoney Creek Township 3313 Wayne Township Harrison 3101 Blue River Township 3102 Boone Township Howard 3401 Center Township 3103 Franklin Township 3402 Clay Township 3104 Harrison Township 3403 Ervin Township 3105 Heth Township 3404 Harrison Township 3106 Jackson Township 3405 Honey Creek Township 3107 Morgan Township 3406 Howard Township 3108 Posey Township 3407 Jackson Township 3109 Spencer Township 3408 Liberty Township 3110 Taylor Township 3409 Monroe Township 3111 Washington Township 3410 Taylor Township 3112 Webster Township 3411 Union Township

6

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Huntington 3501 Clear Creek Township Jay 3801 Bearcreek Township 3502 Dallas Township 3802 Greene Township 3503 Huntington Township 3803 Jackson Township 3504 Jackson Township 3804 Jefferson Township 3505 Jefferson Township 3805 Knox Township 3506 Lancaster Township 3806 Madison Township 3507 Polk Township 3807 Noble Township 3508 Rock Creek Township 3808 Penn Township 3509 Salamonie Township 3809 Pike Township 3510 Union Township 3810 Richland Township 3511 Warren Township 3811 Wabash Township 3512 Wayne Township 3812 Wayne Township Jackson 3601 Brownstown Township Jefferson 3901 Graham Township 3602 Carr Township 3902 Hanover Township 3603 Driftwood Township 3903 Lancaster Township 3604 Grassy Fork Township 3904 Madison Township 3605 Hamilton Township 3905 Milton Township 3606 Jackson Township 3906 Monroe Township 3607 Owen Township 3907 Republican Township 3608 Pershing Township 3908 Saluda Township 3609 Redding Township 3909 Shelby Township 3610 Salt Creek Township 3910 Smyrna Township 3611 Vernon Township 3612 Washington Township Jennings 4001 Bigger Township 4002 Campbell Township Jasper 3701 Barkley Township 4003 Center Township 3702 Carpenter Township 4004 Columbia Township 3703 Gillam Township 4005 Geneva Township 3704 Hanging Grove Township 4006 Lovett Township 3705 Jordan Township 4007 Marion Township 3706 Kankakee Township 4008 Montgomery Township 3707 Keener Township 4009 Sand Creek Township 3708 Marion Township 4010 Spencer Township 3709 Milroy Township 4011 Vernon Township 3710 Newton Township 3711 Union Township 3712 Walker Township 3713 Wheatfield Township

7

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Johnson 4101 Blue River Township Lagrange 4401 Bloomfield Township 4102 Clark Township 4402 Clay Township 4103 Franklin Township 4403 Clearspring Township 4104 Hensley Township 4404 Eden Township 4105 Needham Township 4405 Greenfield Township 4106 Nineveh Township 4406 Johnson Township 4107 Pleasant Township 4407 Lima Township 4108 Union Township 4408 Milford Township 4109 White River Township 4409 Newbury Township 4410 Springfield Township Knox 4201 Busseron Township 4411 Van Buren Township 4202 Decker Township 4203 Harrison Township 4204 Johnson Township 4205 Palmyra Township 4206 Steen Township Lake 4501 Calumet Township 4207 Vigo Township 4502 Cedar Creek Township 4208 Vincennes Township 4503 Center Township 4209 Washington Township 4504 Eagle Creek Township 4210 Widner Township 4505 Hanover Township 4506 Hobart Township 4507 North Township Kosciusko 4301 Clay Township 4508 Ross Township 4302 Etna Township 4509 St. John Township 4303 Franklin Township 4510 West Creek Township 4304 Harrison Township 4511 Winfield Township 4305 Jackson Township 4306 Jefferson Township 4307 Lake Township 4308 Monroe Township 4309 Plain Township 4310 Prairie Township 4311 Scott Township 4312 Seward Township 4313 Tippecanoe Township 4314 Turkey Creek Township 4315 Van Buren Township 4316 Washington Township 4317 Wayne Township

8

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP La Porte 4601 Cass Township Madison 4801 Adams Township 4602 Center Township 4802 Anderson Township 4603 Clinton Township 4803 Boone Township 4604 Coolspring Township 4804 Duck Creek Township 4605 Dewey Township 4805 Fall Creek Township 4606 Galena Township 4806 Green Township 4607 Hanna Township 4807 Jackson Township 4608 Hudson Township 4808 Lafayette Township 4609 Johnson Township 4809 Monroe Township 4610 Kankakee Township 4810 Pipe Creek Township 4611 Lincoln Township 4811 Richland Township 4612 Michigan Township 4812 Stony Creek Township 4613 New Durham Township 4813 Union Township 4614 Noble Township 4814 Van Buren Township 4615 Pleasant Township 4616 Prairie Township 4617 Scipio Township 4618 Springfield Township Marion 4901 Center Township 4619 Union Township 4902 Decatur Township 4620 Washington Township 4903 Franklin Township 4621 Wills Township 4904 Lawrence Township 4905 Perry Township 4906 Pike Township 4907 Warren Township Lawrence 4701 Bono Township 4908 Washington Township 4702 Guthrie Township 4909 Wayne Township 4703 Indian Creek Township 4704 Marion Township 4705 Marshall Township 4706 Perry Township Marshall 5001 Bourbon Township 4707 Pleasant Run Township 5002 Center Township 4708 Shawswick Township 5003 German Township 4709 Spice Valley Township 5004 Green Township 5005 North Township 5006 Polk Township 5007 Tippecanoe Township 5008 Union Township 5009 Walnut Township 5010 West Township

9

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Martin 5101 Center Township Montgomery 5401 Brown Township 5102 Halbert Township 5402 Clark Township 5103 Lost River Township 5403 Coal Creek Township 5104 Mitcheltree Township 5404 Franklin Township 5105 Perry Township 5405 Madison Township 5106 Rutherford Township 5406 Ripley Township 5407 Scott Township 5408 Sugar Creek Township 5409 Union Township Miami 5201 Allen Township 5410 Walnut Township 5202 Butler Township 5411 Wayne Township 5203 Clay Township 5204 Deer Creek Township 5205 Erie Township Morgan 5501 Adams Township 5206 Harrison Township 5502 Ashland Township 5207 Jackson Township 5503 Baker Township 5208 Jefferson Township 5504 Brown Township 5209 Perry Township 5505 Clay Township 5210 Peru Township 5506 Green Township 5211 Pipe Creek Township 5507 Gregg Township 5212 Richland Township 5508 Harrison Township 5213 Union Township 5509 Jackson Township 5214 Washington Township 5510 Jefferson Township 5511 Madison Township 5512 Monroe Township 5513 Ray Township 5514 Washington Township Monroe 5301 Bean Blossom Township 5302 Benton Township Newton 5601 Beaver Township 5303 Bloomington Township 5602 Colfax Township 5304 Clear Creek Township 5603 Grant Township 5305 Indian Creek Township 5604 Iroquois Township 5306 Perry Township 5605 Jackson Township 5307 Polk Township 5606 Jefferson Township 5308 Richland Township 5607 Lake Township 5309 Salt Creek Township 5608 Lincoln Township 5310 Van Buren Township 5609 McClellan Township 5311 Washington Township 5610 Washington Township

10

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Noble 5701 Albion Township Owen 6001 Clay Township 5702 Allen Township 6002 Franklin Township 5703 Elkhart Township 6003 Harrison Township 5704 Green Township 6004 Jackson Township 5705 Jefferson Township 6005 Jefferson Township 5706 Noble Township 6006 Jennings Township 5707 Orange Township 6007 Lafayette Township 5708 Perry Township 6008 Marion Township 5709 Sparta Township 6009 Montgomery Township 5710 Swan Township 6010 Morgan Township 5711 Washington Township 6011 Taylor Township 5712 Wayne Township 6012 Washington Township 5713 York Township 6013 Wayne Township Ohio 5801 Cass Township Parke 6101 Adams Township 5802 Pike Township 6102 Florida Township 5803 Randolph Township 6103 Greene Township 5804 Union Township 6104 Howard Township 6105 Jackson Township 6106 Liberty Township 6107 Penn Township Orange 5901 French Lick Township 6108 Raccoon Township 5902 Greenfield Township 6109 Reserve Township 5903 Jackson Township 6110 Sugar Creek Township 5904 Northeast Township 6111 Union Township 5905 Northwest Township 6112 Wabash Township 5906 Orangeville Township 6113 Washington Township 5907 Orleans Township 5908 Paoli Township 5909 Southeast Township 5910 Stampers Creek Township Perry 6201 Anderson Township 6202 Clark Township 6203 Leopold Township 6204 Oil Township 6205 Tobin Township 6206 Troy Township 6207 Union Township

11

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Pike 6301 Clay Township Pulaski 6601 Beaver Township 6302 Jefferson Township 6602 Cass Township 6303 Lockhart Township 6603 Franklin Township 6304 Logan Township 6604 Harrison Township 6305 Madison Township 6605 Indian Creek Township 6306 Marion Township 6606 Jefferson Township 6307 Monroe Township 6607 Monroe Township 6308 Patoka Township 6608 Rich Grove Township 6309 Washington Township 6609 Salem Township 6610 Tippecanoe Township 6611 Van Buren Township 6612 White Post Township Porter 6401 Boone Township Putnam 6701 Clinton Township 6402 Center Township 6702 Cloverdale Township 6403 Jackson Township 6703 Floyd Township 6404 Liberty Township 6704 Franklin Township 6405 Morgan Township 6705 Greencastle Township 6406 Pine Township 6706 Jackson Township 6407 Pleasant Township 6707 Jefferson Township 6408 Portage Township 6708 Madison Township 6409 Porter Township 6709 Marion Township 6410 Union Township 6710 Monroe Township 6411 Washington Township 6711 Russell Township 6412 Westchester Township 6712 Warren Township 6713 Washington Township Randolph 6801 Franklin Township Posey 6501 Bethel Township 6802 Green Township 6502 Black Township 6803 Greensfork Township 6503 Center Township 6804 Jackson Township 6504 Harmony Township 6805 Monroe Township 6505 Lynn Township 6806 Stoney Creek Township 6506 Marrs Township 6807 Union Township 6507 Point Township 6808 Ward Township 6508 Robb Township 6809 Washington Township 6509 Robinson Township 6810 Wayne Township 6510 Smith Township 6811 White River Township

12

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Ripley 6901 Adams Township Scott 7201 Finley Township 6902 Brown Township 7202 Jennings Township 6903 Center Township 7203 Johnson Township 6904 Delaware Township 7204 Lexington Township 6905 Franklin Township 7205 Vienna Township 6906 Jackson Township 6907 Johnson Township 6908 Laughery Township 6909 Otter Creek Township 6910 Shelby Township 6911 Washington Township Shelby 7301 Addison Township 7302 Brandywine Township 7303 Hanover Township Rush 7001 Anderson Township 7304 Hendricks Township 7002 Center Township 7305 Jackson Township 7003 Jackson Township 7306 Liberty Township 7004 Noble Township 7307 Marion Township 7005 Orange Township 7308 Moral Township 7006 Posey Township 7309 Noble Township 7007 Richland Township 7310 Shelby Township 7008 Ripley Township 7311 Sugar Creek Township 7009 Rushville Township 7312 Union Township 7010 Union Township 7313 Van Buren Township 7011 Walker Township 7314 Washington Township 7012 Washington Township St. Joseph 7101 Centre Township 7102 Clay Township 7103 German Township 7104 Greene Township 7105 Harris Township Spencer 7401 Carter Township 7106 Liberty Township 7402 Clay Township 7107 Lincoln Township 7403 Grass Township 7108 Madison Township 7404 Hammond Township 7109 Olive Township 7405 Harrison Township 7110 Penn Township 7406 Huff Township 7111 Portage Township 7407 Jackson Township 7112 Union Township 7408 Luce Township 7113 Warren Township 7409 Ohio Township

13

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Starke 7501 California Township Switzerland 7801 Cotton Township 7502 Center Township 7802 Craig Township 7503 Davis Township 7803 Jefferson Township 7504 Jackson Township 7804 Pleasant Township 7505 North Bend Township 7805 Posey Township 7506 Oregon Township 7806 York Township 7507 Railroad Township 7508 Washington Township 7509 Wayne Township Tippecanoe 7901 Fairfield Township 7902 Jackson Township 7903 Lauramie Township 7904 Perry Township Steuben 7601 Clear Lake Township 7905 Randolph Township 7602 Fremont Township 7906 Sheffield Township 7603 Jackson Township 7907 Shelby Township 7604 Jamestown Township 7908 Tippecanoe Township 7605 Millgrove Township 7909 Union Township 7606 Otsego Township 7910 Wabash Township 7607 Pleasant Township 7911 Washington Township 7608 Richland Township 7912 Wayne Township 7609 Salem Township 7913 Wea Township 7610 Scott Township 7611 Steuben Township 7612 York Township Tipton 8001 Cicero Township 8002 Jefferson Township 8003 Liberty Township 8004 Madison Township 8005 Prairie Township Sullivan 7701 Cass Township 8006 Wildcat Township 7702 Curry Township 7703 Fairbanks Township 7704 Gill Township Union 8101 Brownsville Township 7705 Haddon Township 8102 Center Township 7706 Hamilton Township 8103 Harmony Township 7707 Jackson Township 8104 Harrison Township 7708 Jefferson Township 8105 Liberty Township 7709 Turman Township 8106 Union Township

14

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Vanderburgh 8201 Armstrong Township Wabash 8501 Chester Township 8202 Center Township 8502 Lagro Township 8203 German Township 8503 Liberty Township 8204 Knight Township 8504 Noble Township 8205 Perry Township 8505 Paw Paw Township 8206 Pigeon Township 8506 Pleasant Township 8207 Scott Township 8507 Waltz Township 8208 Union Township Warren 8601 Adams Township Vermillion 8301 Clinton Township 8602 Jordan Township 8302 Eugene Township 8603 Kent Township 8303 Helt Township 8604 Liberty Township 8304 Highland Township 8605 Medina Township 8305 Vermillion Township 8606 Mound Township 8607 Pike Township 8608 Pine Township 8609 Prairie Township Vigo 8401 Fayette Township 8610 Steuben Township 8402 Harrison Township 8611 Warren Township 8403 Honey Creek Township 8612 Washington Township 8404 Linton Township 8405 Lost Creek Township 8406 Nevins Township 8407 Otter Creek Township 8408 Pierson Township 8409 Prairie Creek Township 8410 Prairieton Township 8411 Riley Township Warrick 8701 Anderson Township 8412 Sugar Creek Township 8702 Boon Township 8703 Campbell Township 8704 Greer Township 8705 Hart Township 8706 Lane Township 8707 Ohio Township 8708 Owen Township 8709 Pigeon Township 8710 Skelton Township

15

16

INDIANA COUNTIES & TOWNSHIP CODE LIST COUNTY CODE TOWNSHIP COUNTY CODE TOWNSHIP Washington 8801 Brown Township White 9101 Big Creek Township 8802 Franklin Township 9102 Cass Township 8803 Gibson Township 9103 Honey Creek Township 8804 Howard Township 9104 Jackson Township 8805 Jackson Township 9105 Liberty Township 8806 Jefferson Township 9106 Lincoln Township 8807 Madison Township 9107 Monon Township 8808 Monroe Township 9108 Prairie Township 8809 Pierce Township 9109 Princeton Township 8810 Polk Township 9110 Round Grove Township 8811 Posey Township 9111 Union Township 8812 Vernon Township 9112 West Point Township 8813 Washington Township Wayne 8901 Abington Township 8902 Boston Township 8903 Center Township Whitley 9201 Cleveland Township 8904 Clay Township 9202 Columbia Township 8905 Dalton Township 9203 Etna-Troy Township 8906 Franklin Township 9204 Jefferson Township 8907 Greene Township 9205 Richland Township 8908 Harrison Township 9206 Smith Township 8909 Jackson Township 9207 Thorncreek Township 8910 Jefferson Township 9208 Union Township 8911 New Garden Township 9209 Washington Township 8912 Perry Township 8913 Washington Township 8914 Wayne Township 8915 Webster Township Wells 9001 Chester Township Michigan 9500 All 9002 Harrison Township 9003 Jackson Township Illinois 9600 All 9004 Jefferson Township 9005 Lancaster Township Kentucky 9700 All 9006 Liberty Township 9007 Nottingham Township Ohio 9800 All 9008 Rockcreek Township 9009 Union Township Missouri 9900 All

Appendix 6 Indiana Hospital Destination /Facility List & Codes

CODE NUMBER DESTINATION / FACILITY NAME 0001 Home 0002 Medical Office / Clinic 0003 Extended Care Facility 0004 Hospital 0005 Other EMS Responder - Ground 0006 Other EMS Responder - Air 0007 Morgue 0008 Not Applicable 0030 Parkview Huntington Hospital 0100 Adams County Memorial. Hospital Skilled Nursing Unit 0105 Golden Meadows Home 0110 Albany Health Care, Inc. 0120 Alexandria Convalescent Center 0125 Alexandria Residential Center 0127 St. Mary's Hospital - Evansville - East 0130 Columbia City Community Care Center 0140 Allison Healthcare Corporation 0150 Alpha Home (The) 0160 Altenheim Community 0164 Amber Manor Care Center 1065 Harrison Healthcare Corporation 0170 Americana Healthcare Center 0180 Americana Healthcare Center - Elkhart 0190 Americana Healthcare Center - East 0200 Americana Healthcare Center - Midtown 0210 Americana Healthcare Center - North 0220 Americana Healthcare Center 0224 Portage Community Hospital - Portage 0230 Murdock Manor 0240 Anderson Healthcare Center 0250 Angola Nursing Home 0255 AMI Culver Extended Care - Union Hospital

0270 Westfield Village 0280 Arcadia Developmental Center 0290 Archibald Memorial Home for Aged Deaf 0300 Asbury Towers 0305 Heartland Health Care Center - Prestwick 0310 Baker's Rest Haven, Inc. 0313 Ball Memorial Hospital Skilled Care Center 0320 Bartholomew County Home 0330 Barton House Nursing Home 0340 Beach Cliff Lodge Nursing Home 0350 Bedford Nursing Home 0360 Beech Grove Healthcare Center 0370 Lockerbie Healthcare Facility 0380 Ben Hur Home, Inc. 0385 Benton County Retirement Village 0390 Chalet Village Health Care Center 0395 Elkhart General Hospital 0400 Bertha D. Garten Ketcham Memorial Center, Inc. 0410 Bethany Village Nursing Home 0411 Bethany Village Residential Care 0420 Bethel Manor 0430 Betz Nursing Home, Inc. 0435 Bickford Cottage Extended Care - Wabash 0440 Bloomfield Health Care Center 0450 Bloomington Convalescent Center 0460 Hoosier Hills Health Care Center 0475 Mapleview Rest Home 0480 Bradner Village Health Care Facility, Inc. 0490 Braun's Nursing Home, Inc. 0500 Brethren's Home of Indiana, Inc. 0505 Brighton Hall Nursing Center 0515 Meridian Nursing Center - Dyer 0520 Brown County Community Care Center, Inc. 0530 Butler Health Care Center 0540 Bryon Health Care Center 0545 Cambridge Health Care Center 0550 Camelot Care Center 0560 Maplewood Manor 0570 Life Care Center of Rochester

2

0580 Canterbury Place 0600 Meridian Nursing Center - Cardinal 0610 Carllin Park Healthcare Center 0620 Carlyle Healthcare Center 0630 Carmel Care Center 0633 Manor House of Carmel (The) 0640 Carmel Nursing Home, Inc. 0645 Carroll County Home 0660 Castle Shannon Nursing Home 0665 Castleton Health Care Center 0670 Cedar Crest Health Center, Inc. 0675 Americana Healthcare Center - South 0680 Central Healthcare Center 0685 Caylor-Nickel Medical Center Continuing Care Center 0690 Capital Care Health Center, Inc. 0700 Charles Ford Memorial Home (The) 0710 Chase Center 0732 Miller's Merry Manor - Chesterfield 0735 Chesterton Health Care Center 0738 Christian Care Retirement Community 0740 Crystal's Country Home, Inc. 0750 Sheridan Special Care Center 0760 Clara Fairbanks & Chauncey Rose Home, Inc. 0765 Wedgewood Manor Healthcare Center 0768 Clark County Memorial Hospital Continuing Care Center 0770 Plainfield Health Care Center 0780 Willow Brook Manor 0785 Holly Hill Health Care Center 0790 Clay County Health Center 0800 Clifty Falls Convalescent Center 0810 Seasons of Heart Care Center 0820 Clinton House 0830 Clinton Nursing Home 0835 Coburn Place 0840 Three Rivers Convalescent Center 0850 Churchman Manor 0860 Greenbriar Manor 0870 Brandywine Manor 0880 Oak Ridge Convalescent Center

3

0890 North Willow Center 0900 Brookview Manor 0905 Colonial Oaks Health Care Center 0910 Colonial Nursing Home 0920 Columbia City Nursing Home 0930 Arcadia Care Manor 0940 Columbus Convalescent Center 0950 Cottonwood Manor Nursing Home 0960 Comfort Retirement & Nursing Home, Inc. 0969 Community Care Center of Wabash 0970 Caroleton Manor 0980 Connersville Nursing Home 0990 Continental Convalescent Center 1000 Cooper Community Care Center 1010 Corydon Nursing Home 1020 Miller's Merry Manor - Hartford City 1030 Miller's Merry Manor - Dunkirk 1035 Countryside Manor Healthcare Center 1040 Countryside Place - LaPorte 1050 Countryside Place 1070 Covington Manor Nursing Center 1080 Covington Manor, Inc. 1090 Crescent Manor Nursing Home 1100 Crestview Convalescent Home 1110 Crestview Health Care 1120 Bethany Care Center of Fort Wayne 1130 Community Healthcare of Indianapolis 1133 Community Hospital Extended Care Facility 1137 Community Hospitals Transitional Care Unit 1140 Primrose Manor 1145 Daviess County Home 1147 Daviess County Hospital 1150 West Haven Health Care 1155 George Davis Manor 1160 Lakeside Manor 1165 Decatur Nursing and Rehabilitation Center 1167 DeKalb County Home 1168 DeKalb Health Care Center 1170 De Mare Nursing Home

4

1180 Delaware County Health Center 1190 Delaware Health Care 1200 Woodbridge Nursing Care Center 1205 St. Elizabeth Health Care Center 1210 Birchwood Manor Living Center 1220 Dickey Nursing Home, Inc. 1230 Dillsboro Manor 1250 Spencer Health Care Center 1260 Dreyerhause 1262 Dukes Memorial Hospital Continuing Care Center 1265 Lincolnshire health Care Center 1270 Lake County Rehabilitation Center, Inc. 1275 Eagle Valley Healthcare Center 1290 Eastgate Manor Nursing & Residence, Inc. 1300 Pine Tree Manor 1310 Edgewood View Healthcare 1315 Valley View Health Care Center 1318 Elkhart General Hospital 1320 Chelsea Manor 1330 Elsie M. Dreyer Nursing Home I 1331 Elsie M. Dreyer Nursing Home II 1340 Emerson Nursing Home 1350 Flynn Memorial Home 1360 English Nursing Home 1370 Estelle Peabody Memorial Home (The) 1380 Washington Manor 1390 Evansville Protestant Home, Inc. 1400 Rosewood Healthcare Center 1410 Ewing Nursing Home 1430 Anthony Wayne Living Center 1440 Faith Nursing Home 1450 Americana Family Tree Care Center 1452 Scenic Hills Care Center 1454 Flatrock River Lodge 1455 Floyd County Home 1460 Fontanbleau Nursing Center 1470 Forest Del Convalescent Center 1480 Forest Park Healthcare Center 1490 Willow Ridge Living Center

5

1500 Fort Wayne Nursing Home 1502 Forum at the Crossing (The) 1510 Miller's Merry Manor, Inc. - Hobart 1520 Rosewood Terrace 1522 Regency Place Corporation - Lafayette 1525 Regency Place of South Bend 1530 Fountainview Place - Mishawaka 1540 Fountainview Place of Portage 1542 Regency Place Corporation of Fort Wayne 1545 Regency Place of Dyer 1550 Carriage Manor 1560 Regency Place of Greenfield 1570 Regency Place of Greenwood 1580 Canterbury Village 1585 Southlake Care Center 1590 Williamsburg Village 1600 Fountainview Terrace 1610 Four Seasons Retirement & Health Care Center 1620 Frame House Manor 1630 Frankfort Nursing Home 1640 Sheffield Manor 1660 Franklin Nursing Home 1670 Franklin United Methodist Home (The) 1680 Freelandville Community Home, Inc. 1690 Northeast Healthcare Center of Muncie, Inc. 1700 Friends Fellowship Community, Inc. 1710 Lowell Healthcare Center 1719 Garfield Park Health Facility 1720 Keystone Health Care Center 1725 George Ade Extended Care Facility 1730 Gertha's Nursing Center, Inc. 1733 Gibson County Home 1735 Gibson General Hospital Skilled Nursing Facility 1740 Oak Meadows Learning Center 1750 Woodview Healthcare, Inc. 1760 Glenburn Home, Inc. 1770 Goble Nursing Home 1780 Countryside Place - Mishawaka 1790 Northgate Healthcare Center

6

1800 Community Care Center of Dale 1810 Brownsburg Health Care Center 1820 Ladoga Health Care Center 1830 Kingsbury Center 1840 Golden Rule Nursing Center 1845 Autumwood Extended Care Unit - Tipton Hospital 1850 Cardinal Healthcare of Danville 1860 Procare Development Center 1870 Golden Years Homestead 1880 Good Samaritan Home, Inc. - Evansville 1885 Good Samaritan Hospital Extended Care Facility 1890 Good Samaritan Home, Inc.- Oakland City 1900 Crystal Valley Care Center 1910 Gosport Nursing Home 1915 Columbia Nursing Plaza, Inc. 1920 Grace Village Health Care Facility 1928 Grandview Convalescent Center 1930 Grandview Living Center 1935 Green Acres Home 1937 Green Acres 1940 Green Valley Convalescent Center 1950 Green-Hill Manor, Inc. 1960 Greencastle Nursing Home 1970 Greencroft Nursing Center 1980 Green's Geriatric Health Center, Inc. 1990 North Lincoln Village 2000 Miller's Merry Manor, Inc. - Indianapolis 2010 Greenwood Convalescent Center 2013 Kingston Care Center 2017 Hamilton County Home 2020 Hamilton Grove 2030 New Horizons Developmental Center 2040 Hammond Nursing Home 2050 Hammond-Whiting Convalescent Center 2060 Hanover Nursing Center 2066 Harbour Manor Care Center - St. John's 2070 Hartford City Community Care Center 2080 Cleveland of Knightsville 2085 Lyons Convalescent Center

7

2086 Woodlands Convalescent Center 2090 Milan Healthcare Center 2095 Kendallville Manor Healthcare Center 2099 Miller Beach 2100 Healthwin Hospital 2107 Sullivan Convalescent Center 2110 Henderson Nursing Home, Inc. 2120 Hendricks County Home 2125 Henry County Home 2127 Oakwood Health Care Center - Henry County Memorial Hospital 2130 Heritage Healthcare, Inc. 2140 The Haven Center 2150 Heritage House Convalescent Center - Martinsville 2160 Heritage House Convalescent Center - Sheridan 2162 Heritage House Convalescent Center of Putnam County, Inc. 2164 Heritage House of Clinton 2165 Heritage House of Connersville, Inc. 2170 Heritage House of Richland 2173 Heritage House of Salem, Inc. 2180 Heritage House of New Castle 2190 Riverbend Health Care Center 2200 Heritage Manor, Inc. - Shelbyville 2203 Heritage Manor Retirement Center 2205 Heritage Regency, Inc. 2210 Miller's Merry Manor, Inc. - Tipton 2220 Highland Nursing Home 2230 South Street Health Care Center 2240 Hillcrest Healthcare Center 2250 Hillside Haven 2260 Hillside Manor 2270 Petersburg Healthcare Center 2280 Holliday Home of Evansville 2290 Holiday Manor 2300 Holly Hill Nursing Home 2305 Homecare Center 2306 Paoli Convalescent Center 2310 Homeview Center of Franklin 2320 Hoosier Christian Village 2330 Community Care Center of North Vernon

8

2340 Hoosier Village (The) 2350 Hooverwood 2360 Hospitality House - Bedford 2370 Hospitality House, Inc. - Bloomington 2380 Heritage House of Greensburg 2390 Houston Health Care, Inc. 2400 Cloverdale Community Healthcare. 2403 Williamsburg Health Care 2405 Houston Village, Inc. 2407 Howard County Home 2410 Hubbard Hill Estates, Inc. 2418 Woodridge Healthcare 2420 Huntingburg Convalescent Center, Inc. 2425 Evergreen Manor 2428 Community Care Center of Huntington 2430 Huntington Nursing Home 2440 Independent Living Club 2448 Indian Creek Convalescent Center 2450 Indian Village Health Care 2460 Village Christian Parke (The) 2470 Indiana Masonic Home 2480 Indiana Pyhian Home 2490 Indiana Veterans Home 2500 Indianapolis Retirement Home, Inc. 2510 Miller's Merry Manor - Rushville 2520 Jackson Park Convalescent Center 2535 Century Villa Health Care 2540 Jasper Nursing Center, Inc. 2545 Jay County Retirement Center 2550 Jeffersonville Nursing Home 2560 Jenkins Hall 2565 Todd Aikens Health Center - Johnson Co. Memorial Hospital 2570 Ken-Joy Convalescent Home 2580 Kendallville Nursing Home 2585 Lake Park Residential Care 2590 Kennedy Living Center 2593 Kenney Health Care Center 2600 Kentland Nursing Home 2605 Longworth Skilled Care Center - North Clark Community

9

2610 Longworth Villa 2615 Knox County Association for Retarded Citizens 2620 Mayflower Nursing Home 2625 Knox County Home 2630 Greentree Manor 2650 Lafayette Healthcare Center 2655 Life Care Center of LaGrange 2660 LaGrange Nursing Home 2670 Lake County Convalescent Home 2680 Lake Holiday Manor Nursing Home 2690 Lakeview Home 2700 Lakeland Loving Care Center, Inc. 2710 Lakeland Nursing Center 2720 Life Care Center of Michigan City 2730 Lakeview Manor, Inc. 2740 Lakeview Health Care Center 2750 Lane House, Inc. 2755 LaPorte County Home 2757 Continuing Care Center of LaPorte Hospital 2760 Houston Health Care, Inc. - Clarks Hill 2770 Lawrence Manor Nursing Home 2780 Life Care Center of Fort Wayne 2790 Essex Manor 2800 Lee Alan Bryant Health Care Facility, Inc. 2805 Liberty Village 2810 Lewisville Hotel for Senior Citizens 2815 Hillcrest Estates 2818 Lifelines of Indianapolis 2820 Lincoln Hills Nursing Home, Inc. 2830 Lincoln Hills of New Albany 2840 Lincoln Lodge Nursing Center 2850 Lincoln Manor Nursing Center 2860 Linton Nursing Home 2870 Little Company of Mary Hlts. Facility, Inc. 2875 Lodge of the Wabash 2880 Lu Ann Nursing Home 2890 Lutheran Community Home, Inc. 2900 Lutheran Home of Northwest Indiana, Inc. 2910 Lutheran Home, Inc.

10

2920 Lutheran Home, Inc. - Kendallville 2930 Lynhurst Healthcare Center 2940 Macanell Nursing Home, Inc. 2950 Madison Nursing Home 2960 Manderle Health Care Center 2980 Miller's Merry Manor - Manor Care Division 2983 Wintersong Village of Knox 2990 Maple Manor Christian Home, Inc. - Adult Division 2995 Maple Manor Residential Home 3000 Miller's Merry Manor - Middletown 3017 Markel Health Care, Inc. 3020 Marion County Healthcare Center 3030 Marquette Manor 3035 Martin County Nursing Center 3050 Mason Health Care Facility, Inc. 3052 Royal Oaks 3058 Mayfair Manor 3060 River Valley Health Care Center 3070 McCurdy Residential Center 3080 Country Care Nursing Center 3085 Meadowbrook Manor 3090 Meadheaven Nursing Home 3100 Meadows Manor Convalescent & Rehabilitation 3110 Meadows Manor North, Inc. 3120 Meadowvale Care Center 3125 Meadwood Health Pavilion 3130 GentleCare of French Lick 3140 Medco Center of Chandler 3150 Medco Center of Elkhart 3160 Medco Center of Evansville - North, Inc. 3170 Medco Center of French Lick 3180 GentleCare of Huntingburg 3190 GentleCare of Loogootee 3200 Medco Center of Mt. Vernon 3210 Medco Center of Newburgh 3213 Medco Plaza of Fort Wayne 3220 Holy Cross Living Center 3221 Memorial Hospital and Health Care Center 3225 Meridian Nursing Center - East Lake

11

3230 Meridian Nursing Home 3240 Country Heaven Healthcare 3250 Middletown Nursing Center 3255 Midland House, Inc. 3265 Miller's Merry Manor - Indianapolis 3270 Miller's Merry Manor - Columbia City 3280 Miller's Merry Manor - Culver 3283 Miller's Merry Manor - Fort Wayne 3285 Miller's Merry Manor - Garret 3290 Miller's Merry Manor - Hope 3300 Miller's Merry Manor - Huntington 3310 Miller's Merry Manor - LaGrange 3315 Miller's Merry Manor - Logansport 3317 Miller's Merry Manor - New Castle 3320 Miller's Merry Manor - Peru 3325 Miller's Merry Manor - Wabash (Alber Street) 3330 Miller's Merry Manor - Plymouth 3332 Miller's Merry Manor - Portage 3335 Renaissance Village 3337 Miller's Merry Manor - Syracuse 3340 Miller's Merry Manor - Wabash (Manchester Ave.) 3345 Miller's Merry Manor - Wakarusa 3350 Miller's Merry Manor - Walkerton 3360 Miller's Merry Manor - Warsaw 3370 Miller's Merry Manor - Mooresville 3390 Milner Community Health-Care, Inc. 3400 Mitchell Manor 3405 Montgomery County Home 3410 Monticello Community Healthcare Center 3420 Boonville Convalescent Center, Inc. 3430 Bicknell Health Care 3435 Morgan County Home 3440 St. Joseph's Care Center - Morningside 3450 Morristown Healthcare and Residential Care Center 3460 Mount Zion Geriatric Center 3470 Mulberry Lutheran Home 3480 Muncie Health Care Center, Inc. 3490 Munster Med-Inn 3500 Neal Home (The)

12

3505 River Oaks Healthcare Campus - Princeton 3508 Rolling Hills Health Care Center 3510 New Albany Nursing Home 3505 River Oaks Healthcare Campus - Princeton 3520 New Castle Community Care Center 3530 New Castle Healthcare Center 3535 New Harmony Healthcare Center 3540 St. Vincent Hospital 3550 St. Vincent New Hope, Inc. 3560 Newburgh Health Care & Residential Center 3570 Westview Manor Health Care Center 3580 Noblesville Healthcare Center 3590 Noblesville Nursing Home 3600 North Vernon Nursing Home 3610 Country Trace Healthcare Center 3620 Northwest Manor Health Care Center 3630 Northwood Good Samaritan Center 3640 Northwood Nursing Home 3650 Miller's Merry Manor - Rockport 3665 Oak Village, Inc. 3680 Odd Fellows Home 3681 Ossian Health Care, Inc. 3682 Owen County Home 3683 Otterbein Nursing and Care Center, Inc. 3685 Our Lady of Mercy Hospital. Skilled Nursing Unit 3690 Owensville Convalescent Center, Inc. 3700 Paoli Nursing Home 3710 Park Manor Nursing Home 3720 Parke County Nursing Home, Inc. 3730 Parkview Convalescent Center, Inc. 3740 Parkview Convalescent Center 3750 Parkview Haven 3760 Parkview Home 3770 Parkview Manor 3780 Parkview Nursing Center 3790 Parkwood Health Care, Inc. 3800 Medco Center of Fort Wayne 3805 Coventry Manor Miller's Merry Manor 3820 Peru Nursing Home

13

3830 Pilgrim Manor 3840 Pine Haven Nursing Home 3850 Pinehurst Care Center 3860 Pleasant View Lodge 3863 Life Care Center of Valparaiso 3865 Porter County Home 3870 Portland Community Care Center - West 3880 Portland Community Care Center - East 3885 Prairie View Healthcare Center 3890 Prairie Village, Inc. 3900 Professional Care Nursing Center 3910 Providence Home 3920 Providence Retirement Home 3931 Pulaski Health Care Center, Inc. 3932 Pulaski Health Care Center 3934 Bremen health Care Center 3938 Randolph County Home 3940 Randolph Nursing Home 3955 Pine Knoll Residential Facility 3960 Red Oaks Health Care Center 3965 Regency Place of Castleton 3970 Regina Continuing Care Center (The) 3980 Rensselaer Care Center 3986 Rawlins House, Inc. 3988 Richland-Bean Blossom Health Care Facility 3990 Spring Groove Care Center 4000 Medco Center of South Bend 4010 Riley Health Care 4020 Rising Sun Care Center 4030 Ritter Healthcare Center 4040 Meridian Nursing Center - River Park 4050 St. Joseph's Care Center - Notre Dame 4055 St. Joseph's Care Center - Transitional Care Unit 4060 Greensprings Manor Healthcare, Inc. 4070 Arbors at Fort Wayne 4080 Rosewood Manor 4085 Manor House at Riverview 4090 Riverbend learning Center 4100 Milton Home (The)

14

4105 Robert E. Lee Inn 4110 Rochester Nursing Home 4120 Rose-Seal Memorial Home 4130 Rolling Hills Convalescent Center 4140 Merrillville Manor 4145 Rose Manor 4150 Rural Healthcare 4155 Rush County Home 4156 Rush Health Care Management, Inc. 4157 Medco Center of Evansville - West 4158 Southwood Health Care Center 4160 Sacred Heart Home 4163 Tioga Pines Living Center of Monticello 4170 Saint Anne Home 4172 St. Paul's Retirement Community 4180 Sherman Drive Health Facility, Inc. 4190 Scott Manor Nursing Home, Inc. 4200 Scott Villa Living Center 4210 Scottsburg Nursing Home 4220 Sebo Heritage Manor Nursing Home 4225 Community Care Center of Seymour 4230 Shady Nook Care Center 4240 Shady Rest Home 4250 Shakamak Good Samaritan Center 4260 Rolling Meadows Health Care Center 4265 Shelby Manor 4267 Shepherd of the Hill 4270 Sheridan Health Care Center, Inc. 4280 Silver Bell Nursing Home 4290 Simmons Loving Care Health Facility 4300 St. Joseph's Care Center - Lombardy 4310 Southwestern Nursing Home 4320 Southside Healthcare Center 4325 Countryside Healthcare Center 4338 Saint Anthony Health Care Center 4340 St. Anthony Home, Inc. - Crown Point 4350 St. Augustine Home for the Aged 4355 Saint Elizabeth Hospital Extended Care Unit 4360 St. John's Home for the Aged

15

4362 St. John's Continuing Care Center 4365 St. Mary Continuing Care Center 4370 St. Paul's Home for the Aged 4380 St. Paul's Hermitage 4387 Steuben County Rest Home 4390 Stone Manor Convalescent Center 4400 Heritage Manor Health Care Center of Ligonier 4410 Sugar Creek Convalescent Center, Inc. 4415 Lakeview Rest Home 4420 Miller's Merry Manor - Sullivan 4425 Summer Trace 4430 Summit Convalescent Center 4435 Community Care Center of Anderson 4437 Community Care Center of Muncie 4440 Sunset Manor 4445 Swiss Villa Health Care Facility 4450 Swiss Village, Inc. 4460 Sycamore Village Health Center 4470 Countryside Healthcare 4480 Medco Center of Clarksville 4490 Medco Center of Danville 4500 Terrace View Health Care Center 4510 Terre Haute Nursing Home 4520 Springfield Health Care Center, Inc. 4530 Timbercrest 4540 Tippecanoe Villa 4545 Tipton County Rest Home 4550 Tipton Nursing Home 4570 Todd Dickey Medical Center 4577 Towne Center Health Care 4580 Towne House Retirement Community 4600 Twin City Nursing Home 4605 Union Hospital Transitional Care Unit 4610 United Methodist Memorial Home 4620 University Nursing Center 4630 University Park Nursing Center 4640 Pavilion Health Care Center 4650 Vermillion Convalescent Center 4660 Vernon Manor Children's Home

16

4670 Vigo County Home 4675 Villa of the Woods 4677 Greenwood Village Manor 4680 Sullivan Developmental Skill Center 4690 Gentle Care of Vincennes 4700 Vinewood Nursing Home 4710 Wabash Healthcare Center / Americare 4715 Wabash County Hospital Skilled Nursing Unit 4720 Waldron Health Care Home, Inc. 4730 Westridge Healthcare Center 4735 Walnut Creek Manor 4740 Lakeland Manor 4760 Loogootee Nursing Center 4770 Washington Nursing Center, Inc. 4775 University Heights Convalescent Center 4780 Webster's Rest Home 4790 Meadow Private Home Care 4795 Brentwood Convalescent Center 4800 Welcome Nursing Home 4805 Maplewood Home 4810 Wesley Manor 4820 Wesleyan Health Care Center 4825 Westside Village 4830 West Side Health Care Center 4832 Davis Gardens Health Center 4840 Greenwood Village South 4850 Westminster Health Care Center 4860 Westminster Village Muncie 4870 Westminster Village North, Inc. 4880 Westminster Village West Lafayette 4886 Westview Hospital Extended Care 4890 Westview Nursing Home 4900 Whispering Pines Health Care Center 4905 White River Lodge 4910 Wildwood Manor Health Care Facility - Mount Vernon 4920 Wildwood Manor Health Care Facility - Clark 4930 Meadow View Health Care Center 4933 Wildwood Convalescent Center 4935 Williams health Facility

17

4940 Cardinal Healthcare of Scottsburg 4950 Willow Manor Convalescent Center, Inc. 4960 Willows (The) 4970 Willows Rehab. Center (The) 4980 Winamac Nursing Home 4985 Community Care Center of Winchester 4990 Windsor Estates of Kokomo 4991 Windsor Manor Health Care Center 4992 Woodland Manor Nursing Center 4994 Woodlands (The) 4995 Midwest Medical Center SNF 4996 Michigan City Health Care Center 4998 Yorktown Health Care Center, Inc. 5000 Adams County Memorial Hospital 5005 Ball Memorial Hospital 5010 Broad Ripple Nursing Home 5015 Bedford Medical Center 5020 Blackford County Hospital 5025 Bloomington Hospital 5030 Methodist Hospital of Gray-Southlake 5035 Cameron Memorial Community Hospital 5040 Caylor-Nickel Hospital 5045 Clark Memorial Hospital 5050 Clay County Hospital 5055 Clinton County Hospital 5060 Community Hospital of Munster 5065 Community Hospital Association 5070 Community Hospital of Anderson & Madison Co. 5075 Community Hospital of Bremen 5077 Community Hospital of Indianapolis-North 5080 Community Hospital of Indianapolis-East 5085 Daviess County Hospital 5090 Manor (The) (Division of Meridian Nursing Center) 5100 Dearborn County Hospital 5105 Decatur County Memorial Hospital 5110 DeKalb Memorial Hospital 5115 Dukes Memorial Hospital 5120 Dunn Memorial Hospital 5125 Elkhart General Hospital

18

5130 Fayette Memorial Hospital Association 5135 Witham Memorial Hospital Association 5145 Gibson General Hospital 5150 Good Samaritan Hospital 5155 Goshen General Hospital 5160 Greene County General Hospital 5165 Hancock Memorial Hospital 5170 Harrison County Hospital 5175 Healthwin Hospital (Chronic Disease) 5180 Hendricks Community Hospital 5185 Henry County Memorial Hospital 5190 Howard Community Hospital 5195 Huntington Memorial Hospital 5200 Indiana Masonic Home Hospital (Geriatrics) 5209 Indiana University Hospitals 5210 Jackson County Schneck Memorial Hospital 5215 Jasper County Hospital 5220 Jay County Hospital 5225 Jennings Community Hospital 5230 Johnson Memorial Hospital 5235 King's Daughters' Hospital 5240 Kosciusko Community Hospital 5245 Lafayette Home Hospital 5250 LaGrange Hospital 5255 LaPorte Hospital 5260 Lutheran Hospital of Indiana 5265 Kendrick Memorial Hospital (Proctologic) 5270 Margaret Mary Community Hospital 5275 Marion General Hospital 5280 Holy Cross Parkview Hospital 5285 Mary Sherman Hospital 5290 McCray Memorial Hospital 5295 Memorial Hospital and Health Care Center 5300 Memorial Hospital 5305 Memorial Hospital of Michigan City 5310 Floyd Memorial Hospital 5315 Memorial Hospital of South Bend 5320 Mercy Hospital 5325 Methodist Hospital of Gray-North Lake

19

5330 Methodist Hospital of Indiana 5335 Culver Union Hospital / St. Clair Medical Center 5340 Morgan County Memorial Hospital 5345 North Clark Community Hospital 5350 Orange County Hospital 5355 Our Lady of Mercy Hospital 5360 Parkview Memorial Hospital 5365 Perry County Memorial Hospital 5370 Porter Memorial Hospital 5375 Pulaski Memorial Hospital 5385 Putnam County Hospital 5390 Randolph County Hospital 5395 Reid Memorial Hospital 5400 Riverview Hospital 5405 Rush Memorial Hospital 5410 St. Anthony Hospital 5415 St. Anthony Medical Center 5420 St. Catherine Hospital of Each Chicago 5425 St. Elizabeth Hospital Medical Center 5430 St. Francis Hospital Center 5435 St. John's Medical Center 5440 St. Joseph Hospital of Mishawaka 5445 St. Joseph's Medical Center 5450 St. Joseph Memorial Hospital of Kokomo 5455 St. Joseph's Hospital 5460 St. Joseph's Hospital of Huntingburg 5465 St. Margaret Hospital 5470 St. Mary Medical Center-Gray 5475 St. Mary Medical Center-Hobart 5480 St. Mary's Medical Center of Evansville 5485 St. Vincent Hospital & Health Care Center 5487 St. Vincent Carmel Hospital 5490 Scott County Memorial Hospital 5495 Michiana Community Hospital 5500 Starke Memorial Hospital 5505 Terre Haute Regional Hospital 5510 Tipton County Memorial Hospital 5515 Union Hospital 5520 Union City Memorial Hospital

20

5525 Community Hospital of Indianapolis-South 5530 Vermillion County Hospital 5535 Wabash County Hospital 5540 Kingwood Hospital 5545 Warrick Hospital 5550 Washington County Memorial Hospital 5555 Welborn Memorial Baptist Hospital 5560 Wells Community Hospital 5565 Westview Hospital 5570 White County Memorial Hospital 5575 Whitley County Memorial Hospital 5580 William N. Wishard Memorial Hospital 5585 Major Hospital 5590 Midwest Medical Center 5595 Wirth Osteopathic Hospital 5597 Humana Woman's Hospital-Indianapolis 5600 Woodlawn Hospital 5605 Lifelines Hospital 5610 Tri-State Regional Hospital 5615 Vencor Hospital 5620 Riley Children's Hospital, Indianapolis 5630 Deaconess Hospital, Evansville 6050 Woodland Acres 7020 Chateau Care Center 7030 Cherish Nursing Center 7040 Richard L. Roudebush VA Medical Ctr, Indianapolis 7045 Winona Hospital, Indianapolis 7050 Children's Hospital Medical Center, Cincinnati 7055 Portage Community Hospital, Portage 7100 St. Francis South Campus, Beach Grove, IN 7110 Winona Hospital, Indianapolis 7115 The Indiana Heart Hospital Indianapolis 7120 7125 7130

Americare Willowbend The Heart Center of Indiana - Carmel

7135 VA Hospital - Fort Wayne 7140 Clarian West Hospital - Hendricks County 7145 Parkview North Hospital 7150 DuPont Hospital

21

22

7155 Clarian North Hospital - Carmel 7160 Deaconess Gateway Hospital 7165 Deaconess Women's Hospital 7170 Reserved 7175 St. Vincent Women's Hospital 7180 St. Vincent Manning Pediatric Hospital 9400 MO 9500 MI 9600 IL 9700 KY 9800 OH 9900 Other States

Appendix 7

National Highway Transportation Safety Administration (NHTSA)

NHTSA Uniform Pre-Hospital EMS Dataset Version 2.2

National EMS Information Agency Project (NEMSIS)

www.nemsis.org

In 1994, Version 1 of the National Highway Traffic Safety Administration’s Uniform Pre-Hospital EMS Dataset was created through a consensus based national data conference. The NHTSA Version 1 EMS dataset has been acknowledged as the national standard for the EMS industry. The Version 2.2 dataset was also created through a national consensus process to update and revise this standard. The NHTSA EMS Uniform Pre-Hospital Dataset, Version 2.2 is composed of three separate components. A Demographic Dataset provides a standardized set of definitions describing an EMS System. An EMS Dataset provides a standardized set of definitions describing an EMS event. The third component of the Version 2.2 standard is an XML format and definition created to promote the movement of the Version 2.2 data elements between data systems. Any implementation of the NHTSA Version 2.2 dataset must include the use of the Demographic dataset, EMS dataset, and XML standard. This document provides over 400 definitions which can be implemented by an EMS system. The National EMS Information System Initiative (NEMSIS) serves to provide technical assistance for the implementation of the dataset. National data elements are defined which should be collected by a National EMS Database but additional data elements should be considered for use at the state and local levels depending on each state or local EMS systems need. The goal of NEMSIS is to establish an EMS data system at the local, state, and national levels. Please see www.nemsis.org for more information. Information provided in this document includes the following:

Name of the Data Element Definition of the Data Element Data Type of the Data Element (many data elements have comments provided to assist in the

implementation of a database schema and the NHTSA Version 2 XML standard) How to deal with missing or incomplete information (See Missing Data or Null Values below) The Variables associated with each Data Element What Data Elements are associated with the Data Element (for example Date/Time Medication

Administered is associated with each Medication Given Data Element) Whether the Data Element is part of the Data Elements to be collected in the National EMS Database

(NDB) Whether the Data Element is part of the medical record information (Patient Care Report) or is a quality

management Data Element to be used internally by the EMS system and protected by Peer Review. What Reports are possible through the use of the Data Element Who is responsible for collecting the Data Element How the Data Element is related to other National Data Tools such as NHTSA Version 1, NFIRS, and

Utstein.

http://www.nemsis.org/

http://www.nemsis.org/

Documents

Indiana Emergency Medical Services...The EMS Commission's "ongoing review" is designed to evaluate EMS systems in . Indiana. This is accomplished by "compiling data and statistics"