HL7 NTE Segment: Notes and Comments

The HL7 NTE segment (Notes and Comments) carries free-text notes that annotate other segments. It repeats and can appear after many parent segments — OBR, OBX, ORC, PID, and others — to add context that doesn’t fit into structured fields.

NTE Field Reference

NTE 8 fields

All Fields Required & Critical With Notes

Seq	Name	Type	Opt	Description
NTE-1	Set ID	SI	O	Sequence number (1, 2, 3...)
★ NTE-2	Source of Comment	ID	O	L (Filler/Lab), P (Placer/Ordering), O (Other)
★ NTE-3	Comment	FT	O	Free-text comment content
★ NTE-4	Comment Type	CE	O	PI, AI, GI, RE, DR (HL7 Table 0364)
NTE-5	Entered By	XCN	O	Person who created the note
NTE-6	Entered Date/Time	TS	O	When the note was created
NTE-7	Effective Start Date	TS	O	When the note becomes effective
NTE-8	Expiration Date	TS	O	When the note expires

NTE-1 O

Set ID SI

Sequence number (1, 2, 3...)

Multi-segment notes must be concatenated in Set ID order to reconstruct the complete comment.

★ NTE-2 O

Source of Comment ID

L (Filler/Lab), P (Placer/Ordering), O (Other)

L=Lab/ancillary system comment, P=Ordering provider comment, O=Other source. Helps route and display notes appropriately.

★ NTE-3 O

Comment FT

Free-text comment content

FT (Formatted Text) data type supports HL7 escape sequences: \.br\ for line breaks, \F\ for pipe, \S\ for caret, \E\ for backslash.

★ NTE-4 O

Comment Type CE

PI, AI, GI, RE, DR (HL7 Table 0364)

PI=Patient Instructions, AI=Ancillary Instructions, GI=General, RE=Interpretive Remark on results, DR=Drug interaction/duplicate warning.

NTE-5 O

Entered By XCN

Person who created the note

NTE-6 O

Entered Date/Time TS

When the note was created

NTE-7 O

Effective Start Date TS

When the note becomes effective

NTE-8 O

Expiration Date TS

When the note expires

R = Required, O = Optional, C = Conditional, W = Withdrawn (backward compatibility only)

NTE-2: Source of Comment

Code	Source	Description
L	Filler (Lab/Ancillary)	Comment from the system performing the test or service
P	Placer (Ordering)	Comment from the ordering provider or system
O	Other	Comment from another source (registration, quality, etc.)

The source code helps receiving systems route and display notes appropriately. Lab comments (L) may appear in the result viewer, while placer comments (P) may route to the performing department.

NTE-4: Comment Type Codes (Table 0364)

Code	Meaning	Use Case
PI	Patient Instructions	Preparation instructions, follow-up guidance
AI	Ancillary Instructions	Lab-specific handling or processing notes
GI	General Instructions	General clinical context
RE	Remark	Interpretive comment on results
DR	Duplicate/Interaction Check	Drug interaction or duplicate order warning

Context-Dependent NTE Usage

NTE segments take their meaning from the segment they follow. The same NTE structure serves different purposes depending on its position in the message:

After OBR (Order-Level Notes)

OBR|1|ORD5678^EPIC||58410-2^CBC with Diff^LN|||202603011400
NTE|1|P|Patient febrile x 24hrs, rule out infection.
NTE|2|P|Currently on Vancomycin — check trough level if appropriate.

Notes after OBR provide clinical context for the entire order — relevant history, special instructions, or reason for testing. These route to the performing department.

After OBX (Result-Level Notes)

OBX|1|NM|6690-2^WBC^LN||15.2|10*3/uL|4.5-11.0|H|||F
NTE|1|L|Elevated WBC consistent with acute infection.
NTE|2|L|Manual differential performed — see below.

Notes after OBX annotate individual results — interpretive comments, methodology notes, or critical value notifications. Lab pathologists use these to communicate clinical significance.

After ORC (Order Control Notes)

ORC|CA|ORD5678^EPIC||||||||||ATT1234^SMITH^JANE^^^MD
NTE|1|P|Cancelled — duplicate order. Original order ORD5672 still active.

Notes after ORC explain order lifecycle events — cancellation reasons, hold justifications, or modification context.

Multiple NTE Segments

When a note spans multiple NTE segments, they must be concatenated in Set ID order to reconstruct the complete comment:

NTE|1|L|METHODOLOGY: Automated cell count with manual differential
NTE|2|L|performed when abnormal WBC flags are detected. Results
NTE|3|L|reviewed and released by laboratory supervisor.

The receiving system should join NTE-3 values from NTE|1 through NTE|3 with line breaks to display the complete note. Truncation or reordering of NTE segments corrupts the message.

Key Implementation Considerations

NTE vs OBX with TX Value Type

Both NTE and OBX with value type TX carry free text, but they serve different purposes:

Feature	NTE	OBX (TX)
Purpose	Supplementary comment on another segment	Discrete observation/result
Structured	No — free text only	Yes — has observation ID, status, flags
Searchable	Typically not indexed	Indexed by OBX-3 identifier
LOINC coded	No	Yes (via OBX-3)
Status tracking	No	Yes (OBX-11: F, P, C, etc.)

Rule of thumb: If the text is an observation that should be tracked, coded, and reported on, use OBX. If it’s a supplementary annotation or instruction, use NTE.

Character Encoding in NTE-3

NTE-3 uses the FT (Formatted Text) data type, which supports HL7 escape sequences:

Sequence	Meaning
\.br\	Line break
\F\	Literal pipe |
\S\	Literal caret ^
\T\	Literal ampersand &
\E\	Literal backslash \

Long notes with line breaks should use \.br\ rather than splitting into multiple NTE segments, though both approaches are used in practice.

Preserving Note Order

NTE segments must be processed in the order received. Integration engines should:

• Maintain Set ID sequence when forwarding or transforming messages
• Not reorder NTE segments during message routing
• Concatenate multi-segment notes correctly when converting to other formats (FHIR Annotation, CDA narrative)

Related Resources

HL7 ORM Messages ORM message structure — where NTE segments provide clinical context for orders.

HL7 ORU Messages ORU message structure — NTE segments annotating lab and radiology results.

HL7 Workbench Parse and validate HL7 messages with segment highlighting and field lookup.

HL7 Resource Center Message types, segments, reference guides, and integration tools.