Query purpose:
The Overall Disability (v1) definition is part of a group of eight definitions (seven domain-specific and one overall) to identify emergency department visits by people with disabilities using a set of criteria based on diagnostic codes, including ICD-9, ICD-10, SNOMED codes, and keywords representing patient reason for visit. These definitions can be used to disaggregate monitored health outcomes by disability status and type and will ultimately help improve emergency and ongoing surveillance efforts. We encourage National Syndromic Surveillance Program (NSSP) Community of Practice (CoP) members to work with disability organizations and members of the disability community within their jurisdictions when using the definitions, interpreting results, and developing recommendations based on these findings.
The final Overall Disability (v1) definition includes seven domain-specific definitions for disability as well as other non-specific disability-related diagnostic codes and chief complaints:
- Hearing Disability (v1)
- Vision Disability (v1)
- Mobility Disability (v1)
- Intellectual and Developmental Disability (v1)
- Cognition and Central Nervous System Disability (v1)
- Specific Developmental, Behavioral, and Learning Disability (v1)
- Self-care and Independent Living Disability (v1)
Generic diagnostic codes and chief complaints associated with disability not covered under any specific domain
We have also developed a list of codes related to chronic conditions and immune system disorders and mental health. For mental health, we started with codes included in an existing NSSP Mental Health syndrome definition (Anderson et al., 2022 and Radhakrishnan et al., 2022) with suggested additions related to disability; see accompanying spreadsheet. These optional resources may be used 1) to customize this definition to include mental health and chronic conditions as disabilities or 2) in combination with the disability definitions to examine chronic conditions and mental health as outcomes among people with disabilities. This definition was tested and intended to run on the “CC and DD parsed free text” field in ESSENCE.
How it was developed:
The Association of State and Territorial Health Officials (ASTHO) worked collaboratively with CDC and the Council of State and Territorial Epidemiologists (CSTE)-led NSSP CoP to create diagnostic code-based definitions to identify emergency department visits from people with disabilities through a stakeholder-informed process. ASTHO, with support from Thought Bridge LLC, collected stakeholder feedback through a two-step process to inform the development of diagnostic code- and chief complaint-based definitions for disability to be used in NSSP. This two-step process included key informant interviews (KIIs) followed by five scientific panel sessions to inform definition development and broader dissemination efforts to promote uptake of the definitions. A detailed look at the process can be found in the attached document.
Plain language syntax Description:
The Overall Disability (v1) definition intends to identify emergency department visits by people with disabilities. The definition includes diagnosis codes and words related to: 1) disability overall, 2) intellectual and developmental disability, 3) specific developmental, behavioral, and learning disability, and functional difficulty related to 4) hearing, 5) vision, 6) mobility, 7) cognition, and 8) self-care and independent living. Users can combine the Overall Disability (v1) definition with other definitions used to track important public health outcomes (e.g., heat-related illness, suicide attempts, or infection) to find out if emergency department visits for these important outcomes are more common among people with disabilities compared to people without disabilities. This definition will not capture everyone with a disability, but it can be used to look at trends and help public health professionals better understand the impact of health concerns on the disability community. This information can be used to help make sure the needs of people with disabilities are considered and addressed when responding to health concerns.
For consideration:
CA and IL only tested non-specific disability-related diagnostic codes and chief complaints that are not already captured under seven domains of disability included in this suite of disability definitions. However, the Overall Disability (v1) definition includes non-specific disability-related diagnostic codes and chief complaints as well as all other codes and chief complaints from identified subdomains. The non-specific disability-related diagnostic codes and chief complaints included in the Overall Disability definition have limitations, including some false positives that remain (though infrequently) related to disability in the family presenting to the hospital with the patient. Potential false positives also remain related to “grave disability”, a legal status in California, referring to disability related to mental health (and/or substance use disorder, as of 2024), where the person is unable to provide for their basic personal needs for food, clothing, or shelter.
Diagnostic codes associated with Intellectual and Developmental Disability and Specific Developmental, Behavioral, and Learning Disability domains may be applied differently for children and adults; therefore, data users should be aware that certain codes may be more or less frequently used depending on age. Examples are developmental disorders that are more commonly diagnosed in school-aged children, such as learning disabilities (dyslexia, dyscalculia, dysgraphia, etc.), attention-deficit/hyperactivity disorder (ADHD), and behavioral disorders such as conduct disorder. Intellectual disability may also not be clinically recognized, particularly among adults, depending on the severity or underlying cause (see Patel et al., 2020).
Additionally, there are at least five limitations common to the Overall Disability (v1) definition and all seven disability domain-specific definitions. First, identifying people with disabilities as a demographic using diagnostic codes follows a medical model of disability, and does not capture the social or identity-based aspects of disability preferred by many disability advocates. However, NSSP-ESSENCE is limited by the information routinely collected in the medical record such as diagnostic codes and notes captured as “chief complaint” to document presenting medical and relevant information for the visit. Future efforts to also include self- or other-report of functional disability collected as a demographic at the point of care may inform refinements to these definitions. Second, diagnostic codes do not map directly to functional limitations. However, we can assume that certain conditions can be reasonably expected to produce functional limitations (e.g., someone with muscular dystrophy could reasonably be categorized as having a mobility disability). Third, coding practices can vary by region, hospital, and provider. Fourth, this method depends on factors outside the provider’s control (billing considerations; EMR systems such as Epic or Cerner may have limits on how many dx codes can be listed under a visit). As a definition that is dependent on secondary diagnosis codes for detection not necessarily captured by the chief complaint, the ability to identify a person with a disability is influenced by the number of diagnosis codes a facility submits for syndromic surveillance. Therefore, this definition may be better able to identify people with disabilities in better resourced facilities, while data from lower cost EMR systems may be more likely to underrepresent the disability community. Fifth, many people with disabilities will be missed using this method as it relies on existing data collected on electronic health records (EHR), rather than standard self-reported questions that are commonly used to identify people with disabilities. People presenting to an emergency department for a health crisis or emergency may not have disability-related diagnoses indicated on their EHR, because their disability was not recognized by the provider and/or disclosed by the patient. Mild (or non-apparent) disabilities and/or disabilities unrelated to the reason for the ED visit may be more frequently under-documented than more apparent disabilities or those directly associated with the reason for visit.
The definitions can be used to identify important trends and serve as a “signal” of group variation for key outcomes of interest. However, NSSP users must be aware that results are likely an incomplete indicator of disability status or type. Despite limitations, these definitions can help serve as a stopgap to identify people with disabilities within NSSP-ESSENCE while we work collectively to address systemic issues related to collecting disability as a demographic at the point of care.
This definition was tested and intended to run on the “CC and DD parsed free text” field in ESSENCE.
Overall Disability
- ICD9
- (,^;389;^,or,^;389[278];^,or,^;389[1][0-9];^,or,^;38906;^,or,^;2251;^,or,^;2251[0-9];^,or,^;31523;^,or,^;3563;^,or,^;3563[0-9];^,or,^;386[02];^,or,^;386[02][0-9];^,or,^;388[2589];^,or,^;388[2589][0-9];^,or,^;38811;^,or,^;744;^,or,^;744[0-9];^,or,^;744[0-9][0-9];^,),ANDNOT,(,^;380.4;^,or,^;382[0-9];^,),or,(,^;190^,or,^;224;^,or,^;250;^,or,^;3563;^,or,^;36[01234679];^,or,^;3684[1-7];^,or,^;37[0145678];^,or,^;379[35];^,or,^;743;^;190[0-9];^,or,^;224[0-9];^,or,^;2505[0-3];^,or,^;3563;^,or,^;36[01234679];^,or,^;36[01234679][0-9];^,or,^;3684[0-7];^,or,^;37[0145678][0-9];^,or,^;3793[123459];^,or,^;379[5];^,or,^;743[0-9];^,or,^;743[0-9][0-9];^,ANDNOT,^;37484;^,),or,(,^;046;^,or,^;046[0-9];^,or,^;046[0-9][0-9];^,or,^;2533;^,or,^;2533[0-9];^,or,^;2594;^,or,^;2594[0-9];^,or,^;2632;^,or,^;2632[0-9];^,or,^;2700;^,or,^;2700[0-9];^,or,^;27739;^,or,^;3239;^,or,^;3239[0-9];^,or,^;3308;^,or,^;3308[0-9];^,or,^;331[0126-9];^,or,^;331[0126-9][0-9];^,or,^;333[046];^,or,^;333[046][0-9];^,or,^;3337[29];^,or,^;3338[12359];^,or,^;334[012389];^,or,^;334[012389][0-9];^,or,^;335;^,or,^;335[0-9];^,or,^;335[0-9][0-9];^,or,^;338[234];^,or,^;338[234][0-9];^,or,^;34[0124];^,or,^;34[0124][0-9];^,or,^;34[0124][0-9][0-9];^,or,^;34939;^,or,^;356[01248];^,or,^;356[01248][0-9];^,or,^;357[349];^,or,^;357[349][0-9];^,or,^;35789;^,or,^;35789[0-9];^,or,^;359;^,or,^;359[0-9];^,or,^;359[0-9][0-9];^,or,^;438[2345];^,or,^;438[2345][0-9];^,or,^;5880;^,or,^;5880[0-9];^,or,^;714[0-49];^,or,^;714[0-49][0-9];^,or,^;71489;^,or,^;715;^,or,^;715[0-9];^,or,^;715[0-9][0-9];^,or,^;720[09];^,or,^;720[09][0-9];^,or,^;721[01239];^,or,^;721[01239][0-9];^,or,^;722[56];^,or,^;722[56][0-9];^,or,^;72[34]4;^,or,^;72[34]4[0-9];^,or,^;728;^,or,^;728[0-9];^,or,^;728[0-9][0-9];^,or,^;729[12];^,or,^;729[12][0-9];^,or,^;7301;^,or,^;7301[0-9];^,or,^;73671;^,or,^;73689;^,or,^;740[012];^,or,^;740[012][0-9];^,or,^;74[12];^,or,^;74[12][0-9];^,or,^;74[12][0-9][0-9];^,or,^;7545[01];^,or,^;7553[135];^,or,^;7561[034579];^,or,^;7564;^,or,^;7564[0-9];^,or,^;7568[39];^,or,^;7807;^,or,^;7807[0-9];^,or,^;806;^,or,^;806[01236789];^,or,^;806[012389][0-9];^,or,^;806[67][345678];^,or,^;897[2-5];^,or,^;897[2-5][0-9];^,or,^;907[29];^,or,^;907[29][0-9];^,or,^;95200;^,),or,(,^;270;^,or,^;270[0-9];^,or,^;271;^,or,^;271[0-9];^,or,^;2701;^,or,^;2701[0-9];^,or,^;2727;^,or,^;2727[0-9];^,or,^;2772;^,or,^;2772[0-9];^,or,^;299;^,or,^;299[0-9];^,or,^;299[0-9][0-9];^,or,^;31[789];^,or,^;31[789][0-9];^,or,^;31[789][0-9][0-9];^,or,^;315[4589];^,or,^;330;^,or,^;330[0-9];^,or,^;33371;^,or,^;343;^,or,^;343[0-9];^,or,^;343[0-9][0-9];^,or,^;520;^,or,^;520[0-9];^,or,^;520[0-9][0-9];^,or,^;7548;^,or,^;7548[0-9];^,or,^;7551;^,or,^;7551[0-9];^,or,^;758;^,or,^;758[01235];^,or,^;758[01235][0-9]^,or,^;7583[1-9];^,or,^;759[57];^,or,^759[57][0-9];^,or,^;7598[139];^,or,^;7607[17];^,),or,(,(,^;43[01456];^,or,^;43[01456][0-9];^,or,^;43[01456][0-9][0-9];^,or,^;433[012389];^,or,^;99702;^,or,^;2904;^,or,^;29410;^,or,^;2941;^,or,^;2941[0-9];^,or,^;310;^,or,^;310[0-9];^,or,^;310[0-9][0-9];^,or,^;331;^,or,^;331[0-9];^,or,^;331[0-9][0-9];^,or,^;345;^,or,^;345[0-9];^,or,^;345[0-9][0-9];^,or,^;36816;^,or,^;7800[13];^,or,^;7846;^,or,^;78469;^,or,^;7845[129];^,or,^;907;^,or,^;907[0-9];^,or,^;907[0-9][0-9];^,),ANDNOT,(,^;800;^,or,^;800[0-9];^,or,^;800[0-9][0-9];^,or,^;8049;^,or,^;8049[0-9];^,or,^;850;^,or,^;850[0-9];^,or,^;850[0-9][0-9];^,or,^;8541;^,or,^;8541[0-9];^,),),or,(,^;31[245];^,or,^;3124;^,or,^;31[2345][0-9][0-9];^,or,^;31381;^,or,^;314[12];^,or,^;315[0-9];^,or,^;315[0-9][0-9];^,or,^;7813;^,or,^;78461;^,)
- ICD10
- (,^;Z710^,or,^;Z751^,or,^;Z755^,or,^;Z271^,or,^;Z736^,),or,(,^;D333^,or,^;G601^,or,^;H81[04]^,or,^;H90[03-8]^,or,^;H90A[23]^,or,^;H91[02389]^,or,^;H9325^,or,^;H933^,or,^;Q16[0-9]^,or,^;Z9621^,),ANDNOT,(,^;H66[012349]^,or,^;H612[0-3],),or,(,^;C69^,or,^;D31^,or,^;E093^,or,^;E133^,or,^;E103^,or,^;E113^,or,^;G360^,or,^;G453^,or,^;G601^,or,^;G902^,or,^;H02[0-9[0-9][0-9]^,or,^;H023[0-9]^,or,^;H026[0-9]^,or,^;H0270^,or,^;H0289^,or,^;H029^,or,^;H0430^,or,^;H18[69]^,or,^;H201^,or,^;H2[567]^,or,^;H3[0135]^,or,^;H442^,or,^;H476^,or,^;H49^,or,^;H5[045]^,or,^;H53[0356]^,or,^;H534[1-9][1-9]^,or,^;H531[0123]^,or,^;Q1[0-5]^,ANDNOT,^;H02829^,or,^;H57^,),or,(,^;A81^,or,^;E3431^,or,^;E45^,or,^;G041^,or,^;G1[0123]^,or,^;G231^,or,^;G24[1-9]^,or,^;G3[01256]^,or,^;G37[123489]^,or,^;G60[0389]^,or,^;G61[89]^,or,^;G65[12]^,or,^;G71[02]^,or,^;G7111^,or,^;G8[123]^,or,^;G89[234]^,or,^;G901^,or,^;G9611^,or,^;I680^,or,^;I690[3-6]^,or,^;I691[3-6]^,or,^;I692[3-6]^,or,^;I693[3-6]^,or,^;I698[3-6]^,or,^;I699[3-6]^,or,^;M0[568]^,or,^;M1[25-9]^,or,^;M21[89]0^,or,^;M215[1-4]^,or,^;M2420^,or,^;M357^,or,^;M4[157]^,or,^;M469^,or,^;M488^,or,^;M513[4-7]^,or,^;M541^,or,^;M60[128]0^,or,^;M60[89]^,or,^;M60009^,or,^;M61[014]0^,or,^;M6159^,or,^;M619^,or,^;M62[0145]0^,or,^;M623^,or,^;M628[129]^,or,^;M62838^,or,^;M72[01246]^,or,^;M79[127]^,or,^;M86[3456]^,or,^;M864^,or,^;M865^,or,^;M866^,or,^;N250^,or,^;Q0[0-7]^,or,^;Q6[678]^,or,^;Q7[123]^,or,^;Q7649^,or,^;Q77[148]^,or,^;Q796^,or,^;Q898^,or,^;R5382^,or,^;S1[24]^,or,^;S13113A^,or,^;S220[0-8]9^,or,^;S24[01]^,or,^;S34[01]__[AS];^,or,^;S343XXA^,or,^;S78^,or,^;Z736^,or,^Z740^,or,^;Z89[014569]^,or,^;Z892[012]^,or,^;Z993^,or,^;Z9989^,or,^;Z740^,),or,(,^;E03[01]^,or,^;E70^,or,^;E70[01234589]^,or,^;E70[2348][0-9]^,or,^;E70[3][0-9][0-9]^,or,^;E71^,or,^;E71[012345]^,or,^;E71[1345][0-9]^,or,^;E71[345][0-9][0-9]^,or,^;E72^,or,^;E72[0123459]^,or,^;E72[01258][0-9]^,or,^;E74^,or,^;E74[012348]^,or,^;E74[01238][0-9]^,or,^;E748[0-9][0-9]^,or,^;E75^,or,^;E75[0123456]^,or,^;E75[012][0-9]^,or,^;E752[0-9][0-9]^,or,^;E76^,or,^;E76[012389]^,or,^;E76[02][0-9]^,or,^;E762[0-9][0-9]^,or,^;E77^,or,^;E77[0-9]^,or,^;E787[12]^,or,^;E791^,or,^;F7[0-9]^,or,^;F7[0-9][0-9]^,or,^;F78A^,or,^;F78A[19]^,or,^;F8[489]^,or,^;F84[0-9]^,or,^;G3181^,or,^;G80[0-9]^,or,^;M952^,or,^;P043^,or,^;Q04[0-9]^,or,^;Q67[678]^,or,^;Q68[01]^,or,^;Q70[49]^,or,^;Q70[0123][0123]^,or,^;Q743^,or,^;Q767^,or,^;Q851^,or,^;Q86[01]^,or,^;Q87[1235]^,or,^;Q871[19]^,or,^;Q878[129]^,or,^;Q89[78]^,or,^;Q90[0129]^,or,^;Q91[0-7]^,or,^;Q92[0125789]^,or,^;Q926[12]^,or,^;Q93[0123479]^,or,^;Q935[19]^,or,^;Q938[189]^,or,^;Q95[23]^,or,^;Q992^,or,^;R4183^,),or,(,^;G45[01289]^,or,^;G46^,or,^;G973[12]^,or,^;I6[013456]^,or,^;I678[49]^,or,^;I978[12]^,or,^;S0190XA^,or,^;S02[0123][0129X][0-9X][AB]^,or,^;S02[89][0-9X][0-9X][AB]^,or,^;S0211[GH][AB]^,or,^;S0212[129][DGKS]^,or,^;S024[0-9][0-9A-B][AB]^,or,^;S026[0-9][0-9X][AB]^,or,^;S028[345][129X][DGKS]^,or,^;S06[012]X[1-9][AB]^,or,^;S06[456]X[0-9]A^,or,^;S063[0-9][0-9]A^,or,^;S068[129][0-9]A^,or,^;S069X[0-9]A^,or,^;Z51.89^,or,^;A06A1^,or,^;F01^,or,^;F028[12]^,or,^;F03^,or,^;F05^,or,^;F070^,or,^;F078^,or,^;F482^,or,^;G13^,or,^;G20^,or,^;G21^,or,^;G30^,or,^;G31^,or,^;G318[12459]^,or,^;G40^,or,^;G454^,or,^;G90[A04589]^,or,^;G94^,or,^;G97[45]^,or,^;I67850^,or,^;I68858^,or,^;R40243^,or,^;R403^,or,^;R414^,or,^;R418[49]^,or,^;R470[0-2]^,or,^;R471^,or,^;R478[129]^,or,^;R479^,or,^;R48[1389]^,or,^;S04[0-9][0-9][0-9X]S^,or,^;S060-9][0-9X][0-9]S^,or,^;S06A0^,),or,(,^;F63[01239]^,or,^;F638[19]^,or,^;F80[01249]^,or,^;F808[129]^,or,^;F81[0249]^,or,^;F818[19]^,or,^;F82^,or,^;F90[0-9]^,or,^;F91[0-9]^,or,^;H9325^,or,^;R48[02]^,or,^;V400^,),or,(,^;R460^,or,^;Z593^,or,^;Z602^,or,^;Z73[68]^,or,^;Z74[123]^,or,^;Z7409^,or,^;Z710^,)
- SNOMED
- (,^;79471008;^,or,^;427772009;^,or,^;60700002;^,or,^;229752008;^,or,^;194424005;^,or,^;61947007;^,or,^;13445001;^,or,^;359612003;^,or,^;111339003;^,or,^;15188001;^,or,^;77507001;^,or,^;194429000;^,or,^;25362006;^,or,^;15241006;^,or,^;77949003;^,or,^;188061000119100;^,or,^;788953003;^,or,^;38403006;^,or,^;95820000;^,or,^;126949007;^,or,^;95821001;^,or,^;20425006;^,),ANDNOT,(,^;18070006;^,or,^;65363002;^,),or,(,^;193638002;^,or,^;78455002;^,or,^;24982008;^,or,^;83275001;^,or,^;12184005;^,or,^;367469000;^,or,^;65194006;^,or,^;193699007;^,or,^;218951000119100;^,or,^;193722001;^,or,^;267727004;^,or,^;105597003;^,or,^;193745007;^,or,^;193731001;^,or,^;371481006;^,or,^;92068002;^,or,^;25093002;^,or,^;35387008;^,or,^;19620000;^,or,^;35387008;^,or,^;19620000;^,or,^;267611002;^,or,^;35210752;^,or,^;39450006;^,or,^;32022003;^,or,^;15250008;^,or,^;60113004;^,or,^;85777005;^,or,^;65636009;^,or,^;25044007;^,or,^;22066006;^,or,^;400942002;^,or,^;128327004;^,or,^;33521009;^,or,^;429448005;^,or,^;24010005;^,or,^;10810001;^,or,^;19416009;^,or,^;10810001;^,or,^;19416009;^,or,^;204113001;^,or,^;128534003;^,or,^;88032003;^,or,^;230659005;^,or,^;46627006;^,or,^;77971008;^,or,^;128329001;^,or,^;267664003;^,or,^;25362006;^,or,^;764939004;^,or,^;93764002;^,or,^;92070006;^,or,^;5368009;^,or,^;193329008;^,or,^;193570009;^,or,^;58882000;^,or,^;128468007;^,or,^;93766000;^,or,^;128468007;^,or,^;93766000;^,or,^;92321003;^,or,^;739681000;^,or,^;38599001;^,or,^;7183006;^,or,^;61142002;^,or,^;93181004;^,or,^;93987004;^,or,^;92059004;^,or,^;422099009;^,or,^;193338005;^,or,^;93755007;^,or,^;92060009;^,or,^;34711008;^,or,^;93756008;^,or,^;92169007;^,or,^;42059000;^,or,^;371993008;^,or,^;187906008;,or,^;371993008;^,or,^;187906008;^,or,^;109948008;^,or,^;371986009;^,or,^;92258000;^,or,^;92097004;^,),or,(,^;105501005;^,or,^;1148757008;^,or,^;125606003;^,or,^;128605003;^,or,^;129565002;^,or,^;15241006;^,or,^;15758002;^,or,^;1576173;^,or,^;1576311;^,or,^;15802004;^,or,^;16269008;^,or,^;17230005;^,or,^;193180002;^,or,^;193250002;^,or,^;197663003;^,or,^;201789001;^,or,^;201796004;^,or,^;203082005;^,or,^;20484008;^,or,^;212355006;^,or,^;212357003;^,or,^;212359000;^,or,^;23685000;^,or,^;239791005;^,or,^;239792003;^,or,^;239805001;^,or,^;239872002;^,or,^;239920006;^,or,^;24700007;^,or,^;254749001;^,or,^;26889001;^,or,^;26889001;^,or,^;276654001;^,or,^;29426003;^,or,^;298382003;^,or,^;302297009;^,or,^;315271000119104;^,or,^;33209009;^,or,^;363302008;^,or,^;36427004;^,or,^;371082009;^,or,^;372109003;^,or,^;373621006;^,or,^;386033004;^,or,^;396275006;^,or,^;398100001;^,or,^;39912006;^,or,^;399269003;^,or,^;400054000;^,or,^;410795001;^,or,^;410797009;^,or,^;417373000;^,or,^;441960006;^,or,^;44551007;^,or,^;47032000;^,or,^;52702003;^,or,^;55999004;^,or,^;57148006;^,or,^;57160007^;,or,^;60168000;^,or,^;609557004;^,or,^;6118003;^,or,^;65354004;^,or,^;67531005;^,or,^;68962001;^,or,^;69896004;^,or,^;72274001;^,or,^;72274001;^,or,^;73573004;^,or,^;737303004;^,or,^;74257000;^,or,^;74391003;^,or,^;74877002;^,or,^;75047002;^,or,^;76886005;^,or,^;77595004;^,or,^;78373000;^,or,^;82423001;^,or,^;84017003;^,or,^;85551004;^,or,^;86044005;^,or,^;88425004;^,or,^;8847002;^,or,^;928000;^,or,^;95860004;^,or,^;9631008;^,or,^;98921000119102;^,),or,(,^;1855002;^,or,^;7199000;^,or,^;7573000;^,or,^;8447006;^,or,^;10406007;^,or,^;16652001;^,or,^;17122004;^,or,^;17760001;^,or,^;20415001;^,or,^;23560001;^,or,^;31216003;^,or,^;34111000;^,or,^;35919005;^,or,^;40700009;^,or,^;40930008;^,or,^;42012007;^,or,^;43929004;^,or,^;48637007;^,or,^;57148006;^,or,^;58193001;^,or,^;58459009;^,or,^;59033006;^,or,^;61152003;^,or,^;66091009;^,or,^;68528007;^,or,^;68618008;^,or,^;70156005;^,or,^;70173007;^,or,^;71961003;^,or,^;74345006;^,or,^;75019001;^,or,^;75511006;^,or,^;76880004;^,or,^;77287004;^,or,^;82354003;^,or,^;86765009;^,or,^;110359009;^,or,^;111246005;^,or,^;111270009;^,or,^;128188000;^,or,^;190794006;^,or,^;192562009;^,or,^;192782005;^,or,^;205615000;^,or,^;205616004;^,or,^;205619006;^,or,^;205620000;^,or,^;205623003;^,or,^;205624009;^,or,^;205627002;^,or,^;205636003;^,or,^;205660004;^,or,^;205666005;^,or,^;205673000;^,or,^;205674006;^,or,^;205720009;^,or,^;205788004;^,or,^;205791004;^,or,^;205808005;^,or,^;205812004;^,or,^;238028008;^,or,^;254041007;^,or,^;254264002;^,or,^;254266000;^,or,^;254268004;^,or,^;254269007^,or,^;254270008;^,or,^;254272000;^,or,^;254274004;^,or,^;267431006;^,or,^;268674003;^,or,^;270520003;^,or,^;270521004;^,or,^;274908005;^,or,^;276654001;^,or,^;278512001;^,or,^;297231002;^,or,^;373413006;^,or,^;391987005;^,or,^;396338004;^,or,^;400038003;^,or,^;408856003;^,or,^;409709004;^,or,^;444655009;^,or,^;471282000;^,or,^;767263007;^,or,^;770414008;^,or,^;1010276004;^,or,^;367041000119108;^,or,^;813921000000104;^,),or,(,^;29164008;;^,or,^;25762009;^,or,^;271721006;^,or,^;26929004;^,or,^;79631006;^,or,^;19598007;^,or,^;278510009;^,or,^;407675009;^,or,^;230390002;^,or,^;84757009;^,or,^;241006;^,or,^;6204001;^,or,^;270907008;^,or,^;195230003;^,or,^;195190007;^,or,^;195186005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- All together
- (,^;Z710^,or,^;Z751^,or,^;Z755^,or,^;Z271^,or,^;Z736^,or,^disabled^,or,^disabilit^,or,^limitation^,or,(,(,^service^,or,^guide^,),AND,(,^animal^,or,^dog^,or,^horse^,),),or,(,(,^needs^,or,^requires^,or,^asked for^,),AND,(,^accommodations^,or,^accomondations^,or,^accomodations^,or,^accessible^,),),or,^ADA require^,or,^handicap^,or,^auxiliary aid^,or,(,(,^disability determination^,or,^percent^,),AND,(,^disabled^,or,^function^,or,^disability rating^,),),or,(,(,^assistive^,),AND,(,^device^,or,^technology^,or,^equipment^,),),^measured restrictions and limitations^,or,^accessib^,or,^handicap^,or,^artificial limb^,ANDNOT,(,^not disab^,or,^no disab^,or,^denies disab^,or,^no limitation^,or,^without limitation^,),),or,(,(,^;389;^,or,^;389[278];^,or,^;389[1][0-9];^,or,^;38906;^,or,^;2251;^,or,^;2251[0-9];^,or,^;31523;^,or,^;3563;^,or,^;3563[0-9];^,or,^;386[02];^,or,^;386[02][0-9];^,or,^;388[2589];^,or,^;388[2589][0-9];^,or,^;38811;^,or,^;744;^,or,^;744[0-9];^,or,^;744[0-9][0-9];^,or,^;D333^,or,^;G601^,or,^;H81[04]^,or,^;H90[03-8]^,or,^;H90A[23]^,or,^;H91[02389]^,or,^;H9325^,or,^;H933^,or,^;Q16[0-9]^,or,^;Z9621^,or,^;79471008;^,or,^;427772009;^,or,^;60700002;^,or,^;229752008;^,or,^;194424005;^,or,^;61947007;^,or,^;13445001;^,or,^;359612003;^,or,^;111339003;^,or,^;15188001;^,or,^;77507001;^,or,^;194429000;^,or,^;25362006;^,or,^;15241006;^,or,^;77949003;^,or,^;188061000119100;^,or,^;788953003;^,or,^;38403006;^,or,^;95820000;^,or,^;126949007;^,or,^;95821001;^,or,^;20425006;^,or,(,^deaf^,or,^hearing impair^,or,^sign language^,or,!ASL!,or,^D HH^,or,(,^trouble^,or,^hard^,or,^difficulty^,or,^impair^,or,^problem^,or,^loss^,or,^reduced^,),AND,(,^hear^,),),),ANDNOT,(,^;380.4;^,or,^;382[0-9]^,or,^;H66[012349]^,or,^;H612[0-3]^,or,^;18070006;^,or,^;65363002;^,or,^ear infection^,or,^impacted cerumen^,or,(,(,^voices^,or,^sound^,or,^noise^,or,^scream^,or,^cry^,or,^pop^,or,^wheez^,or,^cough^,),AND,(,^hear^,),),or,^heart^,or,^hear for dialysis^,or,(,(,^denie^,or,^deny^,or,^no^,),AND,(,^hear^,),AND,(,^loss^,or,^problem^,),),),),or,(,^;190;^,or,^;224;^,or,^;250;^,or,^;3563;^,or,^;36[01234679];^,or,^;3684[1-7];^,or,^;37[0145678];^,or,^;379[35];^,or,^;743^;190[0-9];^,or,^;224[0-9];^,or,^;2505[0-3];];^,or,^;3563;^,or,^;36[01234679];^,or,^;36[01234679][0-9];^,or,^;3684[0-7];^,or,^;37[0145678][0-9];^,or,^;3793[123459];^,or,^;379[5];^,or,^;743[0-9];^,or,^;743[0-9][0-9];^,or,^;C69^,or,^;D31^,or,^;E093^,or,^;E133^,or,^;E103^,or,^;E113^,or,^;G360^,or,^;G453^,or,^;G601^,or,^;G902^,or,^;H02[0-9[0-9][0-9]^,or,^;H023[0-9]^,or,^;H026[0-9]^,or,^;H0270^,or,^;H0289^,or,^;H029^,or,^;H0430^,or,^;H18[69]^,or,^;H201^,or,^;H2[567]^,or,^;H3[0135]^,or,^;H442^,or,^;H476^,or,^;H49^,or,^;H5[045]^,or,^;H53[0356]^,or,^;H534[1-9][1-9]^,or,^;H531[0123]^,or,^;Q1[0-5]^,or,^;193638002;^,or,^;78455002;^,or,^;24982008;^,or,^;83275001;^,or,^;12184005;^,or,^;367469000;^,or,^;65194006;^,or,^;193699007;^,or,^;218951000119100;^,or,^;193722001;^,or,^;267727004;^,or,^;105597003;^,or,^;193745007;^,or,^;193731001;^,or,^;371481006;^,or,^;92068002;^,or,^;25093002;^,or,^;35387008;^,or,^;19620000;^,or,^;35387008;^,or,^;19620000;^,or,^;267611002;^,or,^;35210752;^,or,^;39450006;^,or,^;32022003;^,or,^;15250008;^,or,^;60113004;^,or,^;85777005;^,or,^;65636009;^,or,^;25044007;^,or,^;22066006;^,or,^;400942002;^,or,^;128327004;^,or,^;33521009;^,or,^;429448005;^,or,^;24010005;^,or,^;10810001;^,or,^;19416009;^,or,^;10810001;^,or,^;19416009;^,or,^;204113001;^,or,^;128534003;^,or,^;88032003;^,or,^;230659005;^,or,^;46627006;^,or,^;77971008;^,or,^;128329001;^,or,^;267664003;^,or,^;25362006;^,or,^;764939004;^,or,^;93764002;^,or,^;92070006;^,or,^;5368009;^,or,^;193329008;^,or,^;193570009;^,or,^;58882000;^,or,^;128468007;^,or,^;93766000;^,or,^;128468007;^,or,^;93766000;^,or,^;92321003;^,or,^;739681000;^,or,^;38599001;^,or,^;7183006;^,or,^;61142002;^,or,^;93181004;^,or,^;93987004;^,or,^;92059004;^,or,^;422099009;^,or,^;193338005;^,or,^;93755007;^,or,^;92060009;^,or,^;34711008;^,or,^;93756008;^,or,^;92169007;^,or,^;42059000;^,or,^;371993008;^,or,^;187906008;^,or,^;371993008;^,or,^;187906008;^,or,^;109948008;^,or,^;371986009;^,or,^;92258000;^,or,^;92097004;^,or,^vision 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