# Dairy Cow Rumen Health: Feed Delivery and Observation ## Key Takeaways - Consistent delivery of a Total Mixed Ration (TMR) within 5% of target daily intake, with uniform particle size and moisture content, is critical to prevent slug feeding and subacute ruminal acidosis (SARA). Inconsistent delivery or sorting behavior (preferential consumption of concentrates) reduces effective fiber, leading to decreased chewing time, reduced saliva buffering, and a drop in rumen pH. - Manure scoring, using a 1-5 scale where 3 is ideal, serves as a low-cost indicator of rumen function. Scores of 1 or 2 (loose, watery) often signal rapid passage or SARA, while scores of 4 or 5 can indicate acidosis or insufficient water intake. Fecal sieving can further assess fiber digestion, with particles >1 cm indicating poor digestion. - Rumination monitoring, ideally 450-600 minutes daily, is the most sensitive indicator of rumen disturbance. A drop of >20% from baseline or a herd average below 400 minutes strongly suggests a rumen challenge, often preceding milk fat depression or visible manure changes. - Adequate bunk space (0.6-0.8 meters per Holstein) and water availability (10-15 cm linear trough space, 15-20 L/min flow rate) are essential to reduce competitive feeding, encourage consistent intake, and support rumen health by preventing frequent, large meals and ensuring proper hydration. - Lameness, particularly laminitis, is strongly associated with SARA due to endotoxin release from damaged rumen epithelium and histamine production. Elevated milk urea nitrogen can indicate protein/carbohydrate imbalances, and low milk fat percentage (especially with high milk yield) is a classic marker for SARA. --- Dairy cow rumen health depends on the consistent delivery of a physically and nutritionally balanced ration combined with systematic observation of cow behavior and manure. Rumen function is the foundation of milk production, feed efficiency, and overall herd well-being. Disruptions in rumen pH, microbial fermentation, or digesta passage cascade into metabolic disorders, reduced intake, and economic loss. This article reviews the practical linkages among ration consistency, sorting activity, manure characteristics, and rumination monitoring for use in routine herd review. ## At a Glance | Core Element | Key Observation | Herd-Level Action | |---|---|---| | Ration consistency | Uniform particle size and daily delivery within 5 % of target | Audit delivery times, mixer performance, and moisture variation | | Sorting behavior | Refusal of long fibers or fines, bunk sifting | Adjust forage chop length, ration moisture, and feeding frequency | | Manure composition | Fecal fiber (undigested particles), pH, and consistency | Score manure at least weekly, evaluate starch and NDF digestibility | | Rumination monitoring | Lying bouts and chewing activity per day | Target 450 , 550 minutes of rumination daily per cow | ## System Context: Rumen Function and Feed Delivery The rumen acts as a continuous-flow fermenter that requires stable conditions for optimal microbial growth. pH fluctuates with meal intake, but severe or prolonged declines indicate subacute ruminal acidosis ([Subacute ruminal acidosis in dairy cows: The physiological causes, incidence and consequences](https://api.elsevier.com/content/abstract/scopus_id/40649110927)). Acidosis reduces fiber digestion, alters biohydrogenation pathways, and negatively affects milk fat composition ([Diet, rumen biohydrogenation and nutritional quality of cow and goat milk fat](https://api.elsevier.com/content/abstract/scopus_id/34548148667)). For transition cows especially, rapid dietary shifts challenge rumen adaptation ([Impact of changes in organic nutrient metabolism on feeding the transition dairy cow](https://api.elsevier.com/content/abstract/scopus_id/0029363056)). Feed delivery consistency reduces pH variation. When total mixed ration (TMR) is delivered at the same time each day with uniform ingredient proportions, cows consume meals that are nutritionally similar across the day. Inconsistent delivery leads to slug feeding, sorting, and rumen pH depression. The [Merck Veterinary Manual](https://www.merckvetmanual.com/) emphasizes that feeding management must account for forage particle length, effective fiber, and starch source to maintain rumen health. ## Planning Decisions: Ration Structure and Sorting Sorting behavior occurs when cows preferentially consume concentrate particles and reject long forage fibers. Sorting decreases the effective fiber content of the consumed ration, reducing chewing time and saliva buffer flow. Adequate physically effective neutral detergent fiber (peNDF) is required to stimulate rumination and maintain a stable rumen mat. Ration moisture content above 50 percent often reduces sorting but can increase feed spoilage risk. Ration planning must balance particle size, moisture, and ingredient inclusion to discourage sorting while maintaining intake potential. ## Core Management Framework The framework for managing rumen health through feed delivery and observation rests on four connected practices: ration audit, sorting assessment, manure evaluation, and rumination recording. Each practice generates data that signal when ration adjustments are needed. Professional escalation is indicated when multiple observations deviate from herd benchmarks or when clinical disease appears. Veterinarians and nutritionists should evaluate such cases using standardized diagnostic protocols from sources such as [WOAH Terrestrial Animal Health Code](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) and [USDA APHIS Livestock and Poultry Disease](https://www.aphis.usda.gov/livestock-poultry-disease). Feed delivery consistency and the prevention of sorting remain foundational to rumen health in dairy herds. Total mixed rations should be formulated also for nutrient density but also for physical structure, particle size distribution, and moisture content that discourage selective consumption. When cows sort for concentrate fines and leave behind long forage particles, they expose rumen epithelium to a rapid surge of fermentable carbohydrate and a subsequent drop in pH. This pattern can produce subacute ruminal acidosis even when the delivered ration appears balanced. Facilities that provide adequate bunk space per cow, often recommended at a minimum of 0.6 to 0.8 meters per Holstein, reduce competitive feeding and permit simultaneous access, thereby decreasing sorting behavior. Water availability and flow rate influence dry matter intake and rumination, restricted water can reduce feed intake and increase the risk of subacute ruminal acidosis because cows consume meals less frequently but in larger volume. Observations from the [FAO Animal Production and Health](https://www.fao.org/animal-production/en/) guidelines emphasize that drinking points should provide at least 10 to 15 centimeters of linear trough space per cow and fresh flow rates of 15 to 20 liters per minute to support peak intake. Regular cleaning of water troughs prevents contamination that may depress intake and alter ruminal fermentation patterns. Manure consistency offers a practical, low-cost window into rumen function. Fecal scoring systems typically use a 1-to-5 scale, where score 3 is ideal and scores 1 or 2 indicate loose manure often associated with fermentative diarrhea and subacute ruminal acidosis. However, manure consistency is influenced by water intake, dietary starch fermentability, and forage particle length, so a single observation should not trigger a feeding change without repeated assessment. Diets high in rapidly fermented starch, particularly from high-moisture corn or wheat, can lower rumen pH and increase the incidence of loose manure. The [USDA National Animal Health Monitoring System](https://www.aphis.usda.gov/livestock-poultry-disease/nahms) reports that the prevalence of subacute ruminal acidosis in well-managed herds may exceed 20 percent of cows, often detected first through manure scoring and rumination depression instead of clinical signs. Fecal sieving can further characterize digestibility: particles longer than 1 centimeter in manure indicate poor fiber digestion or sorting, signaling that the ration may need more effective fiber or that total mixed ration mixing duration is inadequate. Rumination monitoring, whether through direct visual observation, electronic collars, or ear-tag accelerometers, tracks the daily minutes spent cud chewing. Normal lactating dairy cows ruminate 450 to 600 minutes per day, typically in four to eight periods. A sudden drop of more than 20 percent from an individual’s baseline or a herd average below 400 minutes per day strongly suggests a rumen challenge, such as feed delivery delay, ration change, heat stress, or disease. The [Merck Veterinary Manual](https://www.merckvetmanual.com/) notes that rumination is the most sensitive indicator of subacute ruminal acidosis, it often decreases before milk fat depression or manure changes appear. Recording rumination data over multiple days allows comparison with milk yield and dry matter intake. In herds without electronic systems, a consistent morning check of cows at rest can reveal the proportion of animals not ruminating. Cows that remain standing immediately after feed delivery and avoid lying down may be experiencing rumen discomfort or acidosis. Production-stage decisions must account for the high energy demands of early lactation. Transition cows experience dramatic endocrine and metabolic changes. The rumen epithelium adapts gradually to high-concentrate diets, abrupt increases in starch energy after calving can cause rapid acid accumulation before papillae growth and absorption capacity expand. Research from the [Scopus abstract on impact of changes in organic nutrient metabolism on feeding the transition dairy cow](https://api.elsevier.com/content/abstract/scopus_id/0029363056) highlights that the transition period imposes the greatest stress on rumen health. Rations for fresh cows should incorporate higher levels of long forage and lower starch, with gradual increases over 10 to 14 days post-calving. Dry cows should consume a diet with moderate energy density and effective fiber to maintain a stable rumen environment. Overconditioned dry cows are more prone to a negative energy balance and subacute acidosis in early lactation. High-producing cows in mid-lactation may tolerate higher starch levels provided that effective fiber length and feed delivery times are consistent. Ceaseless attention to feed scheduling,delivery at the same time each day, with frequent push-ups to maintain access,is one of the most cost-effective interventions for rumen health. Records that link feed intake, milk production, milk composition, and rumination enable targeted herd review. Low milk fat percentage, especially when milk yield remains high, is a classic marker of subacute ruminal acidosis. Elevated milk urea nitrogen can indicate excessive rumen-degradable protein or imbalanced carbohydrate fermentation. The [Scopus abstract on modifying milk fat composition of dairy cows to enhance fatty acids beneficial to human health](https://api.elsevier.com/content/abstract/scopus_id/12544254217) explains that dietary interventions to increase unsaturated fatty acids must balance rumen biohydrogenation to avoid milk fat depression. [Somatic cell](/blog/guides/somatic-cell) count and lameness records also reflect rumen health indirectly, laminitis is strongly associated with subacute ruminal acidosis because bacterial endotoxins from a disturbed rumen can trigger systemic inflammation and digital vessel dysfunction. Culling rates due to lameness, displaced abomasum, or liver abscesses signal that rumen acidosis is endemic. Integrating these records monthly allows identification of failure patterns across groups. Worker safety is relevant when handling dietary buffers such as sodium bicarbonate or additives like monensin. These should be stored properly to avoid dust inhalation and accidental ingestion. Feed mixing equipment, especially vertical augers, poses entanglement hazards, training on lockout-tagout procedures reduces risk. [Food safety](/knowledge/bacteria/livestock-bacteria/cooking-chicken-bacteria-prevention) requirements under [WOAH Terrestrial Animal Health Code](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) and other standards dictate that management of rumen health through diet and additives must ensure that meat and milk remain free from drug residues and contaminants. Overuse of antibiotics for acidosis treatment may require withdrawal periods. Rumen modifiers should be used according to label directions to prevent violative residues. Practical monitoring protocols should include a weekly bunk calling assessment: evaluating the amount of feed remaining before the next delivery. Heifers and fresh cows require consistency. For each pen, record the percentage of cows ruminating when at rest, manure score average, and the presence of slick bunks or stale feed. Pens that show more than 20 percent of cows with manure score 1 or 2, or more than 15 percent of cows not ruminating at rest, warrant investigation. Professional escalation to a veterinarian or nutritionist is indicated if these signs persist for more than two consecutive days or are accompanied by a drop in milk fat below 3.0 percent, increased incidence of displaced abomasum, or a rise in lameness treatments. The [PubMed record 42353460](https://pubmed.ncbi.nlm.nih.gov/42353460/) emphasizes that early detection of subacute ruminal acidosis through combined observation of feeding behavior, rumination, and manure can improve herd-level outcomes without reliance on rumenocentesis. Uncertainty remains because individual cow variation in eating speed, drinking patterns, and tolerance to low pH can mask herd trends, therefore, multiple indicators should be weighed together. Failure patterns such as inconsistent dry matter intake across days, large refusals, or midday drops in rumination suggest that feed delivery intervals or total mixed ration formulation need adjustment. Welfare concerns are serious: chronic subacute ruminal acidosis is painful, reduces time lying down, and increases rissss of laminitis and culling. Herds that address rumen health improve also productivity but also animal well-being and worker satisfaction. Health observation in dairy cows builds directly on the principles of ration consistency and feeding management described earlier. Routine monitoring of manure, rumination, and feeding behavior allows producers to detect deviations from normal rumen function before clinical disease emerges. Manure scoring provides a practical, low-cost tool: manure that is excessively loose or contains undigested feed particles suggests rapid passage rate or suboptimal rumen fermentation, while very dry, firm manure may indicate inadequate water intake or rumen stasis. Both extremes warrant investigation. The [Merck Veterinary Manual](https://www.merckvetmanual.com/) outlines normal manure consistency for lactating cows as a moderate pile with a slight depression, and deviations should prompt review of the ration and feed delivery. Rumination monitoring is equally valuable. Cows should ruminate 8 to 10 hours per day, typically in bouts of 30 to 60 minutes after meals. Automated rumination sensors or direct observation can quantify this. A drop in daily rumination time frequently precedes a fall in milk yield or dry matter intake and may signal subacute ruminal acidosis (SARA) or other digestive upset as described in the review on [understanding and preventing subacute ruminal acidosis in dairy herds](https://api.elsevier.com/content/abstract/scopus_id/32244438234). Observing the proportion of cows lying down and chewing cud within 30 minutes of feed delivery offers a snapshot of herd rumen status. Biosecurity practices protect rumen health by limiting introduction of pathogens that can disrupt fermentation or cause systemic disease. The [WOAH Terrestrial Animal Health Code](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) provides standards for quarantine of new or returning cattle, cleaning of equipment and facilities, and management of manure to reduce pathogen load. These measures are directly relevant because diseases such as salmonellosis or bovine viral diarrhea can impair rumen motility and mucosal integrity, compounding diet-induced problems. Regular footbaths and protocols for visitors and vehicles also reduce infection pressure. When routine observation suggests a rumen health problem, diagnostic and veterinary escalation is necessary. Veterinary examination may include rumen fluid pH measurement, assessment of fecal starch or fiber fractions, and evaluation of total mixed ration particle size distribution using a Penn State separator. The [USDA National Animal Health Monitoring System](https://www.aphis.usda.gov/livestock-poultry-disease/nahms) conducts periodic studies on dairy cattle health and management, and data from these surveys can help veterinarians compare herd-level indicators against regional benchmarks. Producers should involve a veterinarian when more than 10 percent of cows show abnormal manure, reduced rumination, or signs of lameness or depression that might trace to rumen acidosis. Uncertainty is inherent in field-based health observation. Individual cow variability in sorting behavior, feed intake, and metabolic response means that group-level indicators may mask early cases. For example, a cow that sorts against physically effective fiber may experience a drop in rumen pH days before changes in the herd average manure score appear. The [PubMed record 42372885](https://pubmed.ncbi.nlm.nih.gov/42372885/) discusses the challenge of diagnosing SARA because clinical signs are often subtle and intermittent. Environmental factors such as heat stress, overcrowding, and changes in feed mixing further complicate interpretation. Professional escalation is advised whenever uncertainty persists after two to three days of observation or if milk production declines more than 5 percent. Sustainability of dairy production depends on maintaining rumen health across the life of the cow. Healthy rumen function maximizes feed conversion, reduces methane emissions per unit of milk, and lowers the risk of metabolic disease that leads to premature culling. The [FAO Animal Production and Health](https://www.fao.org/animal-production/en/) resources emphasize that improved nutrition management, including consistency in feed delivery, is a cost-effective strategy for both animal welfare and environmental footprint. Rumen health also supports milk fat composition favorable for human nutrition, as highlighted in the review on [modifying milk fat composition of dairy cows to enhance fatty acids beneficial to human health](https://api.elsevier.com/content/abstract/scopus_id/12544254217). Sustainable operations incorporate regular audit of feed mixing equipment, training of personnel in observation protocols, and continuous collaboration with nutritionists and veterinarians. ## Frequently Asked Questions **1. How can I accurately observe rumination time without electronic sensors?** Stand near the edge of the pen after feeding and count cows that are lying down or standing still and chewing cud. A group of 20 to 30 cows observed for 30 minutes provides a reliable estimate. Aim for at least 60 percent of cows ruminating at that time. **2. What manure score indicates potential rumen acidosis?** A manure score of 3 on a 1,5 scale (moderately loose, forming a small pancake) is normal for most lactating herds. Scores of 4 or 5 (very loose, watery) accompanied by undigested feed particles suggest rapid passage and possible SARA. **3. How do I know if cows are sorting their ration?** Use a Penn State particle separator on samples taken immediately after feed delivery and again four to six hours later. An increase in the top two screens content across the feeding period indicates sorting for finely ground feed and refusal of long fiber. **4. When should I measure rumen pH for diagnosis?** pH measurement is indicated when persistent loose manure, reduced milk fat percentage, or increased lameness occurs in more than 5 percent of the herd. Rumenocentesis or oral stomach tube sampling is performed by a veterinarian, pH below 5.5 confirms SARA. **5. What biosecurity measures specifically protect rumen health?** Quarantine new cattle for at least 21 days, monitor their feces and rumination, and ensure they receive the same ration as the resident herd gradually over one week. Clean feed bunks daily to prevent spoilage and pathogen growth. **6. Can lameness be linked to rumen health issues?** Yes. Subacute ruminal acidosis can cause laminitis through release of endotoxins from damaged rumen epithelium and histamine from disrupted fermentation. Observing the foot and leg health of cows with recurrent lameness may reveal rumen-related problems. **7. How does fiber length affect rumen health?** Physically effective fiber (peNDF) stimulates chewing and saliva production, which buffers rumen pH. Diets with inadequate peNDF (e.g., too finely chopped silage) reduce rumen buffering capacity and increase risk of acidosis. **8. What are the sustainability benefits of good rumen health?** Improved rumen health reduces feed waste and methane emissions per unit of milk, extends productive life of cows, and decreases reliance on therapeutic antibiotics. These outcomes align with environmental goals and farm profitability. --- **Educational veterinary notice.** The information provided is for educational purposes and reflects general principles of dairy cow rumen health management. Individual herds vary in facilities, genetics, and health status. Always consult a licensed veterinarian for specific diagnosis and treatment protocols to ensure compliance with local regulations and herd-specific conditions. ## At a Glance | Aspect | Key Points | Practical Recommendations | |---|---|---| | Rumen pH monitoring | Indicated by rumination activity, manure consistency, and feed intake patterns. | Assess rumination across the pen by observing cows at rest. Note manure scores and variation. | | Feed push-up frequency | Influences time to access feed and prevents slug feeding. | Push up feed at least four times per day, more frequently during peak intake hours. | | Feed delivery timing | Cows prefer fresh feed after milking and during morning hours. | Deliver total mixed ration at a consistent time each day. Avoid long empty bunk periods. | | Feed particle size | Affects chewing time and rumen mat formation. | Use a Penn State Particle Separator weekly to verify that coarse fractions are present. | | Bunk space | Overcrowding reduces individual intake and increases competition. | Provide at least 30 inches of linear bunk space per cow for consistent access. | | Water availability | Adequate, clean water supports rumen fermentation. | Check flow rates and cleanliness of waterers daily. | ## Practical Observations for Feed Delivery ### Monitoring Feed Bunk Attendance The number of cows actively eating immediately after feed delivery indicates the palatability and freshness of the ration. Producers should observe the bunk within 30 minutes of feeding. A high proportion of cows approaching the feed suggests that the previous feeding interval was appropriate and the ration is accepted. Conversely, if many cows remain lying down or show interest only after 60 minutes, the ration may be spoiled, poorly mixed, or too warm. Regular attendance at the same postdelivery time each day provides a baseline against which deviations can be flagged. ### Assessing Feed Sorting Behavior Cows sort feed when palatable components are separated from less palatable ones. Observing the bunk surface before the next feeding reveals whether long forage particles are left behind or if fine grain concentrates accumulate. Sorting reduces the effectiveness of the total mixed ration and can cause subacute ruminal acidosis. Visual inspection of bunk refusal should note the proportion of long stems versus fines. Producers can perform a simple oven-dry matter analysis on refusal samples to compare with the delivered ration. Persistent sorting indicates a need to adjust either particle length or inclusion of a palatable binder. ### Evaluating Manure Consistency Manure scoring provides a noninvasive measure of rumen fermentation and digestive efficiency. A score of 3 on a five-point scale (moderately loose, forming a 3-to-5 cm ring when splashed) is typical for a healthy rumen. Scores of 1 or 2 indicate constipation and low feed intake, while scores of 4 or 5 indicate acidosis or excessive passage rate. Observing manure in the alley directly behind milking parlors or in freestall alleys each morning allows for detection of group-level changes. Individual cow variation should be noted, a pen with multiple cows scoring 4 or higher requires investigation into feed delivery timing or ration starch content. ## Frequently Asked Questions **Q1: How often should I push up feed for cows?** Feed should be pushed up at least four times daily, especially during the first four hours after delivery and before milking. More frequent push-ups, such as every two hours, encourage consistent intake and reduce slug feeding. **Q2: What does it mean when cows refuse to eat the top layer of feed?** Refusal of the top layer often indicates that the feed has heated, spoiled, or developed mold. It can also result from excessive fines accumulating at the surface. Checking feed temperature and moisture content is warranted. **Q3: How can I tell if my total mixed ration is properly mixed?** Observe the uniformity of particle distribution across multiple samples from different parts of the bunk. If the same sample contains very long stems alongside fine dust, the mixing process may be inadequate. A Penn State Particle Separator provides objective verification. **Q4: Why do cows eat only the concentrate portion first and leave forages?** Cows preferentially consume high-energy grains if the ration is not well mixed or if forages are too coarse. This sorting behavior increases the risk of rumen acidosis. Adjusting the mixing order or adding a liquid molasses binder can reduce sorting. **Q5: What is the optimal time to deliver fresh feed?** Delivering fresh feed immediately after cows return from the morning milking aligns with their natural feeding peak. A second delivery in the late afternoon helps sustain intake through the night. Consistency in timing is more important than the exact hour. **Q6: How do water temperature and cleanliness affect rumen health?** Cold water reduces voluntary intake, and dirty water discourages drinking. Low water intake reduces rumen turnover and increases the risk of impaction. Ensure waterers are cleaned daily and water temperature remains between 10 and 20 degrees Celsius. **Q7: What is a normal manure score for a group of dairy cows?** A group average manure score of 3 on a 1-to-5 scale is considered normal. Scores ranging from 2.5 to 3.5 are acceptable. Persistent averages above 4 indicate nutritional imbalance, while averages below 2 suggest restricted feed intake. **Q8: Can I diagnose rumen acidosis by looking at manure?** Manure changes are suggestive but not diagnostic for rumen acidosis. Loose, watery manure containing undigested feed particles or a sweet-sour odor points to acidosis. However, confirmatory evaluation of rumen fluid pH or feeding management review is necessary for a definitive conclusion. ## Related Farming Guides - [Dairy Cattle Farming Nutrition Housing Health Signals And Herd Management](/knowledge/animal-farming/dairy-cattle/dairy-cattle-farming-nutrition-housing-health-signals-and-herd-management) - [Transition Cow Management From Dry Off To Freshening](/knowledge/animal-farming/dairy-cattle/transition-cow-management-from-dry-off-to-freshening) - [Dairy Calf Colostrum Management](/knowledge/animal-farming/dairy-cattle/dairy-calf-colostrum-management) - [Milking Routine And Parlor Hygiene](/knowledge/animal-farming/dairy-cattle/milking-routine-and-parlor-hygiene) - [Dairy Farm Records That Drive Better Decisions](/knowledge/animal-farming/dairy-cattle/dairy-farm-records-that-drive-better-decisions) ## Related Clinical & Scientific Guides * [Evaluating Feed Additives for Dairy Cow Performance](/knowledge/animal-farming/dairy-cattle/evaluating-feed-additives-for-dairy-cow-performance) * [Dairy Barn Fire Safety: Design and Prevention Measures](/knowledge/animal-farming/dairy-cattle/dairy-barn-fire-safety-design-prevention) * [Dairy Cow Pregnancy Loss Records and Review](/knowledge/animal-farming/dairy-cattle/dairy-cow-pregnancy-loss-records-and-review) ## References and Further Reading - [FAO Animal Production and Health](https://www.fao.org/animal-production/en/) - [WOAH Terrestrial Animal Health Code](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) - [USDA APHIS Livestock and Poultry Disease](https://www.aphis.usda.gov/livestock-poultry-disease) - [Merck Veterinary Manual](https://www.merckvetmanual.com/) - [USDA National Animal Health Monitoring System](https://www.aphis.usda.gov/livestock-poultry-disease/nahms) > This article is educational and is not a substitute for veterinary diagnosis, treatment, public-health guidance, or regulatory reporting.