SNOMED International SNOMED CT Browser includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of SNOMED International. All rights reserved. SNOMED CT® was originally created by the College of American Pathologists. “SNOMED”, “SNOMED CT” and “SNOMED Clinical Terms” are registered trademarks of the SNOMED International (www.snomed.org).

Use of SNOMED CT in SNOMED International SNOMED CT Browser is governed by the conditions of the following SNOMED CT license issued by the SNOMED International:

1. The meaning of the terms “Affiliate”, or “Data Analysis System”, “Data Creation System”, “Derivative”, “End User”, “Extension”, “Member”, “Non-Member Territory”, “SNOMED CT” and “SNOMED CT Content” are as defined in the SNOMED International Affiliate License Agreement (see www.snomed.org/license.pdf).

2. Information about Affiliate Licensing is available at http://snomed.org/license-affiliate. Individuals or organizations wishing to register as SNOMED International Affiliates can register at mlds.ihtsdotools.org, subject to acceptance of the Affiliate License Agreement (see http://snomed.org/license-affiliate).

3. The current list of SNOMED International Member Territories can be viewed at snomed.org/members. Countries not included in that list are “Non-Member Territories”.

4. End Users, that do not hold an SNOMED International Affiliate License, may access SNOMED CT® using SNOMED International SNOMED CT Browser subject to acceptance of and adherence to the following sub-license limitations:

a) The sub-licensee is only permitted to access SNOMED CT® using this software (or service) for the purpose of exploring and evaluating the terminology.

b) The sub-licensee is not permitted the use of this software as part of a system that constitutes a SNOMED CT “Data Creation System” or “Data Analysis System”, as defined in the SNOMED International Affiliate License. This means that the sub-licensee must not use SNOMED International SNOMED CT Browser to add or copy SNOMED CT identifiers into any type of record system, database or document.

c) The sub-licensee is not permitted to translate or modify SNOMED CT Content or Derivatives.

d) The sub-licensee is not permitted to distribute or share SNOMED CT Content or Derivatives.

5. SNOMED International Affiliates may use SNOMED International SNOMED CT Browser as part of a “Data Creation System” or “Data Analysis System” subject to the following conditions:

a) The SNOMED International Affiliate, using SNOMED International SNOMED CT Browser must accept full responsibility for any reporting and fees due for use or deployment of such a system in a Non-Member Territory.

b) The SNOMED International Affiliate must not use SNOMED International SNOMED CT Browser to access or interact with SNOMED CT in any way that is not permitted by the Affiliate License Agreement.

c) In the event of termination of the Affiliate License Agreement, the use of SNOMED International SNOMED CT Browser will be subject to the End User limitations noted in 4.

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LOINC Copyright Notice and License

Definitions:

– “LOINC” – the work of clinical nomenclature called Logical Observation Identifiers Names and Codes, which provides a universal code system for identifying laboratory and clinical observations and related content.

– “Licensed Materials” – the collection of all of the following individually defined groups of artifacts and documents:

– “Group 1 Artifacts” – LOINC codes, LOINC Table (regardless of format), LOINC Table Core, and LOINC Changes File.

– “Group 1 Documents” – LOINC Release Notes and LOINC Users’ Guide

– “Group 2 Artifacts” – RELMA program, RELMA database and associated search index files, RELMA Community Mapping Feature Database, LOINC FHIR Terminology Services

– “Group 2 Documents” – RELMA Release Notes and RELMA Users’ Manual

– “Group 3 Artifacts” – LOINC Panels and Forms File, LOINC Answer File, LOINC Part File, LOINC Group File, LOINC Document Ontology File, LOINC Document Ontology OWL File, LOINC Hierarchies, LOINC Linguistic Variants Files, LOINC/RSNA Radiology Playbook, LOINC/IEEE Medical Device Code Mapping Table, LOINC Consumer Name File, LOINC Change Snapshot File, LOINC Imaging Document Codes File, LOINC Common UCUM Codes File, and the Universal Lab Order Codes Value Set File.

– “Group 3 Documents” – Release and Readme notes associated with all of the Group 3 Artifacts.

– “You”, “Your”, and “User” – either an individual or the organization specified by an individual on whose behalf these terms and conditions are being accepted.

The Group 1 Artifacts and Group 1 Documents are copyright © 1995-2023, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. All rights reserved.

The Group 2 Artifacts, Group 2 Documents, Group 3 Artifacts, and Group 3 Documents are copyright © 1995-2023, Regenstrief Institute, Inc. All rights reserved.

LOINC® and RELMA® are registered United States trademarks of Regenstrief Institute, Inc. Regenstrief Institute, Inc. and, as applicable, the LOINC Committee reserve all other rights not expressly granted herein.

Permission is hereby granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the Licensed Materials for any commercial or non-commercial purpose, subject to the following terms and conditions:

1. To prevent the dilution of LOINC’s purpose to provide a definitive standard for identifying clinical information in electronic reports, neither the Licensed Materials, nor any portion thereof, may be used for the purpose of developing or promulgating a different standard for identifying patient observations, such as, but not limited to, laboratory test results; other diagnostic service test results; clinical observations and measurements; reports produced by clinicians and diagnostic services about patients; panels, forms, and collections that define aggregations of these observations; and orders for these entities in electronic reports and messages.

2. The name of, or any contents of, any fields in the Group 1 Artifacts shall not be changed. The contents of any fields in the Group 3 Artifacts shall not be changed. New fields may be added to the Group 1 Artifacts and Group 3 Artifacts to attach additional information to existing LOINC records.

3. Records may be deleted from the LOINC Table or LOINC Table Core to deal with local requirements. Records also may be added to the LOINC Table and LOINC Table Core to deal with local requirements, provided that if new records are added, any new entry in the LOINC_NUM field of such new records must contain a leading alphabetic “X” so that the new codes and records cannot be confused with existing LOINC codes or new LOINC codes as they are defined in later releases, and further provided that reasonable efforts are made to submit requests to LOINC for new records to cover observations that are not found in the LOINC Table (and LOINC Table Core) in order to minimize the need for X-codes. Records deleted or added to deal with local requirements are not reflected in the official LOINC Table and LOINC Table Core maintained by the Regenstrief Institute, Inc.

4. The Group 1 Documents, Group 2 Documents, and Group 3 Documents may not be modified, nor may derivative works be created, without the prior written permission of the Regenstrief Institute, Inc. To request written permission, please contact loinc@loinc.org.

5. The LOINC parts and LOINC part hierarchies shall not be used in any manner except as they are presented in the Licensed Materials (and/or in other formats of distribution approved by Regenstrief Institute, Inc.) to organize, categorize, and be constituents of LOINC terms, and provide links to external terminologies. The LOINC parts and LOINC part hierarchies are subject to change, addition, modification, or deletion, without notice, and are not strictly managed under the same policies as LOINC terms.

6. The RELMA program is provided with the full RELMA database and associated search index files, as well as the LOINC Table and other database tables comprising the RELMA database. In addition to its use with the RELMA program, the LOINC Table that is obtained with the RELMA program may be used independently and the LOINC Table also may be modified as permitted herein. The other database tables from the RELMA database or the associated search index files may not be used or modified except in conjunction with the authorized use of the RELMA program, unless prior written permission is granted by the Regenstrief Institute, Inc. To request written permission, please contact loinc@loinc.org. The RELMA program also provides access to certain internet-based content copyrighted by Regenstrief Institute, Inc. No additional permission to modify or distribute this internet-based content is granted through the use of the RELMA program.

7. The RELMA program includes the RELMA Community Mappings feature and access to the RELMA Community Mappings feature database. Use of the RELMA Community Mappings feature and the RELMA Community Mappings feature database is subject to the following terms and conditions:

1. The accuracy and completeness of the information in the RELMA Community Mappings feature is not verified by Regenstrief Institute, Inc. or the LOINC Committee. Neither Regenstrief Institute, Inc. nor the LOINC Committee is liable for the information provided by the RELMA Community Mappings feature. Each user accepts the risk of using the information provided by the RELMA Community Mappings feature.

2. The information provided by the RELMA Community Mappings feature may not be copied or distributed.

3. Access to the information provided by the RELMA Community Mappings feature may not be shared.

4. Reasonable efforts will be made to submit new mappings back to the RELMA Community Mappings feature database. New mappings may contain the following information (as applicable):

1. Local battery/panel/test code;

2. Local battery/panel/test name/description;

3. Units of Measure;

4. LOINC code to which it is mapped;

5. Date of mapping;

6. Language of test names;

7. Version of LOINC used to do the mapping; and/or

8. Contact information.

5. If mappings are submitted on behalf of an organization, the person submitting the mappings represents that he or she has the authority to submit the mappings.

6. Regenstrief Institute, Inc. shall have a non-exclusive, irrevocable license, without payment or fees, to use mappings submitted to the RELMA Community Mappings feature for any and all purposes related to LOINC, RELMA, and Regenstrief Institute Inc.’s mission, including, but not limited to:

1. Modifying the information;

2. Making information publicly available;

3. Performing aggregate analysis;

4. Conducting and publishing research; and

5. Developing and enhancing LOINC and associated software tools.

8. LOINC codes and other information from the LOINC Table (and LOINC Table Core) may be used in electronic records and electronic messages in conjunction with laboratory test results and clinical observations without the need to include this Copyright Notice and License or a reference thereto in the message (and without the need to include all fields required by Section 10 hereof). When the LOINC code (from the LOINC_NUM field) is included in the message, inclusion of the corresponding LOINC short name (from the SHORTNAME field), the LOINC long common name (from the LONG_COMMON_NAME field), or for laboratory terms, the LOINC Display name (from the DisplayName field) in the message is encouraged (but not required) if the message provides a place for a text name representation of the code.

9. There is no limit on the number of copies of the Licensed Materials that may be made and distributed, provided that each copy must include this Copyright Notice and License, and must include the appropriate version number of the Licensed Materials if the Licensed Materials have a version number, or the release date if the Licensed Materials do not have a version number. This Copyright Notice and License must appear on every printed copy of the LOINC Table (and LOINC Table Core). Where the Licensed Materials are distributed on a fixed storage medium (such as CD-ROM), a printed copy of this Copyright Notice and License must be included on or with the storage medium, and a text file containing this information also must be stored on the storage medium in a file called “license.txt”. Where the Licensed Materials are distributed via the Internet, this Copyright Notice and License must be accessible on the same Internet page from which the Licensed Materials are available for download. This Copyright Notice and License must appear verbatim on every electronic or printed copy of the RELMA Users’ Manual and the LOINC Users’ Guide.

10. Subject to Section 1 and the other restrictions hereof, portions of the Group 1 Artifacts or Group 3 Artifacts may be incorporated into other products and services, such as laboratory test compendiums, data dictionaries, online terminology services, software programs including mobile device applications, and documents such as implementation guides and other technical specifications, provided that:

1. Any such product or service includes the following notice:

“This material contains content from LOINC (http://loinc.org). LOINC is copyright © 1995-2023, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.”

Where the product or service is distributed with a printed license, this notice must appear in the printed license. Where the product or service is distributed on a fixed storage medium, a text file containing this notice also must be stored on the storage medium in a file called “LOINC_short_license.txt.” Where the product or service is distributed via the Internet, this notice must be accessible on the same Internet page from which the product is available for download. Where the product or service is provided as an online resource (e.g., to be accessed programmatically through an application programming interface (API) or through a user interface), this notice must be available in the license or terms of use.

2. Any such product or service is either (1) in compliance with all applicable third-party copyright license terms as described in the Notice of Third-Party Content and Copyright Terms section of this license, or (2) third-party copyrighted contents (e.g., third-party survey instruments and answers) are deleted; and

3. Any information that is extracted from the Licensed Material must always be associated with the corresponding identifier from LOINC (e.g., LOINC code, LOINC Answer List ID, LOINC Answer String ID, LOINC Part Number, or LOINC Group ID) and include the corresponding LOINC display name:

1. For LOINC codes, one of the following LOINC display names from the LOINC Table, LOINC Table Core, or the LOINC Linguistic Variants File (as available) must be included:

1. The fully-specified name, which includes the information from the COMPONENT, PROPERTY, TIME_ASPCT, SYSTEM, SCALE_TYP, and METHOD_TYP fields;

2. The LOINC short name (from the SHORTNAME field);

3. The LOINC long common name (from the LONG_COMMON_NAME field); or

4. The LOINC Display name (from the DisplayName field).

2. For LOINC identifiers other than LOINC codes, the primary corresponding display name (e.g. LOINC Answer List Name, LOINC Answer String Display Text, LOINC Part Name, LOINC Group Name) must be included.

4. Including the appropriate version number of the Licensed Material is strongly encouraged, but not required.

5. When LOINC codes are included, including the LOINC term status is strongly encouraged, but not required.

6. When material from Group 3 Artifacts is included, any other fields that would be necessary to preserve the meaning of the contents and relationships between records are included.

11. Use and distribution of the Licensed Materials in ways that are not specifically discussed herein shall always be accompanied by the notice provided in Section 10 hereof. The guidelines for providing the notice that is contained in the first paragraph of Section 10 also shall apply. Questions about whether a particular use of any of the Licensed Materials is permissible may be directed to Regenstrief Institute, Inc. by e-mail at loinc@loinc.org.

12. Regenstrief Institute, Inc. shall be notified via email at loinc@loinc.org prior to translation of any of the Licensed Materials into a language other than English. Any such translation is a derivative work, and Regenstrief Institute, Inc. shall be assigned and hereby is assigned all right, title and interest in and to such derivative work: (a) to Regenstrief Institute, Inc. and the LOINC Committee if the translation is a derivative of Group 1 Artifacts or Group 1 Documents, and (b) to Regenstrief Institute, Inc. if the translation is a derivative work of the Group 2 Artifacts, Group 2 Documents, or Group 3 Artifacts. Further, you shall fully cooperate with Regenstrief Institute, Inc. in the filing and reviewing of any copyright applications or other legal documents, and signing any documents (such as declarations, assignments, affidavits, and the like) that are reasonably necessary to the preparation of any such copyright application. The assignment granted by this paragraph extends to all proprietary rights in the United States, and in all other countries. Except for the right to translate the Licensed Materials into a language other than English pursuant to this section, no other right to create a derivative work of any of the Licensed Materials is hereby granted. All such translations shall be electronically transmitted to Regenstrief Institute, Inc., and such translations shall be made available and are subject to the same license rights and restrictions contained herein. Regenstrief Institute, Inc. will give credit on the LOINC website and on applicable screens in RELMA to the party that created the translation. Accuracy of each translation is not verified by Regenstrief Institute, Inc. or the LOINC Committee.

13. The names “Regenstrief,” “Regenstrief Foundation,” “Regenstrief Institute, Inc.,” and “LOINC Committee” may not be used in a way which could be interpreted as an endorsement or a promotion of any product or service without prior written permission of the Regenstrief Institute, Inc. Further, no right to use the trademarks of Regenstrief Institute, Inc. is licensed hereunder. To request written permission, please contact loinc@loinc.org.

14. DISCLAIMER: REGENSTRIEF INSTITUTE, INC. AND THE LOINC COMMITTEE, AS WELL AS ANY CONTRIBUTORS WHO HAVE PROVIDED TRANSLATIONS OF THE LICENSED MATERIALS, DO NOT ACCEPT LIABILITY FOR ANY OMISSIONS OR ERRORS IN THE LICENSED MATERIALS OR ANY OTHER MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC. AND/OR THE LOINC COMMITTEE. THE LICENSED MATERIALS AND ALL OTHER MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC. AND/OR THE LOINC COMMITTEE ARE PROVIDED “AS IS”, WITHOUT WARRANTY OF ANY KIND. ANY EXPRESSED OR IMPLIED WARRANTIES ARE HEREBY DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF TITLE, NON-INFRINGEMENT, MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE AND WARRANTIES ARISING FROM A COURSE OF DEALING, TRADE USAGE, OR TRADE PRACTICE. FURTHER, NO WARRANTY OR REPRESENTATION IS MADE CONCERNING THE ACCURACY, COMPLETENESS, SEQUENCE, TIMELINESS OR AVAILABILITY OF THE LICENSED MATERIALS OR ANY OTHER MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC. AND/OR THE LOINC COMMITTEE, OR ANY TRANSLATIONS OR DERIVATIVE WORKS OF ANY OF THE FOREGOING. IN NO EVENT SHALL REGENSTRIEF INSTITUTE, INC. OR THE LOINC COMMITTEE OR ITS CONTRIBUTORS BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, RELIANCE, OR CONSEQUENTIAL DAMAGES OR ATTORNEYS’ FEES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; OPPORTUNITY COSTS; LOSS OF USE, DATA, SAVINGS OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER CAUSED AND ON ANY THEORY OF LIABILITY WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THE LICENSED MATERIALS OR ANY OTHER MATERIALS OBTAINED FROM REGENSTRIEF INSTITUTE, INC. AND/OR THE LOINC COMMITTEE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE OR IF SUCH DAMAGES WERE FORESEEABLE. SOME JURISDICTIONS DO NOT ALLOW THE LIMITATION OR EXCLUSION OF CERTAIN WARRANTIES OR CONDITIONS, SO SOME OF THE FOREGOING MAY NOT APPLY TO YOU.

15. This license shall be construed and interpreted in accordance with the laws of the State of Indiana, United States of America, excluding its conflicts of law rules.

Notice of Third-Party Content and Copyright Terms

A small portion of the content of the Licensed Material consists of content subject to copyright from third parties. This third-party content is either used with permission or under the applicable terms of use. In all such cases, we have included the copyright notice. The copyright of the LOINC codes per se remains owned by Regenstrief Institute, Inc. and the LOINC Committee and subject to the LOINC Copyright Notice and License.

Some included third-party content requires attribution specific to a particular LOINC code or codes. Such third-party content is identified in the LOINC Table and LOINC Table Core by the applicable copyright notice (up to 250 characters) stored in the EXTERNAL_COPYRIGHT_NOTICE field. In RELMA and our web-based search application (http://search.loinc.org), the third-party content is highlighted as follows: When such content appears in a search result grid, the programs will display a field with a link to a page containing the copyright notice and terms of use for that content. The programs may also visually highlight the rows of these LOINC codes.

When LOINC terms with third-party copyright are included in any products or services as described in Section 10 above, the copyright notice contained in the EXTERNAL_COPYRIGHT_NOTICE field must be included in addition to the LOINC copyright notice. Any use or administration of third-party content is in accordance with the third-party content owner’s license and/or terms of use; third-party content is included in LOINC to allow standardization of clinical data associated with the third-party copyright content. Inclusion in LOINC does not imply permission to use or administer third-party content without following the third-party content owner’s license and/or terms of use.

Required Attributions for Third-Party Content not identified as such in the EXTERNAL_COPYRIGHT_NOTICE field:

A. The LOINC Part File, LOINC/SNOMED CT Expression Association and Map Sets File, RELMA database and associated search index files include SNOMED Clinical Terms (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights are reserved. SNOMED CT® was originally created by The College of American Pathologists. “SNOMED” and “SNOMED CT” are registered trademarks of the IHTSDO. Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org. Under the terms of the Affiliate License, use of SNOMED CT in countries that are not IHTSDO Members is subject to reporting and fee payment obligations. However, IHTSDO agrees to waive the requirements to report and pay fees for use of SNOMED CT content included in the LOINC Part Mapping and LOINC Term Associations for purposes that support or enable more effective use of LOINC.

B. The LOINC Answer File, RELMA database and associated search index files include content from SNOMED Clinical Terms (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO) under license. All rights are reserved. SNOMED CT® was originally created by The College of American Pathologists. “SNOMED” and “SNOMED CT” are registered trademarks of the IHTSDO. Use of SNOMED CT content is subject to the terms and conditions set forth in the SNOMED CT Affiliate License Agreement. It is the responsibility of those implementing this product to ensure they are appropriately licensed and for more information on the license, including how to register as an Affiliate Licensee, please refer to http://www.snomed.org/snomed-ct/get-snomed-ct or info@snomed.org. This may incur a fee in SNOMED International non-Member countries.

C. The LOINC Part File, LOINC Answer File, RELMA database and associated search index files includes content from the US Edition to SNOMED CT, which is developed and maintained by the U.S. National Library of Medicine and is available to authorized UMLS Metathesaurus Licensees from the UTS Downloads site at https://uts.nlm.nih.gov.

D. The Unified Medical Language System (UMLS) from the U.S. National Library of Medicine (https://www.nlm.nih.gov/research/umls/ is the source of RxNorm® content and is available to authorized UMLS Metathesaurus Licensees.

E. The LOINC/RSNA Radiology Playbook and the LOINC Part File contain content from RadLex® (http://www.radlex.org), copyright © 2005-2020, The Radiological Society of North America, Inc., available at no cost under the license at http://www.rsna.org/uploadedFiles/RSNA/Content/Informatics/RadLex_License_Agreement_and_Terms_of_Use_V2_Final.pdf.

F. The LOINC/IEEE Medical Device Code Mapping Table contains content from IEEE (http://ieee.org), copyright © 2019 IEEE.

G. This product includes all or a portion of the UCUM table, UCUM codes, and UCUM definitions or is derived from it, subject to a license from Regenstrief Institute, Inc. and The UCUM Organization. Your use of the UCUM table, UCUM codes, UCUM definitions also is subject to this license, a copy of which is available at http://unitsofmeasure.org. The current complete UCUM table, UCUM Specification are available for download at http://unitsofmeasure.org. The UCUM table and UCUM codes are copyright © 1995-2020, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. THE UCUM TABLE (IN ALL FORMATS), UCUM DEFINITIONS, AND SPECIFICATION ARE PROVIDED “AS IS”. ANY EXPRESS OR IMPLIED WARRANTIES ARE DISCLAIMED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.