HESS HL7 Implementation Guide - Missouri
Hospital ElectronicSyndromic Surveillance(HESS)HL7 Implementation GuideDocument Release 1.36/5/2015Missouri Department of Health and Senior Services6/5/2015DHSS HESS HL7 Implementation Guide Release 1.3
Table of Contents1INTRODUCTION . 51.11.21.32How to Use this Guide .5Audience .6Transport Method .6GENERAL HESS MESSAGE INFRASTRUCTURE . 72.12.22.32.42.52.5.12.5.22.5.3Basic HL7 Terms .7Data Types for HESS Implementation Guide .8Encoding Rules .8HESS Message Structure Attributes .9Constrained Message Types .10HESS Constrained Message Structure ADT A01, A04, A08 .10Constrained Message Structure ADT A03 .11Constrained Message Structure ACK .113DATA ELEMENTS OF INTEREST FOR SYNDROMIC SURVEILLANCE. 124HESS SEGMENT ATTRIBUTES AND DEFINITIONS . 134.15HESS Segment Attributes.13HESS HL7 VERSION 2.5.1 MESSAGE SEGMENT DEFINITION . Version 2.5.1 Message Structure and Definitions .14MSH: Message Header Segment Definition .15EVN: Event Type Segment Definition .18PID: Patient Identification Segment Definition .19PV1: Patient Visit Segment Definition .24PV2: Patient Visit Additional Information Segment Definition .28OBX: Observation/Result Segment Definition .29DG1: Diagnosis Segment Definition .35PR1: Procedures Segment Definition .36IN1: Insurance Segment Definition .37APPENDIX A – SAMPLE MESSAGES. 38A.1A.2A.3A.4A.5A04 EMERGENCY DEPARTMENT REGISTRATION; NO UPDATES; ACKNOWLEDGEMENT REQUESTED .38A04 EMERGENCY DEPARTMENT REGISTRATION FOLLOWED BY A08 UPDATE .39A04 EMERGENCY DEPARTMENT REGISTRATION; A01 INPATIENT ADMISSION; A03 DISCHARGE INCLUDINGPATIENT DEATH .41A01 INPATIENT ADMISSION; NO UPDATES .44BATCH EXAMPLE .44APPENDIX B – MESSAGE TRANSMISSION . 46B.1B.2B.3A.3.1B.3.2A.3.3B.3.4Memorandum of Agreement .46Transmission Methods .46HL7 Batch Protocol .48FHS: File Header Segment .48FTS: File Trailer Segment .50BHS: Batch Header Segment Definition .50BTS: Batch Trailer Segment Definition.51APPENDIX C – ACK GENERAL ACKNOWLEDGEMENT MESSAGE . 52C.1MSH: Message Header for General Acknowledgement Message Segment Definition .526/5/2015DHSS HESS HL7 Implementation Guide Release 1.3
C.2MSA: Message Acknowledgement Segment Definition .55APPENDIX D – HESS CODE SETS . 56D1HESS HL7 Version 2.5.1 Code Set – HL7 and CDC .56This implementation guide contains descriptions of HL7 Messages to be sent from hospitals and urgent carefacilities for inpatient admissions, emergency department visits and urgent care facility visits. These messagesare sent to Missouri Department of Health and Senior Services for syndromic surveillance purposes.6/5/2015DHSS HESS HL7 Implementation Guide Release 1.3
Missouri Department of Health and SeniorServicesRevision HistoryVer/Rel #DraftV1.0V1.1V1.2V1.3Issue DateApril 18, 2011December 31,2011September 14,2012June 5, 2015AuthorSummary of ChangesInitial Draft.Updates from release final PHIN GUIDEUpdates for more clarification.Updates for more clarification. Removal of HL7Standard Specifications for HESS Version 2.3.1.R1.0R1.0.1R1.0.2R1.0.36/5/2015DHSS HESS HL7 Implementation Guide Release 1.3
1IntroductionThe term “syndromic surveillance” applies to the use of data from health-seeking behavior thatprecedes a final diagnosis by a physician such as emergency department (ED) chief complaints,over-the-counter drug sales, and school or work absenteeism. Missouri Department of Health andSenior Services (DHSS), currently receives data from Missouri hospitals under the Hospital ElectronicSyndromic Surveillance (HESS) Reporting Rule (19 CSR 10-33.040) specifically for syndromicsurveillance. HESS data is processed using the Electronic Surveillance System for the EarlyNotification of Community-based Epidemics (ESSENCE), which is web-based software specificallydesigned for syndromic surveillance.Syndromic Surveillance will use Chief Complaint information from HL7 Admit-Discharge-Transfer(ADT) messages to provide an early warning system of public health emergencies and for generalpublic health surveillance and analysis. Chief Complaint is the initial complaint provided within the firstmoments of the admission and does not represent a final diagnosis. The data collection portion ofthis system is called the Hospital Electronic Syndromic Surveillance (HESS) System. Only thefollowing message types will be accepted:ADT A01ADT A03ADT A04ADT A08Inpatient AdmissionDischarge / End VisitEmergency Department RegistrationUpdates to information on previously sent A01 and A04 messages.This Implementation Guide provides the HESS HL7 specifications required for submission of HESSdata to DHSS.1.1How to Use this GuideThere are currently two versions of HESS HL7 standard specifications in use at DHSS. ThisImplementation Guide only includes HESS Version 2.5.1.The following table provides recommendations as to which standard a hospital should use whenreporting Syndromic Surveillance data to DHSS.HESS HL7 StandardHESS Version 2.5.1Use Recommendations New hospitals who do not currently report Syndromic Surveillance data toDHSS. Hospitals who report under the current reporting rule but are preparing toupgrade their interfaces should upgrade to HESS Version 2.5.1.This Implementation Guide is based on the drSurvMessagGuide2 MessagingGuide PHN.pdf withfurther constraints specifically for syndromic surveillance requirements. For more information on HL7,go to http://www.hl7.org/.6.5.2015DHSS HESS HL7 Implementation Guide Release 1.35
1.2AudienceThis HESS Implementation Guide for Syndromic Surveillance contains the necessary specificationsfor data exchange from healthcare to DHSS. This guide is designed for healthcare and public healthinformation systems, data exchange, database management staff, and DHSS public health dataanalysts and developers who require guidance on Syndromic Surveillance data elements andmessaging specifications.Users of this guide must be familiar with the details of HL7 message construction and processing.This guide is NOT intended to be a tutorial on HL7. For more information about HL7 messaging, goto.http://www.hl7.org/.1.3Transport MethodApproved facilities will have two options for transmitting HL7 messages to DHSS: HTTPS SOAP orHTTPS POST messages. To help make data transmissions secure, messages will be sent via theHTTPS protocol. Each real-time HL7 message must include a valid username, password, and facilityidentifier to authenticate a facility’s right to access the State data network.Single Messages: Facilities who submit messages (ADT) one at a time will transmit those usingSOAP or POST protocols via HTTPS. DHSS will generate a General Acknowledgement message(ACK) for each message (ADT) indicating that the message was received.Note: This message (ACK) does not represent or imply that the message was successfully applied tothe applicable State database, only that the message was received.Batched Messages: Facilities who transmit messages (ADT) as a batch with intent to process willdo so using secured file transfer protocol (SFTP). These messages will be placed in a secured filetransfer protocol directory (SFTP). Batched messages (ADTs) must be accompanied by theappropriate batch header and footer segments. Messages (ACKs) are NOT generated by thisprocess.For more information, reference Appendix B, Message Transmission.6.5.2015DHSS HESS HL7 Implementation Guide Release 1.36
2General HESS Message Infrastructure2.1Basic HL7 TermsTable 2.1TermMessageSegmentFieldComponentData TypeDelimitersBasic HL7 TermsDefinitionA message is the entire unit of data transferred between systems in a singletransmission. It is a series of segments in a defined sequence, with a message typeand a trigger event.A segment is a logical grouping of data fields. Segments within a defined messagemay be required or optional and may occur only once or may be allowed to repeat.Each segment is named and identified by a segment ID, a unique 3-character code.A field is a string of characters. Each field has an element name and is identified bythe segment it is in and its sequence within the segment. Usage and cardinalityrequirements are defined in the Segment Definitions.A component is one of a logical grouping of items that comprise the contents of acoded or composite field. Within a field having several components, not allcomponents are necessarily required to be populated.A data type restricts the contents and format of the data field. Data types are given a2- or 3- letter code. Some data types are coded or composite types with severalcomponents. The applicable HL7 data type is listed in each field definition.The delimiter values are given in MSH-1 and MSH-2 and are used throughout themessage. The delimiters supported by HESS are: Field Separator Component Separator&Sub-Component Separator Repetition Separator\Escape Character6.5.2015DHSS HESS HL7 Implementation Guide Release 1.37
2.2Data Types for HESS Implementation GuideThe following Data Types have been used in the HESS HL7 Implementation Guide.Table 2.2Data typeCEData Types used in HESS Implementation GuideData Type NameCoded NCoded with ExceptionsExtended Composite ID with check DigitDate/TimeEntity IdentifierFamily NameHierarchic DesignatorCoded Value for HL7-defined tablesCoded Value for user-defined tablesMessage TypeNumericPerson LocationProcessing TypeSequence IdentifierString DataTimestampText DataVersion IdentifierExtended AddressExtended Composite ID Number and Name for PersonsXPNExtended Person Name2.3Encoding RulesThe following list details the encoding rules. Encode each segment in the order specified in the Message Structure. Begin each segment with the 3-letter segment ID (e.g., PID). End each segment with the carriage return terminator (hex 0D). Note that in theexamples in this guide, this character is illustrated as “ cr ”. This character is a singleASCII character; the segment terminator is NOT the four-character sequence. Encode the data fields in the sequence given in the corresponding segmentdefinition tables. Encode each data field according to the data type format listed in this guide.Components, subcomponents, or repetitions that are not valued at the end of a fieldneed not be represented by component separators. Likewise, field separators are notrequired for empty fields at the end of a segment. For example, the data fields andsegments below are equivalent: XXX&YYY&& is equal to XXX&YYY ABC DEF is equal to ABC DEF and6.5.2015DHSS HESS HL7 Implementation Guide Release 1.38
MSH \& Facillity NPI 0131191934 NPI 201009221330 ADT A04 ADT A011 P 2.3.1 cr MSH \& Facillity NPI 0131191934 NPI 201009221330 ADT A04 ADT A01 1 P 2.5.1 cr is equal toMSH \& Facility NPI 0131191934 NPI 201009221330 ADT A04 ADT A01 1 P 2.3.1 cr MSH \& Facility NPI 0131191934 NPI 201009221330 ADT A04 ADT A01 1 P 2.5.1 cr If a data segment is not documented in this guide, the Sender should not send thesegment.2.4HESS Message Structure AttributesThe structure of the supported messages in this guide are described in tabular format (refer to thefollowing section). The columns of those tables are used as described in the table below.Table HESS Message Structure AttributesDefinitionA three-character code for the segment plus the square and curly braces structuresyntax. If a segment is not documented in this guide, it should not be sent.[XXX]Optional{XXX}RepeatingXXXRequired[{XXX}] Optional and RepeatingName of the segment.Explanation of the use of the segment.Describes the use of the segment by HESS. Values used in this implementation are:RRequired. Segment must be sent with fields populated according tothe segment definition. Must always be populated.RERequired, but may be empty (segment is not sent). If the Sender has data, itmust be sent. The Receiver must be capable of processing data if sent andmust not raise an error or warning if the data is not sent.OOptional. There is no specified conformance rules for either Sender orReceiver for this segment in this guide. As an implemented interface mustfollow known rules for populating segments, a specific interface for aparticular Sender or Receiver must constrain this usage to either “R, RE, C,CE, or X”. This has been deliberately left unconstrained in this guide tosupport differing and sometimes mutually exclusive statutory requirements indifferent jurisdictions; this must be determined locally.Defines the minimum and maximum number of times the segment may appear in thismessage.[0.1]Segment may be omitted and can have, at most, one occurrence.[1.1]Segment must have exactly one occurrence.[0.*]Segment may be omitted or may repeat an unlimited number of times.[1.*]Segment must appear at least once, and may repeat unlimitednumber oftimes.6.5.2015DHSS HESS HL7 Implementation Guide Release 1.39
2.5Constrained Message TypesThe following HL7 ADT Messages have been identified for Syndromic Surveillance reporting: ADT A01ACK A01ADT A03ACK A03ADT A04ACK A04ADT A08ACK A08Admit / Visit NotificationGeneral AcknowledgementDischarge / End VisitGeneral AcknowledgementRegister a PatientGeneral AcknowledgementUpdate Patient InformationGeneral AcknowledgementMessage types that are NOT documented in this guide are considered NOT SUPPORTED.2.5.1 HESS Constrained Message Structure ADT A01, A04, A08The following table shows the order in which the ADT A01, ADT A04 and ADT A08 messages arestructured.Table2.5.1SegmentMSHHESS Simple Message Structure: A01, A04, and A08NameMessage HeaderEVNEvent TypePIDPatientIdentificationPatient VisitPV1[PV2]{OBX}Patient VisitAdditionalInformationObservation urance6.5.2015DescriptionInformation explaining how to parse andprocess the message. This includesidentification of message delimiters, sender,receiver, message type, timestamp, etc.Trigger event information for receivingapplication.Patient identifying and demographicinformation.Information related to this visit at this hospitalincluding the nature of the visit, critical timinginformation, and a unique visit identifier.Admit Reason 1]RE[0.1]Information regarding the chief complaint,patient age, temperature, and otherinformation relevant to the observation of thepatient.Admitting Diagnosis and, optionally, Workingand Final Diagnosis information. DG1 is REif a PV2 segment is sent. If no PV2 segmentis sent, one or more DG1 segments arerequired.Information relative to various types ofprocedures performed.Information about insurance policy coverage.R[1.*]RE[0.*]O[0.*]O[0.*]DHSS HESS HL7 Implementation Guide Release 1.310
2.5.2 Constrained Message Structure ADT A03Table2.5.2SegmentMSHHESS Simple Message Structure: A03NameMessage HeaderEVNEvent TypePIDPatientIdentificationPatient VisitPV1[PV2][{DG1}]Patient es{OBX}Observation /Result[{IN1}]InsuranceDescriptionInformation explaining how to parse andprocess the message. This includesidentification of message delimiters, sender,receiver, message type, timestamp, etc.Trigger event information for receivingapplication.Patient identifying and demographicinformation.Information related to this visit at this hospitalincluding the nature of the visit, critical timinginformation, and a unique visit identifier.Admit Reason 1]RE[0.1]Admitting Diagnosis and, optionally, Workingand Final Diagnosis information. DG1 is RE ifa PV2 segment is sent. If no PV2 segment issent, one or more DG1 segments arerequired.Information relative to various types ofprocedures performed.RE[0.*]O[0.*]Information regarding the chief complaint,patient age, temperature, and otherinformation relevant to the observation of thepatient.Information about insurance policy coverage.R1.*]O[0.*]2.5.3 Constrained Message Structure ACKNote: The same Message Structure is used for the ACK A01, ACK A03, ACK A04, and ACK A08.See Appendix C for more information on the Message Header Segment for the ACK.Table2.5.3SegmentMSHMSAHESS Simple Message Structure: ACKNameMessage ormation explaining how to parse andprocess the message. This includesidentification of message delimiters, sender,receiver, message type, timestamp, etc.Acknowledgement information identifying theability of a receiver to accept a S HESS HL7 Implementation Guide Release 1.311
3Data Elements of Interest for Syndromic SurveillanceIn September 2010, the CDC supported the International Society for Disease Surveillance (ISDS) torecommend EHR requirements for Syndromic Surveillance business practices. As part of this effortthe ISDS made final recommendations on the minimum data set required for reporting SyndromicSurveillance to public health.For the purposes of this HESS guide relevant details from the required minimum data set have beenadded as notes in the “Values/Value Set” column in this guide for each component where applicable.For more information on the ISDS Final Recommendation please review Section 4, vMessagGuide2 MessagingGuide PHN.pdf Thisguide will provide current and future information on the required Minimum Data as recommended bythe ISDS.6.5.2015DHSS HESS HL7 Implementation Guide Release 1.312
4HESS Segment Attributes and Definitions4.1HESS Segment AttributesTable 4.1AttributeField NameSequence (Seq)Data Type (DT)Length (Len)Sender UsageReceiver UsageSegment AttributesDefinitionDescriptive name of the data element.Sequence of the elements as they are numbered in the HL7 segment.A data type restricts the content and format of the data field. Data types are given a 2- or 3- letter code. Some data types arecoded or composite types with several components. The applicable HL7 data type is listed in each field definition.Maximum length of the field.This indicates whether a data element is required, optional, or conditional in a message, set separately for Senders andReceivers. Legal values are:RRECardinalityRequired. Must always be populated by the Sender, and if not present the Receiver may reject the message.Required, but may be empty (no value). If the Sender has data, the data must be sent. The Receiver must be capableof processing data if sent, and must not raise an error or warning if the data is not sent.OOptional. There are no specified conformance rules for either Sender or Receiver for this field in this guide. As animplemented interface must follow known rules for populated fields and components, a specific interface for aparticular Sender or Receiver must constrain this usage to either “R, RE, C, CE, or X”. This value has beendeliberately left unconstrained in this guide to support differing and sometimes mutually exclusive statutoryrequirements in different jurisdictions; this must be determined locally.CConditional. When conditionality predicate evaluates to “True”, considered the same as “R”. When conditionevaluates to “False”. Senders must not populate the field, and Receivers may raise an error if the field is presentbut must not raise an error if the field is not present.CEWhen conditionality predicate evaluates to “True”, behaves the same as “RE”. When conditionality predicateevaluates to “False”, the Sender should not populate the field, and the Receiver may raise an application error if thefield is present.XNot supported. Senders must not populate. Receivers may ignore the element if it is sent, or may raise an error if fieldis present.Note: A required field in an optional segment does not mean the segment must be present in the message. It means that ifthe segment is present, the required fields within that segment must be populated. The same applies to requiredcomponents of optional fields. If the field is being populated, then the required components must be populated. Thesame applies to required sub-components of optional components. If a component is being populated, then therequired sub-components of that component must be populated.Defines the minimum and maximum number of times the field may appear in this segment.[0.0] Field never present.[0.1] Field may be omitted and can have, at most, one occurrence.[1.1] Field must have exactly one occurrence.6.5.2015DHSS HESS HL7 Implementation Guide Release 1.313
Table 4.1AttributeValues/ValueSetSegment AttributesDefinition[0.n] Field may be omitted or may repeat up to n times.[1.n] Field must appear at least once, and may repeat up to n times.[0.*]Field may be omitted or repeat an unlimited number of times.[1.*]Field must appear at least once, and may repeat an unlimited number of times.[m.n] Field must appear at least m and at most n times.Link to value set or literal value of data expected to be populated in the field. Numbers in this field denote the relatedvocabulary in that HL7 Table. Contains the name and/or the PHIN Value Set (accessible through PHIN VADS) whenrelevant as well as notes, condition rules, and general/ISDS recommendations.Note: Components and subcomponents of a single field are noted as a dotted decimal number.5HESS HL7 Version 2.5.1 Message Segment Definition5.1Version 2.5.1 Message Structure and DefinitionsThe HESS HL7 Version 2.5.1 contains the following segments: MSH:EVN:PID:PV1:PV2:OBX:DG1:PR1:IN1:Message Header Segment DefinitionEvent Type Segment DefinitionPatient Identification Segment DefinitionPatient Visit Segment DefinitionPatient Visit Additional Information Segment DefinitionObservation/Result Segment DefinitionDiagnosis Segment DefinitionProcedures Segment DefinitionInsurance Segment DefinitionThe following tables outline the specific message structure and segment definitions supporting the HESS HL7 2.5.1 version. If thesegment is not outlined in this section, it is not supported. Do not send any other segments.6.5.2015DHSS HESS HL7 Implementation Guide Release 1.314
5.1.1 MSH: Message Header Segment DefinitionThe MSH segment defines the intent, source, destination, and selected message syntax specifications. This segment includesidentification of message delimiters, sender, receiver, message type, timestamp, etc. The MSH segment is required.MSH Example:MSH \& EHR SYSTEM NAME MIDLAND HLTHCTR 9876543210 NPI MOHESS MODHSS 201112091114 ADT A04 ADT A01 201112091114-0078 P 2.5.1 cr Table 5.1.1Field NameSegField SeparatorEncoding Characters1MSH: Message Header Segment ageST1RR[1.1]2ST4RR[1.1]Sending Application3HD227OO[0.1]Sending Facility4HD227RR[1.1]Namespace ID4.1IS6.5.201520RR[1.1]Values/Value SetDefault Value: “ ” (ASCII 124).Default Values: “ \&” (ASCII 94, 126, 92,and 38).Identifies the sending application from theother HL7 message exchange applicationsbelonging to the sender. Hospitalsfrequently send the name of their softwarevendor or an internally developed systemhere. Ex: MYEMR-2000Field that uniquely identifies the facilityassociated with the application that sendsthe message (i.e., the “owner” of themessage information). Ex: LOCALGENERAL HOSPITAL 9876543210 NPIIf Acknowledgements are in use, thisfacility will receive any relatedAcknowledgement message.Name of originating hospital. HESSsuggests that a shortened name,abbreviation or acronym be used in thefirst component. Ex: LOCAL GENL HOSPDHSS HESS HL7 Implementation Guide Release 1.315
Table 5.1.1Field NameSegUniversal ID4.2Universal ID TypeReceiving ApplicationReceiving FacilityDate/Time of Message4.3567MSH: Message Header Segment ageST199RR[1.1]Values/Value SetIDHDHDTSNote: NPI yHome.doLiteral Value: “NPI”Literal Value: “MOHESS”Literal Value: “MODHSS”Note: Date/Time the sending systemcreated the message in the followingformat: YYYYMMDDHHMMSS[.S[S[S[S]]]]][ /-ZZZZ]622722726RRRRRRRR[1.1][1.1][1.1][1.1]Ten digit National Provider Identifiernumber (NPI).The minimum acceptable precision is tothe nearest minute; seconds are desirable.Message Type9MSG15RR[1.1]Message CodeTrigger Event9.19.2IDID33RRRR[1.1][1.1]Message Structure9.3ID7RR[1.1]If Coordinated Universal Time (UTC) offsetis not sent, it is assumed to the offset ofthe receiver.Note: All messages will be AdmitDischarge- Transfer (ADT) message types.The triggering event is a real-worldcircumstance causing the message to besent.Supported trigger events are A01(Inpatient Admission), A04 (EmergencyDepartment Registration) and A08(Update).Literal Value: “ADT” or “ACK”One of the following Literal Values: “A01”,“A03”, “A04” or “A08”Trigger events A01, A04, and A08 sharethe same “ADT A01” Message Structure.One of the following Literal Values:“ADT A01” or “ADT A03, or “ACK”6.5.2015DHSS HESS HL7 Implementation Guide Release 1.316
Table 5.1.1Field NameSegMessage Control ID10MSH: Message Header Segment ageST199RR[1.1]Processing ID11PTVersion ID12VID6.5.201535RRRR[1.1][1.1]Values/Value SetA number or other identifier that uniquelyidentifies the message and is echoed backin the message acknowledgment segment(MSA). Some hospitals send a Date/Timestamp using
6.5.2015 DHSS HESS HL7 Implementation Guide Release 1.3 7 2 General HESS Message Infrastructure 2.1 Basic HL7 Terms Table 2.1 Basic HL7 Terms Term Definition Message A message is the entire unit of data transferred between systems in a single transmission. It is a series of segments in a defined sequence, with a message type
HL7 Messaging Tool - EHR Vendor All new products will be listed under Your Product List. To start validating products go to the Validating EHR Projects/Versions section under Validating HL7 Messages. Validating HL7 Messages This section will go into detail on how to validate each EHR Product, Group HL7 Messages, and Practice HL7 Messages.
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This is the first HL7 interface that MCIR has developed. Query and other bidirectional interface options will be developed soon and will be documented in an updated version of this document. How to Format Data MCIR currently supports the following versions of HL7 formatted messages: HL7 v2.5.1 Preferred format. HL7 v2.3.1 Supported format
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standardized input and output documents conforming an HL7-CDA wrapper. We define the HL7-CDA restrictions in a HL7-CDA implementation guide. Patient data and rule infer-ence results are mapped respectively to and from the CDSS by means of a binding method based on an XML binding file. As an
Alfredo López Austin). Co-Edited Volume: Art and Media History –––Modern Art in Africa, Asia and Latin America: An Introduction to Global Modernisms. Boston: Wiley-Blackwell, 2012 (Elaine O’Brien, editor; Everlyn Nicodemus, Melissa Chiu, Benjamin Genocchio, Mary K. Coffey, Roberto Tejada, co-editors). Exhibition Catalogs ––– “Equivocal Documents,” in Manuel Álvarez Bravo (c
